The COVID‐19 crisis: reflections on cardiothoracic surgery training

The COVID‐19 pandemic has impacted profoundly on all aspects of our life, including our surgical specialty. Cardiothoracic surgical trainees and fellows had a particularly challenging time as most training programs were put on hold in the UK and worldwide. The cessation of training was multifactorial. First, some areas of the UK, that were disproportionately more affected than others required redeployment of cardiothoracic surgery trainees to the front line, predominantly in critical care areas, due to their unique skillset. In the less‐ affected regions, the volume of cases was significantly impacted by the reduced critical care bed capacity hence the reduced training opportunities. Most cardiothoracic surgery units have decided, from the onset of the crisis, to switch to a consultant‐led practice model. One argument is that the consultant outcomes might be better than those of the trainee, and overall, this results in less time spent in critical care and better patient flow. However, for standardized procedures such as coronary artery bypass grafting, there is data to show that there is no difference in clinical outcomes between trainees and consultants. A prerequisite to this is that operations should be performed in a center with a dedicated training program and under the direct supervision of a consultant. Nevertheless, we also must be aware that trainees might take longer to perform specific operative steps compared to consultants, resulting in more prolonged exposure of theater staff and pressure and fatigue of the team during a critical period. Moreover, performing these operations with the dedicated cumbersome personal protective equipment might be more challenging for a trainee than for a consultant (Figure 1). However, part of the return of the services to normal is also the return of cardiothoracic surgical training, and each unit will have to decide the best timing to reintroduce gradually training, depending on their circumstances. Cardiothoracic surgery training continues to attract very ambitious individuals, and it remains by far the most competitive surgical specialty during national training application in the UK. Therefore, getting a training number in cardiothoracic surgery is preceded by lots of hard work and preparation. To become competitive enough to get a national training number in cardiothoracic surgery, trainees spend a few years in nontraining posts, and research positions than in other specialities and any pause in their long‐awaited progression can be very daunting. Surgical trainees want to be active in the management of patients and particularly in the operating theater from which they draw satisfaction and a sense of achievement. Getting cases from consultants to operate on is probably the highest reward for a trainee. As a consequence, cardiothoracic surgery trainees are willing to put extra work and goodwill by coming to work in their days off or even weekends to review patients for tomorrow's list or perform a more mundane task. Therefore, the withdraw of the training opportunities has significantly impacted the trainees drive on motivation. While nothing compares to the first hand, theater exposure, the pause in training was also an opportunity for some trainees to catch up on writing research papers or to get involved in local management projects. Examples of such projects include developing COVID‐19 assessment protocols for patients referred for cardiothoracic surgery, developing practical preop assessment and follow‐up patient clinics, or managing the inflated elective pool list of patients. Working in the front line was also a rare opportunity to train in extreme circumstances such as disaster management and management of complex patients. During such, one hope, once in a lifetime events, many trainees would have acquired valuable leadership and resilience skills.