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.