The coronavirus disease 2019 (COVID-19) was first reported in Wuhan, China in late 2019. On March 11, 2020, the World Health Organization (WHO) characterized COVID-19 as a pandemic. The first confirmed case of COVID-19 in Algeria was reported on February 25, 2020. The COVID-19 pandemic put immense pressure on health care systems across the world, including orthopedic practice. By the end of March 2020, strong and aggressive measures have been taken by orthopedic surgery departments across Algeria. Elective, nonurgent surgical cases have been postponed or cancelled. This measure has allowed to free-up beds and increase hospitals’ capacity to treat suspected or COVID-19 positive patients requiring hospitalization. Furthermore, this measure has helped to limit the risk of potential of exposure to COVID-19 as only urgent surgeries such as trauma and tumor cases were approved to proceed1,2.
Medical education has been negatively impacted during this crisis. While students were taken out of clinical rotations to protect them from the risk of exposure to COVID-19, residents, who play a major role in providing health care in Algerian’s university hospitals, have had to continue working and even for longer shifts than prepandemic3,4. In addition to their effective participation in maintaining the continuity of health care and ensuring protection of medical staff and patients, some orthopedic departments have redeployed residents to assist in caring for COVID-positive patients in intensive care units5.
From an educational standpoint, teaching conferences for residents have been suspended. Grand rounds and in-person meetings have also been cancelled5. Those of us at teaching hospitals had to balance priorities and demands between patient care and resident education. Because of increased concern of shortage of personal protective equipment (PPE) in our hospitals, in person didactics were canceled to protect residents from the risk of contamination. In addition, the education program had to be readjusted rapidly as a result of the reduced surgical volumes3. Streamlining residents activities is necessary to reduce potential exposure to COVID-19. A large number of orthopedic departments has adapted the resident planning to reduce the weekly working days and the number of residents in the hospital at any one time. Number of residents scrubbing into surgical procedures has been reduced and surgical team should be kept to the minimum, whenever possible. Residents shifts and patient handoffs have been reorganized to reduce resident-to-resident spread5. It is evident that notable decreases in elective surgeries have negative impact on residency training programs. In Algeria, residents take a promotion intradepartmental examination each year to be qualified for the next postgraduate year. This examination has been postponed since the beginning of the pandemic. Promotion examination is one of the main opportunities for residents to study4. In addition, the higher postgraduate year qualifications require accomplishment of predefined numbers of surgeries to improve their clinical and operative skills, which are not expected to be accomplished under the current circumstances4,5.
The emergence of such a crisis provides a timely opportunity for us to reflect and evaluate the use of novel technologies in the workplace. This includes the adoption of teleconferencing solutions to ensure the continuity of learning for residents even during the pandemic2,5. Residents should be transitioned from an in-person didactic program to a videoconferencing-based system to facilitate academic activities without compromising the safety of the faculty personnel and the learners5,6. Thanks to the contribution of technology, the period of COVID-19 pandemic has seen an impressive number of webinars organized in the field of orthopedic surgery. This has permitted to Algerian residents and young surgeons to benefit from the shared experience of world-renowned orthopedic surgeons via online medical education platforms6,7. However, we deplore the lack of online conferences and webinars organized for residents by the different medical faculties and also by the Algerian society of orthopedic surgery during this period of crisis, such initiatives would have been very beneficial for residents’ education. Nevertheless, a group of young surgeons called Algerian Orthopaedic Club (AOC) has distinguished itself in this period of COVID-19 pandemic by organizing outstanding webinars presented by world-renowned speakers, who responded favorably to the request of the AOC. These weekly webinars hosted on the GoToMeeting (LogMeIn, Boston, MA) online platform, have known a great success, gathering hundreds of residents and young orthopedic surgeons from Algeria and also from many other French speaking African countries. This initiative is to be encouraged but remains insufficient. The Faculties of medicine and orthopedic societies should get more involved in proposing scientific training programs to residents through webinars and videoconferences, taking advantage of the contribution of technology to ensure the continuity of residents’ education in this period of global crisis.
The COVID-19 pandemic will persist to affect the usual delivery of orthopedic care and resident education. This crisis has reminded our community that health care and education have limited resources8. The pace of change in the teaching techniques in orthopedic surgery and indeed, in medicine in many countries including Algeria has been disappointing, with largely centuries-old lecture based approaches. Existing gaps in the surgical training are well known to us. We should look at the educational crisis we are going through as an opportunity to seize for transformation and establishment of a new road map for residency training6. Drastic and rapid changes should be implemented in medical education to provide our residents with the best education possible despite extenuating circumstances3. The advantage of the current crisis is that institutions will consider the benefit of integrating the new technology solutions such as webinars and simulation-based learning to their academic programs6. Residents should be transitioned from an in-person didactic program to a videoconferencing-based system. Such a platform could be utilized to stream daily case conferences for residents and medical students. In addition, we could create resources, such as a database of exam questions with answers or an online library that can be accessed anytime, suggesting that there are additional opportunities to support resident education5. Mobile telephone applications represent an additional resource that can be incorporated into the curricula of residents working remotely5.
COVID-19 has been a drastic change in medical and surgical education. This is absolutely the opportune moment to reorient and remap orthopedic surgery education and allow residents to genuinely learn via dealing with those massive challenges. The technology is accessible to all teachers and residents nowdays. We have a significant pool of teachers across all subspecialties willing to share their knowledge and experience using the new technology. The transition would not be achievable without a supportive leadership who should catalyze the process of continuous training of the next generation of orthopedic surgeons6.
Finally, maintaining residents safety and mental wellbeing is an important factor to consider. In this time of crisis, an extreme physical and emotional stresses are being placed on health care workers at all levels. The trainees themselves have experienced unique stressors. The feeling of loss of control over the situation and disruption of daily schedules and routine patient care has added a lot of emotional burden. In addition, the possibility of accidental COVID-19 exposure without proper personal protective equipment and lack of testing protocols, have all added to the overall anxiety9.
Several residents have been isolated far from their families for a long period. Residents report stress regarding the physical risks posed by having to care for COVID-positive patients as well as the risk of contracting the infection and passing it on to their families. The health care system should consider to protect the mental health of residents. Institutions should offer all trainees free mental telehealth counseling to deal with some of the new challenges, stress, and anxiety. To address resident burnout, mental wellbeing initiatives in the setting of this COVID pandemic should be implemented. Various activities shared via videoconferencing software can help to boost resident performance and quality of life5.
The current generation of residents is being trained not only as future orthopedic surgeons but also as doctors who contributed to the fight against COVID-1910.
Sources of funding
The authors received no external funding for this research.
N.M.: concept and design, writing the paper, validation; N.S.:concept and design, validation: R.S.L.: concept and design, validation.
Conflicts of interest disclosure
The authors declare that they have no financial conflict of interest with regard to the content of this report.
Research registration unique identifying number (UIN)
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