Covid-19 lockdown influenced population in all aspects of life¹. It affected medical education including both of undergraduates as well as post graduate residents²,³. The closure of outpatient departments and postponement of elective procedures had impact on patients as well as trainees⁴. The postgraduate residents faced unpredicted circumstances during the pandemic. Like many other specialties, ophthalmology department also served only emergency patients. The residents did not have many opportunities to deal with routine patients, elective surgeries, lectures and clinical rounds. Some of the trainees also performed duties in covid-19 wards. This also led them away from their subject. Some trainees had Psychological effects of this lockdown⁵.

The departments tried to cope up with the crisis with different modalities such as decreasing number of working hours to prevent spread of disease and online classes and case discussions to help out trainees⁶. In some cases, students liked the idea of online classes but some didn’t get it helpful.⁷

An online survey was conducted among postgraduate trainees of ophthalmology in ATH hospital KPK to observe the impact of COVID-19 on Postgraduate teaching and learning. The problems and difficult situations dealt by them during the pandemic in terms of their surgical and medical skills, the progress in dissertations, lectures, clinical case discussions, exam preparation and the effect on mental health were enquired and also noted the gap in their training as some of them served in covid-19 wards. The target population for this study were PG students who were fellowship in ophthalmology FCPS

Majority of the participants were females ((Table-I).) while the average age of the participants was 28 ± 4 years. According to 18 (48%) respondents, outpatient department was closed for 3 months on average, while rest had on average 2.5 months closure of outpatient department. Indoor was open only for emergency patients. Operation Theater was closed for elective lists for 4 months as told by 50% candidates but open for emergency patients in all hospitals.

According to PG trainees, 85.7% thought that covid-19 had affected their training a lot. Regarding surgical skills, 95.5% postgraduates believed that it was being impaired whereas 85.7% trainees felt that medical training was lagging. Among all trainees 71.5% considered harm to their theoretical knowledge (Table- II). Clinic pathological conferences affected as per 71.5% candidate’s response.

Table- I: Gender distribution Among Participants

Table- II: Effect of Covid on different aspects of Training

Table- III: Opinion of Trainees Regarding Digital learning

Exam preparation and schedule was also hindered due to covid-19 lockdown as 76.1% felt that exam preparation was hampered and exam schedule was delayed of 95.2% pupils. Online classes were organized in some institutes as responded by 57.3% candidates. Among these 80.9% thought that these were helpful in case of theoretical knowledge (Table- III). But none of them favored online classes in surgical training. Telemedicine was arranged in all departments. 47.6% thought it was helpful in their clinical assessment skills.

Compared to the senior residents, 90.5% juniors felt that their seniors were better trained surgically and 95% better in clinical assessment. Overall 90.5% thought that their training was lagging behind.70% were depressed over this lagging of training.

This was an online questionnaire based cross sectional study done on the ophthalmology residents of different public teaching hospitals. Questionnaire comprised 13 questions regarding the surgical training, clinical knowledge and examination preparation. Out of all the participants, 71.4% were females and 28.6% were males with average age 28 ± 4 years. Data of our study showed that according to post graduate trainees, 85.7% thought that covid-19 had affected their training a lot. Regarding surgical skills, 95.5% postgraduates believed that it had been impaired whereas 85.7% trainees felt that medical training was lagging. Among all trainees 71.5% considered harm to their theoretical knowledge. 76.1% felt that exam preparation was hampered and exam schedule was delayed of 95.2% pupils. Online classes were organized in some institutes as responded by 57.3% candidates. Among these 80.9% thought that these were helpful in case of theoretical knowledge. But none of them favored online classes in surgical training. Telemedicine was arranged in all departments. 47.6% thought it was helpful in their clinical assessment skills. WHO published different reports regarding the spread and incidence of cases at different times since December 2019. The number of confirmed cases was 581 as per WHO report on 23rd January 2020 worldwide⁸. Another report published on 18th February 2020 showed increase in number of confirmed new cases up to 73,332 and the number of countries affected by Covid-19⁹. While in Pakistan as per report, on 10th April 2020, suspected cases were 10,54706. Among these 4695 cases tested positive.¹⁰ The previous pandemics in the world like Plague, Cholera, and small pox did not significantly affected domain of ophthalmology. But different studies showed how overall medical fraternity got affected in this pandemic. Feroze et al did a study on surgical residents concluding that their surgical as well as academic activities were affected¹¹. A similar study showed the effects on ophthalmology field and as no treatment is available so far, quarantining can help reducing the virus spread¹². Bakshi et al highlighted on the ophthalmology training in the year of Covid-19 that how the clinical experience and the undergraduate medical education suffered and that the virtual conferencing will be helpful in continuation of the education¹³. A similar study done in India by Mishra et al showed how most of the trainees responded that their surgical training was negatively affected. Their stress levels were raised and their families showed concern regarding their well-being. Also the trainees positively responded to online classes¹⁴. As outpatient department was closed and no direct dealing of patients was done, clinical approach was invariably compromised. Wong et al emphasized on the changes in ophthalmology training during the pandemic that how the outpatient and surgical volumes reduced to urgent care only. Also the lectures as well as the international conferences moved online. An article wrote on how patients got postponed or being rescheduled for their follow ups¹⁵. Covid-19 also affected mental health of medical care providers which is concern able. So it is important to take measures for the psychological wellbeing of health professions. Khanna et al carried out a study in India reporting that the mental health of a greater number of ophthalmologists affected and personalized help should be provided¹⁶. Qiao et al did a survey in February 2020 reporting 28 eye professional from 10 hospitals contracted Covid-19 pulmonary symptoms¹⁷. Jo et al emphasized on the importance of early detection Covid-19 as well as viral conjunctivitis as a possible presentation. He also suggested the studies on tears and conjunctival secretions in this regard¹⁸. Some researchers speculated that SARS Cov-2 might be detected in tears and conjunctival secretions in patients with conjunctivitis¹⁹. However, other researchers did not agree on the ocular manifestation in SARS patients²⁰. As per 27th February 2020, an ophthalmologist Dr. LI Wen Liang suffered from Covid-19 and passed away. Different studies were done on the safety measures for both public and doctors as well. APAO presentation guideline for ophthalmic practice showed that how the early screening should be done and the safety measures i.e. no touch policy, frequent hand washing general public education cleaning of Operation Theater and consultation rooms and wearing of PPE could reduce the transmission. As no treatment is available at present, prevention is the ultimate cure. Wearing N 95 mask, face shields, use of PPE and not reusing the gowns could help reducing the spread, was more effective compared with topical use.²⁰

As doctors were unable to attend the patients physically so telemedicine emerged as a new tool. The use of artificial intelligence as well as telemedicine with video conversations could be useful to combat this pandemic.

The limitations of study are a smaller sample size and shorter time duration. It is suggested that further studies should be done including the private sector hospitals as well.

Disclaimer:
Nothing to declare.

Acknowledgement:
The author thank the department medical staffs for their help and support. They keep patient record properly and managed the data carefully which helped in completing this research

Authors’ CONTRIBUTION:

^1,2,3 Conceptualized the study and contributed in the data collection and aided in drafting of the article, Active Participation in active methodology.

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