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

The impact of a neurosurgical boot camp upon medical student preparedness for sub-internships

BACKGROUND

The sub-internship is a formative experience for neurosurgical applicants. No formal neurosurgery sub-internship curriculum exists, with students preparing via ad hoc online resources and guidance from mentors. Students can feel unprepared for these crucial rotations, impacting their subsequent performance and application success. Therefore, we developed a neurosurgical sub-internship boot camp and evaluated its impact on student preparedness.

METHODS

A one-day boot camp was conducted, including lectures and a pig cadaver lab. Surveys were distributed before and after to assess competency and comfort with neurosurgery topics and skills, including knowledge-based multiple-choice questions. Pre- and post-scores were compared with one-sided paired t-tests; a p-value < 0.05 was considered significant.

RESULTS

Attendees included 30 in-person and 80 virtual students. Both pre-and post-surveys were completed by 22 students, 10 (45 %) in-person and 12 (55 %) virtual. Attendees were predominantly male (73 %) and third-year medical students (55 %). Participants' self-reported knowledge increased by a mean of >=1 point on a 1-5 scale within skull base, spine, and trauma domains (p < 0.001). Participants self-reported preparedness increased by a mean of >=1 point for extraventricular drain placement (p < 0.001), burr hole drilling (p < 0.001), shunt reprogramming (p < 0.001), patient positioning (p = 0.004), pedicle screw placement (p < 0.001), drain removal (p < 0.001), and image guidance registration (p = 0.009). Participants reported feeling more prepared for sub-internships (p < 0.001) with a better grasp of expectations (p < 0.001). Specifically, students felt more confident in performing a neurological exam (p < 0.001), creating spine pathology differentials (p < 0.001), reading brain and spine images (p < 0.001), and performing well on overnight call (p = 0.004). For content-based questions, participant scores increased by an average of 2 out of 14 points (14.2 %) after boot camp participation (p < 0.001).

CONCLUSIONS

Through the boot camp, students improved their knowledge and felt more prepared for upcoming rotations. Other institutions can conduct similar boot camps at minimal cost, expanding access to these critical educational opportunities.

Active Teaching Techniques Using Virtual Didactics: Novel Experience From a National Neurosurgery Resident Course

OBJECTIVE

To investigate the attitudes of neurosurgery residents regarding active teaching techniques and virtual didactics based on a national neurosurgery resident sample. We also evaluated the relative cost and time commitment required for faculty participation in virtual versus in-person resident courses.

DESIGN

The Society of Neurological Surgeons (SNS) national junior resident courses (JRCs) were reformatted for active teaching in a virtual setting in 2020 due to the COVID-19 pandemic. We analyzed course evaluations from the virtual 2020 courses in comparison to the 2019 in-person SNS JRCs. We also compared course budgets and agendas from these courses to identify comparative costs and the time commitment for faculty participation using these 2 course models.

SETTING

Survey of nationwide participants in virtual junior resident courses.

PARTICIPANTS

A total of 122 residents from 80 ACGME neurosurgery residency training programs attended the 2020 virtual JRC.

RESULTS

The survey response rate of attendees was 36%. In-class engagement was thought to be good to great by 73% to 80% of the virtual learners. In-class activities and active learning techniques also were evaluated positively by 61% to 82% of respondents. Expenses were significantly lower for the virtual course, at $118 per course participant, than for the in-person course ($2722 per participant). There also was a 97.3% reduction of faculty hours and a 97.6% reduction of faculty cost for the virtual JRC compared to the in-person course.

CONCLUSIONS

Neurosurgeon residents embraced the active teaching techniques used to teach portions of the prepandemic JRCs in a virtual format. Other aspects of the course curriculum could not be replicated virtually. Virtual courses were dramatically less expensive to produce, used fewer faculty teachers and required less time per faculty member. The data from this study may inform the choice of active teaching techniques for other neurosurgery residency and continuing medical education courses to optimize learner engagement and participant satisfaction in the virtual setting. We recommend that the curriculum of in-person courses emphasize hands-on, experiential learning and professional enculturation that cannot be recreated in the virtual space. Curricular elements suitable to virtual learning should take advantage of lower costs, reduced faculty time requirements, and scalability. They should also utilize active teaching techniques to improve learner engagement.

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.

