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Plastic surgery training during COVID-19: Challenges and novel learning opportunities

2020; Elsevier BV; Volume: 74; Issue: 2 Linguagem: Inglês

10.1016/j.bjps.2020.08.076

1878-0539

A. Reed, James Chan,

Telemedicine and Telehealth Implementation

The COVID-19 pandemic has fundamentally changed the way we work and care for patients. We read with interest the correspondence by Armstrong et al. outlining the response of their plastic surgery department in one of the largest teaching hospitals in Europe including leadership strategies, team restructuring and altered patient pathways.1Armstrong A. Jeevaratnam J. Murphy G. Pasha M. Tough A. Conway-Jones R. et al.A plastic surgery service response to COVID-19 in one of the largest teaching hospitals in Europe.J Plast Reconstr Aesthet Surg. 2020; https://doi.org/10.1016/j.bjps.2020.03.027Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar However, one vitally important area not discussed is the impact on training. Furthermore, social distancing has necessitated a shift in teaching paradigms and there has been an almost-viral uptake in webinar-based learning opportunities. Notable examples include the Pulvertaft Hand Centre/PLASTA and ICOPLAST series, whilst the inaugural British Society for Surgery of the Hand "Great Debates of Hand Surgery" webinar attracted over 500 attendees. Here we consider the impact of COVID-19 on plastic surgery training and discuss the merits of webinar-based learning including how to best utilise this increasingly important teaching resource. COVID-19 has significantly impacted training in plastic surgery. Reduced working hours due to illness, changes in rotas to limit exposure to the virus, a reduction in face-to-face patient assessments, an increasingly non-operative approach to common conditions, and a move to consultant-led services have limited learning opportunities for trainees in both acute and elective settings. Furthermore, examinations, educational courses and conferences have been cancelled, as have many fellowship placements. Redeployment of trainees to other specialties during the pandemic will impact training, but whether transferable skills can be obtained remains to be seen; for example, greater experience in critical care may be relevant for burns management. In response to these challenges the webinar has become king. Whilst widely described in the pedagogical literature, the use of webinars in plastic surgery has received limited attention.2Martin-Smith J.D. McArdle A. Carroll S.M. Kelly E.J. Webinar: a useful tool in plastic surgery specialty trainee education.J Plast Reconstr Aesthetic Surg. 2015; 68: 1323-1324https://doi.org/10.1016/j.bjps.2015.05.034Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar Webinars represent a synchronous virtual learning platform and confer a number of advantages. Most importantly, webinars offer geographic flexibility, which not only facilitates compliance with social distancing but also increases learning opportunities from leading experts, often across international boundaries.3Knipfer C. Wagner F. Knipfer K. Millesi G. Acero J. JA H. et al.Learners' acceptance of a webinar for continuing medical education.Int J Oral Maxillofac Surg. 2019; 48: 841-846https://doi.org/10.1016/j.ijom.2018.11.010Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar Many large online events are attended by participants from different healthcare settings, enriching discussions and facilitating the dissemination of information on a global scale. Furthermore, the synchronous setup allows participants to communicate directly with trainers and removes barriers caused by shyness, for example through the use of text-chat boxes.4Nadama H.H. Tennyson M. Khajuria A. Evaluating the usefulness and utility of a webinar as a platform to educate students on a UK clinical academic programme.J R Coll Physicians Edinb. 2019; 49: 317-322https://doi.org/10.4997/JRCPE.2019.415Crossref PubMed Scopus (38) Google Scholar Finally, compared to traditional teaching methods, webinars also offer greater temporal flexibility through recording and storage online for revision. The educational benefits of webinars are clear and methods to optimise training in plastic surgery through this novel platform should be explored. Here we present 6 key lessons from our experience:1.Choose an appropriate platform: A number of different online video conferencing platforms are available including ZoomⓇ, Google MeetⓇ, Microsoft TeamsⓇ and SkypeⓇ, each with unique features (Table 1).Table 1Online video conferencing applications.SoftwareCompatibilityCost (per month)Maximum numberOther free-versionAdditional usefulof participantslimitationsfeaturesGoogle MeetWindows, MacWeb browsers*Internet explorer, Edge, Chrome, Firefox, Safari.iOS, AndroidFree100 for freeUp to 250 for G Suite subscribersGmail account requiredScreen shareVideo recordingLive subtitlingLow-light mode Integration with other video conferencing appsMicrosoft TeamsWindows, MacWeb browsers*Internet explorer, Edge, Chrome, Firefox, Safari.iOS, Android, WinTeams - freeBasic - £3.80Standard - £9.40E3 - £17.60250, or10′000 for live events†Live event limits extended to 20′000 attendees and 16 hours until 1st July 2020.8 hour limit on group chat,4 hour limit on live events†Live event limits extended to 20′000 attendees and 16 hours until 1st July 2020.No video recordingNo hostingScreen shareBackground blurFile-share and co-authoring documentsIntegrated appsSkypeWindows, MacEdge, ChromeiOS, Android, Win Amazon Kindle/FireAlexa, XboxFree unless making international calls to phone numbers504 hours/chat and 10 hours/day limit on group chatsScreen shareVideo recordingLive subtitlingCan call phone numbers not on SkypeZoomWindows, MacWeb browsers*Internet explorer, Edge, Chrome, Firefox, Safari.iOS, Android, WinBasic - FeePro - £11.99Business/ Enterprise - £15.99100 freeUp to 1000 depending on plan40 minute limit on group meetingsScreen shareVideo recordingVirtual backgroundCo-annotation Internet explorer, Edge, Chrome, Firefox, Safari.† Live event limits extended to 20′000 attendees and 16 hours until 1st July 2020. Open table in a new tab 2.Decide on the size of audience desired: Local or regional webinars would typically have fewer than 20 attendees and can be held in a 'chat-room' format where all participants can see each other, maximising real-time interactions and discussion. On a national or international scale there are often >100 attendees in which case opportunity for in-depth discussion is limited and a formal presentation, followed by a structured Q&A may be more appropriate. Very large events can be live-streamed on YouTube to overcome participant limits on video-conferencing platforms.3.Advertisement: To reach a wider audience consider advertisement through regional and national networks, and/or social media.4.Security: Consider using password protection to prevent unauthorised access, and ensure all material does not risk breaching patient confidentiality.5.Establish a code of conduct: Punctuality and professionalism should be maintained. Participants should be muted when not speaking to avoid background noise and distractions.6.Encourage participation: Whilst many traditional pedagogical methodologies should be maintained in webinar-based teaching, novel opportunities to engage participants exist. For example, we have used the real-time co-annotation functionality on Zoom to allow trainees to demonstrate the planning of local flaps, and the polling functionality to ask questions, test learning and gather feedback. This would enable one to engage in higher levels of learning including application, analysis, synthesis and evaluation as per Bloom's hierarchy. The war against coronavirus has challenged training in plastic surgery; however, we believe that in the midst of chaos, there is also opportunity. Webinar-based learning may be the norm for weeks or months to come, but also offers a fantastic platform through which educators can reach a wider audience and trainees can access expert teaching. Furthermore, reduced costs, greater flexibility and reduced carbon footprint make webinars an attractive option for the future. Further research should focus on how we can best utilise this powerful educational tool in plastic surgery training, whilst a coordinated approach from different providers could help avoid timetabling clashes and optimise attendance.