Spinal surgery training adapted during COVID-19 pandemic

James A Dowdell

Training of spine fellows has been impacted but not diminished as a result of the COVID-19 pandemic, according to a paper published online in The Spine Journal. Authored by James E Dowdell and colleagues from the Department of Orthopedic Surgery at the Hospital for Special Surgery (New York, USA) the paper details how the spine service at a tertiary single surgical specialty hospital at the epicentre of the pandemic has restructured to serve at the frontlines of the battle against COVID-19.

“COVID-19 has changed the world significantly over the last few months as we struggle to contain the largest public health crisis in our lifetime,” Dowdell and colleagues write in the introduction to the article, adding that while the primary focus throughout the pandemic has been managing COVID-19 patients and ensuring a safe outcome for as many patients as possible, “it is hard not to think about the potential negative impact this has had on residents and fellows in surgical subspecialties who will never regain this lost time in training.”

The paper notes that the suspension of non-essential care, taken in mid-March to reduce the risk of COVID-19 exposure to patients and staff, has had an immediate effect on trainees in all subspecialties. Spine surgery fellows are in a unique position, Dowdell and colleagues add, as they have a focused time frame of training offering few accommodations for pauses of instruction. “The effects of curtailed training greatly impacts fellows’ case volumes and heightens concerns for those with limited exposure during residency,” the paper notes.

Dowdell and colleagues then detail how the fellowship has found “creative ways” to optimise educational opportunities, whilst also responding to the COVID-19 pandemic. “This includes the completion of numerous research projects as well as the formation of a comprehensive educational curriculum involving staff, fellows, and residents that includes daily didactic sessions,” the paper notes. “Combining this with the unexpected opportunity to work with medical colleagues caring for patients suffering from COVID-19 and/or other serious medical conditions that required inpatient medical care has resulted in a well-rounded educational experience that no one would have predicted.”

During this pandemic, Dowdell et al write, surgical trainees have undergone significant temporary re-assignments to help cover the emergency department, inpatient care, and intensive care units. Not only has this has helped alleviate the healthcare worker shortage, it has also resulted in new relationships with colleagues across all specialties. “As such, the new lessons of dynamic teamwork, empathy, courage, and quickly learning new tasks are essential to the personal development and the moulding of a physician.”

Dowdell and colleagues go on to state that the pandemic has “forced everyone to understand the concept of rational management of limited resources and new versatility to adapt to constant change and uncertainty”.

“It is important to remember that the role of surgical subspecialty trainees during this COVID-19 pandemic is critical and many have played a significant role in supporting healthcare colleagues and society,” the authors add.

In their concluding remarks, Dowdell and colleagues write: “Changes that were made to hospital practice structures will benefit the community and ultimately our hospital system through this COVID-19 crisis and beyond. This includes ensuring proper training for our residents and fellows and adapting to the community as this crisis dictates. The spine fellowship has been impacted, but not diminished, by this crisis and ultimately we are uniquely positioned for the future to have had the opportunity to learn from a pandemic that has been unseen for the last 100 years. This will pass and we will be stronger than ever.”


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