Impact of COVID-19 pandemic on specialty training in Obstetrics and Gynaecology in Hong Kong: what is the future prospect?

Impact of COVID-19 pandemic on specialty training in Obstetrics and Gynaecology in Hong Kong: what is the future prospect? | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of COVID-19 pandemic on specialty training in Obstetrics and Gynaecology in Hong Kong: what is the future prospect? Janice Tsz Ching LEUNG, Yan Yu LI, Choi Wah KONG, William Wing Kee TO This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4085910/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 19 Aug, 2024 Read the published version in BMC Medical Education → Version 1 posted 12 You are reading this latest preprint version Abstract Introduction The COVID-19 pandemic in the past few years have led to major adjustments in the provision of healthcare. This study aimed to investigate the impact of the pandemic on specialty training in Obstetrics & Gynaecology (O&G) in Hong Kong. Methods A cross-sectional questionnaire survey was performed on all the O&G trainees and the young fellows of the Hong Kong College of Obstetricians and Gynaecologists (HKCOG). The questionnaires included 5 parts: demographic data, impact on clinical activities, redeployment, educational activities and career progression. Results A total of 104 questionnaires (92.9%) were received for final analysis. The majority of the participants had reductions in elective and emergency operations, as well as exposure to in-patient admissions and out-patient clinics in both obstetrics and gynaecology. The reduction was most significant in elective gynaecology operations. One-third (34.6%) of the participants had been redeployed to other departments, and educational activities were reduced during the pandemic. Around 58% of the trainees were concerned with the reduction in clinical exposure, and 78% worried they would not be able to log sufficient number of surgical procedures. Basic trainees were significantly more worried than higher trainees. Around half of the trainees had doubts or regrets about choosing to undergo O&G specialty training. Conclusion The COVID-19 pandemic had significant negative impacts on O&G training in Hong Kong. Many trainees were worried they would not be able to attain the required level of competence when they complete their specialist training. COVID-19 training obstetrics gynaecology Hong Kong New knowledge added by this study COVID-19 had negative impacts on O&G training in Hong Kong due to the reduction in elective and emergency operations, as well as clinical exposure to in-patient admissions and out-patient clinics. The switch of educational activities such as grand rounds and seminars into virtual format during the pandemic was welcomed by the participants and they prefer to keep the virtual format after the pandemic. Many O&G trainees were worried they will not be a competent specialist in future and had doubt or regrets in their career choice. Implications for clinical practice or policy Educational activities via virtual platforms can be continued even after the pandemic as such format are more accessible, and offers more flexibility for learning. Trainers in O&G departments should attempt to identify the individual gaps in clinical exposure and insufficiencies in procedure logging for each trainee, and then adopt targeted training plans tailored for each of them to make up for the deficient areas before they approach their exit assessment. The Hong Kong College of Obstetricians and Gynaecologists should explore means to and improve the training programme for O&G trainees in order to prevent high attrition rates for existing trainees, and to boast the currently low preference for O&G among medical graduates seeking specialty training. Introduction The global pandemic of Coronavirus disease 2019 (COVID-19) has posed a significant burden and a major challenge to the health care system all around the world. The pandemic has led to overwhelming surges of hospitalizations, leading to redeployment of trainees in many specialties to care for COVID-19 patients and significant reduction in elective surgeries 1 . A study in Italy found 88.5% of surgical residents had decreased surgical activities due to reduced hospital bed capacity and reduction of elective surgery 2 . Another large study conducted in the United States found 84% of surgical residents had more than 50% reduction in operative volume and inability to meet minimum case requirements for training 3 . A recent study in Hong Kong has found that the COVID-19 has caused significant disruptions in caseload, technical skills training, work-based assessment and continued medical education on the training of anesthesiologists 4 . The resident training programme in obstetrics and gynaecology (O&G) in Hong Kong is organized by the Hong Kog College of Obstetricians and Gynaecologists (HKCOG), and trainees have to undergo 4 years of basic training and 2 years of higher training in various public training hospitals. They are required to pass of an exit assessment at the end of the six years before they can be recognized as specialists and as fellows of the College. While it appears inevitable that such specialty training would be similarly affected by the pandemic waves in Hong Kong, the extent of this impact in O&G has not been studied. The first confirmed COVID-19 case in Hong Kong was on 23 January 2020. Waves of the pandemic have hit Hong Kong within the past 4 years with the fifth wave in January 2022 resulting in a total of 1,049,959 reported confirmed cases and 5,906 death cases from 6 January to 21 March in 2022 5 . After battling with the virus for more than three years, WHO finally announced that COVID-19 is no longer defined as a Public Health Emergency of International Concern in May 2023 6 . The Hong Kong government has lifted the quarantine requirements for travelers since September 2022 and dropped the mask mandate in March 2023. However, compared to other western and Asian countries, Hong Kong had adopted mandatory quarantine for COVID-19 infected patients and for persons having close contacts as well as for international travellers for almost three years. The impact of the pandemic on resident training in our hospitals could therefore be more profound than in other countries. The objective of this study is to investigate the impact of COVID-19 pandemic on specialty training of Obstetrics & Gynaecology (O&G) in Hong Kong and the implications on the competence of our future O&G specialists. Methods This was a cross-sectional questionnaire survey conducted from 1 to 31 August 2023 in all the eight O&G training units in Hong Kong (Kwong Wah Hospital, Pamela Youde Nethersole Eastern Hospital, Prince of Wales Hospital, Princess Margaret Hospital, Queen Elizabeth Hospital, Queen Mary Hospital, Tuen Mun Hospital and United Christian Hospital). The questionnaires were distributed to all trainees and young fellows obtaining their fellowship in 2021 or after and who were still working in the Hospital Authority during the time of the questionnaire study. The questionnaires were anonymous, self-administered, and was in English format (Appendix 1). The questionnaires consisted of 43 questions with five domains, including ( 1 ) demographic data of the participants ( 2 ) impact of COVID-19 on their clinical activities ( 3 ) impact of redeployment on training ( 4 ) impact of COVID-19 on educational activities ( 5 ) impact on career progression. A written consent with a printed questionnaire was distributed to all eligible participants and they were asked to return the completed questionnaires and signed consent to the principal investigator by fax or internal mail. SPSS software (Windows version 20.0; IBM Corp, Armonk [NY], United States) was used for data entry and analysis. Descriptive categorical data were expressed as numbers and percentages; they were compared and analyzed by the Chi squared test or Fisher’s exact test as appropriate. A P-value of < 0.05 was considered statistically significant. Results A total of 112 questionnaires were sent out to all the eligible participants and a total of 106 completed questionnaires were returned. Two questionnaires were excluded due to missing answers in key items. The overall rate of participation for analysis was 92.9% (104/112), of which 31.7% were basic trainees who had less than 4 years of recognized O&G training, 34.6% were higher trainees who had at least 4 years of recognized training and 33.7% of them were young fellows who had obtained their fellowship in 2021 or after. The majority of them (80.8%) were female. (Table 1 ) Table 1 Demographic data of the participants (n = 104) Demographic data Number (%) Current level of training Basic trainee 33 (31.7%) Higher trainee 36 (34.6%) Junior specialist 35 (33.7%) Age =41 1 (1.0%) Gender Female 84 (80.8%) Male 20 (19.2%) Marital status Single 65 (62.5%) Married 39 (37.5%) Any children No 92 (88.5%) Yes 12 (11.5%) The majority of the participants reported significant decreases (over 25%) in clinical activities during COVID-19 pandemic as compared to pre-COVID levels. For gynaecology activities, 92.3% and 78.8% of participants had reduction in elective and emergency operations respectively, 86.5% and 67.3% of participants had reduction in exposure to in-patient admissions and exposure to out-patient clinics respectively. For obstetrics activities, 87.5% and 76.9% of participants had reduction in elective and emergency caesarean sections respectively, 88.5% had reduction in instrumental deliveries, 90.4% and 88.5% had reduction in exposure to in-patient admissions and exposure to out-patient clinics respectively. (Table 2 ) Table 2 Changes in clinical activities during COVID-19 Clinical activities Number (%) Gynaecology Reduction in elective gynaecology operations 96 (92.3%) Less than 25% 14 (13.5%) Reduced 26–50% 37 (35.6%) Reduced 51–75% 31 (29.8%) Reduced more than 76% 14 (13.5%) Reduction in emergency gynaecology operations 82 (78.8%) Less than 25% 41 (39.4%) Reduced 26–50% 27 (26.0%) Reduced 51–75% 12 (11.5%) Reduced more than 76% 2 (1.9%) Reduction in