Virtual Training Could Ease Transition to Medical Residency Programs

By Carolyn Crist

January 26, 2021

NEW YORK (Reuters Health) - Virtual boot camps may create a more seamless transition between undergraduate and graduate medical education, both during and after the pandemic, according to a group of residency-program directors.

Residencies that require hands-on training, particularly surgery, can ship simulation materials in the mail and allow trainees to join the virtual meetings from any location and time zone, they write in JAMA Surgery.

"The issue of 'resident readiness' has been on the minds of medical educators for quite some time. As medicine changes, we've needed to rapidly adapt to make sure the next set of medical school graduates comes into residency with at least a minimum set of skills," said senior author Dr. Kareem AbdelFattah, program director of the general-surgery residency at the University of Texas Southwestern Medical Center in Dallas.

"Students are sometimes lacking in certain skills when they begin residency," he told Reuters Health by email. "Many schools and residency programs have instituted 'boot camp' experiences, intended to rapidly help students in this transition period gain whatever skills represent this 'gap.'"

In 2020, AbdelFattah and his colleagues shifted their preclinical curriculum for incoming residents to a virtual setting to adhere to pandemic restrictions. Each resident received a suture trainer, including simulated skin and tissue, needle drivers, forceps, scissors, suture models, silk ties and suture.

Trainees followed videos of suturing and knot-tying tasks filmed from two perspectives - toward the learner and from the learner's viewpoint - and then attended video review sessions. Faculty held small group meetings virtually and also taught a patient handoff simulation and a root-cause-analysis simulation.

Overall, the virtual setting allowed participants to join from any location and created greater schedule flexibility, the authors write, which meant more faculty could become involved and develop relationships sooner. Students also appreciated the extra time to learn and bond with classmates, and the sessions were well-received and well-attended.

Of course, virtual formats can't replace valuable aspects of live trainings, the authors write. Team-building activities and social events are more beneficial in person, so a hybrid approach with online training and in-person events could be useful in the future.

In addition, sending expensive materials and equipment to the students through the mail can be cost prohibitive, depending on the exercise. Laparoscopic trainers and virtual robotic modules, for example, might be too expensive or not yet available. The materials needed for this program cost about $77 per student before shipping.

Although the virtual training was voluntary, students and faculty may feel compelled to attend, which should be considered in future iterations of the program, the authors write. Students may need to handle other needs in the final months of medical school and after graduation, such as moving, spending time with loved ones before rigorous training begins, and resting before they start a program with little downtime.

"There will be a learning curve, especially when it comes to remote teaching of clinical skills," Dr. AbdelFattah said. "I think keeping the learner's experience in mind was critical in making this effective."

Virtual trainings could become more routine immediately, the authors write, due to the prevalence of technology use at the moment. At the same time, medical educators will need to quickly review and improve their programs with each iteration to ensure that incoming residents receive the training they need.

Previous research has shown that traditional boot camp training boosts confidence among new residents and leads to improved competence, and future research should track whether virtual formats give trainees more time to process information, practice basic procedures and feel more prepared for clinical care.

"The COVID-19 pandemic has had an unprecedented impact on the healthcare system and on medical education," said Dr. Laura Huppert, a hematology and oncology fellow at the University of California, San Francisco. Dr. Huppert, who wasn't involved with this paper, wrote about the transition to virtual interviews for graduate-medical-education training programs in 2020.

"If virtual educational innovations like this one are successful, it is certainly possible that these opportunities will continue in the future, even after the COVID-19 pandemic," she told Reuters Health by email.

SOURCE: JAMA Surgery, online January 6, 2021.