Changing the Status Quo: Developing a Virtual Sub-Internship in the Era of COVID-19

Overview

Journal J Surg Educ

Publisher Elsevier

Specialty General Surgery

Date 2021 Apr 26

PMID 33896734

Citations 11

Authors

David Mikhail

Ezra J Margolin

John Sfakianos

Marisa Clifton

Mathew Sorenson

Simone Thavaseelan

George Haleblian

Louis Kavoussi

Gina M Badalato

Lee Richstone

Affiliations

Soon will be listed here.

Abstract

Problem: Subinternships are integral to medical education as tools for teaching and assessing fourth-year medical students. Social distancing due to COVID-19 has precluded the ability to offer in-person subinternships - negatively impacting medical education and creating uncertainty surrounding the residency match. With no precedent for the development and implementation of virtual subinternships, the Society of Academic Urologists (SAU) developed an innovative and standardized curriculum for the Virtual Subinternship in Urology (vSIU).

Methods: The vSIU committee's mandate was to create a standardized curriculum for teaching foundational urology and assessing student performance. Thirty-three members from 23 institutions were divided into working groups and given 3 weeks to develop 10 modules based on urologic subspecialties, Accreditation Council for Graduate Medical Education core competencies, technical skills training and student assessment. Working groups were encouraged to develop innovative learning approaches. The final curriculum was assembled into the "vSIU Guidebook."

Results: The vSIU Guidebook contains 212 pages - 64 pages core content and 2 appendices (patient cases and evaluations). It outlines a detailed 4-week curriculum with a sufficient volume of resources to offer a completely adaptable virtual course with the same rigor as a traditional subinternship. Modules contain curated teaching resources including journal articles, lectures, surgical videos and simulated clinical scenarios. Innovative learning tools include reflective writing, mentorship guidelines, videoconference-based didactics, surgical simulcasting and virtual technical skills training. The guidebook was disseminated to program directors nationally.

Next Steps: The vSIU is the first virtual subinternship in any specialty to be standardized and offered nationally, and it was implemented by at least 19 urology programs. This curriculum serves as a template for other specialties looking to develop virtual programs and feedback from educators and students will allow the curriculum to evolve. As the pandemic continues to challenge our paradigm, this rapid and innovative response exemplifies that the medical community will continue to meet the needs of an ever-changing educational landscape.

Citing Articles

A Systematic Review of Virtual Subinternships in Surgical Education: Impact on Curriculum Delivery and Learner Outcomes.

Monte O, Yousef A, Watson D J Grad Med Educ. 2025; 17(1):38-47.

PMID: 39980948 PMC: 11838050. DOI: 10.4300/JGME-D-24-00381.1.

Designing the "match of the future": challenges and proposed solutions in the interview and match phase of the UME-GME transition.

McKinley S, Altieri M, Sheppard O, Hendershot K, Williams K, Smith B Global Surg Educ. 2023; 1(1):69.

PMID: 38013709 PMC: 9670067. DOI: 10.1007/s44186-022-00073-6.

Association of Virtual Away Rotations With Residency Applicant Outcomes in Otolaryngology.

Lenze N, Benjamin W, Bohm L, Thorne M, Brenner M, Mihalic A OTO Open. 2023; 7(3):e78.

PMID: 37693828 PMC: 10487303. DOI: 10.1002/oto2.78.

The Impact of COVID-19 on the Urology Residency Match and Geographic Proximity of Applicants.

Wang K, Shah Y, Simhal R, Quinn A, Denisenko A, Mann E Urology. 2023; 176:21-27.

PMID: 36963668 PMC: 10033143. DOI: 10.1016/j.urology.2023.01.050.

The Impact of COVID-19 on Surgical Training and Education.

Fu M, Islam R, Singer E, Tabakin A Cancers (Basel). 2023; 15(4).

PMID: 36831609 PMC: 9954522. DOI: 10.3390/cancers15041267.

References

Scott D, Dunnington G . The new ACS/APDS Skills Curriculum: moving the learning curve out of the operating room. J Gastrointest Surg. 2007; 12(2):213-21. DOI: 10.1007/s11605-007-0357-y. View

Thomson F, Morrison I, Watson W . 'Going Professional': using point-of-view filming to facilitate preparation for practice in final year medical students. BMJ Simul Technol Enhanc Learn. 2022; 4(3):148-149. PMC: 8990222. DOI: 10.1136/bmjstel-2017-000224. View

Drolet B, Brower J, Lifchez S, Janis J, Liu P . Away Rotations and Matching in Integrated Plastic Surgery Residency: Applicant and Program Director Perspectives. Plast Reconstr Surg. 2016; 137(4):1337-1343. DOI: 10.1097/PRS.0000000000002029. View

