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Physician Burnout in Neurosurgery: An Under-Recognized Phenomenon

By Burnout, Health, Work-Life BalanceNo Comments

As conversations about work-life balance are becoming more prevalent, and given the stresses associated with the COVID-19 pandemic, there has been a renewed interest in the issue of physician burnout. Burnout is a long-term stress reaction marked by emotional exhaustion, depersonalization and a lack of sense of personal accomplishment. In recent years, the rising prevalence of burnout among clinicians — more than 50 percent according to a Medscape report — has led to probing questions on how it affects access to care, patient safety and care quality. Burned-out physicians are more likely to leave their practices or the practice of medicine altogether, which reduces patients’ access to and continuity of care. Burnout can also threaten patient safety and care quality when depersonalization leads to poor interactions with patients, and when burned-out physicians suffer from impaired attention, memory and executive function.

In addition to the impact of burnout on physicians and patients, according to a recent study published in the Annals of Internal Medicine, the health care system loses more than $4.8 billion a year due to this phenomenon. Although neurosurgeons work long hours, balance outpatient and inpatient practices, and deal with life and death issues, we have paid limited attention to burnout in this field.

For the next few weeks, Neurosurgery Blog will highlight the issue of burnout — including in the field of neurosurgery. Here are some staggering facts about burnout in neurosurgery:

  • A recent survey of 783 neurosurgeons found the rate of burnout to be 62.9 percent among nonacademic neurosurgeons and 47.7 percent for academic neurosurgeons;
  • Poor work-life balance, health care reform and financial uncertainty were the major factors contributing to career dissatisfaction; and
  • Burnout and depression — sometimes associated with emotional exhaustion — were a significant predictor of preventable major medical errors in a study using data from 7,905 members of the American College of Surgeons.

Among neurosurgeons, many factors were found to lower the chances of burnout. High volume surgeons, with stable families, who are intellectually challenged, with leadership roles and a good work-life balance, are more effectively shielded against burnout.

Understanding burnout will push more health care organizations to adopt strategies to protect their members from this phenomenon. Physician engagement will undoubtedly be crucial to the prevention of burnout. We must take the lead by being active and vocal for ourselves, our colleagues and our patients and fight against the forces that erode our mental health and the quality of our work.

Join us in an insightful journey, understanding burnout as it pertains to the field of neurosurgery. We aim to identify the reasons behind this phenomenon and the best strategies to prevent it or minimize its impact on the careers of neurosurgeons.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #PhysicianBurnout.

Kimon Bekelis, MD
Vice-chair, AANS/CNS Communications and Public Relations Committee
Catholic Health Services of Long Island
West Islip, N.Y. 

 

 

Kristopher T. Kimmell, MD, FAANS
Vice-chair, AANS/CNS Communications and Public Relations Committee
Rochester Regional Health
Rochester, N.Y. 

 

 

Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Chair, AANS/CNS Communications and Public Relations Committee
Geisinger
Wilkes Barre, Pa.

September 3, 2020
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Lasting Change: Assessing the Potential Long Term Impact of COVID-19

By COVID-19, HealthNo Comments

“Real change, enduring change, happens one step at a time.”

Ruth Bader Ginsburg

Associate Justice, U.S. Supreme Court

The economic, medical, political and psychological tsunami unleashed by the COVID-19 virus is unlike anything we have seen in our lifetime. The traumatic disruption of 9-11 was limited in comparison to our current crisis. While impossible to include up to the minute statistics, already more than 15 million cases have been confirmed with at least 620,000 deaths, and U.S. unemployment is approximately 11%. Is it possible that any good will come of these months of tragedy and lock-down? What do we know about the immediate and longer-term consequences on us as humans, on the health care community and neurosurgery? I have been given the monumental task of trying to peer into that future as the Neurosurgery Blog’s focus on COVID-19 draws to a close.

Silver Linings: Our World

Today, the canals of Venice are clear, and dolphins have returned — an amazing and rapid transformation. During the pandemic lock-down, our environment improved dramatically with blue skies seen across India, air pollution around major cities visibly and measurably improved, leading to improved health, and images from space revealing stunning clarity. Beyond recognizing how reversible the damage to our physical world is, we have witnessed the very best of humanity in our communities. Touching stories have filled our news feeds:

These represent the many things individuals are doing every day to make the lives of those around them safer and more fulfilling.

