Medical education: COVID-19 and surgery

The role of ChatGPT in enhancing ENT surgical training - a trainees' perspective

OBJECTIVE

ChatGPT, developed by Open AI (November 2022) is a powerful artificial intelligence language model, designed to produce human-like text from user-written prompts. Prompts must give context-specific information to produce valuable responses. Otolaryngology is a specialist field that sees limited exposure during undergraduate and postgraduate education. Additionally, otolaryngology trainees have seen a reduction in learning opportunities since the coronavirus disease 2019 pandemic.

METHOD

This article aims to give guidance on optimising the ChatGPT system in the context of education for otolaryngology by reviewing barriers to otolaryngology education and suggesting ways that ChatGPT can overcome them by providing examples using the authors' experience.

RESULTS

Overall, the authors saw that ChatGPT demonstrated some useful qualities, particularly with regards to assistance with communication skills and individualised patient responses.

CONCLUSION

Although ChatGPT cannot replace traditional mentorship and practical surgical experience, it can serve as an invaluable supplementary resource to education in otolaryngology.

A comparison of the impact of the COVID-19 pandemic on urological surgeries in Japan and Taiwan

OBJECTIVE

We report the impact of the COVID-19 pandemic on urological surgeries and hospital policies at two hospitals in Japan and Taiwan.

METHODS

We retrospectively surveyed the number of surgeries every 3 months in the Urology Department of Kobe University Hospital (KUH), Kobe, Japan before (January 2019-March 2020) and after (April 2020-September 2021) the COVID-19 outbreak, and in the Urology Department of Shuang Ho Hospital, Taipei Medical University (SHH-TMU), Taiwan before (January 2021-March 2021) and after (April 2021-September 2021) the outbreak, and compared the averages and types of surgery.

RESULTS

In Kobe, COVID-19 patients were stratified such that other regional hospitals gave priority to treating COVID-19 while KUH gave priority to treating non-COVID-19 patients. In KUH, the number of surgeries did not change significantly, 237.2 ± 29.6 versus 246.3 ± 20.8 (p = 0.453). In Taiwan COVID-19 patients increased sharply in May 2021, and teaching hospitals in Taiwan were obliged to provide 20% of their total beds for COVID-19 patients. At SHH-TMU, there was a 33.3% drop in the number of surgeries during April-June 2021 compared to the pre-pandemic average. However, no significant changes were observed, 423.4 ± 68.4 versus 373 ± 91.0 (p = 0.298), because of the subsequent success in controlling the COVID-19 infection.

CONCLUSIONS

The comparison of infection control measures between the two countries revealed that while both KUH and SHH-TMU successfully maintained the number of surgeries, the reasons for this were different for each.

Online Survey Evaluation of Three Years of European Society of Thoracic Surgeons Educational Webinars as Part of The E-learning Platform

BACKGROUND

E-learning has become an important tool in surgical education in the last decade. The European Society of Thoracic Surgeons launched its e-learning platform in 2013 and started its educational webinars series in 2018. The aim of this paper is to discuss the introduction, evolution and impact of the educational webinars within this e-learning platform.

METHODS

Twenty-four English spoken webinars discussing different subdomains in general thoracic surgery (21 expert talks, 2 pro-con debates and 1 multidisciplinary case discussion) were analyzed. An online questionnaire on timing, quality and technical aspects of the webinars was sent to 3012 registrants.

RESULTS

The webinars reached 3128 unique registrants from 76 countries worldwide. The mean number of registrants was 355 with 171 live attendees (48%) and 155 replay watchers (36%). Hundred and twenty-six attendees (13.1% of people who registered for at least 4 webinars) completed the questionnaire. Timing and duration of the webinars were rated "very good" to "excellent" in 78%, and the quality of the webinar content and the expertise of the webinar presenters were rated "very good" to "excellent" in 88% and 90%, respectively. The impact on knowledge and clinical practice was scored with a weighted average of 7.27 out of 10 and 6.79 out of 10, respectively.

CONCLUSIONS

The ESTS educational webinars were effective in delivering up-to-date knowledge to almost half of the countries around the globe. The impact of these events on knowledge and clinical practice were rated high. New e-learning tools should be added to the surgical educational curriculum.

Educational Effects of Simulation and Non-Simulation Training in Airway Management according to Levels of the Kirkpatrick Model: A Systematic Review and Network Meta-Analysis

There is insufficient validation of the effectiveness of simulation-based training (Sim) or non-simulation-based training (non-Sim) for teaching airway management to healthcare professionals within the literature. We thus conducted a network meta-analysis comparing the effectiveness of Sim, non-Sim, and no educational intervention (NI) for airway management. The primary endpoints were knowledge scores (KnS) and behavioral performance scores (BpS) corresponding to assessments at levels 2 and 3 of the Kirkpatrick model, respectively. Effect sizes were expressed as standardized mean differences (Std. MD) and 95% credible intervals (CrIs). Regarding KnS, the educational effects of Sim and non-Sim were significantly improved compared to those of NI (Std. MD [95% CI]: 1.110 [0.903–1.316] and 0.819 [0.209–1.429], respectively); there was no significant difference between Sim and non-Sim. The educational effect of Sim in BpS was significantly improved compared to that of non-Sim and NI (0.850 [0.015–1.691] and 0.660 [0.241–1.076]); there were no differences between non-Sim and NI. Surface under the cumulative rank curve values demonstrated that Sim ranked highest in efficacy for KnS and BpS. This study provides valuable information regarding the educational efficacy of Sim and non-Sim in airway management. Larger randomized controlled trials are needed to confirm these findings.

