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Table of Contents
Year : 2019  |  Volume : 2  |  Issue : 3  |  Page : 55-57

Academics and training of residents in pandemic norm of physical distancing and restrained surgeons – Remembering Osler and Halsted!

1 Department of Laparoscopic and General Surgery, Sir Ganga Ram Hospital, New Delhi, India
2 Department of Anatomy, Lady Harding Medical College, New Delhi, India
3 Department of Colorectal Surgery, Zen Hospital, Mumbai, Maharashtra, India
4 Department of Surgery, Bombay Hospital, Mumbai, Maharashtra, India

Date of Submission13-Sep-2020
Date of Decision13-Sep-2020
Date of Acceptance13-Sep-2020
Date of Web Publication22-Sep-2020

Correspondence Address:
Prof. Brij B Agarwal
F-81 and 82, Street #4, Virender Nagar, Janakpuri, New Delhi - 110 058
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2666-0784.295862

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How to cite this article:
Agarwal BB, Agarwal S, Dhamija N, Patankar RV, Agarwal N. Academics and training of residents in pandemic norm of physical distancing and restrained surgeons – Remembering Osler and Halsted!. Indian J Colo-Rectal Surg 2019;2:55-7

How to cite this URL:
Agarwal BB, Agarwal S, Dhamija N, Patankar RV, Agarwal N. Academics and training of residents in pandemic norm of physical distancing and restrained surgeons – Remembering Osler and Halsted!. Indian J Colo-Rectal Surg [serial online] 2019 [cited 2022 Dec 2];2:55-7. Available from: https://www.ijcrsonweb.org/text.asp?2019/2/3/55/295862

Onset of COVID pandemic had all the omens of doom but the thought, of it becoming a never-ending catastrophe even after six months, was at best a random dream. The dream has become a perpetual nightmare, having disrupted all existential systems. The upheaval has handicapped all domains of health care services, but it has hit surgeons like a noogie of Himalaya being knuckled on our heads by a cunning opponent. Surgeons used to their alpha personality of getting systems work their way have suddenly found themselves abandoned in choppy seas like a rudderless ship.[1],[2],[3] We have suddenly been thrown back to being a toddler looking over their shoulders for a paternal reassurance, beautifully penned by the Beatles writer, John Lennon in his song, 'Beautiful Boy' for his son, telling him, “Close your eyes, Have no fear, The monster's gone, He's on the run And your daddy's here”. We are left seeking indulgence of guidance to banish the monster of COVID. Apart from the global anxieties of whether & when the vaccine will come, or will the economies rejuvenate to sustain basic existence, the surgeons must think of concerns linked to their duties beyond their needs. The persona of an academic surgeon is multifaceted being a clinician, an educator, and a researcher, at all the times. They are innovative, always pushing the horizons and crossing frontiers to do things in new and better ways.[4] They play the role of both a mentor and a mentee. They juggle their role as a teacher of clinical care with related basic sciences, a guide for research & a skilled navigator of operative care. Their delight is palpable & rubs on you when you engage them academically, gaining not only their wisdom, but awakening of your own intellectual spark. It is this delight being taken away that is troubling the grey matter of an academic surgeon in these times of curtailed volumes & physical distancing.[2] The loss of academic interactions is troubling the surgical residents & teachers equally as echoed universally.[5],[6],[7],[8] In the song 'Beautiful Boy' Lennon uses the quote “Life is What Happens To You While You're Busy Making Other Plans” by cartoonist Allen Saunders.[9] Similarly all our plans as academic surgeons are gone with the wind & whatever remains is blowing in the wind of uncertainty of the beginning of the end of this pandemic. The training of residents in all clinical specialties especially surgery is premised upon bed-side clinics and observation while rubbing shoulders with your teacher in operating rooms. Time and again the wisdom of Osler has stood us well in his famous guidance “To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.” He used to say, that the bedside is where the patient is and “Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from the words heard in the lecture room or read from the book. See and then reason and compare and control. But see first. The whole art of medicine is in observation… but to educate the eye to see, the ear to hear and the finger to feel takes time, and to make a beginning, to start a man on the right path, is all that you can do”. Halsted, the surgical colleague of Osler and one of the 'Big Four' founders of John Hopkins developed the first formal surgical residency training program, that has become universal. He aimed at not only training residents in a appraisal based yearly progression of residents for skills but also to groom role models and teachers for the next generation of surgeons. With the impact & demands on healthcare by the ongoing pandemic, the bedside clinical teaching as well as opportunity to train in surgical skills has blown in the wind. The surgeons, the inherent innovators and imagination driven engineers, are adapt at finding solutions even while running out of aces.[10] We have to find solutions to the lost opportunity to teach as per the guidance of Osler and Halsted shuffling cards in our hand as Kenny Rogers sang in 'The Gambler', “If you're gonna play the game, boy You gotta learn to play it right”. Like the adoption of technology of minimally invasive surgery was promptly incorporated in our practice, the technology of digital media has been coopted as a handy academic tool, surgeons being savvy in emerging technologies always.[11],[12],[13]

Technology to enable educational outreach was originally developed to widen the accessibility by students from scattered geographies to sought after academic programs and teachers. University of Illinois developed the first generalized computer-assisted instruction system PLATO (Programmed Logic for Automatic Teaching Operations) in 1970s. With rapid evolution of digital technologies holding events widely with physical distancing became economically feasible. Social disruption by COVID-19 pandemic has led to explosion of virtual platforms enabling online academics. Webinar, a portmanteau of Web and Seminar has become popular lingo and a simple means of delivering information to professional fraternity. Musicians established the stability of online platforms as reliable mediums starting with the performance of 'Severe Tire Damage' in 1993 and current Pandemic time online concert 'Music for Hope' from Milan's Duomo by Andrea Bocelli on Easter Sunday accelerated popular adoption of Webinars.