To fill the void left by social distancing, many have become facile with video technology to provide essential human contact during long weeks of isolation. Religious services, theaters, concerts and more have rapidly adapted to provide their communities invaluable connection and engagement.

Silver Linings: Health Care and Neurosurgery

As grim headlines unfolded, the health care community united. Traditionally competitive institutions have reached beyond those boundaries to share expertise, resources and staff to provide the best care for patients. Necessary innovation has blossomed creating change that will survive beyond COVID-19 such as:

The Centers for Medicare & Medicaid Services (CMS) authorized payment for telemedicine services, with many private insurance companies following on their heels. This marks a crucial advance and should herald a new era of health care delivery. A world free of many of the inconveniences associated with a visit to the doctor — days off work, parking, travel, navigating complex hospital corridors — is no longer a figment of the imagination. Reimbursement for these services will drive technological innovation that will enhance the value and experience of these visits. While there will always be an essential role for the face-to-face appointment —especially in the surgical disciplines such as neurosurgery — and the importance of human touch, the provision of telemedicine care should be more comfortable and more convenient.

Neurosurgery stepped up and came together in many meaningful ways. Many of our national and international organizations, as well as neurosurgical publications, provided state of the moment information to connect us around the world. Neurosurgeons continued to keep their practices afloat to provide care to those with emergent conditions despite considerable risks to themselves and, by extension, their loved ones. Many stepped into roles of supporting other physicians overwhelmed by the sheer volume and acuity of COVID-19 patients. In contrast, others assumed leadership roles helping their hospitals and communities in many ways — designing systems for surge redeployment of staff and creating new operating room policies to enhance airflow. Each institution has found ways to protect their resident team while ensuring they continue to receive valuable education and feel fully supported during a time of great strain.

Not All Roses

Still, many vulnerabilities were revealed, and scars will be left from the crisis. Neurosurgery lost one of our most beloved colleagues when COVID-19 took the life of James T. Goodrich, MD, PhD. Questions arose, such as how could things as simple as masks, gloves and gowns become such a challenge to procure? Known health care disparities were shown to exist, likely reflective of such differences at every level of medical care, but poignantly and tragically demonstrated in COVID-19 related deaths, morbidity and availability of resources. This was further brought into the spotlight by the death of George P. Floyd, Jr. and the dramatic national response that followed. Finally, people learned it isn’t so glamorous or pleasant to wear a mask, as neurosurgeons have known our whole careers.

Lasting Change

Most meaningful change does evolve incrementally; however, cataclysmic events like the COVID-19 crisis instigate sudden and dramatic change. Given the potential for positive unintended consequences, here is my wish list (please add your own!) for enduring gifts we deserve from COVID-19:

  • A deep appreciation not only for the fragility of the world around us but also its capacity for resiliency — let us remain mindful of how all of our actions impact the earth, our health, and our fellow humans;
  • A new dawn of real innovation in medicine that builds new frontiers of access and engagement by leveraging the best of augmented intelligence and melding it with the personal touch that only humans can provide;
  • Restoration of travel because of all the good it brings but with a profound sensitivity on how to preserve the beauty of the natural and man-made world; and
  • A renewed and sustaining appreciation for the difficult work done by neurosurgeons and all physicians, along with their dedicated teams, to care for patients and their loved ones every day.

We thank our readers for following Neurosurgery Blog as it recorded the real-time impacts of the COVID-19 global pandemic. As the world emerges from these trying times, we invite you to continue the conversation on Twitter by following and using the hashtag #COVID19. With new therapeutics and promising vaccines, the glimmer of hope becomes stronger with each passing day.

Deborah L. Benzil, MD, FACS, FAANS
Cleveland Clinic, Vice-Chair, Neurosurgery
Cleveland, Ohio

July 24, 2020
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Aerosolization, Endonasal Surgery and the Neurosurgeon

By COVID-19, HealthNo Comments

Neurosurgeons never stop learning. As a result of the COVID-19 pandemic, previously obscure terms such as airflow and aerosolization — the dispersal of a substance such as medicine or viral particles in the form of an aerosol — have entered our regular lexicon. We can now readily identify which of our operating rooms has the highest airflow — usually the smallest room — and the standard for the minimum number of air exchanges per hour, which is at least 15.

