Advancing Surgical Education During COVID-19
By Mark Soliman, MD
Seemingly overnight, surgeons worldwide watched as a virus tore through country after country, ravaging local communities. In contrast to our medical colleagues, we have been asked, and/or mandated, to rest our scalpels and sit on the sidelines until the pandemic is controlled. As a surgical educator, lifelong learner and self-confessed OR addict, this has been a difficult position to be forced into.
For those of us who are not on the front lines of the COVID-19 pandemic, taking care of ICU patients and dusting off our residency texts on ventilator management, what do we do with this newfound time to maintain, or even improve, our surgical skills? What can we do to advance our personal, medical and/or surgical education?
We undoubtedly live in an age of information abundance. If leveraged to its fullest, we can use this unique gift of time and emerge from this pandemic stronger than how we entered it, from both a personal and professional perspective.
Professional, Technical Pursuits
Prevention of surgical skill decay should be a high priority for any surgeon or surgical trainee. Degradation of surgical skills is a real and prevalent dilemma that has appeared in the literature and been of particular interest to the United States military (JSLS2012;16:218:228). Use of surgical simulators has been a well-studied topic and proven to maintain or, in a more novice trainee, render technical improvement of surgical skills (Urology2018;111:110-115; J Am Coll Surg2000;191:272-283; J Surg Educ2012;69:242-248). This is particularly true for robotic and laparoscopic surgery, and, with the abundance of procedural simulators in surgical training programs, should be at the center of surgical skill maintenance
Surgical video review is an incredibly important and effective means to hone technical skills in the OR (Urology2018;111:110-115; Nat Rev Urol2019;16:261-267), and even at the bedside or trauma bay (J Trauma Nurs2018;25(5):307-310). The logic behind review of both personal and expert surgical videos is to objectively compare one’s current technical skill and to adopt from expertly performed surgical procedures. This review affords the surgeon ample opportunity to study and modify personal technique in an honest and self-reflective manner, outside of the stress and pressure of the OR.
Professional, Nontechnical Pursuits
Surgeons and surgical trainees often suffer from similar limitations when working at full capacity: They lack ample time to review literature, textbooks or nontechnical manuscripts. Most surgical training programs implement and maintain regular journal review conferences (“Journal Club”), but these usually involve preselected articles that may or may not interest the reader (Int J Surg2015;18:159-162). Now is an opportune time to review articles that are of interest to the reader, those that are pertinent to one’s area of practice, and even far outside of one’s area of expertise. Many surgical societies and their respective journals have preselected journal articles on their websites with expert commentary and tutorials on how best to read the respective articles, including the journal Diseases of the Colon and Rectum (https://bit.ly/2xQesWd) and the American College of Surgeons (https://bit.ly/3buk474).
Additionally, in the era of COVID-19, where in-person meetings are few and Zoom calls are abundant, many societies and even individual surgeons are holding international open journal clubs.
It comes as no surprise that individual surgeon outcomes vary. These variations occur for many reasons. Perhaps now more than ever, we can use this time to understand these reasons and aggregate data to benchmark our outcomes compared with our colleagues (J R Soc Med2015;108:127-135).
As a Surgical “YouTuber,” (youtube.com/marksoliman) I enjoy creating video content for my trainees and community surgeons alike. It remains a vehicle for me to sit and audit my data, videos, and learn about novel topics that I otherwise would not. To that end, this is an opportune time for others to create content in like manner: video, scientific manuscripts, updating research databases, podcast creation and other media.
Since our operative volumes have likely declined, this physical distancing from one another becomes a perfect time for us to become socially connected via countless social media platforms—the most common of which are Facebook and Twitter. Nearly every surgical society has invested time and effort into cultivating a social media presence, thereby giving their membership a common platform to connect. The Society of American Gastrointestinal and Endoscopic Surgeons, for example, has made it a point to put on weekly webinars across all of its Facebook groups to discuss pertinent topics in each representative group that it sponsors.
Weekly, dozens of webinars are being advertised by many surgical societies, social platforms and medical device companies. The wide selection of these webinars and their abundance allow surgeons an opportunity to select those that are of keen interest for maximum benefit.
Oftentimes, the most easily neglected areas of a surgeon’s life are the most important: either themselves, or their family, friends and loved ones.
Use this time to reconnect with family, friends, loved ones, or those with whom you have lost touch. Whether by FaceTime, Google Hangouts or Zoom, reaching out and reconnecting with those who are closest to you is easier than ever; and in most cases, those to whom you’re reaching out will no longer have the excuse that they missed your call because they were busy.
Physicians wholeheartedly believe that exercise is a much-needed activity to maintain the health of both body and mind. However, most of us simply do not have the time to actually do it (Can Fam Physician1992;38:2015-2018vfudeqzqzbzyyvrbcuade).
Finding time to exercise now is probably not as impossible as before, and something that would pay dividends if one planted the seeds of this habit from now. Additionally, participating in self-reflection, meditation, spirituality and/or deep introspection is a critical way to rejuvenate oneself, reduce stress and anxiety, and prevent burnout (Schizophr Bull2018;44:226-228;Pychosom Med2016;78(6):667-676; Acad Med 2018;93:537-539;Curr Opin Cardiol2019;34:94-97).
As we sit and wait to get back in the game, or hold our breath until we are pulled to the front lines of the COVID-19 pandemic, we now have the time we may never receive again to further our surgical education and improve our personal lives.
—Dr. Soliman is the System Chairman of Colorectal Surgery for AdventHealth Central Florida, and the program director of the Advanced Minimally Invasive Colorectal Surgical Fellowship at the Colon and Rectal Clinic of Orlando.