American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Never Let a Good Crisis Go to Waste: Continuing Professional Development in COVID-19

Jason C. Pradarelli, MD, MSSudha Pavuluri Quamme, MD, MSCaprice C. Greenberg, MD, MPH, FACS

Never let a good crisis go to waste.
-Sir Winston Churchill, circa 1940

Medical education has shifted drastically—even halted at times—during the Coronavirus Disease 2019 (COVID-19) pandemic. Gradual change was already in progress for medical students1 and post-graduate trainees,2 but the pandemic has forced innovation abruptly onto medical education in 2020.3,4 Virtual learning has become commonplace for preclinical and clerkship students, residents, and fellows as safety concerns led institutions to maximize physical distance and minimize time for learners in the clinical environment. But what about physicians in practice?

One year before COVID-19 struck, the American Board of Medical Specialties (ABMS) announced its “Vision for the Future of Continuing Board Certification,” issuing strong recommendations to overhaul the system for physicians’ continuing professional development (CPD).5 Addressing major criticisms of the existing Maintenance of Certification programs,6 the “Vision” report charged ABMS Member Boards with replacing ineffective traditional CPD activities—such as conferences and weekend courses—with longitudinal, formative, and personalized strategies that embrace adult learning principles and demonstrate value to physicians for continually improving patient care.

To achieve the ABMS’s vision in the COVID-19 era, we cannot simply translate in-person CPD activities to an online format. Virtual conferences, webinars, and online module-based courses are merely incremental tweaks that will produce the same lukewarm results for physicians’ learning as the in-person versions. The need to urgently move all educational activities to a virtual format provides a unique opportunity for disruptive innovation and may prove to be a silver lining of the pandemic for physicians’ CPD.

Assessing clinical performance virtually

A cornerstone in efforts to improve medical practice is the assessment of current performance. Today, assessment is primarily limited to measurement of one’s ability to apply medical knowledge in a non-clinical environment, such as through standardized testing. But this provides no assessment of physicians delivering care to patients in a clinical setting and no assessment of technical performance for procedure-based specialties.

Technology has advanced in recent decades to enable virtual performance assessments that are feasible, scalable, and—most importantly—safe during a pandemic. For example, video-based assessments using virtual surgical platforms such as theator,7 Proximie,8 or caresyntax9 allow surgeons to be evaluated on their practice-specific competency of performing an operation by reviewing operative video and offering individualized feedback remotely after a case is completed.10,11

Novel technology platforms like the OR Black Box® can also record full-room audio/video in clinical environments.12 These data capture systems allow clinicians to ground performance assessments in reality, rather than relying on subjective memory of events. Routine review of operating room, trauma bay, or clinic activities facilitates longitudinal, tailored feedback that would help physicians conduct self- and peer-assessments that directly reflect their patient care practices during and after the pandemic.

Improving clinical performance virtually

Assessment without a plan for improvement is like being handed a map without a compass. Performance feedback for physicians only becomes clinically meaningful when it is translated into improvement efforts. Before the pandemic, the medical community’s conception of quality improvement or performance coaching was often limited to the walls of our own institutions or to in-person collaborations. In the face of physical distancing, we contend that videoconferencing and video-sharing technologies have opened the floodgates to performance improvement opportunities that favorably disrupt the status quo of physicians’ CPD.

Building on video-based assessments, video-based coaching enables physicians to act on individualized clinical assessments to improve their everyday patient care performance.13 Through guided, longitudinal reflections on one’s practice, video-based coaching allows a coach to anchor a surgeon’s performance goals, feedback, and action plans in the reality of their clinical video, which assists with sustained behavior change. With videoconferencing technology, coaches can connect with surgeons safely and efficiently across the country to continually improve their practice under “new normal” work environments.

One established route for implementing video-based surgical coaching is the Academy for Surgical Coaching,14 a nonprofit organization that empowers surgeons through coaching to improve their clinical performance, well-being, and patient care. At the Academy, we train surgeons to serve as peer coaches, connect surgeons with trained coaches and facilitate virtual one-on-one coaching sessions (Figure), and support the development of surgical coaching programs by hospitals, surgical societies, and industry partners. The Academy’s process is grounded in a decade of research on surgical coaching,15–19 using evidence-based implementation strategies to help surgeons and organizations improve surgical performance virtually and, when safe to do so, in-person.

Figure. Example timeline of a surgeon’s progression through a surgical coaching partnership with the Academy for Surgical Coaching. Copyright: Academy for Surgical Coaching, 2020.

Example timeline of a surgeon’s progression through a surgical coaching partnership with the Academy for Surgical Coaching. Copyright: Academy for Surgical Coaching, 2020.

Addressing challenges to virtual CPD

Certain issues like funding and time will not be new to the virtual look of CPD, but the pandemic itself may enable physicians to address these challenges successfully. First, physicians often have dedicated funding for CPD. Amidst cancellations of in-person conferences and courses due to COVID-19, now is the ideal time to use those funds for personalized improvement efforts like video-based coaching.

Delays in clinical operations can also be leveraged for physicians’ individual growth. With travel restrictions in place and clinical operations resuming at variable paces across the nation, many surgeons will experience some lull in their clinical volume. Videoconferencing and video-sharing technology enable timely, meaningful assessment and improvement opportunities during these lulls, sparing the time commitments of traveling off-site.

Other challenges like medicolegal risk and technological learning curves are unique to virtual CPD, although the pandemic has also opened doors to tackle these questions with optimism. For example, the explosion of telemedicine during COVID-19 may accelerate existing work to protect clinicians and researchers from liability when implementing other video-based technological advances like artificial intelligence.

Regarding the technological learning curve, the pandemic has rapidly forced physicians to adopt the same videoconferencing technology that facilitates video-based assessment and coaching. As such, physicians already have a head start on the basic functionalities required to implement virtual CPD.

Conclusions

Though challenges are expected, virtual CPD may be closer within reach than any glimmer of in-person CPD activities of the past. Not only may virtual learning be a safer and more feasible option for ensuring that physicians uphold their professional expectations to continually improve, but it may prove to be more meaningful and valuable than pre-pandemic versions. The personalized, formative nature of video-based assessment and coaching can enrich CPD immediately and rescue the ABMS’s Vision for continuing certification from the pandemic’s educational crisis.

Acknowledgments

The authors would like to thank Adrienne E. Faerber, PhD, for developing the figure in this article.

Requests for reprints may be made to the Corresponding Author:

Jason Pradarelli, MD, MS
Academy for Surgical Coaching
2858 University Ave #264
Madison WI 53705
Phone: (608) 301-5155
Email: jpradarelli@partners.org

About the Authors

Jason Pradarelli, MD, MS, is the medical director at the Academy for Surgical Coaching (A4SC), a not-for-profit organization that strives to empower surgeons through surgical coaching to improve their clinical performance, well-being, and patient care. He is a general surgery resident at Brigham and Women’s Hospital in Boston, MA.

Sudha Pavuluri Quamme, MD, MS, is the vice president and co-founder of the A4SC. She is a researcher at the University of Wisconsin School of Medicine and Public Health in Madison, WI.

Caprice Greenberg, MD, FACS, is the president and co-founder of the A4SC. She is a Professor of Surgery and the Morgridge Distinguished Chair in Health Services Research at the University of Wisconsin School of Medicine and Public Health in Madison, WI.