How virtual learning enhanced my immersion and mentorship in neurosurgery

A message appeared in the chatbox. “Always trust the parents. If they think the shunt has failed, more likely than not, they’re right.” It was one of the two fifth-year neurosurgery residents, both present on the video platform for virtual clinic to moderate medical students through patient cases.

Prior to each virtual clinic session, the two residents would meet with me, fellow MS2 summer research students, and MS4 “visiting” interns, in order to walk through images and explain the patient cases for the day. During clinic, they provided live monitoring as the attending met with patients virtually; in-between, the attending neurosurgeon herself was able to quickly walk us through imaging scans to prepare us for meeting the next patient.

Several patients later, the same resident offhandedly mentioned that the team could drive a small endoscope through a hole in the skull into a patient’s ventricles, and practically “swim” through the CSF circulation to approach hard-to-access regions of the brain. My jaw dropped; I had no idea that this kind of procedure was possible. It sparked a long conversation between me and the resident about the incredible nature of brain anatomy, the beautiful environment of the ventricular system and the feeling of privilege one gets when looking at it, and the diversity of procedures neurosurgeons can conduct—all through the chatbox during live patient care, without interrupting the attending or her patients.

It was only natural, given the current nature of the COVID-19 pandemic, that all my engagements with the neurosurgery department would have to be conducted virtually. I had just completed my first year at UNC School of Medicine, and I had committed many months ago to joining the UNC Neurosurgery department as part of my summer research program, looking at surgical outcomes in skull base surgery. When my research mentor told me and the other student researchers that we would not be able to come to the hospital or join in-person patient care, I was, of course, disappointed but understanding. I definitely did not expect, however, that the virtual engagements would be as insightful and rewarding as they became—especially in a surgical specialty where so much learning traditionally comes from being in the operating room. In fact, I got more time, energy, and mentorship from the residents and faculty because of the virtual format of patient care and our interactions.

The sub-internship 4th-year medical students joined the department virtually in July, and they only added to my experience. They eagerly answered my questions about the residency application process, and even provided their contact information if I had more questions down the road. While these interactions would have occurred had I been in-person, I was able to learn and vicariously experience far more of their sub-internship activities through the virtual environment. I observed them interact with each other in remote clinic and during didactics as well as with residents and faculty; this in and of itself taught me a lot about the expectations I would have during my final year of medical school, and how to surpass those expectations the way the sub-interns did. Their professionalism, emotional intelligence, and collegiality helped me see what makes a successful student outside of academic knowledge and classroom learning.

My enhanced experiences even extended to the operating room. As we virtually observed our attending repair a newborn baby’s brain malformation, the beeps of the heart monitor coming out of my laptop’s speaker brought me into the zone—just as much as if I had been present in the theater myself. Observing the operation virtually, however, I had the added benefit of the residents’ commentary throughout the procedure: they not only highlighted what was going on at each stage of the procedure, but also conversed with us freely during lulls in the operation. As an MS2, I would not have asked questions so freely if I been present in-person in the operating theater, to avoid being disruptive or interfering with the attending’s work.

What made my summer immersion especially rewarding was being able to learn about aspects of neurosurgery beyond clinic and the OR. During multiple social hours or didactics, the residents and attendings would come together to talk to us about their personal experiences as a part of the field. They talked about how they balanced their workload with their family life, feelings of burnout, and how to navigate wellness, and what it is like to have difficult conversations with families or negative outcomes. They also talked about the aspects of the field they wish they had known about when they entered residency, and advised us at length about how we should approach the residency application process to be successful. I had long been interested in neurosurgery, but one of the big uncertainties I had about the field was how it impacted the doctors’ lives. Hearing the residents talk openly about their experiences helped me realize that though the field presents its challenges, it is not impossible to adjust. These open discussions were not something that would ordinarily have been a part of my summer research program, but due to virtualization, the department was able to easily host these opportunities from the comfort of everyone’s homes.

I came out of the summer with not only my expected research data, abstract, and manuscript drafts, but also unexpected mentorship and deeper insight into the field of neurosurgery. This was due to the department’s creative use of a fully virtual learning experience, and the incredible dedication of the faculty and residents to providing education throughout the pandemic. It not only deepened my interest in the field, but also inspired me to pay forward the same sort of effort and creative energy when confronting obstacles in patient care. It has also inspired me to apply that passion for mentorship in my future career, and in my current education by guiding and informally mentoring MS1s.

The author would like to acknowledge Drs. Carolyn Quinsey, Randaline Barnett, and Marty Piazza.

Chhitij Tiwari is a medical student.

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