**7. Personal practice change**

A nationwide questionnaire survey in Malaysia revealed the majority of respondents are still working (223/235, 94.9%), operating outpatient clinics (168/223, 75.3%), and continuing to perform semi-emergency (190/223, 85.2%) and emergency surgery (213/223, 95.5%). Among surgeons, 11.2% (25/223) did not screen patients for COVID-19 before elective surgery, 30.9% (69/223) did not receive any training on the proper handling of personal protective equipment (PPE), and 84.8% (189/223) made more conservative management decisions due to COVID-19, and 61.9% (138/223) of income was affected. Among surgeons, 19.3% (43/223) started using telemedicine facilities [27].

A questionnaire survey in Spain revealed 85.7% of the respondents had to reduce their surgical activities by 50%−100%. Forty-six percent of them were asked to collaborate in other units or services, and another 43% felt that their work was underutilized. Fifty percent revised the indications for the treatment of various fractures, and there are differences between the center and the community. Thirty percent of the respondents said they were satisfied with the management of the country, and 60% said they were satisfied with the management of their province and center. Seventy percent of the respondents were almost dissatisfied with the training they received on the use of masks and personal protective equipment. Another 80% were not satisfied with the sample-taking training they received. Sixty-five percent of people did not have protective equipment to carry out their work. Forty-six percent refused protective measures to treat patients with suspected or confirmed infections [35].

A nationwide questionnaire survey in India showed most (88.3%) found that trauma surgery and non-traumatic surgery were severely affected (>50%). Significant changes had taken place in individual hospital protocols (91.7%). Most hospitals (74.3%) were equipped with the appropriate personal protective equipment required. Most surgeons (89.5%) did not modify or upgrade the existing operating room infrastructure [41].

A nationwide questionnaire survey in UK showed all 202 respondents reported that their daily practice was disrupted. Ninety-one percent reported that all elective surgeries had been canceled, and only 24% of cases had trauma that continued to be normal. Seventy percent reported interruption of trauma surgery. The capacity of elective clinics was significantly reduced, and there were no elective clinics that were functioning normally. Fifty-five percent reported that their elective clinics were completely canceled, while 38% reported that the operational capacity of elective clinics was reduced and non-emergency appointments were postponed. Only 9% of fracture clinics were operating normally, and 69% had reduced services. Sixty-seven percent of people reported cancelation of teaching and study leave. It is worth noting that 69% of respondents believe that the pandemic will delay the completion of the registrar training program [42].

Finally, a questionnaire survey of orthopedic surgeons received responses from 45 countries. 358 (78.5%) respondents reported the lockdown measures in their area during the survey. Most (n = 337, 94.4%) reported suspension of all elective programs. Surgeons reported that the average number of operations per week has decreased, from 6.89 before the pandemic to 1.25 at the time of the survey. The average weekly number of elective clinic appointments decreased from 67.89 before the pandemic to 11.79 at the time of the survey. A total of 177 (39.4%) surgeons reported using the virtual outpatient appointment model for the first time. Of the 290 surgeons with trainees, 223 (84.5%) reported implementing systems for continuing training, such as webinars or virtual inspections [36].