COVID-19 has brought to light a new spectrum of difficulties for neurosurgeons. Of particular concern are increasing reports of significant morbidity and mortality among otolaryngologists in several countries that have been putatively linked to endonasal surgery. Patel and coworkers from Stanford University highlighted this issue in a letter to the editor in Neurosurgery. They urge precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic due to the concern that aerosol droplets coming from surgery may increase the possibility of infection of medical staff in the operating room.

In a reply, Huang and colleagues from Huazhong University of Science and Technology in Wuhan, China, were able to provide additional information regarding COVID-19 spread. They believe that compared to droplet transmission, contact transmission may be an equally important factor in transmission in medical workers and was ignored during the early stages of the pandemic due to lack of knowledge. They urge washing hands and cleaning all surfaces in patient units and living areas.

The authors also share that they have learned that intraoperative aspirators, protective clothing, N95 masks and face shields can provide sufficient protection to our medical staff in the surgery room. Huang and colleagues warn that the claim that endonasal surgery will increase the possibility of infection of medical personnel in the operating room might provoke unnecessary anxiety toward endonasal endoscopic procedures based on an anecdotal statement.

Patel and collaborators in their rebuttal accept some of these arguments but point out that emerging evidence also points towards a high viral load within the nasal cavity. When performing endoscopic surgery, while working in and through this corridor, surgical maneuvers can aerosolize mucus particles along with the virus.

In a convergence of the scholarly debate, both groups arrive at similar recommendations with an emphasis on preoperative COVID-19 testing, which should be performed whenever possible. Reduced contact with infected patients and the use of personal protective equipment — including N95 masks, face shields and protective clothing — should be employed for all endoscopic cases and all involved personnel. Powered air-purifying respirator use should be encouraged in cases of symptomatic COVID-19-positive patients needing emergent endonasal surgery. A negative pressure operating room is also recommended. Elective endoscopic transsphenoidal surgery should be delayed, and consideration should be given to transcranial approaches for certain locations where possible.

We share the optimism for the future of endonasal surgery as more data comes to light to guide best practices that will maximize its benefit for our patients while minimizing potential risks to surgeons and other operating room personnel.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.

Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Chair, AANS/CNS Communications and Public Relations Committee
Geisinger
Wilkes Barre, PA

July 13, 2020
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AANS Neurosurgeon Spotlight: The State of Neurosurgical Education

By AANS Spotlight, Burnout, COVID-19, GMENo Comments

Recent global circumstances have had considerable effects on neurosurgery. In the latest articles from AANS Neurosurgeon, the official socioeconomic publication of the American Association of Neurological Surgeons (AANS), authors discuss the state of neurosurgical education. Practices have taken steps to not only adapt to a multitude of changes due to the COVID-19 pandemic, but to thrive among them, while helping their patients do the same. Browse the Education issue for a scientific, artistic and realistic view from those tasked with providing and navigating valuable educational experiences during a time when there is no such thing as “normal.”

Article Spotlight

This Crisis is an Opportunity
Lola B. Chambless, MD, FAANS

Dr. Chambless explains how the pandemic has provided an unprecedented opportunity to study, learn and reform.

A Combined Spine Surgery Fellowship
Jason Savage, MD ꟾ Michael P. Steinmetz, MD, FAANS

Discover the makings of a successful spine fellowship – strong leadership, constant re-evaluation and a collaborative surgeon group.

Pen versus Penfield: A Proposed New Training Modality for Neurosurgery Residents
Erin N. D’Agostino, MD

Dr. D’Agostino describes how art “can serve a role in surgical skill building, learning and teaching of anatomy, patient education and combating burnout.”

Read More

Follow @aansneurosurg on Twitter, Instagram and like AANS Neurosurgeon on Facebook!

July 10, 2020
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Reflecting on COVID19, the Death of George Floyd and the Need for Change

By COVID-19, Equity, Social JusticeNo Comments

“I want to touch the world.”
George Perry Floyd, Jr.

