Teaching through the screen: a toolbox for creating a virtual neurosurgical subinternship program

View More View Less
  • 1 Harvard Medical School, Boston; and
  • | 2 Department of Neurosurgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Free access

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic disrupted the landscape of traditional neurosurgical subinternships, ramifications of which persist to this day. The outright cancellation of in-person subinternships in 2020 presented not only a challenge to both applicants and programs, but also an opportunity to establish an effective and efficient platform for virtual neurosurgical training. To address this need, the authors designed and trialed a novel virtual neurosurgical subinternship (Virtual Sub-I).

METHODS

The weeklong, case-based Virtual Sub-I program combined flipped-classroom and active learning approaches. Students worked in small groups to discuss neurosurgical cases. Faculty and residents offered personalized mentorship sessions to participants. Surveys were used to assess students’ experience with the authors’ subinternship program, consistent with level 1 of the Kirkpatrick model.

RESULTS

A total of 132 students applied from both international and American medical schools. The final cohort comprised 27 students, of whom 8 (30%) were female and 19 (70%) were male. Students characterized the subinternship as “interactive,” “educational,” and “engaging.” One hundred percent of survey respondents were “very likely” to recommend the Virtual Sub-I to their peers. Faculty involved in the Virtual Sub-I stated that the program allowed them to determine the fit of participating medical students for their neurosurgery residency program, and that information gathered from the Virtual Sub-I had the potential to influence their ranking decisions.

CONCLUSIONS

The Virtual Sub-I recapitulates the educational and interpersonal benefits of the traditional subinternship experience and can serve as a prototype for future virtual surgical education endeavors. Furthermore, the Virtual Sub-I presents a more equitable platform for introducing medical students across the undergraduate medical education spectrum to neurosurgical education and mentorship.

ABBREVIATIONS

BIDMC = Beth Israel Deaconess Medical Center; COVID = coronavirus disease 2019; Virtual Sub-I = virtual subinternship.

OBJECTIVE

The coronavirus disease 2019 (COVID-19) pandemic disrupted the landscape of traditional neurosurgical subinternships, ramifications of which persist to this day. The outright cancellation of in-person subinternships in 2020 presented not only a challenge to both applicants and programs, but also an opportunity to establish an effective and efficient platform for virtual neurosurgical training. To address this need, the authors designed and trialed a novel virtual neurosurgical subinternship (Virtual Sub-I).

METHODS

The weeklong, case-based Virtual Sub-I program combined flipped-classroom and active learning approaches. Students worked in small groups to discuss neurosurgical cases. Faculty and residents offered personalized mentorship sessions to participants. Surveys were used to assess students’ experience with the authors’ subinternship program, consistent with level 1 of the Kirkpatrick model.

RESULTS

A total of 132 students applied from both international and American medical schools. The final cohort comprised 27 students, of whom 8 (30%) were female and 19 (70%) were male. Students characterized the subinternship as “interactive,” “educational,” and “engaging.” One hundred percent of survey respondents were “very likely” to recommend the Virtual Sub-I to their peers. Faculty involved in the Virtual Sub-I stated that the program allowed them to determine the fit of participating medical students for their neurosurgery residency program, and that information gathered from the Virtual Sub-I had the potential to influence their ranking decisions.

CONCLUSIONS

The Virtual Sub-I recapitulates the educational and interpersonal benefits of the traditional subinternship experience and can serve as a prototype for future virtual surgical education endeavors. Furthermore, the Virtual Sub-I presents a more equitable platform for introducing medical students across the undergraduate medical education spectrum to neurosurgical education and mentorship.