exposure to gynaecology in-patient admissions 90 (86.5%) Less than 25% 31 (29.8%) Reduced 26–50% 38 (36.5%) Reduced 51–75% 16 (15.4%) Reduced more than 76% 5 (4.8%) Reduction in exposure to gynaecology out-patients 70 (67.3%) Less than 25% 40 (38.5%) Reduced 26–50% 18 (17.3%) Reduced 51–75% 9 (8.7%) Reduced more than 76% 3 (2.9%) Obstetrics Reduction in elective caesarean sections 91 (87.5%) Less than 25% 37 (35.6%) Reduced 26–50% 40 (38.5%) Reduced 51–75% 8 (7.7%) Reduced more than 76% 6 (5.8%) Reduction in emergency caesarean sections 80 (76.9%) Less than 25% 44 (42.3%) Reduced 26–50% 25 (24.0%) Reduced 51–75% 10 (9.6%) Reduced more than 76% 1 (1.0%) Reduction in instrumental deliveries 92 (88.5%) Less than 25% 40 (38.5%) Reduced 26–50% 34 (32.7%) Reduced 51–75% 15 (14.4%) Reduced more than 76% 3 (2.9%) Reduction in exposure to obstetric in-patient admissions 94 (90.4%) Less than 25% 43 (41.3%) Reduced 26–50% 34 (32.7%) Reduced 51–75% 14 (13.5%) Reduced more than 76% 3 (2.9%) Reduction in exposure to obstetric out-patients 92 (88.5%) Less than 25% 48 (46.2%) Reduced 26–50% 31 (29.8%) Reduced 51–75% 11 (10.6%) Reduced more than 76% 2 (1.9%) Over one-third (36/104, 34.6%) of the participants had been redeployed to other departments during the COVID-19 pandemic. Among them, the most common department or facility for redeployment was Department of Medicine (16/36, 44.4%), followed by Asia Expo (9/36, 25%) and Penny Bay (8/36, 22.2%), and 27.8% (10/36) of them had been redeployed for less than 4 weeks, 52.7% (19/36) had been redeployed for 4–7 weeks, 5.6% (2/36) had been redeployed for 8–11 weeks and 13.9% (5/36) had been redeployed for 12 weeks. Around 44.4% (16/36) in the redeployed group regarded the redeployment experience as having a positive impact on their professional training, increasing their knowledge and experience in managing medical diseases, while 25% (9/36) thought redeployment had negative impact on their training. Two-thirds of the participants (65.4%) reported significant reductions (60.6%) or even total cancellations (4.8%) of teaching sessions/ grand rounds during the pandemic. Attendance of seminars or lectures was reduced in around half of them (49.0%), while paradoxically 27.9% of participants reported an increase in attendance, which was mostly attributable to availability of online lectures and webinars. The majority of participants (71.2%) would prefer online or virtual seminars rather than physical ones even after COVID-19 pandemic. While 76.9% of participants reflected the pandemic had no effect on their research training, 59.6% found the pandemic had no impact on their personal study time and 31.7% of them even found more time to study. (Table 3 ) Table 3 Changes in educational activities during COVID-19 Educational activities Number (%) Teaching rounds/ Grand rounds All cancelled 5 (4.8%) Decreased 63 (60.6%) No change 33 (31.7%) Increased 3 (2.9%) Seminars / lectures attended Decreased 51 (49.0%) No change 24 (23.1%) Increased 29 (27.9%) Scientific conferences or courses All cancelled 7 (6.7%) Decreased 41 (39.4%) No change 29 (27.9%) Increased 10 (9.6%) Not applicable to his/her level of training 17 (16.3%) Research training Negative effect 16 (15.4%) Positive effect 8 (7.7%) No effect 80 (76.9%) Personal study time Less time 9 (8.7%) No change 62 (59.6%) More time 33 (31.7%) With regard to the trainees’ views on their specialty training programme and their career prospects, around one third (34.8%) of the trainees had at least some degree of dissatisfaction in their current training schedule, with 71.0% worrying they would not have enough number of procedures when applying for fellowship examination and 58.0% worrying they would not have enough clinical exposure in their training. Basic trainees were more significantly concerned in these aspects than higher trainees (p = 0.003 and p = 0.017 respectively). The majority of the trainees (76.8%) had worries about not being able to be a competent specialist after completion of their training, and 44.9% of them had some degree of doubts or regrets about their choice of undergoing training to be an O&G specialist. Almost half (47.8%) of them had recalled transient or even persistent thoughts of quitting their training. (Table 4 ) Among those with doubts or regrets on choosing this specialty, major concerns included not being able to be a competent specialist even after six years of training, and promotion aspects in the specialty being not as promising as before. Around two-third of them (45/69, 65.2%) felt that their department had already tried to maximize the number of procedures for them to perform by swapping duties on ad hoc basis, or arranging rotations to other O&G units for them. More than half of them (53.6%, 37/69) hoped that the HKCOG can adopt more flexible assessment criteria at the time of their exit assessment, such as accepting the use of OSAT as proof of competence for certain procedures if they were unable to log the minimum number to satisfy training requirements. Table 4 Views of the trainees on their O&G training and career with comparison between basic trainees and higher trainees View on their training and career Total number of trainees (n = 69) (%) Number of basic trainees (n = 33) (%) Number of higher trainees (n = 36) (%) P value Were unsatisfied about the current training 24 (34.8%) 13 (39.4%) 11 (45.8%) 0.441 Worried for not having enough number of procedures when applying for fellowship examination 49 (71.0%) 29 (87.9%) 20 (55.6%) *0.003 Worried about not having enough clinical exposure in their training 40 (58.0%) 24 (72.7%) 16 (44.4%) *0.017 Worried about not being able to be a competent specialist after completion of training 53 (76.8%) 28 (84.8%) 25 (69.4%) 0.130 Had doubts about choosing O&G for specialty training 31 (44.9%) 14 (42.4%) 17 (47.2%) 0.689 Had considered to quit O&G training 33 (47.8%) 13 (39.4%) 20 (55.6%) 0.179 * statistically significant Discussion Our data showed there was a significant overall reduction of clinical exposure during the COVID-19 pandemic. This was compatible with the trends of diversion of clinical resources away from O&G during the pandemic worldwide. A study in the United States found the surgical volume in two large O&G organizations had dropped to 48–67% in 2020 compared with 2019 7 . A study on 103 O&G trainees in Turkey found 98% of them reported decrease in the number of surgeries, so that 63% of the trainees thought that their surgical skills were hindered by the reduced number of surgeries and 67% reported insufficient outpatient clinic experience to meet education targets 8 . Our data should that the degree of reduction in clinical exposure was apparently more profound in gynaecology compared with obstetrics. Almost half of our trainees (43.3%) perceived the number of elective gynecological operation sessions assigned were reduced by more than 50% while half of them (48.1%) perceived that elective caesarean sections assigned was not reduced or reduced by less than 25%. This was compatible with the findings from other countries. A study on the impact of COVID-19 in United Kingdom on 87 O&G trainees found that almost all the trainees (99%) felt their surgical training on benign gynaecological conditions had been negatively affected compared while only 43% felt their obstetric training was negatively affected 9 . Another study conducted on 476 Italian O&G trainees found benign gynaecology procedures, infertility treatments and urogynaecology related activities underwent a significant reduction with a reported total suspension from 54–60%, while labour/ delivery training and prenatal diagnosis was less reduced with a total suspension of training from 8.2–23.1% only 10 . This was logical as urgent and non-deferrable surgeries such as labour/delivery and oncologic procedures had to be maintained despite elective gynaecological surgeries for benign conditions being postponed. However, reduction on obstetric services in public hospitals in Hong Kong was still remarkable as a significant proportion of women opted to deliver in private hospitals instead of public hospitals during the pandemic. The practical reasons for this trend included the strict prohibition of all visiting in public hospitals and the cancellation of husband accompanying labour programme during the peaks of the pandemic. In addition, the risk of contracting COVID-19 was believed to be lower when delivering in private rather than public hospitals, as private hospitals would not admit confirmed COIVID patients 11,12 . The redeployment rate for O&G trainees to other units such as medical department during COVID-19 pandemic varied among different countries. A survey on 110 O&G trainees from 25 different European countries found the redeployment rate was 15%, compared with 34.6% in our study to as high as 65.3% in Turkey 8,13 . The trainees in European countries valued their experience in redeployment and thought they have increased their knowledge and skills in medicine with a positive impact on their training, which was similar to the views of our redeployed trainees 13 . As our specialty training focused on O&G knowledge and skills, and elective year training in other specialties in no longer mandatory in our training programme, our trainees seldom had the experience in managing medical diseases or work in other specialties during their training. Our data showed that 44.4% of our redeployed trainees were seconded to the Department of Medicine, which offered them a variety of valuable clinical experiences apart from merely looking after COVID patients to broaden their medical knowledge. Furthermore, the majority of our trainees (86.1%) were redeployed less than 12 weeks, so that the chances of jeopardizing their O&G exposure and training due to the redeployment should be low. Similar to our findings, around half of the trainees (51.2%) in the Italian study reported a reduction in teaching activities during the COVID-19 pandemic with decreases in teaching/ grand rounds, attendance of seminars and conferences 10 . A virtual continuing medical education program had been constructed