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Table of Contents
Year : 2020  |  Volume : 3  |  Issue : 1  |  Page : 1-3

Looking forward to a post-COVID era: A mentor's perspective

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 Colo-Rectal Surger, Currae Specialty Hospital, Thane, Maharashtra, India

Date of Submission27-Sep-2020
Date of Decision28-Sep-2020
Date of Acceptance29-Sep-2020
Date of Web Publication02-Oct-2020

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

DOI: 10.4103/2666-0784.297114

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How to cite this article:
Agarwal BB, Agarwal S, Mital K. Looking forward to a post-COVID era: A mentor's perspective. Indian J Colo-Rectal Surg 2020;3:1-3

How to cite this URL:
Agarwal BB, Agarwal S, Mital K. Looking forward to a post-COVID era: A mentor's perspective. Indian J Colo-Rectal Surg [serial online] 2020 [cited 2022 Aug 9];3:1-3. Available from: https://www.ijcrsonweb.org/text.asp?2020/3/1/1/297114

“We are not at the mercy of this virus,” said the World Health Organization (WHO) Director-General at the March 9, 2020 media briefing. A day before, he had acknowledged the spread of the virus to more than 100 countries, affecting more than 100,000 humans and causing almost 5000 deaths by then. After spread to many more countries and more deaths, the searchlight having been kept fixated on Europe, the tragedy was declared a Pandemic on March 11, 2020 with reluctance of a caveat “Pandemic is not a word to use lightly or carelessly”.[1],[2] The world has neither taken it lightly nor been careless, and yet lives at the mercy of the virus. After an eerie delay, WHO watches the virus spread to 188 country regions claiming more than a million lives during gestation period of just nine months, since it was officially reported by China on December 2019. United Nations (UN), WHO's parent body, has been questioned for missing in action with uncomfortable questions like, “Where is the United Nations in this joint fight against the pandemic? Where is its effective response?”.[3] India, home to 17% of world population, so far has less than 10% share in global mortality. It is said “There is no challenge more challenging than the challenge to improve yourself.” (anonymous). India has led the world in rising to the challenge, having sent medical supplies to more than 150 countries and already moving towards Phase 3 of Vaccine trials in a scenario of doing its best to avoid third world war, as our Prime Minister declared at UN.[3]

The COVID response has pointed the needle of suspicion towards the underbelly of sponsored science and personal biases of scientists.[4] Literature is deluged by anecdotal success reports of underpowered, sub-optimally designed clinical trials with disregard to multiple confounders. Such laxity in scientific rigor is premised upon 'giving a chance to all possible therapies in setting of people dying in an outbreak' doctrine adopted during Ebola outbreak in 2014.[5] While humanity came together in compassion, the industry exploited a commercial opportunity to push 'Drug treatment' over 'Harmless non-drug interventions' through 'commercial press' publishing the findings of non-peer reviewed, underpowered, non-randomized, uncontrolled, company funded descriptive studies. It distorted the administrative efforts and betrayed the public trust.[6] Multi-billion-dollar molecules like Remdesivir continue to have a field day, riding on a study funded by its manufacturer and authored by their employees, published in a high impact factor journal.[6] Even the molecular basis of COVID “Cytokine Storm” is under question with the reported findings of significantly lower levels of TNF, IL-6, and IL-8 in COVID-19 cohort arm of a controlled study.[7],[8] Scientific apprehensions of 'Medisin' creeping into Medicine, aided and abetted by political interests, media navigation and commercialization, have led to a call for 'Protecting the Editorial Independence' of science.[9],[10],[11],[12] Despite the commercially driven and provocative reprimands, India has done well to steer away from such temptations. While the world awaits results of more than 200 trials registered on ClinicalTrials.gov, India continues to, implement prophylactic use of Hydroxychloroquine (HCQ) for COVID warriors, advocate the use and supply of HCQ to other countries and use its ancient wisdom of 'Harmless non-drug interventions'.[13],[14],[15] India marches on, to help the humanity in face of this adversity, true to the 'Gita' teaching of not to be paralyzed in inaction and act as per the call to celebrate with optimism, development of a Indian vaccine in current context.[16]

