Yoshua Esquenzai
Yoshua Esquenazi, MD

The COVID-19 pandemic has affected virtually all aspects of the health care system. From fighting the virus on the front lines, to the cancellation of elective surgeries, and even changes in medical education, the pandemic will have both immediate and future impacts on health care worldwide.

In a recently article published in World Neurosurgery, titled “Challenges of Neurosurgery Education During the Coronavirus Disease 2019 (COVID-19) Pandemic: A U.S. Perspective,” Yoshua Esquenazi, MD, assistant professor in the Vivian L. Smith Department of Neurosurgery; as well as neurosurgery residents Cole Lewis, MD; and Hussein Zeineddine, MD; discuss the changes faced by residents in the field of neurosurgery and available resources to help education continue in difficult times.

In late January 2020 the first case of COVID-19 was reported in the United States, and with cases continuing to rise, the American College of Surgeons recommended the suspension of all elective surgeries on March 13, 2020. Moreover, to help combat the virus, health care systems shifted resources, including rearranging staff, which has led to a decrease in the amount of clinical training for neurosurgery residents.

“Surgical residents have long reaped the learning benefits of all aspects of training,” the authors of the paper said. “The large drop in the number of cases invariably witnessed by all programs due to elective surgery cancellations takes a toll on resident technical training. This decrease in operative intervention affects not only the technical training of surgical residents, but also the postoperative management experience that comes with elective surgeries.”

Although hands-on clinical experience for residents has suffered, institutions like McGovern Medical School have been able to use emerging technologies like phone visits and telemedicine to help bridge the gap.

“Although these do not offer the same experience as tradition visits, they still allow residents the opportunity to evaluate patients, review imaging, and form a differential diagnosis and plan,” the authors said. “The residents also can continue to conduct postoperative care.”

“Furthermore, telemedicine is being used in health care on a routine basis for certain pathologies, and resident experience with telemedicine provides and educational opportunity to participate in an advancing field.”

In addition to hands-on training, residents have lost the ability to meet in person at subspecialty conferences, departmental grand rounds, and didactic lectures, which offer real-world advice and guidance from professionals in the field. Cancellations for neurosurgery residents include the annual meetings of the, World Federation of Neurosurgical Societies, the American Association of Neurological Surgeons (AANS), and the Society of Neurological Surgeons (SNS) as well as the postponement of the American Board of Neurological Surgery (ABNS) Annual Primary Examination.

However, with the modern benefit of eLearning, neurosurgical training includes numerous online training tools such as anatomy resources, case illustrations, operative videos, and a wide breadth of peer-reviewed publications. In addition, the AANS and the Congress of Neurological Surgeons (CNS) have opened access to online lecture series, virtual visiting professor conferences and created COVID-19 information hubs, while the SNS has provided online training videos to show patient assessment pearls, medical management techniques, and operative approaches.

“The educational hurdles placed by the COVID-19 pandemic has emphasized the importance of online educational tools by allowing continued learning without increasing exposure risks,” the authors said. “In today’s unique environment, it is paramount that neurosurgical education evolves to ensure safety of its trainees, as well as effective training. Now more than ever, resident trainees must be self-disciplined, creative, and resilient.”