The coronavirus disease-2019 (COVID-19) pandemic has had an unparalleled impact on cardiology training worldwide. In the next few sections, we highlight several foundational considerations for building a successful technology-enabled model in the new normal for cardiology training.
Key features of the e-learning process are centred on the internet with international sharing of learning resources, information broadcasts and knowledge flow through network courses, and flexible learning in a computer-based environment that overcomes barriers of distance and time. A United Kingdom (UK)-based group of registrars have come together to engage global experts for regular teaching webinars on core cardiology curriculum topics. This approach to learning could change the way fellow ‘training days’ are delivered for continuing professional development, which can in turn mitigate pre-existing rota commitments and travel requirements.1
Internationally, cardiology societies have reverted to e-learning portals and video-conferencing for continuing medical education, including the European Society of Cardiology Scientific Congress 2020 which was delivered as a digital experience. Whilst virtual live sessions and replays have previously been made available for various subspecialty conferences over the years, the COVID-19 era has indeed accelerated the widespread adoption of digital content delivery platforms at a much larger scale than before.
Augmented reality through medical holography and extended virtual reality with various degrees of immersive, overlay, and integrative interactivity are part of the spectrum of mixed reality techniques that are highly applicable in educational domains. Already available for interactive teaching by allowing intuitive depth perception and accurate understanding of 3D anatomy and surgical procedures within hands reach, these technologies may be leveraged to replace in part what trainees previously learned during in-person clinical rotations. A future further extension of mixed reality could be haptic rendering techniques, whereby a haptic feedback system’s capacity to transcribe palpable physiologic parameters into tactile information can provide an operator with valuable real-time information that can improve procedural learning.2
The effects of COVID‐19 on procedural training can be moderated by simulation‐based e-learning delivered in various formats, including virtual patients, computer‐based physiology simulators or advanced surgical simulators that allow the practice of procedures such as valve replacement or coronary artery bypass surgery. These can be most valuable in the earlier stages of learning a new procedure when there is a higher propensity for complications.
Simulation-based training has been shown to improve transoesophageal echocardiography (TOE) procedural skills.3 Simulation-based training for coronary angiography has also been shown to reduce procedure time and improve technical ability in real-life patient procedures.4 Trainees can learn at their own pace in a stress-free environment with immediate feedback for improved manual dexterity, whilst minimizing risks during this learning phase.
Customized learning through continuous computerized algorithm assessment can be used to compare individual decision-making with real-life expert decision-making. In the form of self-teaching and active learning known as adaptive learning, more emphasis is placed on areas where a trainee requires further development. One study of TOE interpretation among anaesthesia residents showed that an adaptive learning module resulted in improved accuracy and proficiency.5
Trainee review of instructional materials before the actual class can be very helpful for learning within a paradigm known as the flipped classroom approach, whereby class time is used more constructively to identify mixed competency levels, learner difficulties, and differentiated learning preferences. One study showed superior quality improvement in residents who underwent a flipped classroom curriculum.6 Video-based coaching has also been shown to be effective in training for coronary intervention and transcatheter valve procedures.