Discussion
The advanced, intensive, short period of head and neck surgical training
brings specific challenges to its educators. The fellowship is generally
one year and relies on exposure to a high number of clinical cases,
structured learning in oncology, and gradual advancement in performing
more complex operations. As can be seen from the survey results from
both the fellows and the program directors, the immediate impact on the
surgical case experience of this year’s trainees have been substantial,
with 70% of program directors reporting 50-90% reduction in elective
cases. Robust fellow participation in cancer related surgical procedures
has continued, however, with 81% of fellows reporting ongoing
participation in these cases. A review of the surgical case logs of this
year’s fellows appears to support these results, as the case numbers for
laryngectomy, radical tonsillectomy and microvascular procedures have
already reached 70-100% of the final volumes reported for the preceding
year’s fellowship class while parotidectomy and thyroidectomy (cases
with mix of benign and malignant indications) lag somewhat behind (Table
1). Survey results suggest many fellow-run clinics have been curtailed.
However, a minority of fellows are beginning to participate in
telemedicine clinic experiences.
Successful completion of the AHNS head and neck fellowship has several
requirements, all of which could be affected by the COVID-19 pandemic.
Each fellow is required to directly participate in the evaluation and
management of at least 200 patients with head and neck neoplastic
disease (Council, 2020), which should lead to the participation as
either operative or teaching surgeon on at least 100 major head and neck
surgical procedures. Analysis of the case logs of this year’s fellows
indicates that 82% of current fellows have already met this surgical
benchmark. While this is certainly reassuring with regard to the current
fellow class, the events of the COVID-19 pandemic provide a cautionary
tale for future pandemics and how fellowship programs must be both
nimble and creative with regard to their educational offerings and
methods. Had pandemic conditions occurred earlier in the academic year,
the impacts on surgical volumes would have likely been far more
substantial.
The clinical impacts of COVID-19 may be perceived as the most obvious,
and perhaps most acute with regard to fellowship training. But, social
distancing and substantially altered scheduling routines have had a
similarly profound impact on the didactics of the training programs. As
summarized above, the majority of programs have quickly transitioned to
online and video learning platforms, often alongside with their
associated residency programs, and were able to rapidly adapt to these
changes with robust ongoing educational offerings. Other external
resources have simultaneously supplemented these didactic offerings, or
may be available for programs to consider implementing. Such offerings
may also be applicable to conditions of more severely curtailed surgical
experiences.