Commentary: Halsted meets Zoom.

David L. Joyce, MD, MBA

Videoconferencing technology has created new opportunities and new challenges for thoracic surgery education.

See Article page 524.

No sooner had the words “shelter in place” been introduced to the world's vocabulary than the surge in demand for videoconferencing platforms became almost obscene. This instantaneous change in business practices transformed the world into a virtual metaverse, with disruptions across every industry. In some cases, innovative leaders had already become early adopters of the technology, as was the case at Tenwek Hospital in Bomet, Kenya, where residents were already attending weekly virtual lectures by American surgeons via the Society of Thoracic Surgeons online curriculum. The present work of Kenichiro and colleagues represents the next iteration of innovation in online education, introducing new challenges and opportunities in the realm of simulation.

As with swinging a golf club or practicing scales on the piano, the benefits of repetitive, deliberate practice in the craft of performing coronary anastomoses have been well validated.2, 3, 4 It is therefore not surprising that statistically significant improvement in the technical appearance of the anastomoses occurred between the first and last assessments of the exercise. While Zoom fatigue was not specifically addressed in this study, the high participant satisfaction scores suggest that these strategies hold promise as a sustainable approach for augmenting the existing simulation experiences that are currently employed across most residency programs.

Perhaps one of the most important implications for the future of simulation as a tool in the education of a cardiac surgeon has to do with some data not explicitly mentioned in the discussion but that can be easily appreciated when watching the video. Positioning the YOUCAN (EBM Corporation, Tokyo, Japan) anastomotic simulator within the Anastothon A-1 Kit (EBM Corporation) as the authors have done creates the opportunity for standardization of image capture. This provides the ideal conditions for the use of deep learning as a more accurate and objective assessment of resident performance. TensorFlow (https://www.tensorflow.org/) has come a long way from identifying cats in a You Tube video and has already been implemented in surgical education. It seems to be a small step forward to build a library of videos that can produce new metrics for the assessment of technical precision.

The adoption of videoconferencing technology across educational platforms is not without its own limitations. It is not clear if the skills developed in a virtual teaching environment will translate easily into success in the operating rooms of the real world. It is possible that many members of the teaching faculty will struggle with the adjustment to this new way of learning. Forgetting to unmute one's microphone before berating a resident for poor performance seems to be just the tip of the iceberg when it comes to the pitfalls of integrating Zoom into the in-person system of graded enhanced responsibility that has dominated our profession for the past 117 years. Nevertheless, this early experience suggests great promise for the future of simulation in cardiac surgery and creates the foundation for significant improvements in formative feedback.