The coronavirus disease 2019 (COVID-19) pandemic produced unprecedented interruptions in the surgical residency application cycle for the 2020–2021 academic year. The early months of the pandemic overlapped with the traditional start of “away-rotation” season, in which fourth-year medical students applying to surgical residencies travel to institutions around the country to complete monthlong subinternships. Recognizing the public health hazards such travel would impart, the Coalition for Physician Accountability’s Work Group on Medical Students released official guidelines recommending that away rotations be discouraged for all students for the 2020–2021 cycle.1 The Society of Neurological Surgeons (SNS), which oversees undergraduate and postgraduate neurosurgical education, released a similar statement in April of 2020 reaffirming that “[all] external medical student rotations in neurological surgery will be deferred in 2020.”2

The decision by these governing bodies to cancel in-person subinternships unquestionably protected medical students from unnecessary exposure to COVID-19. Unfortunately, the loss of subinternships deprived both medical students and residency programs of a traditional component of the surgical residency matching process. Away rotations allow medical students to demonstrate their surgical knowledge base and aptitude, interpersonal skills, and interest in specific programs, especially programs outside the geographic area of their home institution. Both students and residency programs use the subinternship period to engage in bidirectional assessment of an applicant’s “fit,” which may influence ranking decisions on both sides of the match. Finally, subinternships foster the expansion of mentorship networks across institutions, which can significantly augment students’ professional development at the onset of their surgical training.

Unlike other aspects of undergraduate medical education, which were rapidly converted to virtual programming at the onset of the pandemic, no system yet existed that could recapitulate the vital benefits of a surgical subinternship. Local opportunities for surgical education were severely curtailed by 1) nationwide personal protective equipment shortages precluding medical student involvement on the wards, 2) cancellation of elective procedures and reassignment of surgical staff to COVID-19 wards, and 3) surgical society guidelines limiting students to one home subinternship. Amid the obvious stressors associated with a rapidly accelerating pandemic, fourth-year medical students now faced the prospect of applying to surgical residency without the traditional tools for success.

In response to this urgent need, we developed a virtual subinternship for neurosurgery applicants hosted by the Beth Israel Deaconess Medical Center (BIDMC) Department of Neurosurgery. Here, we present a virtual subinternship (Virtual Sub-I) toolbox, describing the materials and methodologies used to construct our weeklong program. We also report students’ experiences with the Virtual Sub-I, which demonstrate the efficacy and utility of our program.

Methods

Curriculum Development

The overarching objective of our Virtual Sub-I was to recreate essential components of the traditional subinternship experience. First, to arm students with neurosurgical knowledge that would prepare them for internship, we designed a case-based curriculum that spanned the breadth of neurosurgical subspecialties. Faculty, fellows, and residents from the Department of Neurosurgery volunteered to lead discussions and activities on neurosurgical oncology, deep brain stimulation, vascular neurosurgery, neurotrauma, spine neurosurgery, and skull base neurosurgery. Through case discussions and interactive review sessions, students were encouraged to not only showcase their existing knowledge, but also generate and elaborate on new concepts throughout the week. The small-group case review activities also permitted us to accomplish our second goal: to evaluate students’ interpersonal skills and capacity for teamwork. To allow students ample opportunity to assess the BIDMC neurosurgery residency, we devoted three separate blocks to question-and-answer sessions with the residency program leadership. Finally, we developed two mentorship sessions to enable students to build their professional network. Informal mentorship took place during a virtual lunch with BIDMC neurosurgery residents, while structured mentorship on navigating the upcoming match took place in one-on-one sessions with BIDMC neurosurgery attendings toward the end of the course. A sample program syllabus can be found in Fig. 1; a detailed curriculum can be found on the course website (http://bidmcneurosurgerysubi.weebly.com; password: BIDMC2021).

FIG. 1.
FIG. 1.

A sample syllabus for our weeklong Virtual Sub-I in neurosurgery at BIDMC. DBS = deep brain stimulation; Q&A = question and answer.

All synchronous sessions were held using the Zoom platform. Synchronous learning was limited to three sessions per day to avoid virtual learning fatigue. Students were also encouraged to complete 1 to 2 hours of asynchronous learning per day, typically in the form of postsession knowledge consolidation and reflection.

Material Acquisition

Patient data, including MR and CT images, past medical history and clinical examination findings, and consultation notes, were collected from prior BIDMC neurosurgery case records and used as the basis for group-based learning activities. All protected health information was de-identified according to Health Insurance Portability and Accountability Act (HIPAA) guidelines because of the inherent risk of students screenshotting or otherwise sharing images from the Virtual Sub-I with others.

