Alternatives surgical training approaches during COVID-19 pandemic

Impact of COVID-19 on surgical exposure and training for general surgery trainees in Australia: a national audit

PURPOSE

The COVID-19 pandemic has caused a major disruption in operative volumes over the last few years, which has directly impacted on surgical training. This study aims to quantify the impact of COVID-19 and the relevant restrictions on General Surgery trainees in Australia.

METHODS

Logbook data of General Surgery trainees from 2019 to 2021 was analysed and compared to assess the impact of COVID-19 on operative numbers and supervision levels during major operations.

RESULTS

There was a statistically significant reduction in overall operative numbers in Australia, with a decrease of 2.0% in 2020 (IRR 0.980, 95% CI 0.973-0.986, P < 0.001) and 6.8% in 2021 (IRR 0.932, 95% CI 0.926-0.938, P < 0.001). Elective operations reduced by 6.6% in 2020 (IRR 0.934, 95% CI 0.927-0.942, P < 0.001) and 10.3% in 2021 (IRR 0.934, 95% CI 0.927-0.942, P < 0.001). Victoria and NT were the most affected jurisdictions; while hepatobiliary, trauma and surgical oncology were the most affected subspecialties. The proportion of overall primary operating has significantly decreased (41.8% vs. 40.2%, P < 0.001) between 2019 and 2020, and decreased further to 39.7% in 2021.

CONCLUSION

The COVID-19 pandemic has had an overall negative impact on surgical training in General Surgery. Efforts should be directed at minimizing detraining of trainees and further disruptions to their training.

What are trainees watching? Assessing the educational quality of online laparoscopic cholecystectomy training videos using the LAP-VEGaS guidelines

BACKGROUND

Laparoscopic cholecystectomy is the most common laparoscopic procedure performed in the US and a key component of general surgery training. Surgical trainees frequently access YouTube for educational walkthroughs of surgical procedures. This study aims to evaluate the educational quality of YouTube video walkthroughs on laparoscopic cholecystectomy by using the LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) video assessment tool.

METHODS

A YouTube search was conducted using "laparoscopic cholecystectomy." Results were sorted by relevance, and the top 100 videos were gathered. Videos with patient education or concomitant procedures were excluded. Included videos were categorized as Physician (produced by an individual physician), Academic (produced by a university or medical school), Commercial (produced by a surgical company), and Society (produced by a professional surgical society) and were rated by 3 investigators using the LAP-VEGaS video assessment tool (0-18).

RESULTS

In all, 33 videos met the selection criteria. The average LAP-VEGaS score was 7.96 ± 3.95, and inter-rater reliability was .86. Academic videos demonstrated a significantly higher mean LAP-VEGaS score than Commercial (10.69 ± 3.54 vs 5.25 ± 2.38, P = .033). Most academic videos failed to provide formal case presentations (63%), patient positioning (50%), intraoperative findings (50%), graphic aids (63%), and operative time (75%).

CONCLUSION

This is the first study to evaluate the quality of YouTube video walkthroughs on LC using the LAP-VEGaS tool. Despite demonstrating higher LAP-VEGaS scores than other categories, video walkthroughs provided by academic institutions still lack several essential educational criteria for this procedure, highlighting areas of improvement for educators.

Identification of potential targets against SARS-CoV-2 of antiviral drugs based on photoaffinity probes

Facing the sudden outbreak of coronavirus disease 2019 (COVID-19), it is extremely urgent to develop effective antiviral drugs against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Drug repurposing is a promising strategy for the treatment of COVID-19. To identify the precise target protein of marketed medicines, we initiate a chemical biological program to identify precise target of potential antivirus drugs. In this study, two types of recombinant human coronavirus SARS-CoV-2 RdRp protein capturing probes with various photoaffinity labeling units were designed and synthesized based on the structure of FDA-approved drugs stavudine, remdesivir, acyclovir, and aladenosine. Fortunately, it was found that one novel photoaffinity probe, RD-1, could diaplayed good affinity with SARS-CoV-2 RdRp around the residue ARG_553. In addition, RD-1 probe also exhibited potent inhibitory activity against 3CLpro protease. Taken together, our findings will elucidate the structural basis for the efficacy of marketed drugs, and explore a rapid and efficient strategy of drug repurposing based on the identification of new targets. Moreover, these results could also provide a scientific basis for the clinical application of marketed drugs.

LATIN AMERICAN RESIDENTS' SURGICAL EDUCATION AFTER THE PANDEMIC: WHAT STRATEGIES HAVE EMERGED FOR ADAPTING TO THIS NEW ERA?