for O&G trainees in Singapore in 2020 to replace the traditional face to face continuous medical education program comprising of grand rounds, clinical governance, journal clubs and research presentations and was highly evaluated by their trainees 14,15 . Indeed, virtual platforms for lectures and conferences had been increasingly used worldwide as well as in Hong Kong during the COVID-19 pandemic. Virtual platform is convenient, and apart from lifting geographic constraints and saving travel time, also allows recording and playback to retain and review information. The majority of our trainees expressed that they preferred online or virtual seminars rather than physical ones even after COVID-19 pandemic. In response to the reduction in elective gynaecology surgery, various authors from different countries had advocated simulation training in O&G during COVID-19 pandemic such as using laparoscopic box trainers and surgical simulators to train tissue handling and laparoscopic suturing 8,9,14,15 . Use of archived surgical videos and live tele-mentoring in operation theaters by experienced seniors had also been advocated so that more trainees can observe the operations simultaneously to compensate for their gap in surgical education and exposure 8,14,15 . Although hands-on training cannot be replaced by simulation and e-learning, increased staff confidence and comfort, enhanced technical and clinical performance were confirmed in a systemic review on training in health workers during COVID-19 pandemic 16 . In fact, individual study time was found to be increased in 68.1% of the Italian trainees 10 as well as 31.7% of our trainees during the COVID-19 pandemic. Trainees should make best use of their additional study time to visit such virtual education platforms for learning to compensate for their loss in clinical exposure. O&G trainees worldwide were worried that the decrease in clinical exposure and procedure numbers during the COVID-19 pandemic will affect their training and their level of competence. Up to 60% of the trainees in European countries and 71% of the trainees in Turkey were worried on their training respectively 8,13 . In Italy, 84% of the trainees had anxiety about their professional future and 59% of them had the perception that their training was irreversibly compromised 10 . A study in United Kingdom performed a survey on O&G trainees after the peak of the COVID-19 pandemic with restoration of normal clinical activities and they still found the pandemic had negative impact on their overall training 17 . Apart from reduction of elective gynaecology operations, our trainees were also worried about reduction in obstetric procedures and exposure as Hong Kong is currently facing a historically low number of obstetric deliveries during the pandemic. The number of live births in Hong Kong dropped from 53,168 in year 2019 to 32,950 in year 2022. Even after lifting the quarantine requirements for travellers in year 2022 and restoration of most of the normal social activities, the number of live births only showed a slight rise to 33,288 in year 2023 18,19 without obvious signs of recovery in the number of deliveries. Basic trainees were significantly more worried than higher trainees on not having enough number of obstetric procedures, such as instrumental deliveries, in our survey. The higher trainees may already have acquired adequate or acceptable numbers before the pandemic, while basic trainees had only very limited number of loggings and exposure in the few years of the pandemic, and with no signs of a significant rebound in the number of deliveries in the coming few years as they enter higher training, the chances they will acquire sufficient numbers in these procedures to satisfy training requirements appear guarded. It is disturbing to note that around half of our trainees had doubts or regrets on choosing O&G for specialty training. The majority of the trainees had worries of not being able to be a competent specialist after completion of training. According to a cross-sectional questionnaire survey on medical gradates in 2016, the career interest in O&G among medical graduates were low and the key influential factors in their career choice included working style and career prospects 20 . In our survey, many of our trainees attributed their doubts in specialty training to the frequent call schedules and high working hours leading to an undermined work-life balance, and concerns over their competence and career prospects were highlighted. The HKCOG should find solutions on improving the working schedules for O&G trainees in order to prevent high drop-out rate for our existing trainees, to boast the currently low preference for O&G among medical graduates seeking specialty training. Trainers in O&G departments should attempt to identify the gaps in clinical exposure and insufficiencies in procedure logging for each individual trainee, and then adopt training plans tailored for each of them to make up for the deficient areas before they approach their exit assessment. Such targeted remedial training programmes should hopefully make up for any negative impacts posed by the pandemic so that all trainees will be able to achieve the desired comprehensive level of competence when they attain specialist status. The main strength of our study was that our findings should truly reflect the opinions of the majority of O&G trainees and young fellows in Hong Kong. We achieved a high comprehensive response rate 92.9% of all trainees, whereas other similar studies only reported selected samples with response rates of 51 to 69%. 9,10,17 The limitation of this study was that the questionnaires were gathered when the peak of COVID pandemic had passed and there was already gradual restoration of many routine clinical activities, so that the reported impact on training might already be attenuated as compared to the peak of the pandemic. Nonetheless, the findings gathered from our study should be valuable to improve our training system and to ensure the competences of our future specialists. Conclusion The COVID-19 pandemic had negative impacts on specialty training in O&G in Hong Kong. There was an overall reduction in clinical activities and exposure for O&G trainees particularly for elective gynecology operations. Educational activities via virtual platforms should be continued even after the pandemic as it is preferred by trainees and offers more flexibility for learning. O&G trainees were concerned with insufficient clinical exposure and number of procedures for logging to satisfy their training requirements. A significant proportion of them were in doubt about their career choice. Improvements in working schedules and training and assessment systems should be adopted by trainers in different O&G departments and the HKCOG in order to retain current trainees and to attract future medical graduates. Declarations Ethics approval and consent to participate Formal ethics approvals for this research were granted by the Central Institutional Review Board / Cluster Research Ethics Committee (Ref No.: CIRB-2023-018-3), the Joint Chinese University of Hong Kong - New Territories East Cluster Clinical Research Ethics Committee (Ref No.: CREC-2023-082) and the Institutional Review Board of the University of Hong Kong / Hospital Authority Hong Kong West Cluster (Ref No.: UW-23-241). Written informed consent was obtained from all subjects. Consent for publication Not applicable as no individual person’s data in any form has been included in the manuscript. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interest. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors' contributions LJTC has made substantial contributions to the conception and the design of the work, the acquisition and analysis of the data as well as the drafting of the manuscript. LYY acquired, analyzed and interpreted the data. KCW contributed to the conception and the design of the work, analyzed the data and drafted the manuscript. TWWK analyzed the data and provided critical revision for important intellectual content. All authors had full access to the data, contributed to the study, approved the final version of manuscript for publication, and take responsibility for its accuracy and integrity. Acknowledgements The authors would like to thank all participants of this survey study and the COVID-19 Training Impact Study Group consisting of Dr Chan Yuen Yee Yannie, Dr Hung Man Wai Catherine, Dr Luk Hiu Mei, Dr Tang Yuen Chung, Dr Tse Kai Yeung, Dr Wong Kwun Long Natalie, Dr Yuen Tony from Princess Margaret Hospital, Kwong Wah Hospital, Queen Mary Hospital, Tuen Mun Hospital, Queen Elizabeth Hospital, Prince of Wales Hospital and Pamela Youde Nethersole Eastern Hospital respectively, for their coordination in this research project in each O&G unit. References Fu MZ, Islam R, Singer EA, Tabakin AL. The Impact of COVID-19 on Surgical Training and Education. Cancers (Basel). 2023;15:1267. Abati E, Nelva Stellio L, Manini A, Moroni F, Azzalini L, Vilca LM. A cross-sectional survey study of the impact of COVID-19 pandemic on the training and quality of life of Italian medical residents in the Lombardy region. Ann Med. 2022;54:2326–39. Coleman JR, Abdelsattar JM, Glocker RJ, RAS-ACS COVID-19 Task Force. COVID-19 Pandemic and the Lived Experience of Surgical Residents, Fellows, and Early-Career Surgeons in the American College of Surgeons. J Am Coll Surg. 2021;232(2):119–e13520. Chan KKW, Yang TX, Chan AKM. The Impact of COVID-19 on the Training of Anesthesiologists in Hong Kong: Overcoming the Challenge. J Med Educ Curric Dev. 2023;10:23821205231216264. Smith DJ, Hakim AJ, Leung GM, et al. COVID-19 Mortality and Vaccine Coverage - Hong Kong Special Administrative Region, China, January 6, 2022-March 21, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:545–8. Sarker R, Roknuzzaman ASM, Hossain MJ, Bhuiyan MA, Islam MR. The WHO declares COVID-19 is no longer a public health emergency of international concern: benefits, challenges, and necessary precautions to come back to normal life. Int J Surg. 2023;109:2851–2. Liang AL, Turner LC, Voegtline KM, Olson SB, Wildey B, Handa VL. Impact of COVID-19 on gynecologic and obstetrical services at two large health systems. PLoS ONE. 2022;17:e0269852. Topçu G, Özçivit İB, Erkılınç S. Effects of the COVID-19 pandemic on obstetrics and gynecology residency training in Turkey. Turk J Obstet Gynecol. 