EFAS/EAN survey on the influence of the COVID-19 pandemic on European clinical autonomic education and research
Authors: Fanciulli Alessandra , Skorić Magdalena Krbot , Leys Fabian , Carneiro Diogo Reis , Campese Nicole , Calandra-Buonaura Giovanna , Camaradou Jennifer , Chiaro Giacomo , Cortelli Pietro , Falup-Pecurariu Cristian , Granata Roberta , Guaraldi Pietro , Helbok Raimund , Hilz Max J. , Iodice Valeria , Jordan Jens , Kaal Evert C. A. , Kamondi Anita , Le Traon Anne Pavy , Rocha Isabel , Sellner Johann , Senard Jean Michel , Terkelsen Astrid , Wenning Gregor K. , Moro Elena , Berger Thomas , Thijs Roland D. , Struhal Walter , Habek Mario ,   the Collaborators of European Network of Neurological Autonomic Laboratories, Adamec Ivan , Aerts Arnaud , Canta Leo L. R. , Delamont Robert Shane , de Lange Frederik , Del Sorbo Francesca , Devigili Grazia , Di Leo Rita , Dinh Trang , Fortrat Jacques-Olivier , Gierthmühlen Janne , Hemels Martin , Köhn Julia , Krøigård Thomas , Lipp Axel , Maier Andrea , Marinelli Lucio , Mazzeo Anna , Milenkovic Ivan , Motyl Maciej , Sora Maria Grazia Natali , Navarro-Otano Judith , Nilsen Kristian Bernhard , Oliveira Mario , Omland Petter Moe , Pelliccioni Giuseppe , Pereon Yann , Resch Roland Josef , Rocchi Camilla , Roche Frederic , Rutten Joost , Tijero-Merino Beatriz , Tutaj Marcin , van der Heijden-Montfroy A. M. H. G. , van Hoeve Bas J. A. , van Orshoven Narender , Wang Ruihao , Z’Graggen Werner J. 
Published: October 2023

Abstract
Purpose
To understand the influence of the coronavirus disease 2019 (COVID-19) pandemic on clinical autonomic education and research in Europe.

Methods
We invited 84 European autonomic centers to complete an online survey, recorded the pre-pandemic-to-pandemic percentage of junior participants in the annual congresses of the European Federation of Autonomic Societies (EFAS) and European Academy of Neurology (EAN) and the pre-pandemic-to-pandemic number of PubMed publications on neurological disorders.

Results
Forty-six centers answered the survey (55%). Twenty-nine centers were involved in clinical autonomic education and experienced pandemic-related didactic interruptions for 9 (5; 9) months. Ninety percent (n = 26/29) of autonomic educational centers reported a negative impact of the COVID-19 pandemic on education quality, and 93% (n = 27/29) established e-learning models. Both the 2020 joint EAN–EFAS virtual congress and the 2021 (virtual) and 2022 (hybrid) EFAS and EAN congresses marked higher percentages of junior participants than in 2019. Forty-one respondents (89%) were autonomic researchers, and 29 of them reported pandemic-related trial interruptions for 5 (2; 9) months. Since the pandemic begin, almost half of the respondents had less time for scientific writing. Likewise, the number of PubMed publications on autonomic topics showed the smallest increase compared with other neurological fields in 2020–2021 and the highest drop in 2022. Autonomic research centers that amended their trial protocols for telemedicine (38%, n = 16/41) maintained higher clinical caseloads during the first pandemic year.

Conclusions
The COVID-19 pandemic had a substantial negative impact on European clinical autonomic education and research. At the same time, it promoted digitalization, favoring more equitable access to autonomic education and improved trial design.