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Virtual Implementations on Traditional Away Rotation Experiences for Students Interested in Otolaryngology during the COVID-19 Pandemic
Brandon R Perez1, Nicholas R Curran2 and Jeffrey Yu1,*
1Department of Otolaryngology-Head & Neck Surgery, University of Illinois at Chicago, USA
2Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati, USA
Received Date: 13/12/2022; Published Date: 30/12/2022
*Corresponding author: Dr. Jeffrey Yu, Department of Otolaryngology-Head & Neck Surgery, University of Illinois at Chicago, 1855 W. Taylor, Suite 2.42, Chicago, IL 60612, USA
Abstract
The coronavirus pandemic suspended visiting student electives, an integral component of residency applicants and programs’ determination of fit prior to the match. As a result, many institutions needed novel ways to enable remote learning, such as virtual clinical experiences. The cancellation of clinical away rotations during this cycle has further diminished opportunities for exposure to the field of otolaryngology, including forming relationships with faculty, working on research projects, and experiencing the culture of different programs firsthand. We discuss ways residency programs developed and implemented innovative learning modalities during the COVID-19 pandemic, such as virtual didactics, online interactive surgical cases, and telehealth services. These innovative approaches during the COVID-19 crisis represent a step forward in further improving medical education in the field of otolaryngology both during the current pandemic and in the future.
Keywords: COVID-19; Otolaryngology; Away Rotation; ENT
Introduction
This year the medical education community has experienced unprecedented challenges due to the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes the infectious disease COVID-19 [1]. Consequently, unforeseen accommodations were made to protect the health and safety of both staff and students involved in clinical education. One such adjustment was the restriction of visiting student electives.
On March 17th, 2020, The Association of American Medical Colleges (AAMC) and Accreditation Council for Graduate Medical Education (ACGME) recommended that away rotations be suspended during the 2021 residency application cycle except under extenuating circumstances in an effort to help slow the spread of COVID-19, preserve PPE, and guarantee student safety [2]. This proposal, while essential, disrupted many students’ plans, especially those planning away rotations.
Visiting student electives, also known as away rotations, are opportunities for students to rotate at a program other than their home institution. These rotations serve as a way for students and residency programs to learn more about each other in the clinical environment. In recent match years, applicants have been more likely to match at either their home institution or at a program where they completed an away rotation. Furthermore, over 90% of otolaryngology applicants participate in at least one visiting student elective each cycle [3]. Thus, these electives are incredibly valuable for both residency applicants and programs alike. These away rotations are particularly important for students who do not have an otolaryngology department with a residency program at their medical school, often providing much of their exposure to the specialty.
Given otolaryngology’s status as a high-exposure specialty due to its aerosolizing procedures, balancing students’ safety and exposure to the specialty presented a significant challenge [4]. In response to the AAMC’s recommendations, residency programs developed and implemented virtual activities to engage potential applicants. In this commentary, we discuss these implementations that are designed to confer the benefits of traditional away rotations, in the absence of in-person activity, (Figure 1).
Figure 1
1. Live Stream Surgeries
In lieu of in-person experiences, some programs turned to virtual invitations to the OR. For example, Proximie enables surgeons and students alike to virtually “scrub in” to an operating room remotely from their computers. This experience allows students to visualize procedures in real time through captured footage from intra-operative microscopes, endoscopes, and head mounted GoPro cameras [5].
2. Involvement in Telehealth
Telehealth has been utilized well before the COVID-19 pandemic but has enjoyed newfound popularity due to limitations of in-person interactions.8 Medical students have been given the opportunity to participate in telehealth patient care at residency programs regionally distant from their homes. Boston University was amongst the programs that allowed students to partake in telehealth as part of their virtual away rotation.7 Such experiences range from observation of attending physicians and residents to directly interviewing patients and presenting to attending physicians.
