Section of Urology and Renal Transplantation, Virginia Mason Franciscan Health, Seattle, Washington, USA.
Department of Laboratory Medicine & Pathology, University of Washington, Seattle, Washington, USA.
Neurourol Urodyn. 2023 Nov;42(8):1789-1794. doi: 10.1002/nau.25261. Epub 2023 Aug 7.
During the COVID-19 pandemic and subsequent staffing shortages there was concern about the case volume, and thus competency, of graduating trainees due to reduced surgical volumes. Elective procedures were particularly affected, which includes Female Pelvic Medicine and Reconstructive Surgery (FPMRS) cases. To understand whether FPMRS fellows were affected, we assessed their case logs for changes during the pandemic.
The nationally aggregated case logs of graduating FPMRS fellows, both urology and obstetrics and gynecology (OBGYN), were obtained from the Accreditation Council for Graduate Medical Education. The available academic years (AYs) included 2018-2019, 2019-2020, and 2020-2021. Standard deviation for each index category was derived from the average and 90th percentile data. One-way analysis of variance was used to compare differences in case volumes for tracked index categories between AYs.
Graduating fellows logged an average of 517.4 (standard deviation [SD] 28.6) and 818.0 (SD 37.9) cases, for urology and OBGYN respectively, over their fellowship training during the examined period. No significant differences in total surgical procedures were found for either specialty between pre-COVID AY 2018-2019 and COVID-affected AYs 2019-2020 and 2020-2021. For urology fellows, gastrointestinal (GI) procedures was the only index case category with a significant difference, and it was a decrease between the two COVID-affected AYs: 2020-2021 compared to 2019-2020 (8.9 vs. 4.2, p = 0.04). For both urology and OBGYN fellows, there was a statistically significant decrease in graft/mesh augmentation procedures from COVID-affected AY 2019-2020 to AY 2020-2021. This may be attributed to the reclassification of mesh removal cases from graft/mesh augmentation procedures to genital procedures in 2020-2021. There was not a significant decrease in these procedures from pre-COVID AY 2018-2019 to the COVID-affected AYs. There were no other statistically significant differences between AYs for OBGYN fellows.
Surgical case volumes for FPMRS urology and OBGYN fellows who trained during the COVID-19 pandemic were comparable to those of their pre-pandemic peers. No significant differences between pre-COVID and COVID-affected years were found for either total surgical procedures or index case categories. Despite disruptions in health care nationwide, FPMRS trainee case volumes were largely unaffected.
在 COVID-19 大流行期间以及随后的人员短缺期间，人们担心由于手术量减少，即将毕业的受训者的病例量（因此也包括他们的能力）会受到影响。择期手术受到的影响尤其大，其中包括女性盆底医学和重建外科（Female Pelvic Medicine and Reconstructive Surgery，FPMRS）的病例。为了了解 FPMRS 研究员是否受到影响，我们评估了他们在大流行期间的病例记录。
从毕业后医学教育认证委员会（Accreditation Council for Graduate Medical Education）获得了即将毕业的 FPMRS 研究员（泌尿科和妇产科）的全国汇总病例记录。可获得的学术年度（Academic Year，AY）包括 2018-2019 年、2019-2020 年和 2020-2021 年。从平均值和 90 百分位数数据中得出每个指数类别的标准偏差。使用单因素方差分析比较各年度跟踪指数类别中手术量的差异。
在接受调查期间，即将毕业的研究员在其研究员培训期间平均记录了 517.4（标准差[Standard Deviation，SD]28.6）和 818.0（SD 37.9）例泌尿科和妇产科手术。在这两个专科中，在 COVID 前的 AY 2018-2019 年和受 COVID 影响的 AY 2019-2020 年和 2020-2021 年之间，总手术量没有明显差异。对于泌尿科研究员，胃肠道（Gastrointestinal，GI）手术是唯一有显著差异的指数病例类别，并且在这两个受 COVID 影响的 AY 之间存在减少：2020-2021 年与 2019-2020 年相比（8.9 比 4.2，p=0.04）。对于泌尿科和妇产科研究员，从受 COVID 影响的 AY 2019-2020 年到 AY 2020-2021 年，移植物/网片增强程序有统计学意义的减少。这可能归因于 2020-2021 年移植物/网片去除病例从移植物/网片增强程序重新分类为生殖器程序。从 COVID 前的 AY 2018-2019 年到受 COVID 影响的 AY 年，这些程序没有显著减少。妇产科研究员在 AY 之间没有其他统计学意义上的显著差异。
在 COVID-19 大流行期间接受培训的 FPMRS 泌尿科和妇产科研究员的手术病例量与他们大流行前的同行相当。在总手术量或指数病例类别方面，没有发现 COVID 前和受 COVID 影响的年份之间有显著差异。尽管全国范围内的医疗保健受到干扰，但 FPMRS 研究员的病例量基本没有受到影响。
