The CNS Response to COVID 19:
Adapting Education to the Needs of the Learner
Ashok R. Asthagiri, MD,
Maryam Rahman, MD
Lola B. Chambless, MD,
Garni Barkhoudarian, MD
Akash J. Patel, MD
Justin Hilliard, MD
The CNS exists to enhance health and improve lives through the advancement of neurosurgical education and scientific exchange. During the COVID pandemic, tried and true methods for the exchange of scientific progress and dissemination of clinical advances and research came to an almost immediate halt. The cessation of meetings began as cancellation of large national and international gatherings, but soon crept into even departmental conferences and social activities. As the necessity for safe distancing and travel restrictions grew, social isolation has become the new norm to fight and control an unseen force. Whilst our everyday lives have been impacted by these shutdowns in every imaginable way, the healthcare system has only been tasked with even more responsibility and expectations. In recognition of the practicing neurosurgeon’s need to adapt to this shifting landscape from a medical knowledge and clinical competency perspective, and the continuing need to provide critical education to trainees, the CNS embarked on a monumental shift to providing interactive and virtual web-based education that would meet these changing needs. With the help of numerous individual volunteer neurosurgeons and the CNS headquarters staff, a growing portfolio of online education was created immediately and made widely available, to both the national and international community of neurosurgeons. The CNS vision has always been to be the essential partner organization for neurosurgeons, trainees and industry innovators in neurosurgical disease. While the COVID pandemic has been a challenge to each of us in our own ways, the CNS has strived to connect and provide resources for our membership and industry innovators in novel ways.
In response to the training and educational challenges created by the COVID-19 crisis, the CNS Education Division has developed a suite of complimentary online offerings accessible to all training programs.
Virtual Visiting Professor
One of the unique strengths of the CNS organization is its ability to respond to changing circumstances, due in part to the close working relationships between core CNS staff members the CNS surgeon volunteers. This agility was demonstrated during the CNS response to educational challenges posed during the COVID pandemic. The CNS Education Division developed the Virtual Visiting Professor (VVP) series and Online Grand Rounds within days of most hospital systems closing elective services and instituting measures limiting didactic conferences.
The VVP series was launched after program directors from all of the U.S. Neurosurgery residency programs were surveyed about their interest in virtual grand round offerings to provide remote didactics to trainees prohibited from gathering in groups at their institution, as they typically would for departmental conferences. In response to overwhelming enthusiasm for this type of educational offering, the CNS launched live webinars with active Q&A sessions from prominent neurosurgeons and other physicians, addressing a wide variety of general and subspecialty topics. These webinars were intended to reproduce a visiting professor lecture experience for participants.
Drs. Robert J. Dempsey and Michael G. Haglund delivered a VVP Presentation on Global Neurosurgery: Personal perspectives, lessons learned, and worldwide opportunities for neurosurgical development.
The VVP webinar topics have included COVID-19 care experience for neurosurgeons, treatment of spinal cord injury, brain tumors, spinal cord tumors, management of aneurysms, endovascular advancements, functional and pain discussions, and unique topics such as global neurosurgery and practice development. Live participation per webinar has averaged 110 participants, with a high of 295 attendees. Access of the recorded versions of all of the webinars in sum has reached almost 12,000 views. Over 50 VVPs have been hosted through June 2020. Through a generous grant from the CNS Foundation, VVP webinars are available live and in their recorded version for free. They can also be purchased for CME.
In addition to live offerings, Online Grand Rounds was put into place to offer pre-recorded webinars for free. Each week, two to three webinars are chosen from the CNS catalog and highlighted, allowing programs to develop a diverse and free educational resource to residents during a time when many programs had canceled their educational conferences.
As practices are resuming elective cases and most states have reopened businesses, we understand that programs may still not be able to invite in-person visiting professors and many trainees and surgeons may not be able to attend live courses for months to come. The CNS is committed to addressing this ongoing need, and the VVP and Online Grand Rounds programs will continue to provide online education to practicing neurosurgeons in need of CME, as well as for residents in training. The VVP faculty and moderators are due gratitude for their willingness to provide engaging content despite busy and uncertain schedules.
“We often miss opportunity because it’s dressed in overalls and looks like work.”
- Thomas A. Edison
The CNS Town Hall Xperience — A Virtual Forum for Urgent Discussions
One of the goals of the CNS Education Division is to remain conscious of the shifting needs of the membership and to be nimble in addressing those needs with innovative platforms and programs. As neurosurgeons experienced seismic changes in our lives and practices this spring, we recognized a new urgency underlying our conversations; we wanted a way to communicate about critical topics quickly and transparently. Out of this new reality grew the CNS Town Hall Xperience.
