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Objective: To investigate how medical congresses have evolved since the COVID-19 pandemic, and its impact on how healthcare professionals interact with and develop congress publications. Research design and methods: International and regional congresses (2019-2022) in two therapy areas (obesity and oncology) were included. Data on attendance, attendee demographics, registration fees, and virtual capabilities were obtained from publicly- available sources or contacting congresses directly. Data on accepted publications were from authors' experience. Result(s): Twenty-three congresses were included. Congresses moved from face-to-face to fully virtual in 2020 and 2021, with most becoming hybrid in 2022. Despite the option of virtual attendance, total attendee numbers did not significantly change compared with pre-pandemic levels, although slightly decreased in 2021. Registration fees decreased during 2020-2021 but returned to pre-pandemic levels (regardless of virtual/live attendance) by 2022. Virtual and hybrid congresses provided access to oral session recordings and digital posters via congress apps or websites for a limited time after the event. In general, a broader range of digital publications was supported in 2021/2022, often associated with shorter lead times. Conclusion(s): Since the COVID-19 pandemic, congresses have embraced hybrid formats, offering virtual attendance options and a range of digital possibilities. Overall attendance and demographics remain relatively unchanged. Delegate testimonials support in-person attendance, citing the value of networking opportunities. Broader digital options from virtual congresses may be confounded by general advancements in journal publication extenders. As publication professionals, it is important to consider how congress delegates interact with live and digital content, and adapt content and delivery to maximise impact and optimise dissemination to all audiences.
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Objective: Representing diverse perspectives in medical publications is of great importance. We assessed diversity among investigators, study participants, authors and tweeters of recent publications on COVID-19 vaccine trials, a topic likely to have significant global implications. Research design and methods: Primary publications reporting on COVID vaccine randomized controlled trials (RCTs) were identified via PubMed (n=302 hits, 23 September 2022). The 100 articles with the greatest impact (Altmetric score) were selected for evaluation. National affiliation of authors and investigators, and demographics of participants were collected. Geographic locations of Tweets mentioning the publications were collected via Altmetric. Result(s): In our preliminary analysis, as expected, selected publications most frequently appeared in top-tier journals, e.g. New England Journal of Medicine (n=24) and Lancet (n=19), and had high Altmetric scores (median 886, range 30-29,153). Articles included authors from mean 2.2 countries, most frequently the USA (n=43 articles), the UK (n=31) and China (n=23). Investigators' locations were often not reported, but most frequent were the UK (n=2711 investigators), USA (n=1029) and South Africa (n=269). There was a gender balance among participants across the studies (mean 49.4% female). The most frequent ethnic groups were white, Hispanic and Asian. Tweets mentioning the publications most commonly came from the USA (8.1%), the UK (3.1%) and Japan (2.9%). Conclusion(s): Despite COVID-19 being a global health emergency, most authors, investigators and readers of high impact COVID-19 vaccine RCT publications were from a small group of countries, with some notable exceptions. Numerous studies did not report the geographic location of investigators or participant ethnicity. Consistent and transparent reporting would support the drive towards greater diversity and representation in medical research.