Mixed Reality as a Teaching Tool for Medical Students in Neurosurgery

Background and Objectives: Simulation-based learning within neurosurgery provides valuable and realistic educational experiences in a safe environment, enhancing the current teaching model. Mixed reality (MR) simulation can deliver a highly immersive experience through head-mounted displays and has become one of the most promising teaching tools in medical education. We aimed to identify whether an MR neurosurgical simulation module within the setting of an undergraduate neurosurgical hands-on course could improve the satisfaction of medical students. Materials and Methods: The quasi-experimental study with 223 medical students [120 in the conventional group (CG) and 103 in the MR-group (MRG)] was conducted at the University Hospital Münster, Münster, Germany. An MR simulation module was presented to the intervention group during an undergraduate neurosurgical hands-on course. Images of a skull fracture were reconstructed into 3D formats compatible with the MR-Viewer (Brainlab, Munich, Germany). Participants could interact virtually with the model and plan a surgical strategy using Magic Leap goggles. The experience was assessed by rating the course on a visual analog scale ranging from 1 (very poor) to 100 (very good) and an additional Likert-scale questionnaire. Results: The satisfaction score for CG and MRG were 89.3 ± 13.3 and 94.2 ± 7.5, respectively. The Wilcoxon rank-sum test showed that MR users (Mdn = 97.0, IQR = 4, n = 103) were significantly more satisfied than CG users (Mdn = 93.0, IQR = 10, n = 120; ln(W) = 8.99, p < 0.001) with moderate effect size (r^biserial = 0.30, CI95 [0.15, 0.43]), thus indicating that the utilization of MR-simulation is associated with greater satisfaction. Conclusions: This study reports a positive response from medical students towards MR as an educational tool. Feedback from the medical students encourages the adoption of disruptive technologies into medical school curricula.

Urology boot camp for medical students: Using virtual technology to enhance undergraduate education

Objectives

The study aims to describe the methodology of converting the urology boot camp for medical students into a virtual course with key take home points for a successful conversion and to present quantitative and qualitative data demonstrating the impact of the boot camp on improving delegates' knowledge and clinical acumen.

Materials and methods

The face-to-face boot camp was converted to a virtual format employing a variety of techniques including; utilizing an online platform to deliver live screened lectures, using online polling software to foster an interactive learning environment and displaying pre-recorded videos to teach practical skills. Validated Multiple Choice Questionnaires (MCQs) were used prior to and after the course. This enabled the assessment of delegates' knowledge of urology according to the national undergraduate curriculum, and paired t tests were used to quantify the level of improvement. Thematic analysis was carried out on post-course delegate feedback to identify highlights of the course and ways of improving future iterations.

Results

In total, 131 delegates took part in the pilot virtual course. Of these, 105 delegates completed the pre- and post-course MCQs. There was a statistically significant improvement in the assessment following the course (p = <0.001) with mean score increasing from 47.5% pre-course to 65.8% post-course. All delegates who attended the most recent implementation of the virtual course (n = 31) felt it improved their knowledge and confidence in urology. Twenty delegates (64.5%) felt that it prepared them for both final year medical school examinations and working as a foundation year doctor. Positive themes in feedback were identified, which included the interactive nature of the course, the quality of teaching, the level and content of information provided and the high yield, concise organization of the teaching schedule.

Conclusion

Using virtual technology and innovative educational frameworks, we have demonstrated the successful conversion of the urology boot camp for medical students to a virtual format. At a national level, with support from the British Association of Urological Surgeons, the face-to-face component of the course will continue to run in parallel with the virtual course with the aim of standardizing and improving UK undergraduate urological education. The virtual course has been implemented on an international scale, and this has already shown promising results.

Shared Objective Mentorship via Virtual Research and Education Initiatives for Medical Students and Residents in Neurosurgery: A Systematic Review and Methodological Discussion of the Neurosurgery Education and Research Virtual Group Experience

OBJECTIVE

Virtual mentorship and research programs are becoming increasingly popular to facilitate education and career development for students and residents. We review virtual research initiatives for early trainees in neurosurgery and describe our effort to expand access to resources and shared objective mentorship (SOM) via the novel Neurosurgery Education and Research Virtual Group (NERVE).

