The Neurosurgical Atlas: advancing neurosurgical education in the digital age

Social media as a clinical, educational and networking tool for neurosurgeons: A systematic review of literature

BACKGROUND

The use of social media has been drastic in the field of neurosurgery over the last two decades. Almost 70 % of neurosurgeons use social media platforms such as Facebook, X (formerly Twitter), YouTube, and Instagram for purposes of professional growth. This literature review aims to quantify the use of social media in the field of neurosurgery, its benefits, and implications.

METHODS

A systematic review was conducted by searching PubMed, Science Direct, and Google Scholar for articles pertaining tosocial media and neurosurgery.Mesh terms employed in the search strategy encompassed "Social Media", "neurosurgery", "education""benefits", "consequences"and related variations.Inclusion criteria involved studiesvaryingin methodology, includingobservational studies, case reports and comprehensive reviewsand investigatingvarious aspects of benefits and limitations of social media for neurosurgeons, encompassing its importance in community building, professional development, contribution to research and publications, mentorship, cultural diversity and other pertinent benefits.

RESULTS

The search yielded635articles, with437unique articles screened based on relevance. Following a meticulous screening process,86articles underwent full-text assessment, resulting in the inclusion of22articles meeting the eligibility criteria.Insights were derived onthebenefits of social media,its current limitationsas well astrends and demographics surrounding social media use in neurosurgery.

CONCLUSION

In todays modernized world, social media acts as a double-edged sword when it comes to neurosurgery; it offers unparalleled opportunities for collaboration, education, patient engagement, and support while demanding careful use and navigation to mitigate the risks associated with it.

A Narrative Review on 3-Dimensional Visualization Techniques in Neurosurgical Education, Simulation, and Planning

BACKGROUND

High-fidelity visualization of anatomical organs is crucial for neurosurgical education, simulation, and planning. This becomes much more important for minimally invasive neurosurgical procedures. Realistic anatomical visualization can allow resident surgeons to learn visual cues and orient themselves with the complex 3-dimensional (3D) anatomy. Achieving full fidelity in 3D medical visualization is an active area of research; however, the prior reviews focus on the application area and lack the underlying technical principles. Accordingly, the present study attempts to bridge this gap by providing a narrative review of the techniques used for 3D visualization.

METHODS

We conducted a literature review on 3D medical visualization technology from 2018 to 2023 using the PubMed and Google Scholar search engines. The cross-referenced manuscripts were extensively studied to find literature that discusses technology relevant to 3D medical visualization. We also compiled and ran software applications that were accessible to us in order to better understand them.

RESULTS

We present the underlying fundamental technology used in 3D medical visualization in the context of neurosurgical education, simulation, and planning. Further, we discuss and categorize a few important applications based on the 3D visualization techniques they use.

CONCLUSIONS

The visualization of virtual human organs has not yet achieved a level of realism close to reality. This gap is largely due to the interdisciplinary nature of this research, population diversity, and validation complexities. With the advancements in computational resources and automation of 3D visualization pipelines, next-gen applications may offer enhanced medical 3D visualization fidelity.

A Medical Student's Guide to Online Resources in Neurosurgery

Early exposure to neurosurgery during medical school is critical to improving recruitment into the specialty. About 30% of medical schools in the U.S. lack a home program in neurosurgery, thereby, limiting their exposure to the field of neurosurgery. The transition to virtual education was largely facilitated through webinars during the coronavirus disease of 2019 pandemic. Advantages of these resources include their widespread global outreach, with a large number of attendees being international medical students. Although many such resources exist, they are primarily available through social media platforms. To our knowledge, there exists no clear outline of these resources. We identified 16 resources through a database search and through popular social media platforms. Nine out of 16 resources were video based, and 2 utilized the concept of spaced repetition through flashcards. Our review describes these educational resources and aims to serve as a guide for medical students interested in neurosurgery.

The Effectiveness of OsiriX and the Anatomage Virtual Dissection Table in Enhancing Neuroanatomy and Neuroradiology Teaching

Introduction

In recent years with the advent of technology in medical education, teaching methodology has shifted towards heavy use of online-learning modalities. This has been especially the case for anatomy and radiology courses since they require students to visualize structures of the human body. Several studies indicated that Anatomage and OsiriX can be effective at enhancing students' learning experiences in anatomy and radiology.

