The coronavirus disease 2019 (COVID‐19) has rapidly been spreading worldwide, and
Italy has been hit hard, forcing the Italian Healthcare System to change and adapt
to these extreme conditions. The daily activities of the Urology Department have been
drastically reduced and limited only to non‐deferrable procedures, and the entire
organogram re‐organised following a rigorous flowchart [1].
It is evident that this unprecedent scenario will have an impact on resident training
programmes, as it is very difficult to predict the duration of the COVID‐19 emergency.
Urology residents do not have the opportunity to carry out clinical activities or
to be tutored, as senior physicians are engaged in the emergency’s management.
In particular, the Authorities have limited unnecessary access to urology departments
for residents in order to contain the infection. Moreover, the procedures most affected
by these restrictions are those in which the residents are mostly involved (benign
pathologies, lower urinary tract surgery, and andrology); the surgical interventions,
when performed, are carried out by expert surgeons, with the aim to standardise the
procedures, reduce the operative time and the risk of complications. Very conflicting
positions have emerged recently in Italy about the safety of laparoscopic and robot‐assisted
surgical procedures during the COVID‐19 pandemic. This is mainly related to the recently
published claims on the potential risk of dissemination of the coronavirus infection
through surgical gas [2].
Lastly, case discussions and departmental meetings have been cancelled, to avoid gathering.
Attempts to systematically analyse and categorise the most affected activities during
the 5‐year training programme (e.g. surgical training, research) are impossible, due
to the absence of a homogeneous national training programme. Therefore, it is clear
that urology resident training is affected transversally throughout the 5‐year residency,
due to the involvement of ambulatory, outpatient surgery and major surgery (either
open, minimally invasive surgery or endoscopic).
A recently published survey gives a snapshot of residency training in Italy in 2018
[3], showing a high level of satisfaction amongst the residents, notwithstanding limitations
concerning scientific activity and surgical training.
In order to limit the impact of the COVID‐19 emergency on the residents’ learning
curves, which can further affect surgical and scientific learning, new alternative
teaching methods should be introduced (Table 1).
Table 1
Summary of the different smart‐learning technologies and their respective fields of
application.
Smart‐learning technology
Smart‐learning applications
Pre‐recorded videos on‐demand
Taught class
Video library
Fundamentals of surgery
Surgical procedure’s commentary
Expert’s ‘tips and tricks’
Webinar
Interactive lessons
Discussion of clinical cases
Non‐technical skills
Live debates
Journal Club via social media
Differed debates
Critical analysis of the literature
Resident’s editorials
Shared working experiences
Podcast
Lectures
Case reports
Clinical staff and rounds
Daily updates (single or multiple)
‘Virtual’ rounds
Collegial discussions of surgical approach
Administration’s directives
Simulation
Home simulators (experimental)
John Wiley & Sons, Ltd
This article is being made freely available through PubMed Central as part of the
COVID-19 public health emergency response. It can be used for unrestricted research
re-use and analysis in any form or by any means with acknowledgement of the original
source, for the duration of the public health emergency.
So, thanks to new web‐based technologies, teaching activity can continue.
Among the different technologies available, different types of smart‐learning can
be implemented.
The first one is represented by an online dedicated platform, where pre‐recorded videos
of lessons or surgical procedures are uploaded; these files could be available on‐demand
for the residents.
In this setting, users greatly appreciate the ability to watch pre‐recorded surgical
procedures commented upon by an expert, with focus on routinely performed urological
manoeuvres or new techniques and technologies in urology or, furthermore, expert ‘tips
and tricks’ for challenging cases.
The Surgery in Motion School of the European Urology Association (https://surgeryinmotion-school.org)
represents a well‐established video‐based educational tool for efficient mentorship
in surgical training.
The next facet of online teaching is represented by the webinar format. It has already
been shown to be useful in this setting [4], giving to both professors and students
the chance to interact and to enjoy multimedia content in real‐time. Classes, clinical
cases discussion and interactive pre‐recorded video presentations can be held by an
expert, and the residents have the ability to ask questions. Moreover, various non‐technical
skills can be covered.
Furthermore, exploiting web microblogging services, like Twitter online Journal Clubs
can be done. By using social media, residents can engage in critical appraisal of
evidence‐based medicine with dynamic worldwide shared discussion amongst themselves,
having the chance to interact with opinion leaders in specific topics. This format
has already proven to change clinical practice in 50% of young attendees [5].
Lastly, pre‐recorded audio files of expert opinion can be shared online, creating
dedicated Podcast channels. This modality of e‐learning is not novel and every week
>500 000 podcasts are active worldwide. Today, for urology there are a total of two
podcasts experiences and only one of which was active (i.e. https://www.bjuinternational.com/podcasts).
From this examination, it appears clear how the theoretical training of residents
can continue with smart‐learning modalities. However, in reality the implementation
of such clinical smart‐learning appears to be more challenging.
The daily clinical staff meeting can be web‐based and planned by using dedicated webinar
slots, opening an interactive discussion amongst the urologists and residents concerning
the recovery of patients; a second daily update can be done in the afternoon. The
procedures of the day can be discussed jointly: in this emergency period it is important
to choose the best surgical approach and surgeon for the selected patient, in order
to maximise the efficacy of the procedure and reduce the risk of adverse events. Moreover,
planning strategies concerning the management of COVID‐19 and non‐COVID‐19 patients
should be planned according to the hospital administration decrees.
Furthermore, thanks to the advent of new telepresence robotic platforms like the Intouch
Vita by Intouch Health, Goleta, CA, USA (https://intouchhealth.com/?gdprorigin=true),
the morning rounds can be potentially shared with online attendees. Thanks to advanced
features including auto‐drive capabilities, remote providers can control or automatically
head to a patient care location, having the possibility to live‐broadcast images and
audio to physicians in their homes.
Finally, notwithstanding the well‐established usefulness of surgical simulation training
programmes [6], in this particular historic moment, where the Authorities have limited
unnecessary transfers, the access to simulation platforms usually located in hospitals
or universities is difficult. Preliminary experiences with home‐made simulators have
already been presented, but their real clinical utility is still under investigation.
In conclusion, we think that the use of smart technology should be maximised and implemented,
in order to guarantee continuity in the learning curve of residents. Now, during this
extraordinary emergency in which it is very difficult to predict the duration of disruption,
the current necessity should hopefully be translated into a future opportunity, in
which smart‐learning can become a useful tool integrated routinely into residency
training programmes and urology daily life.
Conflict of interest
None disclosed.