Surgical training delay due to COVID persists


Surgeon training in Canada has been hit hard by the chaos of the COVID-19 pandemic, and some doctors say their clinical training has been delayed again in recent months due to the COVID-19 pandemic. Many hospitals across the country cancel elective procedures to keep up with urgent care.

Not expecting to enter the workforce, some recent surgeons say they are worried and frustrated about the backlogs that have brought operations to a halt.

Dr Kelly Brennan, a general surgery trainee in eastern Ontario, said: “I went months without participating in routine surgeries.

The delay also affects less urgent professional procedures such as endoscopy, Brennan added.

Provinces are taking different measures to address surgical backlogs. The Government of Ontario recently said in a statement that it will invest more than $300 million over the next year and launch a new software tool for managing waitlists. This month, Premier Doug Ford also announced plans to expand the number and types of procedures that will be offered at private clinics.

According to a report commissioned by the Canadian Medical Association released last September, British Columbia plans to invest $303 million over the next three years to speed up imaging and surgical procedures.

Manitoba’s 2022 budget includes a $110 million investment to reduce backlogs while Saskatchewan plans to allocate $21.6 million to address the surgery waiting list as they anticipate time waiting to return to pre-COVID by the end of March 2025. Nova Scotia also approved a similar plan to return to the national standard for surgery waiting time in 2025.

Brennan said of Ontario’s plans that, despite the government’s funding, it remains unclear whether there will be enough health professionals, including nurses, to accomplish these goals.

“Nursing staff continues to be a challenge,” she said, noting that high patient numbers, bed shortages and elective cases are often affected by delays.

“Although things are improving, it is not working as it should,” said Dr. Najma Ahmed, a trauma surgeon and educator in Toronto.

She added: “The university hospital is a factory for doctors. When it’s not working, teaching will be delayed and to the detriment of learners.”

“There’s no substitute for going to the operating room,” says Ahmed.

A University of Toronto study published in July 2021 found that about 4 out of 5 doctors in residency training programs in plastic surgery across Canada believe the pandemic has limited their ability to do so. their exposure to clinical activities and skills, derail their future study and practice plans.

Dr Sultan Al-Shaqsi, a plastic surgeon and one of the study’s authors, said that for most of 2020, there were fewer people in the operating room than usual and even fewer people in the operating room. more medical students.

For surgical specialties such as orthopedics or plastic surgery, many people miss out on on-the-job training, especially regarding “complex elective surgical procedures,” Al-Shaqsi said. which has been delayed due to COVID”.

Al-Shaqsi said the move to a mostly online lecture format, surgery video and simulation made it more difficult to teach procedure techniques and give feedback.

When the pandemic hit in March 2020, medical schools expanded virtual care and reallocated learners for COVID-19 and vaccine-related work. The Canadian Institutes of Health Information estimates that the number of surgeries has fallen sharply by 600,000 in the first 18 months of the pandemic compared with the number expected during that time period.

And while service is improving at some hospitals, the triple threat of COVID-19, influenza and respiratory syncytial virus (RSV) this past fall hit hard. burden many facilities as they deal with a large number of patients, many of whom are children. Children’s hospitals across the country are canceling or restricting elective procedures.

Al-Shaqsi said he is concerned that some surgical residents have delayed further specialized training, including cancer surgery or minimally invasive procedures, until surgical care is available. stabilization technique.

Since fellowship training often focuses on highly specialized and infrequent surgeries, Al-Shaqsi said practitioners are concerned that they will not receive adequate training if the surgeries do not return soon. in normal quantities.

This means that while most surgical residents graduate and enter the workforce as planned, they are likely to do so without the additional specialized skills they would otherwise have. get in the fellowship — at a time when patients are least likely to wait.

The National Permanent Resident Combined Program (NRMP), which manages participation in a variety of surgical specialty programs in the United States and Canada, only lists 43 Canadian applicants in 2022, down from 70 in 2018. even though the number of available positions has increased over the same period.

In Al-Shaqsi’s own craniofacial surgery, which regularly filled all specialty positions prior to COVID-19, more than half a dozen fellowship positions are currently unfilled.

Dr Youjin Chang, an orthopedic surgeon who completed her final fellowship training in 2022 and is based in the Durham region of Ontario, said: “Elective procedures such as repair Knee ligaments and other sports injuries are also delayed.

“Even as we are coming out of the worst of the pandemic, the pressure on staffing in hospitals is preventing a return to normal,” Chang said, adding the operating room schedule. daily “usually delayed by hours” and “smaller elective cases are more likely”. affected.”

Delays have taken a physical and emotional toll on patients stuck in the backlog.

“Our practitioners and patients have suffered a lot,” Ahmed said.

“Initially, we only operated on very sick patients. That made teaching and mentoring very difficult,” she said of the early days of the pandemic.

“Now, the backlog is so large, we need health and human resource solutions.”

A recent report from the Fraser Institute said, “Canada’s healthcare wait times reach 27.4 weeks in 2022 – the longest time on record – and 195% higher than 9.3 weeks. that Canadians waited for in 1993.

The Professional Association of Residents of Ontario, which advocates for new doctors, has expressed concern about changes to surgical education early in the pandemic.

According to a survey among members in mid-2020, more than 40% of respondents said they were tasked with direct patient care rather than attending surgeries and clinics. Nearly 45 percent of residents noted increased work hours and on-demand claims to cover sick co-workers.

In response to the findings of their survey, PARO is pushing universities to evaluate students based on a holistic view of inpatient performance during training, as well as their skill sets. them, rather than the minimum clinical hours spent in a given rotation.

This is part of a broader evolution in medical education towards competency-based, rather than time-based, skills assessment.

The Royal College of Physicians and Surgeons of Canada has also signaled that it wants a more flexible approach to medical education.

“Perfection is not the goal,” the school said in a publication, updated in early 2022, with guidance on changes to training during the pandemic. They reinforce that “patient care comes first” and that individual accommodation may be required because “graduated residents and interns must be qualified to practice unsupervised. “

Advances in augmented reality and simulation-based training for surgeons may also allow new resident surgeons to gain more surgical experience than their predecessors. .

While Al-Shaqsi is optimistic about the role of simulation and augmented reality in the future of surgical education, he notes that these technologies are not yet advanced enough to provide education equivalent to those of surgical procedures. actual surgery.

Ahmed says more high-tech solutions will be needed to tackle the current backlog.

More post-acute care, rehabilitation, aged care, long-term care and other resources are needed to improve surgical care nationally, she said.

“With COVID, at first, all was ready,” said Ahmed.

But “there is a shortage of trained people right now” due to the staffing crisis facing Canada’s hospitals, she said.

This report by the Canadian Press was first published on January 27, 2023

Dr. Adam Pyle is an emergency physician and lecturer at the University of Toronto, and a journalist at the Dalla Lana School of Public Health.

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