Residents’ experiences of working under Covid

Residents’ Committee gets ready for Barcelona

The restrictions imposed by the Covid pandemic have been especially challenging for residents, with reduced opportunities for social interaction, exchange and training. But as we move into the post-pandemic era, the Residents’ Committee has been preparing new activities to promote training and education. The first of these will take place at the EACTS Annual Meeting in Barcelona in October – a programme of resident-specific sessions provide the perfect opportunity to catch up on the latest developments: • Friday 15 October, 1615 to 1745, Game of Thrones.

Surgery? Intervention? Or conservative treatment? Young surgeons and cardiologists discuss their trickiest cases to find the optimal treatment for challenging patients. Join us and watch the Heart Team perform live on stage. • Saturday 16 October, 0830 to 1000, Nightmares in CT Surgery.

An all-time classic in our programme – find out how experienced experts have solved their biggest nightmares in the OR. • Saturday 16 October, 1215 to 1445, Residents’ luncheon.

Seize the opportunity to discuss issues with senior surgeons at lunch. Pre-registration is required. The official EACTS Residents’ Zone at the Annual Meeting is also a great opportunity to come and meet the residents in person, how you can stay in touch and learn about the latest activities, and how you can take part in shaping the future of CTS surgery in Europe. Applications are now open for the new Thoracic Surgery Foundation and Francis Fontan Fund International Travelling Fellowship. This new Fellowship offers young faculty surgeons an exciting opportunity to travel internationally and learn from surgeons dedicated to the highest standards of cardiothoracic care. The Fellowship provides financial support to surgeons from Europe and North America to learn new techniques, adapt innovative technology, and foster collaboration among surgical investigators. To find out more, see page 18.

All over the world, the pandemic has blown residents’ training off course. Four current residents share their experiences of having to adapt to the new and often challenging experiences that Covid-19 has thrown at them…

Francesca D’Auria, MD PhD Cardiovascular Surgery Department, Azienda Ospedaliera Universitaria Maggiore della Carità, Novara, Italy In Italy, the first real perception of the seriousness of the Covid pandemic came at the end of February in the north. The escalation of infection was spine-chilling. Life changed for us all. Our surgical department emptied as all resources were diverted to Covid departments. We saw our operating beds transformed in ICU beds. The training rotations in cardiac surgery, thoracic surgery, and vascular surgery were frozen. The growing number of patients and lack of doctors meant cardiothoracic and vascular surgeon trainees were called to cover shifts in Covid departments, sometimes outside their primary hospitals. Webinars delivered training on Covid – fast echography diagnosis, treatment in the different stage of the disease, epidemiology, and data analysis. Surgical activities were limited to emergencies. The waiting lists are exploding. After the pandemic, the trainees’ surgical exposure is likely to soar. This year in Italy the medical degree has automatically become qualifying, with a license to practice without general training and examination. Outside of the strict surgical training, each of us has learned additional skills. In my free time I continued to train using my homemade wet lab (hen intestines and pig hearts for CABG). I also built a simulator for thoracoscopic operations. I suffer from operating room withdrawal! In hospital, social distancing and PPE have changed human relationships. Despite the distance, in my experience real friendship and collaboration bloomed. I think surgeons are among the first bulwarks in the defence of healthy human beings and this should never be overlooked. We are all in training and from this crisis we need to improve for our common future.

Kwabena Mensah, cardiothoracic trainee, the Royal Brompton Hospital, London I am in my final year of training at the Royal Brompton Hospital, one of five centres in Britain that provide extracorporeal membrane oxygenation (ECMO) for severe adult respiratory distress syndrome (ARDS). The hospital had an early influx of cases during the Covid pandemic and elective operating was stopped on 18 March 2020. Tutorials were set up in theatre and the adult intensive care unit (AICU) to help to up-skill staff. Questionnaires were sent out asking about skills and previous experience in ICU. The non-ICU medical staff were incorporated into a rota with the anaesthetic and intensive care team.

I was redeployed to AICU. To prepare us, online resources and lots of tutorials were made available on the intranet. We also took part in an online course run by Brunel University to up-skill medical and nursing staff. In London, Harefield Hospital was marked as a clean cardiothoracic centre. At the Royal Brompton & Harefield NHS Trust, urgent cases were discussed daily at an online cardiac hub meeting. The merits of performing these cases were discussed, based on the medical condition and co-morbidities as well as the current resources.

I passed the first part of the Cardiothoracic Collegiate exam and was due to take the second part this May, but this has now been set back several months. However, this time has not been a waste. I have gained a lot of experience of ECMO, which I hope will be useful in my future practice. I also have a closer understanding and a working relationship with anaesthetic and intensive care colleagues. Hopefully, the pandemic will soon end so we can continue to provide the highest level of care to cardiac patients. Vinci Naruka and Philip Hartley, cardiothoracic surgery trainees, the Royal Brompton Hospital, London The Royal Brompton Hospital is a specialist heart and lung hospital. During the pandemic it became the largest ECMO centre in the UK. This required rapid adjustment for trainees – rota changes, new colleagues, unfamiliar wards and keeping updated with local Covid-related policies. Despite this, an atmosphere of encouragement and support eased the transition. The complexity and uncertainty of the disease process was new. Those with critical care experience were paired with those without. There was a dedicated ICU registrar for non-ECMO patients in the expanded ICUs.

Wearing PPE, often for many hours at a time, when seeing patients can be uncomfortable and presents unforeseen challenges, such as loss of visual cues during communication. To minimise exhaustion, doctors going into critical care ‘red zones’ with PPE were rotated.

To further support frontline staff, the trust set up a programme of wellbeing initiatives such as accommodation and meal support. Every trainee has been affected by Covid. Teaching sessions, conferences, fellowships, training opportunities and exams were cancelled or postponed. Training rotations were delayed without clear timelines. However, learning opportunities have been present. For trainee surgeons it has been beneficial to be involved in the systematic approach that intensivists use, managing ventilators, ECMO circuits, central venous catheter insertions, flexible bronchoscopies and tracheostomies. We’ve had the opportunity to work with leading experts in ECMO and respiratory conditions. Observing and listening to their thought process on managing a new disease has been valuable. Although there has been no operative opportunity for most, some surgical trainees have focused on other training aspects such as research and teaching. The pandemic has enhanced our collaborative efforts to look after patients and one another. Having experienced many positive gestures at work has given us more hope than ever. With our lifelong commitment to the NHS, together, we will get through this.