Practical Techniques to Adapt Surgical Resident Education to the COVID-19 Era

摘要

The novel COVID-19 pandemic will alter the educational experience for surgical residents across the country. It has already led to significant changes within most hospitals, including limiting the number of residents who are in-house, cancellation of elective procedures, decreased volume of acute care surgery following surgical society guidelines, and cancellation of lectures and educational conferences to adhere to social distancing recommendations. In response to these necessary changes, the American Board of Surgery has modified the training requirements of graduating chief residents to include 44 weeks of clinical time with a 10% reduction in required total cases.1 However, these changes and recommendations do not remedy the hours of surgical education content lost when residents are unable to participate in didactics, simulation, and operative cases. Historically, surgical resident education has been overseen at an institutional level, with individual programs determining the best resources and delivery format for instruction. National curriculum and resources exist, including the Surgical Council on Resident Education (SCORE) curriculum, the ACS/APDS Surgery Resident Skills Curriculum, and various question banks. However, given the new work environment and demands placed on surgery residents during the COVID-19 pandemic, many standard instructional modalities must be altered. Daodu et al provide an insightful overview of the general implications that COVID-19 has on surgical education.2 Herein, we describe several practical strategies for resident education focused on operative preparation, educational didactics, and skills development and simulation, that transcend the geographical and temporal restrictions brought about by the COVID-19 pandemic (Fig. 1).FIGURE 1: Adapting the 3 pillars of surgical resident education to the COVID-19 era. Traditional in-person lectures and didactic sessions can be transitioned to video-based and recorded teaching sessions. Simulation and skills development can adapt appropriate social distancing recommendations by utilization of home-based skills recording and remote assessment. Operative education and preparation can employ peer-reviewed video-based education modules.OPERATIVE VIDEO-BASED EDUCATION Before the COVID-19 pandemic, video-based education (VBE) has become an increasingly utilized, effective technique for both knowledge acquisition and operating room preparation.3 VBE is the delivery of educational content through video platforms, which stimulates dual use of a learners auditory and visual processing pathways. Previous studies in dual-coding learning theory have demonstrated when educational content is presented to both pathways concurrently, as in VBE, learners have a higher likelihood of recall.4 This platform is particularly useful for operative case preparation, especially in the setting of a pandemic where limited surgical cases are proceeding. Although individual residency programs may choose to create their own VBE modules, this is often labor intensive, cost prohibitive, and can feel daunting. Instead, preexisting operative video libraries could be utilized to supplement resident education. Two examples of peer-reviewed libraries with VBE operative content include the Journal of Medical Insight (JOMI) and the American College of Surgeons (ACS) Online Video Library. Our institution is further answering this call, by creating an open-access, peer-reviewed video library available to all learners world-wide. This free resource, MGH SurgEdOnline, will be available in the next couple of months. These resources instruct residents on proper surgical indications, preoperative workup, and operative anatomy and techniques. With COVID-19 limitations on elective cases and acute care surgical management, the videos offer an educational alternative that can be safely watched from a learner's home or call room. Multi-institutional collaborations can alleviate the administrative burden