The perceived impact of webinars during the COVID.19 pandemic: A survey of ophthalmology trainees from India.

OBJECTIVE: The objective of the study was to assess the perceived utility and the impact of web-based teaching programs being conducted following the COVID-19 pandemic.
METHODS: An online survey was sent to trainee ophthalmologists across India through various social media platforms. The responses were tabulated and analyzed.
RESULTS: A total of 768 valid responses were recorded. Majority of respondents (52.2%) felt that the ideal duration for webinars was 1 hour or less. Factors that helped trainees in choosing a webinar were the topic (95.1%), the timing (53.6%), and the speaker list (42.4%). Residents indicated a preference for webinars to attend aimed at postgraduate residency training, more specifically clinical problem-solving. Further questions were answered using a 1-10 Likert scale (1: least useful and 10: extremely useful). The median score when asked for overall usefulness of the webinars in general was 8 (interquartile range/IQR: 2). The median response when asked about utility of webinars in enhancing theoretical knowledge was 8 (IQR: 2) and the median for utility of webinar-based teaching programs in enhancing practical knowledge/surgical learning was also 8 (IQR: 2). The median score when asked about the utility of the webinar programs in acquiring skills for writing research papers/thesis was 7 (IQR: 3). Connectivity issues, audio/voice issues, and the long duration of webinars were some of the problems faced while attending webinars.
CONCLUSIONS: Ophthalmology trainees in India found online teaching programs and webinars to be useful in enhancing their theoretical knowledge and practical skills/surgical learning. Administrators and educational institutes should tailor online teaching programs as per the needs and preferences of the residents. Copyright:

Introduction

The coronavirus-19 disease (COVID-19) pandemic has led to a paradigm shift in the practice of medicine across the world. Not only were health-care systems overwhelmed with doctors having to care for patients with an unfamiliar illness but also soon nonemergency services in all specialties were also feeling the repercussions. A survey of ophthalmologists in India indicated that an overwhelming majority (72.5%) were not seeing any nonemergency patients during the COVID-19 lockdown that extended from March to July 2020, with a near-total cessation of elective surgeries.[1] Apart from health-care delivery, another area that has been severely impacted is medical education at all levels – undergraduate medical courses, as well as residency and superspecialty training programs. This is more the case for nonemergency branches, not directly involved in COVID-19 patient care. In the United States, the Association of American Medical Colleges released guidelines strongly suggesting that medical students should not be involved in direct patient contact activities.[2] At many centers, ramping down surgical volume and redeployment of in-house call schedules had been enforced to reduce the chances of cross-infection among hospital staff.[3] Several teaching hospitals in the United Kingdom, too, suspended medical and observership students from attending clinical attachments. In India, ophthalmology trainees reported that the pandemic had adversely affected their learning, especially surgical training. In addition, the trainees' self-reported stress levels were higher than normal.[4] All these changes and its effects have had obvious implications, with medical students receiving reduced clinical exposure, causing a detrimental effect to exam performance and competency.[5]

In response to these events, major medical meetings and congresses have been cancelled or postponed. Many of them evolved and went virtual, allowing delegates to log in and participate remotely. Classrooms in medical colleges and universities have shifted online. While the concept of webinars has been around for many years, the circumstances of the COVID-19 have led to widespread utilization of webinars as innovative and indispensable tools for remote learning, where trainees could interact and ask questions to facilitate deep and meaningful learning.[6] The use of social media platforms to promote and screen the webinars has also contributed to the popularity of webinars. Surgical education has mirrored this trend, and it has been observed that webinars are being launched through specialty and trainee association social channels to keep up with the fast-paced demand for accessible online content.[5] The most benefitted from these multiple online teaching programs have been residents and fellows who now have access to multiple platforms with global experts available for direct interaction, albeit through a virtual platform. There is limited literature with objective data about the effectiveness of webinars, especially from the trainees' perspective. Therefore, in an attempt to fill these lacunae, this survey was conceived to assess the utility and the impact of such web-based teaching programs by surveying ophthalmology trainees in India.

