key: cord-0851000-cfbwycc1 authors: Singh Aulakh, Gurnam; Duggal, Simone; Sutton, Mr David title: Findings from an OMFS Journal Club: Is COVID 19 The Catalyst We Have Needed to Embrace Technology? date: 2020-08-18 journal: Br J Oral Maxillofac Surg DOI: 10.1016/j.bjoms.2020.08.056 sha: 0bf71f95675832c8cd5752d709516f90d8372384 doc_id: 851000 cord_uid: cfbwycc1 INTRODUCTION: The COVID-19 outbreak has rapidly progressed into a worldwide pandemic and the need for social distancing has changed the way we learn and work. Our monthly OMFS journal club has been no different and is currently being performed using the video conferencing application Microsoft Teams. The use of a virtual setting for training in Medicine and Dentistry is not new, and, like in the case of our recent move to a virtual medium, it may be that COVID-19 has resulted in fast tracking this digital transformation. There are of course disadvantages to online teaching that traditional face to face teaching overcomes. We conducted a survey to examine how trainees' attitudes and experiences have altered with this change, and to understand whether some elements of this new style of training may be advantageous in the post-pandemic world. OBJECTIVES: To assess trainee attitudes towards online teaching and which, if any, elements of this new style of training are advantageous even once face-to-face teaching becomes possible again. METHODS: A survey was created for all trainees taking part in journal club meetings at Bradford Teaching Hospitals. Questions were aimed to ascertain differences in experience between online and face-to-face settings for journal club, including multiple-choice and Likert scale questions. A Wilcoxon matched pairs signed test was used for analysis of results comparing the two settings. Responses were kept anonymous. RESULTS: Results from the survey found that the majority of trainees found it significantly easier to attend journal club after it had been moved to an online setting and also indicated that the majority of trainees found Microsoft Teams easy to use when accessing journal club, though we did not have another online application for comparison. There was no significant difference in participation comfort between the two settings, though trainees felt that the online setting significantly improved learning effectiveness. Furthermore, 78% of trainees thought that online tutorials and meetings should replace traditional face to face meetings in the future. CONCLUSIONS: The use of internet technology such as video conferencing is not a new phenomenon and although journal clubs are typically held in academic institutions, online and virtual journal clubs are flourishing. With an array of advantages, there is no shying away from the trend to move our teaching over to a virtual medium. COVID-19 may have just provided the stimulus that has forced this transformation to accelerate. The COVID-19 outbreak has rapidly progressed into a worldwide pandemic and the need for social distancing has changed the way we learn and work. This paper explores the effect on training and skills acquisition in the context of a journal club within an Oral and Maxillofacial Surgery department. A number of studies have found that learning critical appraisal skills can have a positive impact on the evidence-based medicine skills of healthcare professionals. 1,2 Journal clubs are a common example of this: They are described as a "well-recognized quality improvement strategy used by health practitioners to critique and keep up-to-date with relevant health literature". 3 When critical appraisal checklists are applied they can be an effective approach J o u r n a l P r e -p r o o f to teaching critical appraisal skills; 4 a study involving Canadian paediatric surgery trainees showed a significant increase in knowledge of evidence-based medicine following Journal Club meetings. 5 In a systematic review by Deenadayalan et al, 3 it was found that "journal club activities made a significant impact on at least one outcome measure when compared with a control activity (such as lectures or general reading)". The study did concede that there was no evidence of knowledge application, and Harris et al 6 were also unable to conclude that journal clubs are effective in supporting evidence-based decision making. Other studies have reported no significant effect on outcomes from a journal club intervention. 7 The traditional journal club takes place as a discussion in a small group setting lead by faculty. 8 This same system has been utilised for the Junior Dental Trainees based at Bradford Teaching Hospitals NHS Foundation Trust. As part of this, juniors take turns in presenting and critiquing papers selected by a Senior Trainee. Prior to the arrival of COVID-19, these meetings would take place face-to-face within the maxillofacial department once monthly. However, the impact of the coronavirus has resulted in cancellation of almost all routine operating, meaning that the day-to-day running of the department and staff timetables have been drastically affected. While the effects of this are wide-ranging, the impact upon training is significant. On top of this, the advent of "social distancing" has prevented numerous meetings and conferences from taking place, with many users instead moving to video conferencing. 9 The monthly OMFS journal club has been no different and is currently performed using the video conferencing application Microsoft Teams. In addition to the change in setting, the meetings have increased in frequency to once weekly, owing to the change in clinical activity J o u r n a l P r e -p r o o f and consequent flexibility for clinicians. We conducted a survey to examine how trainees' attitudes and experiences have altered with this change, and to understand whether some elements of training may be advantageous in the post-pandemic world. A structured survey was created for all dental trainees taking part in journal club meetings at Bradford Teaching Hospitals NHS Trust. The online survey platform, surveyhero.com, was used to run this survey. A mix of Likert scale and multiple-choice questions aimed to ascertain differences in experience between online and face-to-face settings for journal club, along with opinions regarding the setting for future meetings. A Wilcoxon matched pairs signed test was carried out to assess statistical significance where question responses compare face-to-face and online setting. Responses were kept anonymous. Results were collected from all trainees involved in journal club, providing a response rate of 100% (n=14). Results from the survey and statistical analysis indicate that the majority of trainees found it significantly easier (p<0.05) to attend journal club