Purpose

This aim of this study is to assess the effectiveness of online case-based learning modules in teaching medical students about the anatomy and radiology of different types of brain tumors.

Methods

Two online case-based learning modules were designed using Anatomage Table® and OsiriX DICOM viewer®, consisting of a clinical case and CT and MRI images. We recruited 36 fourth-year medical students that completed two 10-question quizzes (one on glioblastoma multiforme and one on pituitary adenomas). Participants were randomly assigned to either a study group that completed both modules prior to completing the quizzes, or a control group that completed the quizzes without access to the modules. The performance of both groups was compared to assess the effectiveness of the modules. Participants in the study group also completed a feedback survey to assess the quality and convenience of using the modules.

Results

Students who used the case-based learning modules performed significantly better than those who did not (Quiz 1: mean = 6.56 vs 3.28, p<0.01. Quiz 2: mean = 6.67 vs 3.06, p<0.01). Students who completed the modules would like to see similar modules used in teaching anatomy and radiology in the future (64%). They found them easy to navigate (72%), useful in teaching anatomy and radiology (72%), and helpful in improving understanding of anatomical and radiological clinical correlations (77%).

Conclusion

Online case-based learning modules created using Anatomage and OsiriX can be used effectively in teaching medical students about the anatomy and radiology of different types of brain tumors.

The role of neurosurgery in advancing pediatric CNS tumor care worldwide

Introduction

There is substantial inequity in survival outcomes for pediatric brain tumor patients residing in high-income countries (HICs) compared to low- and middle-income countries (LMICs). To address disparities in pediatric cancer survival, the World Health Organization (WHO) established the Global Initiative for Childhood Cancer (GICC) to expand quality care for children with cancer.

Research question

To provide an overview of pediatric neurosurgical capacity and detail the burden of neurosurgical diseases impacting children.

Material and methods

A narrative review of the current context of global pediatric neurosurgical capacity as it relates to neurooncology and other diseases relevant to children.

Results

In this article, we provide an overview of pediatric neurosurgical capacity and detail the burden of neurosurgical diseases impacting children. We highlight concerted advocacy and legislative efforts aimed at addressing unmet neurosurgical needs in children. Finally, we discuss the potential implications of advocacy efforts on treating pediatric CNS tumors and outline strategies to improve global outcomes for children with brain tumors worldwide in the context of the WHO GICC.

Discussion and conclusion

With both global pediatric oncology and neurosurgical initiatives converging on the treatment of pediatric brain tumors, significant strides toward decreasing the burden of pediatric neurosurgical diseases will hopefully be made.

The Greatest Healthcare Disparity: Addressing Inequities in the Treatment of Childhood Central Nervous System Tumors in Low- and Middle-Income Countries

The antithesis between childhood cancer survival rates in low- and middle-income countries (LMIC) and high-income countries (HIC) represents one of healthcare's most significant disparities. In HICs, the 5-year survival rate for children with cancer, including most brain tumors, exceeds 80%. Unfortunately, children in LMICs experience far worse outcomes with 5-year survival rates as low as 20%. To address inequities in the treatment of childhood cancer and disease burden globally, the World Health Organization (WHO) launched the Global Initiative for Childhood Cancer. Within this initiative, pediatric low-grade glioma (LGG) represents a unique opportunity for the neurosurgical community to directly contribute to a paradigm shift in the survival outcomes of children in LMICs, as many of these tumors can be managed with surgical resection alone. In this chapter, we discuss the burden of pediatric LGG and outline actions the neurosurgical community might consider to improve survival for children with LGG in LMICs.

A novel 3D surgical neuroanatomy course for medical students: Outcomes from a pilot 6-week elective

BACKGROUND

Developing and maintaining a three-dimensional working knowledge of neuroanatomy is an essential skill in neurosurgery. However, conventional 2D head, neck, and neuroanatomy education is typically characterized by the separate rote learning of constituent tissues and often fails to provide learners with a contextual understanding of the relationships between these highly complex and interconnected structures. This can pose a significant challenge to medical students entering neurosurgery who lack a topographic understanding of intracranial anatomy.

METHODS

We report on the design and efficacy of a novel 6-part 3D surgical neuroanatomy pilot elective for medical students that utilized a navigation-based pedagogical technique with the goal of providing students with a framework for developing a 3D mental map of the skull base, neurovasculature, ventricular system, and associated brain regions. Students took on the perspective of physically traveling along the paths of key structures with a 360-degree view of surrounding anatomy such that they could appreciate the integration and relative spatial relationships of the varying tissues within the cranium. Mental navigation exercises and pre- and post-course surveys were used to assess students' baseline and learned familiarity with the different anatomical regions covered.

