Introduction: Global medical advances within healthcare have subsequently led to the widespread introduction of biological products such as grafts, haemostats, and sealants. Although these products have been used for many decades, this subject is frequently not discussed during the consent process and remains an area of contention. Methods: A nationwide confidential online survey was distributed to UK-based junior registrars (ST3-5), senior registrars (ST6-8), post-CCT fellows, specialist associates/staff grade doctors and consultants working in general/vascular surgery, neurosurgery, otolaryngology, oral & maxillofacial surgery and plastic surgery. Results: Data was collected from a total of 308 survey respondents. Biological derivatives were correctly identified in surgical products by only 25% of survey respondents, only 19% stated that they regularly consent for use of these products. Our results demonstrate that most participants in this study do not routinely consent (81%) to the intra-operative use of biological materials. An overwhelming 74% of participants agreed that further education on the intra-operative use of biological materials would be valuable. Discussion: This study highlights deficiencies in knowledge that results in potential ethical compromise of the consenting process for surgical procedures. A solution to this would be for clinicians to increase their awareness via educational platforms and to incorporate an additional statement on the consent form which addresses the potential intraoperative use of biological products and what their derivatives may be. Conclusion: Modernising the current consent process to reflect the development and use of surgical biological products will help to ensure improved patient satisfaction, fewer future legal implications as well as a better surgeon-patient relationship.

Abstract Introduction The COVID-19 pandemic has resulted in a significant burden on healthcare systems causing disruption to medical and surgical training of doctors globally. Aims and objectives This is the first international survey assessing the perceived impact of the COVID-19 pandemic on training of doctors of all grades and specialties. Methods An online global survey was disseminated using Survey Monkey® between 4th August 2020 and 17th November 2020. A global network of collaborators facilitated participant recruitment. Data was collated anonymously with informed consent and analysed using univariate and adjusted multivariable analysis. Results 743 doctors of median age 27 (IQR: 25-30) were included with the majority (56.8%, n=422) being male. Two-thirds of doctors were in a training post (66.5%, n=494), 52.9% (n=393) in a surgical specialty and 53.0% (n= 394) in low- and middle-income countries. 69.2% (n=514) reported an overall perceived negative impact of the COVID-19 pandemic on their training. A significant decline was noted among non-virtual teaching methods such as face-to-face lectures, tutorials, ward-based teaching, theatre sessions, conferences, simulation sessions and morbidity and mortality meetings (p≤0.05). Doctors from low or middle-income countries were associated with perceived inadequate supervision while performing invasive procedures under general, local or regional anaesthetic. (p≤0.05) Conclusion In addition to the detrimental impact of the COVID-19 pandemic on healthcare infrastructure, there has been an indirect consequence of disrupted training within medical and surgical subspecialties. A focus on reconfiguration of training programs through a variety of additional resources will become imperative to reduce the long-term sequalae of COVID-19 on doctors’ training.

Introduction:In late December 2019, a cluster of pneumonia cases of unknown aetiology were reported in Wuhan, Hubei Province, Central China. The causative agent was subsequently identified as the novel coronavirus (SARS-CoV-2, previously known as 2019-nCoV). The coronavirus disease 2019 (COVID-19) was eventually declared as a global pandemic by the World Health Organisation (WHO), having been detected in over 72 countries worldwide, with Europe and the United States now deemed the viral epicentres [1].Healthcare professionals (HCP) are considered high risk due to a multitude of factors including exposure to higher viral loads [2] and aerosolisation [3,4]. The rising number of deaths amongst healthcare professionals and burden of sick leave secondary to self-isolation, raises significant safety concerns during patient assessment and management. This is particularly of concern when undertaking droplet and aerosol generating procedures (AGP), although the evidence is derived largely from low quality studies [6]. Postulated mechanisms thought to generate aerosol and droplets include laryngeal activity (speech & coughing), high velocity gas flow, and cyclical opening and closure of distal airway. These have been found to generate particles in a range of sizes, increasing the viral load in confined spaces, and possibly increasing transmission risk.Recent literature suggests an increased risk posed to otorhinolaryngologists, as diagnostic, interventional and therapeutic procedures involving the upper aerodigestive tract, paranasal sinuses and middle ear exposes HCPs to both direct and indirect transmission of SARS-CoV-2 [7]. At the point of formulating this article, elective clinical workload has been reduced within the United Kingdom. Two-week-wait clinics have continued due to the prevalence and rising incidence of head and neck cancers [8], albeit at a significantly reduced capacity due to lengthened infection control measures.We describe a novel and cost-effective safety adjunct when undertaking flexible nasendoscopy (FNE) within ward/ outpatient settings.