We are living in trying and turbulent times in our country. A global pandemic has claimed the lives of more than 100,000 people across America and has threatened to overwhelm our health care systems in some of the worst affected areas. On top of this health crisis, we are now facing the greatest civil unrest our country has experienced in over 50 years in response to a recent series of tragic deaths of black men and women — the cataclysmic event being the deplorable death of George P. Floyd, Jr. while in police custody.

While we look to our politicians for the political answers that will heal the strife in our country, we are all struggling with our personal feelings and response to these events. It has been extremely heartening, however, to see the expression and renewed commitment to inclusion and diversity, particularly within the medical community.

As voices cry out across the world underscoring the systemic problems of racism and inequality, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) have joined the chorus speaking out against all forms of discrimination and acts of violence — particularly that which is driven by intolerance and hatred. We reaffirm our commitment to inclusion and diversity. We reflect on the past and the messages of Dr. Martin Luther King, Jr. and Robert F. Kennedy. And we listen to our Black and Brown colleagues who provide a uniquely pertinent perspective on these issues, and we are thankful for their leadership and willingness to speak out.

We hope our readers will be inspired by the words of our colleagues from across the medical profession, which are reposted below in this piece. Millions around the world were horrified in disbelief at the killing of an unarmed man in police custody. As individuals and together as a society, we owe it to George Floyd and countless others to not let his death be in vain and to work to seek lasting change to stamp out racism, inequality and violence. We encourage you all to engage your patients, your colleagues and your communities in discussions as to how we can help heal our country and care for all who need us, including our most vulnerable.

In addition to the above message from the AANS and CNS, neurosurgeons and neurosurgical organizations spoke out.

A group of Black neurosurgeons who came together to publish an OpEd pointed out that as neuroscientists and surgeons, they see firsthand the effects of neurotrauma on those subjected to violence at especially alarming rates in the Black community. From the debilitating effects of blunt and penetrating trauma to the brain and spine to the “intangible neuropsychological effects stemming from fearing for one’s life on a daily basis,” there “is a slow but inevitable erosion of the state of health amongst Black people… This has culminated in a public health crisis shortening not only the lives of too many too early but diminishing the quality of life of those who remain to bear it.”

Reflecting on the shocking video depicting the death of George Floyd, neurosurgeon Fredric B. Meyer, MD, FAANS, the Juanita Kious Waugh Executive Dean for Education of the Mayo Clinic College of Medicine and Science and dean of the Mayo Clinic Alix School of Medicine, wrote to all medical students, residents and fellows. In his letter, Dr. Meyer reminded us “that although our country has made tremendous advances in civil and human rights, we all have significant work to do on so many levels to fight hatred, bigotry, and violence.” He recalled how Bobby Kennedy was one of his family’s heroes and how, as U.S. Attorney General, he was a strong advocate for civil rights. Dr. Meyer went on to note that in this time of terrible strife, anger, mistrust and hatred in our country, he is reminded of a powerful speech that Bobby Kennedy gave spontaneously on the back of a pickup truck when he learned of the assassination of Martin Luther King, Jr. He, along with his brother, President John F. Kennedy, and Dr. King, were all assassinated for the truth they spoke about human decency, civil rights, and a humane society. Dr. Meyer commends to the medical community the YouTube video of Bobby Kennedy announcing Dr. King’s death and to also listen to his speech on humanity, mindless violence and affirmation. His words are as relevant today as they were decades ago, and, as Dr. Meyer aptly stated, it is distressing that fifty years later, the same hatred that killed Dr. King continues to be pervasive in our society.

Leaders of the Society of Neurological Surgeons (SNS) — M. Sean Grady, MD, FAANS, president; Karin M. Muraszko, MD, FAANS, past-president; and Nathan R. Selden, MD, PhD, secretary — wrote to SNS members, neurosurgery department chairs and neurosurgical residency directors. In their message, they called on “educators to exemplify the highest moral and ethical standards for our trainees.” They noted that as educators and leaders in neurosurgery, we must ensure “that the American principles of fair and equal treatment for all are the bedrock of our Neurosurgical community.” Reaffirming a commitment to be “an inclusive organization reflective of the ‘higher’ principles,” they pledged “to grow and adapt and to listen to those we educate and those we serve. Although we may not have walked in their shoes, we will remain open to the knowledge and experience of every colleague and trainee and will respect and acknowledge them for their character and skills rather than for their appearance. Like our society, we believe we can continue to grow towards a more perfect union of our ideals and the reality in which we live,” and to strive together to reach higher ground.