Association of Colon and Rectal Surgeons of India (ACRSI) took the lead in designing structured academics using the medium of Webinars. The webinars of ACRSI have become much sought after, awaited, and attended academic modules [Table 1].
Table 1: Webinars by ACRSI

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Training of surgical residents is done bedside and in operating rooms by structured apprenticeship under their seniors. In these times we can use our freedom from busy schedules productively using webinars to impart our expertise and knowledge to our residents. Though not an ideal medium of surgical academics and not true to the Osler Halsted vision, they are here to stay at least till the pendency of the pandemic. While Osler succumbed to bronchopneumonia of Spanish Flu pandemic and Halsted to bronchopneumonia following cholecystectomy, the causalities to surgical academics from Chinese Virus pandemic need to be minimized by ensuring quality content of webinars. While the webinars have become essential in current times, people are developing reservations. To ensure that 'webinar Fatigue' doesn't set in and “Death by PowerPoint” doesn't kill the academics, we must do our best to keep the utility alive. The fatigue and “Death by PowerPoint” allude to audience sitting back, half-listening, half-reading the text and looking at clock. We can avoid it by slides with cool images and minimal text, which is just a backdrop, underscoring your ideas instead of competing with them. This way audience will have more attention to the presenter and be involved with speaker body language, tone of voice, energy level and the power of the message beyond written text. The presentation shouldn't be a communication to impress but to impress a point and message.[14] While PLATO was the first online program to enable distant learning, teacher Plato has already told us the means of effective communication. For effective teaching Plato said-

“And what, Socrates, is the food of the soul? Surely, I said, knowledge is the food of the soul. Opinion is the medium between knowledge and ignorance. Wise men speak because they have something to say; Fools because they have to say something. Thinking – the talking of the soul with itself. Writing is the geometry of the soul.”

Our responsibility towards our next generation would do well on this wisdom lest any failure on our part compromise their future.


Our sincere gratitude for our tirelessly hardworking, and enthusiastically innovative Secretary of ACRSI, Dr. Kushal Mittal who made the transition from physical to digital medium of academics by organizing meticulously planned Webinars.

  References Top

Tambyraja AL. New order, new hope. N Engl J Med 2020; (Online ahead of print).  Back to cited text no. 1
Agarwal BB, Agarwal N, Sharma S, Patankar RV, Agarwal N. Surgeons navigating pandemic times-lessons, past & future. Indian J Colo-Rectal Surg 2019;2:25-9.  Back to cited text no. 2
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Agarwal BB, Agarwal N, Dhamija N, Chintamani. Mentoring in surgery-mentor, Parshuram, Dronacharya, Krishan. Indian J Surg 2018;80:81-3.  Back to cited text no. 3
Cochran A. I'm just a Medical Student. What's this “Academic Surgery” Business? Available from: https://www.aasurg.org/blog/medical-student-academic-surgery/. [Last accessed on 2020 Sep 13].  Back to cited text no. 4
Gupta U, Agarwal KA. Medical students in the time of COVID-19: Age quod agis. Indian J Colo-Rectal Surg 2019;2:46-7.  Back to cited text no. 5
  [Full text]  
Kashyap A. Letter to the editor-COVID. Indian J Colo-Rectal Surg 2019;2:48.  Back to cited text no. 6
Ricciardi G, Biondi R, Tamagnini G. Go back to the basics: Cardiac surgery residents at the time of COVID-19. J Card Surg 2020;35:1400-2.  Back to cited text no. 7
Chintamani. COVID and the carpe diem spirit – Is there a tomorrow? Indian J Colo-Rectal Surg 2019;2:49.  Back to cited text no. 8
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Life is What Happens to You While You're Busy Making Other Plans. Available from: https://quoteinvestigator.com/2012/05/06/other-plans/. [Last accessed on 2020 Sep 13].  Back to cited text no. 9
Agarwal BB. Journey of the carbon-literate and climate-conscious endosurgeon having a head, heart, hands, and holistic sense of responsibility. Surg Endosc 2008;22:2539-40.  Back to cited text no. 10
Agarwal N, Chintamani. Cashless, tech-savvy future surgeon. Indian J Surg 2016;78:171-2.  Back to cited text no. 11
Agarwal BB, Chintamani, Ali K, Goyal K, Mahajan KC. Innovations in endosurgery-journey into the past of the future: To ride the SILS bandwagon or not? Indian J Surg 2012;74:234-41.  Back to cited text no. 12
Agarwal N. Even handed future of surgery-ambidextrous, serious gamers with innate left hand laterality. Indian J Surg 2016;78:509-10.  Back to cited text no. 13
Agarwal BB, Mahajan KC. Nomenclature of abbreviated acronyms (Naa.)--caveamus surgeones. Surg Endosc 2010;24:724-5.  Back to cited text no. 14


  [Table 1]


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