2021;18:304–10. Mallick R, Odejinmi F, Sideris M, Egbase E, Kaler M. The impact of COVID-19 on obstetrics and gynaecology trainees; how do we move on? Facts Views Vis Obgyn. 2021;13:9–14. Bitonti G, Palumbo AR, Gallo C, et al. Being an obstetrics and gynaecology resident during the COVID-19: Impact of the pandemic on the residency training program. Eur J Obstet Gynecol Reprod Biol. 2020;253:48–51. Lok WY, Chow CY, Kong CW, To WWK. Knowledge, attitudes, and behaviours of pregnant women towards COVID-19: a cross-sectional survey. Hong Kong Med J. 2022;28:124–32. Hui PW, Ma G, Seto MTY, Cheung KW. Effect of COVID-19 on delivery plans and postnatal depression scores of pregnant women. Hong Kong Med J. 2021;27:113–7. Boekhorst F, Khattak H, Topcu EG, Horala A, Gonçalves Henriques M. The influence of the COVID-19 outbreak on European trainees in obstetrics and gynaecology: A survey of the impact on training and trainee. Eur J Obstet Gynecol Reprod Biol. 2021;261:52–8. Kanneganti A, Lim KMX, Chan GMF, et al. Pedagogy in a pandemic – COVID 19 and virtual continuing medical education (vCME) in obstetrics and gynecology. Acta Obstet Gynecol Scand. 2020;99:692–5. Chan GMF, Kanneganti A, Yasin N, Ismail-Pratt I, Logan SJS. Well-being, obstetrics and gynaecology and COVID-19: Leaving no trainee behind. Aust N Z J Obstet Gynaecol. 2020;60:983–6. Boutros P, Kassem N, Nieder J, et al. Education and Training Adaptations for Health Workers during the COVID-19 Pandemic: A Scoping Review of Lessons Learned and Innovations. Healthc (Basel). 2023;11:2902. Duggan I, Hablase R, Beard L, Odejinmi F, Mallick R. The impact of COVID-19 on O&G trainees; where are we now? Facts Views Vis Obgyn. 2022;14:69–75. Hong Kong Monthly Digest of Statistics February. 2021. Available from: https://www.censtatd.gov.hk/en/data/stat_report/product/B1010002/att/B10100022021MM02B0100.pdf . Accessed 26 Feb 2024. Hong Kong Monthly Digest of Statistics February. 2024. Available from: https://www.censtatd.gov.hk/en/data/stat_report/product/B1010002/att/B10100022024MM02B0100.pdf . Accessed 26 Feb 2024. Lam CY, Cheung CS, Hui AS. Factors influencing the career interest of medical graduates in obstetrics and gynaecology in Hong Kong: a cross-sectional questionnaire survey. Hong Kong Med J. 2016;22:138–43. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Aug, 2024 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 14 May, 2024 Reviews received at journal 12 May, 2024 Reviews received at journal 10 May, 2024 Reviewers agreed at journal 28 Apr, 2024 Reviewers agreed at journal 25 Apr, 2024 Reviewers agreed at journal 08 Apr, 2024 Reviewers agreed at journal 20 Mar, 2024 Reviewers invited by journal 18 Mar, 2024 Editor assigned by journal 18 Mar, 2024 Editor invited by journal 18 Mar, 2024 Submission checks completed at journal 18 Mar, 2024 First submitted to journal 12 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4085910","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":280960892,"identity":"3f7c5e74-6fa2-4fe0-9f03-3156eafb6d24","order_by":0,"name":"Janice Tsz Ching LEUNG","email":"","orcid":"","institution":"United Christian Hospital","correspondingAuthor":false,"prefix":"","firstName":"Janice","middleName":"Tsz Ching","lastName":"LEUNG","suffix":""},{"id":280960893,"identity":"dff5ec0f-bfd1-4a36-828c-2bba2d1cb45c","order_by":1,"name":"Yan Yu LI","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYDACdsYGBoYCCTkQ+8ADorQwg7QYSBiDtSQQpwVEGDAkNoBoorTwMzO3SfMYWKTPDzv8EGiLnZxuAwEtks2MIC0SuRtvpxkAtSQbmx0goMXgMEzL7ASQlgOJ2whpsYdqSTecnf6BOC0GzBAtCfLSOUTaInGYsdlyjoGE4QbpnIIDCQZE+IW/vf3hjTcVdfLys9M3f/hQYSdHUAsQsEjxgFwIVmlAWDkIMH/8ASTlG4hTPQpGwSgYBSMQAAB9RT8UGFaN5QAAAABJRU5ErkJggg==","orcid":"","institution":"United Christian Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yan","middleName":"Yu","lastName":"LI","suffix":""},{"id":280960894,"identity":"8f743d01-c75e-449b-8b82-a8fa55be38cb","order_by":2,"name":"Choi Wah KONG","email":"","orcid":"","institution":"United Christian Hospital","correspondingAuthor":false,"prefix":"","firstName":"Choi","middleName":"Wah","lastName":"KONG","suffix":""},{"id":280960895,"identity":"d683fc32-9a30-4032-b885-eb324b49bbc9","order_by":3,"name":"William Wing Kee TO","email":"","orcid":"","institution":"United Christian Hospital","correspondingAuthor":false,"prefix":"","firstName":"William","middleName":"Wing Kee","lastName":"TO","suffix":""}],"badges":[],"createdAt":"2024-03-12 16:21:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4085910/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4085910/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-024-05727-1","type":"published","date":"2024-08-19T15:56:50+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":63299898,"identity":"25d4badd-3cfe-4943-9071-8104c2bff6fb","added_by":"auto","created_at":"2024-08-26 16:01:31","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":525186,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4085910/v1/53d4f609-5cfd-4c04-98ab-d5449bca4f75.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of COVID-19 pandemic on specialty training in Obstetrics and Gynaecology in Hong Kong: what is the future prospect?","fulltext":[{"header":"New knowledge added by this study","content":"\u003cul\u003e\n \u003cli\u003eCOVID-19 had negative impacts on O\u0026amp;G training in Hong Kong due to the reduction in elective and emergency operations, as well as clinical exposure to in-patient admissions and out-patient clinics.\u003c/li\u003e\n \u003cli\u003eThe switch of educational activities such as grand rounds and seminars into virtual format during the pandemic was welcomed by the participants and they prefer to keep the virtual format after the pandemic.\u003c/li\u003e\n \u003cli\u003eMany O\u0026amp;G trainees\u0026nbsp;were worried they will not be a competent specialist in future and had doubt or regrets in their career choice.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for clinical practice or policy\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eEducational activities via virtual platforms can be continued even after the pandemic as such format are more accessible, and offers more flexibility for learning.\u003c/li\u003e\n \u003cli\u003eTrainers in O\u0026amp;G departments should attempt to identify the individual gaps in clinical exposure and insufficiencies in procedure logging for each trainee, and then adopt targeted training plans tailored for each of them to make up for the deficient areas before they approach their exit assessment.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eThe Hong Kong College of Obstetricians and Gynaecologists should explore means to and improve the training programme for O\u0026amp;G trainees in order to prevent high attrition rates for existing trainees, and to boast the currently low preference for O\u0026amp;G among medical graduates seeking specialty training. \u0026nbsp;\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Introduction","content":"\u003cp\u003eThe global pandemic of Coronavirus disease 2019 (COVID-19) has posed a significant burden and a major challenge to the health care system all around the world. The pandemic has led to overwhelming surges of hospitalizations, leading to redeployment of trainees in many specialties to care for COVID-19 patients and significant reduction in elective surgeries\u003csup\u003e1\u003c/sup\u003e. A study in Italy found 88.5% of surgical residents had decreased surgical activities due to reduced hospital bed capacity and reduction of elective surgery\u003csup\u003e2\u003c/sup\u003e. Another large study conducted in the United States found 84% of surgical residents had more than 50% reduction in operative volume and inability to meet minimum case requirements for training\u003csup\u003e3\u003c/sup\u003e. A recent study in Hong Kong has found that the COVID-19 has caused significant disruptions in caseload, technical skills training, work-based assessment and continued medical education on the training of anesthesiologists\u003csup\u003e4\u003c/sup\u003e. The resident training programme in obstetrics and gynaecology (O\u0026amp;G) in Hong Kong is organized by the Hong Kog College of Obstetricians and Gynaecologists (HKCOG), and trainees have to undergo 4 years of basic training and 2 years of higher training in various public training hospitals. They are required to pass of an exit assessment at the end of the six years before they can be recognized as specialists and as fellows of the College. While it appears inevitable that such specialty training would be similarly affected by the pandemic waves in Hong Kong, the extent of this impact in O\u0026amp;G has not been studied.\u003c/p\u003e \u003cp\u003eThe first confirmed COVID-19 case in Hong Kong was on 23 January 2020. Waves of the pandemic have hit Hong Kong within the past 4 years with the fifth wave in January 2022 resulting in a total of 1,049,959 reported confirmed cases and 5,906 death cases from 6 January to 21 March in 2022\u003csup\u003e5\u003c/sup\u003e. After battling with the virus for more than three years, WHO finally announced that COVID-19 is no longer defined as a Public Health Emergency of International Concern in May 2023\u003csup\u003e6\u003c/sup\u003e. The Hong Kong government has lifted the quarantine requirements for travelers since September 2022 and dropped the mask mandate in March 2023. However, compared to other western and Asian countries, Hong Kong had adopted mandatory quarantine for COVID-19 infected patients and for persons having close contacts as well as for international travellers for almost three years. The impact of the pandemic on resident training in our hospitals could therefore be more profound than in other countries.