Virtual Subinternship in Plastic Surgery: The Start of a New Era in Surgical Education?

Surgical training programs ceased offering in-person subinternships because of the coronavirus disease of 2019 pandemic, stripping medical students of an unparalleled opportunity to gain plastic surgery knowledge and to improve their chances of matching into a program they are interested in.[1] To overcome this hurdle, the University of Pittsburgh implemented a virtual subinternship in plastic surgery.

The virtual subinternship program consisted of a virtual 2-week experience (four students per 2-week block), in which the student participated in synchronous activities (academic, educational, and simulation activities) and asynchronous activities (one-on-one meetings with program faculty). The student also participated in virtual social events with residents. At the conclusion of the rotation, each student was given the opportunity to present a 15-minute talk during grand rounds about their background and clinical/research interests. The schedule and list of sessions are shown in Figure 1, and the questionnaires sent to participants and faculty are shown in Supplemental Digital Content. (See Appendix, Supplemental Digital Content 1, which shows the questionnaires sent to participants and faculty, http://links.lww.com/PRS/E799.)

Fig. 1.

Schedule for synchronous content of the virtual plastic surgery subinternship. Synchronous material: predesigned educational and simulation sessions and participation in the academic activities of the department including indications conference, journal clubs, grand rounds, and core conferences. Asynchronous material (not shown): one-on-one virtual 20-minute discussion sessions with the leadership and representative program faculty. CHP, Children’s Hospital of Pittsburgh; H&N, head and neck; PPS, pediatric plastic surgery; Recon, Reconstruction; VSP, virtual surgical planning.

Twenty applicants took part in the virtual subinternship between August and October of 2020. As part of our departmental priority to promote diversity and inclusion, we reserved at least one spot per block for underrepresented minority applicants and accepted equal numbers of female and male applicants. Overall, 18 (90 percent) were U.S. medical students, and two (10 percent) were international medical graduates. Six (30 percent) identified themselves as underrepresented minority. Mean age was 26.9 ± 1.9 years. Mean subjective level of knowledge before and after completion of the virtual subinternship was 2.9 ± 1.0 and 3.8 ± 0.8, respectively, and mean improvement was 0.9 ± 0.8 (p < 0.0001). [See Figure, Supplemental Digital Content 2, which shows the schematic representation of subjective knowledge before and after the virtual subinternship (Sub-I), http://links.lww.com/PRS/E800.] Mean student and faculty satisfaction was 4.8 ± 0.5 and 4.4 ± 0.8, respectively (Table 1).

Table 1.

Reported Participant and Faculty Satisfaction after the Virtual Subinternship

Domain	Mean Score ± SD
Participant (n = 20)
I feel I achieved what I set forth before participating in this subinternship.	4.9 ± 0.4
I feel I gained insight of the clinical volume and breadth of the residency program.	4.8 ± 0.5
I feel I gained insight of the culture of the residency program.	5.0 ± 0.2
I feel I gained insight of the faculty of the residency program.	4.8 ± 0.5
I feel I gained insight of the residents of the residency program.	4.6 ± 0.7
I feel I gained plastic surgery knowledge.	4.9 ± 0.3
Faculty (n = 7)
I feel I gained insight of the medical student’s knowledge.	4.1 ± 0.7
I feel I gained insight of the medical student’s personality.	4.3 ± 1.1
I feel the virtual subinternship allowed me to identify medical students that would be a bad fit for our program.	4.1 ± 0.9
I feel the virtual subinternship allowed me to identify medical students that would be a good fit for our program.	4.3 ± 0.8
I feel the virtual subinternship is a cost-efficient method of getting to know medical students.	4.7 ± 0.8
I feel the virtual subinternship is a time-efficient method of getting to know medical students.	4.4 ± 1.0
I feel I the virtual subinternship program gave students a good and realistic view of our program.	4.4 ± 0.5
My overall satisfaction level with the subinternship is high.	4.7 ± 0.5

Subinternships are mutually beneficial for medical students and residency programs.[2-4] Lindeman et al.[4] showed that the most common objective achieved by students enrolling in surgical subinternships was career decision-making. In our study, most participants strongly agreed with having achieved the objectives they desired before participating in the virtual subinternship and having gained plastic surgery knowledge. Drolet et at.[2] showed that the most significant student objective for most program directors and applicants enrolling in a subinternship was finding a “good fit.” We found that the faculty strongly felt that a virtual subinternship allows the identification of students who are a good or a bad fit for the program.

This virtual subinternship emerged as a response to the challenges of this era. This is the first study to objectively assess its impact on medical student education and faculty satisfaction. Our data suggest that virtual subinternships offer medical students a highly satisfactory experience by allowing direct involvement with various aspects of a program. We believe that it could be used as an adjunct to away rotations in the future or even replace in-person rotations all together, especially if the pandemic persists in 2021. If extensively implemented, these virtual initiatives will also promote equity in the application process, as many more students will have access to more programs. This virtual subinternship curriculum has demonstrated to be a cost- and time-efficient method to deliver plastic surgery education to medical students and to identify potentially good-fit candidates.

DISCLOSURE

None of the other authors has any financial interest in relation to the content of this article.