Absite Smackdown! · Episode 51: How To Learn Surgery In 2021

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Jessica: Hey guys! It's me, Jess...your host of The Absite Smackdown Podcast. And of course I'm here today with Dr. David Kashmer. Hi Dr. David.


Dr. Kashmer: Hi Jessica. Welcome to the new year!


Jessica: It is—it is the new year. And speaking of the new year, that really is what our entire podcast today is about. So the title is How To Learn Surgery In 2021. 


Dr. Kashmer: Jessica, it's a timely one. Obviously we're in the new year and I'm going to tell you, even in my time as a resident and then as a program director, I'll tell you things have changed so much. And now as we come out of 2020 into 2021, things are poised to change more than ever. And it's not just because of regulations and things like that. It's because of the obvious pandemic. 


Jessica: Right. And speaking of that, so just real quick, see if you can remember, what years were you learning Surgery? 


Dr. Kashmer: Well, so many years. And I would say as a surgeon who's big into lifelong learning that I'm still learning something new every day. And what that lets me do is avoid giving you the year when I was a surgical resident. I'll just tell you this: back when we started I was still looking for x-rays on film and we had to go to the file room and find the x-ray. It would end up in someone's call room when we had to return it because they were using it to prepare for a conference. So let me tell you this. If you're a fan of Star Wars, it'll make sense: this was a long time ago in a galaxy far, far away. 


Jessica: So it's funny that you say that. I actually remember that because in college I worked in radiology and it was my job to go fetch all the films and hang them in the ER and loan them out to people and run through the floors trying to find where the heck all the residents put my films. 


Dr. Kashmer: And nowadays when the computer system for x-rays doesn't work, whether it's PACS or whatever it is, we're crippled…there's just no way. We have no idea what to do. The whole place shuts down. It's funny to watch, but the headline for this podcast is just, as you said, what it takes to learn surgery and what it will take in 2021 amidst what is hopefully the end of the pandemic, and all of the many things we're required to do. So I think it's a really timely topic that you picked. And I think it's a good one to spend some time on today. 


Jessica: All right. Wonderful. Well, the main reason I wanted to talk about this is just with your experience alone. I know so many doctors are going through right now, but with us doing less surgeries and focused more on patient care and COVID, and just the underlying conditions that make COVID worse and taking care of those patients right now, that's what you've been doing a lot of is taking care of those and teaching how to do so. So I just was really interested in how you think that it's changed from your experience, what you've been going through and what you've seen other people doing. 


Dr. Kashmer: Well, I think the first thing to my mind is philosophy and flexibility. So I'm big into teaching that when we do something, whether it's decision-making or procedurally, we have a plan, and we don't sort of deviate from it unless we have to. We make it as much like baseball as we can. The challenge with that is, although it gets you very good at what you're doing and the clinical scenarios that you're covering, you're not as flexible maybe as you otherwise could be. And one thing this pandemic has done is reshuffled things. A lot of the surgical decision-making around things like tracheostomy for COVID patients, and other things, you know, we didn't really have a pathway until COVID came for who gets a tracheostomy from these long-term ventilated patients who have COVID.


Dr. Kashmer: So I think there was a utility to having things realigned with COVID coming in. And I think the people who are coming through training now to be excellent future surgical colleagues have had such a different experience than what all of us who trained without a pandemic ever had. They will have a new appreciation for flexibility. I don't just throw the word “resilience” around, but they'll have a feel for what it takes to be resilient in a crisis that is really bigger than sort of all of us—not just a crisis with a patient who is right in front of you. So I think the philosophy of trainees who come through and their approach will be a little different, because they've lived through this. So I think that's really interesting. 


Jessica: Right. So besides just becoming expert at placing chest tubes…


Dr. Kashmer: I’ve placed a lot of chest tubes and placed a lot of central lines for COVID patients. And I'll tell you, the American Board of Surgery has been really good about this too. They have shown a flexibility with respect to still ensuring excellent training for trainees, but they've come out with some adapted guidelines based on how life looks in the midst of a pandemic. And, it just really shows how everybody sort of needs to be flexible, but still focused on excellent education. So with that set up in mind for how things are now, I think education in 2021, we'll have some ways that it is different than all other years we've educated surgical residents. 


Jessica: So do you have an idea already, or is it something that you're still working on, on how you're going to change your approach to being a director, being a teacher for the next generation of surgeons? Or is that still something that's just evolving as you go daily?


Dr. Kashmer: A lot of my generic approach will be the same. Now I've worked with surgical residents across the country, in both the program I started and others in general. I to look at them as colleagues and try to help them. And it's like a coaching style: try to help them become lifelong learners, and give them the basics and then have them want to be lifelong learners and then contribute back to our field. That's what I try to kind of educate or coach into people. In that respect, it's going to be the same. We teach about quality and what excellence looks like and all those different things that I think will remain the same, but the big change to my mind is how I leverage things like online tools and education. You know, a lot of the studies about how people do on the ABSITE, for example, deal with things like conference attendance as a marker for predictor for how well they'll do.