Methods

Institutional Review Board approval was obtained before the commencement of the study. An online survey (Google Forms) was circulated among Indian trainee ophthalmologists. They survey was open from July 15 to July 31, 2020. An invitation to participate was circulated through multiple groups on social media, namely, Facebook, WhatsApp, and Telegram. The survey, which consisted of twenty questions [Table 1], was open for a period of 15 days. Respondents had the option of adding their names and e-mail addresses. However, this was not mandatory. Association between categorical variables was assessed using Fisher's exact test or Chi-squared test. We considered a P < 0.05 as statistically significant. All statistical analysis was performed with GraphPad Prism 6 (GraphPad Inc., La Jolla, CA).

Table 1

List of questions in the questionnaire

1. What is your age?

2. What is your sex?

3. What training course are you pursuing?

Residency

Fellowship

Others

4. What year of training are you in?

First year

Second year

Third year

5. How many ophthalmology webinars have you attended since the COVID-19 pandemic began?

<5

Between 5 and 10

Between 10 and 15

>15

6. How would you rate the webinars you attended in terms of overall usefulness? (on a scale of 1-10, with 1 being least useful and 10 being extremely useful)

7. How would you rate the webinars you attended in terms of enhancing theoretical knowledge? (on a scale of 1-10, with 1 being least useful and 10 being extremely useful)

8. How would you rate the webinars you attended in terms of enhancing practical knowledge/surgical learning? (on a scale of 1-10, with 1 being least useful and 10 being extremely useful)

9. How would you rate the webinars you attended in terms of acquiring skills for writing research papers/thesis? (on a scale of 1-10, with 1 being least useful and 10 being extremely useful)

10. How satisfied are you with the level of interaction that you have with the speakers/panelists on the webinars that you attended? (on a scale of 1-10, with 1 being extremely dissatisfied and 10 being extremely satisfied)

11. What were the main problems/concerns that you have observed over the webinars that you have attended? (you may choose more than one)

Connectivity/bandwidth issues

Audio issues

Long duration of webinars

Uninteresting topics

Repetition of topics/lectures

No issues

12. What is your preferred device to view/attend a webinar?

Laptop/desktop computer

Mobile phone

Tablet

13. According to you, what is the ideal duration for a webinar? (h)

<1

Between 1 and 2

Between 2 and 3

>3

14. Which are the factors that help you in choosing to attend a webinar? (you may choose more than one)

The speaker line-up

The selection of topics

The panelists/discussants

The duration of the webinar

Webinar being held over the weekend

The timing of the webinar

The hosts/organizers

15. What do you think about the number of ophthalmology webinars being conducted at the moment?

There is a need for more webinars

The number of webinars being conducted is adequate

Too many webinars are being held

16. What type of ophthalmic webinars are you looking forward to attending?

General ophthalmology webinars

Sub-specialty webinars

Residency-curriculum based webinars

Others

17. In your opinion, what topics should be covered in future webinars?

Basic science

Laboratory medicine

Clinical examination techniques

Clinical problem-solving (case-based approach)

Others

Results

A total of 768 valid responses were received, which were tabulated and analyzed. The average age of the respondents was 29.1 years. In all, 64.6% (496/768) of the respondents were female. Over half of the respondents (51.2%) were trainees in government medical colleges/hospitals. In our survey, 95.2% (731/768) of the respondents were enrolled in residency programs and 4.8% of the respondents were pursuing their specialty fellowship programs. A year-wise split showed that 13% (100/768) were in their first year of training, 34.4% (264/768) were in their second year, and 52.6% (404/768) of the trainees were in their third year of ophthalmic training [Figure 1]. The trainees were asked how many webinars they had attended in the previous 3 months: 41.5% had attended between 5 and 10 webinars; 36.4% had attended between 10 and 15 webinars; and 22.1% had attended 5 or fewer webinars.