Construction of a Centralized Website

For ease of access to course material and centralized submission of pre- and postsession assignments, we constructed a Virtual Sub-I website using the free Weebly website builder. This password-protected website was available to course faculty and registered Virtual Sub-I participants only. All materials were made available to students and faculty prior to the start of the program to allow sufficient time for prereview.

The home page of the website housed the Zoom link and password that students would use to access all synchronous sessions throughout the course. We also crafted a separate page for each day of the course. Each subpage included an overview of the daily schedule, the objectives for each session, and suggested readings for that day’s subject matter. During the Virtual Sub-I, students would submit group assignments and individual postcourse work on the corresponding day’s web page for faculty evaluation.

To facilitate future implementation of the Virtual Sub-I at other institutions, we have made our course website available (http://bidmcneurosurgerysubi.weebly.com; password: BIDMC2021). Access is also available through the QR code in Fig. 2. This website contains the details of our syllabus broken down into tabs detailing each day’s curriculum.

FIG. 2.
FIG. 2.

QR code linking to the BIDMC neurosurgery Virtual Sub-I website. The link represented by the QR code houses the actual website used during the BIDMC neurosurgery Virtual Sub-I program and contains a day-by-day breakdown of the program curriculum, educational materials, and learning objectives.

Recruitment

Inspired by successes of other programs in advertising virtual medical education opportunities on social media, we used Twitter outreach as our primary recruitment strategy. We first posted a poll on Twitter inquiring about which time frame students preferred for Virtual Sub-I sessions; our results indicated stronger interest in evening sessions than morning or afternoon sessions. Later in the spring of 2020, course directors posted an advertisement for the Virtual Sub-I on their personal Twitter pages that included a brief description of the program and a registration link (Fig. 3). Twitter analytics revealed 2368 instances of engagement with our advertisement, including likes, retweets, and clicks. Independent, unsolicited retweets and quote tweets of the advertisement facilitated greater spread of our message to different medical communities on Twitter. Additional advertisements were posted to the Harvard Medical School Neurosurgery interest group mailing list, along with requests to forward the message to interested parties at other medical schools. Students submitted their registration via a brief SurveyMonkey form that collected information on applicants’ year in medical school, home institution name and country, gender, and preference for subinternship date out of three available options.

FIG. 3.
FIG. 3.

Advertisement for the BIDMC neurosurgery Virtual Sub-I program posted on the Twitter account of course director Dr. Stippler on June 22, 2020. The text of the advertisement includes a brief description of the curriculum and a link to the registration form. All images included in the advertisement are of residents and faculty in the BIDMC Department of Neurosurgery.

Participant Selection

We decided to limit our enrollment to third- and fourth-year medical students who were entering the 2020–2021 neurosurgical residency match, as these students compose the intended audience for advanced surgical subinternships. Students from United States medical schools were prioritized over international applicants given their greater likelihood of entering that year’s match. To verify academic status and good standing, we required accepted students to obtain a letter of support and eligibility confirmation from the administrations of their respective medical schools. Applicants also selected which of the three Virtual Sub-I sessions they would prefer to attend, with the option to select one, two, or all dates. Accepted students were notified of their selection by email 2 weeks prior to the start of their Virtual Sub-I session.

Although the virtual format theoretically granted us space for every student who applied, our curriculum was designed to engage students in small-group learning formats with a maximized faculty-to-student ratio. Therefore, we selected 10 students to participate in each of the three Virtual Sub-I sessions using the criteria listed above. Of 30 accepted students, 3 notified us of their inability to participate prior to starting the Virtual Sub-I, resulting in a final cohort of 27 participants in our program.

Evaluation of Student Experience

At the conclusion of the weeklong program, participants were invited to complete an online survey about their experience with the Virtual Sub-I. The survey comprised 45 questions, the majority of which asked students to rate their experience with individual course components on a 6-point Likert scale: “strongly agree,” “agree,” “somewhat agree,” “somewhat disagree,” “disagree,” and “strongly disagree.” Three free-response questions encouraged students to 1) rate their likelihood to recommend the Virtual Sub-I to a colleague, 2) describe the Virtual Sub-I with three adjectives, and 3) recommend improvements for future programming. The full list of questions can be found in the Online Appendix.