METHODS

A systematic review of neurosurgical programming delivered via a virtual platform was conducted using PubMed, Embase, and Scopus databases. Identified articles were screened. Those meeting prespecified inclusion criteria were reviewed in full and examined for relevant data. Data analysis was performed using Microsoft Excel, and means and standard deviations were calculated. Descriptive analysis of NERVE characteristics was also performed.

RESULTS

Of the 2438 identified articles, 10 were included. The most common (70%) implementation style was a webinar-based lecture series. The least common (10%) was a longitudinal curricular interest group. Of the total NERVE cohort, 90% were first generation medical students and 82% attended institutions without home programs. Survey results indicated 73.8% had contributed to at least 2 research projects throughout the year.

CONCLUSIONS

There is a scarcity of virtual neurosurgical resources which facilitate SOM opportunities for trainees. In our systematic review, NERVE is the only multi-institutional virtual initiative aimed at increasing access to neurosurgical education and research opportunities for the purpose of SOM among early trainees from disadvantaged backgrounds. This highlights the group's niche and potential impact on increasing diversity in neurosurgery, improving trainees' career development, and facilitating future resident research productivity.

Utility of a Pilot Neurosurgical Operative Skills Boot Camp in Medical Student Training

OBJECTIVE

The neurosurgical sub-internship is a crucial step for prospective neurosurgeons. However, the expectations for sub-interns, particularly the technical skills required by residents and attendings, often are unclear. We present survey data on what medical students, residents, and attendings believe are important procedural proficiencies for neurosurgical sub-internships. We incorporated these tasks into a pilot skills-based craniotomy workshop, and here we report on the impact of the session on the neurosurgical training of medical students.

METHODS

A 1-day craniotomy lab using cadaveric cranial specimens was conducted for medical students. Surveys querying important competencies for sub-internships were answered by residents and attendings at affiliated hospitals. Pre- and postlab surveys querying interest in and perceptions of neurosurgery, self-assessment of skills, and important competencies for sub-internship preparation were answered by attendees.

RESULTS

Medical students, residents, and attendings agreed that burr-hole placement, bone replating, and galea and skin closure were of high importance for sub-interns. There was significant disagreement on the importance of dural opening and closure, establishing a craniotomy, and neuronavigation. The workshop altered perceptions of neurosurgery, with significant changes in recognizing the value of peer mentorship. Students also expressed increased confidence in technical skills, with significant improvements shown in understanding of neurosurgical high-speed drill use (P < 0.001).

CONCLUSIONS

Although the expectations for sub-interns may be heterogeneous, there is general agreement that proficiency in the initial and final steps of craniotomies, as well as minor procedures, is recommended. Cadaveric labs can improve student engagement in neurosurgery, facilitate interactions with neurosurgical departments, and enhance technical skills.

Evaluation of a Role for Virtual Neurosurgical Education for Medical Students Over 2 Years of a Global Pandemic

BACKGROUND

Subinternships are critical experiences for medical students applying into neurosurgery to acquire knowledge of the field and network with colleagues. During the coronavirus disease 2019 pandemic, in-person rotations were suspended for 2020 and reduced for 2021. In 2020, our department developed a neurosurgical course to address this need. The course was continued in 2021, enabling assessment of student perceptions as the pandemic progresses.

METHODS

The virtual course consisted of weekly 1-hour seminars over a 3- to 4-month period. Prior to starting, participants were sent a comprehensive survey assessing their backgrounds, experiences, and confidences in core concepts across neurosurgical subdisciplines. Participants also completed postcourse surveys assessing the course's value and their confidence in the same topics. Responses from students completing both precourse and postcourse surveys were included, analyzed in pairwise fashion, and compared across course years.

RESULTS

Students shared similar baseline characteristics in terms of demographics, educational background, and exposure to neurosurgery prior to the course. In the 2020 and 2021 cohorts, quality ratings for presentations were favorable for all seminars, and participants reported significantly increased confidence in core topics across all neurosurgical disciplines after the course (2020: 3.36 ± 0.26, P < 0.0001; 2021: 3.56 ± 0.93, P = 0.005). Most participants felt the course would remain useful following the pandemic in both the 2020 (96.9%) and 2021 (100.0%) cohorts.

CONCLUSIONS

Survey results suggest that the course adds value for students seeking a basic didactic curriculum to supplement their education, and perhaps, an online curriculum for medical students would still be beneficial going forward as in-person rotations resume.

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.