Figure 1

Distribution of the respondents based on their year of training

The respondents were asked to score the overall usefulness of the webinars attended on a scale of 1 to 10 (with 1 being not useful and 10 being very useful). The median score when asked for overall usefulness of the webinars in general was 8 (inter-quartile range [IQR]: 2). The median response when asked about utility of webinars in enhancing theoretical knowledge was 8 (IQR: 2), and the median for utility of webinar-based teaching programs in enhancing practical knowledge/surgical learning was also 8 (IQR: 2). The median score when asked about the utility of the webinar programs in acquiring skills for writing research papers/thesis was 7 (IQR: 3). The number of prior webinars attended, the gender of the trainee, and the year of training had no statistically significant impact on any of these scores.

The respondents were asked to score the utility of the webinars toward writing manuscripts, research projects, and theses. The median response was 7 (IQR: 3). The mean scores of the 1st year, 2nd year, and 3rd year trainees were 7.1, 6.9, and 6.6, respectively. A one-way ANOVA was performed to assess if the year of training impacted the reported score. There was a significant effect of the year training on the reported utility of the webinars in preparing manuscripts, research projects, and theses at the P < 0.05 level (F = 3.392; P = 0.03).

The respondents were asked if they were satisfied with the quality of direct interaction with the speakers on the webinars on a scale of 1 to 10 (with 1 being not satisfied and 10 being very satisfied). The median was 8 (IQR: 2). The respondents were asked what issues/problems faced while viewing webinars; they had the option to select more than one option [Figure 2]. The most frequently faced problem was internet connectivity/strength (40.8%). This was followed by voice/audio issues (37.1%). With regard to the content of the webinar itself, the respondents indicated that long duration of lectures was an issue they would like addressed (25.8%). The respondents were asked about their preferred device for viewing webinars and 450/768 (58.7%) indicated that they were attending the webinars through their mobile phones. Only 201/768 (26.2%) preferred to attend through their laptop computers and 111/768 (14.5%) used a tablet. A very small proportion (0.06%) used desktop computers. The trainees were asked: "What in your opinion is the ideal duration for a webinar?." In response, 52.2% indicated that the ideal duration should be between 1 and 2 h, whereas 38.8% preferred webinars which were less than an hour long [Figure 3].

Figure 2

Distribution of the responses when asked about the problems faced/issues while attending webinars

Figure 3

The distribution of responses when asked about the ideal/preferred duration for ophthalmology webinars

The respondents were asked about the factors that help them decide which webinar to attend [Figure 4]. Nearly all the trainees (95.1%) indicated that the selection of topics was the single most important factor, followed by the timing of the webinar (53.6%), the speaker list (42.4%), and the duration of the webinar (37.8%). The organization that was hosting the webinar was the least important for trainees (10.8%). Given that there were numerous webinars being held every day and multiple simultaneous webinars being conducted over the weekend, the respondents were asked what they felt about the number of webinars currently being conducted. In response, 49.5% indicated that the number of webinars taking place was adequate. Nearly a third (29.9%) felt that too many webinars were being conducted and only 20.6% felt that there is a scope for more webinars.

Figure 4

Distribution of responses when asked about factors that help in choosing to attend a webinar

Trainees were asked the type of webinars that they would see more of, in future. In response, 73.7% of the surveyed trainees wanted more webinars that were more reflective of their residency curriculum, followed by subspecialty webinars (20.2%). Specifically, the most preferred topics were clinical problem-solving (40.9%), clinical examination techniques (21.7%), and basic sciences (15.8%).

