Orthopedic surgery residents' perception of online education in their programs during the COVID-19 pandemic: should it be maintained after the crisis?

A national survey on the impact of the coronavirus pandemic on gynecologic surgical training

OBJECTIVE

The objective of this study was to assess the impact of the coronavirus pandemic on gynecology surgical training.

METHODS

A national cross-sectional online survey was distributed to all trainees and trainers in the higher specialist training program for obstetrics and gynecology in Ireland. The survey consisted of questions on topics which included: the volume of surgical procedures performed before and since the pandemic, confidence in performing various gynecologic procedures before and since the pandemic and questions regarding the impact of the pandemic on wellbeing and work practices.

RESULTS

Trainers and trainees experienced a significant reduction in operative volumes for most procedure types. Analysis showed a significant reduction in the number of minor procedures performed by trainees (z = -2.7, P = 0.007) and a significant reduction in the number of all procedure types performed by trainers (minor procedures z = -3.78, P = <0.001; intermediate procedures z = -4.48, P = < 0.001; major procedures z = -3.69, P = < 0.001). Respondents reported they had less time for research and audit, were less able to attend courses or conferences and worried about the impact of their work on their families.

CONCLUSIONS

In conclusion, this study has highlighted the current difficulties facing surgical trainees in gynecology because of the COVID-19 pandemic. These challenges have compounded an already challenging training environment for gynecology trainees. Efforts must be made to continue to provide high-quality tailored training to ensure the development of the next generation of gynecologic surgeons.

Perceptions of online surgical-focused learning amongst surgeons during the COVID pandemic: A scoping review 2020-22

INTRODUCTION

During the COVID pandemic many centres adopted e-learning as a tool to adhere to social distancing recommendations while continuing to provide ongoing postgraduate medical education. We aimed to complete this scoping review in order to map experience and perceptions amongst surgeons and surgical trainees to remote learning during the COVID pandemic.

METHODS

Using Arksey and O'Malley's five step model for conducting a scoping review, a systematic search strategy was undertaken across three online databases SCOPUS, MEDLINE and Web of Science. Only original articles in English in the field of postgraduate education in surgery were included.

RESULTS

44 studies were selected for review. Of these 44, 21 were studies of perception of a newly developed e-learning tool/platform. 17 were surveys of surgeon's attitudes towards e-learning during the COVID pandemic. The remaining 6 studies were studies of knowledge or skills acquired through new e-learning, which included a survey of experience. The United States was the most common country of origin with General Surgery the most represented surgical speciality. Response rates across all three study subgroups were on average >60%. Surgeon's experience of e-learning was reported in only positive terms in 86% (n = 38/44) of studies.

CONCLUSIONS

This paper is informative in that it focuses specifically on surgeons' perceptions of a e-learning tools used in addition to skills or knowledge gained. Positive e-learning experience reported in these studies may lead to more blended learning curriculums being developed, deployed and evaluated going forward.

The Rise of Online Medical Education in Craniofacial Surgery

BACKGROUND

International travel had been radically disrupted by coronavirus disease 2019 (COVID-19), leaving traditional medical conferences on a 2-year hiatus. The International Craniofacial Chang Gung Group (ICC) was thus created to disseminate knowledge related to craniofacial surgery. This study aimed to reveal how webinars fundamentally transformed the traditional format of medical conferences.

MATERIALS AND METHOD

In total, 64 ICC webinars held between December 13, 2020, and May 21, 2023, were documented and reviewed. A questionnaire was designed and sent to ICC members. The questionnaire collected information on attitudes and habits relating to videoconferencing in general before and after the start of COVID-19 and on the ICC webinars specifically. Responses were analyzed to inform our understanding of respondents' experience and satisfaction with the webinars.

RESULTS

The webinars covered a variety of topics related to craniofacial surgery. In total, 64 webinars were included for analysis. The mean number of attendees at each webinar was 86.7. In total, 111 respondents were more satisfied (4.25 ± 0.72 out of 5) with ICC webinars than with other media of online meetings ( P < 0.001). In total, 89.2% of respondents were willing to continue attending ICC webinars after COVID-19 restrictions have been lifted.

CONCLUSIONS

Webinars are an effective format for imparting knowledge, especially in the ICC, and will become key in continuing medical education.

Zoomification of medical education: can the rapid online educational responses to COVID-19 prepare us for another educational disruption? A scoping review

Introduction

In response to the COVID-19 pandemic, educators have increasingly shifted delivery of medical education to online/distance learning. Given the rapid and heterogeneous nature of adaptations; it is unclear what interventions have been developed, which strategies and technologies have been leveraged, or, more importantly, the rationales given for designs. Capturing the content and skills that were shifted to online, the type of platforms used for the adaptations, as well as the pedagogies, theories, or conceptual frameworks used to inform the adapted educational deliveries can bolster continued improvement and sustainability of distance/online education while preparing medical education for future large-scale disruptions.

Methods

We conducted a scoping review to map the rapid medical educational interventions that have been adapted or transitioned to online between December 2019 and August 2020. We searched MEDLINE, EMBASE, Education Source, CINAHL, and Web of Science for articles pertaining to COVID-19, online (distance) learning, and education for medical students, residents, and staff. We included primary research articles and reports describing adaptations of previous educational content to online learning.

Results

From an initial 980 articles, we identified 208 studies for full-text screening and 100 articles for data extraction. The majority of the reported scholarship came from Western Countries and was published in clinical science journals. Cognitive content was the main type of content adapted (over psychomotor, or affective). More than half of the articles used a video-conferencing software as the platform to pivot their educational intervention into virtual. Unfortunately, most of the reported work did not disclose their rationale for choosing a platform. Of those that did, the majority chose technological solutions based on availability within their institutions. Similarly, most of the articles did not report the use of any pedagogy, theory, or framework to inform the educational adaptations.

