Eurospine audience sceptical of digital learning’s potential in spinal surgery training

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As emerging and existing technologies continue to shape the way we communicate and spread knowledge, the potentials of digital learning is given increasing consideration. At the recent Eurospine 2018 annual meeting (19–21 September, Barcelona, Spain), the importance of remote or internet-based learning via a digital platform, also known as e-learning, was debated at length. An audience poll following the debate showed 89% of Eurospine delegates agreed that the format “may have a role in spinal surgery education”, though only 18% believed that “e-learning is definitely the future of spinal surgery education”.

Arguing for the benefits of e-learning, Bernhard Meyer from the Technical University of
Munich, Germany, stated that for him, basic e-learning involves the transfer of face-to-face activities to an online platform.

Meyer pointed to the versatility of e-learning, with pre-course learning, referencing and mutual classrooms already having been implemented in other disciplines. Of the extent
the field is likely to change due to e-learning, he said: “Not so much for now—except for one important thing: education and training will become more homogenous. […] If we
give access that is affordable to people for online learning, education and training will inevitably become what I think it should be—more regular.” He further noted that there should not be a difference in treatment or education depending on where in Europe one trains, and that digital learning can help to standardise education and training.

“It is inevitable; it is in-line with the general development of society […] the only question is how to transform it,” Meyer stated, arguing that e-learning opens opportunities for developing countries: “The number one pre-requisite for this is that it must be affordable, otherwise it becomes an elite thing.”

Despite these benefits however, Meyer acknowledged certain shortcomings of e-learning. He used the example of case-based discussions to illustrate that the lack of direct contact between teacher and trainee could become an issue: “People open up and express their opinion on a particular case […] while talking on a social level about it sometimes changes the way you view your opinion and work, [which is] an important aspect, and lacking within e-learning.”

Although younger specialists and trainees may be more flexible and accepting of digital learning modalities, the older demographic of surgeons (including the Eurospine Education
Committee) are more likely to question its efficacy, Meyer suggested. In light of this, he proposed the use of a “hybrid model”, where lectures are presented online first, and face-to-face sessions occur afterwards. Throughout, progress would be dependent on acceptance of this methodology, allowing for a “step-wise transition”.

Meyer suggested that if acceptance is high, a live case discussion could occur through live media streams, for example. However, he reiterated the issue with skills training—approximating that skills training through eLearning may occur five to six years down the line. Irrespective of this, he concluded that the future of e-learning is in-line with the development of our current society, and is certainly feasible.

Taking into account Meyers’ argument for the use of e-learning in spinal surgery, counter-argument debater Paulo Pereira (Centro Hospitalar São João, Porto, Portugal) began by implying that learning over the internet produces an oversimplified and reductive means in which to understand the complex nature of the task at hand. He stated that although the advantages of e-learning should be taken into consideration, its potential application to spinal surgery is another matter.

In agreement with Meyer, Pereira acknowledged that e-learning is not a novel concept, as over 100 presentations on e-learning took place during the 2005 meeting of the International Association for Medical Education. However, Pereira maintained that although the method may work in order to teach neuroanatomy, it may only be moderately effective for teaching examination of the cranial nerve. More importantly, he asked the audience, “how effective is it in order to train a student to tell a patient that they have cancer?”

Pereira acknowledged that in terms of face-to-face learning, it is important to know exactly what can be replaced. Through e-learning, he argued, there is no possibility for immediate feedback to particular questions a trainee may have. Additionally, the course may be patients would not want to be operated on by a surgeon that had received digital surgical skills training, stating that surgical skills training in the operation room is still needed, regardless of digital learning components; however, being better prepared by an interactive feed of a successful surgery is “better than fiddling around in a corpse”. Yet Pereria maintained that the future should focus on live interaction, using e-learning as a facilitative instruction tool—albeit a powerful one.

In complete agreement, Meyer and Pereria both stressed that mentorship and bonds with peers are important benefits of face-to-face learning which are unlikely to be replaced in a purely digital environment. “Even in 10 years from now,” Meyer said, “once in a while you will need to see someone face-to-face.”

Once the debate had finished, Acaroglu presented three statements to the audience, of whom were asked to vote whether they were in agreement. Following the debate, an audience poll revealed 89% to be in agreement with the statement: “e-learning may have a role in spinal surgery education”, while only 18% of the audience agreed that “e-learning is definitely the future of spinal surgery education”. To the latter, 44% answered “maybe”, and 38% disagreed.

In light of these figures, Meyer agreed that some scepticism of e-learning as the future of spine surgery is healthy, concluding that “nobody can look to the future, so [we] need to be careful in any transition [we] try to propagate.”

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