Increasing Equity in Medical Student Neurosurgery Education Through Distance Learning

OBJECTIVE

Addressing equitable opportunities for medical student (MS) education is important for minimizing disparities in neurosurgical care. However, international MSs, particularly from low- and middle-middle income countries (LMICs) may lack access to educational opportunities compared with their contemporaries in high-income countries. We compare the usefulness of virtual neurosurgery training camps (VNTC) between U.S. and international MSs.

METHODS

A survey assessing demographics, baseline interests, and ratings of usefulness was sent to attendees after the VNTC. Ratings were compared between international and U.S. MSs.

RESULTS

Thirty-three (27.7%) of 119 attendees were international MSs, of whom 24 (72.7%) were from LMICs. International MSs were more likely to hold an advanced degree (P = 0.0009), more likely to be MS3/MS4s (P = 0.0111) or postdoctoral (P < 0.0001), and less likely to be MS1/MS2s (P = 0.0059). After the VNTC, international MSs reported greater increase in interest in neurosurgery in general (P = 0.0009) and subspecialties of spine (P = 0.0002), peripheral nerve (P = 0.002), vascular (P = 0.0468), functional/epilepsy (P = 0.001), pediatric (P = 0.0285), and trauma/neurocritical care (P = 0.0067). International MSs reported greater post-VNTC willingness to pursue a career in neurosurgery (P = 0.0001), likelihood of taking a year off during medical school (P = 0.0363), and preparedness for subinternships (P = 0.0003). International MSs reported greater increases in awareness of burnout (P = 0.0157) and work-life balance in neurosurgery (P = 0.0249).

CONCLUSIONS

International MSs experience prolonged periods of education before applying to residency and have unmet informational needs. Distance learning is useful for international MSs. MS neurosurgery education, through online platforms, represents a long-term strategy for addressing disparities in neurosurgical care worldwide.

Distance Learning for Medical Students without a Neurosurgery Interest Group

OBJECTIVE

Interest groups for medical students (MSs) facilitate interest and engagement in neurosurgery. Students without interest groups are at a disadvantage as a result of greater barriers to exposure. We aimed to compare the usefulness of a virtual neurosurgery training camp for MSs with and without interest groups.

METHODS

A survey assessing demographics, interests, and ratings of informativeness and usefulness was sent to attendees of virtual neurosurgery training camps. Ratings were quantified on modified 7-point Likert scales. Data were compared between respondents with and without neurosurgery interest groups.

RESULTS

Students without an interest group were less likely to be MS1/MS2 (P = 0.0007) and more likely to be postdoctoral students (P = 0.0017). Students without an interest group were less likely to list breakout sessions as their primary reason for attendance (P = 0.0007), more likely to rate the resident panel as most useful (P = 0.0429), and less likely to rate the breakout session as most useful (P = 0.0231). Students without interest groups reported greater increases in interest in neurosurgery in general (P = 0.0284) and subspecialties of spine (P = 0.0003), peripheral nerve (P = 0.0054), and pediatric (P = 0.0137). There was no difference in willingness to pursue a neurosurgical career (P = 0.06), likelihood of taking a year off during medical school (P = 0.45), or preparedness for subinternships (P = 0.18) or residency application process (P = 0.43).

CONCLUSIONS

Distance learning increases both general and subspecialty-specific interest in neurosurgery among MSs without neurosurgery interest groups to a greater degree than among those with interest groups. Future initiatives seeking to benefit students without home programs should address the specific concerns of these students.

Qualitative Methodology for Planning and Executing In-Person and Virtual Neurosurgery Educational Opportunities for Medical Students: Lessons Learned from Five Years of Medical Student Neurosurgery Training Center Initiatives

INTRODUCTION

There is a growing need for collaborative and broad-scale medical student neurosurgery educational initiatives. Here, we propose a comprehensive methodology and structure for hosting both in-person and virtual learning opportunities for early trainees interested in clinical neurosciences.

METHODS

We conducted an internal review of educational courses hosted by Medical Student Neurosurgery Training Center from 2017 to 2022. Inspired by the lessons learned from these activities, we examine the elements vital to the planning, production, funding, and execution of future programs.

RESULTS

Six domains were deemed important for carrying out medical student neurosurgery educational opportunities: directorship, curriculum, logistics, faculty and instructor outreach, funding, and marketing. Each of these elements is discussed in detail for both in-person and web-based programs, as well as an examination of the advantages and disadvantages of various implementation strategies.

