“Necessity is the mother of innovation.”
Proverb
“What is now paved was once only imagined.”
William Blake, Auguries of Innocence
Innovation is woven into the fabric of neurosurgical training. While during the senior years of residency, this takes the form of adapting operative technique or clinical decision-making to unanticipated situations, in the more junior years, innovation plays a different role. Time management, efficient communication and optimizing the educational yield of clinical encounters all take on new life when a trainee’s agenda is maximized, schedule stretched and daily routine stripped of meaningful reliability. Similarly, with each case, rotation, or year, a resident’s understanding of the scope of neurosurgery expands, while the available resources to explore and master it shrink, forcing the trainee to acquire new, creative approaches to learning. To a degree, neurosurgery training programs have adapted to the whirlwind lifestyles required of its residents. But even in programs where innovative resources are available, much of the critical learning is carried out independently. Perhaps more so than any other aspect of our para-clinical lives, resident education has been unexpectedly challenged and upended by the COVID-19 pandemic, requiring sweeping changes that once again have demonstrated the remarkable capacity of neurosurgeons to innovate under unexpected circumstances.
At my institution, the Medical University of South Carolina, formal didactics were markedly limited, and residents were initially given freedom to engage in independent learning—with emphasis placed on activities that would help maintain and improve clinical acumen. As the pandemic lockdown proceeded and clinical volume declined, resident duties were minimized; those residents not directly involved in clinical care were instructed to leave campus for social distancing purposes. Quite unexpectedly, with this windfall of unallocated free time, came the decision to build a daily didactics session for the residents’ collective benefit.
Each afternoon, all off-campus residents would digitally congregate for one to two hours of didactics that covered the breadth of neurosurgery. For many sessions, a senior resident would present a video lecture; for others, faculty would lead a more focused discussion within their area of expertise. Still other sessions involved “visiting professors” from outside institutions, who would host grand rounds-style discussions on their research and academic interests. Within days, what had been proposed as an improviso avenue for addressing an emerging educational need had transformed into a powerful “new normal,” wherein the conference itself dictated numerous aspects of our daily schedules. Indeed, the “pick-up conference” quickly evolved into a complex and rigorous program of speakers, topics and formats, that were tailored to both the advantages and inherent limitations of the medium.
Though our COVID-19 conference experience was ultimately reined in by reactivation of the clinical practice, it provided several key lessons that continue to influence the educational experience today. First, it served as a proof-of-concept that online, video conference-based didactics were not just viable alternatives to routine meetings, but were superior in many regards. Second, it demonstrated that resident-led interactive sessions offer a reliable source of compelling educational content for neurosurgery trainees, even on a casual basis as long as both residents and faculty members support the effort. Third, it validated the value—both intellectually and psychologically—of maintaining a robust schedule of formal didactic exercises within any neurosurgery resident core curriculum. And finally, it once again proved neurosurgery to be a fertile space for the cultivation of those ideas and innovations borne of necessity.
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