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Editorial
Impact of COVID‑19 on urology residency in India – Results
of a nationwide survey
The novel coronavirus (COVID‑19) pandemic
has brought about unprecedented uncertainty
and chaos to the lives and training of urology residents.
Residents at many centers across the country have
been deputed to the frontlines in the fight against
COVID‑19. As health‑care workers, the residents have
soldiered on despite the disruption to their careers
and training.

As we enter the 6th month of this on‑going global

pandemic, the direct and long‑term effects of
this pandemic on urological training are yet to be
understood. However, various urology programs across
the globe have acknowledged that the practical and
psychological implications of low case volumes, lack
of nonemergent surgeries, and the lack of adequate
Figure 1: Perceived implications of COVID‑19 on training and academics
surgical preparedness cannot be overlooked.[1‑3]

We conducted a nationwide, cross‑sectional,
anonymous, online survey among urology residents
in India for 3 weeks from June 21, 2020, to July
11, 2020, to study the impact of COVID‑19. The
questionnaire was developed to understand the impact
of COVID‑19 in three domains– training and academics,
clinical work, and personal life (7–9 questions
each) [Supplementary Material]. The questionnaire
was disseminated through social media (Facebook,
WhatsApp, and Twitter) as well as E‑mail. The study
was approved by the Institutional Review Board and
Ethical Committee of Christian Medical College and
Hospital, Vellore, India (IRB no. 13133/7/2020).
In this nationwide survey, we received 286 responses
over 3 weeks, representing forty cities and 18 states.
The majority of the respondents were in their final
year of training (55.9%). Of the respondents, 61.2%
worked in a medical college hospital.
RESULTS OF THE SURVEY
Impact on academics and training
81.1% of the respondents stated that COVID‑19 had a
detrimental effect on their training [Figure 1]. Around
80% felt that the lack of surgical exposure had a negative
impact to their training. The residents reported a reduction
in case‑load across all subspecialties by almost 90%.
Although bedside teaching and operative training
have taken an obvious hit, it was reassuring to note
that majority of the respondents have utilized their time
for research activities (67.5%) and gaining theoretical
knowledge (75.2%). Moreover, >70% of the respondents
reported the use of virtual seminars, presentations, and
multidisciplinary meetings at their centers.
The perceived impact of the pandemic on the academics
and training was similar between government and private
institutes (P > 0.05) and between those enrolled for Mch
Urology versus DNB Urology (P > 0.05).
Majority of the residents (74%) agreed that webinars and
virtual conferences were a resourceful mode of continuing
medical education with a mix of practical, didactic lectures
and video‑based teaching and supported by fairly good
evidence (29%‑high levels I/II and 52.3%‑moderate level
III).
Impact on clinical work: Urology and COVID‑care
Disturbingly, less than half the respondents reported
workforce restructuring and social distancing at
work (43.8% and 46.8%, respectively). Furthermore,
it was concerning to note that only 66.5% of the
respondents reported focused training and updates by
their institutes regarding COVID‑19 management and
protocols [Figure 2].[4,5] Less than 60% of the residents felt
adequately prepared for redeployment. Only 35.6% and
53.5% of respondents felt adequate PPE as per regulations
was available in the clinical area and operation rooms,
respectively. Unfortunately, these findings were consistent
with other surveys from India.[6]

