While trainees are encouraged to strive to meet 100% of current training expectations with respect to length of training time, the Complex General Surgical Oncology Board (CGSOB) understands the nature of the impact that the COVID-19 pandemic has had on surgical training. To this effect, any non-voluntary offsite time that is used for clinical or educational purposes can be counted as clinical time. The types of activities done in this time should be documented by the program.
In addition, the CGSOB will accept 44 weeks of clinical time (including the non-voluntary time) for the 2019-20 academic year, without the need for pre-approval, permission or explanation. This represents approximately a 10% decrease in time requirements.
In total, 2020 graduating fellows must have completed at least 92 weeks of training throughout the two years of fellowship (48 weeks for the first year of fellowship + 44 weeks for the second year of fellowship).
The Complex General Surgical Oncology Board (CGSOB) will consider special requests for excused absences on a case-by-case basis from trainees who contract COVID-19 and miss training for an extended period due to severe coronavirus-related illness. Similarly, special requests for trainees who are excused from clinical care due to pregnancies and/or immunocompromised states will also be evaluated on a case-by-case basis.
These requests should be accompanied by an attestation of competence from the program director and the local Clinical Competency Committee. In some cases where competency is not clear, the trainee will not be eligible for graduation or registration for the Complex General Surgical Oncology Qualifying Exam (CGSO QE) and will be required to extend their training.
While graduating fellows are encouraged to make their best attempt to meet 100% of case volume requirements, the Complex General Surgical Oncology Board (CGSOB) understands the nature of the impact that the COVID-19 pandemic has had on surgical training. To this effect, the CGSOB will accept a 10% decrease in total cases, without the need for further documentation. For 2020, the graduating fellow is required to have 216 operative cases and 108 multi-disciplinary management experiences in order to apply for the CGSO QE.
Graduating fellows who fall short of this minimum threshold for procedures may petition the CGSOB to grant credit for their final year, provided that they have letters of support from their program director and chair of their Clinical Competency Committee, and their overall application is acceptable to the CGSOB. Those whose requests are granted will receive credit for their accrued cases and be advanced to graduation and registration for the CGSO QE. Those whose requests are not granted for any reason will not receive credit and must extend their training.
Note: Other possible evidence of competency may include higher than average Milestones ratings (4 or greater), documentation of clinic time, operative and rotation evaluation, among others acceptable to your program director.
The CGSOB will accept the program director’s attestation of sufficient training in these disciplines without the need for further approval. However, the fellow must also participate in and document acceptable alternative learning tools to help offset loss of rotation time. These tools must be discussed with and approved by the program director. Examples include appropriate SOSAP questions, CGSO SCORE modules that correspond to the rotations lost, Annals of Surgical Oncology Landmark Series, or other material acceptable to the program director and your local Clinical Competency Committee. All deficiencies and alternative learning tools must be documented by the program director for the CGSOB to consider, if asked for such documentation.
In this situation, the program director should take into consideration the fellow’s overall participation in multidisciplinary oncologic care and conferences such as tumor board. Other factors that consider multidisciplinary oncologic care such as the Milestone evaluations by the Clinical Competency Committee and additional evaluations should be considered as well.
Fellows are required to meet 90% of the expected total number of cases (216 operative cases, 108 multidisciplinary management experiences). However, the CGSOB will not enforce specific disease site minimums. The CGSOB does anticipate that the program director will assign to the appropriate fellow, in need of specific cases, any urgent/emergent or allowable elective cancer case that is performed during the COVID restriction. Other factors for the program director to consider include the Milestone evaluations by the Clinical Competency Committee and other evaluations.
In addition, the fellow also must participate in and document acceptable alternative learning tools to help offset loss of rotation time. These tools must be discussed with and approved by the program director. Examples include appropriate procedural videos, CGSO SCORE procedural modules, Annals of Surgical Oncology Landmark Series, or other material acceptable to the program director and Clinical Competency Committee that correspond to the disease site in question. All deficiencies and alternative learning tools must be documented by the program director for the CGSOB to consider, if asked for such documentation.
If the senior fellow misses a disease site rotation due to the pandemic but has rotated through that disease site previously, then the CGSOB will accept the affirmation of the program director. If the PD believes that he or she possesses the knowledge and technical skills equivalent to a graduating fellow, then the CGSOB will accept program director attestation to this.
These hardship modifications apply to the complex general surgical oncology fellows graduating in 2020 only. As we begin to understand the impact of COVID-19 and the tools, options, and situational changes employed during this time, we will be better positioned to make recommendations for the future trainees. We fully expect to recognize the impact of the pandemic for all fellows currently in training.
Graduating fellows should promptly assess their educational and clinical experience critically to identify any gaps in training. This assessment should utilize metrics available including milestone evaluations, case numbers, number of weeks in “clinical activity” (with the broader definitions), quality improvement projects, and clinic attendance, among others. Fellows should promptly approach their program directors and together, with Clinical Competency Committee input, honestly and critically evaluate the trainee’s knowledge, skills and abilities. The results of this systematic assessment should be used to create a focused plan to be enacted for the rest of the academic year.
At this time, the September 14, 2020 CGSO QE will continue as planned. Candidates who choose to wait have the option to postpone and take it in 2021, as there are multiple opportunities to take and pass the CGSO QE. If you choose to wait, please note that 2020 will be counted as a missed opportunity.
Likewise, the 2021 CGSO CE will continue as scheduled. If necessary, the CGSOB will reassess and make a determination at that time.