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


ACS Academy of Master Surgeon Educators Committee Addresses Challenges and Opportunities in Surgical Training during COVID-19

COVID-19 has affected so many aspects of life. Lives have been lost, many people find themselves unemployed, life milestones such as weddings and graduations have been missed. Few adversities can affect the private surgeon in Arizona in a very similar manner to the surgical resident in Massachusetts. Resilience is defined as the ability to thrive in the face of adversity. A major tenet of resilience is positive psychology that relies on optimism. We learn that adversity is not personal, pervasive, or permanent. A growth mindset guides us to thrive and improve as a result of the adversity we are facing.

It is with this spirit of resilience and positive thinking that the ACS Academy of Master Surgeon Educators™ set up a Special Committee, co-chaired by L.D. Britt, MD, MPH, DSc(Hon), FACS, FCCM, FRCSEng(Hon), FRCSEd(Hon), FWACS(Hon), FRCSI(Hon), FCS(SA)(Hon), FRCSGlasg(Hon), ACS Past-President, and Ajit K. Sachdeva, MD, FACS, FRCSC, FSACME, Director, ACS Division of Education, to explore ways of innovating and improving surgical education in the aftermath of COVID-19. The goal of the committee from inception in March 2020 was to assist surgical educators who were living with a surge of COVID-19 or who were anticipating it, with the task of teaching their learners. A second objective of the committee was to document the effects of COVID-19 on surgical education. The final purpose was to use this adversity to innovate in surgical education. The latter objective led to the formation of the Subcommittee on Novel Teaching and Assessment Methods.

The members of this subcommittee include Mohsen M. Shabahang, MD, PhD, FACS (Chair); ACS Regent Anthony Atala, MD, FACS; Dr. Britt; Paris Butler, MD, MPH; ACS Regent James Denneny, MD, FACS; Brenessa Lindemann, MD, MEHP; John Mellinger, MD, FACS; Dr. Sachdeva; and Kathryn Spanknebel, MD, FACS. The group began deliberations in late March through a series of interviews with each member. The fundamental tenets that emerged from these early deliberations can be summarized in the following principles:

  • There is a need for increased communications among thought leaders in surgical education, such as members of the Academy, to discuss and curate the innovations that will be necessary as a result of the pandemic.
  • The use of virtual methods for communication and education should be used to allow for the purpose of “democratization” of surgical education, allowing all learners in different programs access to thought leaders and experts.
  • These concepts should be used to provide some guidelines for long-lasting innovation in surgical education, including concepts of distance learning.

This group has met weekly and, through an iterative process, arrived at action items and deliverables for the principles above. Some action items have already been set in motion, some will be done over the next month, and others will take form over the next few months. Here is a list of deliverables:

  1. Increased communication among surgical educators: The most important deliverable in this area is the creation of the Academy listserv. The Academy listserv was created to allow the exchange of ideas between members in a dynamic, organic, and flexible fashion. We plan to promote discussions about issues that are facing us in the aftermath of COVID-19. However, this mechanism will allow for a continual discussion of issues pertinent to surgical educators. We believe that the postings and discussions will illuminate areas of debate that can then be further explored in other forums.
  2. The discussions of the subcommittee in the arena of utility of virtual learning methods has led to two areas of focus:
    1. Virtual grand rounds: Throughout our surgical careers, we have held the concept of grand rounds as an opportunity to be exposed to a thought leader who traveled to our institution. What if this could be accessible at our discretion any time? That is the thought process behind this concept. The subcommittee plans for this process to take shape in three different ways:
      1. Make available archived audio and video recordings of lectures from the ACS Clinical Congress to membership.
      2. Provide a live virtual grand rounds with experts starting in June 2020. These will be recorded and made available in an asynchronous fashion.
      3. Archive and provide access to recordings of grand rounds delivered by visiting professors donated by departments of surgery.
    2. Surgical learning collaboratives: The members of the subcommittee have discussed methods for bringing groups of learning programs together to share resources. These resources can be in the form of faculty and their expertise, assessment methods, and simulation. Many programs already do this in the form of regional mock orals. We anticipate that by possibly linking this concept to the Consortium of ACS-Accredited Education Institutes, we can further formalize some of these relationships. Through the use of virtual methods, we can downplay the limitations of physical distance in surgical education.
  3. As we considered the most pressing issues in surgical education, especially in the era of COVID-19, the subcommittee has decided to focus on two areas:
    1. Virtual interviews: As many have used virtual technology for didactic teaching, high-stakes examination such as the Certifying Exam of the American Board of Surgery, and fellowship interviews, the group plans on studying the use of virtual interviews in the recruitment of surgical learners. This takes on more significance as organizations such as the American Association of Medical Colleges have recommended virtual interviews for the recruitment season in 2020–2021. The plan is to explore this topic through the viewpoint of program directors, learners, and our colleagues in the business world. The logistics and reliability of the interview as an assessment tool will be addressed. These guidelines will be published by August 2020, before the start of the next recruitment season.
    2. Telemedicine: One of the most significant outcomes of the COVID-19 pandemic in the medical world has been the intense increase in the use of telemedicine for patient visits. This technology provides obstacles to surgical education, but the opportunities far outweigh the challenges. The subcommittee membership will be exploring best practices in incorporating surgical learners into clinical visits using telemedicine. We will further explore opportunities that telemedicine offers in surgical education.

In summary, the COVID-19 pandemic has caused much suffering. Ironically, as much as physical travel has been reduced, the pandemic has allowed us to explore ways in which virtual technology brings us closer together as a community. The work of this subcommittee has focused on applying this reality to surgical education.