© 2020 Indian Journal of Urology | Published by Wolters Kluwer - Medknow 243

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Cheriyan and Kumar: COVID‑19‑ Impact on urology residency
Figure 2: Perceived impact and changes due to COVID‑19 on clinical work
and personal life
Impact on personal life and morale
Disruption due to COVID‑19‑related restrictions, fear of
infecting family members, nonavailability of adequate
PPE, and lack of job opportunities are an added source
of anxiety and stress, which was reported by more than
two‑thirds of our respondents.[7,8] It also dents the morale
and focus of a young trainee. Similar results have been
reported by two studies from India, among psychiatrists and
ophthalmologists[6,9] and from the USA and Italy.[1,2]
IMPLICATIONS OF THE SURVEY
As urology residents contribute in the COVID‑19 frontlines,
the urological training programs, apart from ensuring the
future competence of these young urologists, have an added
responsibility to ensure their safety and well‑being. To this
end, psychological support systems, helplines, and access to
counseling services should be ensured.[10]
Forming teams working alternatingly, with 2‑weeks‑off,
will reduce PPE usage and reduce exposure to potential
COVID‑19 carriers while providing adequate time for those
who come in contact to quarantine and providing additional
time for research and non‑bedside learning.
The impact of this pandemic is likely to result in residents
feeling incompetent as a urologist. Incorporation of
surgical simulation in training programs, which combine
both technical (virtual reality and wet laboratories) and
nontechnical skills (real‑life scenarios and teamwork),[11]
will go a long way in improving the surgical preparedness
of residents. While advanced simulators may not be afforded
by most of the programs in the country, basic laparoscopy
simulators and wet laboratories should be a part of all training
programs. Additional support systems and mentorship
should be offered to those who finish their residency this
year. Workshops specifically meant to bridge the gap in
244
clinical experience can also be organized. Policies and
guidelines made for the resumption of practice should not
neglect the challenges faced by young urologists who have
been impacted by this pandemic. We believe that structured
e‑learning modules and simulated surgical‑training should
be part of a revamped curriculum to maintain uniform
standards across the board. These novel methods will ensure
that our training systems are more flexible and can cope
with extraordinary circumstances such as this. It may well
be the way forwards, not just in the short‑term but even
for the future.
In conclusion, the COVID‑19 pandemic has decreased
the clinical and surgical exposure of trainees and has had
a perceived negative impact on academics, training, and
personal lives of a resident. It would be important to ensure
measures to mitigate the effects of the pandemic and enable
both technical and emotional support systems for the
residents who have been affected to ensure the safety of
the clinician and patients.
Acknowledgments
We acknowledge the help of all the Urology Residents of
our institute in forwarding the survey to their colleagues
and providing valuable feedback.
Abhilash Cheriyan, Santosh Kumar*
Department of Urology, Christian Medical College and Hospital,
Vellore, Tamil Nadu, India
*E‑mail: drsksingh@hotmail.com
REFERENCES
1. Fero KE, Weinberger JM, Lerman S, Bergman J. Perceived impact of
urologic surgery training program modifications due to COVID‑19 in
the United States. Urology 2020;143:62‑7.
2. Amparore D, Claps F, Cacciamani GE, Esperto F, Fiori C, Liguori G,
et al. Impact of the COVID‑19 pandemic on urology residency training
in Italy. Minerva Urol Nefrol 2020;72:505‑9.
3. He K, Stolarski A, Whang E, Kristo G. Addressing general surgery
residents’ concerns in the early phase of the COVID‑19 pandemic.
J Surg Educ 2020;77:735‑8.
4. Kwon YS, Tabakin AL, Patel HV, Backstrand JR, Jang TL, Kim IY, et al.
Adapting urology residency training in the COVID‑19 Era. Urology
2020;141:15‑9.
5. Nassar AH, Zern NK, McIntyre LK, Lynge D, Smith CA, Petersen RP,
et al. Emergency restructuring of a general surgery residency program
during the coronavirus disease 2019 pandemic: The University of
Washington experience. JAMA Surg 2020;155(7):624-7.
6. Mishra D, Nair AG, Gandhi RA, Gogate PJ, Mathur S, Bhushan P,
et al. The impact of COVID‑19 related lockdown on ophthalmology
training programs in India – Outcomes of a survey. Indian J Ophthalmol
2020;68:999‑1004.
7. Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated
with mental health outcomes among health care workers exposed to
coronavirus disease 2019. JAMA Netw Open 2020;3:e203976.
8. Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M,
et al. The immediate psychological and occupational impact of the
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[Downloaded free from http://www.indianjurol.com on Friday, October 2, 2020, IP: 47.8.45.210]
2003 SARS outbreak in a teaching hospital. CMAJ 2003;168:1245‑51.
9. Nanjundaswamy MH, Pathak H, Chaturvedi SK. Perceived stress and
anxiety during COVID‑19 among psychiatry trainees. Asian J Psychiatr
2020;54:102282.
10. Benedek DM, Fullerton C, Ursano RJ. First responders: Mental health
consequences of natural and human‑made disasters for public health
and public safety workers. Annu Rev Public Health 2007;28:55‑68.
11. Shamim Khan M, Ahmed K, Gavazzi A, Gohil R, Thomas L, Poulsen J,
et al. Development and implementation of centralized simulation
training: Evaluation of feasibility, acceptability and construct validity.
BJU Int 2013;111:518‑23.
Indian Journal of Urology, Volume 36, Issue 4, October-December 2020
Cheriyan and Kumar: COVID‑19‑ Impact on urology residency
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Access this article online
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DOI:
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How to cite this article: Cheriyan A, Kumar S. Impact of COVID-19 on
urology residency in India – Results of a nationwide survey. Indian J Urol
2020;36:243-5.
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QUESTIONNAIRE - SUPPLEMENTARY MATERIAL

Impact of COVID 19 on Urology Training in India

- This form is meant only for Mch/DNB residents undergoing Urology Training in India
- Please take 5 mins to Ell this form for us to study the impact of COVID 19 on urological training from the
residents point of view.
- There are 4 sections - Demography, Impact on training, Impact on Personal life, Impact on Work : Each
with 6-8 multiple choice questions.
- This form is conEdential and no data will be collected that will reveal your identity
- Kindly read through all questions and chose the best option provided.
* Required

1. I give consent to pa!icipate in this questionnaire based study *

Mark only one oval.

Yes

No

2. Gender *

Mark only one oval.

Male

Female

3. Course *

Mark only one oval.