\u003c/p\u003e \u003cp\u003eThe objective of this study is to investigate the impact of COVID-19 pandemic on specialty training of Obstetrics \u0026amp; Gynaecology (O\u0026amp;G) in Hong Kong and the implications on the competence of our future O\u0026amp;G specialists.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was a cross-sectional questionnaire survey conducted from 1 to 31 August 2023 in all the eight O\u0026amp;G training units in Hong Kong (Kwong Wah Hospital, Pamela Youde Nethersole Eastern Hospital, Prince of Wales Hospital, Princess Margaret Hospital, Queen Elizabeth Hospital, Queen Mary Hospital, Tuen Mun Hospital and United Christian Hospital). The questionnaires were distributed to all trainees and young fellows obtaining their fellowship in 2021 or after and who were still working in the Hospital Authority during the time of the questionnaire study. The questionnaires were anonymous, self-administered, and was in English format (Appendix 1). The questionnaires consisted of 43 questions with five domains, including (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) demographic data of the participants (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) impact of COVID-19 on their clinical activities (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) impact of redeployment on training (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) impact of COVID-19 on educational activities (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) impact on career progression. A written consent with a printed questionnaire was distributed to all eligible participants and they were asked to return the completed questionnaires and signed consent to the principal investigator by fax or internal mail.\u003c/p\u003e \u003cp\u003eSPSS software (Windows version 20.0; IBM Corp, Armonk [NY], United States) was used for data entry and analysis. Descriptive categorical data were expressed as numbers and percentages; they were compared and analyzed by the Chi squared test or Fisher\u0026rsquo;s exact test as appropriate. A P-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 112 questionnaires were sent out to all the eligible participants and a total of 106 completed questionnaires were returned. Two questionnaires were excluded due to missing answers in key items. The overall rate of participation for analysis was 92.9% (104/112), of which 31.7% were basic trainees who had less than 4 years of recognized O\u0026amp;G training, 34.6% were higher trainees who had at least 4 years of recognized training and 33.7% of them were young fellows who had obtained their fellowship in 2021 or after. The majority of them (80.8%) were female. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic data of the participants (n\u0026thinsp;=\u0026thinsp;104)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDemographic data\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent level of training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBasic trainee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigher trainee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36 (34.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eJunior specialist\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35 (33.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;=25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61 (58.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e31\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e35 (33.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (3.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;=41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e84 (80.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e65 (62.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92 (88.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe majority of the participants reported significant decreases (over 25%) in clinical activities during COVID-19 pandemic as compared to pre-COVID levels. For gynaecology activities, 92.3% and 78.8% of participants had reduction in elective and emergency operations respectively, 86.5% and 67.3% of participants had reduction in exposure to in-patient admissions and exposure to out-patient clinics respectively. For obstetrics activities, 87.5% and 76.9% of participants had reduction in elective and emergency caesarean sections respectively, 88.5% had reduction in instrumental deliveries, 90.4% and 88.5% had reduction in exposure to in-patient admissions and exposure to out-patient clinics respectively. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChanges in clinical activities during COVID-19\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical activities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGynaecology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduction in elective gynaecology operations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96 (92.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (13.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 26\u0026ndash;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (35.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 51\u0026ndash;75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (29.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced more than 76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (13.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduction in emergency gynaecology operations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82 (78.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (39.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 26\u0026ndash;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27 (26.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 51\u0026ndash;75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced more than 76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduction in exposure to gynaecology in-patient admissions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e90 (86.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (29.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 26\u0026ndash;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (36.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 51\u0026ndash;75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced more than 76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduction in exposure to gynaecology out-patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70 (67.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 26\u0026ndash;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (17.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 51\u0026ndash;75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced more than 76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObstetrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduction in elective caesarean sections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e91 (87.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (35.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 26\u0026ndash;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 51\u0026ndash;75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced more than 76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduction in emergency caesarean sections\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80 (76.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44 (42.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 26\u0026ndash;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25 (24.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 51\u0026ndash;75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced more than 76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduction in instrumental deliveries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92 (88.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 26\u0026ndash;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 51\u0026ndash;75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e15 (14.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced more than 76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduction in exposure to obstetric in-patient admissions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e94 (90.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (41.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 26\u0026ndash;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e34 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 51\u0026ndash;75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (13.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced more than 76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduction in exposure to obstetric out-patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e92 (88.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 25%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48 (46.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 26\u0026ndash;50%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (29.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced 51\u0026ndash;75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (10.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReduced more than 76%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eOver one-third (36/104, 34.6%) of the participants had been redeployed to other departments during the COVID-19 pandemic. Among them, the most common department or facility for redeployment was Department of Medicine (16/36, 44.4%), followed by Asia Expo (9/36, 25%) and Penny Bay (8/36, 22.2%), and 27.8% (10/36) of them had been redeployed for less than 4 weeks, 52.7% (19/36) had been redeployed for 4\u0026ndash;7 weeks, 5.6% (2/36) had been redeployed for 8\u0026ndash;11 weeks and 13.9% (5/36) had been redeployed for 12 weeks. Around 44.4% (16/36) in the redeployed group regarded the redeployment experience as having a positive impact on their professional training, increasing their knowledge and experience in managing medical diseases, while 25% (9/36) thought redeployment had negative impact on their training.