BACKGROUND

The COVID-19 pandemic has had a negative effect on surgical education in Latin America, decreasing residents' surgical training and supervised clinical practice.

AIMS

This study aimed to identify strategies that have been proposed or implemented to adapt surgical training and supervised clinical practice to COVID-19-related limitations in Latin America.

METHOD

A literature review was performed between April and May 2021, divided into two searches. The first one sought to identify adaptation strategies in Latin America for surgical training and supervised clinical practice. The second one was carried out as a complement to identify methodologies proposed in the rest of the world.

RESULTS

In the first search, 16 of 715 articles were selected. In the second one, 41 of 1,637 articles were selected. Adaptive strategies proposed in Latin America focused on videoconferencing and simulation. In the rest of the world, remote critical analysis of recorded/live surgeries, intrasurgical tele-mentoring, and surgery recording with postoperative feedback were suggested.

CONCLUSIONS

Multiple adaptation strategies for surgical education during the COVID-19 pandemic have been proposed in Latin America and the rest of the world. There is an opportunity to implement new strategies in the long term for surgical training and supervised clinical practice, although more prospective studies are required to generate evidence-based recommendations.

Telemedicine and medical education: a mixed methods systematic review protocol

OBJECTIVE

The objective of this review is to synthesize and appraise the available research on educational strategies required to prepare medical learners for engaging in telemedicine and virtual care.

INTRODUCTION

The COVID-19 pandemic has resulted in significant uptake of virtual care and telemedicine, highlighting the growing need for health care organizations and medical institutions to support physicians and learners navigating this new model of health care delivery, clinical learning, and assessment. Developing a better understanding of how best to prepare medical trainees across the continuum of undergraduate, postgraduate, and continuing professional development to engage in virtual care is critical in ensuring our continued ability to meet educational mandates and provide ambulatory care that is safe, efficient, and timely.

INCLUSION CRITERIA

Eligible studies will include medical learners who receive education on how to deliver telemedicine. The quantitative component of the review will compare learners exposed to educational interventions with learners not exposed to an intervention, or to a different intervention. Outcomes will include competencies in telemedicine delivery, knowledge, and behaviors. The qualitative component of the review will explore learners' experiences with the delivery of educational strategies that address telemedicine.

METHODS

Embase, MEDLINE, Evidence-Based Medicine Reviews: Cochrane Central Register of Controlled Trials, Web of Science Core Collection, Education Source, and ProQuest Dissertations and Theses Global will be searched to identify published and unpublished studies. No date or language restrictions will be applied. This systematic review will be conducted in accordance with the JBI methodology for mixed methods systematic reviews using a convergent segregated approach. Titles and abstracts of potential studies will be screened, and potentially relevant studies will undergo full-text review for eligibility and critical appraisal of the study methodology. Data will be extracted from those studies selected for inclusion. Findings will be described relating to the effectiveness of educational curricula, initiatives, and best practices in trainee engagement in telemedicine and virtual care.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42021264332.

The impact of the COVID-19 pandemic on surgical education: A survey and narrative review

Background

Since the emergence of the COVID-19 pandemic, medical education has been a concerning issue, especially in surgical fields. Due to the postponement of many elective surgeries and even alternations in the pattern of emergent surgeries, concerns have been raised about whether residents of surgical disciplines are experienced enough after graduation or not. We aimed to describe the impact of the COVID-19 pandemic on surgical residency training in different fields.

Materials and methods

We conducted a cross-sectional study with a 20-item questionnaire on residents of surgical disciplines from three different educational hospitals of Tehran University of Medical Sciences, Iran in 2020. In addition, we reviewed the current literature regarding the impact of COVID-19 pandemic on surgical education worldwide.

Results

Our survey, with a response rate of 56.8% demonstrated significant reduction in the time spent in elective surgeries, surgical clinics and even in emergent surgeries for residents. Besides, it has reported that significant time has been spent in COVID 19 wards which resulted in decreased satisfaction of educational activities.

Conclusions

The impacts of COVID 19 pandemic on surgical education are significant and inevitable. Thus, we must integrate novel educational methods in surgical curriculum to optimize training and minimize the adverse effects of the pandemic on surgical education.

•

The impacts of COVID 19 on surgical education are significant and inevitable.

•

We must integrate novel educational methods in surgical curriculum.

•

We need to optimize training and minimize the adverse effects of the pandemic.