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INTRODUCTION AND OBJECTIVE: The Certified Curriculum of ERUS (CC-ERUS) fellowship on robot-assisted radical prostatectomy (RARP) is almost 10 years old. To complete the CCERUS outcome-based fellowship, a video of a full RARP performed by the fellow must be assessed by an expert. The aim of the current study was to 1) understand and report the completion rate of the fellowship (i.e. achievement of the Certificate of Excellence award) and 2) identify reasons for non-completion. METHOD(S): The CC-ERUS is a 6 months structured training program that includes an eLearning part, followed by one-week robotic skills course;then, trainees have 6 months of modular training at a host center. At the end of the fellowship, trainees are requested to submit a video of a full RARP performed by themselves. The video is objectively assessed by experts and, in case of positive assessment, the fellowship is completed and the fellow can receive the Certificate of Excellence. We analysed our prospectively collected data on all CC-ERUS fellows. We then conducted a telephone survey on 2018-2021 CC-ERUS fellows to investigate the reasons for noncompletion. Standardized interview format questions were used to conduct the survey. RESULT(S): Data on 87 subjects enrolled in the fellowship between were collated. While all subjects successfully completed the 1-wk robotic skills course, only 26 (30%) fellows achieved the certificate of excellence. The completion rate by year was 20% in 2018, 29% in 2019, 36.4% in 2020, and 31.4% in 2021. Therefore, the COVID-19 pandemic had only a modest impact on completion rate. The response rate to the telephone interview survey was 77%. The following reasons for non-completion emerged: insufficient console exposure (49%), insufficient fellowship duration (20%), COVID-19 pandemic (11%), logistic difficulties in submitting the video (20%). CONCLUSION(S): The CC-ERUS for RARP was the first validated robotic curriculum in the world, and still one of the very few outcome-based fellowships. Nonetheless, we observed a low completion rate that needs to be addressed with appropriate actions. To increase the fellowship completion rate, three solutions should be considered by the ERUS board: 1. Review of the Host Centers, to exclude those which do not meet the certification criteria (e.g. insufficient console time for fellows) 2. Periodical Train-The-Trainers courses for the mentors at host centers 3. Follow-up procedural diary: the fellows will be requested to submit videos of each phase while progressing in their modular training and self-assess their performance using validated RARP metrics.
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Introduction & Objectives: The Certified Curriculum of ERUS Fellowship (CC-ERUS) on robot-assisted radical prostatectomy (RARP) is almost 10 years old. To complete the ERUS outcome-based fellowship, a video of a full RARP performed by the fellow must be assessed by an expert. The aim of the current study was to 1) understand and report the completion rate of the fellowship (i.e., achievement of the Certificate of Excellence award) 2) identify reasons for non-completion. Material(s) and Method(s): The CC-ERUS consists of a structured training program that includes an eLearning part, followed by one-week robotic skills course, and then 6 months of modular training at a host center. At the end of the fellowship, trainees are requested to submit a video of a full RARP performed by themselves. After the video is objectively assessed by experts, the fellowship is completed and the fellow can receive the Certificate of Excellence (after positive assessment). We analysed our database which includes prospectively collected data on all CC-ERUS fellows. We then conducted a telephone survey on 2018-2021 CC-ERUS Fellows to investigate the reasons for non-completion. Standardized interview format questions were used to conduct the survey. Result(s): Data on 87 subjects who were enrolled in the fellowship between January 2018 and December 2021 were collated. All subjects successfully completed the CC-ERUS training in the lab but only 26 (29.9%) fellows achieved the certificate of excellence, while 61 (70.1%) did not. The completion rate by year was 20% in 2018, 29% in 2019, 36.4% in 2020, and 31.4% among the 2021 fellows. Therefore, the COVID-19 pandemic had only a modest impact on the completion rate. The response rate to the telephone interview survey was 77%. The following reasons for non-completion emerged: insufficient console exposure (49%), insufficient fellowship duration (20%), COVID-19 pandemic (11%), logistic difficulties in submitting the video (20%). Conclusion(s): The CC-ERUS for RARP was the first validated robotic curriculum in the world, and still one of the best and the very few outcome-based fellowships. Nonetheless, we observed a low fellowship completion rate that needs to be addressed with appropriate actions. To increase the fellowship completion rate, three solutions should be considered by the ERUS board: 1. Review of the Host Centers, to exclude those which do not meet the certification criteria (amongst whom insufficient console time for the fellow) 2. Periodical Train-The-Trainers courses for the mentors in the Host Center 3. Follow-up procedural diary: the fellows will be requested to submit videos of each phase while progressing in their modular training and self-assess their performance using validated RARP metrics.Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.
