The Impact of COVID-19 Pandemic on Gynaecological Services and Registrar Teaching in Three Academic Hospitals in Johannesburg

Abstract

Objectives: To evaluate the impact of the Covid-19 pandemic on gynaecological services and registrar training. Study design: This was a descriptive cross-sectional study. Data on gynaecological visits and procedures was gathered from three teaching hospitals in Johannesburg, using hospital patient registers from November 2019 to November 2020. An online survey was used to assess registrar opinions on the impact of Covid-19 restrictions on training. The Monthly Percentage Change (MPC) and p-values were calculated using the formula (eb1 -1) × 100. The Joinpoint Regression Program (Version 4.9.1.0 2020) was used to measure the magnitude of changes in visits and procedures. A p-value < 0.05 indicated a significant change. The Human Research Ethics Committee of the University of the Witwatersrand approved the study (Ethics clearance number: M220509). Results: There was a decrease in gynaecological services during the pandemic: Gynaecological outpatient department (Nov 2019-July 2020 MPC= -13%, p = 0.05), Termination of pregnancy services (Nov 2019-June 2020 MPC= -2%, p = 0.01), and elective major gynaecological procedures (Nov 2019-July 2020 MPC= -14%, p = 0.05). Of 64 registrars surveyed, 19 (54.3%) were male; 16 (45.7%) were female. The median age was 33 years (IQR = 31-38, range = 27-48 years). Twelve (36.4%) registrars were in the first- year of study, seven (21.2%) second-years, nine (27.3%) third-years, and five (15.2%) final- years. The registrars performed fewer major surgical cases; total abdominal hysterectomies (Nov 2019-Jul 2020 MPC= -7%, p = 0.05), vaginal hysterectomies (Nov 2019-Jul 2020 MPC= -2.2%, p = 0.02), and myomectomies (Nov 2019-Jun 2020 MPC= -16%, p = 0.03). The above gynaecological services began to show recovery after July 2020. Conclusion: There was a decline in outpatient and surgical gynaecological services in all participating academic hospitals. The pandemic had a negative impact on registrars’ training as seen by the smaller number of major gynaecological cases.