AOA Critical Issues Symposium: Leadership and Education During and After COVID-19: Back to the Future or a New Normal

ABSTRACT

The devastating impact of COVID-19 has reshaped how we lead and train our future surgeons in the field of orthopaedics. Overnight, leaders in our field had to dramatically shift their mindset to continue to lead a hospital, department, journal, or residency or fellowship program in the face of an unprecedented level of adversity in the history of the United States. This symposium discusses the role of physician leadership during and after a pandemic, as well as the adoption of technology for training surgeons in the field of orthopaedics.

Orthopaedic Surgery Training and Education During COVID-19: A Systematic Review

COVID-19 forced surgical resident training programs to adapt to meet educational requirements within the constraints of various guidelines. Some of the changes implemented during the pandemic have imparted a lasting effect on orthopaedic education. As such, the purpose of this article was to review how orthopaedic training and education were affected during the COVID-19 pandemic.

Methods

The published literature was queried using search strategies devised by a medical librarian, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Studies eligible for inclusion were studies related to COVID-19, orthopaedic surgical training, and medical education. Studies were excluded if they (1) were abstracts, conference proceedings, letters, perspective pieces, reviews, or editorials; (2) evaluated medical student education; (3) included other specialties; or (4) were unrelated to COVID-19 and/or orthopaedic training.

Results

Eighty-three (n = 83) studies were included. Five themes emerged including (I) Fellowship Application, Interview, and Match Processes; (II) Social Media and Websites for Program Information; (III) Changes in Trainee Surgical Volume; (IV) Trainee Mental Health and Well-being; and (V) Innovations in Education. The pandemic decreased opportunities for medical students to gain exposure to orthopaedic surgery. Social media use, particularly Instagram, among orthopaedic residencies increased during the pandemic. Between the cancellation of away rotations and in-person interviews, applicants saved over $6,000; however, both residency applicants and interviewers preferred in-person interviews. The pandemic led to decreased surgical volume and in-person didactics for trainees, thus relying more on virtual learning. Orthopaedic trainees had mixed feelings regarding online virtual education. Although some respondents reported that they preferred the convenience of online learning, others expressed dissatisfaction with the quality of virtual education.

Conclusions

The shift to virtual learning affected how applicants learned about residency programs, with many relying on virtual away rotations and social media to compare different programs. The pandemic also highlighted issues of diversity and accessibility within orthopaedic surgery, with cost savings from virtual interviews and canceled away rotations potentially benefiting applicants from lower socioeconomic backgrounds. Although some innovative approaches and adaptations to orthopaedic education and training have shown promise and may continue to be used in the future after the COVID-19 pandemic, the role of others, such as virtual interviews, is less clear.

General Surgery Training and One Year of COVID-19. What Has Been the Impact on Residents' Operating Room Surgical Activity? A Report From an Italian Academic Hospital

BACKGROUND

In the last year and a half, the COVID-19 pandemic has put great pressure on the healthcare systems of many countries, Italy included, leading to a reorganization of hospital activities and a dramatic reduction in surgical activity. Our study aimed to evaluate, from a quantitative and qualitative perspective, the impact of this reduction on the formation of surgery residents at the Academic Hospital of Udine.

METHODS

We compared the resident's surgical activity during the pandemic year (March 2020-2021) with the one during the pre-pandemic year, declining the surgical procedures by timing, type, and complexity and categorizing the residents by postgraduate year (PGY) and surgical role.

RESULTS

Our analysis highlighted how the main reductions occurred in the elective and medium complexity surgery due to the procrastination of benign pathologies such as hernias, cholelithiasis, and hemorrhoids, which also appeared to be the more frequent cases where the residents are first operators. On the other hand, the residents of the last PGY still maintained a good exposure to neoplasm and high complexity interventions, which are cardinal aspects in the last year of formation.

CONCLUSIONS

These results mostly confirmed the critical points noted by the resident surgeons themselves, highlighting however the specific impact on different PGY and surgical activities, offering a starting point to better understand how to challenge the negative effect that the COVID-19 pandemic has had on the surgical resident formation.

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.

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We must integrate novel educational methods in surgical curriculum.

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

[Translated article] Has 2020 been a lost year in orthopaedic surgery and trauma training? Residents’ perceptions

Objective

The COVID-19 pandemic has affected specialised healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopaedic surgery residency training has so far not been assessed.

Material and methods

An online survey of 17 questions was sent via web link to orthopaedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analysed.

Results

A total of 307 orthopaedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad.

Conclusions

The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximising learning opportunities.

COVID-19 and the transition to virtual teaching sessions in an orthopaedic surgery training program: a survey of resident perspectives

BACKGROUND

COVID-19 has had a tremendous impact on medical education. Due to concerns of the virus spreading through gatherings of health professionals, in-person conferences and rounds were largely cancelled. The purpose of this study is the evaluate the implementation of an online educational curriculum by a major Canadian orthopaedic surgery residency program in response to COVID-19.

METHODS

A survey was distributed to residents of a major Canadian orthopaedic surgery residency program from July 10^th to October 24^th, 2020. The survey aimed to assess residents' response to this change and to examine the effect that the transition has had on their participation, engagement, and overall educational experience.

RESULTS

Altogether, 25 of 28 (89%) residents responded. Respondents generally felt the quality of education was superior (72%), their level of engagement improved (64%), and they were able to acquire more knowledge (68%) with the virtual format. Furthermore, 88% felt there was a greater diversity of topics, and 96% felt there was an increased variety of presenters. Overall, 76% of respondents felt that virtual seminars better met their personal learning objectives. Advantages reported were increased accessibility, greater convenience, and a wider breadth of teaching faculty. Disadvantages included that the virtual sessions felt less personal and lacked dynamic feedback to the presenter.