Mch Urology

DNB Urology
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4. Level of training *

Mark only one oval.

1st year

2nd year

3rd year

5. Type of Institute *

Mark only one oval.

Medical College - Govt

Medical College - Private

Speciality - Urology/Nephrology

Multispeciality hospital

6. City - Where institute is located *

7. State - Where institute is located *

Impact of COVID on 1- strongly disagree/decreased considerably, 2- disagree/somewhat decreased, 3-

neutral, 4- agree/somewhat increased, 5- strongly agree/increased considerably.
training (Last 4
months)

8. COVID has reduced OPD and o"ce procedures *

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

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9. Elective case load has decreased *

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

10. Operating/assisting oppo!unities in elective OR have reduced thereby hampering training

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

11. Bedside teaching and grand rounds are fewer *

Mark only one oval.

1 2 3 4 5

Strongly Disagree Strongly Agree

12. Journal club and seminars have been adversely impacted by COVID *

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

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13. We have more time for research activities and academic writing *

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

14. Additional time for self-study and gain theoretical knowledge *

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

15. Disrupted plans to present/a#end conferences and workshops *

Mark only one oval.

1 2 3 4 5

Strongly Disagree Strongly Agree

16. Disrupted future plans/Job / IELTS/ RCS exams/ USMLE (SKIP if irrelevant)

Mark only one oval.

1 2 3 4 5

Strongly Disagree Strongly Agree

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17. Case volume by subspecialty

Mark only one oval per row.

None Decreased Same Increased

Urologic Oncology

Endourology/Stone

Recontructive/Pelvic

Pediatric

Emergency

Andrology/Infertilty

General Urology

Transplant

18. Webinars during COVID -Positive impact on resident training *

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

19. Webinars during COVID - what is the level of evidence in most webinars according to you?

Mark only one oval.

High level of evidence - Level I and II - Systematic review/ RCTs

Moderate level of evidence - Level III - Observational

Low level of evidence - Level IV/V - Expert opinions, case reports, personal observations
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20. How o$en do you a#end webinars *

Mark only one oval.

Once a month

Once a week

Never

More than once per week

21. Focus of webinars (SKIP if you don't a#end webinars)

Check all that apply.

PG/exam focussed
Urology Practice focussed
Showcase of skills/tips/tricks
Other:

22. Overall, COVID 19 had a negative impact on my training

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

1- strongly disagree/decreased considerably, 2- disagree/somewhat decreased, 3-

COVID19 impact on
neutral, 4- agree/somewhat increased, 5- strongly agree/increased considerably.
personal life (last 4
months)

23. Members of my house hold *

Check all that apply.

Spouse
Children (one or more)
Parents/In-Law (>60 years)
None
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24. Time to spend with family and kids (SKIP if living alone)

Mark only one oval.

1 2 3 4 5

Decreased Increased

25. Worried about infecting children and elderly in the family (SKIP if living alone)

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

26. A%ected by current economic situation and concerned about &nances *

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

27. Felt increased anxiety and stress during COVID and current situation - worried about
job/future/competence *

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

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28. I feel frustrated and my morale is low- Feeling unprepared/lost focus *

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

1- strongly disagree/decreased considerably, 2- disagree/somewhat decreased, 3-

COVID19 and
neutral, 4- agree/somewhat increased, 5- strongly agree/increased considerably.
workplace (last 4
months)

29. Adequate PPE has been provided according to prescribed guidelines (WHO/MoHFW/CDC) -
IN OPD *

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

30. Adequate PPE has been provided according to prescribed guidelines (WHO/MoHFW/CDC) -
IN THEATRE

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

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31. Have been updated regularly regarding COVID guidelines and special precautions and
needs by the hospital

Mark only one oval.

1 2 3 4 5

Strongly disagree Strongly agree

32. What has your program done to aid your urological residency during COVID 19

Check all that apply.

Use of virtual seminars/presentations/meeting

Time allotted for thesis/dissertation/research
Social distancing at work
Schedule to conserve man-power , time off/rotation of personnel
Academic assignments/tasks during off-days

33. Are you worried about exposure to COVID-19 at work

Mark only one oval.

1 2 3 4 5

Not at all Yes, extremely stressed

34. Have you had contact with diagnosed COVID 19 positive patients needing to quarantine
thereby a%ecting your residency/learning

Mark only one oval.

Yes

No

Not applicable, Not exposed to known COVID positive cases

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35. Have you been deputed to medical wards/ICU/COVID special ward/ Fever clinics

Mark only one oval.

YES

NO

36. If YES , Do you feel prepared to man COVID wards and clinics -
Instructions/orientation/adequate PPE (SKIP if you answered no in the previous question)

Mark only one oval.

Yes

No

37. Feedback regarding the questionnaire *

Mark only one oval per row.

Yes No

Easy to understand

Relevant

Fairly comprehensive

38. Please feel free to share any comments on the survey and please forward it to your batch-
mates and juniors
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