\u003c/p\u003e \u003cp\u003eTwo-thirds of the participants (65.4%) reported significant reductions (60.6%) or even total cancellations (4.8%) of teaching sessions/ grand rounds during the pandemic. Attendance of seminars or lectures was reduced in around half of them (49.0%), while paradoxically 27.9% of participants reported an increase in attendance, which was mostly attributable to availability of online lectures and webinars. The majority of participants (71.2%) would prefer online or virtual seminars rather than physical ones even after COVID-19 pandemic. While 76.9% of participants reflected the pandemic had no effect on their research training, 59.6% found the pandemic had no impact on their personal study time and 31.7% of them even found more time to study. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eChanges in educational activities during COVID-19\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational activities\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching rounds/ Grand rounds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll cancelled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (4.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e63 (60.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (2.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeminars / lectures attended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e51 (49.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (27.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScientific conferences or courses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll cancelled\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (6.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDecreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41 (39.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e29 (27.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncreased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot applicable to his/her level of training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (16.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResearch training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNegative effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePositive effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e80 (76.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePersonal study time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9 (8.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo change\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e62 (59.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMore time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (31.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWith regard to the trainees\u0026rsquo; views on their specialty training programme and their career prospects, around one third (34.8%) of the trainees had at least some degree of dissatisfaction in their current training schedule, with 71.0% worrying they would not have enough number of procedures when applying for fellowship examination and 58.0% worrying they would not have enough clinical exposure in their training. Basic trainees were more significantly concerned in these aspects than higher trainees (p\u0026thinsp;=\u0026thinsp;0.003 and p\u0026thinsp;=\u0026thinsp;0.017 respectively). The majority of the trainees (76.8%) had worries about not being able to be a competent specialist after completion of their training, and 44.9% of them had some degree of doubts or regrets about their choice of undergoing training to be an O\u0026amp;G specialist. Almost half (47.8%) of them had recalled transient or even persistent thoughts of quitting their training. (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) Among those with doubts or regrets on choosing this specialty, major concerns included not being able to be a competent specialist even after six years of training, and promotion aspects in the specialty being not as promising as before. Around two-third of them (45/69, 65.2%) felt that their department had already tried to maximize the number of procedures for them to perform by swapping duties on ad hoc basis, or arranging rotations to other O\u0026amp;G units for them. More than half of them (53.6%, 37/69) hoped that the HKCOG can adopt more flexible assessment criteria at the time of their exit assessment, such as accepting the use of OSAT as proof of competence for certain procedures if they were unable to log the minimum number to satisfy training requirements.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eViews of the trainees on their O\u0026amp;G training and career with comparison between basic trainees and higher trainees\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eView on their training and career\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal number of trainees\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;69) (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of basic trainees\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;33) (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of higher trainees\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;36) (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWere unsatisfied about the current training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (39.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11 (45.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.441\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorried for not having enough number of procedures when applying for fellowship examination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e49 (71.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (87.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e*0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorried about not having enough clinical exposure in their training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (58.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (72.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e*0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWorried about not being able to be a competent specialist after completion of training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e53 (76.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28 (84.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (69.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.130\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHad doubts about choosing O\u0026amp;G for specialty training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e31 (44.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14 (42.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17 (47.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHad considered to quit O\u0026amp;G training\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e33 (47.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13 (39.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.179\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e* statistically significant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur data showed there was a significant overall reduction of clinical exposure during the COVID-19 pandemic. This was compatible with the trends of diversion of clinical resources away from O\u0026amp;G during the pandemic worldwide. A study in the United States found the surgical volume in two large O\u0026amp;G organizations had dropped to 48\u0026ndash;67% in 2020 compared with 2019\u003csup\u003e7\u003c/sup\u003e. A study on 103 O\u0026amp;G trainees in Turkey found 98% of them reported decrease in the number of surgeries, so that 63% of the trainees thought that their surgical skills were hindered by the reduced number of surgeries and 67% reported insufficient outpatient clinic experience to meet education targets\u003csup\u003e8\u003c/sup\u003e. Our data should that the degree of reduction in clinical exposure was apparently more profound in gynaecology compared with obstetrics. Almost half of our trainees (43.3%) perceived the number of elective gynecological operation sessions assigned were reduced by more than 50% while half of them (48.1%) perceived that elective caesarean sections assigned was not reduced or reduced by less than 25%. This was compatible with the findings from other countries. A study on the impact of COVID-19 in United Kingdom on 87 O\u0026amp;G trainees found that almost all the trainees (99%) felt their surgical training on benign gynaecological conditions had been negatively affected compared while only 43% felt their obstetric training was negatively affected\u003csup\u003e9\u003c/sup\u003e. Another study conducted on 476 Italian O\u0026amp;G trainees found benign gynaecology procedures, infertility treatments and urogynaecology related activities underwent a significant reduction with a reported total suspension from 54\u0026ndash;60%, while labour/ delivery training and prenatal diagnosis was less reduced with a total suspension of training from 8.2\u0026ndash;23.1% only\u003csup\u003e10\u003c/sup\u003e. This was logical as urgent and non-deferrable surgeries such as labour/delivery and oncologic procedures had to be maintained despite elective gynaecological surgeries for benign conditions being postponed. However, reduction on obstetric services in public hospitals in Hong Kong was still remarkable as a significant proportion of women opted to deliver in private hospitals instead of public hospitals during the pandemic. The practical reasons for this trend included the strict prohibition of all visiting in public hospitals and the cancellation of husband accompanying labour programme during the peaks of the pandemic. In addition, the risk of contracting COVID-19 was believed to be lower when delivering in private rather than public hospitals, as private hospitals would not admit confirmed COIVID patients\u003csup\u003e11,12\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eThe redeployment rate for O\u0026amp;G trainees to other units such as medical department during COVID-19 pandemic varied among different countries. A survey on 110 O\u0026amp;G trainees from 25 different European countries found the redeployment rate was 15%, compared with 34.6% in our study to as high as 65.3% in Turkey\u003csup\u003e8,13\u003c/sup\u003e. The trainees in European countries valued their experience in redeployment and thought they have increased their knowledge and skills in medicine with a positive impact on their training, which was similar to the views of our redeployed trainees\u003csup\u003e13\u003c/sup\u003e. As our specialty training focused on O\u0026amp;G knowledge and skills, and elective year training in other specialties in no longer mandatory in our training programme, our trainees seldom had the experience in managing medical diseases or work in other specialties during their training. Our data showed that 44.4% of our redeployed trainees were seconded to the Department of Medicine, which offered them a variety of valuable clinical experiences apart from merely looking after COVID patients to broaden their medical knowledge. Furthermore, the majority of our trainees (86.1%) were redeployed less than 12 weeks, so that the chances of jeopardizing their O\u0026amp;G exposure and training due to the redeployment should be low.