Results

A total of 132 students applied to participate in our Virtual Sub-I, representing 38 United States medical schools and 68 different international institutions. The majority of applicants (54%) were fourth-year medical students; third-year students were the next most common group at 16% of all applicants. Women represented a minority of applicants. In total, 27 students participated in one of our three Virtual Sub-I blocks. Of these, 21 were from United States medical schools spanning 13 states; the remaining 6 were international medical students. Nineteen of the 27 participants (70%) were male. Six participants were third-year medical students, and all remaining students were in their fourth year of medical school.

Twenty of 27 participants (74%) responded to our postcourse survey. All (100%) of the survey respondents said that they were “very likely” to recommend the Virtual Sub-I to their peers on a 3-point Likert scale of “very likely,” “likely,” or “not likely.” The three most common adjectives used to describe the Virtual Sub-I experience were “interactive,” “engaging,” and “educational.” Importantly, students highlighted the “low-pressure” and “welcoming” environment as ideal for continuing their surgical education amid the dual external stressors of applying to residency and the ongoing pandemic. All respondents agreed that the mentorship session was a valuable component of the program and should be continued in future iterations of the Virtual Sub-I. Across all six major topics presented in the course (neurosurgical oncology, deep brain, skull base, vascular, trauma, and spine), students found the content to be both relevant and contributory to new learning. Overall, students agreed that the Virtual Sub-I gave them the opportunity to apply their current knowledge. A summary of responses to each of the 45 questions can be found in Fig. 4.

FIG. 4.
FIG. 4.

Survey responses collected from Virtual Sub-I program participants. The number in the gray box represents the mean response across all survey participants, from a scale of 1 = “strongly disagree” to 6 = “strongly agree.” A higher mean score indicates higher average agreement with the survey statement. The percentage of survey respondents who selected each answer choice for a given question is represented both in numerical annotation and in color gradient. angio = angioplasty.

Faculty feedback was ascertained with an 8-question survey sent to the eight Virtual Sub-I teaching faculty, with a response rate of 75%. Eighty-three percent of faculty respondents stated that they were able to determine the fit of Virtual Sub-I participants for their neurosurgery program. All respondents found that the structure of the Virtual Sub-I allowed them to determine the breadth and depth of medical knowledge of the participating medical students. None of the faculty found their involvement in the Virtual Sub-I to be burdensome, and all of the faculty stated that they would participate again in future Virtual Sub-I sessions. Despite the limitations of the virtual format, 33% of faculty respondents indicated that the insight they gained about a candidate during the Virtual Sub-I would “definitely” influence their ranking decisions about residency candidates, while 67% stated that it would “maybe” influence their ranking decisions.

Of the 27 participants, 6 (22%) applied to the BIDMC neurosurgery residency program in 2020. Of the remaining students, 6 were third-year medical students and therefore ineligible for that year’s residency match. Another 6 participants were international students who chose not to enter the match. We extended interview invitations to all 6 students who applied to our program, and all accepted and attended our virtual interview day. Five of these 6 students were ranked for potential admission into our residency program, and all 6 obtained positions in the neurosurgery match, although none eventually matched to our program.

Discussion

The responses to our postcourse survey demonstrate the effectiveness of our Virtual Sub-I. We achieved a net promoter score of 100%, indicating that students universally enjoyed the experience and would recommend the Virtual Sub-I to other advanced medical students. We attribute our success to the active learning methodology used in our program design, which enabled students to not only apply their existing knowledge, but also learn how to think like a neurosurgeon. Our case-based curriculum involved students at all times in relevant discussions and knowledge generation. Outside of the educational component, students responded positively to the mentorship opportunities included in the Virtual Sub-I. For many students, the informal and formal mentorship sessions provided a rare opportunity for outside feedback on the strength of their residency applications and for career advice. The dedication of neurosurgery residents and faculty to the creation and execution of this Virtual Sub-I played a significant role in its eventual success.

