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What is the Role of OBGYN Residents during COVID-19 Pandemics?
We have read with great interest the Special Article from Romão et al., with recommendations from the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO, in the Portuguese acronym) regarding medical residency training during the coronavirus disease (COVID-19) pandemic. While it is clear in considering aspects of theoretical activities, it is less conclusive of how practical workload should be accomplished: can we participate in COVID-19 care while practicing obstetrics and gynecology (OBGYN)?
We agree that there are major concerns of how the COVID-19 pandemic will impact the apprenticeship of the residents and, especially, women's health care. We are aware of and respectful to all the necessary arrangements in dealing with the COVID-19 pandemic. In Brazil, at least a third of OBGYN residents were relocated to deliver care to suspected or confirmed COVID-19 patients. Although it may represent OBGYN interrupted regular activities, it comes to our attention that the relocation of residents was simultaneous to important modifications in women's health care in Brazil.
First, women are afraid of seeking medical care and exposing themselves to SARS-CoV-2, therefore tending to underestimate their health condition and to delay arrival to medical facilities; they presume there is a great risk of viral infection. Second, quarantine and lockdown measures have restricted health care to essential services, decreasing access to on-time diagnosis. Health personnel were deviated from women's health facilities, including antenatal clinics, to help emergency services. Ultrasound and laboratory tests, which were never adequate, are now restricted to a bare minimum. Therefore, women are admitted to hospitals in worsened medical conditions; it seems that 10% of maternal deaths in Brazil this year are related to COVID-19. Third, other health issues arise during the pandemic. To cite just a few, domestic violence, anxiety, and perinatal depression are rising in times of social isolation and emotional constraints.  We understand that OBGYN are the leading professionals in women's integral health care, and residents must take part on it. Finally, and of the uttermost importance, we still do not know how SARS-CoV-2 behaves in specific conditions of our field, such as in pregnancy or oncology. Therefore, we can still afford COVID-19 care while offering OBGYN care.
In our view, the role of OBGYN personnel in taking care of women's health is irreplaceable. In times of pandemics, our role is to provide a safe environment for the continuity of our species, which is not a lesser endeavor. In this context, program directors and institutions should focus the efforts of OBGYN residents on activities for which they have the best training for, and in sectors where they can really help. For example, emergency obstetrical care, which is historically overburdened in terms of resource personnel. Many lessons can be learned from the pandemic as a whole, but in our field, we have a clear picture of how essential our work really is. Antenatal care, labor wards, OBGYN emergency rooms, and gynecological oncology procedures are still places for assistance and residency training. If there is less gynecological training during the pandemic, residents must be replaced to obstetrics or oncology, which is in accordance with the FEBRASGO statement.
The pervasive feeling among some institutions that OBGYN is a common specialty is unequivocally wrong. We have a unique set of abilities which are simply indispensable. Obstetrics and gynecology personnel cannot be relocated without considerable impact on the quality of care. It is a waste of precious human resources to use the OBGYN workforce in the frontline of COVID when we have pressing needs in attending obstetrics emergencies and oncologic cases. Perhaps more lives will be wasted – or an increase of long-term sequelae for both mother and newborn –with this shift of personnel from where they are most effectively used to performing general COVID-19 care. Gynecological and perinatology health care must be seen as essential areas of medical assistance and education.
Residency training in 2020 has been challenging for residents, program directors, institutions and policy makers. Obstetrics and gynecology residents are skilled professionals and need to work as such. In Brazil, women's health is marked by inequalities of access and deliver of care, which impairs the maternal morbidity and mortality rate. Residency programs need to be in line with women's needs.
Conflict of Interests
The authors have no conflict of interests to declare.
Text prepared by the members of the National Specialized Commission on Medical Residency and endorsed by the Scientific Board and Presidency of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO).
Article published online:
31 October 2020
© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).
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