key: cord-330728-tul659fr authors: Zaed, Ismail; Tinterri, Benedetta title: How is COVID-19 going to affect education in neurosurgery? A step toward a new era of educational training date: 2020-06-11 journal: World Neurosurg DOI: 10.1016/j.wneu.2020.06.032 sha: doc_id: 330728 cord_uid: tul659fr nan Despite being underestimated during the isolation of the first cases in Wuhan, China, back in December 33 2019, severe acute respiratory syndrome coronavirus (SARS-CoV-2) has dramatically changed the world 34 from that moment. Nowadays approximately half of the world's population is or has been in some form of 35 lockdown with almost all countries imposing travel restrictions in an attempt to retard the spread 1 . 36 The medical staff has always been at higher risk of contagious diseases compared to the general population. 37 Knowing that COVID-19 can be transmitted even from asymptomatic individuals, the risk is multiplied 2 , 38 evaluated to be about 29% higher 3 . As a consequence, this pandemic has necessitated a dramatic paradigm 39 shift in terms of interaction among health care professionals. Many medical offices have either made the 40 transition to telemedicine or greatly reduced their patient volumes to accommodate the widely accepted 41 "social distancing" recommendation by the World Health Organization (WHO) and the United States COVID-19 has forced us to rapidly adapt, integrate, and use technology to help us survive during these 46 challenging times. To avoid an interruption of residency and fellowship training programs in neurosurgery, it 47 has been imperative to find a strong integration among the different technologies and tools now available. 48 Here we briefly discuss the emerging educational delivery methods and the utilization of technology 49 platforms, some that already exist, some that must be developed further in response to COVID-pandemic. 50 Because of the full schedules of residents in neurosurgery, it very difficult for them to attend daily or weekly 52 educational activities or even multiple conferences under normal circumstances. In fact, trainees have 53 variable timetables, often making attendance of educational activities, such as grand rounds and journal clubs 54 difficult and stressful. Virtual attendance using web-based services may be helpful to overcome these issues. 55 Virtual meetings allow us to connect and educate the future class of neurosurgeons from the safety of their 56 own homes. In such a difficult moment, it should be asked how we could improve the use of virtual meetings 57 up to the point of allowing conferences at national and international scales. Another point of discussion 58 should be the real possibility of these new types of meetings to become the new standards, somehow offering 59 the same benefits of physical encounters, such as case-based panels with questions and answers and the 60 possibility of networking for the younger doctors 6 . Some of the possible flaws could include the risk of 61 losing passion live question and answer sessions, due to broadcasting delays, and the decision of some 62 presenters to answer to selected questions, which may be found frustrating to the public. All virtual meetings 63 will be considerably different from the traditional ones where there are the chances to see live surgeries in the job's duties and focus in a rigorous way in the training session. Even if the assumptions of these 68 technologies are great, there are still a lot of questions that are waiting for an answer, such as if the same 69 feeling of involvement could be achieved, if the environment could be a strong source of distraction, if there 70 will be any technological malfunction that will take away from the educational experience and if the 71 responsibility to report to work will take over. 72 As a profession, we must critically evaluate the value of face-to-face interaction and whether virtual 73 meetings can serve as a substitute, particularly in a field that is dependent on human interaction and technical 74 skills? Additionally, we must ask ourselves if these technology platforms afford the same networking 75 opportunities as an in-person event. 76 Because of the pandemic, all the universities in countries where lockdown has been established had to 78 include distance learning as part of the curriculum. Many neurosurgical societies and associations have also 79 already added educational materials on their websites 7 . E-learning is based on using technologies to educate 80 a certain class of people outside the traditional spaces. One of the potential advantages of this form of 81 learning is that the teachings can be live or can be pre-recorded, allowing participants to both see the lectures 82 at their own pace and even provide the opportunity to go back and review what they have already learned. 83 Also, this modality can claim the advantage of having already several programs that are commonly used, 84 such as Blackboard, Moodle, Vista, or Angle. These programs allow some forms of interaction since they 85 present features such as chat and messaging 8 . E-learning opportunities are not limited to these procedures; in 86 fact, webinars and podcasts can be added to this list of educational tools for participants. Obviously, the 87 attendance of these sessions can be recorded, allowing also to provide continuing medical education (CME) 88 credits. Also, in this case, this type of technology allows overcoming problems related to locations and 89 scheduling constraints, reducing also in a significant way the associated costs. E-learning platforms could be 90 also used to try to provide a more heterogeneous formation among the different programs, which could also 91 rely on national and international experts. 92 Technology is a powerful tool that will likely emerge to enhance educational experiences but should not 93 serve to be the sole replacement. boost the surgeon's confidence and reduce the steepness of her/his learning curve, especially with 106 technically-demanding procedures 10 . These simulations are not resident-dependent; in fact, they need to be 107 supervised by experts who should be able to evaluate the performance of residents and suggest to them how 108 to improve their skills. Residents' performance should be also recorded, not only for the supervisors' 109 evaluation, but also to be able to track signs of progress over time. Despite being a very promising 110 technology able to influence neurosurgical training, several barriers still need to be defeated, such as the 111 expensiveness of the acquisition, the significant amount of space that many hospitals and programs do not 112 have for its installation and the fact that even the most modern simulators allow the performance of only a 113 few specific procedures. 114 Even if it is a well-established area, there is still the need to study to better understand if the skills learned on 115 the simulators could be transferred in the operating rooms 11,12 . Other concerns arise about the use of surgical 116 simulators, such as the fear that they can compromise the learning of nontechnical skills essential to patient 117 care and the need to find the right balance between the simulation-based, cadaveric skills training, and live 118 surgical cases. 119 Even if they started to be appreciated in medical fields only in the most recent years, virtual reality (VR) 121 technologies have been widely used in other fields, such as entertainment industries, for some time already, 122 with great results. VR aims to make the subject visualize a realistic three-dimensional environment, able to 123 provide feedback from the subject's actions 13 . In more recent times, VR technologies started to be used also 124 in surgical fields, allowing an enhanced training of surgical skills. 125 It is possible to imagine that in a near future, virtual meeting platforms can be combined with VR 136 technology to provide participants with a real-time feel compared to watching a screen, improving different 137 aspects of the meetings, such as watching live surgeries, being able to interact with the surgical team. 138 Nowadays, it is widely accepted that Mobile-based apps are to be considered an important source of learning The future of neurosurgical training is rapidly evolving. This evolution is partially due to the increasing 174 integration with technologies and its strong innovations abilities. The modern society puts an increasing 175 pressure on surgical staff to deliver high-quality patient care and, to do so, it is important to find new ways to Acquisition of data: All authors. Analysis and 201 interpretation of data: All authors. Drafting the article: All authors. Critically revising the article: All authors Consent: No consent was needed for publication of this study Severe acute respiratory syndrome coronavirus 2 228 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges Clinical Characteristics of 138 Hospitalized Patients With Coronavirus-Infected Pneumonia in Wuhan, China Public Health Recommendations after Travel-Associated COVID-19 Exposure Coronavirus disease (COVID-19) advice for the public. World Health Organization Coronavirus disease 2019 The Changing Face of Orthopedic Education: 240 Searching for the New Reality After COVID-19 Innovations in neurosurgical education 243 during the COVID-19 pandemic: is it time to reexamine our neurosurgical training models? 244 Zaed I. COVID-19 consequences on medical students interested in neurosurgery: an Italian 265 perspective Abbreviations: three-dimensional (3D); Virtual reality (VR) COVID-19); Centers for 270 World Health Organization (WHO)