What is it like to be a surgical trainee in a global pandemic?
15 Jul 2020
Parvathi Varma and Diana Kazzazi
Parvathi Varma is a core surgical trainee and Diana Kazzazi is a plastic surgery registrar, both based at the Yorkshire and Humber Deanery. In this blog series, they discuss their respective experiences of the COVID-19 pandemic and the ways in which it has altered training.
We are in the middle of an unprecedented global crisis. Healthcare systems and healthcare workers around the world are continually adapting to the evolving pressures from the COVID-19 pandemic. In the UK, elective operations and outpatient clinics have been scaled back, along with the cancellation of postgraduate exams, courses and conferences. Surgical training has changed, and trainees have been redeployed to areas of greater need to join their colleagues on the frontline.
We present our thoughts about being a surgical trainee at different stages in our careers amidst this crisis.
Parvathi Varma: A core trainee’s perspective
On 1 April 2020, the senior house officer rota at my hospital was dramatically changed to help deliver an emergency service to ensure that all patients were given the highest level of care during the COVID-19 surge. All surgical and medical trainees were placed on the same rota so that redeployment would be easier if any sickness ensued. Trainees report to a hub at the beginning of their shift and are expected to cross-cover specialties if there are rota gaps. In the first few weeks, the uncertainty of where I would be for each shift left me feeling apprehensive and nervous. Furthermore, the new timetable has seen an increase in the number of shifts, especially unsociable hours worked and a two-in-three weekends pattern. This taxed my usual friends-and-family support system, and it began to feel like life had become a series of short phone conversations. However, thanks to the increasing number of social media apps, we have developed a routine of video calls and Netflix parties. I am thankful for my network and encourage you all to take the time you need to cultivate yours.
As a junior trainee during this pandemic, I have encountered many experiences which have pushed me outside of my comfort zone and taught me to be resourceful. Our plastic surgery department was placed on the intensive care ‘proning rota’. Having only a week-long intensive care unit (ICU) placement under my wing as a medical student, this was a daunting experience. The first day was overwhelming, given my minimal knowledge and the hesitation of whether I had ‘donned’ and ‘doffed’ my protective personal equipment (PPE) correctly when moving between patients. The support of my brilliant ICU colleagues helped me overcome my anxieties and soon I found my redeployment to be an informative and invaluable learning experience – one that I will definitely draw on in my future practice.
As the epidemic in the NHS starts to diminish, a personal struggle has been battling my own career ambitions with my current duties as a doctor. I worry that the limited theatre and clinic time and variability in clinical exposure are slowing my progression. This has left me anxious about application for specialist training and insecure about how I will compare to my peers as a junior registrar. I have tried to rationalise my current situation, but I have found it difficult to shake the uncertainty about my future. Nevertheless, I am fortunate to be surrounded by a supportive team of consultants who take an active interest in my training. I am grateful for the case-based discussions and virtual Zoom meetings to deliver deanery teaching.
Many of us feel tentative approaching the future and taking the time to look after yourself has never been more important. The crisis has given me the opportunity to expand my skills both at work and at home; from learning to care for critically unwell intensive care patients to baking new recipes! No man is an island, and I am certain that this has never been truer. I am incredibly proud of my colleagues and it is a privilege to work with them.
Diana Kazzazi: A registrar’s perspective
As a plastic surgery registrar in the COVID-19 pandemic, my role has changed weekly to keep up with the new challenges we have been facing. We have seen a shift in common presentations as the general public’s activities have changed. More time at home means more injuries related to frustration, DIY and angry pets. A holistic approach to each patient has never been more important, trying to minimise hospital contact time for patients while still making accurate clinical judgements and management plans.
Spending less time in the theatre to reduce staff exposure and to minimise PPE usage is necessary to protect us, but it has been difficult to contend with the feeling of falling behind. Proper practice prevents poor performance, and the very nature of surgery calls for hands-on experience. So how can we ensure skills are kept up to date? Simulated surgical procedures and regular teaching sessions have been invaluable during this time, and consultant support in education has meant that we can continue to work on our logbooks and workplace-based assessments.
Despite not spending as much time in theatre, it is important to remember that we are still progressing as trainees. Telemedicine has allowed us to develop our outpatient skills and has certainly changed daily clinical practice as it integrates itself as a possible long-term solution for such problems as transport issues. Technology has connected the world – international news has kept us updated with statistics and scientific advice; social media has allowed us to stay in touch with friends, family and colleagues; and telemedicine has now revolutionised the way we work. This could be seen as reducing opportunities for surgical trainees, but I think it is manifesting different skill sets – adaptability, resilience and innovation.
Taking on a leadership role has never been more important for each member of the team, as organising theatre lists becomes more challenging, and providing support to junior colleagues more important. Developing brand new skills has also been incredibly interesting; being a member of the proning team on the ICU has allowed me to revise dusty knowledge such as setting up medication infusions and respiratory physiology. Moreover, learning about the pathophysiology of COVID-19 has been valuable in managing surgical patients who are COVID-positive. However, working with unwell patients prior to the pandemic does not prepare you for the sight of rows of the sickest patients on intensive care and respiratory support units, and seeing DNACPR forms behind the beds of young and old alike is shocking on a human level. I approached my first day with trepidation as I donned my FFP3 gear and entered the mist.
Ultimately, no matter which specialty or grade you are, we are all in the same position. All training progression has been slowed or halted, and we all have a lot of catching up to do.
These are extraordinary times but we are surrounded by extraordinary people, and I am proud to call them my colleagues. We stand in solidarity.