key: cord-0876986-sw6pb4vp authors: Nakashima, Yasuharu title: The state of the Japanese Orthopedic Association during and after the COVID-19 pandemic date: 2021-12-08 journal: J Orthop Sci DOI: 10.1016/j.jos.2021.11.007 sha: 391d5d056163a93b0a2a03edbf29bcae26bd1105 doc_id: 876986 cord_uid: sw6pb4vp nan Since early 2020, coronavirus disease 2019 (COVID-19) has swept across the globe and changed the very nature of society. As of November 2021, the fifth wave of the COVID-19 pandemic in Japan has receded, and the number of new cases has decreased. Other countries, however, are witnessing an increase in breakthrough infections in vaccinated individuals; consequently, Japan may experience a sixth wave at any moment. The spread of infection has prompted curbs on large gatherings and international travel, and this has greatly affected the Japanese Orthopedic Association (JOA) as well. This situation has demanded execution of unprecedented methods for hosting academic meetings, conducting international exchange, administering certification examinations. Under the title, "The state of the Japanese Orthopedic Association during and after the COVID-19 pandemic", we will discuss the efforts of the JOA until now and our prospects for the future. From March 2020 to April 2020, the JOA was compelled to decide whether to halt or continue various academic enterprises. When the pandemic began, people believed that it would come to an end within a few months, and a fair number of us in the JOA adopted an optimistic view that the solution was merely to postpone our certification examinations and our workshops for a short time. However, under the guidance of former JOA President Matsumoto, we reached the following consensus: "Due to the possibility that the COVID-19 pandemic may not be contained easily, we will continue our academic enterprises as much as is feasible in whatever forms we can". Consequently, the JOA's Board of Directors adopted the following basic management policy in order to adapt to the pandemic (1). The policy can be summarized into four points as below: 1. Since we cannot foresee an end to the COVID-19 pandemic, the JOA will operate under the premise that postponing our enterprises is not a viable solution. 2. The JOA will continue its mission as defined by its bylaws as much as possible; this mission includes pursuits in academia, education, and research. 3. The JOA will not be bound by precedent in its operations as it prioritizes the safety of its members and the alleviation of burdens on its members while striving to benefit them. 4. In response to COVID-19, the JOA will promote digital transformation (DX) and strive to adopt advanced digital management. This basic policy was agreed upon only several months after the first wave of the pandemic commenced. The JOA was subsequently able to conduct academic meetings, certification examinations, and workshops without delays, and therefore, we believe that we undertook the correct course of action. Owing to the growth of online meetings, committee activities have also been proceeding as they did before the emergence of COVID-19. Going forward, bearing this basic policy in mind, we at the JOA must proceed with our academic enterprises more vigorously than before without succumbing to the adverse situation created by the COVID-19 pandemic. Due to the pandemic, our three annual meetings in 2020 (the General Meeting of the JOA, the Orthopedic Research Meeting of the JOA, and the Musculoskeletal Tumor Meeting of the JOA) were all held entirely online; these were the JOA's first experiences with full-scale online meetings. Despite being in different locations, all participants could attend the same lectures and presentations and were able to share their opinions. Another major benefit of holding our meetings online was that people who were previously unable to attend these meetings due to the burden of transportation or other hurdles had the opportunity to participate. However, various problems became evident as well: difficulty in online hosting of active discussions, which forms the most important part of our meetings; technical issues in the system; fraudulent earning of credits, for example, via participation on multiple devices; and earning too many credits in one meeting, among others. The JOA has formed a working group to determine the ideal format for annual meetings and formulate meeting management policies that can be uniformly adapted during and after the pandemic. After taking into account the perspectives of infection prevention and ease of access for all our members, we agreed, through discussion, on a policy of holding all annual meetings in an in-person/online hybrid format for the next three years starting from 2021; after conclusion of in-person meetings, they will be available for streaming on demand for a certain period of time (2) . Table 1 shows the number of participants in each annual meeting since the past three years. As can be seen, in the year 2020, when meetings were held online, the number of participants in all meetings was far greater than that in the year 2019, when meetings were held in-person. Although the ease of earning credits was a crucial incentive, we can conclude that holding the meetings virtually had a massively positive impact on the number of participants. For the hybrid meetings in the year 2021, the number of participants was somewhat lower than that in the year 2020; however, it