Emerging role of online virtual teaching resources for medical student education in plastic surgery: COVID-19 pandemic and beyond.

Dear Sir,

On March 17th, 2020, the Association of American Medical Colleges released a communication recommending that medical students be withdrawn from all clinical rotations. While the duration for which this pause will persist remains elusive, the acute need for social distancing and shortages in personal protective equipment are likely to keep medical students at a distance from clinical learning environments for some time. As the pandemic continues to unfold, online and virtual teaching resources are set to play a larger role in the continuity of medical education, particularly for medical students who remain interested in pursuing postgraduate training in plastic and reconstructive surgery.

To address this educational disparity, the American Society of Plastic Surgeons (ASPS) announced on April 13th that all medical students with an interest in plastic surgery may now obtain free access to its online Education Network (EdNet). This program offers over 90 learning modules spanning eight curriculum branches, each with didactic lectures, case discussions, suggested readings, as well as pre- and post-module tests. Medical students interested in this resource may register by contacting their local plastic surgery program coordinator, or may do so directly by filling out this communicated link.

In light of this ongoing need, the authors sought to survey and report on all presently available learning resources for medical students seeking to maintain or advance their education in plastic surgery, during time away from formal clinical rotations and beyond. A search was performed using a variety of databases and sources, including the google search engine, social media platforms, international plastic surgery society websites and recently released communications. Available resources were evaluated for their utility and accessibility to medical students, and a total of 18 resources, spanning 7 major categories, were identified. These included online educational networks (n=1), virtual grand rounds (n=3), webinars (n=6), journal clubs (n=2), anatomy instructional video channels (n=2), smartphone and tablet applications (n=2), as well as online clinical resources (n=2). A detailed summary is presented in Table 1 , complete with links to each of the resources identified, resource descriptions, sample topics covered, as well as pricing information; all resources were free of charge either directly or through institutional subscriptions available to medical students.

Table 1

Medical Student Educational Resources for Plastic Surgery.