The pandemic seems to have driven holes in civilizational serving-platter of opportunities and progress. It is said “If opportunity doesn't knock, build a door”. The existential holes caused by the pandemic, being blackhole for most, need to be our window of opportunity. The turmoil in the integrity and quality of clinical research with the ignominy of article retraction by reputed western journals, is one such window to reboot the Indian clinical research, driven by Imagineering, digitization, and technology.[17],[18],[19],[20]

Our foremost duty is to produce our own replacements who are better than us. Best of our replacement is possible, only if the senior surgical faculty actively supports and mentors the students, like parents working for own child's pusuits. Only such faculty can attract the best students into surgery.[21],[22]

The structure of Indian post-graduate medical education is a perfect catalyst for meaningful clinical research. Indian surgical residents grind through, arguably the most competitive residency match program in the world. After a rigorous school progression from multilingual alphabet learning to understanding structure of language to build thoughts, sentences and integrate existential complexities of mathematics, sciences and social sciences into aspirational pursuit of medical school entry, they are the best of 'transition generation'(TG). The TG needs mentors who can withstand the contemporary market temptation driven pursuits, which have made us mere skilled technicians and not physicians who can operate too, metaphorically called 'de-professionalized as bin man' by an eminent surgeon.[23] This 'de-professionalized as bin man' is attributed to 'managerialization' of our profession putting higher incentives and premium on video-gaming like hand-eye coordination skills acquired on repetitive 10000+ performance on a strict regional anatomy and simulator for a given procedure 'assembly line' in 'garage' of elective surgery'. This is not what Osler and Halsted preached but what Gladwell advises as a mantra to become outlier in professions devoted for selfish goals and not striving to save other's lives.[24] The rigors of more than 12 years of structured medical-surgical training, in all facets of clinical sciences foundational to surgery, specially academics become unattractive. The challenges of training and mentorship have been listed, as one of the 17 'great existential challenges of the twenty- first century' by top computer scientist, James Martin.[25] Current pandemic reminds of his saying. “'Make no mistake, this is the first century since our caveman days in which Homo sapiens could be terminated. Even if Homo sapiens survives, civilization may not.” Giving solution to the 17 existential challenges he emphasizes the need for mentoring next generation.

Evolution of civilization has passed from Nature to our hands as Mentors. Taking the cue from visionary Martin, we as senior faculty need to prepare the transition generation entrusted to us in our residency programs with the following realization-

  1. The “transition generation” will navigate the existence in periods of chaos, peril, and opportunity determining whether civilization survives or not.
  2. Paradigm transition is needed. We are doing much but not efficiently enough because we are not thinking ahead.
  3. We are trustees of Nature; celestial equations & atmospheres will change. We must mentor holistic living styles sensitive to consumption led climate change
  4. Empathy, intrinsic to clinical care should be demonstrable and imitable, by becoming the advocate of underprivileged, usually the material of entire 'hands on' training in surgery.
  5. Planet is shrinking and bandwidths increasing; regular frequent updating of knowledge led curiosity sessions will drive research.
  6. Advanced civilization will bring in biosphere upheavals and new microorganisms to deal with even in surgical domain. Surgeons being frontrunners in adoption of technology, will have to innovate not in techniques but in practices, protecting themselves and their teams besides saving lives.
  7. We will need to train TGs to remain abreast with machine learning, artificial intelligence and singularity to avoid being overwhelmed by them.
  8. Sooner than later, above singularity will do most of what we do; to teach, how and what to do, in leisure will be especially important.
  9. To sum it up, we will have to harness our lost wisdom, as Martin says, “A serious problem is the 'skill-wisdom gap. Wisdom has not kept pace with furiously accelerating science and technology'.