CONCLUSIONS

Based on the Medical Student Neurosurgery Training Center experience, successful production and hosting of both in-person and virtual educational endeavors seems to be contingent on a collaborative effort by medical students, resident physicians, and neurosurgery faculty. Including medical students throughout the planning phase adds to the overall educational value of each experience and promotes program longevity and consumer engagement. Curricula should be guided by clear learning objectives and a variety of teaching modalities available to the organization. Finally, methods for assessing course outcomes are important, including institutional review board-approved data curation and analysis. Further investigation of neurosurgical learning outcome measurement is needed and has the potential to shape the future of medical student education and neurosurgery career preparation.

Neurosurgical Education for Medical Students: A Scoping Review

Neurosurgeons have a rich history of involvement in medical student education. We review the scope of related published works with the goal of highlighting recently increased efforts to innovate in neurosurgical education and discuss where future efforts must go. A scoping review was performed after comprehensive search of PubMed MEDLINE and Embase databases. Among the 2314 articles returned in the search, 54 were selected for inclusion and review. Articles are discussed in the context of neurosurgery electives, American Association of Neurological Surgeons chapters and medical school programs, national neurosurgery courses, neurosurgery education materials, neurosurgery career perceptions, and the impact of coronavirus disease 2019. Despite increasing need for neurosurgical education in medical school, available experiences in formal curricula are diminishing. Longitudinal exposure to neurosurgery throughout medical school will help ensure a foundational understanding of neurosurgical disease management for all physicians and provide a pathway of exploration, education, and mentorship for the most suitable candidates. Neurosurgery faculty mentorship is particularly important to ensure that the next generation of neurologic surgeons is well equipped to treat patients, catalyze innovative research, and espouse both diverse perspectives and novel ideas.

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.

Interns Without Subinternships

Surgical interns who have completed medical school in the era of Covid-19 will not have the same experience gained through the traditional multi-month fourth-year surgical subinternships. During subinternships, medical students learn relevant anatomic and radiographic features of surgical pathologies, hone technical skills, and gain exposure to surgical consults and procedures. This lack of intensive exposure will have this cohort starting at a lower comfort and knowledge level compared to years prior. Residency programs, especially subspeciality programs, should review and utilize national resources to facilitate the transition to intern year, such as the American College of Surgeons Entering Resident Readiness Assessment and American College of Surgeons/ Association of Program Directors in Surgery/Association for Surgical Education Resident Prep Curriculum. We recommend the use of a specialty-tailored intern boot-camp and longitudinal curriculum that focuses on learning procedural skills and surgical conditions, anatomy, pathology, clinical examination, radiographic findings, surgical approach, and postoperative complications. These steps will help address knowledge gaps and promote intern readiness in this cohort of individuals.

Solutions, enablers and barriers to online learning in clinical medical education during the first year of the COVID-19 pandemic: A rapid review

AIMS

The COVID-19 pandemic has seen a major disruption to undergraduate and postgraduate clinical medical education. The aim of this rapid review was to identify and synthesize published literature relating to the solutions, enablers and barriers to online learning implemented in clinical medical education during the first year of the COVID-19 pandemic.

METHODS

All articles published before March 2021 in peer-reviewed journals, including MedEdPublish, that described authors' experience of online learning in response to the COVID-19 pandemic. A descriptive analysis of the solutions and a qualitative template analysis of enablers and barriers.

RESULTS

87 articles were identified for inclusion. Face to face teaching was maintained with interactive approaches between learners and/or learners and teachers. Several innovative solutions were identified. The enablers were a readiness and rapid response by institutions, with innovation by teachers. The barriers were the lack of planning and resources, usability problems and limited interactivity between teachers and students.

CONCLUSIONS

Important and timely evidence was obtained that can inform future policy, practice and research. The findings highlighted the urgent need to use rapid design and implementation methods with greater explicit descriptions in published articles to ensure applicability to other contexts.

Online learning developments in undergraduate medical education in response to the COVID-19 pandemic: A BEME systematic review: BEME Guide No. 69

BACKGROUND

The COVID-19 pandemic spurred an abrupt transition away from in-person educational activities. This systematic review investigated the pivot to online learning for nonclinical undergraduate medical education (UGME) activities and explored descriptions of educational offerings deployed, their impact, and lessons learned.

