Establishing a Virtual Curriculum for Surgical Subinternships

Abstract

Sir: The coronavirus disease 2019 (COVID-19) pandemic has thrust our medical community into a time of unprecedented change, both socially and professionally. The Association of American Medical Colleges and the American Council of Academic Plastic Surgeons issued statements recommending the cessation of in-person student rotations and interviews for the foreseeable future.1,2 Although program directors lament lost recruitment opportunities, senior medical students stand to lose important professional development opportunities.3 Subinternships are vital to mitigate educational and clinical experience gaps before residency.4 These rotations also allow students to find mentors to guide them through the recruitment process, which is particularly relevant for students without a home plastic surgery training program. In response, we developed a surgical subinternship to bridge the gap for both programs and students during this vital time in training. The objectives for the virtual subinternship remain relatively the same as those outlined by the Accreditation Council for Graduate Medical Education core competencies for in-person rotations. Adjustments were made to accommodate transition to a virtual medium while maintaining equity toward both students and programs (Table 1). To ensure success of our virtual curriculum, materials (e.g., modules, videos, standardized anatomical atlases, surgical preparation tools) are provided to both instructors and learners before the rotation. Familiarity with course materials allows for ease of understanding during interactions and solidifies the first step in knowledge retention. Table 1. - Virtual Subinternship Course Objectives and Educational Modalities Used Objective Educational Modality Clinical and operative learning 1. Weekly virtual inpatient rounds with all residents and faculty 2. Daily clinical case discussions with faculty and residents, focusing on procedural sequence and surgical anatomy 3. Standardized anatomical manual for faculty and students to identify and discuss simulated surgical cases Didactic learning 1. Introductory plastic surgery learning module 2. Weekly virtual grand rounds lecturers 3. Resident didactic conference 4. Morbidity and mortality conference 5. Assigned ASPS EdNet modules Improvement in technical skills 1. Suture skills training video 2. Weekly virtual suture laboratory (Fig. 1) Opportunity for faculty mentorship 1. Multiple one-on-one virtual meetings with faculty members Professional development and research opportunities 1. Interview preparation session 2. Weekly research conference 3. Opportunities for longitudinal research projects 4. End-of rotation presentation Assessing mutual personality fit between program and student rotator 1. Exit interview with faculty 2. End-of-rotation presentation 3. Virtual social hour with residents 4. All scheduled interactive activities ASPS, American Society of Plastic Surgeons; EdNet, Education Network. Fig. 1.: An inexpensive virtual suture laboratory setup. Four sides are removed from a cardboard box, a small hole is made at the top, and the base is secured flush with the workspace. A smartphone equipped with video conference software is placed with the camera viewfinder over the box’s small hole to allow live recording of suture technique with basic surgical instruments, suture material from provided retailers, and everyday objects. Before their rotation, students are provided links to high-quality, open-sourced instructional video for suture skills for additional precourse preparation.The American Society of Plastic Surgeons has generously opened the Education Network platform to students, which alleviated the burden of developing a topical curriculum de novo. Education Network modules provide didactic plastic surgery instruction through slide presentations, clinical case scenarios, journal articles, and quizzes. Selected modules focusing on the most relevant topics for incoming interns (e.g., hand and face anatomy, critical care) are assigned before the start of the rotation in addition to modules pertinent to upcoming cases at our hospital each week. These precourse modules allow for deeper discussions of technical sequence and complex anatomy during simulated surgical cases and more comprehensive discussion during virtual clinical scenarios. Formative feedback is provided using both Education Network module quizzes and curated quizzes created by our program. Verbal feedback is provided to the students through midcourse mentorship meetings and finalized during the student’s exit interview. Surgical technical skills are challenging to teach and evaluate without in-person interaction. To overcome this, we developed an inexpensive suture laboratory setup to facilitate real-time technical skills instruction, allowing the instructor to virtually observe the student’s progress and provide live instruction (Fig. 1).5 To our knowledge, we are the first to design and execute a virtual subinternship for rising fourth-year medical students. Early postrotation feedback has been promising, but formal evaluation of the program’s efficacy is still ongoing. We anticipate that the course will evolve as feedback is obtained to optimize the experience within our stated objectives. In light of the recent American Council of Academic Plastic Surgeons position discouraging in-person away rotations during the ongoing COVID-19 pandemic, we strongly encourage other residency training programs to offer similar virtual learning opportunities for medical students, particularly for those without access to a home plastic surgery training program. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

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