BOFAS ‘Lectures of Distinction’

Yaser Ghani, Tim Williams, Robert Clayton and Rick Brown

Yaser Ghani is currently a Foot and Ankle Fellow at Imperial having completed his training on the Stanmore Rotation. His interest in medical education and surgical training led him to instigate the ‘Lectures of Distinction’ webinar series with BOFAS and he is now a member of the BOFAS Education Committee.

Tim Williams is a Consultant Orthopaedic Surgeon at East Suffolk & North Essex Foundation Trust with a specialist interest in the Foot and Ankle. He is current secretary of the BOFAS Education Committee and moderator for the BOFAS ‘Lectures of Distinction’.

Robert Clayton has been a Consultant Orthopaedic Surgeon in NHS Fife since 2010. He has an interest in elective and trauma surgery in all conditions of the Foot and Ankle, and is also interested in postgraduate specialist surgical training. He has served as Director of Media and Communications for BOFAS since 2017.

Rick Brown is a Consultant Orthopaedic Foot and Ankle Surgeon at The Nuffield Orthopaedic Centre, Oxford. He is the Chairman of the BOFAS Education Committee. He has been Course Director of many face-to-face courses and enjoyed the challenge of using technology in education and initiating several new online teaching courses.

The global pandemic of Coronavirus disease 2019 (COVID-19) significantly affected the working patterns of UK Higher Surgical Trainees with many reassigned to ‘COVID-19 rotas’. Face-to-face post-graduate surgical teaching was cancelled in line with the UK National Social Distancing policies. A survey of the UK orthopaedic trainees during the COVID-19 pandemic demonstrated that the majority of trainees felt that the most significant areas affected were the reduction in the operative experience and of post-graduate teaching.

In response to this, the British Orthopaedic Foot and Ankle Society (BOFAS) Education Committee recognised the need to supplement the education of trainees and promptly designed a solution using online educational methods to develop a series of webinars covering the foot and ankle (F&A) topics of the FRCS Trauma and Orthopaedics (T&O) syllabus. These interactive weekly ‘BOFAS Lectures of Distinction’ (LoD) webinars are being delivered by leading F&A surgeons from the UK.

Our response - the Lectures of Distinction

28 core topics of Foot and Ankle surgery were selected from the ISCP syllabus and the standard of lecture was set at the FRCS T&O level. The BOFAS Webinar Team invited leading F&A surgeons from around the UK and Ireland. One Royal College of Surgeons of England (RCSEng) Continued Professional Development (CPD) point was accredited to each webinar. Registration for the webinars was free of charge. It was presented as a video conference using Zoom TM for a maximum of 60 minutes in duration and included a didactic lecture lasting around 30 minutes, followed by an interactive session. The interactive component allowed the attendees to post questions, participate in live polls, case-based discussions (CBDs), or mock viva practice. The webinar series was advertised via Training Programme Directors (TPDs), BOFAS members, trainee network groups and social media. After each live attendance a link was emailed to collect both quantitative and qualitative feedback. The final feedback summary was emailed to the lecturer for quality control and annual appraisal.

The webinar series was launched at the end of the first UK lockdown on the 6th July 2020 and continued until February 2021. The webinar was recorded and this was subsequently made available for free access on both the BOFAS website (www.bofas.org.uk/ clinician/webinars/lectures-of-distinction) and the BOFAS Education YouTube channel.

Figure 1: Average feedback scores with 95% confidence intervals of the 28 lectures in each feedback domain.

Feedback and reflection

A total of 2,709 attendances were recorded for all sessions, with a mean number of live attendees per webinar of 97 (range 39 - 259). The level of the participants ranged from UK Specialist Orthopaedic Registrars, Core trainees, Consultants, Podiatrists and Physiotherapists, as well as international Orthopaedic Trainees. A steady state of attendance was established from October with a monthly mean of 69 attendees per lecture. Viewing on the BOFAS Education YouTube channel was more popular than we expected with 750 views within the first week of its launch, with 1,875 views in the first month and has reached over 13,000 views since the end of the first season.

Quantitative and qualitative data have been collected from 69.4% of attendees on the first season of 28 webinars. The five domains of the feedback are shown in Figure 1.

The illustrative quotes from the qualitative responses, shown in Table 1, suggested that the 30 minutes webinar format with CBDs and Q&A sessions was appropriate for their learning. Feedback also suggested that the topics were not only relevant for FRCS T&O preparation but also for the earlier years of higher surgical training. Some Consultant attendees also found it useful for their on-going CPD.

