key: cord-0988267-6cw6m204 authors: Raja , Balgovind S.; Choudhury, Arghya Kundu; Paul, Souvik; Rajkumar, Surjalal; Kalia, R. B. title: Online educational resources for orthopaedic residency—a narrative review date: 2021-06-02 journal: Int Orthop DOI: 10.1007/s00264-021-05101-6 sha: f6a28ef88e2e1314abaa03a18a726d97bcd7a110 doc_id: 988267 cord_uid: 6cw6m204 PURPOSE: Residency programs in the medical education field are considered the keystone in the development of aptitude and skills required for practice. With the worldwide current scenario of the COVID-19 pandemic, there has been a shift in the paradigm especially in the teaching of the residents from face-to-face classes to more and more online sessions. The purpose of this study is to present a compendium of knowledge-providing sites, smartphone applications (apps), YouTube channels, and podcasts that can provide better online resource management for students in the field of orthopaedics. METHODS: Search terms were used for making a list of various online resources which can be of help during orthopaedic residency. An initial list of the selected websites, smartphone apps, podcasts, and YouTube channels was made. The corresponding author with years of teaching experience and faculty for post-graduate and fellowship training programs then selected the final list. RESULTS: A list of 16 websites with brief points on their content and online address along with the availability of free or paid content was identified as being appropriate. A total of 39 apps available for android/apple smartphones, nine podcasts, and 11 YouTube channels were also identified as being extremely useful and have been discussed elaborately in this article. CONCLUSION: Online educational tools are of immense importance in imparting adequate knowledge to an orthopaedic resident and act as an adjunct to conventional teaching methods. This article focuses on presenting various online educational resources in a simple yet concise way, which may be beneficial for the current generation of residents especially in this current time of unprecedented COVID-19 pandemic. Residency programs in the medical education field are considered to be the keystones in the development of aptitude and skills required for practice. The education that residents or students imbibe during their residency ushers them forward to face the difficulties that they may encounter in the future and prepares them with problem-solving skills. Various methods of teaching exist in the curriculum [1] . These may be face-to-face classes, didactic lectures, group discussions, webinars, or conferences [1] . The years one needs to spend in a residency program differs from country to country but the essence of education remains the same [2] . The coronavirus disease-2019 (COVID-19) pandemic without a doubt has created a big hole in the residency programs all over the world with restrictions imposed in the form of social distancing and curtailment of routine surgery [3] [4] [5] [6] . Face-to-face classes and case presentations have seen a drastic decrease in usage limiting the student's learning opportunities [3, 7, 8] . Moreover, the decreased volume of surgery has also made hands-on training and learning more difficult [8, 9] . With the current scenario of the COVID-19 pandemic, there has been a shift in the paradigm especially in the teaching of the residents [10, 11] . Earlier, face-to-face interaction was considered the gold standard for medical education, and the need for maintaining up-to-date knowledge in the field was made possible by subscription to various online specialty-specific journals [12] . The skills needed for surgery were obtained from assisting surgeries first-hand and learning from the masters. Other than these, learning from seminars, journal clubs, hands-on training in cadaveric labs, and surgical skill labs were the usual norm in various surgical residency programs [12, 13] . Recently, online educational tools and platforms such as Google Meet, Microsoft Teams, and Zoom have been increasingly used for knowledge sharing and the faculty, as well as the residents alike, are using these platforms extensively [14] . Although faceto-face educational activities remain valuable [15] , there has been consensus about spreading infections during these serious times. Online tools such as websites with resources relevant to orthopaedics [16] , podcasts, smartphone applications (apps), and YouTube channels are all good sources of information and study material for the budding residents [8, 17, 18] . With the vast number of sites, apps, and varied options available online, it is difficult to select the one with good content, usefulness, and functionality. Orthopaedics is the branch that deals with the diseases of the bones and soft tissues in general. Just as in other specialties, orthopaedics also lays special emphasis on the education of residents. The invention of smartphones and the easy accessibility of the internet over the past few decades have increased the availability of resources that one can access for study [19] . The sheer number of sites and resources makes it difficult to choose and decreases