RESULTS

At the conclusion of the course, all students were able to successfully complete all of the multifaceted mental navigation exercises. Post-course survey data indicated that respondents perceived significant increases in their knowledge of cranial nerves; anterior, middle, and posterior skull base anatomy; anterior and posterior cranial circulation; and the ventricular system.

CONCLUSION

3D navigation-based fly-through instruction is a novel and effective technique for teaching complex anatomy and can provide learners with the foundational skills for developing and maintaining a 3D mental map of intracranial anatomy.

Image Segmentation of Operative Neuroanatomy Into Tissue Categories Using a Machine Learning Construct and Its Role in Neurosurgical Training

BACKGROUND

The complexity of the relationships among the structures within the brain makes efficient mastery of neuroanatomy difficult for medical students and neurosurgical residents. Therefore, there is a need to provide real-time segmentation of neuroanatomic images taken from various perspectives to assist with training.

OBJECTIVE

To develop the initial foundation of a neuroanatomic image segmentation algorithm using artificial intelligence for education.

METHODS

A pyramidal scene-parsing network with a convolutional residual neural network backbone was assessed for its ability to accurately segment neuroanatomy images. A data set of 879 images derived from The Neurosurgical Atlas was used to train, validate, and test the network. Quantitative assessment of the segmentation was performed using pixel accuracy, intersection-over-union, the Dice similarity coefficient, precision, recall, and the boundary F1 score.

RESULTS

The network was trained, and performance was assessed class wise. Compared with the ground truth annotations, the ensembled results for our artificial intelligence framework for the pyramidal scene-parsing network during testing generated a total pixel accuracy of 91.8%.

CONCLUSION

Using the presented methods, we show that a convolutional neural network can accurately segment gross neuroanatomy images, which represents an initial foundation in artificial intelligence gross neuroanatomy that will aid future neurosurgical training. These results also suggest that our network is sufficiently robust, to an unprecedented level, for performing anatomic category recognition in a clinical setting.

Resources for Operative Neurosurgical Education Among Trainees in the Philippines

BACKGROUND

Operative neurosurgical skills education is a vital part of neurosurgical training, and these skills are usually obtained through operating room experience and supplemented by textbooks and other resources. We aimed to determine the resources used by trainees in the Philippines, both prior to and after the onset of the coronavirus disease 2019 pandemic.

METHODS

An online survey was sent to neurosurgical trainees in the Philippines from January to March 2021. Data on demographics, educational resources used, and weekly hours spent on each were collected, for both the pre- and post-coronavirus disease 2019 periods.

RESULTS

A total of 37 neurosurgical trainees (60% response rate) participated in the survey. Most respondents were female (70%), in their senior levels (58%), and undergoing training in a public institution (65%). The main resources for operative neurosurgical education were operative experience, online academic resources, and neurosurgical textbooks. After the onset of the pandemic, the overall time spent decreased to 61.2 hours/week from 67.7 hours/week, with a significant reduction in the hours spent on operative experience (27.3 vs. 21.3 hours/week, P < 0.0001) and a significant increase in the time spent on webinars (0 vs. 3.2 hours/week, P < 0.0001) and online resources as a whole (14.9 vs. 16.4 hours/week, P = 0.0003).

CONCLUSIONS

Operative experience, online academic resources, and neurosurgical textbooks were the main resources for operative neurosurgical education among trainees in the Philippines. After the onset of the pandemic, the hours spent on operative experience decreased and online academic resources increased significantly. New avenues of neurosurgical education, particularly webinars, also became available locally.

Utility of Virtual Spine Neurosurgery Education for Medical Students

OBJECTIVE

Distance learning has become increasingly important to expand access to neurosurgical spine education. However, emerging online spine education initiatives have largely focused on residents, fellows, and surgeons in practice. We aimed to assess the utility of online neurosurgical spine education for medical students regarding career interests, knowledge, and technical skills.

METHODS

A survey assessing the demographics and effects of virtual spine education programming on the interests, knowledge, and technical skills was sent to attendees of several virtual spine lectures. The ratings were quantified using 7-point Likert scales.