The 9 points above might appear disconnected from science, clinical medicine, and surgery, but for a mentor entrusted to train existentially crucial transitional generation, will have to think beyond a 'de-professionalized, tin bin surgeon working for 'managerialized' health care system. The challenges have become real, living at mercy of COVID virus, as astronomer Martin Rees in his book “Our Final Hour” gives humanity a 50 percent chance of surviving this century.[26]

  References Top

Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen. [Last accessed on 2020 Sep 27].  Back to cited text no. 1
Available from: https://www.livescience.com/coronavirus-pandemic-who.html. [Last accessed on 2020 Sep 27].  Back to cited text no. 2
Leading Journals Sound Alarm on COVID-19 Studies-Medscape; 03 June, 2020. Available from: https://www.medscape.com/viewarticle/931696. [Last accessed on 2020 Sep 27].  Back to cited text no. 4
Lane HC, Fauci AS. Research in the Context of a Pandemic. N Engl J Med 2020 Jul 17. Epub ahead of print.  Back to cited text no. 5
Moynihan R, Macdonald H, Bero L, Godlee F. Commercial influence and covid-19. BMJ 2020;369:m2456.  Back to cited text no. 6
Unexpected Results in New COVID-19 'Cytokine Storm' Data – Medscape; 08 September, 2020. Available from: https://www.medscape.com/viewarticle/937044? [Last accessed on 2020 Sep 27].  Back to cited text no. 7
Kox M, Waalders NJB, Kooistra EJ, Gerretsen J, Pickkers P. Cytokine Levels in Critically Ill Patients With COVID-19 and Other Conditions. JAMA Published online September 03, 2020. Epub ahead of print.  Back to cited text no. 8
Agarwal BB, Agarwal S. Surgical pilgrimage - The need to avoid navigation through drains, medicine or 'medisin': Our notes on NOTES. Surg Endosc 2008;22:271-2.  Back to cited text no. 9
Rasmussen SA, Ward JW, Goodman RA. Protecting the Editorial Independence of the CDC From Politics. JAMA. Published September 22, 2020. Epub ahead of print.  Back to cited text no. 10
Agarwal BB. Informed consent-'da Vinci code' for our safety in empowered patient's safety. Surg Endosc 2009;23:1158-60.  Back to cited text no. 11
Agarwal BB. Laparoscopic Surgeon and Basics of Technology- Is There a Need to Revisit the Classrooms? JIMSA 2007:183.  Back to cited text no. 12
Cohen MS. Hydroxychloroquine for the prevention of Covid-19 - Searching for evidence. N Engl J Med 2020;383:585-6.  Back to cited text no. 13
Agarwal BB, Agarwal N. Quo vadis COVID responder – Beat the Chinese virus, Carpe diem. Indian J Colo-Rectal Surg 2019;2:1-2.  Back to cited text no. 15
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. 16
  [Full text]  
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. 17
COVID-19 Update: NEJM, Lancet Studies Retracted; A Look at One Key Author – Medscape; 04 June, 2020. Available from: https://www.medscape.com/viewarticle/931800. [Last accessed on 2020 Sep 27].  Back to cited text no. 18
Agarwal N, Chintamani. Cashless, tech-savvy future Surgeon. Indian J Surg 2016;78:171-2.  Back to cited text no. 19
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. 20
Suliburk JW, Kao LS, Kozar RA, Mercer DW. Training future surgical scientists: Realities and recommendations. Ann Surg 2008;247:741-9.  Back to cited text no. 21
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. 22
Canter RJ. The importance of international consensus statements in surgery. ANZ J Surg 2009;79:100-3.  Back to cited text no. 23
Gladwell M. Outliers: The story of success. Back Bay Books. New York, USA: Back Bay books; 2011.  Back to cited text no. 24
Martin J. The Meaning of the 21st Century. Penguin, USA: Penguin; 2006.  Back to cited text no. 25
Martin R. Our final hour. Basic Books. New York, USA: Hachette Book Group; 2004.  Back to cited text no. 26


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