The covid-19 pandemic has had an enormous impact on trainees’ mental wellbeing and on residents’ progression in training programmes. Obstetrics and gynaecology (O&G), like other specialties, has faced exceptional disruption and workload pressures during the past year. The effect of the pandemic on physician burnout has been well reported, but there is new evidence to indicate that burnout symptoms may, surprisingly, be more prevalent among trainees with low covid exposure, for example in specialties such O&G and orthopaedics, compared to frontline pandemic staff in emergency or respiratory medicine. This is possibly as a result of better pastoral care in the latter group. [1,2]

Shah and colleagues recently published a survey on how the covid-19 pandemic has exerted enormous strain on the mental health of obstetric and gynaecology doctors in the UK, while Bitonti et al revealed that diverting the workforce into emergency care has lead to a suspension in O&G training in Italy. [3,4] According to a Royal College of Obstetricians and Gynaecologists’ (RCOG) survey, over half of all O&G trainees in the UK were redeployed during the pandemic. [5] During this time, resident O&G consultants and staff grade doctors had to provide core maternity and gynaecology services. The full impact of this redeployment, together with amendments to standard maternity care, has been analysed, but its’ effects on training, completion of competencies, deferment of annual review and Certification of Completion of Training (CCT) date, as well as on trainees’ mental wellbeing have still not been analysed. [6] The RCOG survey also reported that there was less adherence to junior doctors’ contract (by increasing shift frequency) in order to accommodate emergency cover and that reduced training opportunities were noted by 82% of O&G trainees. [5]

Anecdotally, many senior O&G trainees have also confirmed that education and training opportunities have been inadequate, highlighting the need for: 

• Deanery support with electronic portfolios 
• Clear guidance on training progression, achieving operative competencies and starting Advanced Training Skills Modules (ATSMs)
• Debriefing for deployed trainees, especially those on Intensive Care Units
• A support group for trainees with delayed CCT

While telemedicine has allowed O&G trainees to review patients remotely (reducing exposure to covid-19 patients), non-verbal cues, previously apparent in face to face appointments, could be missed during remote consultations. [7] During face to face consultations, both doctors and patients need to wear face masks, which hides their facial expressions and can further engender a sense of depersonalisation and detachment.

Medical schools, working with accrediting bodies, licensing boards, and government agencies, have already modified their students’ training algorithm in order to navigate the educational challenges posed by the pandemic. [8] Public health departments in America have enabled healthcare organisations to define senior students as “essential” so that they could fulfil their curriculum requirements and graduate on time, while licensing boards allowed early medical graduates to work temporarily as part of the covid-19 response. Medical students, therefore, have continued to learn, but also in many cases, succeeded in achieving different types of competencies from their predecessors. 

As the NHS starts a slow recovery from the second wave, there is increasing recognition among trainees and trainers that organisational support, clear communication, and an awareness of the importance of mental health, together with a well-defined plan to attain and achieve training goals and competencies, are crucial. Specialties such as radiology and laboratory medicine may be able to offer alternative educational learning pathways during the pandemic, but surgical specialties, for example O&G, with procedure specific components, still have to rely on hands-on modalities in order to maintain hand eye coordination skills and develop muscle memory. [6] Thus, the pandemic has far-reaching effects on training in surgically based programmes, which cannot be replaced by virtual education. 

Yoong W, Das-Patra S, and Gunasekera A, Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London

Competing interests: none declared. 

References

1.Kannampallil TG, Goss CW, Evanoff BA et al. Exposure to COVID-19 patients increases physician trainee stress and burnout. PLoS ONE 2020 15(8): e0237301. https://doi.org/10.1371/journal.pone.0237301 

2.Dimitriu MCT, Pantea-Stoian A, Smaranda AC,, et al. Burnout syndrome in Romanian medical residents in time of the COVID-19 Pandemic. Medical Hypotheses 144 (2020) 109972

3.Shah N, Raheem A, Sideris M, Velauthar L, Saeed F. Mental health amongst obstetrics and gynaecology doctors during the COVID-19 pandemic: Results of a UK-wide study. Eur J Obstet Gynecol Reprod Biol. 2020 Oct;253:90-94. doi: 10.1016/j.ejogrb.2020.07.060. Epub 2020 Aug 11. PMID: 32829231; PMCID: PMC7417944.

4.Bitonti G, Palumbo AR, Gallo C, et al. Being an obstetrics and gynaecology resident during the COVID-19: Impact of the pandemic on the residency training program. Eur J Obstet Gynecol Reprod Biol. 2020 Oct;253:48-51. doi: 10.1016/j.ejogrb.2020.07.057. Epub 2020 Aug 1. PMID: 32771888; PMCID: PMC7395645.

5.RCOG 2020. The impact of the redeployment of maternity staff during COVID-19 A Royal College of Obstetricians and Gynaecologists (RCOG) report of a snapshot survey to Clinical Directors and UK RCOG trainees, associates, members and fellows on working patterns and staff changes during the pandemic https://www.rcog.org.uk/globalassets/documents/careers-and-training/workplace-and-workforce-issues/202006/2020-06-the-impact-of-the-redeployment-of-maternity-staff-during-covid-19.pdf

6.Jardine J , Relph S , Magee LA , et al. Maternity services in the UK during the coronavirus disease 2019 pandemic: a national survey of modifications to standard care. BJOG 2020 Sep 29. doi: 10.1111/1471-0528.16547. PMID: 32992408

7.Kotabagi P, Nauta M, Fortune L, Yoong W. COVID-19 positive mothers are not more anxious or depressed than non COVID pregnant women during the pandemic: A pilot case-control comparison. Eur J Obstet Gynecol Reprod Biol. 2020 Sep; 252: 615-616. doi: 10.1016/j.ejogrb.2020.07.037. 

8.Lucey CR, Johnston C. The Transformational Effects of COVID-19 on Medical Education: JAMA. 2020 Sep 15; 324(11): 1033-1034