Adapting to the Educational Challenges of a Pandemic: Development of a Novel Virtual Urology Sub-Internship During the Time of COVID-19

The landscape of the health system was vastly impacted by the COVID-19 pandemic, spilling over to impact medical education. As social distancing guidelines required medical students and residents to be removed from clinical spaces, it was necessary that we reimagine how we deliver effective learning outside of the clinic. This was both crucial and opportune for urology, as it is a field that is often unfamiliar to students before an in-person rotation piques their interests.

The innovative nature of urologists is one of the field's great strengths. Recognizing the urgent call to provide timely urologic education to upper-level medical students during the pandemic, two senior medical students and faculty members at the University of Pennsylvania developed an online surgical sub-internship that combined flexible, web-based, modular content, with real-time interactions between medical students, residents, and faculty.

The curriculum used both asynchronous and synchronous content covering topics including medical and surgical management of benign, oncologic, and pediatric urology. Asynchronous material was used to accommodate the uncertainty of faculty clinical schedules and was reviewed by students on demand. Faculty members pre-recorded introductory lectures, and a discussion board facilitated asynchronous communication and feedback about content amongst students, residents, and faculty.

Similar to an in-person rotation, resident and faculty facilitators also led synchronous virtual discussion sessions. Facilitators rotated daily to provide flexibility for schedules and expose students to multiple faculty and residents. During these sessions, participants discussed surgical decision-making through problem-based learning (PBL) and presented simulated patients to the group for feedback by faculty and fellow students.

Ten students participated in the two-week course over the first month. By the end of the course, learners were to be able to describe the steps to perform a urologic evaluation, list and describe the common urologic conditions, deliver a urologic oral case presentation, and demonstrate the ability to appraise urologic literature that intersects with other medical and surgical subspecialties. We observed a significant increase in perceived learner knowledge of urology and confidence in urologic evaluation. Students also appreciated the ability to form interpersonal relationships with residents and faculty throughout the course. Over 75% of our faculty participated in the course, dedicating a total of 2.5-3.5 hours over the two week period. Importantly, faculty members commented that they appreciated having facetime with students despite the pandemic and enjoyed now having pre-recorded lectures for other future teaching opportunities.

Although there is no replacement for in-person, direct patient care, a virtual surgical sub-internship proved to be an effective and feasible pedagogy. While a temporizing solution due to COVID-19, this curriculum offers potential for lasting changes to urologic education. As students have returned to the clinic, these materials continue to positively supplement our in-person teachings. With the rise of virtual didactic sessions, town halls, surgical workshops, and mentorship sessions, we are proud to see the immense creativity and initiative that this field has taken to continue educating its trainees. We hope that our virtual sub-internship model will continue encouraging the innovation of teaching modalities within the field of urology.

Written by: Olivia O. Familusi, Medical Student, Twitter: @OliviaFamilusi and Cheyenne Williams, Medical Student, Twitter: @Cheycwilliams, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania

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