Category	Subject Area	Resource / Provider	Cost	Description	Sample Topics Covered	Available Videos / Recorded
Online Education Network	All Plastic Surgery	American Society of Plastic Surgeons Education Network (EdNet)	Free	Learning modules and interactive case reports across eight broad curriculum sections. Each module includes a pre-test, journal article readings, audio slide lecture, typical oral board case, additional resources, and a post-test. Available free of charge until October 16th for medical students.	• Fundamentals of Surgery• Head and Neck Plastic Surgery• Plastic Surgery of the Upper and Lower Extremity, Breast, and Trunk	Yes
Virtual Grand Rounds	All Plastic Surgery	American Society of Plastic Surgeons Virtual Grand Rounds	Free	Grand rounds hosted by expert faculty sharing knowledge and experience on topics covering the breadth and depth of the plastic surgery specialty.	• Contemporary Management of Lower Extremity Amputation• Nerve Transfers for Upper Extremity Reconstruction• Facial Paralysis	Yes
Virtual Grand Rounds	All Plastic Surgery	Yale University Virtual Grand Rounds	Free	Weekly virtual grand rounds for plastic surgery teaching.	• Postoperative Pain Management in Plastic Surgery	n.s.
Virtual Grand Rounds	All Plastic Surgery	UC San Diego Virtual Grand Rounds	Free	Weekly virtual grand rounds for plastic surgery teaching.	• Becoming Consistent in Rhinoplasty• International Humanitarianism and Microsurgery	Yes
Online Clinical Resource	All Plastic Surgery	Continuing Medical Education (CME) Articles	Free;Institutional Subscriptions	Monthly Continuing Medical Education articles published in the Journal Plastic and Reconstructive Surgery	• Masculinizing and Feminizing Gender Surgery• Advancements in Implant-Based Breast Reconstruction• Flap Reconstruction of the Hand	n/a
Online Clinical Resource	Upper Extremity	Ortho Bullets	Free	Free and personalized adaptive learning system, resource, and virtual curriculum; 92 upper extremity learning topics.	• Flexor Tendon Injuries• Extremity Flap Reconstruction• Amputations and Replantations• Various Hand and Wrist Fractures	Yes
Journal Clubs	All Plastic Surgery	Plastic and Reconstructive Surgery	Free	Monthly journal clubs discussing 3 selected articles.	• Direct-To-Implant Prepectoral Breast Reconstruction• Pediatric Hemifacial Atrophy	Yes
Journal Clubs	Aesthetic Surgery	Aesthetic Surgery Journal	Free	Aesthetic Surgery Journal Articles discussed	• Blepharoplasty Anatomy, Techniques and Safety Considerations• Use of Scaffolds in Revision Breast Surgery	Yes
Online Webinars	All Plastic Surgery	University of California Los Angeles MDChat Webinars	Free	UCLA MDChat Webinars discuss recent advances and current management strategies by expert surgeons from UCLA on diverse plastic surgery topics.	• Craniosynostosis Management• Scar and Keloid Management• Congenital Ear Anomalies	Yes
Online Webinars	Upper Extremity	American Association for Hand Surgery Webinars	Free	Free weekly educational webinar program healthcare professionals around the world.	• Pediatric Hand, Wrist and Forearm Trauma• Congenital Upper Extremity Conditions• Pediatric Elbow Fractures	Yes
Online Webinars	Upper Extremity	American Society for Surgery of the Hand Webinars	Free	Webinars featuring ASSH members discussing a variety of topics pertaining to upper extremity surgery.	• Atypical Nerve Compression• Complications of Hand Fractures• Pediatric Hand Trauma	Yes
Online Webinars	Craniofacial Surgery	AO CMF Webinars	Free	AO CMF is a multi-specialty community consisting of clinicians from all around the world, offering webinars on a wide range of topics such as oral and maxillofacial surgery, plastic surgery, ENT, head and neck surgery, ophthalmology, and neurosurgery.	• Microsurgery in Craniomaxillofacial Reconstruction• Temporalis Flaps for Midfacial Reconstruction	n.s.
Online Webinars	Craniofacial Surgery	Baltic Sea Community of Orthognathic Surgery and Orthodontics Webinars	Free	BSCOSO provides a series of webinars that unite a number of national and international speakers around the world, focusing on topics pertinent maxillofacial and craniofacial surgery.	• Zygoma Implants: Indications, Technique and Long-Term Results• Surgical Treatment of Maxillary Hyperplasia• Evolution of Structured Rhinoplasty	No
Online Webinars	Aesthetic Plastic Surgery	IMCAS Online Educational Webinars	Free Month Trial	E-learning plastic surgery and dermatology platform; thousands of available lectures and ongoing webinars	• BIA-ALCL and Breast Augmentation• Botulinum Toxin Combinations and Complications	Yes
Instructional Videos	Surgical Anatomy	Dr. Sanjoy Sanyal Cadaveric Anatomy; YouTube Videos	Free	Didactic Video Tutorials on Surgical and Cadaveric Anatomy	• Forearm Flexor and Extensor Dissections• Brachial Plexus Surgical Anatomy• Upper Extremity Neurovascular Distribution• Craniofacial, Head and Neck, and Abdominal Wall Anatomy	Yes
Instructional Videos	Surgical Anatomy	Dr. Shakti Chandra Cadaveric Anatomy; YouTube Videos	Free	Didactic Video Tutorials on Cadaveric Anatomy	• Upper and Lower Extremity Muscular, Bone, and Neurovascular Dissections• Head and Neck, Genitourinary and Abdominal Wall Dissections	Yes
Smartphone / Tablet Applications	Surgical Anatomy	Complete Anatomy - 3D Medical	$0-$30; Institutional Subscriptions	3-Dimentional Interactive Anatomy Models	• 17,000 Interactive Anatomical Structures• 3D Muscle Movement; Origins, Insertions, Neurovascular Supply, and Bony Anatomy	n/a
Smartphone / Tablet Applications	Surgical Anatomy	Human Anatomy Atlas 2021	$0-$35; Institutional Subscriptions	3-Dimentional, Interactive Anatomy Models	• 10,000 Interactive Anatomical Models• 3D Muscle Movement; Origins, Insertions, Neurovascular Supply, and Bony Anatomy	n/a

Advantages of the virtual learning tools identified were significant and wide-ranging. Barriers previously posed by the geographic dispersion of content experts or by monetary costs are now seen negated giving learners of all levels, including medical students, front-row access to specialized teaching by plastic surgery experts worldwide. Both educators and learners are provided with unprecedented flexibility; didactic lectures are frequently recorded accommodating those unable to attend, and learning objectives are often clearly defined. Online education networks such as the ASPS EdNet provide structured, in-depth teaching on essential plastic surgery topics, complete with assessment methods for medical students to track and identify gaps in their knowledge acquisition process. Didactic cadaveric video tutorials, supplemented with 3-dimentional interactive virtual reality applications, provide an anatomy learning experience unmatched by any of the traditional approaches. Finally, and by means of virtual grand rounds and journal clubs recently made accessible to learners from all institutions, medical students can remain abreast of the latest developments in plastic surgery from the perspective of top training programs worldwide.

With the advent of social media and growing online presence of many academic plastic surgeons, medical students can tune in to live streaming services such as Instagram Live for daily discussions on current hot-topics, and remain in contact with colleagues and mentors through online forums. With accepted presentations of some of the cancelled plastic surgery conferences going virtual, medical student participation is both facilitated and encouraged. Despite the significant reform medical education has witnessed over the past decade,3, 5 it remains without a doubt that the COVID-19 pandemic has kindled change in plastic surgery education at both the undergraduate and postgraduate levels that will persist for generations to come. For medical students interested in a career in plastic surgery, this unique, evolving situation should be embraced, and identified resources leveraged. Albeit through a computer or smartphone screen, much remains to be learned, for, as Stephen Hawking once wrote, “intelligence is the ability to adapt to change.”