CONCLUSIONS

Results of this survey reveal generally positive attitudes of orthopaedic surgery residents about the transition to virtual learning in the setting of an ongoing pandemic. This early evaluation and feedback provides valuable guidance on how to grow this novel curriculum and bring the frontier of virtual teaching to orthopaedic education long-term.

A Pandemic of Webinars in the COVID Era—Can It be the Way Forward?

Introduction Conferences are important and sometimes mandatory to update the clinician with latest knowledge. Attending conferences requires planning, expenditure, and leave from work. Webinars have become the new normal in the coronavirus disease (COVID) era. We surveyed the esteemed medical fraternity on their opinion on webinars.

Methods This was conducted as an online survey (Survey Monkey) through personal electronic mails and social media with 24 questions. Details on demographic profile, specialization and affiliation, experience, choice of frequency of webinar sessions, suitable platform, mode of intimation of webinars, number of days for prior intimation, appropriate timing of the day and week, and ideas on payment options were enquired. Need for technical assistance, choice of topic for discussions, methods to make webinars more interactive, availability of recorded content, and impact on clinical practice were also assessed.

Results A total of 235 medical professionals voiced their opinion; 67% were < 35 years of age and 49% were residents. An average of 2 to 3 webinars per month (33.8%), conducted on weekdays (63%), after 6 p.m. (54%) in the form of case discussion (67.3%) or lectures from experts (55%) with at least 7 days' notice (41.7%) was the most common choice; free webinars were the wish of 56.1% participants and 28% felt webinars would definitely impact practice.

Conclusion Webinars are welcoming even after the COVID era and should go hand-in-hand with conventional conferences. Virtual learning experience should be optimized by proper scheduling of multiple simultaneous events and converting them into interlinked or serial events.

The benefits of virtual learning webinars to both low and high-income countries

The 2019 Covid pandemic has brought about many changes in the relationships between high income countries (HICs) and partner organisations in low or low-middle income countries (LMICs), such as predominate in sub-Saharan Africa. Medicine, surgery and in particular urology is no exception to the changes that Covid-19 has demanded. Urolink represents the British Association of Urological Surgeons (BAUS) on the global urology stage and has been deleteriously impacted by the pandemic. Education, one of the pillars of Urolink's founding philosophies, has conventionally been delivered by face-to face (F2F) teaching, training or mentoring by UK urologists at their host's site outside of the United Kingdom (UK). As a consequence of the inability to travel due to the pandemic, BAUS Urolink has evolved a virtual online webinar package evolved by, and delivered between, urologists in Lusaka, Zambia, and various centres in the United Kingdom. The aim was to deliver curricular-based educational topics to trainees in both countries. This programme has generated a number of live webinars, and archived recordings, during the pandemic that has proven accessible, and educationally acceptable, to trainees in the UK and Zambia. This webinar series has also generated relationships between young urologists on different continents, given each a different view of healthcare delivery outside of their country of origin at no appreciable cost, and would appear to be an educational mechanism that is durable for, and applicable to, a wider participation in the post-pandemic world.

Does quality assured eLearning provide adequate preparation for robotic surgical skills; a prospective, randomized and multi-center study

Purpose

In particular after the onset of the COVID-19 pandemic, there was a precipitous rush to implement virtual and online learning strategies in surgery and medicine. It is essential to understand whether this approach is sufficient and adequate to allow the development of robotic basic surgical skills. The main aim of the authors was to verify if the quality assured eLearning is sufficient to prepare individuals to perform a basic surgical robotic task.

Methods

A prospective, randomized and multi-center study was conducted in September 2020 in the ORSI Academy, International surgical robotic training center. Forty-seven participants, with no experience but a special interest in robotic surgery, were matched and randomized into four groups who underwent a didactic preparation with different formats before carrying out a robotic suturing and anastomosis task. Didactic preparation methods ranged from a complete eLearning path to peer-reviewed published manuscripts describing the suturing, knot tying and task assessment metrics.

Results

The primary outcome was the percentage of trainees who demonstrated the quantitatively defined proficiency benchmark after learning to complete an assisted but unaided robotic vesico-urethral anastomosis task. The quantitatively defined benchmark was based on the objectively assessed performance (i.e., procedure steps completed, errors and critical errors) of experienced robotic surgeons for a proficiency-based progression (PBP) training course. None of the trainees in this study demonstrated the proficiency benchmarks in completing the robotic surgery task.

Conclusions

PBP-based e-learning methodology is an effective training method avoiding critical errors in the suturing and knotting task. Quality assured online learning is insufficient preparation for robotic suturing and knot tying anastomosis skills.

Trial registration

ClinicalTrials.gov Identifier: NCT04541615.

[Impact of the Covid-19 pandemic on specialized healthcare training in a teaching center]

OBJECTIVE

Evaluation of the impact of the health crisis caused by the Covid-19 pandemic on specialized healthcare training in a teaching center.

METHODS

Cross-sectional descriptive study, by means of an electronic questionnaire sent to 167 residents in June 2020, to evaluate the burden of care, suspension of rotations and Covid-19 symptoms. The impact on the acquisition of professional competencies was measured using a four-level Likert scale (none, a little, quiet, a lot). The profile of acquired competencies was constructed and its association with the professional profile was studied using Generalized Linear Models. The qualitative approach was carried out through an open question on how it influenced their learning and the different categories were extracted through triangulation.

RESULTS

The impact on learning was important for 94.8% of the residents. A total of 81.4% left the rotations they were doing and reported high workload, loss of training opportunities, uncertainty and ethical conflicts. They appreciated significant learning in the competencies of teamwork (93.2%), professionalism (86.2%), ethics (79.9%) and communication (78%). Technical competencies were deficient. The final balance of learning was perceived as positive by 54.4%, especially residents in central services and medical specialties. A total of 67.8% felt overwhelmed at times due to fatigue-emotional impact, care overload, ethical conflicts and lack of resources.