the probability for the residents and budding surgeons to identify the ones with quality and usefulness. The purpose of this study is to present a compendium of knowledge-providing sites, smartphone apps, YouTube channels, and podcasts that can provide better resource management and be valuable for students in the field of orthopaedics. The study was conducted over three months from November 2020 to January 2021. The roles of the authors were defined before the study was conducted. The first and second authors were responsible for the initial search and preliminary list development. The third and fourth authors were involved in the final selection which was reviewed by the fifth author. Four online resources were searched for orthopaedic content and their usefulness. These included the online websites with orthopaedic information useful for residents, smartphone apps that have tools helpful for residents, podcasts that focus on academics, and YouTube channels that had videos on orthopaedic topics and surgical procedures. The inclusion criteria used were English language as the communicating medium, resources directed for orthopaedic learning, videos of surgical exposure or implants, and lectures. Online resources that focused on patient education were excluded. The search term used for online websites was "orthopaedics" AND "learning" in the Google search engine with advanced search settings kept as language -English, region -any region, last update -anytime, terms appearing -in link to the page, show explicit results, file type -any type and usage type -not filtered by license. The resources searched that were directed with an aim for academics or can be used as an educational tool for orthopaedics residents were selected. The smartphone apps were searched in the Google Play Store and the App Store for iPhone. The search terms used in combination were Orthopaedic/Orthopedic(s), orthopaedic surgery, musculoskeletal, bones, and fracture. The apps searched were listed with a focus on their content, functionality, rating, and tools available for academics or surgical planning. Podcasts were searched in iTunes, Google Play Music, and Spotify with search terms "Orthopaedic/Orthopedic(s) podcasts". Podcasts that shared educational resources were selected. YouTube was also searched for channels that are dedicated to academics and learning surgical skills in orthopaedics using the search terms "orthopaedics learning/orthopaedics", "orthopaedic surgery", and "academics in orthopaedics". Those channels with less than three thousand subscribers were excluded. Contents of these YouTube channels were scrutinized based on patient education specific or surgeon/resident directed. Only channels with educational materials related to orthopaedic surgery catering to the interests of a physician or trainee residents were included. An initial list of the selected websites, smartphone apps, podcasts, and YouTube channels was made. The third and fourth authors who are part of post-graduation and fellowship programs then selected the final list, which was reviewed and approved by the fifth author. The data were collected in Microsoft (MS) Excel sheet initially and due to the descriptive nature of the current study, no comparative analysis was considered. The online search of websites delivered 27,900 results. An initial list of 489 websites that had orthopaedic resources was made and out of this, 13 sites were chosen. Three sites that were not obtained in the initial search results were added by a manual search, making a total list of 16 websites (Fig. 1) . The complete list of the websites with a brief point on their content and address along with the availability of free or paid contents is presented in Table 1 . The search for smartphone apps in the Google Play Store and Apple Store delivered 41 and 129 results, respectively. Out of these, 53 apps were selected for the initial list. The final list was then subsequently selected and contained a total of 39 apps. Table 2 describes the apps available in smartphones or iPads that residents can take advantage of in learning key concepts. The podcasts search delivered a total of 22 results. The final list contained nine podcasts which are detailed in Table 3 . The total number of results during YouTube search could not be calculated as search results in YouTube do not show the volume. A thorough search was done using the criteria and an initial list of 30 channels was made. The final list after a thorough review gave 11 results. These are listed in Table 4 . The COVID-19 pandemic has brought forward an unexpected dilemma in the field of medical education especially in the surgical branches. The influx of a large number of COVID-19 patients into the health care setup had led to an overburden on the existing medical infrastructure. Moreover, with the need to limit the social interaction between individuals, the residency programs have been compelled to reinvent themselves to continue imparting quality learning experiences to the residents. Pertinent to human character, the need for improvisation leads to the development of newer methods to impart training. The medical education