Orthopedic Residents' Perception of a Hybrid Hand Surgery Rotation during the COVID-19 Pandemic at the Philippine General Hospital: A Qualitative and Quantitative Study

Objectives. The objectives of the study were to determine the resident-physicians' perspectives with regards the changes implemented in their Hand Surgery rotation at the Philippine General Hospital in response to the COVID-19 pandemic, and establish correlation, if any, of these perspectives to their performance in the said rotation based on their final grades. Methods. Thirteen (13) residents were chosen for the study, all of which had rotated with the division at least once after the implementation of the changes were made, to answer an online survey and participate in an online group discussion, focusing on their feedback on the effects of these changes in terms of their skills and overall patient care. Results. In general, the participants agreed strongly to the usefulness of the hybrid set-up with Likert survey answers ranging from 3.5 to 4 points in favor of the changes implemented. Eleven of the 13 participants had their mean survey answer scores matched with their respective grades obtained during his/her rotation with the division, showing no correlation. Conclusion. The study showed a generally positive perception by the orthopedic residents to the hybrid set-up in the Hand Surgery rotation in response to the COVID-19 pandemic. No clear correlations or trends were seen between the trainees' perceptions of the changes implemented and his/her objective performance based on the final grade for his/her rotation. Potential topics for investigation related to this may focus on using larger sample size or clinical outcomes of cases done by trainees who have undergone the hybrid training set-up. © 2022 University of the Philippines Manila. All rights reserved.

Improving the resident assessment process: application of App-based e-training platform and lean thinking.

BACKGROUND: The assessment system for standardized resident training is crucial for developing competent doctors. However, it is complex, making it difficult to manage. The COVID-19 pandemic has also aggravated the difficulty of assessment. We, therefore, integrated lean thinking with App-based e-training platform to improve the assessment process through Define-Measure-Analyze-Improve-Control (DMAIC) cycles. This was designed to avoid unnecessary activities that generate waste. METHODS: Panels and online surveys were conducted in 2021-2022 to find the main issues that affect resident assessment and the root causes under the frame of waste. An online app was developed. Activities within the process were improved by brainstorming. Online surveys were used to improve the issues, satisfaction, and time spent on assessment using the app. RESULTS: A total of 290 clinical educators in 36 departments responded to the survey, and 153 clinical educators used the online app for assessment. Unplanned delay or cancellation was defined as the main issue. Eleven leading causes accounted for 87.5% of the issues. These were examiner time conflict, student time conflict, insufficient examiners, supervisor time conflict, grade statistics, insufficient exam assistants, reporting results, material archiving, unfamiliarity with the process, uncooperative patients, and feedback. The median rate of unplanned delay or cancellation was lower with use of the app (5% vs 0%, P < 0.001), and satisfaction increased (P < 0.001). The median time saved by the app across the whole assessment process was 60 (interquartile range 60-120) minutes. CONCLUSIONS: Lean thinking integrated with an App-based e-training platform could optimize the process of resident assessment. This could reduce waste and promote teaching and learning in medical education.

"The show must go on": Aftermath of Covid-19 on anesthesiology residency programs.

COVID-19 has caused tectonic changes in the personal and professional lives of anesthesiologists and, among several aspects, anesthesiology residency and sub-specialty training has also undergone an unforeseen overhaul. We read the articles published on the impact of COVID-19 on training of anesthesiologists and set out to extract and narrate all the significant observations. At the outset, we begin by explaining how this pandemic posed a threat to the safety of the residents and mitigating measures like PPE and barriers that have now become 'the new normal'. Sub-specialties like critical care, cardiac anesthesia, pain and palliative care have also faced difficulty in imparting training due to an initial dearth in elective surgery case load but have adapted innovative measures to overcome that. Initially, conducting thesis and research became difficult due to problems in achieving the desires sample size needed to get significant results, but this pandemic has emerged as a dynamic laboratory where topics like 'psychological impact of COVID-19' and 'development of artificial intelligence models in COVID -19 ICUs' came into the fore. Pattern of examination has also become virtual and webinars showed how knowledge, with the right medium, has the potential of global outreach. As the pandemic took a toll on the mental health of the residents, attention was paid to this previously neglected aspect and ensuring their emotional well-being became a priority to avoid the issue of burn-out. We comment on how what initially was considered a scary problem, actually paved way for growth. It brought attention to safety, innovation, new tools for training, finding solutions within constraints, continuing developing our residents into future leaders who were also trained for mitigating disasters. Changes like online education, research on socio-economic impact, priority to mental health and artificial intelligence are here to stay and by imbibing it, we ensure that 'the show must go on'.

Redrawing vitreoretinal surgical training program in the COVID-19 era: Experiences of a tertiary care institute in North India.