Discussion

The unprecedented situation of the COVID-19 pandemic has led to inevitable loss of surgical training opportunities and an increasing demand for remote training. In the months following the global lockdown, over 1000 different ophthalmology webinars have been conducted between mid-April and the end of August 2020.[7]

The online transition

The delivery of medical education has rapidly evolved in response to the pandemic. This includes changed in structured training programs such as residency and fellowships, as well in other continuing professional development programs for physicians in practice. One such transition has been the move from physical meets and classroom-based programs to online classes and webinars. The value of online classrooms and webinars has been previously recognized in medicine, as it allows recognized speakers to reach a broader audience, besides being economical and "green."[89] A remarkable spike in the number of webinars has been observed during the COVID-19 pandemic. In ophthalmology, the World Ophthalmic Congress (previously scheduled to be held in Cape Town, South Africa), the annual conference of the American Academy of Ophthalmology (previously to be held in Las Vegas, USA) and the annual meeting of the American Society of Cataract and Refractive Surgery (to be conducted in Boston, USA) were some of the prominent meetings that went "virtual." Webinars and online conferences have multiple advantages: nonexistent venue and traveling costs for faculty and audience go a long way in reducing the carbon footprint in addition to giving participants the flexibility of accessing talks at their own convenience.[1011]

But are the trainees benefitting from these webinars?

In a previous survey by Mishra et al., it was noted that nearly 80.7% of the surveyed ophthalmology trainees felt that COVID-19-related lockdown and subsequent changes had a negative impact on their surgical training. In fact, nearly two-thirds of the respondents felt that there was 50% or more reduction in their surgical training. In addition, 47% of the trainees felt that the lockdown had a negative impact on their theoretical/classroom learning.[4] Similar findings were reported by Balhareth et al., who surveyed residents and fellows across all specialties: 84.6% of them reported a reduction in training activities due to the pandemic.[1] Thus, data point to the demand for more online programs and trainees globally have been attending webinars and e-learning meets in order to make up for lost classroom time and clinical training. Mishra et al. reported that 75.7% of the ophthalmology trainees who were surveyed found the webinars being conducted to be useful.[4] In a similar survey of 100 orthopedic surgery residents in Chile, it was found that 86% of the residents had participated in webinars, 28% had received online presentations, 12% had participated in online tests, and 7% had evaluated patients.[12]

Webinars have traditionally enjoyed high overall acceptance rate as a tool for dissemination of knowledge by attendees; independent of sex, specialty, and years of professional experience.[1314] Our survey showed that, irrespective of the year of training, trainees found the webinars they attended to be useful from a theoretical knowledge standpoint as well as practical knowledge and surgical learning. However, we noted that 3rd-year residents found the webinars less useful when it came to skills to write research papers and theses; when compared to their 1st- and 2nd-year counterparts.

Our survey showed that ophthalmology trainees were very receptive to webinars as a mode of knowledge dissemination, and most respondents found them to be useful. Of the 1000 + ophthalmology webinars have been conducted during the pandemic-related lockdown, only a fraction of them (<15%) were intended specifically for residents and fellows.[7] Furthermore, in spite of such a high number of webinars being conducted, our results show that 489/768 (67.7%) had attended ≤10 webinars over the past few months.

Generally speaking, there is some evidence to show that all webinars are not always effective across the board. Compared to seniors, some junior colleagues reported that they were less comfortable with online lectures. This could be explained by an increased need for educational guidance and accountability, which are best delivered through the nuances of in-person interaction.[15] Similarly, senior residents found online meetings less effective than junior residents, which may again be explained by the more personal nature of in-person communication.[16] In another survey of ophthalmologists, 86% were not satisfied with e-learning as the sole method for undergraduate teaching.[17]

While webinars allow the convenience of remote teaching and accessibility, one of the criticisms is the sheer number of webinars being conducted simultaneously. The ease of logistics and the economical nature of webinars vis-à-vis physical meetings/conferences have led to a "pandemic of webinars."[18] Our results also indicated that a sizable proportion (30%) of the surveyed trainees felt that there were too many webinars being conducted. Issues such as internet connectivity and audio problems were also reported by many respondents. Often times, inadequate bandwidth or due to other connectivity issues, attendees are unable to participate. Rarely, the webinar organizers' themselves too have technical problem which leads to the webinar either getting cancelled or postponed – issues which are physical meets never suffer.[19]

Filling the void of classroom teaching in an organized manner

In large teaching hospitals across the globe, students and faculty are being additionally tasked with COVID-19 rotations. As a result, the biggest area of concern is the disruption of structured curriculum-based classroom and clinical teaching for training ophthalmologists, which needs to be addressed.