CONCLUSIONS

The Covid-19 pandemic had an exceptional impact on specialized health care training. It is necessary to re-evaluate training programs to ensure the acquisition of the technical competencies that are lacking.

Evaluation of utility and usefulness of webinars on COVID-19 management: a questionnaire-based survey

Background

The COVID-19 pandemic and its consequent “social distancing” has fueled the use of social media platforms for educational purposes. Since the start of the pandemic, a plethora of experts and self-proclaimed experts have been keenly delivering webinars on COVID. This begs the question “Do webinars on COVID-19 really help in the improvement of knowledge base or management skills?”. The questionnaire was designed to assess information regarding COVID-webinars and their usefulness from the end-user standpoint. The response to the questions was measured using a 4- or 5-point Likert scale. The survey was open for a 4-week period with the extension of 1 week.

Results

The response rate was 54% as 270 out of 500 participants responded to the questionnaire. The majority of the respondents were anesthesiologists in-training, post-graduates, fellows, and seniors belonging to tertiary care settings with fewer percentages belonging to physicians and others. Most of the doctors had attended an average of 2 webinars per week. The tests of model effects showed a significant negative correlation of webinar quality ratings for district hospital healthcare setting of the attendees (of p value of 0.013) and for the number of COVID-related webinars attended per week (p value of 0.009).

Conclusions

Most respondents had favorable perceptions of webinars happening during the pandemic. However, there is a need for improvisation in the volume of webinars, target-audience-based delivery, and participant interaction to add value to this new dimension of teaching-learning.

Lived Experiences of Surgical Residents During the COVID-19 Pandemic: A Qualitative Assessment

OBJECTIVE

As the COVID-19 pandemic dynamically changes our society, it is important to consider how the pandemic has affected the training and wellness of surgical residents. Using a qualitative study of national focus groups with general surgery residents, we aim to identify common themes surrounding their personal, clinical, and educational experiences that could be used to inform practice and policy for future pandemics and disasters.

DESIGN

Six 90-minute focus groups were conducted by a trained qualitative researcher who elicited responses on six predetermined topics. De-identified transcripts and audio recordings were later analyzed by two independent researchers who organized responses to each topic into themes.

SETTING

Focus groups were conducted virtually and anonymously.

PARTICIPANTS

General surgery residents were recruited from across the country. Demographic information of potential participants was coded, and subjects were randomly selected to ensure a diverse group of participants.

RESULTS

The impact of the COVID-19 pandemic on residents' clinical, educational, and personal experiences varied depending on the institutional response of the program and the burden of COVID-19 cases geographically. Many successes were identified: the use of telehealth and virtual didactics, an increased sense of camaraderie amongst residents, and flexibility in scheduling. Many challenges were also identified: uncertainty at work regarding personal protective equipment and scheduling, decreased case volume and educational opportunities, and emotional trauma and burnout associated with the pandemic.

CONCLUSIONS

These data gathered from our qualitative study highlight a clear, urgent need for thoughtful institutional planning and policies for the remainder of this and future pandemics. Residency programs must ensure a balanced training program for surgical residents as they attempt to master the skills of their craft while also serving as employed health care providers in a pandemic. Furthermore, a focus on wellness, in addition to clinical competency and education, is vital to resident resilience and success in a pandemic setting.

Virtual educational meetings and activities during the COVID-19 pandemic and beyond: Egyptian oncologists' experience

The COVID-19 pandemic has had ramifications for most healthcare activities, including medical education and communication aspects. Virtual educational meetings and activities (VEMAs) have been utilised tremendously in the pandemic era, reflecting a transition to new horizons of cyberspace. This creates the need to explore possible challenges for the implementation of such services in the rapidly evolving field of oncology. The aim of our study is to explore the impact of the COVID-19 pandemic on VEMAs in the oncology community in Egypt. It focused on the evaluation of current attitudes, satisfaction and expectations of Egyptian oncologists during and beyond the COVID-19 era. The study is a cross-sectional study using a survey that was distributed through social media. It targeted Egyptian oncologists during the months of May and June 2020. A total of 118 participants completed the survey and most of them were younger than 35 years (71%). Most participants (93.2%) agreed that COVID-19 affected the stream of live medical educational meetings. About three-quarters of them attended VEMAs during the COVID-19 period compared to 50% prior to the pandemic. The majority reported that evening hours after 8 PM was the best time to attend VEMAs and 1 hour is the optimal duration for a virtual meeting. Although the COVID-19 pandemic appeared as an unprecedented challenge for medical education, it can be a catalyst for VEMAs, especially in a rapidly evolving field such as oncology. Further research is needed to assess whether learners are ready and willing to make greater use of online educational platforms and investigate the possible barriers and strategies to enhance their use.

Teaching strategies and outcomes in 3 different times of the COVID-19 pandemic through a dynamic assessment of medical skills and wellness of surgical trainees

BACKGROUND

The coronavirus disease 2019 pandemic had a substantial impact on surgical training programs. This study describes the teaching strategies and outcomes in 3 different times of the coronavirus disease 2019 pandemic through a dynamic assessment of medical skills and well-being of trainees.

METHODS

Three surveys were administered during 2020 to general surgery residents and fellows in a university hospital in Argentina. Perceptions on the impact of coronavirus disease 2019 were described. The stress rate and risk factors were analyzed.

RESULTS

The study included 124 answers. In total, 59% were men, 82% of trainees reported concerns about the loss of surgical skills in early phase 1. Time spent with academic activities increased in 94.5% of the cases. Owing to the prompt implementation of changes, by the end of 2020, 73% participated in a greater number of procedures (P = .003); personal protective equipment use related problems dropped from 40% to 14% (P = .031), and the lack of adequate spaces where trainees could express reduced from 28% to zero. Half of the trainees felt stressed, and 18% required psychological assistance; reporting problems with personal protective equipment use was identified as a risk factor (P = .012).

