Article Content
COVID-19 pandemic affected health care services all around the world. Accordingly, medical education is disrupted at every level from the first grade of medical school to residency programs. Although the theoretical part of the education has somehow been continued with methodological changes, the clinical training of the sports medicine (SM) residents was negatively impacted by the pandemic. In Turkey, clinical training of SM residents mainly consists of examining patients under the supervision of professors at outpatient clinics, 17 months of clinical rotations in several departments and involving in the sports rehabilitation processes of the injured or operated athletes. As of the outburst of the pandemic, hospitals decreased the outpatient admissions and cancelled the sports rehabilitation services to avoid unnecessary contact. Moreover, all residents have been assigned to COVID clinics, some of them worked in intensive care units, as previously reported. (1,2) Ustaoğlu reported that more than half of the 215 dermatologists were entrusted with a task related to COVID patients in Turkey. (3) Residents who started their training in 2019 and afterward were subjected to a quite divergent education scheme than it was before pandemic. We aimed to depict the deterioration of resident training in terms of outpatient admissions in SM departments to direct attention to necessity of future planning to take measures in order to eliminate the deficiencies in this unprecedented period.
Data Collection
Six of the eight university hospitals having sports medicine residency programs in Turkey provided statistical data related to outpatient admission numbers on monthly basis from August 2018 to November 2021. Since the ministry of health declared the first COVID-19 case on 11th March, 2020, we asked for the outpatient admission numbers 19 months before and after this date. This data provided by 6 university hospitals were enlisted as UH1- UH6 (Table 1). Descriptive statistical analyses were made using Microsoft Office (Figure 1). The number of patients in the same month of the year before and after March 2020 were compared for all and each clinic separately and demonstrated in a graph (Figure 2) to compare the effect of the pandemic.
Results and Discussion
The data demonstrated the dramatic drop in the number of admissions to SM clinics with the start of the pandemic in Turkey (Figure 1). Even though the numbers showed an increasing trend after a few months, the total number of admissions were 40% lower than normal for six months (Figure 2). The average number of total admissions has been found to be 30% lower since the beginning of the pandemic. In contrast to the others, UH-1 had an increase in admissions with the pandemic. This was due to the PCR testing of several soccer teams in Ankara, performed in the SM department of UH-1 before vaccination program has started. Another remarkable point in Figure 2 is that UH-3 had a divergent increase in September and October 2021.
Each specialty has unique settings with various challenges requiring different approaches to compensate the deterioration of its well-established pre-pandemic clinical training such as radiology, neurosurgery, and gastroenterology. (4-6) Mok et al. provided some recommendations about how to continue resident training in emergency medicine during the pandemic. (7) Schwartz et al. suggested strategies for orthopedics and traumatology residents to compensate for the deficiencies in the clinical training. (8) Specialty specific modifications may be established according to the specialty’s conditions and terms in each country. In Turkey, the privilege of prolonging the residency period up to 6 months due to pandemic has been warranted to all residents by the higher education authority (YOK) in November 2020.
Medical doctors should complete a 4 years residency training in one of the 8 university hospitals SM departments in Turkey. The placements are done once or twice a year for each department depending on their need for a resident doctor, and one or two residents can be placed at the same time. This naturally creates 6 to 12 months of gap between each resident if there are no resignations. Therefore, a resident is usually expected to complete any particular part of their residency training, so that the following one can start the same part on time. This systematic has lost its balance during the pandemic. The academic staff who are supervising the residency program need to review and revise it to assure the competency of residents whose trainings were impacted because of the pandemic.
We would like to underline an important issue in SM resident training in Turkey, particularly for those who started their residency programs in the last 3 years. It is obvious that a well-structured compensation method should be introduced based on not only just prolonging the residency period but also improving the training program of residents who had to confront several shortcomings in terms of clinical and academical proficiencies.