Rather than conducting multiple, isolated small meetings, ophthalmic societies, webinar organizers, and medical education administrators need to come together in a concerted effort to completely harness the power of webinars in an effective way. The first step should be assessing the problem – to obtain feedback from trainee ophthalmologists that can help in identifying specific areas of teaching/topics that would be helpful. Our survey showed that 74% of the trainees preferred webinar that were based on their residency curriculum. Clinical problem-solving (40.9%), clinical examination techniques (21.7%), and basic sciences (15.8%) were the specific areas of interest for trainee ophthalmologists. Webinars tailored to these educational needs of trainee ophthalmologists is essential. The next step would be selection of speakers for classroom sessions: oftentimes, competent surgeons, and clinicians do not necessarily make great teachers and perhaps vice-versa as well. Hearing industry leaders speaking on the latest in molecular diagnostics or refractive surgery may not necessarily be useful to the average trainee ophthalmologist, who probably wants to master corneal and retinal drawings or learn how to perform indirect ophthalmoscopy. Instructional hands-on training through web-based classrooms can be a challenge, but ways must be worked out to impart the finer aspects of basic ophthalmic training such as refraction and interpretation of investigations. Teaching online is different from classroom teaching, especially since postgraduate medical teaching is largely a problem based rather than the didactic.[20] Multiple studies have shown that accessibility, flexibility, and increased interactivity with co-participants and communication in a coordinated manner are key to student satisfaction when it comes to online learning. Students have also reported that lack of interaction with the teacher and lesser in-depth group discussion for clarification as drawbacks of e-teaching program.[21]

Basic sciences, anatomy, pathology, and thesis writing are topics that rarely figure among the list of webinars. According to a website that cataloged, most of the ophthalmology webinars showed that webinars specifically meant for residents formed less than 15% of the 1000 + webinars conducted since mid-April 2020. Post hoc feedback should also be actively sought in order to fine-tune subsequent webinars.

Tailoring future webinars

"Content will always be king" – not just in cinema, art, literature but even when it comes to webinars. Our survey highlighted that the single most important factor that was weighed on by attendees was the topics that would be spoken on, during the webinar. It is not just content but also the way it is presented that should matter. Speakers should be mindful of the fact that nearly 60% of the surveyed ophthalmologists viewed the webinars on the mobile phone screens. Therefore, if possible, uncluttered slides with contrasting light-colored backgrounds are likely to be appreciated. The duration of webinars was another issued our survey highlighted: 52.2% indicated that the ideal duration for a webinar should be between 60 and 120 minutes long.

In this survey, a total of 768 responses were recorded: even though this is a large number, the authors acknowledge that this does not represent all the ophthalmology trainees in India. In view of the fast-evolving scenario, with rapidly changing guidelines, the authors felt it was not entirely feasible to run a pilot survey in order to obtain a validated questionnaire. This remains one of the paper's drawbacks.

It is recommended that the online webinar-based model is used to supplement, but not replace, clinical training and face-to-face learning opportunities.[182022] Given that the resumption of classroom teaching is not set to resume in the foreseeable future, the power of webinars should be harnessed appropriately and judiciously, without inducing "webinar fatigue." Our survey shows that, as of now, ophthalmology trainees in India found online teaching programs and webinars to be useful in enhancing their theoretical knowledge and practical skills/surgical learning. The choice of topics was the most important factor in choosing to attend a webinar and shorter programs focusing on topics of relevance for ophthalmology residency and case-based approach to learning were preferred by trainees. We also believe our survey highlights important issues such as the ideal duration of webinars, the preferred topics, and the issues faced by students while attending webinars. This information can be used by administration and educational authorities and regulatory societies to tailor webinars that are able to deliver learning to trainees, successfully.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.