CONCLUSION

Assessing trainees' perceptions at 3 different times of the coronavirus disease 2019 pandemic enabled the implementation of dynamic changes. The negative impact on surgical training was partially offset by the optimal use of virtual learning. Half of them felt stressed, identifying problems in the use of personal protective equipment as a predisposing factor.

Medical and public health instructors' perceptions of online teaching: A qualitative study using the Technology Acceptance Model 2

Many universities in the U.S. shifted from in-person teaching to online teaching due to the COVID-19 pandemic. Instructors' acceptance of online teaching plays a crucial role, as the acceptance level can impact instructors' online teaching behaviors. This qualitative study examined medicine and public health instructors' perceptions of online teaching using the Technology Acceptance Model 2 (TAM2) model. Through semi-structured interviews with ten instructors in a Midwest university in the U.S., this study found that instructors had a high level of acceptance of online teaching. Instructors perceived the usefulness of online teaching in terms of learning objectives, assessment, instructional methods, and learning experience. Online teaching was perceived as useful overall, although challenges existed, such as online interaction, assessment, and hands-on practices. Regarding ease of use in online teaching, instructors perceived technology was easy to use; yet some pedagogical challenges existed, such as class engagement, the focus of learners' attention, and transforming hands-on lab or clinical sessions online. The blended model is recommended to use for teaching and learning in medical and public health education post the pandemic. Detailed implications for practice and research were discussed in the end.

Has 2020 been a lost year in orthopedic surgery and trauma training? Residents' perceptions

OBJECTIVE

The COVID-19 pandemic has affected specialized healthcare training at all levels. Surgical learning has been severely affected, and the impact on orthopedic surgery residency training has so far not been assessed.

MATERIAL AND METHODS

An online survey of 17 questions was sent via web link to orthopedic surgery residents throughout Spain between February 10, 2021 and February 28, 2021. The effects of the COVID-19 pandemic on the care and training activities of residents were analyzed.

RESULTS

A total of 307 orthopedic surgery residents from all over Spain responded to the online survey. A total of 77.2% of the respondents had to suspend their rotations. Of these, 67.5% would like to resume the rotations they missed during the pandemic. A total of 69.7% of scheduled surgeries were suspended. Surgical activity was completely stopped for an average of 8 weeks. 66.8% of the residents consider that their surgical training has been affected and this will have repercussions on their future work. 49.5% considered the online training offered to be insufficient. Of the total number of respondents, 52.1% considered that the impact of the pandemic situation on their training situation was bad or very bad.

CONCLUSIONS

The data collection shows a negative impact on both theoretical and clinical training. This study highlights the need to continue offering quality training by maximizing learning opportunities.

Online educational resources for orthopaedic residency-a narrative review

PURPOSE

Residency programs in the medical education field are considered the keystone in the development of aptitude and skills required for practice. With the worldwide current scenario of the COVID-19 pandemic, there has been a shift in the paradigm especially in the teaching of the residents from face-to-face classes to more and more online sessions. The purpose of this study is to present a compendium of knowledge-providing sites, smartphone applications (apps), YouTube channels, and podcasts that can provide better online resource management for students in the field of orthopaedics.

METHODS

Search terms were used for making a list of various online resources which can be of help during orthopaedic residency. An initial list of the selected websites, smartphone apps, podcasts, and YouTube channels was made. The corresponding author with years of teaching experience and faculty for post-graduate and fellowship training programs then selected the final list.

RESULTS

A list of 16 websites with brief points on their content and online address along with the availability of free or paid content was identified as being appropriate. A total of 39 apps available for android/apple smartphones, nine podcasts, and 11 YouTube channels were also identified as being extremely useful and have been discussed elaborately in this article.

CONCLUSION

Online educational tools are of immense importance in imparting adequate knowledge to an orthopaedic resident and act as an adjunct to conventional teaching methods. This article focuses on presenting various online educational resources in a simple yet concise way, which may be beneficial for the current generation of residents especially in this current time of unprecedented COVID-19 pandemic.

Chronicling the effect of COVID-19 on orthopedic literature

Background

The novel coronavirus disease (COVID-19) has had a significant impact on orthopedic surgery practice, but there has been little investigation of the effects of COVID-19 on the orthopedic surgery literature. Additionally, because orthopedic research plays a vital role in physician education, changes to the characteristics and content of published literature can have lasting impacts on future teaching and learning. This paper represents the first known analysis of the COVID-19 pandemic's impact on peer-reviewed articles published in orthopedic surgery journals.

Methods

The 20 orthopedic journals with the highest impact factors in 2019, according to the Journal Citation Reports, were included in this study. Using PubMed and COVID-19 related keywords as well as manual screening, a final count of 199 articles were assessed for this study and subsequently sorted by country of origin, orthopedic subspecialty, article type, and general theme. Kruskal Wallis and Pearson's Chi-squared tests were used to analyze continuous and categorical variables, respectively.

Results

Fourteen journals published articles relating to COVID-19, representing 26 countries with the United States (37%) and United Kingdom (13%) publishing the greatest proportion of all COVID-19 articles. Sixty percent of publications discussed COVID-19's impact on the overall field of orthopedic surgery, with the remainder focusing on specific subspecialties. Forty-seven percent of publications were original research articles while 46% were editorials or commentaries. The median time to publication for all COVID-19 related articles was 24.5 days, compared to the 129 days reported for orthopedic journals prior to the COVID-19 pandemic (p < 0.001). In the first 100 articles published, 49% (n = 49) originated exclusively from United States institutions, whereas only 25% (n = 25) of the next ninety-nine articles had US-only institutions (p < 0.001).