Purpose: The COVID-19 pandemic has brought medical and surgical training to a standstill across the medical sub-specialties. Closure of outpatient services and postponement of elective surgical procedures have dried up opportunities for training vitreoretinal trainees across the country. This "loss" has adversely impacted trainees' morale and mental health, leading to feelings of uncertainty and anxiety. Therefore, there is an urgent need to redraw the surgical training program. We aimed to describe a systematic stepwise approach to vitreoretinal surgical training. Methods: We introduced a three-pronged approach to vitreoretinal surgical training comprising learn from home, wet lab and simulator training, and hands-on transfer of surgical skills in the operating room in our institute. Results: Encouraging results were obtained as evaluated by feedback from the trainees about the usefulness of this three-pronged approach in developing surgical skills and building their confidence. Conclusion: The disruption caused by the COVID-19 global pandemic should be used as an opportunity to evolve and reformulate surgical training programs to produce competent vitreoretinal surgeons of the future.

Innovative models for vitreoretinal training during COVID-19 times.

Background: Vitreoretinal training has been badly affected during the COVID-19 times. Due to lockdown, the number of patients reaching the hospital has dwindled. Hence we propose two simple cost-effective ways to improve resident training. Purpose: To highlight two simple eye models RETILAPP and RETISURGE, and their use in resident training. This video also highlights how to make and customise laser and surgery eye models and its advantages . Synopsis: : By using 3D printing, two simple, economical and reusable eye models have been proposed to improve resident training especially during COVID-19 times. Highlights: Use of simple easily available materials and 3D printing to make sustainable eye models for practise as against the simulator based learning. Video link: https://youtu.be/dJau9N-sHUE.

Changes to the practice of pediatric otolaryngology as a consequence of the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has shifted medical practice globally. The objective of this study was to examine the changes to the practice of pediatric otolaryngology internationally due to the COVID-19 pandemic and examine potential contributors. METHOD: An online survey was designed to assess practice demographics, patterns of COVID-19 related restrictions in communities, and changes to practice and referrals. This was disseminated via an international Covid-19 WhatsApp™ group of pediatric otolaryngologists. RESULTS: There were 45 respondents of 177 group members (25.4%) from 15 countries. The mean estimated time spent under strictest lockdown measures was 16.2 (±10.7) weeks (range: 1-45 weeks). Operating room time was reduced for 82.9%, with an average reported reduction of 41.5%. Almost all (>75%) of respondents reported reduced referrals for five common conditions: otitis media with effusion (average reported decrease - 56.1%); acute otitis media (average decrease 62.8%); acute mastoiditis (average decrease 66.6%); recurrent pharyngotonsillitis (average decrease 51.0%); and peritonsillar abscess (average decrease 52.1%). COVID-19 cases per million population significantly influenced the acuity of referrals received (p < .05). No conditions were reported as increased in frequency and the acuity of most conditions was reported as unchanged by the majority of respondents. CONCLUSION: The measures taken to reduce the spread of COVID-19 have resulted in many changes to pediatric otolaryngology practice and the referral patterns of common conditions. Some of these changes may have enduring sequelae.

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.

Making Effective Educational Videos for Clinical Teaching.

Prerecorded video content in medical education has become more common. Increasingly accessible technology coupled with the COVID-19 pandemic and subsequent need for distanced learning has greatly increased the interest in and need for high-quality video content. The use of short educational videos to augment other teaching methods has been shown to improve learners' experiences, knowledge retention, and understanding of content. Multiple studies have demonstrated that video education can be a highly effective tool for learning, particularly for hard-to-visualize processes and for procedural education. Videos allow learners to view content at their own pace and revisit materials on demand. In addition, well-designed videos can be repurposed by educators, ultimately reducing time needed to create high-quality educational content. Currently available technology allows educators to create high-quality videos at minimal cost and with a modest investment of time. This article details practical tips for creating high-yield educational videos.

A simple do-it-yourself model of phacoemulsification for resident training.

COVID-19 has immensely affected the training of ophthalmology residents; wet-lab training thus becomes of utmost importance. A simple cost-effective model for cataract surgery training of residents becomes the need of this hour. Hence, we aim to describe a new 'Do It Yourself' model with easily available material for beginners.

Impact of the COVID-19 pandemic on surgical skills training in pediatric surgery residents.

PURPOSE: To analyze the initial impact of the SARS-CoV-2 pandemic on surgical skills training and performance of Pediatric Surgery Residents. METHODS: Retrospective study considering the modifications on the Pediatric Surgery Residency training from March 1st-May 31st, 2020. Exposure to OR learning opportunities was compared to the same 2018-2019 trimesters. An anonymous survey about self-perception on surgical skills development was also performed. RESULTS: Residents performed 209 procedures as leading surgeons during the 2020 trimester with a mean number of surgeries per resident of 20.9, representing a reduction of 46% and 56.8% compared to the 2018-2019 averages, respectively. Reduction in both the number and the percentage of total procedures (n: 209, 56.8%) compared to both 2019 (n: 354, 68.7%, p: 0.000272) and 2018 (n: 420, 76.1%, p < 0,00,001) showed statistical correlation with no changes in their complexity pattern. From the survey (response rate: 100%), hours dedicated to simulation-based training were highly increased. More time was spent studying, but only 60% achieved better preparation for surgery and 70% perceived a decrease in surgical confidence. CONCLUSIONS: Even though the pandemic promoted new teaching strategies and the use of simulation-based training, it drastically reduced "on-the-job" learning opportunities with potential effects on residents' performance and self-confidence during surgery.