Future use of webinars within integrated surgical training

The BOFAS Lectures of Distinction (LoD) webinar series was designed to address a sudden pressing need for maintaining quality education and training when face-to-face post-graduate training was greatly reduced around the UK. Our attendance figures and feedback suggest these post-graduate webinars were effective at fulfilling this need. They can either be viewed live or later at a convenient time, or included as an adjunct to the restarted post-graduate teaching. A recent survey of the Scottish orthopaedic trainees demonstrated that there has been a high satisfaction rate with virtual teaching amongst these trainees since the pandemic. Furthermore the majority of these trainees would like the e-learning format to become part of the formal teaching programme[1].

There are a number of likely reasons for the success of the BOFAS LoD webinar series. The quality of the teaching was due to careful selection of speakers, standard setting by a national surgical specialist society with clear standardised instructions to lecturers, incorporation of the views of experienced FRCS T&O examiners and responding to the high levels of feedback. Within the positive feedback, we found attendees wanted large topics to be split up and more FRCS T&O type ‘hot seat’ vivas and CBDs. These were incorporated to later lectures of distinction. The award of CPD points from RCSEng further validated the high standard.

The recorded webinar technology allows interactivity, geographical flexibility without venue requirements, travel time or cost to either the trainer or trainee. A recent metaanalysis of 12 randomised controlled trials demonstrated that webinars were more effective than faceto-face classroom instructions and showed an increase in the knowledge and skill of the participants[2]. A recent four nations survey of over 100 orthopaedic trainees showed that 90% of participants were of the view that webinars should continue following the COVID-19 pandemic[3].

One drawback is that it requires a robust infrastructure and set up to ensure smooth running of the programme. In our series, the running costs and IT support were provided by our surgical specialist society, BOFAS, and thus content was provided free of cost to the learner. In addition to the time of the lecturer, members from the BOFAS Education and the IT committee freely contributed their time for planning and running the sessions. A pre-lecture meeting was organised between the lecturer, technical support team, moderator and any volunteer registrars.

Table 1: Examples of feedback comments received for the lectures.

This study has shown the phenomenon of ‘webinar fatigue’. The mean attendance for the first two months was 155. However, there was then a significant drop off to a steady state of 65 for the following three months. This coincided with the return to normal working patterns including the on call trauma duties. Several months after LoD first launched, there has also been a surge in non-validated orthopaedic webinars hosted by commercial organisations causing ‘webinar clash’. For other societies and educationalists that wish to set up a similar programme, some of our key learning points, which we feel have contributed to success, are summarised in Table 2.

Table 2: Learning points, which have contributed to the success of this webinar series.

The BOFAS LoD webinar series could be the start of a potential wave of long-term change that we will see in education of Medicine and Surgery. These highly co-ordinated, validated, up-to-date, easily accessibility lectures may reduce the need to gather trainees in a single location. The gathering of health care workers for surgical education will continue to be scrutinised for cost effectiveness, time efficiency, environmental impact and personal safety. Pre-learning with the LoDs will allow more time at the face-to-face courses to be spent in discussions with higher order thinking.

Conclusion

The exceptional circumstances surrounding the COVID-19 pandemic prompted the introduction of remote webinar teaching of Foot and Ankle Surgery. Our experience has shown that high quality, validated, structured learning opportunities can be provided using webinar technology that is easy to access either live or later at a more convenient time with no cost to trainees.

This effective national post-graduate orthopaedic training can be delivered effectively and can be an augment to a regional teaching programme.

Acknowledgements

The authors would like to show their gratitude to all the lecturers, Jo Millard, the BOFAS Administrator, Karan Malhotra, Shelain Patel, Matthew Welck, and the BOFAS IT Committee for continued support and help with the BOFAS LoD webinar series.

References

1. MacDonald DRW, Neilly DW, McMillan TE, Stevenson IM and SCORE Collaborators On behalf of the SCottish Orthopaedic Research collaborativE (SCORE). Virtual orthopaedic teaching during COVID-19: Zooming around Scotland. Bulletin of The Royal College of Surgeons of England. 2021;103(1):44-9.

2. Gegenfurtner A, Ebner C. Webinars in higher education and professional training: a meta-analysis and systematic review of randomized controlled trials. Educ Res Rev. 2019;28:100293.

3. Gonzi G, Gwyn R, Rooney K, et al. The role of orthopaedic trainees during the COVID-19 pandemic and impact on post-graduate orthopaedic education: a four-nation survey of over 100 orthopaedic trainees. Bone Jt Open. 2020;1(11):676-82.