September 9, 2020

'Everyone's the Same Size Square': Transplant Surgery Research Group Finds Real Collaboration in Virtual Mode

The COVID-19 pandemic has eliminated many in-person meetings. For a transplant surgery interest group, the change spurred more engagement. 

A screenshot of a Zoom video conference meeting with participants shown.
Scene from a virtual TREE meeting

The mourning for in-person interaction started not long after the COVID-19 pandemic disrupted work routines and saw meetings transition from conference rooms to computer screens.

Is there a silver lining to the new virtual normal? 

The surgeons involved in the Transplant Research Education and Engagement (TREE) group think so, and have seen tangible benefits from the change. 

From round tables to squares

TREE was launched by Seth Waits, M.D. and Michael Englesbe, M.D. to consolidate research efforts around transplant surgery, enhance collaboration, produce manuscripts, and expose transplant-curious residents to the specialty. 

Waits had worked closely with residents and Englesbe with medical students, so the group reflected a wide range of experience. That range of experience played out in an unspoken hierarchy in the physical meetings. Once the group started meeting virtually, the structure flattened, and the change in dynamic that the pandemic forced was a surprisingly positive one.

“COVID propelled our group forward as much as anything ever could have. We used to meet here at the transplant center and sit around a big table. There was an unspoken hierarchy.  The older people were at the table and the younger people were at the edges. When you switch to the virtual format, everyone’s the same size square,” Waits said.

As much as Zoom fatigue is sometimes lamented, the switch to location-agnostic meetings also removed barriers for attendance. No commute, no hurried walk across the hospital, no bus to catch or parking spot to find. 

The group also started to meet more frequently, which helped move work along, and also provided a needed social outlet. For Meredith Barrett, M.D., a clinical lecturer in Transplant Surgery, the start of a journal club in collaboration with other institutions also scratched the networking itch that in-person events previously satisfied. 

“One thing that's been a struggle for me as an academic surgeon is the prospect of losing all of these research meetings where you not only learn about what’s going on, but also do social networking. That’s going to be lost, at least for a little bit, so we tried to combat some of that,” Barrett said.

TREE recently published their experience in the Journal of Surgical Education.  

A boost to productivity 

Transitioning the work group to a virtual format necessitated a change in communication strategy. In addition to Zoom for meetings, the team turned to the collaboration tool SLACK to focus efforts.  

Waits came up with a novel way to leverage the platform to move manuscript writing along as a group. The technique, which he calls “ping pong,” involves publicly tagging someone to work on the current project. That person then devotes a small amount of time—10-30 minutes—on the manuscript before tagging someone else in. The process continues until the manuscript has taken enough shape to be polished up and published.  

Accountability is baked into the process, and the time-limited nature of the assignment means that even the busiest people can contribute without being overwhelmed. As a result, assignments don’t get bogged down. 

 “We have been able to whip out papers quickly because there’s something about knowing you only have to sit down and write for 30 minutes that really allows you to be productive during those 30 minutes,” Barrett said. 

The process is also visible, which serves as a teaching exercise for students.  

“Learners who are less used to writing manuscripts can contribute to a part of the paper that is more aligned with their strengths, like doing some research into the introduction or the discussion. They also get to witness in real time people essentially writing the paper in front of them,” Waits said. 

Riding the remote engagement wave with video 

Increasing engagement with transplant surgery through sharing “micro-learning” videos on surgical techniques was part of TREE’s plan before the pandemic hit.

Itai Palmon, a first-year medical student, films the procedures performed on consenting patients and edits them down to capture short, key parts of the procedure for distribution on the TREE Twitter account (@UM_TREE). He and General Surgery Resident Glenn Wakam, M.D., collaborate with faculty members to narrate the videos and then distribute them.  

The first videos launched in July and the strategic approach to tagging other prominent transplant surgeons—and keeping the videos short—have generated discussion on everything from retractor placement to methods of arterial reconstruction. 

“It’s been interesting to see everyone’s opinions about the different types of procedures, particularly as someone who’s trained in residency and fellowship at Michigan. I see things the way we’ve always done it here,” Barrett said.  

Finding wins and branching out 

One Slack channel the TREE group uses is called “wins,” and chronicles things the group has published.  Just as the pandemic shifted the group’s mode of meeting, it also provided opportunities to adapt their research focus. Members have submitted and published papers on expanding telehealth use in transplant and smartphone hygiene in hospital settings.  

Sometimes, the branches of the tree extend further. 

While the group is rooted in transplant surgery, members will publish on issues relevant to surgery in general. When Dr. Wakam was struck by the experience of watching COVID-19 patients die alone, he sounded the alarm for better solutions in a paper in the New England Journal of Medicine

“We are transplant surgeons and people interested in transplant but we are also humans interested in the world as a whole. If people have an interest in something else, we encourage and support those efforts if they’re important to medicine as a whole,” Barrett said. 

That kind of close access to faculty isn’t available in many venues, virtual or not, Waits said, and the only barrier to entry is a lack of enthusiasm:

“Our goal is to pick people who are engaged and want to be a part of it.” 

## 

By Colleen Stone

Seth Waits

Seth A. Waits, MD

Assistant Professor, Transplant Surgery
Director, Transplant Surgery Fellowship

Contact Us

Connect with the Department of Surgery to share your ideas or get in touch.

Department of Surgery
2101 Taubman Center
1500 E. Medical Center Dr.
Ann Arbor, MI 48109

Email: dos-websites@umich.edu

Twitter: @UMichSurgery