Virtual surgical education for foundation doctors in the United Kingdom during COVID-19 pandemic: A qualitative study

Background

Methods

Results

Conclusion

•

Online surgical teaching provides opportunity to learn and develop surgical skills during the pandemic.

•

Blended surgical teaching is realistic and can be advantageous.

Distance Education for Basic Surgical Skills Using Homemade Tools—DIY Methods for Emergency Situations

The aim of our research was to establish a reproducible curriculum that offers the possibility to gain basic surgical skills (knot tying, suturing, laparoscopy basics) through distance education in emergency situations by using tools available in the household. Forty-six volunteering third- and fourth-year medical students were involved in the study. The distance education system was set up using homemade or easily obtainable tools (an empty can, shoe box, sponge, etc.) to teach surgical knotting, suturing, and basic laparoscopic skills. The reachable learning objectives were contrasted with the original course plan. Feedback from the students has been collected. The students’ results were compared to the regular course of the previous years. Seventy-nine percent of the original learning objectives could be reached completely, and 15% partially. The necessary tools were available for 82% of the students. The students evaluated the course for 4.26 in general and 4.86 considering the circumstances (on a 5-level-scale). The homemade trainers were assessed over four as an acceptable substitution. Students’ exam results decreased only by 7% compared to the previous two years. Basic surgical skills can be educated with acceptable efficiency and student satisfaction using distance teaching and homemade tools. This is the first study where not only the simulators but the surgical instruments were replaced with household tools and evaluated by a reproducible curriculum.

The state of distance healthcare simulation during the COVID-19 pandemic: results of an international survey

Background

The coronavirus pandemic continues to shake the embedded structures of traditional in-person education across all learning levels and across the globe. In healthcare simulation, the pandemic tested the innovative and technological capabilities of simulation programs, educators, operations staff, and administration. This study aimed to answer the question: What is the state of distance simulation practice in 2021?

Methods

This was an IRB-approved, 34-item open survey for any profession involved in healthcare simulation disseminated widely and internationally in seven languages from January 14, 2021, to March 3, 2021. Development followed a multistep process of expert design, testing, piloting, translation, and recruitment. The survey asked questions to understand: Who was using distance simulation? What driving factors motivated programs to initiate distance sim? For what purposes was distance sim being used? What specific types or modalities of distance simulation were occurring? How was it being used (i.e., modalities, blending of technology and resources and location)? How did the early part of the pandemic differ from the latter half of 2020 and early 2021? What information would best support future distance simulation education? Data were cleaned, compiled, and analyzed for dichotomized responses, reporting frequencies, proportions, as well as a comparison of response proportions.

Results

From 32 countries, 618 respondents were included in the analysis. The findings included insights into the prevalence of distance simulation before, during, and after the pandemic; drivers for using distance simulation; methods and modalities of distance simulation; and staff training. The majority of respondents (70%) reported that their simulation center was conducting distance simulation. Significantly more respondents indicated long-term plans for maintaining a hybrid format (82%), relative to going back to in-person simulation (11%, p < 0.001).

Conclusion

This study gives a perspective into the rapid adaptation of the healthcare simulation community towards distance teaching and learning in reaction to a radical and quick change in education conditions and environment caused by COVID-19, as well as future directions to pursue understanding and support of distance simulation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s41077-022-00202-7.

The Role of Technology in Health Professions Education During the COVID-19 Pandemic

The COVID-19 pandemic has sparked radical shifts in the ways that both health care and health professions education are delivered. Before the pandemic, some degree programs were offered fully online or in a hybrid format, but in-person learning was considered essential to the education and training of health professionals. Similarly, even as the use of telehealth was slowly expanding, most health care visits were conducted in-person. The need to maintain a safe physical distance during the pandemic rapidly increased the online provision of health care and health professions education, accelerating technology adoption in both academic and professional health care settings. Many health care professionals, educators, and patients have had to adapt to new communication modalities, often with little or no preparation. Before the pandemic, the need for cost-effective, robust methodologies to enable teaching across distances electronically was recognized. During the pandemic, online learning and simulation became essential and were often the only means available for continuity of education and clinical training. This paper reviews the transition to online health professions education and delivery during the COVID-19 pandemic and provides recommendations for moving forward.

Telementoring Feasibility Using a Novel Low-cost Lazy Glass Microsurgical Simulator: A "Proof of Concept" Experimental Study

BACKGROUND

In order to mitigate the challenges in microsurgical skill acquisition and training, especially in the COVID-19 era, we devised a novel microsurgical telementoring protocol for imparting microsurgical skill training in a socially distanced setting. We objectively analyzed its feasibility among neurosurgical trainees.