field is dynamically changing to adapt to the new normal. Alternative modes of education and the use of online resources for the betterment and knowledge sharing are being increasingly adopted. A large number of orthopaedic websites [16] are often one click away and are easily available using smartphones and laptops or on personal computers. With the widespread usage of internet facilities around the world, it has become easier for residents to access these websites within a few moments. This kind of electronic resource utilization has been seen throughout other specialized branches of medicine [20] as well as surgical [21] residents, indicating the recent trend of incorporation of technology in learning. Unlike the situations in the past where the residents need to consult a senior or need to visit the library to enhance his/her knowledge, it has become a lot more easier and effective method to look in these sites for information. The study by Sherman et al. [22] revealed that 44.9% of the online educational contents were easily accessible through an internet search. It was also shown by Rogers et al. that Orthobullets has a very high rate of usage (99.5%) among their study subset of residents [17] . A lot of websites have resources for orthopaedic training but only a select few have high quality with an excellent interface, user-friendly nature, design, and functionality. Websites like Orthobullets, Orthopaedic principles, AOtrauma foundation website, VuMedi, and Global Health.org all have an excellent user interface and highquality material that act as adjuncts to the resident training programs [17] . The invention of smartphones has revolutionized the scenario of education and the present generation of residents are more technologically advanced and can easily access the content on the internet [19] . There exist numerous apps that residents can access for e-learning. The functionality of these apps exceeds far more than the websites. There exist apps which one can measure angles, plan surgeries, learn about anatomy, learn academics, keep one updated with recent articles and implant details, etc. But, there are concerns regarding the content and validity of the information shared. It is upon the user to ascertain whether the information provided is credible or not. One can use these apps based on the publisher's reputation. The apps of the AAOS, Orthobullets, and surgical planning apps such as Surgimap, MediCAD, TraumaCad, AO group, Stryker, Acumed, and Arthrex are of special mention wherein the details are trustworthy [17, [23] [24] [25] . Similar to smartphone apps, YouTube has become the medium of sharing videos. As high as 86% of the respondents suggested they were most commonly used in the study by Rapp et al. [26] . Also, video-based education has been emphasized for surgical training [27] and the effectiveness of YouTube as a surgical teaching tool has been already described [28] . One can access the videos of seminars, lectures, surgical exposure videos, and various surgical techniques according to their need. Hence, it would be very useful for the residents to refer to these selected channels for gaining adequate knowledge and information whenever required. Podcasts refer to episodic series of spoken word digital audio files that a user can download to their device for easy listening (Wikipedia). Most of the podcasts can be accessed by streaming apps such as iTunes or Spotify. Orthopaedic podcasts that are helpful in learning are very few. Mostly these podcasts are for patient education and are not directed towards the education of the budding physicians. Orthobullets podcasts seem to contain the maximum educational audio clippings among the lot and are more precise with the knowledge it imparts. It becomes an easy additional option for the residents [29] to access these online audio lecture clippings whenever required. Although the present study highlights various online orthopaedic learning resources concisely, it has some limitations worth mentioning. Being a narrative review, it becomes less important than a systematic review which is much more superior according to evidence-based medicine. One should always strive for a systematic review but the immense number of websites and channels in YouTube make it an exhaustible task. The final selections were made by experienced surgeons on the basis of their assessment. There may be bias in not selecting a few other relevant online educational tools. Online educational tools are of immense importance in imparting adequate knowledge to an orthopaedic resident and acts as an adjunct to conventional teaching methods. With the technological advancements and easy accessibility in modern times, they are gradually becoming more and more acceptable among the group of young residents and trainees. This article focuses on presenting various online educational resources in a simple yet concise way, which may be beneficial for the current generation of residents and trainees in orthopaedics. Ethics approval Approval from the institutional ethics committee was not required for this review article. 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