Supervision of redeployed surgical trainees during the COVID-19 pandemic: what have we learnt and how can we improve?

Esther V Wright, Nicholas D Haden, Kirsten Dalrymple

When cases of patients presenting with Coronavirus Disease 2019 (COVID-19) overwhelmed existing services in the United Kingdom (UK), surgical trainees were redeployed to assist frontline efforts. This project characterises the effects of redeployment on the supervision of these trainees. The resulting generation of practical recommendations could be implemented for future crises. A qualitative approach was utilised, comprised of seven phenomenological interviews with surgical and intensive care consultants, as well as redeployed surgical trainees. Interview recordings were transcribed and subsequently analysed using Thematic Analysis. The project utilised participants currently in surgical training within the London deanery across a variety of surgical specialties representing several UK National Health Service (NHS) Trusts. Three types of participants were interviewed. Four interviews were conducted with redeployed surgical trainees, across all stages of training, in full time employment who were redeployed for two weeks or more. One interview was conducted with an educational supervisor of multiple redeployed trainees. The third group comprised two consultant intensivists who supervised redeployed trainees within their respective departments. Four themes were developed: 'Responding to an unforeseen crisis', 'Maintaining surgical identity and culture; A fish out of water?', 'Trainee supervision and support' and 'Preparation and sequelae'. Participants described a sense of obligation to the pandemic effort. Many described a significant interruption to training, however communication of this to surgical supervisors was suboptimal with minimal mitigation. Supervisors on the frontline were challenged by the assessment of trainee competence and acceptance into a new community of practice. Both trainees and supervisors described the management of uncertainty, advocating for the use of reflective practice to ensure preparation for the future. This project presents an insight into several potentially long-lasting effects on surgical training. The recommendations generated may be applicable to trainees returning to work from time out of training, increasing the utility of this work.