still exceeded the numbers for in-person meetings in the year 2019. The working group has also discussed an ideal format for our three annual meetings in the medium and long term. First, in response to the evidence of increased convenience for our members from holding meetings online as well as in person, the committee has discussed continuing the hybrid format even after the pandemic ends. Moving ahead, maintaining lively in-person discussions will require consideration of the appropriate number of participants for in-person as well as online participation. Another point raised is that in light of the ongoing need to prevent infections, organizing a large-scale general meeting will be difficult in terms of risk management. A proposed solution for reducing the scale of large annual meetings is to focus on education/training programs and symposia and to gradually reduce the number of free papers. However, the overall profit margins must also be considered. We would have to address the increase in expenses associated with the hybrid format as well as the reduction in the number of exhibitions that could occur as a result of scaling down the in-person aspect of meetings. In future, we must continue to discuss better meeting formats while considering the state of the COVID-19 pandemic. One of the most important enterprises of the JOA is the development and certification of orthopedic specialists. The inability to hold gatherings or any other face-to-face meetings hinders conventional methods of conducting exams. In fact, many academic societies have postponed certification examinations, some by as many as two years. In accordance with our basic policy, after considering various methods, the JOA's board of directors decided on May 23, 2020 to conduct certification examinations with Computer-Based Testing (CBT) (3). Specifically, we established proprietary sites in each of Japan's 47 prefectures where we conducted the examinations in private booths. As a measure for preventing infections, examinees who had fevers or otherwise felt unwell were prohibited from taking the exam and were instead asked to take up the exam two weeks later. On January 22 and February 5, 2021, despite several prefectures being under a state of emergency, we successfully held our certification examinations. For senior doctors-in-training and residents, the ability to obtain specialist qualifications without delay was greatly significant. However, technical issues with the system, power outages at the testing sites, and other significant problems affected 86.3% of the examinees. Potential explanations offered for these issues included a burden on the system that exceeded estimates and insufficient management of problems as they arose. Since infections will still need to be prevented going forward, reverting to previous methods would be difficult; therefore, we have decided to continue conducting certification examinations with CBT (2020e21 8th Board of Directors meeting, 2/18/2021). In order to prepare for certification examinations on Friday, January 21, 2022, we are working to prevent troubles with the system, conduct higher-stress system tests, and elaborate upon our implementation manual. During the COVID-19 pandemic, participation in joint symposia and annual meetings of international academic societies has continued to take place in online form. However, events such as traveling fellowships and the Guest Nation Program, which are the major pillars of international exchange, cannot be held. These events are based upon in-person interaction and are therefore difficult to conduct online. Currently, overseas travel and entry into Japan by foreign nationals is limited except for special cases, and people entering or returning to Japan must quarantine for a certain period of time. As a result, traveling fellowships have been suspended for the past two years; fellows cannot be dispatched or brought in, and new fellows cannot be chosen. The Guest Nation Program has faced the same problem; although we invited the Royal College of Orthopedic Surgeons of Thailand to our general meetings in the years 2020 and 2021, both of these meetings have been held online due to the pandemic. A few days ago, the JOA received a guest nation invitation from the German Society for Orthopedics and Trauma, which plans to welcome us in October 2022. We are eager for the pandemic to end so that we may resume the face-to-face exchange of knowledge that has been denied to us since the last two years. The COVID-19 pandemic has greatly changed the manner in which the JOA operates. The general meeting of the year 2020 was our first-ever meeting which was held online, and we have introduced CBT for certification examinations. Although holding meetings online has yielded a unique set of problems, they have allowed us to ensure our members' safety and alleviate their burdens, which are our top priorities. The JOA cannot go back to the way things used to be. We will strive to maximize the advantages of face-to-face and online formats and to operate meetings in a more advanced fashion as we put our members' convenience first. The minute of 2019e2020 11th JOA Board of Directors meeting The minute of 2020e2021 8th JOA Board of Directors meeting The minute of 2019e2020 12th JOA Board of Directors meeting None.Yasuharu Nakashima * Japanese Orthopedic Association, Japan Department of Orthopaedic Surgery, Kyushu University, Japan