Compelled dichotomy of the cardiology training during COVID-19 time: green flag to the distant technologies
Authors: Neplueva G , Soloveva S , Irtyuga O , Zaitsev V , Korostovtseva L , Villevalde S , Parmon E 
Published: October 2021

Abstract

Background
The COVID-19 pandemic has dramatically influenced healthcare systems as well as the training environment worldwide. Numerous concerns have been raised about the disruption of cardiology training due to the social and physical distancing. We aimed to characterize the changes made in cardiology training in response to the COVID-19 pandemic and the personal perception of the new educational realities amongst first-year residents of the university clinic of the national medical research centre.

Methods
The institutional educational program underwent urgent and significant adaptation. Functions of the e-learning platform were extended in the purpose of the accumulation of the recorded lectures, online discussions, meetings, case-based clinical scenarios, virtual simulations, and regular virtual clinical rounds 2 times per week. Using an online 7-items survey, we analyzed the practical experience of 33 clinical cardiology trainees who worked within “red” and “green” zones and their personal perception of the distance educational technologies.

Results
At the peak of the pandemic outbreak, 40.6% of the residents have transferred into facilities restructured for COVID-19 patients for a median of 3 (1; 4) months. According to the responses they did not experience changes in the direct supervision time by their trainers and have achieved a higher level of independence in the procedural activity (arterial and central venous catheterization, CPR, performing intubation and invasive ventilation), decision making (such as prescription of anticoagulants and antibiotics, treatment of comorbid conditions), interpretation of the laboratory (acid-base balance, markers of myocardial, kidney and liver damage) and instrumental findings (ECG, echocardiography, coronary tomography). Despite the challenges, 75% of the trainees positively assessed their training in infectious settings.
Due to the accidental contacts with COVID-19 patients and the associated need for 14-days quarantine residents who remained in the “green” zone experienced a reduction in direct supervision time from 57 to 17 hours per week (−70%) and were lack of procedural skills improvement. However, using the wide range of the educational resources provided in demand resulted in an increase in their learning time (plus 8 hours per week) with improvement in cardiology knowledge. Positive feedback was received from 85% of these residents with mention of the improvement of self-management.

Conclusions
Despite worldwide adoption of the educational program to the distant learning cardiology residents can experience different educational scenarios in the different setting due to COVID-19 cases surge. Combination of direct supervision, teaching remotely with staff support, case-based discussions, wider use of simulation, telemedicine, and social media engagement are urgently needed for adaptation of the educational programs in order to reduce the continuing shortage of specialists.

Funding Acknowledgement
Type of funding sources: None.