3. Virtual Participation in Clinical Rounds
Some residency programs developed systems to allow for medical student rounding. Due to the hands-on, fast-paced nature of rounds, finding reasonable means to include students proves challenging, yet some residency programs devised solutions. Students at Boston University connected with inpatients via telehealth and then presented the patients virtually to the clinical team. This allowed for active student participation on clinical rounds and inclusion of students in clinical decision making [6].
4. Involvement of Research
Although research is often most efficiently conducted through in-person interaction, remote research can be effective, and some residency programs involved students to their program’s active research projects via research meetings and department presentations.
5. Invitations to Join Departmental Educational Activities
Some programs invited students to virtually attend resident-oriented lectures, where they could participate in discussion and experience the educational relationship between residents and faculty. Similarly, some programs allowed students to participate in virtual journal clubs, which allowed for faculty members, residents, and students alike to critically evaluate contemporary academic literature.
6. Virtual Small Group Teaching
Another innovative teaching modality, implemented by the University of Illinois, was student-oriented virtual group teaching sessions. During these scheduled small groups, designed as flipped classrooms, students were able to read up on assigned topics and then come together as a group to discuss under the guidance of an attending physician. The sessions included working through clinical scenarios as well as highlighting focuses of different otolaryngological subspecialties.
7. Virtual Meeting Forums
Much like in-person residency fairs, online virtual meetings allowed applicants the opportunity to meet faculty members and residents. These sessions were advertised by email or on Otomatch, where interested students could interact with programs over Zoom.7 Meetings varied in format but usually consisted of faculty and resident introductions, informative presentations, and question & answer sessions.
Conclusion
In the future, post-pandemic virtual interactions with students will continue to complement in-person activities. Students and faculty from across the nation can interact via a virtual away rotation thus increasing familiarity and assessment of fit without the associated cost of an in-person away rotation. With increasingly competitive matches, innovative virtual away rotations serve as valuable experiences for students to learn about the specialty, enable earlier mentorship, and expand opportunities for student recruitment. Therefore, virtual away rotations are a means to improve the accessibility of the specialty to students from medical schools without academic otolaryngology departments, students who have minimal access to opportunities for research, and minority students underrepresented in the field. We are optimistic that there will be continued implementations of virtual technologies to revolutionize student participation in otolaryngology departments both near and far.
Conflict of Interest: No funding sources were obtained to support this work. The authors claim no conflict of interests. This manuscript has not been previously presented.
Author Contributions:
Brandon R Perez: substantial contributions to conception and design, drafted the article for important intellectual content, made final approval of the version to be published, and agreed to be accountable for all aspects of the work.
Nicholas R Curran: substantial contributions to conception and design, drafted the article for important intellectual content, made final approval of the version to be published, and agreed to be accountable for all aspects of the work.
Jeffrey Yu: substantial contributions to conception and design, drafted the article for important intellectual content, made final approval of the version to be published, and agreed to be accountable for all aspects of the work.
References
- 1. Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health, 2020; 25(3): 278-280. doi:10.1111/tmi.13383.
- AAMC: Important Guidance for Medical Students on Clinical Rotations During the Coronavirus (COVID-19) Outbreak, 2020.
- Puscas L, Sharp SR, Schwab B, Lee WT. Qualities of Residency Applicants: Comparison of Otolaryngology Program Criteria with Applicant Expectations. Arch Otolaryngol Head Neck Surg,2012; 138(1): 10–14. doi:10.1001/archoto.2011.214.
- Wickemeyer JL, Yu J. A Model for Undergraduate Medical Student Education in Otolaryngology During the Post–COVID-19 Era. Otolaryngology–Head and Neck Surgery, 2020. doi:10.1177/0194599820959276.
- Arthur J, Ezell S, Schultz M, Stevens P. Proximie. Expanding virtual surgical collaboration, 2020.
- Hakim AA, Kellish AS, Atabek U, et al. Implications for the use of telehealth in surgical patients during the COVID-19 pandemic. Am J Surg, 2020; 220(1): 48–49. https://doi.org/10.1016/j.amjsurg.2020.04.026
- Otomatch, “Program Info” tab (virtual sub-internships).