Educational Approaches That Enhance Online Clinical Clerkship during the COVID-19 Pandemic

Objective This cross-sectional national study determined which educational approaches are associated with the effectiveness of online clerkship for medical students. Method A survey was conducted for medical students at 78 medical schools in Japan from May 29 to June 14, 2020. It comprised the following aspects: (a) participants' profiles, (b) number of opportunities to learn from each educational approach (lecture, medical quiz, assignment, oral presentation, observation of a physician's practice, clinical skill practice, participation in interprofessional meetings, and interactive discussions with physicians) in online clerkship, (c) frequency of technical problems, and (d) educational outcome measurement (satisfaction, motivation, knowledge acquisition, skill acquisition, change in self-study time, and understanding of the importance of medical care team). Results Of the 2,640 respondents, 2,594 (98.3%) agreed to cooperate. Ultimately, 1,711 matched our inclusion criteria. All educational approaches but assignments were positively associated with satisfaction and motivation. All educational approaches excluding assignment submission and interprofessional meeting were positively associated with knowledge acquisition. Observation, practice, and interprofessional meeting were positively associated with skill acquisition. Only assignment submission was positively associated with the change in self-study time. Educational approaches excluding medical quizzes were positively associated with understanding the importance of the medical care team. Technical problems were negatively associated with motivation, knowledge acquisition, and skill acquisition. Conclusions Educators should implement various educational approaches, especially observation and practice, even in online clinical clerkship. They also need to minimize the technical problems associated with the Internet, as they reduce the effectiveness of online clerkship.

Global Pediatric Surgery in the Era of COVID-19

There is a tremendous unmet need regarding the surgical care of children in low- and middle-income countries. The rapid spread of coronavirus disease 2019 (COVID-19), and the resultant redistribution of health care resources required to combat it, has created even more unique difficulties in the provision of safe, timely, and affordable surgical care of children globally. The downstream effects of potential diminished surgical capacity may even more significantly affect the morbidity and mortality of children. The full effects of these changes are yet to be seen. The COVID-19 pandemic has also created unique opportunities that can be built on moving forward. It is critical that the focus on global surgical needs, particularly for children, continues to be a priority to mitigate the challenges caused by the COVID-19 pandemic. [Pediatr Ann. 2022;51(8):e316-e318.].

Assessment of Esophagectomy Videos on YouTube: Is Peer Review Necessary for Quality?

INTRODUCTION

Various online platforms, such as YouTube, are used for surgical education. Esophageal surgery is sophisticated and surgical videos may help reduce the time it takes for surgeons to learn these complicated operations. There is no clear consensus regarding the quality and reliability of esophagectomy videos on YouTube. We aimed to evaluate esophageal surgery videos published on YouTube in terms of quality and reliability.

METHODS

The keywords "esophagectomy" and "surgery" were both searched on YouTube and the first 150 results were evaluated. Eighty two videos were included in the analysis. The quality and reliability of the videos were determined using the esophagectomy scoring system (ESS) developed by the authors, the Journal of the American Medical Association benchmark criteria, and the video power index.

RESULTS

A total of 82 videos were reviewed. About two-thirds of the videos demonstrated the Ivor Lewis technique and included surgeries performed using the thoracoscopic/laparoscopic method. The videos were analyzed as per the source of the upload: academic (25.7%), industry-sponsored (9.7%), or individual (64.6%). When the scores were compared by the origin of the videos, industry-sponsored videos scored significantly higher than the videos produced by individuals and academic centers (P = 0.01). While the ESS and Journal of the American Medical Association benchmark criteria scores were significantly correlated (P = 0.00), no correlation was found between video length, video power index score, and ESS score.

CONCLUSIONS

Conducting a professional evaluation of videos before they are published on YouTube may enhance video quality. Moreover, valuable videos of better quality can be produced by improving the ESS and by assessing more videos.

