Anaesthetic training during the COVID‐19 pandemic

The COVID-19 pandemic has dramatically impacted anaesthetic services and the delivery of anaesthetic training across the UK and internationally [1, 2]. Trainee case-load is thought to have been reduced during the pandemic by factors including: redeployment to critical care; cancellation of elective surgery; staff self-isolation, quarantine and shielding; and absences due to sickness. We sought to quantify the effect of these changes on anaesthetic training by exploring logbook data recorded by trainees before and during the pandemic. We performed a retrospective analysis of data from Medberry Anaesthetic Logbook App (Medberry Ltd., London, UK), which we have used as a data source for previously published research [3]. After excluding data from non-UK users and non-trainee grade users, we included a total of 329,670 cases from 534 trainees (233 core trainees, 301 specialist trainees) logged in the UK from 11 March 2016 to 11 March 2021 for analysis. We computed the mean number of cases logged by trainees each month (the sum of cases recorded by all trainees logging cases in a particular calendar month, divided by the number of trainees who logged cases). We further computed the logbook case-mix distributions by specialty, surgical urgency and ASA physical status and the number of tracheal tube/supraglottic airway device placements, in order to investigate the changes in anaesthetic training experience during the pandemic. The mean number of logbook cases recorded per trainee from March 2020 to March 2021 (during the pandemic) was compared with the aggregated mean from the same periods in the 4 years preceding the pandemic (March 2016–March 2020). During the pandemic, trainees logged a mean of 254.7 cases, 29.8% lower than the mean from the preceding years, when a mean of 363.6 cases were logged. The number of critical care cases logged increased by 57.5% during the pandemic. To examine trainee case-load from operative/theatre episodes, we removed critical care and transfer cases from the data and repeated the analysis. Operative/theatre cases were reduced by 35.1%, from a mean of 350.2 cases per year pre-pandemic to 227.4 cases during the pandemic. Figure 1 shows the mean number of cases logged each month during the pandemic and pre-pandemic. There was a trough of 11.4 cases logged per trainee in April 2021, compared with a mean of 30.3 in the same period pre-pandemic. While the number of emergency and urgent cases logged reduced by 17.0% and 23.5%, respectively, there was a much larger reduction in day-case (46.1%) and routine (37.2%) cases. While the number of ASA physical status 1–3 cases reduced, there was an increase in ASA physical status 4 and 5 cases (Table 1). As expected from reduced case-load numbers, the number of airway procedures was also reduced during the pandemic compared with previous years. Of note, there was a larger reduction in supraglottic airway device placements (53.2%) compared with tracheal tube insertions (29.9%). While the volume of cases in most specialties reduced – ENT (−53.2%); orthopaedic (−50.7%); dental (−49.3%); gynaecology (−46.5%); general (−37.7%); plastics (−37.1%) – there was an increase in some, including radiology (29.0%), neonates (17.7%) and vascular (29.0%). Pandemic March 2020– March 2021 Pre-pandemic March 2016– March 2020 Our findings are consistent with findings reported by Clement et al. for surgical trainees in their quantitative analysis of surgical logbooks [4]. In their study, they reported a reduction in the overall number of operative cases logged, with elective cases affected more than emergencies, a finding that was similar to that observed in our data. Furthermore, they reported variation in the extent to which case numbers were affected depending on surgical specialty in a pattern similar to our results. The pandemic has had a significant and quantifiable impact on the training experience of anaesthetic trainees in the UK. Although the Royal College of Anaesthetists has acknowledged the issues facing training during the pandemic, and has issued guidance for trainers and trainees in mitigation to the loss of training opportunities, concrete steps must be taken to ensure that trainees do not suffer further loss of training as the pandemic ensues. RC is managing director of Medberry Ltd. No other competing interests declared.