\u003c/p\u003e \u003cp\u003eSimilar to our findings, around half of the trainees (51.2%) in the Italian study reported a reduction in teaching activities during the COVID-19 pandemic with decreases in teaching/ grand rounds, attendance of seminars and conferences\u003csup\u003e10\u003c/sup\u003e. A virtual continuing medical education program had been constructed for O\u0026amp;G trainees in Singapore in 2020 to replace the traditional face to face continuous medical education program comprising of grand rounds, clinical governance, journal clubs and research presentations and was highly evaluated by their trainees\u003csup\u003e14,15\u003c/sup\u003e. Indeed, virtual platforms for lectures and conferences had been increasingly used worldwide as well as in Hong Kong during the COVID-19 pandemic. Virtual platform is convenient, and apart from lifting geographic constraints and saving travel time, also allows recording and playback to retain and review information. The majority of our trainees expressed that they preferred online or virtual seminars rather than physical ones even after COVID-19 pandemic. In response to the reduction in elective gynaecology surgery, various authors from different countries had advocated simulation training in O\u0026amp;G during COVID-19 pandemic such as using laparoscopic box trainers and surgical simulators to train tissue handling and laparoscopic suturing\u003csup\u003e8,9,14,15\u003c/sup\u003e. Use of archived surgical videos and live tele-mentoring in operation theaters by experienced seniors had also been advocated so that more trainees can observe the operations simultaneously to compensate for their gap in surgical education and exposure\u003csup\u003e8,14,15\u003c/sup\u003e. Although hands-on training cannot be replaced by simulation and e-learning, increased staff confidence and comfort, enhanced technical and clinical performance were confirmed in a systemic review on training in health workers during COVID-19 pandemic\u003csup\u003e16\u003c/sup\u003e. In fact, individual study time was found to be increased in 68.1% of the Italian trainees \u003csup\u003e10\u003c/sup\u003e as well as 31.7% of our trainees during the COVID-19 pandemic. Trainees should make best use of their additional study time to visit such virtual education platforms for learning to compensate for their loss in clinical exposure.\u003c/p\u003e \u003cp\u003eO\u0026amp;G trainees worldwide were worried that the decrease in clinical exposure and procedure numbers during the COVID-19 pandemic will affect their training and their level of competence. Up to 60% of the trainees in European countries and 71% of the trainees in Turkey were worried on their training respectively\u003csup\u003e8,13\u003c/sup\u003e. In Italy, 84% of the trainees had anxiety about their professional future and 59% of them had the perception that their training was irreversibly compromised\u003csup\u003e10\u003c/sup\u003e. A study in United Kingdom performed a survey on O\u0026amp;G trainees after the peak of the COVID-19 pandemic with restoration of normal clinical activities and they still found the pandemic had negative impact on their overall training\u003csup\u003e17\u003c/sup\u003e. Apart from reduction of elective gynaecology operations, our trainees were also worried about reduction in obstetric procedures and exposure as Hong Kong is currently facing a historically low number of obstetric deliveries during the pandemic. The number of live births in Hong Kong dropped from 53,168 in year 2019 to 32,950 in year 2022. Even after lifting the quarantine requirements for travellers in year 2022 and restoration of most of the normal social activities, the number of live births only showed a slight rise to 33,288 in year 2023\u003csup\u003e18,19\u003c/sup\u003e without obvious signs of recovery in the number of deliveries. Basic trainees were significantly more worried than higher trainees on not having enough number of obstetric procedures, such as instrumental deliveries, in our survey. The higher trainees may already have acquired adequate or acceptable numbers before the pandemic, while basic trainees had only very limited number of loggings and exposure in the few years of the pandemic, and with no signs of a significant rebound in the number of deliveries in the coming few years as they enter higher training, the chances they will acquire sufficient numbers in these procedures to satisfy training requirements appear guarded.\u003c/p\u003e \u003cp\u003eIt is disturbing to note that around half of our trainees had doubts or regrets on choosing O\u0026amp;G for specialty training. The majority of the trainees had worries of not being able to be a competent specialist after completion of training. According to a cross-sectional questionnaire survey on medical gradates in 2016, the career interest in O\u0026amp;G among medical graduates were low and the key influential factors in their career choice included working style and career prospects\u003csup\u003e20\u003c/sup\u003e. In our survey, many of our trainees attributed their doubts in specialty training to the frequent call schedules and high working hours leading to an undermined work-life balance, and concerns over their competence and career prospects were highlighted. The HKCOG should find solutions on improving the working schedules for O\u0026amp;G trainees in order to prevent high drop-out rate for our existing trainees, to boast the currently low preference for O\u0026amp;G among medical graduates seeking specialty training. Trainers in O\u0026amp;G departments should attempt to identify the gaps in clinical exposure and insufficiencies in procedure logging for each individual trainee, and then adopt training plans tailored for each of them to make up for the deficient areas before they approach their exit assessment. Such targeted remedial training programmes should hopefully make up for any negative impacts posed by the pandemic so that all trainees will be able to achieve the desired comprehensive level of competence when they attain specialist status.\u003c/p\u003e \u003cp\u003eThe main strength of our study was that our findings should truly reflect the opinions of the majority of O\u0026amp;G trainees and young fellows in Hong Kong. We achieved a high comprehensive response rate 92.9% of all trainees, whereas other similar studies only reported selected samples with response rates of 51 to 69%.\u003csup\u003e9,10,17\u003c/sup\u003e The limitation of this study was that the questionnaires were gathered when the peak of COVID pandemic had passed and there was already gradual restoration of many routine clinical activities, so that the reported impact on training might already be attenuated as compared to the peak of the pandemic. Nonetheless, the findings gathered from our study should be valuable to improve our training system and to ensure the competences of our future specialists.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe COVID-19 pandemic had negative impacts on specialty training in O\u0026amp;G in Hong Kong. There was an overall reduction in clinical activities and exposure for O\u0026amp;G trainees particularly for elective gynecology operations. Educational activities via virtual platforms should be continued even after the pandemic as it is preferred by trainees and offers more flexibility for learning. O\u0026amp;G trainees were concerned with insufficient clinical exposure and number of procedures for logging to satisfy their training requirements. A significant proportion of them were in doubt about their career choice. Improvements in working schedules and training and assessment systems should be adopted by trainers in different O\u0026amp;G departments and the HKCOG in order to retain current trainees and to attract future medical graduates.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFormal ethics approvals for this research were granted by the Central Institutional Review Board / Cluster Research Ethics Committee (Ref No.: CIRB-2023-018-3), the Joint Chinese University of Hong Kong - New Territories East Cluster Clinical Research Ethics Committee (Ref No.: CREC-2023-082) and the Institutional Review Board of the University of Hong Kong / Hospital Authority Hong Kong West Cluster (Ref No.: UW-23-241). Written informed consent was obtained from all subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable as no individual person\u0026rsquo;s data in any form has been included in the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLJTC has made substantial contributions to the conception and the design of the work, the acquisition and analysis of the data as well as the drafting of the manuscript. LYY acquired, analyzed and interpreted the data. KCW contributed to the conception and the design of the work, analyzed the data and drafted the manuscript. TWWK analyzed the data and provided critical revision for important intellectual content.