Development and Implementation of an International Virtual Didactic Series for Physical Medicine and Rehabilitation Graduate Medical Education During COVID-19

ABSTRACT

Coronavirus disease of 2019 presented significant challenges to residency and fellowship programs. Didactic lectures were particularly affected as redeployment of faculty and trainees, limitations on in-person gathering, and other barriers limited opportunities for educational engagement. We sought to develop an online didactic series to address this gap in graduate medical education.Lecturers were recruited via convenience sample and from previous Association of Academic Physiatrists presenters from across the United States and Canada; these presented via Zoom during April and May 2020. Lecturers and content reflected the diverse nature of the specialty. Learning objectives were adapted from the list of board examination topics provided by the American Board of Physical Medicine and Rehabilitation.Fifty-nine lectures were presented. Maximum concurrent live viewership totaled 4272 and recorded lecture viewership accounted for an additional 6849 views, for a total of at least 11,208 views between the date of the first lecture (April 9, 2020) and May 1, 2021. Live viewers of one of the lectures reported participating from several states and 16 countries.The Association of Academic Physiatrists-led virtual didactics augmented graduate medical education during the coronavirus disease of 2019 pandemic, and data confirm that the lectures have continued to enjoy a high level of viewership after the cessation of live lectures.

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.

An analysis of anatomy education before and during Covid-19: August-December 2020

Coronavirus disease-2019 (Covid-19) disrupted the in-person teaching format of anatomy. To study changes in gross anatomy education that occurred during August-December, 2020 compared to before the pandemic, an online survey was distributed to anatomy educators. The 191 responses received were analyzed in total and by academic program, geographic region, and institution type. Cadaver use decreased overall (before: 74.1 ± 34.1%, during: 50.3 ± 43.0%, P < 0.0001), as well as across allopathic and osteopathic medicine, therapy, undergraduate, and veterinary programs (P < 0.05), but remained unchanged for other programs (P > 0.05). Cadaver use decreased internationally and in the US (P < 0.0001), at public and private (P < 0.0001) institutions, and among allopathic medical programs in Northeastern, Central, and Southern (P < 0.05), but not Western, US geographical regions. Laboratories during Covid-19 were delivered through synchronous (59%), asynchronous (4%), or mixed (37%) formats (P < 0.0001) and utilized digital resources (47%), dissection (32%), and/or prosection (21%) (P < 0.0001). The practical laboratory examination persisted during Covid-19 (P = 0.419); however, the setting and materials shifted to computer-based (P < 0.0001) and image-based (P < 0.0001), respectively. In-person lecture decreased during Covid-19 (before: 88%, during: 24%, P = 0.003). When anatomy digital resources were categorized, dissection media, interactive software, and open-access content increased (P ≤ 0.008), with specific increases in BlueLink, Acland's Videos, and Complete Anatomy (P < 0.05). This study provided evidence of how gross anatomy educators continued to adapt their courses past the early stages of the pandemic.

Undergraduate Surgical Education: a Global Perspective

Undergraduate surgical education is failing to prepare medical students to care for patients with surgical conditions, and has been significantly compromised by the COVID-19 pandemic. We performed a literature review and undertook semi-structured reflections on the current state of undergraduate surgical education across five countries: Egypt, Morocco, Somaliland, Kenya, and the UK. The main barriers to surgical education at medical school identified were (1) the lack of standardised surgical curricula with mandatory learning objectives and (2) the inadequacy of human resources for surgical education. COVID-19 has exacerbated these challenges by depleting the pool of surgical educators and reducing access to learning opportunities in clinical environments. To address the global need for a larger surgical workforce, specific attention must be paid to improving undergraduate surgical education. Solutions proposed include the development of a standard surgical curriculum with learning outcomes appropriate for local needs, the incentivisation of surgical educators, the incorporation of targeted online and simulation teaching, and the use of technology.

Undergraduate surgical education during COVID-19: could augmented reality provide a solution?

The COVID-19 pandemic has significantly disrupted undergraduate medical education. In this original research letter, we describe how remote, augmented reality-enhanced teaching sessions can be successfully delivered at a time when the provision of surgical education is particularly challenging.

Homeschooling for Quarantined Residents: A Virtual Back to the Basics Curriculum

Introduction The COVID 19 pandemic resulted in local and institutional restrictions with significant effects on the clinical environment for graduate medical education, displacing residents from non-emergency medicine (EM) based rotations. Additionally, resident physicians considered patients under investigation (PUI) were furloughed from clinical practice. The necessity for supplemental learning in a virtual setting prompted the development of an online homeschooling curriculum that incorporated back to the basics textbook learning, application, and retention via virtual sessions for the quarantined and furloughed learners.  Methods An online homeschooling curriculum was developed to replace the cancelled clinical experiences for EM residents and for those who were quarantined utilizing Google Classroom and Zoom teleconference software. After completion of their quarantine or return to normal rotation schedule, residents were asked to evaluate the homeschooling curriculum using an anonymous survey.  Results A total of 12 residents participated in the homeschooling program over eight weeks during the spring of 2020. Of the nine residents surveyed, 88.8% percent felt the homeschooling added to their knowledge of EM, 100% found the online format easy to use, and 88.8% stated it helped maintain a sense of social connection to peers and faculty.  Conclusion An online homeschooling program was considered an effective means of providing an opportunity for synchronous and continuous education for EM resident physicians. This program could be sustainable long term to fill in knowledge gaps or supplement remediation in emergency resident education, post pandemic.