Leraas H, Cox M, Bendersky V, Sprinkle S, Gilmore B, Gunasingha R . Instituting a Surgical Skills Competition Increases Technical Performance of Surgical Clerkship Students Over Time. J Surg Educ. 2017; 75(3):644-649. PMC: 9757025. DOI: 10.1016/j.jsurg.2017.09.007. View

Weissbart S, Stock J, Wein A . Program directors' criteria for selection into urology residency. Urology. 2015; 85(4):731-6. DOI: 10.1016/j.urology.2014.12.041. View

Coburn M, Amling C, Bahnson R, Dahm P, Kerfoot B, King L . Urology milestones. J Grad Med Educ. 2014; 5(1 Suppl 1):79-98. PMC: 3627256. DOI: 10.4300/JGME-05-01s1-07. View

Thomas C, Cabrera-Muffly C . Otolaryngology externships and the match: Productive or futile?. Laryngoscope. 2017; 127(10):2242-2246. DOI: 10.1002/lary.26639. View

Hanson K, Borofsky M, Hampson L, Breyer B, Kern N, Conti S . Capturing the Perspective of Prospective Urology Applicants: Impacts of COVID-19 on Medical Education. Urology. 2020; 146:36-42. PMC: 7525272. DOI: 10.1016/j.urology.2020.09.027. View

Nikonow T, Lyon T, Jackman S, Averch T . Survey of Applicant Experience and Cost in the Urology Match: Opportunities for Reform. J Urol. 2015; 194(4):1063-7. DOI: 10.1016/j.juro.2015.04.074. View

10.

Lebastchi A, Khouri Jr R, McLaren I, Faerber G, Kraft K, Hafez K . The Urology Applicant: An Analysis of Contemporary Urology Residency Candidates. Urology. 2018; 115:51-58. DOI: 10.1016/j.urology.2017.10.065. View

11.

LaPorta 3rd J, McClure 3rd T, Tieman M . Results of a Surgical Simulation Course Designed to Improve Surgery Clerkship Performance. J Surg Educ. 2017; 75(3):656-663. DOI: 10.1016/j.jsurg.2017.09.026. View

12.

Phillips A, Matthan J, Bookless L, Whitehead I, Madhavan A, Rodham P . Individualised Expert Feedback is Not Essential for Improving Basic Clinical Skills Performance in Novice Learners: A Randomized Trial. J Surg Educ. 2017; 74(4):612-620. DOI: 10.1016/j.jsurg.2016.12.003. View

13.

Al-Jundi W, Elsharif M, Anderson M, Chan P, Beard J, Nawaz S . A Randomized Controlled Trial to Compare e-Feedback Versus "Standard" Face-to-Face Verbal Feedback to Improve the Acquisition of Procedural Skill. J Surg Educ. 2016; 74(3):390-397. DOI: 10.1016/j.jsurg.2016.11.011. View

14.

Manning E, Mishall P, Weidmann M, Flax H, Lan S, Erlich M . Early and prolonged opportunities to practice suturing increases medical student comfort with suturing during clerkships: Suturing during cadaver dissection. Anat Sci Educ. 2018; 11(6):605-612. PMC: 6165707. DOI: 10.1002/ase.1785. View

15.

Glass C, Acton R, Blair P, Campbell A, Deutsch E, Jones D . American College of Surgeons/Association for Surgical Education medical student simulation-based surgical skills curriculum needs assessment. Am J Surg. 2014; 207(2):165-9. DOI: 10.1016/j.amjsurg.2013.07.032. View

16.

Nguyen D, Lee J, Domes T, El-Sherbiny M, Andonian S, Franc-Guimond J . Survey of Canadian urology programs: Which aspects of the Canadian Residency Matching Service (CaRMS) application are the most important?. Can Urol Assoc J. 2020; 14(6):169-173. PMC: 7654672. DOI: 10.5489/cuaj.6191. View

17.

Batalden P, Leach D, Swing S, Dreyfus H, Dreyfus S . General competencies and accreditation in graduate medical education. Health Aff (Millwood). 2002; 21(5):103-11. DOI: 10.1377/hlthaff.21.5.103. View

18.

Griffith M, DeMasi S, McGrath A, Love J, Moll J, Santen S . Time to Reevaluate the Away Rotation: Improving Return on Investment for Students and Schools. Acad Med. 2018; 94(4):496-500. DOI: 10.1097/ACM.0000000000002505. View

19.

Chandra S, Laoteppitaks C, Mingioni N, Papanagnou D . Zooming-out COVID-19: Virtual clinical experiences in an emergency medicine clerkship. Med Educ. 2020; 54(12):1182-1183. PMC: 7300610. DOI: 10.1111/medu.14266. View

20.

Lindeman B, Lipsett P, Alseidi A, Lidor A . Medical student subinternships in surgery: characterization and needs assessment. Am J Surg. 2013; 205(2):175-81. DOI: 10.1016/j.amjsurg.2012.10.008. View