Slowdown of urology residents’ learning curve during the COVID‐19 emergency

Abstract

The coronavirus disease 2019 (COVID-19) has rapidly been spreading worldwide, and Italy has been hit hard, forcing the Italian Healthcare System to change and adapt to these extreme conditions. The daily activities of the Urology Department have been drastically reduced and limited only to non-deferrable procedures, and the entire organogram re-organised following a rigorous flowchart [1]. It is evident that this unprecedent scenario will have an impact on resident training programmes, as it is very difficult to predict the duration of the COVID-19 emergency. Urology residents do not have the opportunity to carry out clinical activities or to be tutored, as senior physicians are engaged in the emergency’s management. In particular, the Authorities have limited unnecessary access to urology departments for residents in order to contain the infection. Moreover, the procedures most affected by these restrictions are those in which the residents are mostly involved (benign pathologies, lower urinary tract surgery, and andrology); the surgical interventions, when performed, are carried out by expert surgeons, with the aim to standardise the procedures, reduce the operative time and the risk of complications. Very conflicting positions have emerged recently in Italy about the safety of laparoscopic and robot-assisted surgical procedures during the COVID-19 pandemic. This is mainly related to the recently published claims on the potential risk of dissemination of the coronavirus infection through surgical gas [2]. Lastly, case discussions and departmental meetings have been cancelled, to avoid gathering. Attempts to systematically analyse and categorise the most affected activities during the 5-year training programme (e.g. surgical training, research) are impossible, due to the absence of a homogeneous national training programme. Therefore, it is clear that urology resident training is affected transversally throughout the 5-year residency, due to the involvement of ambulatory, outpatient surgery and major surgery (either open, minimally invasive surgery or endoscopic). A recently published survey gives a snapshot of residency training in Italy in 2018 [3], showing a high level of satisfaction amongst the residents, notwithstanding limitations concerning scientific activity and surgical training. In order to limit the impact of the COVID-19 emergency on the residents’ learning curves, which can further affect surgical and scientific learning, new alternative teaching methods should be introduced (Table 1). So, thanks to new web-based technologies, teaching activity can continue. Among the different technologies available, different types of smart-learning can be implemented. The first one is represented by an online dedicated platform, where pre-recorded videos of lessons or surgical procedures are uploaded; these files could be available on-demand for the residents. In this setting, users greatly appreciate the ability to watch pre-recorded surgical procedures commented upon by an expert, with focus on routinely performed urological manoeuvres or new techniques and technologies in urology or, furthermore, expert ‘tips and tricks’ for challenging cases. The Surgery in Motion School of the European Urology Association (https://surgeryinmotion-school.org) represents a well-established video-based educational tool for efficient mentorship in surgical training. The next facet of online teaching is represented by the webinar format. It has already been shown to be useful in this setting [4], giving to both professors and students the chance to interact and to enjoy multimedia content in real-time. Classes, clinical cases discussion and interactive pre-recorded video presentations can be held by an expert, and the residents have the ability to ask questions. Moreover, various non-technical skills can be covered. Furthermore, exploiting web microblogging services, like Twitter online Journal Clubs can be done. By using social media, resid