after it had been moved to an online setting, with only one participant indicating more difficulty in accessing journal club currently (figure 1). Trainees overall found Microsoft Teams easy to use, with the majority of trainees (11/14) giving a score of 8 or more (figure 2). Furthermore, trainees generally reported that they had found their learning through virtual journal club had been more effective than face to face (figure 3). When asked how comfortable they felt when interacting during journal club, trainees on the whole gave relatively similar answers between face-to-face and online meetings, and the difference was found to be statistically insignificant, though an accurate p-value was not calculable due to the number of identical responses from individual trainees for both questions. (figure 4 ). Trainees generally found that they had more time to read over and critique papers in preparation for journal club (figure 5), with 12 out of 14 trainees giving a Likert score of 7 or higher for the current, online journal club. There was a statistically significant increase in Likert scale scores for the online journal club. Most (10/14) trainees also felt that journal club would benefit from remaining online ( figure 6 ). When asked "Do you think that online tutorials and meetings should replace traditional face to face meetings in the future?", 78% (11 trainees) responded with a combination of both, 14% said yes and only 7% said no. Trainees found the virtual, Teams based journal club significantly easier to access than the "pre-COVID", face-to-face, arrangement. This may be due, in part, to the logistical difficulties J o u r n a l P r e -p r o o f in attending a meeting in a specific location, at a certain time in the working day, as many trainees will be timetabled to clinical activity in settings away from the main Hospital. This finding concurs with the comments of McGlacken-Byrne et al: 10 "Face-to-face meetings that adhere to rigid schedules do not suit healthcare professionals who work different shift patterns or who are geographically isolated". The use of a virtual setting for training in Medicine & dentistry is not new & has taken many forms. Early proponents made use of online discussion forums and blogs, 11 and progressed to Twitter. 12, 13 These types of internet-based forums have the potential to reach a global audience. A recent study by Jabotinsky and Sarel 14 found that a move from face-to-face conversation to virtual communication does not necessarily lead to a loss of information. While we did not test retention of information, the participants considered the Teams webbased learning to be significantly more effective than face-to-face. Some studies have highlighted that moving away from a formal, hospital setting can add to the acceptance of the journal club itself. 15 Indeed, this was a characteristic of the very first journal club held outside St Bartholomew's Hospital. 16 One element that is likely to affect the acceptability of the journal club is the approach & attitude of the senior faculty / trainers. The face to face journal club had minimal senior Consultant input whereas the virtual journal club has, more often than not, had Consultant level input. This was previously not possible as the journal club was held at the same time as the monthly Consultant's meeting and this change has resulted in an injection of experience and knowledge to discussion. Though the subject of each paper is carefully chosen by the J o u r n a l P r e -p r o o f organising Senior Trainee, the authors can unequivocally state that the added expertise of a Consultant weighing in will only benefit the learning experience of all involved. Ahmadi et al 17 stated that "faculty involvement may be a key factor to both online and moderated journal clubs". However, it is important to remain mindful that some authors warn that senior clinicians might contribute disproportionately to discussions 10,18 , so maintaining a flat hierarchy when discussing papers is important. Our survey found that trainees' level of comfort when participating did not change significantly between face-to-face and online meetings, though this does not consider the fact that a Consultant was not present at any face-to-face meeting and therefore may have affected responses for online meetings. Traditional face to face training allows participants to be part of a group and collaborate thoughts and ideas in a discussion. Although this social element can be replicated online, and a team can still collaborate just as effectively, the interaction that comes with web based learning can result in participants feeling isolated, 19 which has already been identified as a problem with recent social distancing and isolation guidelines as a result of the pandemic. 20 A study of an instant-messaging based journal club also found that some participants felt intimidated or not included. 21 The Facilitator for the online learning needs to be aware of this potential isolation, & also the lack of non-verbal communication. They will need strategies to include participants by asking questions & inviting comments Though our results found a statistically significant improvement in time availability for trainees to prepare for the meeting, this may have more to do with increased timetable flexibility due to the raft of changes brought about by the COVID-19 pandemic rather than inherent differences between face-to-face and online settings. Additionally, virtual journal clubs may advantage those more comfortable with use of technology 10 in terms of access and utilising the application's features. A successful meeting in this setting also requires each participant to have a stable internet connection, which might mean that the learning experience of those with a weaker connection may suffer. Our survey findings indicate that the majority of trainees found Microsoft Teams easy to use when accessing journal club (figure 2), though we did not have another application to compare. The use of internet technology such as video conferencing is not a new phenomenon and although journal clubs are typically held in academic institutions, online and virtual journal clubs are flourishing. Our findings from this study have shown significant advantages of online journal clubs over face-to-face settings, though our small sample size may pose questions over the actual significance of these results. There is no shying away from the trend to move our teaching over to a virtual medium. 13 It may be that COVID-19 was the catalyst that has resulted in fast tracking this digital transformation. global approach to a traditional teaching tool. Tropical Doctor 50, 49-53 (2020). 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