Mitigating surgical emergency practice during COVID-19 pandemic?

PURPOSE: To define the change in Emergency Surgical Unit (ESU) workload during the COVID-19 pandemic. METHODS: Patient data for a three-week period was prospectively collected for ESU patients during lockdown period and compared to the ESU workload for the same time period prior to lockdown. RESULTS: Surgical emergencies admissions reduced by 2.5 times during our study period (p value = 0.001). In this changed paradigm, the overall number of surgical emergencies were reduced. A high mortality (n = 4, 5.7%) was noted during lockdown period as compared to pre-lockdown period (n = 1, 0.58%, p value = 0.025). Almost half of surgical admissions were tested for COVID-19 based on their symptoms and more than third (n=14, 38.9%) of them were positive. Gastrointestinal symptoms were common in COVID-19 positive group (85.7%) and only a third (36%) of COVID-19 positive patients needed surgical attention. Chest x-ray findings were comparable to PCR testing in terms of sensitivity and specificity but CT chest was more sensitive. CONCLUSIONS: It remains unclear how COVID-19 reduced surgical emergencies. A significant proportion of COVID-19 presented with gastrointestinal symptoms. In a new outbreak all General Surgical patients should be tested with CRP and WCC used as a triage adjunct. KEY WORDS: Coronavirus, COVID-19, Emergency Surgery Pandemic, General Surgery.

Online-learning: exploring practices among Foundation doctors.

INTRODUCTION: Postgraduate medical education involves the use of online-learning tools. However, there is a paucity of data on the use of online-learning among doctors who are in their 1st and 2nd years of professional work after graduating from medical school (also known as Foundation doctors). Our aim was to explore the use of online-learning among Foundation doctors. METHODS: A cross-sectional study was carried out, using convenience sampling. During one month, 66 Foundation doctors from across 2 district hospitals and 1 teaching hospital in Southeast England filled out a specially designed questionnaire. Data were collected and analyzed using Microsoft Excel™, and reported in numbers and percentages. RESULTS: The majority of Foundation doctors (86.4% (n=57)) reported using online-learning packages. These are the tools which consist of key information on a particular topic, and may be interactive and broken down into several smaller modules. Less than half embarked on online-learning in their 1st month of employment, with a decline in the numbers who started in the later months. Of those who reported completing online-learning packages, 57.9% (n=33) reported completing non-compulsory modules, 66.7% (n=38) reported completing a range of 0-15 modules per week, and 75.4% (n=43) completed the modules without skipping components. More Foundation doctors reported using online-learning for lifelong learning (63.6% (n=42)) and filling knowledge gaps (51.5% (n=34)) than improving their practice following a mistake (24.2% (n=16)). Additionally, online-learning was used less frequently than medical websites or search engines, for the aforementioned purposes. CONCLUSION: Most Foundation doctors use online-learning, but this needs to be incorporated into their postgraduate learning activities earlier in their career and directed more towards improving their clinical practice.