By Dr. Jamila S. Karim, Head of Research & Strategic Development at Proximie
As healthcare systems continue to grapple with COVID-19 cases, governments across the globe are being faced with the prospect of establishing new restrictions and lockdown measures which reduce viral spread and safeguard medical services whilst simultaneously minimising impact on the economy.
2020 has been a year marked by uncertainty. Yet, there is little doubt that the coming months will test the international medical community to its core.
Much has been learnt and achieved since the start of the pandemic — healthcare professionals have more experience in managing COVID- 19 patients, hospitals have implemented new measures to reduce the spread of infection, intensive care capacity has been increased and PPE requirements have been addressed. The recent approval of the Pfizer-BioNTech COVID-19 vaccine by the MHRA has provided the UK healthcare community with another tool with which to tackle the pandemic and, perhaps most importantly, a renewed sense of hope.
Knowledge gleaned over the past months will no doubt be useful when addressing the current increase in cases. However, the second wave presents unique challenges of its own. The surge coincides with the dreaded ‘winter pressures’, a term used to describe a predictable increase in demand on healthcare services that occurs most years in the colder months. Moreover, elective and semi-elective treatments for non-COVID conditions that have recently been reinstated following suspension during the first wave are being affected once again.
“Perhaps most troubling is the profound impact that the second surge is having on what is inevitably an already exhausted medical workforce.”
It is right that emphasis has been placed on bolstering PPE reserves and creating new ITU infrastructure to manage the influx of COVID-19 patients. However, if we are to ensure that healthcare systems are able to cope with the current pandemic and what is projected to be a prolonged and arduous post-COVID recovery process, mechanisms must be established to build resilience within the medical workforce.
This includes ensuring that trainees are supported to continue broadening their skill base and progressing through training.
“Trainees are at the heart of the healthcare workforce and their clinical acumen will be relied upon heavily both during the pandemic and perhaps even more so in the post-COVID recovery phase — a process which is likely to take months if not years.”
Clearing the backlog of patients who were unable to undergo surgery during the first wave alone will require a herculean effort. Indeed, the President of the Royal College of Surgeons of England, Professor Neil Mortensen, recently proposed that a ‘New Deal’ will be required following the pandemic to address the increasing number of patients awaiting treatment.
Trainees are, in effect, the next generation of experts. Yet, this year’s UK General Medical Council (GMC) survey of doctors in training highlighted that “More than 80% of doctors in training say disruption caused by coronavirus reduced their access to the learning they need to progress their careers.”¹
It is incumbent on the global healthcare community to ensure that trainees do not unintentionally become silent victims of the COVID-19 pandemic. Quite simply: we can’t afford not to.
In these trying times, how can trainees be supported to progress in their careers and build the skill set required to tackle the challenges brought forth by the pandemic and its subsequent effects?
New technologies have already been trialled by a number of hospitals and associations to meet learning needs during the pandemic. When applied at scale, they could form the basis for a robust strategy for training healthcare professionals.
One of the greatest barriers to training during a pandemic is appropriate access to cases and learning opportunities. Many face-to-face teaching sessions and courses have been cancelled and certain clinical environments, such as operating theatres, are restricted due to infection control measures. Suspension or reduction of specific services, such as elective and semi-elective surgeries, also curtails the ability for trainees to experience the breadth of patient cases that they would typically be expected to engage with.
The Proximie augmented reality platform is a UK-based technology platform that has been applied by some hospitals and associations to maximise training sessions and ensure that every case is leveraged as a potential learning opportunity. By virtually connecting clinicians in real-time, patient cases can be securely streamed to trainees, enabling them to experience the case as though they were present in the clinical environment.
Proximie Founder and CEO, Dr. Nadine Hachach-Haram says:
“Technology has a crucial role to play in easing the burden on trainees during this challenging time. Our future surgeons must have access to adequate training and educational opportunities despite the challenges of COVID-19. Now is the time for the healthcare community to come together and apply pragmatic solutions to mitigate the current training challenges faced by junior doctors.”
COVID-19 has presented the surgical training community with a myriad of challenges. Within weeks, face-to-face teaching sessions were cancelled, access to theatres was restricted due to infection control measures, and outpatient clinics and elective operations were postponed. In some cases, trainees were re-deployed outside of their specialty to meet service provision requirements in non-surgical areas.
As a forward-thinking group responsible for representing the interests of surgeons in training in the UK, the Association of Surgeons in Training (ASiT) harnessed the capabilities of the Proximie augmented reality platform to deliver remotely accessible surgical teaching to its members. The platform’s augmented reality tools were used to provide an immersive teaching experience and enabled faculty to denote specific structures, particularly when using anatomy models or surgical videos as references. Members were provided with full access to the Proximie platform, enabling them to view videos of the teaching sessions at a later date.
ASIT President and surgical trainee, Dr. Josh Burke, commented:
“Proximie is a technological solution that will facilitate additional, virtual links between trainees and expert surgical mentors, enabling them to experience live surgeries and masterclasses as adjuncts to clinical training. The partnership is an innovation in collaborative surgical education to support trainees, help to mitigate the effect of the pandemic on training and facilitate their drive towards becoming the expert surgeons of tomorrow.”
ASiT and Proximie continue to build on the success of their early sessions by using the platform for other offerings, such as a non-technical skills for surgeons (NOTSS) teaching series.
It is becoming increasingly clear that the pandemic and its after effects will be felt deeply by all aspects of the healthcare system for months and arguably years to come. Management of the pandemic must be viewed as a marathon and not a sprint. Supporting trainees to develop their skills improves overall workforce morale and ensures that the next generation of healthcare professionals is confident and able to tackle the challenges that lie ahead. Indeed, today’s trainee will be expected to fill the shoes of a consultant tomorrow. Increasing hospital infrastructure is of no use without solid investment in the individuals who will be relied on to deliver care in difficult circumstances and re-double their efforts to clear the backlog of patient cases accumulated as a result of the pandemic. Creative strategies, such as the application of new technology solutions, are a necessity to meet the educational needs of trainees during this tumultuous time.
The status quo will no longer do.
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