Conclusions

The COVID-19 pandemic has significantly impacted the characteristics, content, and time to publication of the orthopedic surgery literature. The data and ideas presented in this paper should help streamline future, formal analysis on the lasting implications of COVID-19 on orthopedic surgery practice, teaching, and learning.

Impact of the COVID-19 pandemic on emergency medicine education: Insights from faculty and residents

OBJECTIVES

The COVID-19 pandemic continues to impact health systems across the United States and worldwide in an unprecedented way; however, its influence on frontline medical trainees' educational experiences is unknown. Our objective was to determine the effects of COVID-19 on emergency medicine (EM) training programs and residents.

METHODS

We performed a mixed-methods cross-sectional survey study of faculty and residents at programs registered with Foundations of Emergency Medicine. Participants completed an online survey consisting of closed and open-ended response items. We reported descriptive statistics for discrete and continuous data. Free-response data were analyzed qualitatively using a thematic approach.

RESULTS

Ninety-two percent of faculty (119/129) and 47% (1,965/4,154) of residents responded to our survey. We identified three major themes related to effects on learning: 1) impact on clinical training, 2) impact on didactic education, and 3) impact on the trainee. Nearly all residencies (96%, 111/116) allowed residents to work with patients suspected of having COVID-19, although fewer (83%, 96/115) allowed residents to intubate them. We found that 99% (1918/1928) of residents experienced virtual didactics. Faculty and trainees noted multiple educational challenges and strategies for adaptation. Trainees also expressed concerns about stress and safety.

CONCLUSION

COVID-19 has impacted EM education in many ways including clinical training, didactic education, and trainee emotional state and concentration. Challenges and suggested solutions for learning in the virtual environment were also identified. While the pandemic continues to evolve and impact EM residents in various ways, our results may inform strategies to support medical educators and trainees during pandemics or other periods of significant disruption or crisis.

The perceived impact of webinars during the COVID.19 pandemic: A survey of ophthalmology trainees from India

OBJECTIVE

The objective of the study was to assess the perceived utility and the impact of web-based teaching programs being conducted following the COVID-19 pandemic.

METHODS

An online survey was sent to trainee ophthalmologists across India through various social media platforms. The responses were tabulated and analyzed.

RESULTS

A total of 768 valid responses were recorded. Majority of respondents (52.2%) felt that the ideal duration for webinars was 1 hour or less. Factors that helped trainees in choosing a webinar were the topic (95.1%), the timing (53.6%), and the speaker list (42.4%). Residents indicated a preference for webinars to attend aimed at postgraduate residency training, more specifically clinical problem-solving. Further questions were answered using a 1-10 Likert scale (1: least useful and 10: extremely useful). The median score when asked for overall usefulness of the webinars in general was 8 (interquartile range/IQR: 2). The median response when asked about utility of webinars in enhancing theoretical knowledge was 8 (IQR: 2) and the median for utility of webinar-based teaching programs in enhancing practical knowledge/surgical learning was also 8 (IQR: 2). The median score when asked about the utility of the webinar programs in acquiring skills for writing research papers/thesis was 7 (IQR: 3). Connectivity issues, audio/voice issues, and the long duration of webinars were some of the problems faced while attending webinars.

CONCLUSIONS

Ophthalmology trainees in India found online teaching programs and webinars to be useful in enhancing their theoretical knowledge and practical skills/surgical learning. Administrators and educational institutes should tailor online teaching programs as per the needs and preferences of the residents.

Perceptions of Saudi Plastic Surgery Residents and Attendings of Online Education during the COVID-19 Pandemic

BACKGROUND

The world has faced an unprecedented challenge in controlling the spread of COVID-19-a rapid reshaping of the healthcare system and education was inevitable. Consequently, residency programs adopted e-learning as a social distancing tool for the continuity of the learning process. In this study, we explore the opinions and perspectives of plastic surgery attending doctors and residents on the implications of e-learning.

METHODS

After obtaining ethical approval, this cross-sectional study was conducted electronically between October and December 2020 among plastic surgery residents and board-certified plastic surgeons in Saudi Arabia. Participants completed a validated, anonymous, self-administered questionnaire. The questionnaire gathered participants' demographic data, perceptions of online webinars, and audiovisual evaluations. Finally, we compared traditional (in-person) teaching with online webinars. The analysis was performed at a 95% confidence interval using the Statistical Package for Social Sciences (SPSS), version 23.0 (IBM, Armonk, N.Y.).

RESULTS

A total of 61 responses were included in this study. The majority of respondents (78.7%) were comfortable during webinars, with 38 (62.3%) believing they should supplement traditional teaching methods. Overall, 50.8% were satisfied with the webinars. However, 37.7% were neutral. Most believed that the webinars increased their clinical (67.2%) and surgical skills (67.2%) to reasonable levels.

CONCLUSIONS

Online education provided an excellent educational tool as a viable option to supplement traditional face-to-face training, with most residents being satisfied, supporting the use of this educational tool. More objective research is required to refine existing online plastic surgery teaching methods while creating novel distance e-learning approaches for the future.

Impact of coronavirus disease 2019 (COVID-19) on trauma surgical education at a level I trauma center

BACKGROUND

During the coronavirus disease 2019 pandemic, trauma presentations to the emergency room decreased across the country. The goal of this study is to analyze the educational impact of coronavirus disease 2019 on trauma education and training at a level I trauma center.

METHODS

Trauma patient presentations were analyzed 6 months before a Tennessee executive stay-at-home order and 6 months after the state executive order. To control for the seasonal trauma volumes, an additional 6 months before the executive order was then analyzed comparing month to month. Total number of presentations, demographics, procedures, airway management, and coronavirus disease 2019 status of patients and residents were analyzed.

