{"id":50179,"date":"2021-05-02T14:21:59","date_gmt":"2021-05-02T13:21:59","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=50179"},"modified":"2021-05-02T14:25:28","modified_gmt":"2021-05-02T13:25:28","slug":"covid-19-disruptions-to-training-have-had-a-negative-effect-on-the-mental-health-of-obstetrics-and-gynaecology-trainees","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2021\/05\/02\/covid-19-disruptions-to-training-have-had-a-negative-effect-on-the-mental-health-of-obstetrics-and-gynaecology-trainees\/","title":{"rendered":"Covid-19: Disruptions to training have had a negative\u00a0effect\u00a0on the mental health of obstetrics and gynaecology trainees"},"content":{"rendered":"<p><span style=\"font-weight: 400\">The covid-19 pandemic has had an enormous impact on trainees\u2019 mental wellbeing and on residents\u2019 progression in training programmes. Obstetrics and gynaecology (O&amp;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&amp;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]<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 <\/span><i><span style=\"font-weight: 400\">et al <\/span><\/i><span style=\"font-weight: 400\">revealed that diverting the workforce into emergency care has lead to a suspension in O&amp;G training in Italy.<\/span> [3,4] <span style=\"font-weight: 400\">According to a Royal College of Obstetricians and Gynaecologists\u2019 (RCOG) survey, over half of all O&amp;G trainees in the UK were redeployed during the pandemic. [5] During this time, <\/span><span style=\"font-weight: 400\">resident O&amp;G consultants and staff grade doctors had to provide<\/span><span style=\"font-weight: 400\"> core maternity and gynaecology services<\/span><span style=\"font-weight: 400\">. The f<\/span><span style=\"font-weight: 400\">ull impact of this redeployment, together with amendments to standard maternity care, has been analysed, but its\u2019 effects on training, completion of competencies, deferment of annual review and Certification of Completion of Training (CCT) date, as well as on trainees\u2019 mental wellbeing have still not been analysed. [6] <\/span><span style=\"font-weight: 400\">The RCOG survey also reported that there was less adherence to junior doctors\u2019 contract (by increasing shift frequency) in order to accommodate emergency cover and that reduced training opportunities were noted by 82% of O&amp;G trainees. [5]<\/span><\/p>\n<p><span style=\"font-weight: 400\">Anecdotally, many senior O&amp;G trainees have also confirmed that education and training opportunities have been inadequate, highlighting the need for:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Deanery support with electronic portfolios\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Clear guidance on training progression, achieving operative competencies and starting Advanced Training Skills Modules (ATSMs)<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Debriefing for deployed trainees, especially those on Intensive Care Units<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">A support group for trainees with delayed CCT<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">While telemedicine has allowed O&amp;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.<\/span><span style=\"font-weight: 400\"><br \/>\n<\/span><\/p>\n<p><span style=\"font-weight: 400\">Medical schools, working with accrediting bodies, licensing boards, and government agencies, have already modified their students\u2019 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 \u201cessential\u201d 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.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">As the NHS starts a slow recovery from the second wave<\/span><span style=\"font-weight: 400\">, <\/span><span style=\"font-weight: 400\">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&amp;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.\u00a0<\/span><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Yoong W, Das-Patra S, and Gunasekera A<\/strong>, <\/span><span style=\"font-weight: 400\">Department of Obstetrics and Gynaecology, North Middlesex University Hospital, London<\/span><\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: none declared.\u00a0<\/em><\/p>\n<p><b>References<\/b><\/p>\n<p><span style=\"font-weight: 400\">1.Kannampallil TG, Goss CW, Evanoff BA <\/span><i><span style=\"font-weight: 400\">et al<\/span><\/i><span style=\"font-weight: 400\">. 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\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">2.Dimitriu MCT, Pantea-Stoian A, Smaranda AC,, <\/span><i><span style=\"font-weight: 400\">et al<\/span><\/i><span style=\"font-weight: 400\">. Burnout syndrome in Romanian medical residents in time of the COVID-19 Pandemic. Medical Hypotheses 144 (2020) 109972<\/span><\/p>\n<p><span style=\"font-weight: 400\">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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">4.Bitonti G, Palumbo AR, Gallo C, <\/span><i><span style=\"font-weight: 400\">et al<\/span><\/i><span style=\"font-weight: 400\">. 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.<\/span><\/p>\n<p><span style=\"font-weight: 400\">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 <\/span><a href=\"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\"><span style=\"font-weight: 400\">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<\/span><\/a><\/p>\n<p><span style=\"font-weight: 400\">6.<\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=Jardine+J&amp;cauthor_id=32992408\"><span style=\"font-weight: 400\">Jardine<\/span><\/a><span style=\"font-weight: 400\"> J<\/span><span style=\"font-weight: 400\">\u00a0<\/span><span style=\"font-weight: 400\">,\u00a0<\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=Relph+S&amp;cauthor_id=32992408\"><span style=\"font-weight: 400\">Relph<\/span><\/a><span style=\"font-weight: 400\"> S<\/span><span style=\"font-weight: 400\">\u00a0<\/span><span style=\"font-weight: 400\">,\u00a0<\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/?term=Magee+LA&amp;cauthor_id=32992408\"><span style=\"font-weight: 400\">Magee<\/span><\/a><span style=\"font-weight: 400\"> LA<\/span><span style=\"font-weight: 400\">\u00a0<\/span><span style=\"font-weight: 400\">,\u00a0<\/span><i><span style=\"font-weight: 400\">et al<\/span><\/i><span style=\"font-weight: 400\">. Maternity services in the UK during the coronavirus disease 2019 pandemic: a national survey of modifications to standard care. BJOG 2020 Sep 29.\u00a0doi: 10.1111\/1471-0528.16547.\u00a0PMID:\u00a0<\/span><b>32992408<\/b><\/p>\n<p><span style=\"font-weight: 400\">7.<\/span><span style=\"font-weight: 400\">Kotabagi P, Nauta M, Fortune L, Yoong W. <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32747133\/\"><span style=\"font-weight: 400\">COVID-19 positive mothers are not more anxious or depressed than non COVID pregnant women during the pandemic: A pilot case-control comparison.<\/span><\/a><span style=\"font-weight: 400\"> Eur J Obstet Gynecol Reprod Biol. 2020 Sep; 252: 615-616. doi: 10.1016\/j.ejogrb.2020.07.037.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">8.Lucey CR, Johnston C. The Transformational Effects of COVID-19 on Medical Education:\u00a0JAMA. 2020 Sep 15; 324(11): 1033-1034\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The covid-19 pandemic has had an enormous impact on trainees\u2019 mental wellbeing and on residents\u2019 progression in training programmes. Obstetrics and gynaecology (O&amp;G), like other specialties, has faced exceptional disruption [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/05\/02\/covid-19-disruptions-to-training-have-had-a-negative-effect-on-the-mental-health-of-obstetrics-and-gynaecology-trainees\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":50004,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[236],"tags":[],"class_list":["post-50179","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-nhs"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Covid-19: Disruptions to training have had a negative\u00a0effect\u00a0on the mental health of obstetrics and gynaecology trainees - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2021\/05\/02\/covid-19-disruptions-to-training-have-had-a-negative-effect-on-the-mental-health-of-obstetrics-and-gynaecology-trainees\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Covid-19: Disruptions to training have had a negative\u00a0effect\u00a0on the mental health of obstetrics and gynaecology trainees - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The covid-19 pandemic has had an enormous impact on trainees\u2019 mental wellbeing and on residents\u2019 progression in training programmes. 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