The Efficacy of Virtual Subinternships as a Novel Educational Platform for Education and Recruitment.

The coronavirus disease of 2019 pandemic has created unprecedented challenges disrupting medical education. Most academic surgical societies have recommended against visiting clinical rotations, which have historically served as critical educational opportunities for students and an important tool for programs to interact with residency candidates.[1,2] Competitive surgical subspecialty programs specifically have traditionally relied heavily on in-person interaction for recruitment.[3,4] With the inability to host in-person clinical rotations, programs have instituted virtual platforms.[5]

Our institution created a virtual surgery rotation mirroring a traditional rotation in its structure. Students were immersed in the existing resident curriculum: biweekly educational conferences, grand rounds, visiting professor lectures, and interactive resident teaching sessions. Students also received daily faculty-led, student-focused teaching in the form of indications conferences and teaching sessions. A daily live-streamed surgery component was incorporated to simulate the interactive environment in the operating room as well. Given the novelty of virtual subinternships, we objectively evaluated the efficacy of a virtual subinternship as an educational and recruitment platform. We hope that by sharing our experience, other institutions will be encouraged to implement virtual experiences of their own.

Eleven students from 11 schools participated in the first virtual course offering. Students completed a 48-question knowledge assessment before and after initiating the rotation. Students, residents, and faculty completed a 360-degree assessment of perceptions and efficacy of the virtual subinternship. A Likert scale ranging from 1 (strongly disagree) 5 to (strongly agree) was used.

Knowledge assessments were completed by 100 percent of students and the participant feedback survey was completed by 90.9 percent. Student participant responses across multiple statements revealed that virtual subinternships had educational merit (nine questions; mean Likert scale score, 4.3), which was further substantiated by the increase in average examination scores from 50.0 percent to 68.0 percent (Table 1). Furthermore, responses from our postrotation survey supported that the virtual subinternship was successful in providing a modality to effectively recruit and develop interest in a program (11 questions; mean Likert scale score, 4.6). Individuals generally agreed that through participation, they gained a better understanding of the academic environment and culture at Yale and became more familiar with the faculty and program. Based on survey results, the virtual subinternship impacted the perceived quality of training at Yale and drastically improved overall impression of the program.

Table 1.

Student Participant Responses Related to Virtual Rotation Feedback and Potential Residency Recruitment

	Mean (Range)*
I feel the virtual subinternship has provided a valuable educational opportunity.	4.9 (4–5)
The number of lectures was appropriate for the 1-wk virtual subinternship.	4.6 (4–5)
The number of live cases was appropriate for the 1-wk virtual subinternship.	4.3 (2–5)
The variety of lecture topics gave me a good understanding of the breadth in plastic surgery.	4.7 (4–5)
The variety of cases gave me a good understanding of the breadth in plastic surgery.	4.8 (3–5)
Participating in streamed live operations made me feel engaged.	3.9 (2–5)
I was able to see anatomical details and gained a better understanding of the human anatomy.	4.0 (2–5)
I was able to see anatomical details and gained a better understanding of the technical aspects of the case.	3.7 (2–5)
I felt comfortable asking questions.	4.2 (3–5)
I read all the materials provided for surgery.	4.7 (4–5)
I referenced literature/books while observing surgery.	4.2 (3–5)
Referencing literature/books during the case helped me understand the case better.	4.4 (3–5)
I believe the virtual subinternship offers insight into the quality of training provided by Yale.	4.7 (4–5)
I believe the virtual subinternship offers insight into the teaching environment at Yale’s plastic and reconstructive surgery residency.	4.8 (4–5)
I believe the virtual subinternship provides insight into the culture of Yale’s plastic and reconstructive surgery program.	4.5 (3–5)
I believe the virtual subinternship offers insight into the faculty availability and involvement in teaching at Yale’s plastic and reconstructive surgery program.	4.4 (3–5)
I feel like I was able to get a sense of the academic environment at Yale’s plastic and reconstructive surgery program.	4.4 (4–5)
After completing the virtual subinternship, I feel like I have a better understanding of the personalities of Yale’s plastic and reconstructive surgery faculty.	4.6 (4–5)
After completing the virtual subinternship, I feel like I have a better understanding of the teaching styles of Yale’s plastic and reconstructive surgery faculty.	4.5 (3–5)
After completing the virtual subinternship, I feel like I have a better understanding of the breadth of topics I would be exposed to if I attended residency at Yale.	4.5 (3–5)
After completing the virtual subinternship, I feel like I have a better understanding of the research opportunities available to residents at Yale.	4.6 (4–5)
The virtual subinternship influenced my desire to consider plastic and reconstructive surgery residency at Yale.	4.7 (4–5)
How has your perception of Yale’s plastic and reconstructive surgery program changed after participating in the virtual subinternship?†	4.7 (3–5)
I enjoyed my experience.	4.8 (4–5)
If Yale was to offer other specific virtual educational rotations (e.g., specific hand rotation, breast reconstruction), I would be more likely to apply to it after having experienced the virtual subinternship.	4.8 (4–5)
If away rotations are offered in the fall, I would be more likely to recommend Yale’s program to others after having experienced the virtual subinternship.	4.9 (4–5)
If presented an opportunity to tune in to more live surgery, I would participate.	4.4 (3–5)
If held in the future, how likely are you to recommend these sessions to students interested in plastic surgery?‡	4.9 (4–5)

