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Impact of SARS-CoV-2 on training and mental well-being of surgical gynecological oncology trainees
  1. Faiza Gaba1,2,
  2. Oleg Blyuss3,4,
  3. Isabel Rodriguez5,
  4. James Dilley6,
  5. Yee-Loi Louise Wan7,
  6. Allison Saiz8,
  7. Zoia Razumova9,
  8. Kamil Zalewski10,
  9. Tanja Nikolova11,
  10. Ilker Selcuk12,
  11. Nicolò Bizzarri13,
  12. Charalampos Theofanakis14,
  13. Maximilian Lanner15,
  14. Andrei Pletnev16,
  15. Mahalakshmi Gurumurthy1 and
  16. Ranjit Manchanda6,17
  1. 1 Department of Gynaecological Oncology, NHS Grampian, Aberdeen, UK
  2. 2 Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
  3. 3 Department of Physics, Astronomy and Mathematics, University of Hertfordshire, Hatfield, UK
  4. 4 Department of Pediatrics and Pediatric Infectious Diseases, Institute of Child's Health, Sechenov University, Moskva, Russian Federation
  5. 5 Department of Gynecologic Oncology, University of Washington, Seattle, Washington, USA
  6. 6 Department of Gynaecological Oncology, Barts and The London NHS Trust, London, UK
  7. 7 Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
  8. 8 Department of Gynecologic Oncology, Northwestern University in Chicago, Chicago, Illinois, USA
  9. 9 Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
  10. 10 Department of Gynecologic Oncology, Świętokrzyskie Cancer Centre, Kielce, Poland
  11. 11 Department of Gynecologic Oncology, Academic Teaching Hospital of Heidelberg University, Baden-Baden, Germany
  12. 12 Department of Gynecologic Oncology, Ankara City Hospital, Ankara, Turkey
  13. 13 UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Policlinico Agostino Gemelli IRCCS, Rome, Italy
  14. 14 Department of Gynaecological Oncology, General Hospital of Athens Alexandra, Athens, Attica, Greece
  15. 15 Department of Obstetrics/Gynaecology, Kardinal Schwarzenberg'sches Krankenhaus, Schwarzach, Steiermark, Austria
  16. 16 Department of Gynecology and Obstetrics, University of Zielona Góra, Zielona Góra, Poland
  17. 17 Wolfson Institute of Preventive Medicine, Barts CRUK Cancer Centre, Queen Mary University of London, London, UK
  1. Correspondence to Dr Faiza Gaba, Department of Gynaecological Oncology, NHS Grampian, Aberdeen, UK; faiza.gaba1{at}; Prof Ranjit Manchanda; r.manchanda{at}


Introduction The SARS-CoV-2 global pandemic has caused a crisis disrupting health systems worldwide. While efforts are being made to determine the extent of the disruption, the impact on gynecological oncology trainees/training has not been explored. We conducted an international survey of the impact of SARS-CoV-2 on clinical practice, medical education, and mental well-being of surgical gynecological oncology trainees.

Methods In our cross-sectional study, a customized web-based survey was circulated to surgical gynecological oncology trainees from national/international organizations from May to November 2020. Validated questionnaires assessed mental well-being. The Wilcoxon rank-sum test and Fisher’s exact test were used to analyse differences in means and proportions. Multiple linear regression was used to evaluate the effect of variables on psychological/mental well-being outcomes. Outcomes included clinical practice, medical education, anxiety and depression, distress, and mental well-being.

Results A total of 127 trainees from 34 countries responded. Of these, 52% (66/127) were from countries with national training programs (UK/USA/Netherlands/Canada/Australia) and 48% (61/127) from countries with no national training programs. Altogether, 28% (35/125) had suspected/confirmed COVID-19, 28% (35/125) experienced a fall in household income, 20% (18/90) were self-isolated from households, 45% (57/126) had to re-use personal protective equipment, and 22% (28/126) purchased their own. In total, 32.3% (41/127) of trainees (16.6% (11/66) from countries with a national training program vs 49.1% (30/61) from countries with no national training program, p=0.02) perceived they would require additional time to complete their training fellowship. The additional training time anticipated did not differ between trainees from countries with or without national training programs (p=0.11) or trainees at the beginning or end of their fellowship (p=0.12). Surgical exposure was reduced for 50% of trainees. Departmental teaching continued throughout the pandemic for 69% (87/126) of trainees, although at reduced frequency for 16.1% (14/87), and virtually for 88.5% (77/87). Trainees reporting adequate pastoral support (defined as allocation of a dedicated mentor/access to occupational health support services) had better mental well-being with lower levels of anxiety/depression (p=0.02) and distress (p<0.001). Trainees from countries with a national training program experienced higher levels of distress (p=0.01). Mean (SD) pre-pandemic mental well-being scores were significantly higher than post-pandemic scores (8.3 (1.6) vs 7 (1.8); p<0.01).

Conclusion SARS-CoV-2 has negatively impacted the surgical training, household income, and psychological/mental well-being of surgical gynecological oncology trainees. The overall clinical impact was worse for trainees in countries with no national training program than for those in countries with a national training program, although national training program trainees reported greater distress. COVID-19 sickness increased anxiety/depression. The recovery phase must focus on improving mental well-being and addressing lost training opportunities.

  • COVID-19
  • surgery

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  • Twitter @FaizaGaba, @ilkerselcukmd

  • Contributors Conception: FG. Design and development: FG, RM. Questionnaire development: FG, JD, LW, RM. Data collection: FG, IR, JD, LW, ZR, AS, KZ, TN, IS, NB, CT, ML, AP, MG, RM. Data analysis: FG, OB. Preparation of tables: FG, OB. Initial draft of manuscript: FG, RM. Manuscript writing, review and approval: all authors.

  • Funding The study is supported by researchers at the University of Aberdeen and Global Gynaecological Oncology Surgical Outcomes Collaborative (GO SOAR).

  • Competing interests FG declares research funding from the NHS Grampian Endowment Fund, Medtronic and Karl Storz outside this work. RM declares research funding from Barts & the London Charity, Eve Appeal, British Gynaecological Cancer Society outside this work; an honorarium for grant review from Israel National Institute for Health Policy Research and honorarium for advisory board membership from AstraZeneca/MSD. RM is supported by an NHS Innovation Accelerator (NIA) Fellowship for population testing.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.