Impact of COVID-19 on postgraduate education and mental wellbeing of surgical trainees: a systematic review

Introduction
Coronavirus disease COVID-19 is a global pandemic that has produced adverse effects on many facets of the health care system including surgical specialities. In this systematic review, we aimed to comprehensively analyze the global literature on the impact of COVID-19 on surgical education and the mental wellbeing of surgical trainees.

Methods
We searched PubMed, Scopus, LILACS, Ovid MEDLINE, Web of Science, Google Scholar and Cochrane CENTRAL between 1-January 2020 and 20-January 2021 and performed a systematic review of all observational and experimental studies on the impact of COVID-19 on postgraduate surgical trainees of all specialities. Operative and clinical exposure, surgical education and mental wellbeing were assessed as outcome measures.

Results
Fifty-nine studies including 11544 surgical trainees were analyzed. The majority of the trainees were general surgical trainees [n=4435, 38.4%]. Most studies [n=40, 67.8%] were conducted at national level in high income countries [n=9480; 82.1%]. Most studies reported a significant reduction in the operative exposure [range 45.7-100%] including elective, emergency and other clinical encounters. The mental health of trainees was affected [11.3-100%] and depression [10.6- 40.8%], anxiety [31.7-69%] and burnout [7.1-68%] were noticed. Concerns on contraction and transmission of COVID-19 infection and delays in surgical training and career progression were also reported.

Conclusion
COVID 19 pandemic had caused a considerable impact on surgical training, teaching, learning activities and mental well-being of the trainees. Measures should be taken to mitigate these effects to improve surgical training in the era of the COVID pandemic.