METHODS

In a controlled experimental design, 8 residents at different stages of their tenure participated in a lazy glass microsurgical simulator-based telementoring exercise. Microsuturing with 4-0 silk, 10-0 nylon on silastic sheets, and eggshell peeling tasks were performed by the residents prior to and after a telementoring session by a panel of 4 neurosurgical experts. Impact of telementoring was assessed in terms of surgical accuracy, efficiency, and dexterity by providing objective (Performance score [PS]), subjective (Neurosurgery Education and Training School [NETS] score), and cumulative scores (CS). Subgroup analysis was performed to assess the impact at different stages of residency.

RESULTS

PS, NETS score, and CS were significantly improved by telementoring sessions for 10-0 nylon micro-suturing (P < 0.001), and egg-hell peeling tasks (P < 0.01). PS and CS improved significantly (P = 0.01) after telementoring sessions for 4-0 silk microsuturing. Both pre- and post-training CS were similar across the 2 subgroups PGY 1-4 and PGY 5-6 (P > 0.05).

CONCLUSIONS

Telementoring is a viable alternative for neurosurgical resident training in the COVID-19 era, where reduction in elective surgeries and social distancing norms preclude conventional teaching. Lazy glass microsurgical simulator-based structured telementoring protocol is a cost-effective tool to augment surgical proficiency and finesse, irrespective of stage of residency.

Continuum of Surgical Skill Acquisition for the Postgraduate Residents During COVID Pandemic: Role of Advanced Simulators in a Multipronged Modular Approach

Skill acquisition with required competencies as defined by the National Medical Commission for the postgraduate surgical residents can happen in a step-wise manner from novice or advanced beginner to competent levels. This requires well-defined program-specific objectives, teaching-learning and assessment methods as per the competency-based medical education curriculum. Various modalities of teaching for the residents are adapted during the COVID pandemic to maintain the continuum of learning. In this study, we have attempted to develop, implement, and evaluate the effectiveness of acquiring laparoscopic surgical skills using advanced simulators and with large live animal in a real-life situation by a modular training approach. This skill-based program was developed and implemented for final year General Surgery postgraduate residents of Yenepoya Medical College for training laparoscopic surgical competencies. The training was conducted at Advanced Simulation Centres of Yenepoya (Deemed to be University), Mangalore, Karnataka, India. Three training modules were prepared based on the competency-based medical education curriculum for incremental training with advanced simulators and large live animals in a real-life situation which included the sessions on briefing, scenarios, simulations, hands-on activities, debriefing, feedback, and assessment methods. Assessment after the modular training showed statistically significant improvement in their scores, and they scaled up their skill acquisition ladder after each module. The residents and faculty felt that integration from different specialties has increased their confidence levels and communication skills, exploring team dynamics with 1:1 mentorship to make them competent emphasizing the effectiveness of simulation-based training even during the pandemic.

COVID-19 Restrictions Presented Opportunities and Challenges for Plastic Surgery Residents

BACKGROUND

Restrictions placed during the COVID-19 pandemic to prevent viral spread led to substantial changes in surgical resident education. The aim of this study was to assess the positive and negative impact of COVID-19 on plastic surgery education and training and provide recommendations for continued competency.

METHODS

A cross-sectional online survey of plastic surgery residents across Canada was used to evaluate the impact of COVID-19 on clinical exposure, experience with virtual education, and long-term impact of COVID-19 on surgical training.

RESULTS

This study included 61 plastic surgery residents (40% participation rate). Common educational modalities used during COVID-19 included online seminars (95%) and workshops (58%). Teaching sessions were effective if structured around patient cases (72%), recorded (66%), and limited to 1 hour (64%). There were mixed reactions towards online education sessions; residents reported feeling grateful (54%), motivated (38%), enthusiastic (28%), overwhelmed (41%), pressured to participate (23%), and anxious (13%). There were significantly less residents who felt that their clinical exposure was sufficient during (21%) versus before (72%) pandemic restrictions (P < .001). Overall, 87% of residents felt that the pandemic had a negative impact on their training, surgical skill development, fellowship plans, and job prospects.

CONCLUSIONS

During the initial wave of COVID-19, residents faced altered educational opportunities, which elicited positive and negative emotions with concern regarding surgical skill development and impact on future career plans. Characterizing early educational impact on residency training to identify opportunities for change is worthwhile as the overall effect of the pandemic is ongoing and remains uncertain.