Features
The impact of COVID-19 on orthopaedic training Rob Gregory and Mark Bowditch
The size of the problem
Rob Gregory is a Consultant T&O surgeon who works in Durham. He has a longstanding interest in surgical training and is currently Chair of the SAC for T&O. He is also a Trustee of the BOA.
Even in the early stages of the global pandemic it was apparent that orthopaedic training would be at risk, but the precise focus of harm was unclear. With international travel severely restricted, fellowships were threatened; courses, conferences and meetings were cancelled; alternative teaching methods were untested; and redeployment cut off access to traditional work-based assessments. But in reality, the specialty has been able to adapt to such a degree that many necessary changes are now seen as innovative benefits and a return to training as practiced in the pre-COVID era is now rarely discussed. It is only in the area of the acquisition of surgical skills gained in the operating theatre that there has been a real impact, and the impact for large groups of trainees has been devastating. Both the current and the new curriculum require access to 1,800 operative cases, but it is rare for trainees to fail to reach this target, with a mean case total at CCT historically being much higher at 2,150. The nature of this requirement is often misunderstood: 1,800 is an indicative rather than mandatory figure and was selected as it was felt to represent the surgical exposure required to gain the competencies that are mandatory.
Mark Bowditch is a Consultant at the Ipswich NHS Trust where he was appointed in 2000. He is Head of School of Surgery East of England, Past Chair of the SAC in T&O, and the current BOA Treasurer.
30 | JTO | Volume 09 | Issue 02 | June 2021 | boa.ac.uk
We are fortunate in having e-logbook evidence to help us quantify the impact of COVID-19. A comparative analysis of data entries over the course of the last two years (Figures 1-3) shows that whilst there has been a small (15%) but significant reduction in trauma entries, it is elective case numbers that have been hit most severely with over a quarter of a million (58%) training opportunities lost. This represents an average of around 260 cases lost per trainee in the first year of COVID-19. When this figure is considered alongside the ‘reserve’ of 350 cases, and alongside the fact that trainees have been restricted in their ability to access the full range of subspecialties demanded by the curriculum, the potential consequences are clear.
Figure 1: Total e-logbook entries, UK, T&O, 2019-21
Figure 2: Elective e-logbook entries, UK, T&O, 2019-21
Figure 3: Trauma e-logbook entries, UK, T&O, 2019-21
The e-logbook data, whilst starkly demonstrating the impact of COVID-19, can only be used as an indirect predictor of the numbers of trainees who will require a training extension this year, but at current rates, the 350-case reserve average will have been exceeded by time of the summer ARCP round.
