Education and Training for Craniomaxillofacial Surgeons in the Context of COVID-19

As worldwide efforts to address the COVID-19 pandemic continue, we are seeing the impacts, both positive and negative, on all aspects of craniomaxillofacial (CMF) surgical care. Alterations in clinical practice, ranging from changes in the distribution and type of cases performed to CMF surgeons performing primary medical and critical care functions, have become the norm. The financial impact on practices, both community and hospital-based are unprecedented and remain incompletely defined. The CMF community has been steadfast in working with public health experts and frontline medical colleagues to appropriately tailor care to the changing needs of our health care systems to ensure safe provision of care to patients with post-traumatic, post-ablative, or congenital facial differences. The positive impacts of these concerted efforts are beginning to be evident, both for patients and the health care complex at large. Updated guidelines from the International AO CMF Taskforce reflect this improved understanding of the disease epidemiology.¹

In addition to the impact of CMF surgeons on their patients and communities, there have been a number of adaptations to ensure continued excellence in training for trainees within CMF surgery. Educational programs have been efficiently transitioned to virtual formats, which have not only minimized disruptions in didactic learning for trainees but also potentially expanded the access to education worldwide. Component specialties have begun to document their individualized approaches to maintaining high educational standards in the context of significant workforce challenges. Tailored instructional strategies have included multi-institutional collaborations, modified syllabi for medical and dental student education, improved open-access content, and real-time virtual didactic instruction. These shared experiences have helped shape the “new normal” for CMF education and, in many ways, have improved an already robust educational platform.

Preliminary experiences with modified educational strategies have yielded several observations.^2–7 A large majority of trainees have reported modifications to their training program structures, including redeployment to nonsurgical services (eg, critical care), and have moved to web-based didactic programs, with positive reception. Worrisome trends include concerns from trainees regarding the availability of personal protective equipment, increased risk for contracting COVID-19 when compared to attending surgeons, access to testing, and completion of necessary requirements for graduation in the setting of decreased operative volumes.

Our CMF community has always been at the forefront of innovation for patient care, research, and education and the response to the challenges presented by COVID-19 has been consistent with this. As clinical care guidelines continue to evolve in association with our understanding of the COVID-19 disease pathophysiology and epidemiology, paradigms for education will similarly need to continue to be refined. Our community will need to ensure safe and appropriate care for patients, while also continuing to train the next generation of CMF surgeons. In this latter regard, preliminary assessments are positive, but much work remains to be done to maintain the high standards of education that are fundamental to CMF surgery.

Sat Parmar, Srinivas M. Susarla, Rui P. Fernandes