RESULTS

The number of trauma presentations were sustained after executive orders at our level I trauma center. There was no significant difference in intubations, central line placements, and chest tube placements before and during the pandemic. Blunt trauma decreased after stay-at-home orders. Of the 36 residents, no residents tested positive during the study period.

CONCLUSION

Trauma-focused surgical education was not affected at an academic level I trauma center. Understanding that it is region, city, and hospital specific, this study shows that quality trauma education can continue throughout the coronavirus disease 2019 pandemic while keeping trainees safe. Proper airway management, personal protective equipment, social distancing, and coronavirus disease 2019-preventative protocols seem to protect residents from potential harm while allowing them to participate and continue in quality trauma education and training.

Physicians' attitude towards webinars and online education amid COVID-19 pandemic: When less is more

BACKGROUND

Since the declaration of COVID-19 as a pandemic, all scientific medical activities were shifted to an online format, in the form of webinars, to maintain continuing medical education (CME). We aimed to assess physicians' attitude among different medical specialties towards this sudden and unexpected shift of traditional face-to-face meetings into webinars, and to suggest future recommendations.

METHODS

We conducted a cross-sectional, internet-based survey study using a 25-item questionnaire, from November 1 and November 15, 2020. The survey was created and distributed to physicians from different medical and surgical specialties and from different countries via several social media platforms, using a snowball technique.

RESULTS

A total of 326 physicians responded; 165 (50.6%) were females, mean age of responders was 38.7 ± 7.5 years. The majority of responses (93.2%) came from Arab countries. Of them, 195 (59.8%) reported attending more webinars compared to the same period last year, with average of 3 per month. As regard to the general impression; 244 (74.8%) were "strongly satisfied" or "satisfied", with the most satisfaction for "training courses: by 268 (82.2%), and "International conferences" by 218 (66.9%). However, 246 respondents (75.5%) felt overwhelmed with the number and frequency of webinars during the pandemic, 171 (52.5%) reported attending less than 25% of webinars they are invited to, 205 (62.8%) disagreed that webinars can replace in-person meetings after the pandemic, and 239 (73.3%) agreed that online meetings need proper regulations.

CONCLUSIONS

Webinars comprised a major avenue for education during COVID-19 pandemic, with initial general satisfaction among physicians. However, this paradigm shift was sudden and lacked proper regulations. Despite initial satisfaction, the majority of physicians felt overwhelmed with the number and frequency of webinars. Physicians' satisfaction is crucial in planning future educational activities, and considering that this current crisis will most likely have long lasting effects, webinars should be viewed as complementing traditional in-person methods, rather than replacement. In this study, we are suggesting recommendations to help future regulation of this change.

Perception among ophthalmologists about webinars as a method of continued medical education during COVID-19 pandemic

PURPOSE

To ascertain ophthalmologist's perceptions about webinars as a method of continued medical education during the COVID-19 pandemic.

METHODS

In a cross-sectional study, a 21-question survey was circulated using digital media platform to approximately 1400 ophthalmologists in India between 16th August 2020 to 31st August 2020. The questionnaire focussed on the quality and usefulness of webinars based on the Bloom's taxonomy. The responses (on 4- or 5-point Likert scale) were analyzed among three professional groups- ophthalmologists in-training, consultants in public sector, and private practitioners.

RESULTS

393 ophthalmologists participated in the survey, with a response rate of 28%. The mean age was 34.6 ± 9.7 years, and males constituted 49.6% (199/393) of the respondents. Forty-seven percent of the respondents perceived the quality of webinars as good or excellent (185/393), 72.8% reported knowledge gain from webinars (286/393), and 63.9% felt that webinars are important in clinical practice and should continue post-COVID-19 pandemic (251/393), with distinct responses among the professional groups. The drawbacks perceived were overt number of webinars (371; 94.4%), confusion regarding which webinars to attend (313; 79.6%), repetition of the information (296; 75.3%), limited opportunity for participant interaction (146; 37.2%) and disparate weightage to the core disciplines of Ophthalmology.

CONCLUSION

Most respondents had favorable perceptions of Ophthalmology webinars happening during the COVID-19 pandemic. However, there is need for improvisation in the volume of webinars, target-audience-based delivery, and participant interaction to add value to this new dimension of teaching-learning.

COVID-19 impact on junior doctor education and training: a scoping review

COVID-19 has had a significant impact on healthcare resources and the medical workforce. Clinically-based medical education is the principal source of learning, and this has been profoundly impacted by restrictions due to COVID-19. It follows that junior medical staff and their education would be significantly impacted due to the altered volume and breadth of their clinical exposure. Some literature has been published regarding the impact to medical training during COVID-19. This study sought to review junior medical staff perceptions and their reported impact of the COVID-19 pandemic on their education and training.Nine databases (three Ovid MEDLINE databases, Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Centre and PsychINFO) were searched for studies published in 1 January 2020 through 24 August 2020. Via a scoping review protocol, an iterative process was used to perform the identification, review and charting analysis of the reported outcomes and themes. Descriptive analysis was performed using quantitative and qualitative methods.Of the 25 343 sources identified, 32 were included in the review. There were studies published from nearly all continents, predominantly in surgical journals, with a wide spread of specialties. Themes identified included the current impact of the pandemic in relation to continuation of and modifications to training programmes, as well as the future impact due to training requirements and career progression.Junior medical staff report that the COVID-19 pandemic has had a significant impact on their education and training. Whether the changes imposed by the pandemic on education are temporary measures or permanent fixtures, and whether standards of competence may be impacted, is not yet known. This scoping review forms a basis for further investigation in the field.

