Message from Emory Surgery Chair John Sweeney: Keep doing what you’re doing
MARCH 2020
Dear faculty, students, trainees, and staff of the Department of Surgery and members of the Emory community:
I can safely say that those who choose to work at a high-powered academic medical institution like Emory are not looking for something easy to do with their lives. In the Department of Surgery, committing ourselves to providing high value, compassionate, collaborative care while defining the future of surgery through discovery and education—to paraphrase a principle from the Department of Surgery's 2020-2024 Strategic Plan—is a pretty tall order. Yet here we are, undeterred by the breadth of our duty, and lucky enough to be surrounded by people with the same degree of tenacity, perseverance, and acumen for creative problem-solving.
While battling the COVID-19 pandemic is not the type of mettle-testing mechanism any community would wish for, we find ourselves having to do just that as we grapple with a situation that resists our control and demands heightened vigilance, awareness, adaptability, and resilience. And everywhere I look, I see our people doing their absolute best to do what brought us to Emory in the first place.
On a clinical level, Emory Surgery has had to redefine the parameters of its clinical mission to maintain the safety of our personnel and patients. The Executive Surgical and Interventional Services Leadership Working Group, composed of myself and additional representatives from Surgery, Anesthesia, Nursing, Orthopedics, Neurosurgery, Interventional Radiology, Interventional Pulmonary, Otolaryngology, Urology, Gastroenterology, Critical Care, Gynecology & Obstetrics, Ophthalmology, and Interventional Cardiology, recommended and received approval for such measures as postponing all elective procedures at all Emory Healthcare facilities until further notice. Time sensitive, urgent, and emergent surgeries are being reviewed by on-site adjudicator teams for scheduling based on assessment of the availability of appropriate resources. This can be a taxing process for our people and patients, but decisions are being made on the strongest footing possible and with the purest intentions.
We are also accelerating the deployment of telemedicine to facilitate non-emergent patient visits, consults, and follow ups. Clinical teams across Emory Healthcare are formulating the implementation, systemization, and protocol for scheduling and conducting virtual appointments between our physicians at our clinical sites with patients at home.
Our residents and trainees are having to navigate restricted terrain, with policies and procedures under constant review and revision, but they are also, in the wise words of Dean Vikhas Sukhatme, "gaining firsthand knowledge of how academic health systems respond during a pandemic." Specific guidelines for trainee involvement in the care of patients with suspected or confirmed COVID-19 vary from facility to facility, spanning from not being permitted whatsoever to being limited to occasional patient-facing encounters for those trainees that are fully trained in PPE.
To cope with more rotational downtime and lessened didactic education, residents are accessing various alternative avenues for learning. The Resident and Associate Society of the American College of Surgeons (RAS-ACS) Education Committee is developing a supplemental curriculum that includes suggested landmark journal articles, surgical technique videos, and video lectures graciously provided by leading surgeon educators across the U.S. This material will be augmented by weekly one-hour telephone "hangout" sessions to discuss readings and videos in a flipped classroom, case-based learning format. Additional didactic opportunities are available through the website portal of the Surgical Council on Resident Education (SCORE), including a study tool designed by the American Board of Surgery's In-Training Examination (ABSITE) that creates an individualized study plan based upon the resident's exam results from the previous year.
Medical student education in surgery has been hit particularly hard, with the suspension of M3 clerkships until April 6th and perhaps longer, and the cancelation of all cadaver labs and in-person activities for the annual surgical anatomy and operative techniques course for M4s. Under the management of Dr. Barbara Pettitt, director of medical student education, faculty have responded to the resulting learning gap with lectures, group sessions, and other activities via platforms like Zoom and FaceTime, covering surgical anatomy, specific procedures, and other topics.
In order to ensure the health and safety of our research faculty, staff, and patients, our research arm is modifying its routines and activities. Non-therapeutic and non-interventional trials have been suspended, and critical and essential trials and studies are being identified at the discretion of Dr. Craig Coopersmith, vice chair of research, and division leadership so that they may continue. Strategies to lower exposure risk for patients in trials are being developed and instituted, on-site research staff are being limited as much as possible, and social distancing protocols are being emphasized in all aspects of research staff and patient interactions.
This is a fluid situation, and where we are now and what we are doing today could change tomorrow. That said, I have full and complete confidence that the Department of Surgery and the Emory community at large will strive as hard as humanly possible to do our part in assimilating the changes and alterations required to navigate this new reality, and to gradually slowing the spread of COVID-19. I am grateful for the efforts of all here at Emory and beyond in working to achieve this, and urge all to be safe and cautious without sacrificing our essential connectivity.
John F. Sweeney, MD Joseph Brown Whitehead Professor of Surgery and Chair Department of Surgery Emory University School of Medicine