METHODS

The authors systematically searched four online databases and conducted a manual electronic search of MedEdPublish up to December 21, 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction and assessed risk of bias. A third author resolved discrepancies. Findings were reported in accordance with the STORIES (STructured apprOach to the Reporting in healthcare education of Evidence Synthesis) statement and BEME guidance.

RESULTS

Fifty-six articles were included. The majority (n = 41) described the rapid transition of existing offerings to online formats, whereas fewer (n = 15) described novel activities. The majority (n = 27) included a combination of synchronous and asynchronous components. Didactics (n = 40) and small groups (n = 26) were the most common instructional methods. Teachers largely integrated technology to replace and amplify rather than transform learning, though learner engagement was often interactive. Thematic analysis revealed unique challenges of online learning, as well as exemplary practices. The quality of study designs and reporting was modest, with underpinning theory at highest risk of bias. Virtually all studies (n = 54) assessed reaction/satisfaction, fewer than half (n = 23) assessed changes in attitudes, knowledge or skills, and none assessed behavioral, organizational or patient outcomes.

CONCLUSIONS

UGME educators successfully transitioned face-to-face instructional methods online and implemented novel solutions during the COVID-19 pandemic. Although technology's potential to transform teaching is not yet fully realized, the use of synchronous and asynchronous formats encouraged virtual engagement, while offering flexible, self-directed learning. As we transition from emergency remote learning to a post-pandemic world, educators must underpin new developments with theory, report additional outcomes and provide details that support replication.

Step-by-Step Guide on How to Make a 2-Dimensional Operative Neurosurgical Video: Microsurgical Resection of a Right Lateral Ventricle Subependymoma by an Anterior Interhemispheric Transcallosal Approach

BACKGROUND

Digital video recordings are increasingly used across various medical and surgical disciplines with advances in computer hardware and software technologies. The creation of high-quality surgical video footage requires a basic understanding of key technical considerations, together with creativity and sound aesthetic judgment. Online operative videos have become a core resource within neurosurgical education.

OBJECTIVE

To provide a step-by-step description for making operative videos using a video from a real case as an example.

METHODS

We recorded an operative video of the microsurgical resection of a right lateral ventricle subependymoma performed by an anterior interhemispheric transcallosal approach. The patient consented to surgical resection of the subependymoma and to publication of this operative video. With the video, we explain the step-by-step process the authors used for developing the raw video into a publishable surgical video.

RESULTS

The patient depicted in our video tolerated the surgery well and made a complete recovery. The final video produced from the surgery illustrated elements that Operative Neurosurgery, Neurosurgery, and other journals require in surgical videos.

CONCLUSION

Although more than 1200 peer-reviewed (PubMed) neurosurgical operative videos have been published so far, there has not been a single publication that describes the step-by-step process of producing an operative video. To the best of our knowledge, this is the first published detailed description of editing of an educational operative video in neurosurgery and the first video case report of a microsurgical resection of subependymoma of the lateral ventricle in the peer-reviewed English literature.

National Implementation and Evaluation of a Virtual Subinternship in Urology

OBJECTIVES

To conduct a nationwide evaluation of student and program director (PD) perspectives of virtual subinternships that took place during the COVID-19 pandemic.

METHODS

In December 2020, we distributed anonymous surveys to all 534 urology residency applicants and 161 urology PDs at academic medical centers across the United States to evaluate virtual subinternships. Surveys assessed curriculum composition, goals, satisfaction, barriers, and future reusability. The primary outcome was overall satisfaction with the subinternship, evaluated on a 5-point Likert scale.

RESULTS

The survey was completed by 174 students (33%) and 82 PDs (51%), including 81 students (47%) and 32 PDs (41%) who participated in virtual subinternships at 29 institutions. Overall, 77% of students and 78% of PDs rated the electives "excellent" or "very good." On ordinal logistic regression, higher student ratings were associated with duration ≥3 weeks (OR 4.64, p=0.003) and class size ≤4 students (OR 3.33, p=0.015). Higher PD ratings were associated with full-time electives (OR 11.18, p=0.019), class size ≤4 students (OR 13.99, p=0.042), and utilization of the standardized Guidebook from the Society of Academic Urologists (OR 11.89, p=0.038). The most commonly reported challenge to the subinternship's efficacy was lack of hands-on learning (87% of students and 81% of PDs). Looking forward, 45% of students and 66% of PDs recommended incorporating virtual components into future electives.