Transferring face-to-face sessions to virtual sessions in surgical education: a survey-based assessment of a single academic general surgery program

Background

The purpose of this survey-based study was to evaluate the implementation of virtual learning in a single academic general surgery program, compared with the well-established face-to-face academic curriculum used before.

Methods

From April 2020 to the present, virtual sessions were created via Zoom Videos Communications, Inc. (San Jose, CA, USA). A survey composed of 15 questions about the perceived quality and utility of the virtual sessions was developed. The survey was sent out to all general surgery residents of a general surgery program in November of 2020.

Results

All residents enrolled in the program answered the survey, i.e., 22 (73.3%) men and 8 (26.7%) women with 6 (20.2%) residents per year (PGY 1–PGY 5). Over half of residents (n = 17, 56.7%) felt similar academic performance during online sessions when compared to the older model. Perceptions of the level of organization of academic sessions increased during the online model (n = 20, 66.7%). Twenty (66.7%) residents agreed it was easier to attend sessions during the online model. Fourteen (46.7%) residents reported their attendance to the sessions increased, and 14 (46.7%) residents would prefer this modality after the pandemic is over, with 8 (26.7%) being neutral about it.

Conclusion

This study, to our knowledge, is the first to survey general surgery residents about the transition from a face-to-face curriculum to an e‑learning curriculum. The demonstrated effectiveness of the transition from face-to-face academic activities to virtual activities makes it a feasible tool for graduate medical education programs to adjust to a virtual model.

The impact of COVID-19 on surgical training: a systematic review

Background

Coronavirus disease (COVID-19) has caused global disruption to health care. Non-urgent elective surgical cases have been cancelled, outpatient clinics have reduced and there has been a reduction in the number of patients presenting as an emergency. These factors will drastically affect the training opportunities of surgical trainees. The aim of this systematic review is to describe the impact of COVID-19 on surgical training globally.

Methods

The review was performed in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered with the Open Science Framework (OSF). Medline, EMBASE, PubMed and the Cochrane Central Register of Controlled Trials were searched.

Results

The searches identified 499 articles, 29 of which were included in the review. This contained data from more than 20 countries with 5260 trainees and 339 programme directors. Redeployment to non-surgical roles varied across studies from 6% to 35.1%. According to all of the studies, operative experience has been reduced. Knowledge learning had been switched to online platforms across 17 of the studies and 7 reported trainees had increased time to devote to educational/academic activities. All of the studies reporting on mental health report negative associations with increased stress, ranging from 54.9% to 91.6% of trainees.

Conclusions

The impact of COVID-19 on surgical trainees has been experienced globally and across all specialities. Negative effects are not limited to operative and clinical experience, but also the mental health and wellbeing of trainees. Delivery of surgical training will need to move away from traditional models of learning to ensure trainees are competent and well supported.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10151-020-02404-5.

A look at the global impact of SARS CoV-2 on orthopedic services

BACKGROUND

The COVID-19 pandemic profoundly impacted healthcare institutions worldwide. Particularly, orthopedic departments had to adapt their operational models.

PURPOSE

This review aimed to quantify the reduction in surgical and outpatient caseloads, identify other significant trends and ascertain the impact of these trends on orthopedic residency training programs.

METHODS

Medline and Embase were searched for articles describing case load for surgeries, outpatient clinic attendance, or emergency department (ED) visits. Statistical analysis of quantitative data was performed after a Freeman-Tukey double arcsine transformation. Results were pooled with random effects by DerSimonian and Laird model. When insufficient data was available, a systematic approach was used to present the results instead.

RESULTS

A total of 23 studies were included in this study. The number of elective surgeries, trauma procedures and outpatient attendance decreased by 80% (2013/17400, 0.20, CI: 0.12 to 0.29), 47% (3887/17561, 0.53, CI: 0.37 to 0.69) and 63% (84174/123967, 0.37, CI: 0.24 to 0.51) respectively. During the pandemic, domestic injuries and polytrauma increased. Residency training was disrupted due to diminished clinical exposure and changing teaching methodologies. Additionally, residents had more duties which contributed to a lower quality of life.

CONCLUSIONS

The COVID-19 pandemic has made an unprecedented impact on orthopedics departments worldwide. The slow return of orthopedic departments to normalcy and the compromised training of residents due to the pandemic points to an uncertain future for healthcare institutions worldwide, wherein the impact of this pandemic may yet still be felt far in the future.

Residents' Perceived Impact of COVID-19 on Saudi Ophthalmology Training Programs-A Survey

PURPOSE

To evaluate the impact of the current pandemic on ophthalmology residency training in Saudi Arabia, focusing on its effects on clinical education, training, and the mental well-being of the trainees.

METHODS

An online self-administered questionnaire was distributed among residents in the Saudi ophthalmology training programs between July 7 and 14, 2020. In this study, we explored residents' opinions regarding training disruption and virtual education. The patient health questionnaire (PHQ-9) was used to assess the COVID-19 pandemic's impact on their mental health. We used descriptive statistics for data analysis.

RESULTS

Out of 183 registered ophthalmology residents, 142 participated in this study. Ninety-six participants (35.4%) were rotated at a specialized eye hospital during the COVID-19 pandemic, while 52 (19.2%) had rotations in the ophthalmology department at general hospitals. Those who rotated in both types of hospitals were 123 (45.4%). According to the participants, there was a significant decline in exposure to surgical and office-based procedures compared to emergency eye consultations (Friedman P <0.001). The COVID-19 pandemic's effect on mental health was reported by 100 (70.5%) participants. Eighty-five (55.4%) respondents were satisfied with the virtual method of education.

CONCLUSION

COVID-19 pandemic has disrupted residents' clinical and surgical training in the Saudi ophthalmology training programs. Additionally, we believe that COVID-19 may have a negative impact on trainees' mental health. Fortunately, the current pandemic provided an innovative education method that will likely be used even after the pandemic.