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\begin{document}

\title{Go Back To The Basics: Cardiac Surgery Trainees At The Time Of Covid-19.}



\author[1]{Gabriella Ricciardi}%
\author[2]{Raoul Biondi}%
\author[2]{Gabriele Tamagnini}%
\affil[1]{Leiden Universitair Medisch Centrum}%
\affil[2]{Villa Torri Hospital}%


\vspace{-1em}



  
  \date{June 01, 2024}


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\selectlanguage{english}
\begin{abstract}
Keeping up with the surgical training might be difficult during the time
of COVID-19 pandemic: with most of the health care resources dedicated
to face this reality, trainees can improve themselves deep diving in
scientific literature, study, Telemedicine and Social Media professional
platforms. Moreover, they might be directly involved in COVID patient
care, facing a still a still elusive disease with a high lethality rate.
Often the frustration of having no valid treatment and a poor
incisiveness on the natural course of the COVID19 could lead to a blue
mood or a burnout. Eventually, the natural adaptability and the survival
instinct prevail and teach us the real meaning of resilience. Every
trainee has to be prepared for the second phase, when the new normality
will force everyone to cohabit with the virus. Even the obvious teething
troubles, this could be the right moment for all the Residents to
``grow-up'' and develop their own future Character.%
\end{abstract}%



\sloppy




\textbf{Central Message}

Even in time of forced step back in their personal ambitions and
surgical practice, Residents can achieve self-improvement and work
towards a great future career.

\textbf{Central Figure}

A authors' brain-storming session on a conference call.

\textbf{Article}

Let's make the long story short: life has been completely changed by the
COVID-19 pandemic. Since the virus outbreak has mushroomed, people
worldwide must accept that, so far, the only possible strategies to
``flatten the curve'' were lockdown and social
distance\textsuperscript{1,2}. The need to tailor our life and routine
to this \emph{new} and unique \emph{reality} was subsequently crystal
clear, especially for healthcare professionals (HCPs). At the moment,
the oldest and experienced colleagues are facing the urgency to fight
against an unknown yet scary disease, while we, as Residents, are forced
to deal with both the pandemic and the anticipated delay in our
educational programs.

Indeed, if we put the focus on surgery Residents' training, things get
further complicated. The best way to improve surgical skills is, of
course, practicing in the operating room.~ Nonetheless, presently
trainee's schedule has been disrupted in most of the University
Hospitals. In fact, the number of intensive care unit (ICU) beds and
ventilation sites has been limited due to their commitment to the
COVID-patients' handling.~ Therefore, the surgical activity has been
redirected towards emergent, urgent and not delayable cases. Eventually,
due to the in-hospital risk of disease transmission, the number of
working doctors has been restricted and some providers have been moved
to hospital areas in dire need of physicians experienced in caring for
critically ill patients. The post-COVID19 training schedules, as
expected, have been switched towards a different model.

Giving this challenging setting, Surgery Residents assisted to a
mandatory shift from regular practice in the operation theatre to
``home-sitting'' and remote meetings and discussions\textsuperscript{3}.
For sure, their field of interests had to expand to epidemiological,
immunological and pneumological concepts. Whether it is true that the
pandemic and the correlated diseases still escape complete comprehension
of the mechanisms of spreading and tissue damaging, then every Surgery
Resident, who wants to keep up with this \emph{new reality} , has to
dive deep down into the recent broad literature
production\textbackslash{}sout.

Hence, how could we, on this as Residents, take the pandemic ``special''
scenario with a grain of salt?

It turns out the daily routine should be assessed out of the OR, trying
to get the best from this experience and seizing the opportunity to
invest energies and the ``extra'' leisure on those activities we don't
usually have time enough for.

On the basis that we are still ``rookie'' surgeons, regardless of our
individual advance in career, a thorough knowledge of the
pathophysiology and the surgical procedures and techniques related to
the commonest disorders is crucial. Thus, this seems to be the right
circumstance to go back to our desk and study, simply opening the ``old
but not quite gone'' heavy and dusty books, and also to work up our
personal skills. Actually, out of this historical crisis could come a
moment of enthusiasm, dedication, creativity, innovations and ideas. So,
we should take out ``pen and paper'', or laptops, for the high-tech
addicted, and get our thinking caps on: time has come to go deeply in
scientific literature, write on a new subject or draw/sketch about
anatomy or surgery, to mention just a few, taking benefit likewise from
the powerful internet-based libraries.

The SOcial MEdia platforms (SoMe), such as LinkedIn or Twitter, provide
an excellent example of the unique opportunity of coupling personal
professional advancement with up-to-date technological breakthroughs.
HCPs achieve from the SoMe tools to share information, to discuss about
health care policy and practice issues, to promote health behaviors, to
engage with the public, and to educate and interact with patients,
caregivers, students, and colleagues\textsuperscript{4} and provide
health information to the community\textsuperscript{5}. The role of
these networks is undisguised also from the pandemic perspective, since
they have been used by world-famous iconic surgeons and doctors to
popularize educational daily tips in form of ``tweets'' or short
messages about the disease itself, the way it spreads, the measurements
to minimize its diffusion and other related virus-issues.