The AANS/CNS Cerebrovascular Section, the Society of NeuroInterventional Surgery (SNIS) and the Society of Vascular & Interventional Neurology (SVIN) joined together to issue a statement acknowledging the difficult and disturbing times that the country is experiencing. These neurovascular organizations pointed out that “acts of violence and racism cause psychosocial stress that leads to poor well-being and cerebrovascular health, especially for communities of color. Given that heart disease and stroke are the leading causes of death for communities of color, our organizations are extremely disturbed by violent acts that cut to the core of the lives in our communities. We denounce the incidents of racism and all violence that continue to ravage our communities.”

Beyond the neurosurgical community, leading national medical organizations also spoke out.

The American College of Surgeons stated that it “stands in solidarity against racism, violence, and intolerance, noting that its “mission is to serve all with skill and fidelity, and that extends beyond the operating room. Racism, brutal attacks, and subsequent violence must end. We will help any injured, and we will use our voice in support of the health and safety of every person.”

Leaders from the American Medical Association (AMA) reminded us that AMA policy “recognizes that physical or verbal violence between law enforcement officers and the public, particularly among Black and Brown communities where these incidents are more prevalent and pervasive, is a critical determinant of health and supports research into the public health consequences of these violent interactions.”  The AMA continued, noting that the “disparate racial impact of police violence against Black and Brown people and their communities is insidiously viral-like in its frequency, and also deeply demoralizing… Just as the disproportionate impact of COVID-19 on communities of color has put into stark relief health inequity in the U.S.”

Finally, the Association of American Medical Colleges (AAMC) pointed out that “the coronavirus pandemic has laid bare the racial health inequities harming our Black communities, exposing the structures, systems, and policies that create social and economic conditions that lead to health disparities, poor health outcomes, and lower life expectancy.” The AAMC statement goes on to address how the brutal and shocking deaths of George Floyd, Breonna Taylor and Ahmaud Arbery “have shaken our nation to its core and once again tragically demonstrated the everyday danger of being Black in America.” Issuing a call to action, the AAMC expresses that “as healers and educators of the next generation of physicians and scientists, the people of America’s medical schools and teaching hospitals bear the responsibility to ameliorate factors that negatively affect the health of our patients and communities: poverty, education, access to transportation, healthy food, and health care.”

The AANS and CNS echo this call to action and concur that we “must move from rhetoric to action to eliminate the inequities in our care, research, and education of tomorrow’s doctors.”

Editor’s Note: Neurosurgery Blog invites you to join the conversation for social change at #WhiteCoatsforBlackLives and #ChangeTheSystem.

 

John A. Wilson, MD, FAANS
President, American Association of Neurological Surgeons
David L. and Sally Kelly Professor and Vice-Chair of the
Department of Neurosurgery, Wake Forest School of Medicine

 

 

Steven N. Kalkanis, MD, FAANS
President, Congress of Neurological Surgeons
Chief Executive Officer, Henry Ford Medical Group
Detroit, Mich.

June 10, 2020
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COVID-19 and Prevalence of Stroke: Making Sense of the Data

By COVID-19, Health, StrokeNo Comments

The current COVID-19 pandemic has been a singular event with far-reaching societal and medical ramifications. The enormity of the crisis and the alacrity of its spread across the globe has led to a rapidly evolving understanding of the disease. Current knowledge of the pandemic and the effect of the virus on the human body may become obsolete by week’s end. The COVID-19 crisis’s impact on the care of stroke patients is emblematic of these issues. Over the past few months, several data points have emerged that have been interpreted in divergent ways.

For example, early on, there was speculation from New York City — one of the regions hardest hit by COVID-19 — that COVID-19 was associated with an increased risk of fatal ischemic stroke in young adults. Several physicians from New York authored a report of their experience with five stroke patients infected with SARS-CoV-2, aged 33 to 49. This study received significant attention in both the press and academic journals. We currently understand COVID-19 to be a mild disease in most people. However, occasionally it progresses to a more severe process, including acute respiratory distress syndrome (ARDS), multi-organ dysfunction, cytokine storm, inflammation, coagulation and death. Coagulopathy and vascular endothelial dysfunction have been proposed as complications of COVID-19. Although the authors shed light on the clinical characteristics of young adults with these two pathologies, they were not able to explain the possible association between stroke and COVID-19 fully.