Another major benefit of our Virtual Sub-I is its scalability. In any given year, BIDMC neurosurgery can hold only two to three in-person subinternships; with 1 or 2 students per subinternship, the program can therefore only host a maximum of 6 students in a single application cycle. With the Virtual Sub-I, we were able to engage with 27 learners, a nearly fivefold increase, drastically increasing our exposure to potential residency candidates. The Virtual Sub-I also facilitated greater "face time" between program faculty and neurosurgery applicants than is normally possible in the traditional subinternship format. During 1-month away rotations, students mostly interface with residents and fellows; limited interactions with attendings occur primarily in the operating room. The small-group format of our Virtual Sub-I and dedicated individual mentorship time allowed our faculty to know students on a more personal level, which facilitated downstream ranking decisions for participants who later applied to our residency program.

Furthermore, the virtual platform allows students to engage with surgical residency programs for free, alleviating the financial burden associated with in-person away rotations. A study of the neurosurgery residency matching process in 2014 found that students spent more than $10,000, on average, applying to neurosurgery programs.3 A nontrivial portion of this expense stemmed from the travel and housing costs associated with completing two or more away rotations, for which no dedicated scholarships exist. By enabling students to engage with surgical departments virtually, we can eliminate these costs and enable students to demonstrate interest in more residency programs than is possible with the in-person format. Virtual subinternships may especially benefit students from lower socioeconomic status and those without home neurosurgery programs, who may lack the financial, educational, and mentorship resources that enable success in the match.

Of the students who engaged in our Virtual Sub-I curriculum, 6 students eventually applied to our residency program in the 2020–2021 match cycle. In all, 40% of the medical students who were eligible for the match in 2021 applied to and interviewed with our residency program. Although we did not poll the remaining 60%, we believe that two factors likely influenced their decision not to apply. First, without in-person rotations, students may have been reluctant to apply to programs outside their home institution or of which they had little prior knowledge. Second, our Virtual Sub-I provided detailed insight into our program’s culture that allowed students to selectively apply to our institution based on perceived fit. The latter explanation highlights another benefit of virtual subinternships, namely, reducing “application fever” by allowing students to gauge their true interest in a program prior to applying. Future implementations of the Virtual Sub-I should examine whether the program increases the likelihood of participants to apply to neurosurgery residency in general and at that specific institution.

Our Virtual Sub-I format is one of many developed by institutions nationwide during the early stages of the pandemic. Other surgical subspecialties, ranging from plastic surgery to urology, have also hosted successful workshops for rising fourth-year medical students, highlighting the utility of virtual programming in preparing students for residency.46 While other programs spanned multiple weeks, our 1-week program decreases the time burden on students and faculty. Additionally, unlike other models, we consciously chose not to include lecture-based didactics in our Virtual Sub-I, which we believed would promote passive learning and discourage student participation and attention. Regardless of these differences, our institutional experience supports virtual surgical programming in any format as a means to engage advanced undergraduate medical learners.

From the perspective of the host institution, as reflected in our faculty survey, the Virtual Sub-I offers an excellent opportunity to evaluate the fund of medical knowledge and diagnostic reasoning of potential residency candidates in advance of the neurosurgery match process. Unlike the traditional, in-person subinternship, the Virtual Sub-I allows faculty and residents to interact with students in a small-group format, permitting assessment of both individual talent and teamwork styles. The case-based curriculum encourages participants to demonstrate their diagnostic capabilities, a skill set not often showcased during a typical 1-month rotation. Finally, in the individual mentorship sessions and social components of the Virtual Sub-I, faculty and program residents can easily ascertain the career goals, research interests, and personality of the participating students. This information is usually gleaned during the residency application screening or interview stages of the match process, in which considerably less time is available to consider each applicant. The Virtual Sub-I therefore provides residency programs valuable, additional information with which to prioritize or stratify neurosurgery applicants for interview and ranking considerations.

Limitations and Future Directions

The Virtual Sub-I toolbox presented herein includes multiple components to gauge the interpersonal skills, teamwork capacity, and baseline neurosurgical knowledge of participating students. However, our original design did not include assessment of participants’ surgical aptitude, an important evaluation criterion of traditional, in-person subinternships. Other virtual subinternships incorporated suture and knot-tying workshops to address this need; students would demonstrate their skills over live video by suturing readily available materials, such as raw chicken breast. We recommend including these types of activities in future virtual subinternships to facilitate holistic assessment of surgical residency candidates.

