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\begin{document}

\title{Clinical Medical Education: Cardiothoracic Surgery in the Era of
COVID-19}



\author[1]{Andy Dong}%
\author[1]{Francis Simpson}%
\author[1]{William Qu}%
\author[1]{Jeffrey Javidfar}%
\affil[1]{Emory University School of Medicine}%


\vspace{-1em}



  
  \date{May 19, 2024}


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\begin{abstract}
Background and Aim: Clinical education has been disrupted by the
COVID-19 pandemic. We present a standardized remote alternative online
cardiothoracic surgery primer to accommodate a shortened clinical
calendar. Methods: A week-long cardiothoracic surgery course consisting
of virtual case-based lectures and small groups as well as surgical
operation walkthroughs was conducted iteratively through April and May
2020 at Emory University School of Medicine, Atlanta, GA for new
clinical third-year medical students. Results: Remote learning platforms
helped maintain medical student clinical education. Cardiothoracic
procedure video walkthroughs were highly demanded for remote learning.
Virtual small group discussions were felt to be invaluable in
facilitating active problem solving and clinical decision making of
cardiothoracic surgery. Conclusion: Our online cardiothoracic surgery
curriculum can be a framework for alternative medical student clinical
education. Student feedback is necessary as we adapt to teaching during
the COVID-19 pandemic and future global disruptions.%
\end{abstract}%



\sloppy


Title: Clinical Medical Education: Cardiothoracic Surgery in the Era of
COVID-19

Authors: Andy Dong, BS\textsuperscript{1}, Francis Simpson,
MS\textsuperscript{1}, William Qu, MD\textsuperscript{2}, Jeffrey
Javidfar, MD\textsuperscript{2}

Affiliation:

\begin{enumerate}
\tightlist
\item
  Emory University School of Medicine
\item
  Division of Cardiothoracic Surgery, Department of Surgery, Emory
  University School of Medicine
\end{enumerate}

Disclosure: The authors do not have a conflict of interest. No funding
was used for this paper.

Word Count: 495

Corresponding Author:

Jeffrey Javidfar, MD

The Emory Clinic

1365 Clifton Road NE

Building A, Suite 2220

Atlanta, Georgia 30322

Phone: (404) 778-3730

Jeffrey.Javidfar@emory.edu

The call to action by Newman and Lattouf echoed the concerns of many
educators and students for the need of curricula that adequately support
clinical education during COVID-19.\textsuperscript{1,2,3} With the
possibility of COVID-19 cases increasing in the fall, third- and
fourth-year clerkships may become remote. Furthermore, clinical students
have resumed the semester with modified and shortened schedules which
may curtail exposure to ``non-essential'' electives like cardiothoracic
surgery. Thus, we present our virtual cardiothoracic surgery curriculum
and remote teaching experience with clinical-year medical students. Our
aim is to help maintain clerkship education with an alternative
distance-learning option to accommodate a compressed clinical calendar
impacted by COVID-19.

We created a week-long cardiothoracic surgical education course focusing
on interactive small group lectures and discussions as well as surgical
operation walkthroughs (Figure 1). Although concise, we felt a week-long
course was an appropriate amount of time to cover a wide array of
cardiothoracic topics given it is 25-50\% the length of a surgical
subspecialty rotation. Generally, the day started with virtual case
lectures via Zoom (Zoom Video Communications Inc., San Jose, CA)
followed by supplemental pre-recorded video didactics, then small group
discussions in the afternoon. Paramount to clinical education is
learning clinical problem solving and decision making. Sessions were
interactive with a maximum of five students in order to easily
facilitate active conversation and case-based problem solving. Faculty
also walked students through surgical cases during the aforementioned
small group lectures and discussions. Procedure videos and case-based
discussions provided a welcomed contrast to didactic teaching that
allowed students to participate in active clinical decision making.
Content-wise, we focused on main cardiothoracic diseases and surgeries
(Figure 1) with special attention drawn toward extracorporeal membrane
oxygenation (ECMO) and its significance as a treatment modality for
severe acute respiratory distress syndrome for
COVID-19.\textsuperscript{5}

We taught this course over April and May 2020 to new third-year medical
students. We received survey feedback from every student at the end of
each week and made continuous iterative adjustments. Students cited the
benefit of a smaller, more interactive class with a single primary
instructor, particularly highlighting the afternoon small group
discussions and case problem solving. They also appreciated the
contemporary relevance of the ECMO series. The main critique was that
students really wanted more surgical videos, and so we integrated more
surgical footage into our discussions. From our survey, students
expressed an increase in understanding and interest in cardiothoracic
surgery. Preliminary analysis of the first ten pre- and post-assessment
results demonstrated an increase in mean scores from 62\% to 80\%. For
future course considerations, suture skills sessions could also be
incorporated in the course to provide a more hands-on experience (though
this requires safe distribution of suture materials). Small group
discussions were invaluable, and future courses should continue to
integrate active problem solving and case management pertinent to
clerkship students.

As the pandemic rattles the framework of medical education, we hope that
our remote learning curriculum can be utilized at other medical schools
for cardiothoracic clerkship education.

References

1. Newman NA, Lattouf OM. Coalition for medical education-A call to
action: A proposition to adapt clinical medical education to meet the
needs of students and other healthcare learners during COVID-19. \emph{J
Card Surg.} 2020.

2. Rose S. Medical Student Education in the Time of
COVID-19.\emph{JAMA.} 2020.

3. Theoret C, Ming X. Our Education, Our Concerns: Medical Student
Education Impact due to COVID-19. \emph{Med Educ.} 2020.

4. MacLaren G, Fisher D, Brodie D. Preparing for the Most Critically Ill
Patients With COVID-19: The Potential Role of Extracorporeal Membrane
Oxygenation. \emph{JAMA.} 2020;323:1245-1246.

\textbf{Hosted file}

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