1. J Surg Res. 2018 Dec;232:389-397. doi: 10.1016/j.jss.2018.06.072.

Epub 2018 Jul

19.

Impact of Trauma Hospital Ransomware Attack on Surgical Residency Training.

Zhao JY(1), Kessler EG(2), Yu J(3), Jalal K(3), Cooper CA(4), Brewer JJ(4),
Schwaitzberg SD(1), Guo WA(5).

Author information:
(1)Department of Surgery, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, Buffalo, New York;
Department of Biomedical Informatics, Jacobs School of Medicine and Biomedical
Sciences, University at Buffalo, State University of New York, Buffalo, New York.
(2)Department of Surgery, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, Buffalo, New York;
Department of Epidemiology and Environmental Health, School of Public Health and
Health Professions, University at Buffalo, State University of New York, Buffalo,
New York.
(3)Department of Biostatistics, School of Public Health and Health Professions,
University at Buffalo, State University of New York, Buffalo, New York.
(4)Department of Surgery, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, Buffalo, New York.
(5)Department of Surgery, Jacobs School of Medicine and Biomedical Sciences,
University at Buffalo, State University of New York, Buffalo, New York.
Electronic address: waguo@buffalo.edu.

BACKGROUND: A recent ransomware attack led to the shutdown of the electronic

health information system (HIS) at our trauma center for 2 mo. We investigated
its impact on residency training during the downtime.
MATERIAL AND METHODS: General and orthopedic surgical residents who rotated at
the hospital were invited to participate in a survey regarding their patient care
and residency training experiences during the downtime. Attending surgeons from
both the specialties were invited to participate in a semistructured interview
regarding their attitude toward residency training during the downtime.
RESULTS: Twenty-nine residents responded to the survey with a response rate of
78.4%. Residents acknowledged significant increases in face-to-face communication
and decreases in use of online educational resources during the downtime
(P < 0.01). Residents were significantly stressed by the dearth of online
resources (P < 0.0001) and by paper-based orders and outpatient clinic
(P < 0.05). A multivariate analysis demonstrated an inverse relationship between
postgraduate year and stress from paper orders (P = 0.003). Attending surgeon's
interviews revealed that they recognized residents' unpreparedness and strove
harder to teach more effectively.
CONCLUSIONS: Our study demonstrated that an unexpected shutdown of the hospital
HIS imposed significant stress upon surgical residents providing trauma patient
care and made attending surgeons take greater efforts to be more effective
teachers. Residents who are digital natives lack adaptability to handle a
paper-based workflow. With cyber security threats increasing in health care,
preparedness should be included in the graduate medical education curriculum.

Copyright © 2018 Elsevier Inc. All rights reserved.

DOI: 10.1016/j.jss.2018.06.072
PMID: 30463746