Virtual learning in orthopedics: Continue to adapt, find ways to build with new technology

Last updated: 05-06-2020

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Virtual learning in orthopedics: Continue to adapt, find ways to build with new technology

Throughout the novel coronavirus pandemic, social distancing efforts have been effective in lowering the viral spread. While an orthopedic residency program normally comes together for weekly didactic education, there has been a significant adjustment in the setup and locale of these sessions. Unfortunately, the large gatherings of residents, attendings, students and administrators are currently prohibited and have no near-term end date.

Educational rounds are now being held over proprietary video conferencing software, enabling a streamlined approach to share data, information and educational materials. This setup has been in use for only the past few weeks since the original New York State pause mandated by Gov. Andrew Cuomo.

Thus far, these sessions have been successful. Feedback has been extremely positive and the education of residents, students and attending physicians is getting done. As we look beyond the pandemic, learn from the past and approach our “new normal,” we must question whether these adjustments should have a permanent placement in our curriculum.

Traditionally, orthopedic journal clubs would be held in restaurants or private residences during a cocktail hour-type setting. Invited members sat among residents and students while indulging and participating in small talk. The environment was not always conducive to learning, but it got done. Distractions from food and drink, other patrons’ conversations and also the constrained time and location resulted in less than ideal feedback. While measures were taken to enhance the experience, much room for improvement was available. As such virtual journal clubs have been able to provide a seamless setting for disturbance-free learning with limited distractions.

Digital technology has been thrust into the spotlight as a result of the COVID-19 pandemic. The adoption of digital technology has been paramount to stay afloat in the clinical spectrum, as well as in the education arena. Now, more than ever, residency programs have been forced to adjust to new norms, albeit for an unknown timeframe. As a result, the delivery of educational content has relied more on the internet and virtual than previously done. Access to attending surgeons has become easier with lighter, more defined schedules that precluded previous involvement. The virtual setup enables residents and medical students the benefit of greater flexibility and not having to concern themselves with other logistics and timing constraints.

My question is whether this technology and way of learning is here to stay. Virtual learning is likely not new to today’s generation of residents and medical students. Most, if not all, have had some form of video- or internet-based learning while in medical school and possibly college. There was streaming of lectures made available by some institutions; these lectures were available for students to consume at a convenient time or replay for additional focus or study. If students wished to handle other tasks in the morning instead of focusing on their pharmacology lecture, they could review it on their own time. Furthermore, if the lecturer is not the most engaging speaker, students may wish to increase their talking speed, thus sitting for a lecture in less time.

Virtual learning also has been implemented via virtual reality proprietary systems. Studies published demonstrate its effectiveness, but concerns exist on its ability to translate to real life care. As elective surgeries were put on hold, procedural-based residency programs dashed to various virtual reality learning companies and modules to better enhance education. While this may certainly supplement the void that currently exists, it will likely be here for the long term and continue to enhance one’s approach to mastering surgical techniques.

Overall, this technology is here to stay. We pivoted quickly. Not only are we effectively implementing video technology to educate our patients through telehealth, but we are educating each other and the future members of our profession. Gatherings of all different sizes, from various locations across the globe, enable an exchange of information and ideas that benefit everyone. The advantages and opportunities are mainstay and will continue to evolve. As new platforms come to the forefront with emerging technologies, educational programs will be easily formed to meet the goals of each trainee and subspecialty.

Although our current battle with COVID-19 has produced innovative measures to maintain a sense of normalcy, these virtual learning modalities are staying. It is incredible how some of our seasoned attendings were able to shift and participate in virtual learning with limited issue as well. Digital technology within orthopedics will not prevent “old school” medicine from occurring; it will not disrupt existing systems in place that have been so reliable in the past. We must continue to adapt and find ways to build with new technology. We must advance and adjust to the changing times and incorporate these into our musculoskeletal educational agendas going forward. As such, once we are on the opposite side of this pandemic, it is likely that our educational models will be fundamentally changed forever.

Adam Bitterman, DO, is an assistant professor of orthopaedic surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He is a board certified, fellowship trained foot and ankle orthopedic specialist and has a focus in treating conditions of the lower leg. His clinical interests include arthritis of the foot and ankle, deformity correction, Achilles tendon disorders, and sports-related injuries to the ankle and foot.