The most common feedback from our participants was the desire for the one-on-one mentorship session with faculty to be extended from 10 minutes to 30–60 minutes long. From the faculty perspective, 10 minutes was also too little time to engage fully with each applicant. For future iterations of the Virtual Sub-I, we recommend extending the mentorship session or implementing multiple opportunities for individual mentorship spaced throughout the week.

Impact

Although increases in vaccination rates and personal protective equipment supplies have enabled the gradual return of students to the clinic, the utility of the Virtual Sub-I model will persist. For instance, the Coalition for Physician Accountability’s guidelines for the 2021–2022 residency application cycle encouraged medical schools to limit away rotations to one per student, meaning that students across all surgical subspecialties would benefit from virtual opportunities to increase their exposure to national residency programs. As the full resumption of traditional in-person subinternships develops, we envision several additional advantages that the Virtual Sub-I can confer to both advanced medical students and residency programs over the standard format. First, third-year medical students can use the Virtual Sub-I to learn more about outside institutions and determine which programs they will prioritize for away rotations in the following year. Similarly, fourth-year medical students can signal their interest in more residency programs for no additional cost by combining weeklong Virtual Sub-I sessions with their away-rotation schedules. Residencies should consider hosting Virtual Sub-I sessions in the months leading up to the traditional subinternship period (May–October) to maximize student availability and minimize scheduling demands on residents and faculty. Finally, if held after the match is completed, the Virtual Sub-I can also be adapted as a “boot camp” to prepare graduating students for their upcoming neurosurgical internships, focusing on key diagnostic and treatment concepts required for building student confidence and independence. This platform also provides an ideal forum for incoming interns to familiarize themselves with their co-residents and their program before orientation, thereby easing the interpersonal challenges associated with the transition to residency.

The virtual surgical education techniques described in this toolbox can also be adapted into case-based modules for medical students in earlier stages of undergraduate medical training. The majority of applicants to our Virtual Sub-I program were students in the first 3 years of medical school, demonstrating widespread interest in virtual learning opportunities in neurosurgery. Conversion of the didactic topics from the Virtual Sub-I toolbox into a monthly lecture series, for example, provides a low-pressure environment in which interested students can explore surgical subspecialties in the first 2 years of medical school before entering into clinical rotations. This early exposure will help students make more informed decisions about whether to enter a career in surgery and will enable longer-term mentorship that will especially benefit students without home or nearby surgical programs.

Conclusions

The virtual surgical subinternship is a viable model for continuing surgical education and assessing potential residency candidates amid the COVID-19 pandemic and beyond. While the Virtual Sub-I cannot fully replace the in-person subinternship model, we anticipate that the methods presented above will prove powerful adjuncts to existing surgical curricula, could reduce application fever by allowing students to gauge their true interest in a program prior to applying, and will create an avenue for more equitable and inclusive selection of neurosurgical residents

Acknowledgments

We acknowledge support from the National Institute of General Medical Sciences (grant no. T32 GM141745 to S.E.H.).

Disclosures

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Author Contributions

Conception and design: all authors. Acquisition of data: Hoffman. Analysis and interpretation of data: Hoffman. Drafting the article: Hoffman. Critically revising the article: all authors. Reviewed submitted version of manuscript: all authors. Approved the final version of the manuscript on behalf of all authors: Stippler. Statistical analysis: Hoffman. Study supervision: Stippler, Vega.

Supplemental Information

Online-Only Content

Supplemental material is available online.

Online Appendix. https://thejns.org/doi/suppl/10.3171/2022.5.FOCUS22171.

Previous Presentations

These findings were presented orally at the virtual Association for Surgical Education 2021 Annual Meeting, April 29–May 1, 2021.