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Diabetes affects around 15% of surgical patients and is associated with significant morbidity [1]. Poor peri-operative glycaemic control can result in longer hospital stays, up to 50% increased mortality and adverse postoperative outcomes including wound infection [1, 2]. Therefore, it is important to ensure diabetic peri-operative care is optimal, and as noted, in recent years, there is room for improvement. Methods A retrospective re-audit of electronic patient records was conducted to determine if peri-operative diabetic management was in line with local and national guidelines. We included all diabetic adults undergoing emergency or elective surgery, excluding obstetrics, in January 2022 at Watford General Hospital. Results Forty-seven of 618 (7.6%) patients who underwent surgery in January 2022 were diabetic adults meeting inclusion criteria. Of these 87% had type 2 diabetes, 51% were male and 55% were elective cases. Median age was 67 years (interquartile range 58-78.5 years). The majority (49%) were designated ASA status 2. Five of 21 elective cases had a glycated haemoglobin (HbA1c) result of > 69 mmol.l-1. Median surgical start time for elective diabetic patients was midday with 38% of cases occurring after midday. Starvation time was more than one missed meal or 12 h in 49% of patients. Variable rate intravenous insulin infusions (VRIIIs) were indicated in 43% of patients but only 10% received VRIIIs. Peri-operative blood glucose was maintained between 6-10 mmol.l-1 in 34% patients, 70% had intra-operative glucose monitoring but none hourly. Ketone testing occurred in one of two patients where indicated. Dexamethasone was given to 51% of patients (five of those were diet-controlled). Discussion A larger sample size was obtained on re-audit with 47 patients vs. 10 patients in January 2021, likely due to effects of the COVID-19 pandemic on elective surgery. Blood glucose monitoring pre- and postoperatively in diabetic patients has remained at least 70% in both audit cycles, but use of VRIIIs fell from 60% to 20%. We presented the findings at a clinical governance meeting and discussion of the guidelines identified that multiple documents and significant text acted as barriers to implementation. Therefore, we designed a flowchart to improve compliance and placed this in theatres and pre-operative areas. We hope this initiative, in addition to local teaching, will improve peri-operative diabetic care. We plan to re-audit and consider implementing further changes if care remains suboptimal. (Figure Presented).
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INTRODUCTION AND OBJECTIVE: 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 conducted in September 2020 in the ORSI Academy, International surgical robotic training center. 47 participants with no experience but a special interest in robotic surgery, were matched and randomized into 4 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 (Figure 1a-c). CONCLUSIONS: Quality assured online learning is insufficient preparation for robotic suturing and knot tying anastomosis skills.
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Introduction & Objectives: After the onset of the COVID-19 pandemic there was a precipitous rush to implement virtual and online learning strategies in surgery and medicine. In response there appears to be a precipitous rush to implement virtual and online learning strategies in surgery and medicine which many educators (particularly in industry) appear to believe can mitigate or supplant the necessity of skills laboratory training. It is therefore essential to have a robust and evidence-based understanding of this premise and to evaluate whether this approach is sufficient and adequate for learning basic robotic surgical skills and to prepare individuals to perform a basic surgical robotic task. Materials & Methods: A prospective, randomized and multi-center study 47 participants were matched and randomized into 4 groups who underwent proficiency based progression (PBP) eLearning, eLearning without benchmarks, traditional lectures and learning from peer-reviewed published manuscripts describing the suturing, knot tying and task assessment metrics. Afterwards the PBP group had skills training under COVID secure conditions. Results: The primary outcome was the percentage of trainees who demonstrated the quantitatively defined proficiency benchmark after didactic learning. (i.e., 5-Procedure Steps completed, <10 Errors and 0 = Critical Errors). Figure 1a-c shows that none of the trainees in this study demonstrated all three proficiency benchmarks (Procedure Steps p<0.001 – 0.000;Errors, p=0.403 – 0.001;Critical Errors, 0.016 – 0.001) (Figure 1a-c). After six hands-on training trials and ~ 3 hours training all PBP trained participants met all three proficiency benchmarks. Figure 1a-c. The mean and 95% CI of procedure Steps, Errors and Critical Errors made by the four groups of trainees on the robotic surgery vesico-urethral anastomosis model relative to the proficiency benchmark for each performance metric. Also shown are how far off the proficiency benchmark performance was. (Figure Presented) Conclusions: Although better than traditional learning strategies, quality assured online learning is insufficient preparation for basic robotic surgical skills. Medicine in general but surgery and procedure-based medicine specifically would be imprudent to be overly optimistic about how effective quality assured online learning is without skills lab. training.