Throughout the novel coronavirus pandemic, social distancing efforts have been effective in lowering the viral spread. While an orthopedic residency program normally comes together for weekly didactic education, there has been a significant adjustment in the setup and locale of these sessions. Unfortunately, the large gatherings of residents, attendings, students and administrators are currently prohibited and have no near-term end date.

Educational rounds are now being held over proprietary video conferencing software, enabling a streamlined approach to share data, information and educational materials. This setup has been in use for only the past few weeks since the original New York State pause mandated by Gov. Andrew Cuomo.

Thus far, these sessions have been successful. Feedback has been extremely positive and the education of residents, students and attending physicians is getting done. As we look beyond the pandemic, learn from the past and approach our “new normal,” we must question whether these adjustments should have a permanent placement in our curriculum.

Traditionally, orthopedic journal clubs would be held in restaurants or private residences during a cocktail hour-type setting. Invited members sat among residents and students while indulging and participating in small talk. The environment was not always conducive to learning, but it got done. Distractions from food and drink, other patrons’ conversations and also the constrained time and location resulted in less than ideal feedback. While measures were taken to enhance the experience, much room for improvement was available. As such virtual journal clubs have been able to provide a seamless setting for disturbance-free learning with limited distractions.

Digital technology has been thrust into the spotlight as a result of the COVID-19 pandemic. The adoption of digital technology has been paramount to stay afloat in the clinical spectrum, as well as in the education arena. Now, more than ever, residency programs have been forced to adjust to new norms, albeit for an unknown timeframe. As a result, the delivery of educational content has relied more on the internet and virtual than previously done. Access to attending surgeons has become easier with lighter, more defined schedules that precluded previous involvement. The virtual setup enables residents and medical students the benefit of greater flexibility and not having to concern themselves with other logistics and timing constraints.

My question is whether this technology and way of learning is here to stay. Virtual learning is likely not new to today’s generation of residents and medical students. Most, if not all, have had some form of video- or internet-based learning while in medical school and possibly college. There was streaming of lectures made available by some institutions; these lectures were available for students to consume at a convenient time or replay for additional focus or study. If students wished to handle other tasks in the morning instead of focusing on their pharmacology lecture, they could review it on their own time. Furthermore, if the lecturer is not the most engaging speaker, students may wish to increase their talking speed, thus sitting for a lecture in less time.

Virtual learning also has been implemented via virtual reality proprietary systems. Studies published demonstrate its effectiveness, but concerns exist on its ability to translate to real life care. As elective surgeries were put on hold, procedural-based residency programs dashed to various virtual reality learning companies and modules to better enhance education. While this may certainly supplement the void that currently exists, it will likely be here for the long term and continue to enhance one’s approach to mastering surgical techniques.

Overall, this technology is here to stay. We pivoted quickly. Not only are we effectively implementing video technology to educate our patients through telehealth, but we are educating each other and the future members of our profession. Gatherings of all different sizes, from various locations across the globe, enable an exchange of information and ideas that benefit everyone. The advantages and opportunities are mainstay and will continue to evolve. As new platforms come to the forefront with emerging technologies, educational programs will be easily formed to meet the goals of each trainee and subspecialty.

Although our current battle with COVID-19 has produced innovative measures to maintain a sense of normalcy, these virtual learning modalities are staying. It is incredible how some of our seasoned attendings were able to shift and participate in virtual learning with limited issue as well. Digital technology within orthopedics will not prevent “old school” medicine from occurring; it will not disrupt existing systems in place that have been so reliable in the past. We must continue to adapt and find ways to build with new technology. We must advance and adjust to the changing times and incorporate these into our musculoskeletal educational agendas going forward. As such, once we are on the opposite side of this pandemic, it is likely that our educational models will be fundamentally changed forever.

Adam Bitterman, DO, is an assistant professor of orthopaedic surgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He is a board certified, fellowship trained foot and ankle orthopedic specialist and has a focus in treating conditions of the lower leg. His clinical interests include arthritis of the foot and ankle, deformity correction, Achilles tendon disorders, and sports-related injuries to the ankle and foot.


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