On the contrary, several researchers have indicated a decreased incidence of ischemic stroke across the world during the COVID-19 pandemic. The drop in the rate of stroke presentations has been so dramatic that various medical societies and advocacy groups have issued statements urging patients not to delay stroke care out of fear of being exposed to SARS-CoV-2, the virus causing COVID-19. While this a plausible explanation for the decreased incidence of stroke during the height of the pandemic, we believe it may be too early to tell whether this is, in fact, the case.

Another data point suggests that patients are seeking care for stroke symptoms in a delayed fashion, resulting in suboptimal outcomes. Most stroke experts have attributed this phenomenon of “vanishing strokes and heart attacks” to the unwillingness of patients to be exposed to COVID-19 in an already overwhelmed emergency room. By contrast, researchers from Italy have hypothesized a pathophysiologic mechanism behind the decreased incidence of stroke in COVID-19 patients based on the controversial role of Interleukin 6 (IL-6) — a protein involved in inflammation — in stroke. There is experimental evidence that IL-6 — which is elevated in patients with more severe forms of COVID-19 — has a neuroprotective effect and enhances angiogenesis (formation of new blood vessels). Another possible explanation offered is the thrombocytopenia (low platelet counts) encountered in patients even with mild cases of COVID-19, as low platelet levels may prevent the formation of large clots in the intracranial circulation. Lastly, the widespread mitigation measures, which have minimized the prevalence of influenza in the community, may have attenuated the typical negative impact of the flu on cardiovascular disease and stroke. Further research into the effects of these various associations is warranted.

In these times of crisis, we remain dedicated to offering the highest level of care for stroke patients focusing on the following principles:

  • Clear identification of Comprehensive Stroke Centers (CSCs), which can offer all stroke-related services even during the pandemic;
  • Information for emergency medical services and the public that CSCs will be protected and will remain fully operational during crises; and
  • Education for health professionals and the public — especially those who are at high risk of stroke — leading to early recognition of stroke symptoms and contacting emergency medical services immediately to be taken to a CSC to avoid significant delays in transferring patients between hospitals.

A full picture of how COVID-19 influences the phenotype, incidence, and demographics of acute ischemic stroke patients has yet to emerge and may not for many months. Until then, it remains paramount to focus on measurable outcomes and continue to leverage the proven components of our stroke system of care to the benefit of our patients. Education — as was emphasized throughout May’s National Stroke Awareness Month — needs to continue and must be the cornerstone of engagement of the health care system with the public to reassure that we are able and ready to take care of our patients safely.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.

Kimon Bekelis, MD
Vice-chair, AANS/CNS Communications and Public Relations Committee
Director of the Stroke & Brain Aneurysm Center and co-director of the Neuro ICU at Good Samaritan Hospital Medical Center
Chairman, Neurointerventional Services at Catholic Health Services of Long Island
Director, Population Health Research Institute of New York at CHSLI
Assistant Professor, The Dartmouth Institute for Health Policy and Clinical Practice
West Islip, N.Y.

Clemens M. Schirmer, MD, PhD, FAANS, FAHA
Chair, AANS/CNS Communications and Public Relations Committee
Geisinger
Wilkes Barre, Pa.

June 8, 2020
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Life as a Medical Student During the COVID-19 Pandemic

By COVID-19, Faces of Neurosurgery, Guest Post, HealthNo Comments

The COVID-19 pandemic has caused sweeping systemic changes to the landscape of medicine and society as a whole in the few short months since the virus arose. The pandemic has impacted all medical specialties, and those still in training have experienced significant disruptions to their education. Medical schools were quick to respond to the spread of the virus to keep medical students safe. The first warnings from the University of Rochester School of Medicine and Dentistry (URSMD) administration came in early March — students were informed that those who intended to travel during spring break might be required to quarantine upon their return. At the time, the magnitude of the impending pandemic was unknown, and social distancing measures were still on the horizon.

