**2. Global research trend of COVID-19 impact on the field of orthopedics**

A comprehensive literature search was conducted covering a period from January 1, 2020, to September 1, 2021, to include all possible matching articles since the appearance of the new coronavirus. PubMed served as the database for the literature search. If all the subspecialties of orthopedics were included, the number of searched publications will be too large, so we limit the search to the title that contains "orthopedic" or "orthopedic". The search was performed using the following search items for the title: "impact" AND "COVID-19" AND "orthopedic" (20 search results) plus "impact" AND "COVID-19" AND "orthopedic" (38 search results). One search result was excluded because it was a letter to the editor. In total, 57 studies were identified (**Table 1**). In terms of the regions of these publications, the most are in Europe, followed by Asia and North America.

#### **3. Various aspects affected in the field of Orthopedics**

Research on the impact in the field of orthopedics can be subdivided into education, clinical service volume, changes in clinical practice, workload, psychological factors, research work, etc. The essence of each peer-reviewed publication was listed in a sorted manner. The remaining few studies, focused on a single or some specific index of orthopedics for analysis, were not discussed in this article.

#### **4. Educational impact**

Most research on the impact of education comes from the United States, which may also reveal that the pandemic has disrupted their education system to a greater extent. Routine orthopedic education and training are still more or less affected or even suspended in most countries. The source of the impact may come from the interference of lockdowns or restrictions and various infection prevention measures including social distancing.

#### **4.1 Impact on application**

A perspective/narrative study in the United States discussed and provided potential strategies to understand the impact of COVID-19 on the orthopedic


#### *Perspective Chapter: Impact of the COVID-19 Pandemic on the Field of Orthopedics DOI: http://dx.doi.org/10.5772/intechopen.102847*


#### *Psychosocial, Educational, and Economic Impacts of COVID-19*


*Perspective Chapter: Impact of the COVID-19 Pandemic on the Field of Orthopedics DOI: http://dx.doi.org/10.5772/intechopen.102847*

> **Table 1.** *Characteristics of relevant publications.*

residency application process. Because COVID-19 may have an impact on the matching of residents, there is a great demand for insights into the inevitable changes in the application process and how medical students can adapt. In addition, the procedure is likely to ask the applicants how they spent the time they were not in the hospital due to COVID-19, and the applicants should be prepared to provide meaningful answers [2]. A questionnaire survey was conducted in the United States for medical students. Women stated that they are "unlikely" to apply for orthopedic residents due to the pandemic (14.9% vs. 5.5% for men, P < 0.001). Students identified as black/African American stated that they were "unlikely" to apply (16.9% compared with 8.8% of non-Hispanic whites, P < 0.001). The students stated that they had "slightly fewer" or "much less" opportunities to fully engage in orthopedic surgery training to make professional application choices (88.9% of students) [9].

#### **4.2 Impact on training**

A perspective study in the United States shared the thoughts of 3 orthopedic interns in different levels of a single training program. Although they are all trainees, the difference in training years is crucial to clarify different sources of professional stress. Everyone has their own sources of stress and response to ongoing crises [5].

A questionnaire survey was performed in South Korea for orthopedic residents. The average working time of 72.7 hours/week before the pandemic was reduced to 65.6 hours/week during the pandemic (p < 0.001). During the pandemic, educational time for lectures and clinical case discussions were reduced (both, p < 0.001). While reducing the use of traditional teaching methods, the use of online teaching methods has been increased (p < 0.001). However, compared with traditional teaching methods, the satisfaction of online teaching methods is significantly lower. The average quality of life score before the pandemic was 68.9 out of 100, which dropped to 61.7 during the pandemic (p < 0.001). The most stressful factor for orthopedic residents during the pandemic is family/relative health, followed by their own health and residency plan [6].

A perspective/narrative study in UK described the reductions in trainees' surgical exposure, cancelation of exams and courses, and revisions to professional recruitment and annual evaluations. This group of trainees is witnessing new methods of providing orthopedic services [10]. A four-nation questionnaire survey of orthopedic trainees was conducted in UK. 23.1% (23/101) of the trainees were redeployed to non-surgical positions. A total of 42.9% (42/101)% of the trainees did not have the fracture clinic training on the schedule, 53% (53/101) of the trainees had assigned operating theater training once per week, and 63.8% (64/101) of the trainees did not feel that sufficient experience has been gained in the affiliated subspecialties and preferred repeating training [13].

A questionnaire survey of orthopedic trainees was conducted in 23 European countries. Most trainees retained their usual clinical roles (59.8%), but quite a few were redeployed to COVID-19 units (20.9%). 52.1% stated that teacher-led education was restricted, 46.3% pursued self-directed learning, and 58.6% stated that surgical training was severely impaired. 58.2% of participants expressed concern about achieving the annual training goals, while 25.0% of participants expected an additional year of training [18].

A perspective study in the USA believe that the following suggestions may be helpful to students seeking alternative supplementary learning methods: [1] read major orthopedic journals, [2] contact orthopedic surgeons in the field of interest, [3] contact program coordinators or directors to have the opportunity to participate *Perspective Chapter: Impact of the COVID-19 Pandemic on the Field of Orthopedics DOI: http://dx.doi.org/10.5772/intechopen.102847*

in their education courses in a virtual way, [4] attend online lectures, and [5] use practice kits to practice suture techniques [23].

A questionnaire survey in Ireland found the average total number of operations per trainee in 2019 was 40.6, and reduced to 18.3 during the 2020 pandemic (p = 0.043). Moreover, 7.69% (n = 3) of the trainees were infected with COVID-19 [25].

A questionnaire survey in India revealed that 65.1% of the post-graduate trainees stated that no clinical courses are currently offered. Most (94%) confirmed that COVID-19 has affected their surgical and clinical training. A large number (71.6%) encountered problems when completing the thesis, and 96% were worried about their mental health [28].
