AUTHOR=Busetto Gian Maria , Del Giudice Francesco , Mari Andrea , Sperduti Isabella , Longo Nicola , Antonelli Alessandro , Cerruto Maria Angela , Costantini Elisabetta , Carini Marco , Minervini Andrea , Rocco Bernardo , Artibani Walter , Porreca Angelo , Porpiglia Francesco , Damiano Rocco , De Sio Marco , Arcaniolo Davide , Cimino Sebastiano , Russo Giorgio Ivan , Lucarelli Giuseppe , Di Tonno Pasquale , Gontero Paolo , Soria Francesco , Trombetta Carlo , Liguori Giovanni , Scarpa Roberto Mario , Papalia Rocco , Terrone Carlo , Borghesi Marco , Verze Paolo , Madonia Massimo , De Lisa Antonello , Bove Pierluigi , Guazzoni Giorgio , Lughezzani Giovanni , Racioppi Marco , Di Gianfrancesco Luca , Brunocilla Eugenio , Schiavina Riccardo , Simeone Claudio , Veccia Alessandro , Montorsi Francesco , Briganti Alberto , Dal Moro Fabrizio , Pavone Carlo , Serretta Vincenzo , Di Stasi Savino Mauro , Galosi Andrea Benedetto , Schips Luigi , Marchioni Michele , Montanari Emanuele , Carrieri Giuseppe , Cormio Luigi , Greco Francesco , Musi Gennaro , Maggi Martina , Conti Simon L. , Tubaro Andrea , De Berardinis Ettore , Sciarra Alessandro , Gallucci Michele , Mirone Vincenzo , de Cobelli Ottavio , Ferro Matteo 

TITLE=How Can the COVID-19 Pandemic Lead to Positive Changes in Urology Residency?

JOURNAL=Frontiers in Surgery

VOLUME=Volume 7 - 2020

YEAR=2020

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2020.563006

DOI=10.3389/fsurg.2020.563006

ISSN=2296-875X

ABSTRACT=COVID-19 outbreak, in a few weeks, has overloaded Italian hospitals and the majority of medical procedures have been postponed. During pandemic, and with hospital reorganization, clinical and learning activities performed by residents suffered a forced remodulation. 
Objective of the study was to investigate how Urology training in Italy has been affected during COVID-19 era. In this multi-academic study we compared residents’ training during the highest outbreak level with their previous activity. Overall 387 (67.1%) of the 577 Italian Urology residents participated to a 72-hour 36 items anonymous online survey sent via email.
Main outcomes were clinical/surgical activities, social distancing, distance learning, and telemedicine. 
Clinical and learning activity was significantly reduced for the overall group, and after stratification for those working only in COVID hospitals, for both “junior” and “senior” residents and for those working in any of three geographical areas created (Italian regions were clustered in three major zones according to the prevalence of COVID-19). A significant decrease of the outpatient activity, invasive diagnostic procedures, endoscopic and major surgeries were reported. 
At multivariate analysis year of residency has been found as an independent predictor for all response modification. The zone 3 and zone 2, the “senior” resident status were independent predictors associated with a lower reduction of the clinical and learning activity. Working in a COVID hospital and “senior” resident status were independent predictors associated with higher reduction of the outpatient activity. Working in zone 3 and “senior” resident status were independent predictors of lower and higher outpatient surgical activity, respectively. Working in a COVID hospital was an independent predictor associated with robotic surgical activity.
The majority of residents reported that distance teaching and multidisciplinary virtual meetings are still not used, and 44.8% reported that the relationship with their colleagues decreased. 
The COVID-19 pandemic presents an unprecedented challenge, including training and education changes of urology residents. COVID era can offer an opportunity to balance and implement innovative solutions that can bridge the educational gap and can be part of future urology training.