Invited commentary on “the lasting footprint of COVID-19 on surgical education: A resident and attending perspective on the global pandemic”

There is an often-cited quote (commonly misattributed to Charles Darwin) that reads as follows:

“It is not the strongest of species that survives, nor the most intelligent. It is the one that is the most adaptable to change”

While Darwin may have never uttered these exact words himself, the topic of adaptability in the face of change clearly permeates his writings.¹ In the years following Darwin’s explorations, many of his ideas and hypotheses have been co-opted and expanded to explain the functioning of societies, cultures, and any number of institutions far beyond their original subjects of study. In keeping with this extension of ideas, we posit that in times of significant upheaval, adaptability to change will be just as important to the training of surgical residents as it was to the Galapagos Finch.

In this issue of AJS, Imai et al. discuss the ways that COVID-19 has impacted the training of surgical residents, and offers perspectives from both faculty and trainees on the severity of these changes and strategies for future adaptation.² We applaud the authors for providing this timely perspective on how their program has been affected by the recent global pandemic. While a number of recent articles in literature describe the unique challenges faced by surgical residencies of all subtypes, we have yet to determine the best way forward as a cohesive society of surgeons, and unique perspectives from across the surgical discipline will be necessary to develop mechanisms forward that are both comprehensive yet flexible.3, 4, 5, 6

Of particular interest to us was the authors comments regarding the transition to virtual curriculum. Though this transition was precipitated by necessity in the face of COVID-19, we agree that in some regards it may actually result in an improved educational experience for surgical trainees. Our residency program is spread across four different hospital locations in our community, with all formal education and conferences being held at our largest hospital affiliate. Prior to the pandemic, this meant that we had some residents starting their Mondays by travelling out to training sites, rounding on patients and placing initial orders, and returning to their cars to beat the traffic heading into downtown to make it to our weekly conference on time. The inefficiency of this is apparent. In the 80-h workweek era, it is of the highest importance to maximize the training time of residents, and every minute spent in a car on the interstate is not spent in the operating theater or at the patient’s bedside. While it may have taken a global pandemic to push many industries and organizations fully into the digital era, now that we are here we should not forsake some of the advances in efficiency that we have made once the threat of novel coronavirus subsides.

Now, to reverse course on this topic (and hopefully avoid a slew of animated email responses), our above arguments regarding the implementation of virtual curriculum do not mean that we fail to recognize the value and importance of face-to-face interaction. Clearly there is benefit to the surgical resident standing at the podium under the bright lights of the auditorium to present a case for morbidity and mortality conference, or to review recent literature during a grand rounds presentation to the department. These experiences not only serve to prepare trainees for completion of their oral boards, but as a way to interact with their peers and professors on a level not possible by video monitor. We agree that these experiences are important to a surgeon’s education. We simply state that in the age of duty hour restrictions, it is imperative that we maximize the 80 hours a week of in-hospital education that trainees are allowed, and if the use of virtual methods in certain settings can provide residents more time with patients, all the better.

The challenges of the past year have changed both the way we care for patients as well as the way we train the next generation of surgeons. Circumstances have dictated that we adapt or die, and in the grand scheme of things, this is nothing new. However, not all of our adaptations represent negative change, and we would be remiss if we did not identify and expand upon the areas where adaptation has changed us for the better. As vaccinations rise and case numbers fall, the next challenge in surgical training will be determining which processes need to return to the old way, and which should keep moving forward without looking back.