Trainee Corner: The Impact of COVID-19 on Fellowship Training

The profound impact of the COVID pandemic is being felt throughout the world in many areas including healthcare, education, and research. We asked some of our Canadian trainees about the impact of the pandemic on their urogynecology fellowship training and include their responses in this issue’s Trainee Corner.

I hope you are all staying safe and well during these unprecedented times and look forward to when we can gather together again.

The COVID-19 pandemic had an impact on every aspect of our training. Most notably, hospital lockdowns and OR closures had a profound impact on our surgical volumes, especially in the fall of 2020 and spring of 2021. During that time, we only had one day of surgery per week compared to 3-4 OR days before the pandemic. Unfortunately, there is no substitute for time in the OR, and we are currently working on catching up on our surgical skills. Interestingly, we are now getting experience operating on patients who have more severe pelvic floor disorders due to OR cancellations and lengthening surgical wait lists.

In addition, COVID surges led to closures of post-op wards and as a result, we were unable to operate on patients needing the most complex procedures or those with medical needs requiring overnight admission.  On a positive note, this challenged us to expand our same-day discharge criteria, and we began performing vaginal hysterectomies with pelvic floor repairs as day surgeries. Ultimately, this has helped us rethink our post-operative care and has inspired a quality improvement project to evaluate same-day discharge for FPMRS (Female Pelvic Medicine & Reconstructive Surgery) patients.

From a research and teaching perspective, the pandemic disrupted projects that require in-person visits with study participants. At the height of the COVID-19, it was considered unethical to conduct in-person visits that were not medically necessary, and many projects were put on hold as a result. All our teaching activities were also moved online to minimize interpersonal contact. While there is no replacement for teaching in person, we were able to learn via “Zoom” and other platforms, which allows for more flexibility in the timing and style of teaching. As the COVID-19 situation improves, we are moving toward a blended model of remote and in-person teaching, which will allow us to create learning experiences that are engaging, innovative and flexible.

The COVID-19 pandemic has changed the structure and content of many learners' training programs including my fellowship in Urogynecology at the University of British Columbia. The biggest impact has been on surgical opportunity and exposure as the pandemic has led to OR closures and surgical cases have been shifted to favor day-cases in order to avoid hospital admission. Clinic time has remained largely unchanged but with more time spent on telehealth visits. Finally, fellowship research has been delayed as all research projects were stopped during the 8 months of my fellowship. It has also been difficult to recruit for any projects that require additional visits to the hospital. Due to these issues, my fellowship project has been very delayed in recruitment and progress. The global pandemic has altered the learning environment for many trainees including those in urogynecology.