RESULTS

A total of 36 responses were obtained, of which 15 (41.7%) were from first- or second-year medical students and 18 (50.0%) were from international students. Most respondents were interested in neurosurgery (n = 30; 80.3%), with smaller numbers interested in radiology (n = 3; 8.3%) and orthopedic surgery (n = 2; 5.6%). The rating of utility ranged from 5.69 ± 1.14 to 6.50 ± 0.81 for career, 5.83 ± 0.94 to 6.14 ± 0.80 for knowledge, and 5.22 ± 1.31 to 5.83 ± 1.06 for clinical skills. Of the 36 respondents, 26 (72.2%) preferred virtual neurosurgical spine education via intermixed lectures and interactive sessions. The most common themes regarding the utility of virtual spine education were radiology by 18 (50.0%), anatomy by 12 (33.3%), and case-based teaching by 8 (22.2%) respondents.

CONCLUSIONS

Virtual distance learning for neurosurgical spine education is beneficial for students by enabling career exploration and learning content and clinical skills. Although the overall benefit was lowest for clinical skills, virtual programming could serve as an adjunct to traditional in-person exposure. Distance learning could also provide an avenue to reduce disparities in medical student neurosurgical spine education locally and globally.

Effect of the COVID-19 pandemic on dental interns in Saudi Arabia

BACKGROUND: The coronavirus disease (COVID-19) has emerged as a global pandemic recognized by the World Health Organization. It has a significant impact on Saudi Arabia’s educational process, resulting in several universities suspending on-campus teaching, exams, and training. OBJECTIVE: The study aimed to evaluate the effect of COVID-19 on dental students’ examination, internship placement, and subsequent impact on preparedness and confidence. METHODS: A cross-sectional study was conducted to gather data from dental interns in Saudi Arabia using a pre-tested online questionnaire. Convenient sampling was applied to collect data from 5th September to 15th September 2020. Data were analyzed using SPSS version 23. Descriptive data were presented as frequency and percentages. The Chi-square test was used to evaluate the relationship between variables. RESULTS: Data of 409 dental interns from 8 dental schools reported that 209 (51%) participants’ exams were affected as the format was changed to online examination. 130 (31.8%) dental interns strongly agreed that assistance in hospitals during the outbreak of COVID-19 would complement their learning opportunities. Whereas 115(28.1%) respondents strongly agreed that dental schools’ measures to modify their curriculum were necessary. The impact of COVID-19 on dental intern preparedness discovered that the affected exams had a significant effect on final year students’ readiness to begin the internship (p = 0.042). Considering students’ confidence in starting the training earlier than expected, the student course had a statistically significant impact on their confidence (p = 0.002). CONCLUSION: The current study demonstrates that COVID-19 had disrupted dental interns’ preparedness towards clinical rotation and decreased their confidence performing in the clinical setup. Due to being unprepared and having low confidence, most dental interns were not ready to start working in the hospital on time.

The untapped potential of Instagram to facilitate rheumatology academia

Instagram allows for graphical and visual information exchange. This paper aims to explore the current landscape of rheumatology on Instagram and analyse the accounts available based on their objectives and level of engagement. The search term “#rheumatology” reveals 62 results, leaving 55 after careful exclusion. On grouping into “educational”, “broadcasting”, “support”, and a combination of all three, an analysis is carried out using the total number of posts, follower counts, number of caption characters (last 10 posts), likes per post (last 10 posts), archived stories, reels, IgTV (Instagram Television) videos, hashtags, and links in bio. The analysis reveals that 29 accounts (52.7%) disseminate educational content, 36 (65.4%) are run by organisations, and 22 (40.0%) are of an institute or clinic. Character counts (rho 0.44, p = 0.0006) and videos (likes for ten posts 149 vs. 54, p = 0.006) positively correlate with the number of likes, while hashtag use and post count have no statistical significance with likes. Reels and IgTV videos are infrequently used (18.18%, 3.6%). The rheumatology social media landscape is in its nascency and currently split into educational and broadcasting accounts with a significant overlap between the two. The positive correlation of character counts and videos and the negative correlation of hashtag use and post count with likes lay the case for quality content to improve engagement. Social media editors may ensure quality content for rheumatology education using Instagram.

Key Points • The current landscape of Instagram use in rheumatology is limited and largely orientated towards educative content. • Likes on Instagram are positively correlated with caption character counts and videos. • Using currently underutilised tools like videos, engaging captions, and infographics may enhance the utility of Instagram in rheumatology education.

