Letter to the Editor Regarding “Medical Student Concerns Relating to Neurosurgery Education During COVID-19”

We read with great interest the survey published by Guandix et al.,¹ in which they try to identify the concerns of medical students interested in pursuing a career in neurosurgery during the COVID-19 pandemic. They reported that a concerning percentage of students are worried about opportunities (63%), clinical experience (59%), and examination scores (42%). Worryingly enough, the large majority of students had to cancel/postpone their neurosurgery rotation and there was a significantly increased number of medical students considering taking 1 year off from medical school.

To overcome this problem, virtual mentorship pairing was the highest-rated educational intervention suggested by first- and second-year medical students. The third- and fourth-year medical students had cited virtual surgical skills workshops most frequently.

Unfortunately, these problems are common all over the world in these difficult times.² This situation could be responsible for even worse scenarios because there is the risk that the brightest students could decide to apply for other specialties that they had the chance to experience, instead.³

To overcome this situation, we suggest some of the implementations that we have adopted and that can be easily replicated to allow distant learning.

Blended learning is a new educational approach that consists of the use of online resources to enhance didactic and clinical knowledge as well as reasoning skills.⁴ It is already known that online resources are continuously created to improve education at different levels for surgeons, medical students, residents, and fellows, especially in the surgical fields.^{4 , 5} Because of the COVID-19 outbreak, the incorporation of virtual learning in surgical education has exponentially increased.

It is now clear that virtual learning is not limited to the delivery of didactic materials online. These platforms in fact offer the opportunity to improve clinical skills with decision-making exercises, integrated with surgical anatomy reviews, surgical procedure walkthroughs, and intricate patient cases.^{4 , 5} Students practice developing differential diagnoses and improve clinical reasoning. Through this method, medical students will be more prepared when returning to their clerkships, capturing more positive learning experiences.

Though virtual learning can support certain aspects of surgical education, it cannot bridge certain gaps. It is difficult for the current virtual platforms to address the lack of intraoperative experiences. The use of virtual learning can not only minimize the impact of the delay caused by this pandemic but can also better prepare students for the rigorous surgical clerkship and allow for increased focus on intraoperative experiences.⁶ In order to try to minimize this educational delay, students can take advantage of online courses in suturing techniques with at-home practice kits. Though this does not fully replace hands-on experience, continuing education through virtual means is the best approach to mitigate lost time in the operating room.^{6 , 7}

Now that several vaccines have been approved, we can begin to see the ending of this pandemic; however, the use of virtual learning in surgical education should continue to grow. The permanent utilization of blended learning should be established. It has been widely shown that students exhibit a significant improvement in academic performance when taught via a blended learning style versus a traditional teaching method.⁸ The integration of those interactive modules with traditional teaching creates students who are primed for their surgical clerkship, enhancing their surgical experiences.

This approach should be also considered in residency programs. This strategy is a viable approach to tackling resident burnout by allowing more time for mindfulness, improving overall mental health and morale.⁹ Utilizing blended learning in residency promotes “dual coding” of both visual and verbal experiences, which is associated with enhanced recall and retention. Additionally, virtual learning provides avenues for surgeons to complete required continuing education courses. The time saved from traveling to distant sites can instead be allocated to self-care time, helping address physician burnout.¹⁰ The recommendations to incorporate virtual learning at each level of surgical education creates a constant flow of technological exposure. Across all levels of surgical education, virtual learning provides 24/7 accessible interactive platforms and online resources to continually enrich surgical training. Nevertheless, it is important to highlight that, at present, virtual learning serves as a means to improve surgical education by creating easily accessible platforms for distributing knowledge and practicing skills, but it is not as a full replacement for hands-on clinical experiences.