In Reply to the Letter to the Editor Regarding “Early Changes to Neurosurgery Resident Training During the COVID-19 Pandemic at a Large United States Academic Medical Center”

We are glad for the opportunity to respond to Goyal et al's¹ thoughtful comments and appreciate their interest. They note a remarkably similar lockdown period to that which occurred here in Miami-Dade County, with cancellation of elective cases also disproportionately affecting some subspecialties like neurooncology and spinal deformity.² As part of a broader effort to address resulting deficiencies in resident training during the pandemic, Goyal et al¹ also point out a significant reduction in research activities affecting neurosurgery residents across India as a result of the pandemic. Certainly, while less time in the operating room allows for more clinical analysis and introspection, productivity at the bench and collaboration across laboratories and institutions have required innovative approaches.^{3 , 4}

As eloquently expressed in Goyal et al's¹ letter, the years comprising intensive surgical training are truly a make-or-break time in the life of every neurosurgeon. American football coach Vince Lombardi is noted to have said, “We didn't lose the game; we just ran out of time.”⁵ As residency training must occur over a finite period of time, success may be viewed as a race against the clock. We anticipate the optimal formula during and after the pandemic will include a combination of integrated videoconferencing didactics, anatomic laboratory training, and adjustments to resident rotation schedules.^{6 , 7} Accordingly, early and thorough analysis of the pandemic's impact on resident training within institutions across the world will be critical in identifying deficiencies in time to make meaningful adjustments.