Initially, physical classes were canceled until late March, by which time any students who had traveled to a COVID-19 hotspot would have completed a 14-day quarantine. The plan was to resume regular classes and clinical experiences following this disruption. However, it became clear within a matter of weeks that this would be impossible. For the safety of students, faculty and patients, it was eventually decided that all physical classes and clinical experiences would be canceled for the foreseeable future. Students at all levels were placed in an uncertain position as it became increasingly clear that in-person learning would not be possible for the remainder of the year. This uncertainty fostered fear and anxiety among students — many of whom were also dealing with the stress regarding their safety and that of friends and family.

For preclinical students like myself, we have been utilizing remote learning for the remainder of the year, which has been a significant disruption to our training. In particular, clinical learning has been impaired due to the difficulty of mastering medical history taking and physical exam techniques over Zoom instead of in-person practice with classmates and standardized patients. Another challenge has been coordinating exam proctoring for students who are in different time zones. Some students who have been planning summer research at other institutions or projects involving clinical or volunteer work have had their plans canceled.

Second-year students have been particularly concerned about the logistics of their upcoming United States Medical Licensing Exam (USMLE) Step 1 exams, given that social distancing measures preclude the use of physical test sites. Third-year students have been unable to complete their clinical rotations and have experienced considerable stress due to the ongoing uncertainty in scheduling away rotations for their fourth year. Fourth-year students have had their graduation and Match Day celebrations converted to online events. Graduation has also been moved up. Depending on their specialty of choice, some newly minted physicians have been called upon to begin their residency training early to respond to the COVID-19 pandemic.

Many student doctors have been frustrated because they are unable to contribute to patient care during this crisis. It has been challenging to find ways to help without potentially compromising patient safety. Despite these challenges, medical students at all levels and from all over the country have stepped up to do what they can to support the medical community during this crisis. During the initial stages of the pandemic, students volunteered their time to provide childcare for physicians called to the front lines and organized efforts to produce personal protective equipment (PPE) for health care workers. Additionally, students have made an effort to publicize clinical trials that need healthy volunteers, and the University of Rochester Medical Center (URMC) has initiated a program to recruit volunteer lab techs to help with COVID-19 research. The administration at URSMD has also sent out a request for medical student volunteers who might be called upon to assist in patient transport, ventilator preparation, and supply transport, as well as serving as respiratory care assistants if needed.

Medical education faces challenges moving forward. At this time, it is unclear when or if in-person education can resume. There have already been substantial efforts to promote methods of distance learning for medical students and residents, including Zoom-based lectures and an increased emphasis on online resources. However, this leaves something to be desired for hands-on clinical education, which does not lend itself well to remote learning. It is not clear when clinical rotations can be safely resumed, or when students will once again be able to schedule away rotations. The uncertainty surrounding away rotations is of particular concern for those students who are preparing to apply to residency in the coming year. It also remains to be seen how this crisis will affect the residency match process in the future. Many students have also had research or volunteering opportunities canceled due to the pandemic, and the future of USMLE board exams remains in doubt for the time being.

As a whole, medical educators and students have risen to the challenge of COVID-19. Medical educators have dedicated extra time and effort to minimize disruptions and to maximize students’ learning experience. Many medical students have helped their communities wherever possible and are responding admirably to the unprecedented disturbance in their education. Reactions like these foster hope that both students and educators will continue to work tirelessly to respond to crises as they arise.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.

Stephen Susa
First-year Medical Student
University of Rochester School of Medicine and Dentistry

May 22, 2020
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CNS Launches Town Hall Xperience to Cover COVID-19 and Timely Neurosurgery Topics

By CNS Spotlight, COVID-19, HealthNo Comments

To address the need for neurosurgeons to rapidly share experiences and insights during COVID-19, the Congress of Neurological Surgeons (CNS) recently launched a complimentary Town Hall Xperience for CNS members.

The CNS Town Hall Xperience provides an informal and interactive format, where experts discuss their experiences and answer questions from members. Members can submit topics and questions in advance of the session, as well as during the session. Sessions are facilitated by preeminent faculty.

Multiple sessions each week ensure the latest timely COVID-19 and neurosurgery topics are covered and discussed. Summaries of the sessions will be available following the session, along with other helpful links and resources.

