Perceptions and reality: surgical critical care training in the time of COVID-19

Purpose The COVID-19 pandemic is known to have disrupted educational experiences for surgical trainees. In surgical critical care (SCC) fellowships, trainees encountered changes in rotations, procedure volume, didactic education, and patient population. Effects of the pandemic on SCC training have not been well described. The purpose of this study was to evaluate trainee perceptions of these changes on educational experience and preparation for the American Board of Surgery (ABS) SCC Certifying Exam (CE). We theorized that, although the pandemic caused challenges to training, trainees’ overall experience and CE performance would be unaffected. Methods A 10-question survey was administered electronically to candidates completing the 2020 (CE-20) and 2021(CE-21) exams, regarding the effects of COVID-19 on SCC education and CE preparation. Responses were analyzed with descriptive statistics. Results Response rate to the survey was 100%. Most CE-20 candidates stated that core (66%) and elective (51%) rotations were modified due to the pandemic. For CE-21 candidates, a minority experienced changes to rotations (41% for both rotation types). Most reported caring for COVID-19 patients < 25% of the time during fellowship. Over 70% cared for nonsurgical patients, and a majority of trainees responded that this improved their education. Procedure volumes were decreased overall (most notably for airway procedures) but rebounded between CE-20 and CE-21. At least 95% of respondents reported meeting case minimums in bronchoscopy, endotracheal intubation, and cardiac ultrasonography. For both groups, most candidates reported feeling less prepared for the CE (CE-20 65%, CE-21 59%). CE-20 and CE-21 passing rates were 89% and 84%, similar to prior years. Pass rates for the following year (CE-22) were unchanged at 85%. Conclusions Despite alterations to rotation schedules and exam preparation, SCC trainees benefited from exposure to both COVID-19 and nonsurgical patients. Even with decreased procedure availability, almost all had adequate exposure. Performance on the SCC CE examination was similar to prior CE-22 results, indicating that the report of feeling less prepared did not correlate with exam outcome. Continued exposure to nonsurgical patients during training may be desirable for SCC fellows beyond the pandemic.