\u0026nbsp;All authors had full access to the data, contributed to the study, approved the final version of manuscript for publication, and take responsibility for its accuracy and integrity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank all participants of this survey study and the COVID-19 Training Impact Study Group consisting of Dr Chan Yuen Yee Yannie, Dr Hung Man Wai Catherine, Dr Luk Hiu Mei, Dr Tang Yuen Chung, Dr Tse Kai Yeung, Dr Wong Kwun Long Natalie, Dr Yuen Tony from Princess Margaret Hospital, Kwong Wah Hospital, Queen Mary Hospital, Tuen Mun Hospital, Queen Elizabeth Hospital, Prince of Wales Hospital and Pamela Youde Nethersole Eastern Hospital respectively, for their coordination in this research project in each O\u0026amp;G unit.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cbr\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFu MZ, Islam R, Singer EA, Tabakin AL. The Impact of COVID-19 on Surgical Training and Education. Cancers (Basel). 2023;15:1267.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbati E, Nelva Stellio L, Manini A, Moroni F, Azzalini L, Vilca LM. A cross-sectional survey study of the impact of COVID-19 pandemic on the training and quality of life of Italian medical residents in the Lombardy region. Ann Med. 2022;54:2326\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eColeman JR, Abdelsattar JM, Glocker RJ, RAS-ACS COVID-19 Task Force. COVID-19 Pandemic and the Lived Experience of Surgical Residents, Fellows, and Early-Career Surgeons in the American College of Surgeons. J Am Coll Surg. 2021;232(2):119\u0026ndash;e13520.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan KKW, Yang TX, Chan AKM. The Impact of COVID-19 on the Training of Anesthesiologists in Hong Kong: Overcoming the Challenge. J Med Educ Curric Dev. 2023;10:23821205231216264.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith DJ, Hakim AJ, Leung GM, et al. COVID-19 Mortality and Vaccine Coverage - Hong Kong Special Administrative Region, China, January 6, 2022-March 21, 2022. MMWR Morb Mortal Wkly Rep. 2022;71:545\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarker R, Roknuzzaman ASM, Hossain MJ, Bhuiyan MA, Islam MR. The WHO declares COVID-19 is no longer a public health emergency of international concern: benefits, challenges, and necessary precautions to come back to normal life. Int J Surg. 2023;109:2851\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiang AL, Turner LC, Voegtline KM, Olson SB, Wildey B, Handa VL. Impact of COVID-19 on gynecologic and obstetrical services at two large health systems. PLoS ONE. 2022;17:e0269852.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTop\u0026ccedil;u G, \u0026Ouml;z\u0026ccedil;ivit İB, Erkılın\u0026ccedil; S. Effects of the COVID-19 pandemic on obstetrics and gynecology residency training in Turkey. Turk J Obstet Gynecol. 2021;18:304\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMallick R, Odejinmi F, Sideris M, Egbase E, Kaler M. The impact of COVID-19 on obstetrics and gynaecology trainees; how do we move on? Facts Views Vis Obgyn. 2021;13:9\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBitonti G, Palumbo AR, Gallo C, et al. Being an obstetrics and gynaecology resident during the COVID-19: Impact of the pandemic on the residency training program. Eur J Obstet Gynecol Reprod Biol. 2020;253:48\u0026ndash;51.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLok WY, Chow CY, Kong CW, To WWK. Knowledge, attitudes, and behaviours of pregnant women towards COVID-19: a cross-sectional survey. Hong Kong Med J. 2022;28:124\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHui PW, Ma G, Seto MTY, Cheung KW. Effect of COVID-19 on delivery plans and postnatal depression scores of pregnant women. Hong Kong Med J. 2021;27:113\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoekhorst F, Khattak H, Topcu EG, Horala A, Gon\u0026ccedil;alves Henriques M. The influence of the COVID-19 outbreak on European trainees in obstetrics and gynaecology: A survey of the impact on training and trainee. Eur J Obstet Gynecol Reprod Biol. 2021;261:52\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKanneganti A, Lim KMX, Chan GMF, et al. Pedagogy in a pandemic \u0026ndash; COVID 19 and virtual continuing medical education (vCME) in obstetrics and gynecology. Acta Obstet Gynecol Scand. 2020;99:692\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan GMF, Kanneganti A, Yasin N, Ismail-Pratt I, Logan SJS. Well-being, obstetrics and gynaecology and COVID-19: Leaving no trainee behind. Aust N Z J Obstet Gynaecol. 2020;60:983\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoutros P, Kassem N, Nieder J, et al. Education and Training Adaptations for Health Workers during the COVID-19 Pandemic: A Scoping Review of Lessons Learned and Innovations. Healthc (Basel). 2023;11:2902.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDuggan I, Hablase R, Beard L, Odejinmi F, Mallick R. The impact of COVID-19 on O\u0026amp;G trainees; where are we now? Facts Views Vis Obgyn. 2022;14:69\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHong Kong Monthly Digest of Statistics February. 2021. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.censtatd.gov.hk/en/data/stat_report/product/B1010002/att/B10100022021MM02B0100.pdf\u003c/span\u003e\u003cspan address=\"https://www.censtatd.gov.hk/en/data/stat_report/product/B1010002/att/B10100022021MM02B0100.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 26 Feb 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHong Kong Monthly Digest of Statistics February. 2024. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.censtatd.gov.hk/en/data/stat_report/product/B1010002/att/B10100022024MM02B0100.pdf\u003c/span\u003e\u003cspan address=\"https://www.censtatd.gov.hk/en/data/stat_report/product/B1010002/att/B10100022024MM02B0100.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 26 Feb 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLam CY, Cheung CS, Hui AS. Factors influencing the career interest of medical graduates in obstetrics and gynaecology in Hong Kong: a cross-sectional questionnaire survey. Hong Kong Med J. 2016;22:138\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, training, obstetrics, gynaecology, Hong Kong","lastPublishedDoi":"10.21203/rs.3.rs-4085910/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4085910/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eThe COVID-19 pandemic in the past few years have led to major adjustments in the provision of healthcare. This study aimed to investigate the impact of the pandemic on specialty training in Obstetrics \u0026amp; Gynaecology (O\u0026amp;G) in Hong Kong.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional questionnaire survey was performed on all the O\u0026amp;G trainees and the young fellows of the Hong Kong College of Obstetricians and Gynaecologists (HKCOG). The questionnaires included 5 parts: demographic data, impact on clinical activities, redeployment, educational activities and career progression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 104 questionnaires (92.9%) were received for final analysis. The majority of the participants had reductions in elective and emergency operations, as well as exposure to in-patient admissions and out-patient clinics in both obstetrics and gynaecology. The reduction was most significant in elective gynaecology operations. One-third (34.6%) of the participants had been redeployed to other departments, and educational activities were reduced during the pandemic. Around 58% of the trainees were concerned with the reduction in clinical exposure, and 78% worried they would not be able to log sufficient number of surgical procedures. Basic trainees were significantly more worried than higher trainees. Around half of the trainees had doubts or regrets about choosing to undergo O\u0026amp;G specialty training.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe COVID-19 pandemic had significant negative impacts on O\u0026amp;G training in Hong Kong. Many trainees were worried they would not be able to attain the required level of competence when they complete their specialist training.\u003c/p\u003e","manuscriptTitle":"Impact of COVID-19 pandemic on specialty training in Obstetrics and Gynaecology in Hong Kong: what is the future prospect?","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-20 17:42:14","doi":"10.21203/rs.3.rs-4085910/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-05-14T11:03:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-12T18:23:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-10T20:47:04+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"d0c6f137-7971-4240-acde-03990a3179b7","date":"2024-04-29T01:33:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4926d4af-bd46-4c53-b94e-713434520dec","date":"2024-04-25T04:57:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"7ebf3939-2ccd-401a-a5c8-1b27dfe36710","date":"2024-04-08T13:46:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"09482087-e32d-4223-bd3c-27d71f3f8002","date":"2024-03-20T15:10:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-18T14:36:28+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-18T14:34:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-03-18T14:33:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-18T14:31:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-03-12T15:11:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1701fa78-763a-43f3-be8a-b13950f30eeb","owner":[],"postedDate":"March 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-26T15:58:17+00:00","versionOfRecord":{"articleIdentity":"rs-4085910","link":"https://doi.org/10.1186/s12909-024-05727-1","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2024-08-19 15:56:50","publishedOnDateReadable":"August 19th, 2024"},"versionCreatedAt":"2024-03-20 17:42:14","video":"","vorDoi":"10.1186/s12909-024-05727-1","vorDoiUrl":"https://doi.org/10.1186/s12909-024-05727-1","workflowStages":[]},"version":"v1","identity":"rs-4085910","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4085910","identity":"rs-4085910","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}