by Michael Hu, MD, MPH, MS1, and Jeremie D. Oliver, MS2
1 Plastic Surgery Resident, University of Pittsburgh
2 MD/PhD/MBA Candidate, University of Utah
On March 11, 2020, the World Health Organization (WHO) declared the outbreak of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which causes coronavirus disease 2019 (COVID-19) as a pandemic.1 First identified in Wuhan, China in December 20192, SARS-CoV-2 has spread to 187 countries/regions with over 4.2 million confirmed cases and about 290,000 deaths worldwide as of May 12, 2020. Currently, the United States has the highest number of confirmed cases in any given country at nearly 1.4 million confirmed cases and over 80,000 deaths.3 Although the cases and deaths vary by state, city, and local regions, this pandemic has likely affected all plastic surgery residents and medical students in the United States.
Effects of COVID-19 on Plastic Surgery Training
The effects of the COVID-19 pandemic have varied greatly across hospital systems in the United States. Some of the worst hit regions, such as New York City, have witnessed a tremendous consumption of healthcare resources for the treatment of patients with COVID-19. However, even in regions less burdened by the insidious virus, the mere threat has resulted in unprecedented changes both inside and outside the hospital in hopes to “flatten the curve” and preserve resources.
On March 13, 2020, the American College of Surgeons (ACS) released recommendations for surgical management of elective operations during the COVID-19 pandemic:
Each hospital, health system, and surgeon should thoughtfully review all scheduled elective procedures with a plan to minimize, postpone, or cancel electively scheduled operations, endoscopies, or other invasive procedures until we have passed the predicted inflection point in the exposure graph and can be confident that our health care infrastructure can support a potentially rapid and overwhelming uptick in critical patient care needs.4
Given that a large proportion of operations performed by plastic and reconstructive surgeons can be classified as elective, this has resulted in a reduced operative volume for the plastic surgery trainee.
On March 19, 2020, the American Board of Plastic Surgery (ABPS) notified program directors and residency coordinators of an update to the Personal Leave Policy relative to the COVID-19 pandemic allowing for up to 12 weeks of approved personal leave because of “illness, quarantine or workforce preservation”.5 As such, to reduce risk of SARS-CoV-2 transmission among patients and house staff, many training programs have instituted reduced workdays/hours with a minimal crew.
The Department of Plastic Surgery at the University of Pittsburgh, like many other programs, has instituted a “skeleton crew” consisting of roughly half the typical number of residents on a given service alternating every week with minimal contact between different crews and services. Weekly grand rounds and education conferences have shifted to virtual meetings utilizing Zoom video conferencing. In addition, 3 weekly virtual check-ins with the program director and faculty are held. The Plastic Surgery Foundation (PSF) Visiting Professor Lectureship at the University of Pittsburgh with Dr. Jesse Taylor was successfully held virtually to a large audience on Wednesday, April 29, 2020. Dr. Taylor shared his years of experience on enhancing the appearance and functionality in those with craniofacial disorders. Pitt plastic surgery residents were even able to present cases virtually and had an invaluable educational experience! Finally, given social distancing is necessary both in and out of the hospital, Pitt Plastic Surgery hosts weekly virtual “happy hours”. This consists of virtual games with attendings and residents, such as virtual charades, or a formal “Inside the PittPlastics Studio” interview series where a faculty member is interviewed by a chief resident and promises to be ridiculous, a little enlightening, uplifting, and wholehearted fun. Residency training programs throughout the country have implemented similar changes.
Plastic Surgery Education in the Time of COVID-19
Although plastic surgery residency programs have rapidly enacted changes to maximize resident education during this unprecedented pandemic, the decrease in case volume is impactful. There is no substitute for operative training. However, through web-based surgical videos, webinars, and virtual lectures/educational sessions, there are ample resources for the plastic surgery resident. Dr. Arya Akhavan, plastic surgery resident at the University of North Carolina, has compiled a Google calendar which includes web-based didactics from the American Society of Plastic Surgeons (ASPS), American Society for Surgery of the Hand (ASSH), Aesthetic Society, as well as numerous industry-sponsored events, just to name a few.
Medical Student Perspective
With the widespread social distancing measures enacted across university campuses nationwide, medical students stand at the threshold between the educational system and clinical workforce. For graduating 4th year students, controversies have sparked regarding early graduation, ousting trainees into the clinical frontlines of the pandemic. While a number of eager fresh MD’s have boldly charged into intern duties, some concerns have been raised regarding the safety of allowing these graduates to function in the hospital system in such charged times without having so much as a couple of weeks of internship under their belts. The truly unprecedented nature of COVID-19’s toll on humanity, society, and medical education will span for generations to come.
As most plastic surgery residents and medical students have a reduced clinical workload, the unprecedented free time can also be used to study, maintain academic productivity with basic science or clinical research, prepare manuscripts/reviews/book chapters, or just enjoy the extra time to focus on wellness. During medical education and residency training, it is difficult to find time to exercise, eat healthy, and practice mindfulness/meditation. Moreover, time with family/friends is often deprioritized. The silver lining to this pandemic may be to provide a time to reflect on what is important and why we choose to devote our lives to this amazing yet demanding profession. Like all trials, we will come out of this better and stronger. And as is often said during residency: “this too shall pass!”
1 “WHO Director-General’s opening remarks at the media briefing on COVID-19 – 11 March 2020”. World Health Organization. 11 March 2020. Retrieved 12 May 2020.
2 Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
3 “Coronavirus Resource Center”. Johns Hopkins University & Medicine. 12 May 2020. Retrieved 12 May 2020.
4 “American College of Surgeons releases recommendations for surgical management of elective operations during COVID-19 pandemic”. American College of Surgeons. 13 March 2020. Retrieved 12 May 2020.
5 “Residency Training Requirements for Plastic Surgery”. American Board of Plastic Surgery. Retrieved 12 May 2020.