*Scores graded on a Likert scale, with options including 1 (strongly disagree), 2 (somewhat disagree), 3 (neither agree nor disagree), 4 (somewhat agree), and 5 (strongly agree).

†Options ranged from strongly negative to strongly positive.

‡Options ranged from very unlikely to very likely.

Faculty and residents had a 100 percent and 93.8 percent response rate, respectively. Although student participant responses supported that the virtual subinternship was effective in building familiarity with a program, faculty and resident responses did not reciprocate a parallel increase in ability to evaluate applicants’ personalities, interpersonal skills, or how well of a match they would be for our program (eight questions; mean Likert scale score, 3.0) (Table 2). Despite this, faculty and resident responses confirmed that participation would be viewed favorably when selecting applicants for interviews and in the rank order list (two questions; mean Likert scale score, 3.9).

Table 2.

Faculty Responses Related to Potential Residency Recruitment*

	Faculty	Resident
I was able to get a sense of participants’ personalities.	3.0 (1–4)	2.9 (1–4)
The virtual subinternship allowed me to evaluate participants’ interpersonal skills.	2.9 (1–5)	2.8 (2–4)
The virtual subinternship allowed me to evaluate how well of a match participants would be for our program.	2.5 (1–4)	2.9 (2–4)
The virtual subinternship allowed me to evaluate the participants’ general medical knowledge.	2.8 (1–4)	2.8 (1–4)
The virtual subinternship allowed me to evaluate the participants’ clinical reasoning capabilities.	2.9 (1–4)	2.7 (1–4)
The streamed live operations allowed me to evaluate participants’ knowledge regarding common plastic and reconstructive surgery procedures.	3.3 (1–4)	2.7 (1–4)
I have more familiarity with the participants as it relates to this residency application cycle.	3.1 (1–4)	3.9 (2–5)
The virtual subinternship provided insight into the participant’s overall quality as an applicant.	2.9 (1–4)	3.5 (2–4)
Participation in the virtual subinternship will be viewed favorably by me when selecting applicants for an interview.	4.0 (3–5)	4.3 (3–5)
Participation in this virtual subinternship will be viewed favorably by me for the rank order list.	3.6 (3–5)	3.8 (3–5)

*Scores listed as mean (range) graded on a Likert scale, with options including 1 (strongly disagree), 2 (somewhat disagree), 3 (neither agree nor disagree), 4 (somewhat agree), and 5 (strongly agree).

The responses we received from students indicate the virtual subinternship is effective as both an educational tool and a recruitment tool. Given the effect coronavirus disease of 2019 has had on visiting clinical rotations and its uncertain course, virtual subinternships may continue to serve as a powerful resident recruitment tool for the foreseeable future.

DISCLOSURE

This study was funded by a Yale Department of Surgery COVID Research Grant Award.