CONCLUSIONS

The virtual subinternship was a coordinated nationwide initiative to provide urologic education to medical students during a pandemic. The most successful courses were structured with longer duration, full-time commitment, and small class size.

The impact of the COVID-19 pandemic on global neurosurgical education: a systematic review

The COVID-19 pandemic has disrupted neurosurgical training worldwide, with the shutdown of academic institutions and the reduction of elective surgical procedures. This impact has disproportionately affected LMICs (lower- and/or middle-income countries), already burdened by a lack of neurosurgical resources. Thus, a systematic review was conducted to examine these challenges and innovations developed to adapt effective teaching and learning for medical students and neurosurgical trainees. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA-P) and The Cochrane Handbook of Systematic Reviews of Interventions. MEDLINE, PubMed, Embase and Cochrane databases were accessed, searching and screening literature from December 2019 to 5th December 2020 with set inclusion and exclusion criteria. Screening identified 1254 articles of which 26 were included, providing data from 96 countries. Twenty-three studies reported transition to online learning, with 8 studies also mentioned redeployment into COVID wards with 2 studies mentioning missed surgical exposure as a consequence. Of 7 studies conducted in LMICs, 3 reported residents suffering financial insecurities from reduced surgical caseload and recession. Significant global disruption in neurosurgical teaching and training has arisen from the COVID-19 pandemic. Decreased surgical exposure has negatively impacted educational provision. However, advancements in virtual technology have allowed for more affordable, accessible training especially in LMICs. Using this, initiatives to reduce physical and mental stress experienced by trainees should be paramount.

Hybrid Workshops During the COVID-19 Pandemic-Dawn of a New Era in Neurosurgical Learning Platforms

Background

During the COVID-19 pandemic, disruption of surgical hands-on training has hampered the skills acquisition by budding neurosurgeons. Online and virtual classrooms have not been able to substitute the hands-on experience and learning via direct interaction with senior colleagues. To overcome these challenges, we organized a hybrid workshop where simulation-based learning modules, and direct and virtual interaction with surgeons during live surgeries or didactic lectures were utilized to help delegates in understanding the nuances of neurosurgery.

Methods

A 3-day hybrid workshop was held in March 2021, which was attended by 133 delegates. A structured questionnaire was utilized to record their feedback.

Results

An overwhelming majority of the respondents (94.1%, n = 64) found hybrid conferences to be better than an online conference. Most of the respondents (88.3%, n = 60) rated the utility of direct face-to-face interaction to be more satisfying as compared with online interaction with faculty during a webinar. Again, many the respondents (86.8%, n = 59) believed that similar hybrid events will be the new normal given the current situation of COVID-19 pandemic. A large majority (88.2%, n = 60) of the respondents reported that they will prefer a hybrid event over an online conference.

Conclusions

In this era of the COVID-19 pandemic, “hybrid” microneurosurgery workshops offer unique opportunities to enhance surgical skills acquisition by hands-on simulation-based learning and observing live surgical demonstrations, apart from 2-way interactions with experts under one roof. This may be a stepping stone for what lies ahead in the future of neurosurgical training.

Reimagining the Away Rotation: A 4-Week Virtual Subinternship in Urology

OBJECTIVE

To develop and evaluate the first 4-week virtual subinternship in urology.

DESIGN

Following a needs assessment, we established four course objectives: to teach foundational knowledge, assess students' abilities, highlight our program culture, and evaluate students' compatibility with our program. To meet these objectives, we developed a virtual curriculum that consisted of department conferences, small group didactic sessions, clinical/surgical encounters, interactive online modules, and informal sessions. At the conclusion of the subinternship, we sent anonymous surveys to students and physicians to measure success in meeting the course objectives. Student learning was measured using the framework of the Accreditation Council for Graduate Medical Education (ACGME) core competencies.

SETTING

The study was conducted at Columbia University Irving Medical Center, a tertiary care academic institution.

PARTICIPANTS

Over a 2-month span, the virtual subinternship enrolled a total of 8 fourth-year medical students from 7 different medical schools in 5 different states. All residents and attending urologists in the Columbia University Department of Urology were involved in teaching.