Town Halls are intended to be highly interactive and this required a new format. Zoom provided the best platform for engagement and proved to have become a familiar part of most neurosurgeon's day-to-day lives in the early stages of the COVID-19 pandemic. We quickly learned a few rules to live by: minimize slide presentations, encourage attendees to join with video, and choose panelists and moderators who are excellent facilitators of discussion. Optimizing simple functions like “chat” and “hand raise” can quickly transform a lecture into a vibrant conversation. We opted against recording town halls for rebroadcast because much of the material presented was late-breaking, opinion based, and relatively unvetted. We felt that this was information that should be rapidly disseminated but which could prove stale or irrelevant in future months, and for these reasons we have also chosen not to make these CME-earning events.
The topics of the Town Hall have been intentionally wide ranging. In our first session we heard from neurosurgical leaders around the country about the ways they were managing manpower, telehealth, compensation, and burnout in practices experiencing various versions of the initial pandemic surge. With the help of section leadership, we broadcast Town Hall on COVID-19 specific topics like the use of PPE and testing to facilitate safe skull base surgery and the unusual features and management of COVID-19- related stroke. Our most popular Town Halls have centered on the impact on COVID-19 on trainees. For example, our session discussing changes to the upcoming match reached the Zoom version of “standing room only” as more than 300 attendees tuned in for updates from leaders in the Society of Neurological Surgeons. Other popular Town Hall topics have included building resilience, the job search for graduating trainees, and legislative updates from the Washington Committee.
As we move into a new phase of living with the COVID-19 pandemic, we anticipate that new hot topics will find a home in the Town Hall format. An ongoing series of resident-focused sessions, led by Dr. Maya A. Babu and the CNS Resident Committee, will focus on both the novel and age-old issues facing neurosurgical trainees. Additional sessions will promote discussion of practice management during crisis and ways to navigate new obstacles to providing optimal neurosurgical care. These sessions will remain a live, free CNS member benefit where expert panelists can participate in timely discussions of the challenges facing our community in this unprecedented time. As always, the CNS Education team would love to engage our members in building our program; if you have an idea for a Town Hall you would like to see us produce, please reach out to the team by contacting the CNS Education Division at Education@cns.org.
In Neurosurgery, Self Assessment in Neurosurgery (SANS) has long been an interactive way to learn, fill knowledge gaps, and stay current with the latest practice trends. There are seven subspecialty modules available, each offering 100 peer-reviewed questions that cover the breadth of clinical applications for that discipline. Combined, the bundle of all seven modules offers a comprehensive integrated educational curriculum designed to reinforce practice patterns and recognize knowledge gaps, making it an essential tool for residency training and Primary Examination preparation. Because of its format, it has been an important tool for board preparation.
During the unprecedented COVID-19 pandemic, many residency programs were unable to conduct the usual didactic conferences. To fill this void, the CNS education team developed SANS Live! Unlike lecture-based webinars, SANS Live! utilizes a question/answer, quiz-show style format to help participants enhance their surgical knowledge and decision-making skills. Session moderators deliver SANS questions, which the attendees answer using a polling system. Subspecialty experts then discuss the nuances of the questions and the reasoning behind the answer selection. We have offered SANS Live! webinars since May, with an average attendance of nearly 90 participants per webinar and 245 unique individuals viewing each recording. This is due in large part to the outstanding, internationally renowned experts who volunteered their time to be faculty discussants. The series kicked off with a session on management options in neurotrauma, led by Martina Stippler and David O. Okonkwo, followed by a session on Controversies in Vascular Neurosurgery, led by Elad I. Levy and Michael T. Lawton. In June, Raymond E. Sawaya and Doug S. Kondziolka led a session on Management of Brain Metastases. Nader Pouratian and Ellen L. Air led the July Session on functional neurosurgery. Though many training programs have resumed didactic conferences, the CNS plans to continue SANS Live! sessions on a monthly basis for Residency programs and medical students.
During SANS Live! sessions, SANS questions are used to quiz the audience and the expert faculty provide first-hand rationale with images and video along with references recommendations for the correct answers.
Virtual Tumor Boards
Any tumor neurosurgeon recognizes the value of a multidisciplinary review of complex brain tumor patients in the setting of a tumor board. Typically, these had been conducted behind closed doors. However, through the rapid adoption of secure virtual conferencing platforms instigated by the COVID-19 pandemic, many institutions have adopted virtual tumor boards as a viable solution. In some cases, local tumor boards may request additional input from experts worldwide. This not only improves the care we deliver to our patients, but also serves as a valuable educational opportunity for all involved.
With the spirit of multidisciplinary collaboration, the CNS has joined forces with the Society for Neuro-Oncology (SNO) to introduce a Virtual Brain Tumor Board. In collaboration with the Joint Tumor Section and The Neurosurgical Atlas, we will be introducing regular sessions featuring globally recognized experts in brain tumor management (neurosurgery, neuro-oncology, radiation oncology, neuropathology, neuroradiology and other specialists) to discuss actual cases presented by our faculty. The first of these Virtual Tumor Boards will be on Tuesday, September 29, 2020. We anticipate this collaboration will outlast the COVID crisis and provide a lasting and valuable service for our combined memberships.