The Pandemic Impacts on Surgery Residents Undergoing Plastic Surgery Rotation During the High and Low Waves of COVID-19 in Yogyakarta, Indonesia: A Cross-Sectional Study

Abstract Background: Activity restrictions in the pandemic era have led to drastic changes in the resident learning process during plastic surgery rotations, especially due to fluctuating COVID-19 incidence. This study aimed to evaluate the impact of the COVID-19 pandemic on surgery residents during plastic surgery rotation from residents' perspectives in Yogyakarta and to compare the different responses of residents who rotated during high- and low-wave cases. Method: We conducted a cross-sectional study of all surgery residents at Dr. Sardjito General Hospital Yogyakarta who underwent plastic surgery rotation from March 2020 until March 2022. A questionnaire consisting of 29 questions was distributed online using Google Forms. The questionnaire included demographic characteristics, surgical activity, academic activity, learning adaptation and suggestions for improving clinical skills during rotation. We classified participants into two groups: the high wave (HW) group and the low wave (LW) group. The statistical methods used descriptive analysis and Fisher’s exact test to measure the effects of the size. Results: A total of 43% of the registered residents responded to this questionnaire. Most residents (80%) experienced a 25-75% reduction in the number of plastic surgeries performed during their rotation. All the residents handled burn and wound cases, but the rarest cases handled by residents during rotation involved external genitalia (15%). Most residents agreed to experience a decrease in clinical competence but had more time to deepen the theoretical aspects of plastic surgery in their rotation (51% and 44%, respectively). There has been a great shift in learning resources toward online resources in both groups. Both groups prefer case-based learning to optimize online learning. The HW group experienced significant difficulty in gaining competence due to resident restrictions in the outpatient polyclinic compared to the LW group (p<0,05). There was a significant difference in the least interesting topic to learn before the pandemic between the two groups (p<0,05). Conclusion: Although the overall pandemic prevented residents from gaining clinical competence, interestingly, they had more time to explore the theoretical aspects of the disease. Technology has helped bridge learning due to restrictions from the pandemic, although there is room for improvement in the learning environment.