RESULTS

Overall, 100% of students and 63% of physicians rated the elective as "very good" or "excellent." The highest-rated components of the elective were the didactic curriculum and online modules. All course objectives were met, especially teaching foundational knowledge and highlighting program culture. Students reported high learning scores in all ACGME core competencies and urologic subspecialties, as well as increased confidence in managing a range of urologic conditions. The majority of students and physicians recommended incorporating virtual educational tools into future urology electives, particularly didactic sessions, online modules, and conferences/Grand Rounds presentations.

CONCLUSIONS

A virtual subinternship in urology is a novel and successful model to enable student education, assessment, demonstration of program culture, and evaluation of student-program fit. This curriculum can serve as a template and springboard for the effective integration of virtual learning into surgical education.

Student Survey Results of a Virtual Medical Student Course Developed as a Platform for Neurosurgical Education During the Coronavirus Disease 2019 Pandemic

Background

Before the coronavirus disease 2019 (COVID-19) pandemic, medical students training in neurosurgery relied on external subinternships at institutions nationwide for immersive educational experiences and to increase their odds of matching. However, external rotations for the 2020–2021 cycle were suspended given concerns of spreading COVID-19. Our objective was to provide foundational neurosurgical knowledge expected of interns, bootcamp-style instruction in basic procedures, and preinterview networking opportunities for students in an accessible, virtual format.

Methods

The virtual neurosurgery course consisted of 16 biweekly 1-hour seminars over a 2-month period. Participants completed comprehensive precourse and postcourse surveys assessing their backgrounds, confidence in diverse neurosurgical concepts, and opinions of the qualities of the seminars. Responses from students completing both precourse and postcourse surveys were included.

Results

An average of 82 students participated live in each weekly lecture (range, 41–150). Thirty-two participants completed both surveys. On a 1–10 scale self-assessing baseline confidence in neurosurgical concepts, participants were most confident in neuroendocrinology (6.79 ± 0.31) and least confident in spine oncology (4.24 ± 0.44), with an average of 5.05 ± 0.32 across all topics. Quality ratings for all seminars were favorable. The mean postcourse confidence was 7.79 ± 0.19, representing an improvement of 3.13 ± 0.38 (P < 0.0001).

Conclusions

Feedback on seminar quality and improvements in confidence in neurosurgical topics suggest that an interactive virtual course may be an effective means of improving students' foundational neurosurgical knowledge and providing networking opportunities before application cycles. Comparison with in-person rotations when these are reestablished may help define roles for these tools.

An update on developments in medical education in response to the COVID-19 pandemic: A BEME scoping review: BEME Guide No. 64

BACKGROUND

COVID-19 has fundamentally altered how education is delivered. Gordon et al. previously conducted a review of medical education developments in response to COVID-19; however, the field has rapidly evolved in the ensuing months. This scoping review aims to map the extent, range and nature of subsequent developments, summarizing the expanding evidence base and identifying areas for future research.

METHODS

The authors followed the five stages of a scoping review outlined by Arskey and O'Malley. Four online databases and MedEdPublish were searched. Two authors independently screened titles, abstracts and full texts. Included articles described developments in medical education deployed in response to COVID-19 and reported outcomes. Data extraction was completed by two authors and synthesized into a variety of maps and charts.

RESULTS

One hundred twenty-seven articles were included: 104 were from North America, Asia and Europe; 51 were undergraduate, 41 graduate, 22 continuing medical education, and 13 mixed; 35 were implemented by universities, 75 by academic hospitals, and 17 by organizations or collaborations. The focus of developments included pivoting to online learning (n = 58), simulation (n = 24), assessment (n = 11), well-being (n = 8), telehealth (n = 5), clinical service reconfigurations (n = 4), interviews (n = 4), service provision (n = 2), faculty development (n = 2) and other (n = 9). The most common Kirkpatrick outcome reported was Level 1, however, a number of studies reported 2a or 2b. A few described Levels 3, 4a, 4b or other outcomes (e.g. quality improvement).

CONCLUSIONS

This scoping review mapped the available literature on developments in medical education in response to COVID-19, summarizing developments and outcomes to serve as a guide for future work. The review highlighted areas of relative strength, as well as several gaps. Numerous articles have been written about remote learning and simulation and these areas are ripe for full systematic reviews. Telehealth, interviews and faculty development were lacking and need urgent attention.