Virtual dissection of the real brain: integration of photographic 3D models into virtual reality and its effect on neurosurgical resident education

OBJECTIVE

Virtual reality (VR) is increasingly being used for education and surgical simulation in neurosurgery. So far, the 3D sources for VR simulation have been derived from medical images, which lack real color. The authors made photographic 3D models from dissected cadavers and integrated them into the VR platform. This study aimed to introduce a method of developing a photograph-integrated VR and to evaluate the educational effect of these models.

METHODS

A silicone-injected cadaver head was prepared. A CT scan of the specimen was taken, and the soft tissue and skull were segmented to 3D objects. The cadaver was dissected layer by layer, and each layer was 3D scanned by a photogrammetric method. The objects were imported to a free VR application and layered. Using the head-mounted display and controllers, the various neurosurgical approaches were demonstrated to neurosurgical residents. After performing hands-on virtual surgery with photographic 3D models, a feedback survey was collected from 31 participants.

RESULTS

Photographic 3D models were seamlessly integrated into the VR platform. Various skull base approaches were successfully performed with photograph-integrated VR. During virtual dissection, the landmark anatomical structures were identified based on their color and shape. Respondents rated a higher score for photographic 3D models than for conventional 3D models (4.3 ± 0.8 vs 3.2 ± 1.1, respectively; p = 0.001). They responded that performing virtual surgery with photographic 3D models would help to improve their surgical skills and to develop and study new surgical approaches.

CONCLUSIONS

The authors introduced photographic 3D models to the virtual surgery platform for the first time. Integrating photographs with the 3D model and layering technique enhanced the educational effect of the 3D models. In the future, as computer technology advances, more realistic simulations will be possible.

Largest neurosurgical social media group and its impact on communication and research

BACKGROUND

The use of social media to communicate and disseminate knowledge has increased exponentially, especially in the field of neurosurgery. 'Neurosurgery cocktail' (NC) was developed by a group of young neurosurgeons as a means of sharing didactic materials and clinical experiences via social media. It connects 35.000 neurosurgeons worldwide on multiple platforms, primarily Facebook and Twitter. Given the rising utilization of social media in neurosurgery, the popularity of NC has also increased since its inception. In this study, the authors surveyed the social media analytics of NC for both Facebook and Twitter. Besides, we reviewed the literature on the use of social media in neurosurgery.

METHODS

Facebook and Twitter metrics were extracted through each respective platform's analytics tools from December 2020 (earliest available date for data analysis) through January 2021. A literature search was conducted using PubMed (MEDLINE) and Scopus databases.

RESULTS

On Facebook, as of January 2021, the group had a total of 25.590 members (87.6% male), most commonly (29%) between 35 and 44 years of age with over 100 countries were represented. As of January 2021, they had amassed 6457 followers on Twitter. During the last 28 d between December 2020 and January 2021, the account published 65 tweets that garnered a total of 196,900 impressions. Twelve articles were identified in our literature review on the use of social media within the neurosurgical community.

CONCLUSIONS

NC is one of the most widely utilized neurosurgical social media resources available. Sharing knowledge has been broadened thanks to the recent social media evolution, and NC has become a leading player in disseminating neurosurgical knowledge.

YouTube as a source of information for arteriovenous malformations: A content-quality and optimization analysis

AIM

YouTube (YT) is not only a source of entertainment but also, a popular source of medical knowledge. Our goal was to evaluate the quality of videos concerning arteriovenous malformations (AVM) available on YT.

MATERIALS AND METHODS

A YT search was conducted for the terms "Arteriovenous malformation", "AV malformations", "Intracranial AVM", "Cerebral AVM"," Brain AVM" and "Pial AVM." The first 70 videos for each search were evaluated and yielded 122 unique videos after the exclusion was applied. The videos were examined by two independent Raters using a validated quality criteria such as the Quality Criteria for Consumer Health Information (DISCERN), the Journal of the American Medical Association instrument (JAMA), and the Global Quality Score (GQS).