Dr. Kashmer: But I think this has shown, and there's been some evidence from multiple residencies now, that we can do a lot of the didactic portion in a flexible way for our residents. It can be asymmetric, meaning somebody can watch the course at this time and someone can watch it at some other time. SCORE curriculum, the Surgical Council On Resident Education has a great online resource that almost every residency uses. That's still going to continue to be great. And I think residencies have now proven that they can create their own content for their learners, for their residents, that doesn't always require them to be together in a group for the lecture portion. I think that's going to be more and more in 2021. 


Jessica: I mean, lectures moving to online, conferences moving to online, the adoption of technology and what we can do with it…really is just lifting everybody up in how they learn and what they do. And so, I mean, I thought today you might want to talk a little bit about our next steps for 2021.


Dr. Kashmer: Sure. Well, I mean, it goes without saying that Absite Smackdown with you all has always been designed as sort of a community of learners and most of the content is free, but the part that we do need support for, and we do have to have paid for, is the review book and the video review course.


That’s for hosting fees and all the different things it takes to make it. So with that respect when COVID hit, we were all in the right place at the right time because we saw something like that coming. And our, the vision was always to have an ABSITE course and texts that everybody could access that didn't require travel and it was cheaper. So that worked really well. And like you said, the next part is to start a live conference, to push more interaction, to encourage people, and to get their questions answered in real time.


Dr. Kashmer: So bottom line is yeah, 2021 is going to have a monthly review and coaching sessions, which are going to be super fun. We're already doing it informally. And then a yearly conference is going to start up. It looks like you guys have set out in 2021, which will be great, to be very problem solving focused, to try to help people raise their scores. So I think you guys have your fingers on the pulse of, you know, what's required now in today's post-pandemic world. I'm really excited to be a part of it and it's going to be fun. And the online tools to do it are really pretty cool. 


Jessica: Yeah. 2021…everything that we have planned, everything we have laid out, it's just going to grow and get bigger. Not only having you as my favorite cohost, but we'll be having a lot of the other contributors and authors on to talk about their specialty, to be able to ask questions. The monthly conferences, the yearly conference…is just going to grow and grow. You won't have to see my face all the time. We'll be having other doctors on. So I’m really excited and it's all exciting. I'm looking forward to completing the outline for this year.


Dr. Kashmer: It's going to be great. We're kind of riding a bigger wave. I mean, in Surgery, there comes a moment where you've got to do the procedure, and of course, nowadays with the robot, you can be somewhere else doing the procedure, but there comes a moment where the rubber hits the road in terms of the technical part…but the cognitive part, how we think about it, how we make decisions with the facts we have. We can do those at a distance. We can do those and try to maintain interaction and teaching and have some of the best resources in the world available for our learners, and have complete, you know, ABSITE review courses available…those kinds of things. So in Surgery, I don't want to ever say there's a replacement for being in the OR and decision-making.


Dr. Kashmer: And now, because the technology is there, we can achieve a lot more in a disseminated fashion at a distance than we ever could before. And I think 2021 is going to see more of that. There's been literature about it. Many, like I said, several residents have published now on what they did during the pandemic to maintain their didactic portion. So, one more thing: you know, nighttime…surgical residents have to work at night. We take call, and we work at night. And when we do that, it's really hard to maintain the didactic part of their residency. they may stay around for morning conferences in some residencies and that's hard on hours. They may watch SCORE videos or something like that. But things like ABSITE Smackdown, things like other products out there allow people to have surgical education at night on demand at weird hours. They can listen when they're in their car. So it's fun to be part of that with you guys. I think it's going to be just more of it in 2021, 


Jessica: 2021 will be the year of multitasking. Okay. Well, Dr. David, again, thanks as always for being on here with me, just kind of going through everything and being that, you know, knowledgeable doctor that you are to contribute to these talks and I'm super thankful. And again, I'm looking forward to everything that's coming up. Is there anything that you want to add before we close out today?


Dr. Kashmer: Jessica I think like you you've really done most of it. I think what's coming in 2021 is really exciting, both on a personal level and for where things are going with this and Absite Smackdown. For being able to coach residents across the country who have questions, and, to do that with all of you and to help them perform their best on the ABSITE. All of that is great. And I think it's just been exciting. And 2021 is going to be more of the same in terms of bringing that excitement and content to everyone. So I really appreciate you guys letting me participate. I love teaching and I've done it both in my program and across the country. And I'm telling you these tools like the ones you're using are super important, whether the pandemic continues or in its wake. 


Jessica: I agree every time we're talking about these things and moving forward, I just hear that level up level up song in my head. I can hear it as we're doing things. So it makes me excited. So again, everybody, thanks for tuning in, and we'll see you soon! And remember #AbsiteSmackdown!

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