Beyond chasing a deeper knowledge into our specialty, some of us also
chose (or have been forced, given the circumstances) to be personally
involved in treating COVID-19 patients. Though at the beginning this
appeared just as a different and more selfless way to use our will and
time, straightaway it turned out it was a brave leap from our usual
training setting. We are facing a crude reality, in which a still
elusive disease sustains a lethality rate of 24,6\% in the 70-79 year
age group and 30\% in the 80-89 one (data from \selectlanguage{ngerman}\emph{Istituto Superiore
di Sanità} ~ - Italy). Those bare numbers do not account for the
frustration of treating a patient without a validated therapy.

Aside not being academically prepared to face the SARS-CoV-2 pandemic,
we perhaps stumbled on our psychological stability: the ``usual''
setting does not prepare us to such a highly lethal disease, against
which we are almost helpless. However, after few days of blue mood, the
instinct to survive prevails and teaches us the real meaning of
resilience: ``\emph{get up and try, try''} should not be just a chorus,
but an everlasting lesson for our career. Beyond professional and
logistical thoughts, despite the self-centered universe in which we
usually work and live, we found out and realize how deeply human we are
today. The sudden solitary confinement we were dragged into ended up to
be an optimal starting point to mug the compulsory burnout of our
reality. Long duty hours, multiple consecutive shifts and the price of
performance are the routine of almost any Cardiac Surgeon and the formed
environment of Residents and fellows. Nevertheless, if this step-aside
will lead us to find new and creative ways to enhance our learning path,
it would have been totally of worth.

To the end, these extraordinary times are an opportunity to demonstrate
outstanding collaboration within the Hospital, special staff management,
emergency planning, sense of responsibility, innovative ways for
Outpatient Care through Telemedicine, virtual meetings and conferences
and after all, medical leadership (P.Matt, F,Maisano. Cardiac Surgery
and the COVID-19 outbreak: what does it mean? PCR Online 2020).

Now that we are entering the so called ``\emph{phase two''} the given
setting is changing again. First of all, the number of COVID-19 patients
is slowly decreasing, as well as the number of dedicated ICU beds. On
the other hand, the virus will remain endemic in the society, with an
estimated R value below 1. As expected, there will be chance to resume
the elective surgical procedures, but especially in this moment we need
a keen eye on deciding which~pathologies have to be treated with
priority. For example, Coronary Artery Disease (CAD) showed a higher
mortality rate in patients affected by COVID19, but it's however
reasonable to think that all the cardiac pathologies affecting the lung
circulation - such as symptomatic severe mitral diseases or aortic
stenosis - might deserve a priority access to treatment, in order to
increase the survival rate in case of an acquired-Coronavirus infection
later on.

To the point, The COVID-19 era is teaching us, as doctors and Residents,
that we are scientists before anything else. As such, medicine is not
meant to be experienced passively, but it should be learnt with
ever-increasing passion to understand deeply the diseases' mechanisms
and the rationale supporting therapies and decisions. As surgeons, even
more.

It's plain that we feel the hunger to get a knife in our hands all the
time. Anyway, suturing and sewing is not the only way we can improve as
physicians and - especially so - our human side. Simply cutting and
closing wounds, in a moment in which we are being called upon to show
maturity and wisdom, could sound more like a whim. One of the lessons
you learn during your surgery fellowship is that our specialty is really
multilayered and complex. Awareness of the real meaning behind the mere
surgical act of stitching reaches out to gain an insight into our
resilient role in this emergency. Getting through the ``childish'' need
and desire to improve our handy skills, we found ourselves far from the
leading actors of this pandemic, alone with our desires and ambitions.
In that setting the appropriate adult reaction is to develop our future
Character, that is the best surgeon we could be.

\textbf{References}

1. Iacobucci, G. Covid-19: UK lockdown is `crucial' to saving lives, say
doctors and scientists. \emph{BMJ} 368, m1204 (2020).

2. Lau, H. \emph{et al.} The positive impact of lockdown in Wuhan on
containing the COVID-19 outbreak in China. \emph{J Travel Med} (2020).
doi:10.1093/jtm/taaa037

3. Lewis, E. E., Taylor, L. J., Hermsen, J. L., McCarthy, D. P. \&
Fiedler, A. G. Cardiothoracic Education in the Time of COVID-19: How I
Teach It. \emph{The Annals of Thoracic Surgery} (2020).
doi:10.1016/j.athoracsur.2020.04.002

4. Bernhardt, J. M., Alber, J. \& Gold, R. S. A social media primer for
professionals: digital dos and don'ts. \emph{Health Promot Pract} 15,
168--172 (2014).

5. George, D. R., Rovniak, L. S. \& Kraschnewski, J. L. Dangers and
opportunities for social media in medicine. \emph{Clin Obstet
Gynecol}56, 453--462 (2013).\selectlanguage{english}
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