References

  • 1

    The Coalition for Physician Accountability’s Work Group on Medical Students in the Class of 2021 Moving Across Institutions for Post Graduate Training. Final Report and Recommendations for Medical Education Institutions of LCME-Accredited, U.S. Osteopathic, and Non-U.S. Medical School Applicants.Accessed June 8, 2022. https://www.aamc.org/system/files/2020-05/covid19_Final_Recommendations_05112020.pdf

    • Search Google Scholar
    • Export Citation
  • 2

    Society of Neurological Surgeons. SNS policy on external medical student rotations during the COVID-19 pandemic. Accessed June 8, 2022. https://www.societyns.org/Assets/afd5bf01-5795-4ab9-a819-7dc40caf9975/637504612255770000/sns-policy-on-external-medical-student-rotations-2021-2022-v2-pdf

    • Search Google Scholar
    • Export Citation
  • 3

    Agarwal N, Choi PA, Okonkwo DO, Barrow DL, Friedlander RM. Financial burden associated with the residency match in neurological surgery. J Neurosurg. 2017;126(1):184190.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Dean RA, Reghunathan M, Hauch A, Reid CM, Gosman AA, Lance SH. Establishing a virtual curriculum for surgical subinternships. Plast Reconstr Surg. 2020;146(4):525e527e.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Margolin EJ, Gordon RJ, Anderson CB, Badalato GM. Reimagining the away rotation: a 4-week virtual subinternship in urology. J Surg Educ. 2021;78(5):15631573.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Williams C, Familusi OO, Ziemba J, et al. Adapting to the educational challenges of a pandemic: development of a novel virtual urology subinternship during the time of COVID-19. Urology. 2021;148:7076.

    • Crossref
    • Search Google Scholar
    • Export Citation

Supplementary Materials

  • View in gallery

    A sample syllabus for our weeklong Virtual Sub-I in neurosurgery at BIDMC. DBS = deep brain stimulation; Q&A = question and answer.

  • View in gallery

    QR code linking to the BIDMC neurosurgery Virtual Sub-I website. The link represented by the QR code houses the actual website used during the BIDMC neurosurgery Virtual Sub-I program and contains a day-by-day breakdown of the program curriculum, educational materials, and learning objectives.

  • View in gallery

    Advertisement for the BIDMC neurosurgery Virtual Sub-I program posted on the Twitter account of course director Dr. Stippler on June 22, 2020. The text of the advertisement includes a brief description of the curriculum and a link to the registration form. All images included in the advertisement are of residents and faculty in the BIDMC Department of Neurosurgery.

  • View in gallery

    Survey responses collected from Virtual Sub-I program participants. The number in the gray box represents the mean response across all survey participants, from a scale of 1 = “strongly disagree” to 6 = “strongly agree.” A higher mean score indicates higher average agreement with the survey statement. The percentage of survey respondents who selected each answer choice for a given question is represented both in numerical annotation and in color gradient. angio = angioplasty.

  • 1

    The Coalition for Physician Accountability’s Work Group on Medical Students in the Class of 2021 Moving Across Institutions for Post Graduate Training. Final Report and Recommendations for Medical Education Institutions of LCME-Accredited, U.S. Osteopathic, and Non-U.S. Medical School Applicants.Accessed June 8, 2022. https://www.aamc.org/system/files/2020-05/covid19_Final_Recommendations_05112020.pdf

    • Search Google Scholar
    • Export Citation
  • 2

    Society of Neurological Surgeons. SNS policy on external medical student rotations during the COVID-19 pandemic. Accessed June 8, 2022. https://www.societyns.org/Assets/afd5bf01-5795-4ab9-a819-7dc40caf9975/637504612255770000/sns-policy-on-external-medical-student-rotations-2021-2022-v2-pdf

    • Search Google Scholar
    • Export Citation
  • 3

    Agarwal N, Choi PA, Okonkwo DO, Barrow DL, Friedlander RM. Financial burden associated with the residency match in neurological surgery. J Neurosurg. 2017;126(1):184190.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Dean RA, Reghunathan M, Hauch A, Reid CM, Gosman AA, Lance SH. Establishing a virtual curriculum for surgical subinternships. Plast Reconstr Surg. 2020;146(4):525e527e.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Margolin EJ, Gordon RJ, Anderson CB, Badalato GM. Reimagining the away rotation: a 4-week virtual subinternship in urology. J Surg Educ. 2021;78(5):15631573.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Williams C, Familusi OO, Ziemba J, et al. Adapting to the educational challenges of a pandemic: development of a novel virtual urology subinternship during the time of COVID-19. Urology. 2021;148:7076.

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 118 118 118
PDF Downloads 99 99 99
EPUB Downloads 0 0 0