Throughout my career, I’ve had the privilege of being involved in the education of hundreds of surgeons-in-training and I’ve seen how medical education has slowly evolved over time. Right now, however, the pandemic is triggering radical shifts in the delivery of medical education. In this article, I offer advice to surgeons-in-training as they navigate uncharted waters stemming from Covid-19.
Get the most out of virtual learning
Over the past months, it’s become apparent that virtual classrooms work well in some instances. Online learning can be highly effective for general course delivery, discussion groups, and study groups. It also allows participants to start, stop, and rewind as needed, which can be helpful when tackling large volumes of information. There are some serious shortcomings, however.
Participation is crucial, and it’s often more difficult to engage and interact with classmates and the professor in a virtual setting. But don’t let online learning make you invisible. A 2009 study of first-year medical students in an online learning setting found “there was a significant association between a high rate of classroom attendance/participation and a high score on the comprehensive examination.” Attend all classes; speak up and ask questions; and take advantage of any non-compulsory learning opportunities. Your education is happening now, albeit during a global pandemic, so don’t let any opportunity for active learning pass you by. Connect with classmates, reach out to professors, and avoid isolation.
Furthermore, keep in mind that “Zoom fatigue” is very real, and can lead to a lack of focus. When online learning is combined with the advent of digital textbooks and online note-taking, it can create an overload of screentime. Antidote this by getting outside, perhaps listening to audio recordings of lectures while walking.
Practice your technical skills
Another unique challenge brought by the pandemic is a sudden downturn in hands-on training opportunities. Nothing can rival this practice in the operating room, but according to a McKinsey report, U.S. hospitals saw an average decrease of 35% in operating room (OR) volumes from March to July 2020 and are expected to remain below baseline for a while. Less available OR time for surgeons-in-training means they need to leverage other forms of hands-on training.
One option is to use surgical simulators. There has been a huge push in the use of simulators to learn arthroscopic skills, triangulation, and microscopic skills. There are over 20 computer-based platforms—that cover nine surgical specialties—all available on the internet and accessible from home. Simulators are not a perfect duplication of what happens in live surgery, but they can help students advance through the learning curve. Just as an aviation simulator can play a role in a pilot earning his wings, surgical simulators serve a role as students work towards mastering live surgery skills.
Secondly, cadaver practice is helpful. Some departments of surgery arrange for a cadaver laboratory to enable residents to practice surgical techniques and procedures. The similarity to live tissue and small learning groups can provide a great environment for future surgeons to get valuable hands-on-training while live cases remain limited.
Lean into pandemic lessons
The Covid-19 pandemic is a crisis of a lifetime. Previously, medical students learned about epidemics and pandemics from textbooks. Today’s students are living through a global pandemic, which has provided them with a great opportunity to learn firsthand about how the healthcare community has responded.
For example, the spread of Covid-19 is offering students a front-row seat to the importance of infection control. Students can observe the strictest adherence to hygiene and proper PPE protocols that’s ever been practiced. Modern surgeons have never been so acutely aware of the need to protect themselves against respiratory disease. For those of us who have been involved in medical care since the 1980s, the intense focus on the prevention of a disease primarily transmitted through air and droplets and the subsequent change in the way we interact with our patients brings back memories of the effort to prevent HIV infections from blood and bodily fluid transmission. Hopefully, learners can absorb today’s lessons fully and carry similar diligence with them throughout their whole career.
I would advise surgeons-in-training to understand how theory works in action. Use this experience to really reflect on the role of vaccines in population health, the need for masking when sick (at all times—not just during a pandemic), and the magnitude of what a career in medicine means during times of crisis. For some, there may be an opportunity to re-deploy to the ER, ICU, or another unit. An esteemed colleague of mine, Dr. Chris Ahmad, did so and wrote about it to share how educational and moving he found the experience.
Ask for help
Building meaningful relationships with successful surgeons will help you master the surgical skills required for a long, successful career. This was demonstrated in a 2015 study of 565 UK and Irish surgical trainees who were asked about the role of mentorship in their careers. Responses showed that priorities for areas of mentoring were: career progression (94.9 %), research (75.2 %), clinical skills (66.9 %), and clinical confidence (58.4 %). The study concluded that “mentoring had a positive influence on their professional lives, with career progression being influenced most positively.”
Don’t wait for learning opportunities to come to you. Instead, go and find a surgeon who you respect and admire and establish them as your mentor. You can do this by asking if you can shadow them in their clinic, or better yet, if you can scrub in and observe them in action. If you cannot find anyone nearby, take time off and go visit someone in another location who will allow you to spend time in their practice with them. In fact, this is a career-long recommendation. Visiting other surgeons, both in the US and internationally, after completing my residency and fellowship has been an incredibly rewarding component of my effort to remain educated in regard to the best practices around the world.
This is a challenging time to be training to be a surgeon. It is also a time of unexpected learning opportunities. Don’t let the magnitude of what’s happening overwhelm you. Instead, take responsibility for your education. Speak up in your virtual classes. Get your hands on a simulator. Find a successful surgeon to shadow. In short, keep putting in the work and you’ll have stories—and skills—to last your entire career.
Picture: tonefotographia, Getty Images
