Virtual surgical education for foundation doctors in the United Kingdom during COVID-19 pandemic: A qualitative study.

Background: Foundation training in the UK has been impacted by the COVID-19 pandemic. Surgical education in particular has been impacted due to the reduced exposure of teaching in theatres and clinics. To combat this waning exposure, an online teaching series for the foundation doctors, in affiliation with the Royal College of Surgeons of Edinburgh, was designed and delivered nationally during the pandemic. The aim of this study is to assess the feasibility and the reception of an online teaching programme to become an integral part of surgical education. Methods: A series of virtual teaching sessions lasting between 30 and 60 mintues were delivered live by senior surgical trainees and consultants to foundation trainees nationwide. Online feedback was completed after each session and the results were analysed using Microsoft Excel™. Results: 95.2% of the foundation trainees felt more confident on the subjects taught and were satisfied with the teaching series. The majority of the trainees preferred sessions which were short, held every two or three weeks, delivered by senior surgeons, covering a wide range of surgical specialties and conditions. Conclusion: An online surgical teaching series has been shown to be well received by foundation trainees. It provides a realistic opportunity to have a blended learning environment for surgical training nationally during the pandemic.

Are there benefits to maintaining Covid-19 pandemic pathways for the long-term? A surgical assessment unit based study.

BACKGROUND: The Covid-19 pandemic has led to the introduction of conservative non-operative approaches to surgical management favouring community driven care. The aim of this study was to determine the effect of these pathways on patients attending a surgical assessment unit (SAU). METHOD: This was a retrospective observational cohort study. We included all consecutive attendances to the SAU in April 2020 (Covid-19 period) and April 2019 (pre-Covid-19). The Covid-19 period saw a shift in clinical practice towards a more conservative approach to the management of acute surgical presentations. The primary outcome measure was 30-day readmission. The secondary outcome measures were length of hospital stay, inpatient investigations undertaken and 30-day mortality. RESULTS: A total of 451 patients were included. This represented 277 and 174 attendances in pre-Covid-19, and Covid-19 groups respectively. The rates of unplanned 30-day readmission rates in the Covid-19 and pre-Covid-19 periods were 16.7% and 12.6% respectively (P = 0.232). There were significantly fewer planned follow-ups in the Covid-19 (36.2%) compared to the pre-Covid-19 group (49.1%; P < 0.01; OR 1.7, 95% CI 1.15-2.51). There were no significant differences in length of hospital stay (P = 0.802), and 30-day mortality rate (P = 0.716; OR 1.9, 95% CI 0.38-9.54) between the two periods. CONCLUSION: There were no differences in 30-day readmission rates, length of hospital stay, and 30-day mortality with the changes to pathways. Our findings suggest the resource efficient conservative Covid-19 pathways could potentially continue long-term. However, further multi-centre studies with larger sample sizes and longer follow-up duration will be required to validate our findings.

High-throughput, automated quantification of white matter neurons in mild malformation of cortical development in epilepsy.

INTRODUCTION: In epilepsy, the diagnosis of mild Malformation of Cortical Development type II (mMCD II) predominantly relies on the histopathological assessment of heterotopic neurons in the white matter. The exact diagnostic criteria for mMCD II are still ill-defined, mainly because findings from previous studies were contradictory due to small sample size, and the use of different stains and quantitative systems. Advance in technology leading to the development of whole slide imaging with high-throughput, automated quantitative analysis (WSA) may overcome these differences, and may provide objective, rapid, and reliable quantitation of white matter neurons in epilepsy. This study quantified the density of NeuN immunopositive neurons in the white matter of up to 142 epilepsy and control cases using WSA. Quantitative data from WSA was compared to two other systems, semi-automated quantitation, and the widely accepted method of stereology, to assess the reliability and quality of results from WSA. RESULTS: All quantitative systems showed a higher density of white matter neurons in epilepsy cases compared to controls (P = 0.002). We found that, in particular, WSA with user-defined region of interest (manual) was superior in terms of larger sampled size, ease of use, time consumption, and accuracy in region selection and cell recognition compared to other methods. Using results from WSA manual, we proposed a threshold value for the classification of mMCD II, where 78% of patients now classified with mMCD II were seizure-free at the second post-operatively follow up. CONCLUSION: This study confirms the potential role of WSA in future quantitative diagnostic histology, especially for the histopathological diagnosis of mMCD.