Trauma and orthopaedic higher specialty trainee operating during the COVID-19 pandemic

The COVID-19 pandemic has had a significant impact on training in trauma and orthopaedic surgery owing to redeployment and reductions in both trauma referrals and elective service provision. While trainee surveys have reported reduced operative experience during this period, the case deficit has not previously been quantified. An analysis was undertaken of surgical logbooks from trauma and orthopaedic registrars in the Severn Deanery. A predictive model of pre-COVID monthly cases was fitted using trainee grade, hospital, subspecialty, clinical commitment and time of the year. This model was used to predict expected monthly cases for trainees’ post-COVID rotations, which were compared with the cases actually performed. A similar analysis was undertaken to assess primary surgeon operating. A total of 28,998 cases performed by 34 registrars between 2015 and 2021 were analysed. The COVID-19 pandemic led to an immediate and profound reduction in trainee operating, which had not fully recovered by September 2021. The average deficit accumulated over the 18 months following the onset of the pandemic was 87 cases. The accumulated deficit in trainee operating corresponds to 3–4 months of work at 300 cases per year. Deficits were accrued unequally between hospitals and subspecialties, indicating that recovery efforts will need to be individualised according to trainee experience during the pandemic. Action is urgently required not only to restore operative training in trauma and orthopaedic surgery but also to compensate for the deficit during the current training cycle.