RESULTS

The mean DISCERN score was 30 out of 75 possible points, with an intraclass correlation coefficient for the absolute agreement of 0.98, indicating an excellent interrater reliability. Most videos were produced in the United States (51.6%) and were uploaded by educational channels. Videos had statistically higher DISCERN, JAMA, and GQS scores when they presented clear information, AVM symptoms, angioarchitecture, AVMs with concomitant aneurysms, risks of bleeding, Spetzler-Martin Grading, treatment information, treatment risks, treatment results, follow-up, diagrams, and a doctor as a speaker. Videos that featured animations observed higher popularity as indicated by the Video Power Index (VPI) and observed a higher DISCERN and GQS score. Videos with the overall highest VPI generated poor DISCERN scores.

CONCLUSIONS

YT does not provide high content quality medical information regarding AVMs and, in some cases, offer misleading information.

Social Media in Neurosurgery: A Systematic Review

OBJECTIVE

Social media has been used increasingly in neurosurgery by individuals. We aimed to identify demographics and preferences of social media use, describe the scope of social media use, and characterize its utility.

METHODS

A systematic review was conducted using PubMed, Embase, and Scopus databases. Titles and abstracts from articles identified in the search were read and selected for full-text review. Studies meeting prespecified inclusion criteria were reviewed in full and analyzed for relevant data.

RESULTS

Of 431 resultant articles, 29 were included. Patients and caregivers most commonly used Facebook and Twitter, whereas nearly 50% of neurosurgeons used LinkedIn and Doximity. Patient and caregiver users of social media tended to be <35 years old. Content of posts varied from requesting/providing information (∼40%) to seeking emotional support/forming connections (∼30%). A total of 20.6% of videos were irrelevant to clinical neurosurgery. Factual accuracy of most videos was poor to inadequate. Social media use was associated with greater academic impact for neurosurgical departments and journals. Posts with photos and videos and weekend posts generated 1.2-2 times greater engagement.

CONCLUSIONS

Patients and caregivers who use social media are typically younger than 35 years old and commonly use Facebook or Twitter. Neurosurgeons prefer Doximity and LinkedIn. Social media yields information regarding common symptoms and uncovers novel symptoms. Videos are poor-to-inadequate quality and often irrelevant to clinical neurosurgery. Optimizing social media use will augment the exchange of ideas regarding clinical practice and research and empower patients and caregivers.

Democratizing Access to Neurosurgical Medical Education: National Efforts in a Medical Student Training Camp During Coronavirus Disease 2019

BACKGROUND

National medical student surveys amidst the coronavirus disease 2019 (COVID-19)-driven subinternship cancellations have demonstrated the need for supplemental, standardized subspecialty medical education, mentorship, and career planning nationally. We have presented the first live, cross-institutional virtual medical student subspecialty training camp to deliver standardized neurosurgical educational content to medical students during the COVID-19 pandemic, and its results on medical student anxiety and perceptions of neurosurgery.

METHODS

The online training camp used a video conferencing platform that was open to all medical students. A post-training camp survey was administered.

RESULTS

A total of 305 medical students registered for the event from 107 unique U.S. medical schools. Of the 305 medical students, 108 reported intending to apply to neurosurgery residency in 2021. The top medical student objectives for the training camp were program networking and mentorship. Of the 305 participants, 121 (39.7%) completed the post-training survey. Of the respondents, 65.0% reported improved neurosurgical knowledge, 79.8% reported decreased anxiety about subinternships and interviews, 82.5% reported increased enthusiasm about neurosurgery, and 100% desired a future annual virtual training camp because of the increased accessibility and decreased cost. This was especially important for students at institutions without home subspecialty programs and those with financial burdens.

CONCLUSIONS

COVID-19-driven innovations in medical education have accelerated changes that may have long been necessary. This virtual structure improved resource usage and scalability compared with in-person training, maintained social distancing, and democratized access to standardized, specialized content not often available through traditional medical curricula. Even as a supplement to in-person events, the virtual training camp model could be implemented by national medical societies, which might significantly increase medical students' preparedness for, and education in, neurosurgery and other subspecialties.

Neurosurgical Operative Videos: An Analysis of an Increasingly Popular Educational Resource

OBJECTIVE

Surgical education has increasingly relied on electronic learning. In particular, online operative videos have become a core resource within neurosurgery. We analyze the forums for neurosurgical operative videos.

METHODS

Operative videos from 5 sources were reviewed: 1) the NEUROSURGERY Journal YouTube channel; 2) the American Association of Neurological Surgeons Neurosurgery YouTube channel; 3) The Neurosurgical Atlas Operative Video Cases; 4) Operative Neurosurgery; and 5) Neurosurgical Focus: Video. Title, year of publication, senior author, institution, country, and subspecialty were documented for each video.