Topics will cover a variety of information helpful to practicing neurosurgeons and residents, including:

  • Managing a Neurosurgery Practice in the COVID-19 Crisis;
  • Fellowship Speed Dating: Subspecialties, Timelines and How to Make a Choice;
  • Subspecialty-specific topics; and
  • More.

Throughout the pandemic, publications, including Neurosurgery, are working to expedite breaking research, but there is a limit to the speed in which peer review can be accomplished.

Currently a CNS member? Learn more here.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.

May 15, 2020
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Neurosurgery, COVID-19 and Health Disparities: Perspectives from a Minority Provider

By COVID-19, Faces of Neurosurgery, Guest Post, HealthNo Comments

COVID-19 has had a tremendous global impact and has taken the lives of many people. It has halted economies and disrupted our educational system. It has strained health care resources and has expedited health policy reforms. One particular impact of COVID-19 that troubles me as a minority provider is the disproportionate burden of illness and death among racial and ethnic minority groups. COVID-19 has further illuminated existing health disparities in our society.

Before becoming a neurosurgery resident at Massachusetts General Hospital, I played football at Florida State University and with the Tennessee Titans. My athletic experience taught me valuable lessons that apply to my life as a physician. One of those lessons is awareness. If an offense breaks the huddle with a new personnel grouping in a never-before-seen formation, as the safety on the defense, I have to be aware of this new wrinkle and call it out, so my teammates are ready to make a play.

If there is a new highly contagious infectious disease disproportionately disrupting and taking the lives of a specific subset of people in a never-seen-before fashion, as a black neurosurgery resident volunteering to help fight COVID-19, I have to be aware of this fact and call it out, so my health care and public health teammates are ready to make a play.

In my opinion, the delivery of hospital care is not the principal problem. Regardless of race, you will be treated with quality outstanding care if you enter the Massachusetts General Hospital doors of most hospitals in the US. Hospitals have the resources and providers to treat patients with COVID-19. Unfortunately, the problem is further upstream before a person becomes our patient. Here are some key points to consider:

  • Emerging non-communicable diseases like hypertension, obesity, and diabetes are prevalent in minority communities, and these pre-existing conditions place this population at higher risk for contracting COVID-19 and developing life-threatening complications of infection;
  • Living quarters are tighter in poor neighborhoods, which limits social distancing in these communities;
  • Getting to work often involves public transportation, another close-proximity activity permitting easier human-to-human transmission; and
  • Access and affordability of primary care physicians often are out of the reach for many of these families; thus, diagnoses can be missed, and the costs/effort to manage medical problems may be too much to bear given other financial demands.

How do we solve these problems? That is a complicated question. Key elements include evaluating social determinants of health, providing education and development to children and families, as well as income enhancements in these communities. Tracking equity measures, implementing quality improvement initiatives, building a culturally competent health care system and fostering and encouraging better relationships between clinicians and patients may also be solutions. No matter the methodology, a multi-layered approach between the health system stakeholders and affected communities will be at the core of the answer to this problem.

COVID-19 is hurting all of us; it just has shown a propensity to target more impoverished, underserved populations more. As in football, we see the COVID-19 opponent lining up to attack us with an offense we haven’t seen before. It’s our responsibility to be aware as a team, to respond to that attack, and defend our goal — in this case, the health of the most vulnerable members of our community.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.

Myron L. Rolle, MD, MSc
Massachusetts General Hospital
Boston, Mass.

May 11, 2020
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COVID-19 Perspectives, News and Insights in Neurosurgery

By CNS Spotlight, COVID-19, HealthNo Comments

Neurosurgery, the official journal of the Congress of Neurological Surgeons (CNS), publishes top research on clinical and experimental neurosurgery covering the latest developments in science, technology, and medicine. As the COVID-19 pandemic evolves, Neurosurgery continues to publish the latest COVID-19 news and insights.

Recently, Neurosurgery published 15 articles covering a variety of COVID-19 related topics:

Explore the COVID-19 Information Hub and online education offerings for the latest research, knowledge, and expert insights in the weeks and months ahead. The Neurosurgery Perspectives section of the hub will be updated regularly as new COVID-19 content publishes.

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following and using the hashtag #COVID19.

May 8, 2020
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