key: cord-301480-jk8avgky
authors: Brian, Riley; Stock, Peter; Syed, Shareef; Hirose, Kenzo; Reilly, Linda; O'Sullivan, Patricia
title: How COVID-19 inspired surgical residents to rethink educational programs
date: 2020-10-21
journal: Am J Surg
DOI: 10.1016/j.amjsurg.2020.10.027
sha: 
doc_id: 301480
cord_uid: jk8avgky

nan

Focus group transcripts were independently reviewed by two investigators (RB and PO'S) and codes were identified using qualitative content analysis. (8) This method allowed for interpretation of comments in the evolving context of the COVID-19 pandemic. The investigators developed a codebook and applied codes to the six transcripts. Excerpts from transcripts were reviewed again by code to identify broader themes. Themes were discussed by J o u r n a l P r e -p r o o f investigators to reach consensus. Three major themes of discussion were identified: competencybased education, changes in teaching, and relationships.

The first identified theme was competency-based education and the tension residents experienced between obtaining a certain number of cases to meet requirements and wondering if case number was the right way to determine competency. Residents of all levels were concerned about their decreased operative exposure, with one summarizing "my biggest qualm is the cases" (R3). Others pointed out that to become a surgeon requires a certain operative proficiency, regardless of the actual number of logged cases. One resident said, "our program is still five years and so it just makes me nervous that we'll have to grow more rapidly" (R1) while another thought that "every single month of our five clinical years of training is probably not indispensable to graduate as a good surgeon" (RR).

The second identified theme was changes in teaching. Residents discovered the creation of various new and useful video-based didactics, from a service-specific level up to a national level. Virtual didactics afforded new flexibility, as one resident noted, "you can have these amazing lectures recorded or technical skills recorded and available to you" (R2). Additionally, residents in clinical years benefited from new journal clubs, skills sessions, and dedicated didactic sessions by expert attendings as well as technical practice, operative debriefing, and quizzing with peers. Furthermore, the residents found they had time to learn about each case more thoroughly than before. One resident stated, "I do like how you get a little more time to debrief on what you've done" (R3).

The final identified theme was relationships between surgical residents and their patients, patients' families, and faculty. First, new social distancing and personal protective equipment (PPE) guidelines affected patient relationships. One resident remarked, "wearing the mask all the J o u r n a l P r e -p r o o f time is such a problem in terms of being able to convey empathy…because they [patients] can't see your face" (R1). Second, changes affected relationships with families and some residents recognized that virtual stand-ins for family presence were unsatisfactory. A resident noted of this that "having multiple people conferenced in just doesn't work well for talking" (RR). Third, the pandemic affected relationships between residents and faculty. Some residents questioned the differential exposure to COVID-19 among residents and faculty members, with one resident stating "there was never any plan to reduce resident exposure by using faculty more than usual" Overall, our surgical residents experienced many educational changes due to the COVID-19 pandemic. By applying what we have learned from residents' insights, we hope that we can refine surgical training and education moving forward. We can imagine greater attention to competency-based surgical education. We also envision further emphasis on communication skills ranging from nonverbal communication to family conversations to telemedicine. Importantly, time that residents and faculty spend together should increase. This will both improve education and foster the strong relationships critical to the training of quality surgeons.

J o u r n a l P r e -p r o o f

Rapid Response of an Academic Surgical Department to the COVID-19 Pandemic: Implications for Patients, Surgeons, and the Community

Physically Distant, Educationally Connected: Interactive Conferencing in the Era of COVID-19

Insights on Otolaryngology Residency Training during the COVID-19 Pandemic. Otolaryngol Head Neck Surg

Orthopaedic Education During the COVID-19 Pandemic

Using Technology to Maintain the Education of Residents During the COVID-19 Pandemic

Five Questions for Residency Leadership in the Time of COVID-19: Reflections of Chief Medical Residents From an Internal Medicine Program

Addressing General Surgery Residents' Concerns in the Early Phase of the COVID-19 Pandemic

Three Approaches to Qualitative Content Analysis. Qualitative Health Research

Training disrupted: Practical tips for supporting competency-based medical education during the COVID-19 pandemic