Addressing the Surgical Training Gaps Caused by the COVID-19 Pandemic: An Opportunity for Implementing Standards for Remote Surgical Training

Abstract

As a result of the coronavirus disease of 2019 (COVID-19) pandemic, most medical institutions have discontinued student clinical rotations and modified resident education by drastically limiting hours of hospital exposure. Such social distancing measures have especially affected trainees in fields such as plastic surgery, which is characterized by performing a high volume of elective procedures, which have been discontinued or even prohibited in certain states. To address the gaps in the surgical training for both medical students and residents during this pandemic, we would like to bring attention to the importance of engaging trainees in telemedicine and livestreaming of surgical procedures. The lifting of Health Insurance Portability and Accountability Act of 1996 restrictions surrounding telemedicine have positively impacted patients seeking plastic surgery consultations, especially for conditions such as breast cancer, which cannot wait until the pandemic abates. At our institution, we have experienced an exceptional sense of camaraderie centered on saving lives by mitigating coronavirus disease transmission. The same spirit of collaboration has been evident in health care institutions at both the national and the international levels. As a result of these changes in both regulations and collaboration, support for remote surgical training may be available today more than ever before. Although there are concerns regarding the safety of live-streaming operations,1,2 studies have shown that outcomes are not compromised.3,4 The fields of urology3 and cardiothoracic surgery4,5 used these teaching methodologies extensively, and guidelines have been created to ensure patient safety.5 Some of our proposed teaching concepts are as follows: Sit-down didactic and patient-care conferences using Health Insurance Portability and Accountability Act–compliant teleconference/telemedicine application with both residents and medical students. Following appropriate patient selection and consent, conduct rounds with smart devices and Health Insurance Portability and Accountability Act–compliant teleconference/telemedicine applications. Trainees can log in, along with other patient care team members. With the appropriate patient and consent, conduct clinic patient visits with the medical student and/or resident connected by means of Health Insurance Portability and Accountability Act–compliant teleconference/telemedicine application. During appropriate situations, live-stream crucial portions of the operation from a head-light camera to a laptop, which is connected by means of video conference using Health Insurance Portability and Accountability Act–compliant teleconference/telemedicine application to remote students and residents. We envision ample opportunities in using our encrypted Web-based communication technologies during this time, not only to maintain high standards in patient care but also in teaching medical students and residents. Some of the teaching innovations we would implement will propagate with long-lasting positive impact, even when the current Health Insurance Portability and Accountability Act law relaxation retracts to whatever degree as the pandemic abates. Within the field of plastic surgery, national organizations such as the American Society of Plastic Surgeons should be encouraged to take advantage of the changing times to support the use of remote surgical training. Adopting these practices may help trainees who may not have access to the training opportunities because of distance, leaves of absence, or illness. The strict Health Insurance Portability and Accountability Act rules surrounding telemedicine may relax to some degree permanently as a result of the pandemic, and as a specialty supporting remote surgical training, we can help lead future innovations that will have a crucial impact in patient care and medical education. DISCLOSURE The authors do not have any financial interests to declare in relation to the content of this article. No funding was received for the creation of this article.

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