RESULTS

A total of 1233 videos showing 1247 surgeries were identified. Ten videos included >1 surgery; of those, there was a median of 2 surgeries (interquartile range, 2.0-2.5) per video. The most frequently represented subspecialties included vascular (48.3%), tumor (35.2%), and skull base surgery (27.5%), with almost 40% of videos showing >1 category. Videos were submitted by investigators from 28 countries, but 82.1% of the videos originated in the United States.

CONCLUSIONS

Neurosurgical operative videos have become increasingly common through a variety of online platforms. Future efforts may benefit from collecting videos from underrepresented regions and subspecialties, providing long-term follow-up data and showing techniques for managing complications.

Twitter Hashtag and Online Engagement During Surgical Society Meetings Over a 5-Year Period

BACKGROUND

Utilizing social media platforms can augment medical conferences by sharing new knowledge and information through hashtags. We aim to investigate the use of Twitter, enhanced conference experience, and education at the Eastern Association for the Surgery of Trauma (EAST) Annual Scientific Assembly 2016-2020.

METHODS

EAST hashtags were analyzed for the Annual Scientific Assembly 2016-2020: #EAST2016, #EAST2017, #EAST2018, #EAST2019, and #EAST2020. Using #EAST2016 as a baseline, active interaction through engagement, measured by tweets and retweets, passive interaction through impressions, measured by views, as well as users, and influencers were analyzed.

RESULTS

2016-2018 saw a significant increase in engagement (7400 to 9200 to 11 000, respectively, P < .05). 2018-2020 then showed a significant decrease in engagement (11 000 to 9000 to 6700, respectively, P < .05). Impressions, increased significantly from 2016 to 2020 (6.6 million to 13.3 million to 12.6 million to 19.9 million to 20.3 million, respectively, P < .05). Users significantly increased to 2700 in 2018 compared with 1000 in 2016 (P < .05), and significantly decreased to 814 in 2020 compared with 2700 in 2018 (P < .05). The top online influencer was the EAST organization Twitter account.

CONCLUSION

#EAST2016-2018 showed a significant increase in engagement between users, measured by tweets/retweets. However, #EAST2019-2020 suffered declines in users' engagement, maybe a result of social media fatigue. Although, #EAST2016-2020 showed a significant increase in impressions. Both passive and to a more extent active forms of online social media engagement can potentially disseminate new knowledge and medical information. Scientific societies should focus on more effective ways to maintain and enhance users' online experience and engagement toward better utilization of social media platforms.

Medical and Surgical Education Challenges and Innovations in the COVID-19 Era: A Systematic Review

The aim of this systematic review was to identify the challenges imposed on medical and surgical education by the COVID-19 pandemic, and the proposed innovations enabling the continuation of medical student and resident training. A systematic review on the MEDLINE and EMBASE databases was performed on April 18th, 2020, and yielded 1288 articles. Sixty-one of the included manuscripts were synthesized in a qualitative description focused on two major axes, "challenges" and "innovative solutions", and two minor axes, "mental health" and "medical students in the frontlines". Shortage of personal protective equipment, suspension of clinical clerkships and observerships and reduction in elective surgical cases unavoidably affect medical and surgical education. Interesting solutions involving the use of virtual learning, videoconferencing, social media and telemedicine could effectively tackle the sudden cease in medical education. Furthermore, trainee's mental health should be safeguarded, and medical students can be involved in the COVID-19 clinical treatment if needed.

Letter to the Editor "COVID-19 and Neurosurgical Education in Africa: Making Lemonade from Lemons"

Never in history has the fabric of African neurosurgery been challenged as it is today with the advent of the novel coronavirus identified in 2019 (COVID-19). Even the most robust and resilient neurosurgical educational systems in the continent have been brought to their knees with neurosurgical trainees and young neurosurgeons bearing the brunt. In the face of this new reality, and in order to limit the impact of the current COVID-19 pandemic, multiple programs have implemented physical distancing to reduce in-person interactions. In some cases, residents have been asked to stay home at least until they are instructed otherwise. This unfortunate event presents an innovative opportunity for neurosurgical education in Africa. Herein, we detail the framework of an online neurosurgical education initiative to advance the education of African residents and young neurosurgeons during and after the COVID-19 pandemic.