**Foreword: Integrating experiences, lessons learnt and know-how in Training, Education, and Research for Post-COVID-19 Times**

As a global pandemic, COVID-19 has posed a major challenge in all aspects of life, including how graduate training of healthcare practitioners is conducted. In Saudi Arabia, over 14,000 graduate health professional trainees are in different stages of their training in various specialties distributed in many healthcare facilities across the country. The vast geographical distribution and the diversity of health specialty training programs and activities have remarkably magnified the challenge posed by the pandemic. Among other roles, the Saudi Commission for Health Specialties (SCFHS) is the country's regulatory organization responsible for governing health professionals' training and accreditation and graduate health training. Given its complex mandate and wide stakeholders base, the commission plays an integral role in the healthcare ecosystem.

Over the past three years, the SCFHS has implemented a health training governance reform that granted more autonomy to accredited training facilities in supervising training activities according to preset policies. This autonomy was crucial for mitigating various risks imposed by the pandemic, especially during the extended periods of strict lockdown.

The challenges faced during this period were numerous. However, several common themes constituted most of the challenges and warranted significant focus and deliberate attention to mitigate. First, trainees' safety and wellness were the primary concern for all those involved in the immediate supervision and oversight of training processes in all programs. During the early phase of the pandemic, uncertainty was a common denominator in a multitude of professional circumstances; training was not an exception. As a result of the uncertainty related to the extent of the disease virulence and spread early on, coupled with the variability in the preparedness of many health organizations for combating such a devastating public health catastrophe, hospital and training supervisors reacted quite variably. Trainees and training supervisors from different programs raised concerns about their state of health. Second, training continuity was severely threatened, as many hospitals were overwhelmed with the increasing numbers of COVID-19 cases; some hospitals have been converted completely to accommodate the growing numbers of COVID-19 cases. As a result, many trainees were either forced to practice in training rotations that were not initially scheduled for, were transferred to other training locations, or were forced to withhold their training until further notice. The lucky ones whose training rotations continued faced various logistical difficulties and distractions from issues related to the pandemic. Third, as the pandemic progressed, training quality emerged as a central concern because of the limitation of oversight over training that resulted from training interruptions, unplanned training structural and content update, and redirecting resources to combat the pandemic and its consequences. Trainees in surgical specialties had their training interrupted due to the cessation or limitation in the elective and subacute surgeries during the pandemic.

These challenges called for immediate interventions to mitigate and control the risks posed by this devastating crisis. The response came from different levels of training governance entities at the Saudi commission, including its executive leadership scientific counselors and committees, and supervisor training bodies in training institutions around the country, all joining forces to address the crisis systematically and collaboratively. Their motto focused on a common goal of sailing together through this rampant storm to alleviate its impact and to minimize future consequences on training outcomes. As a result, several initiatives were designed and implemented to successfully achieve immediate and short-term outcomes. In addition, plans were put together to monitor and address long-term outcomes related to disturbances inflicted by the pandemic on the healthcare system. Long-term impacts of this crisis on training outcomes represent the main challenge that is still uncertain and, therefore, unaddressed. Therefore, in the long run, coalitions of training leadership must continue to manage this challenge as an integral component of their activities. They also need to restructure the training system to continuously evaluate the pandemic's long-term effects and adjust the training system accordingly to achieve the best outcomes.

Lessons learned from this experience:


Despite all the difficulties mentioned above and the challenges caused by this pandemic, there was a silver lining of opportunities for innovation and transformation in the graduate health training systems. A key example is the effective utilization of available and emerging technologies in training (e.g., webinars and teleconferencing). Undoubtedly, this accelerated adoption of technology has created an ample window of opportunity for the successful digital transformation of health training environments and practices.

Finally, navigating through the tough COVID-19 challenges was exhausting, but perseverance, hope, and foresight will eventually make us stronger and more agile.

*Guest Editors* 
