The future of procedural training is virtual

John Rundback

In the wake of the COVID-19 pandemic, the world of education went virtual. John Rundback (Advanced Interventional & Vascular Services LLP and American Endovascular & Amputation Prevention PC in Clifton, USA), who has been involved in interventional device education for more than 25 years, believes virtual procedural training is here to stay. In this interview, Rundback details how procedural training has adapted and is thriving in its new digital setting, with available systems offering increasingly immersive learning environments available to an international cohort of students. He predicts an 80:20 split between virtual and in-person training in the future.

What did training look like before the COVID-19 pandemic?

In-person training was the norm before COVID-19. Students would come in to our department to observe cases, to work on projects that we would assign to them and to be involved in live cases. For a live case, we would bring in audio and video crews so that we could broadcast the case for international meetings. There would also be various fellows and residents who would come in and rotate with us. Students had to physically be there, and that was great—you certainly had that personal interaction, but it was also time-consuming in that you had to devote your attention to an individual.

In-person training was dealt a blow due to COVID-19. How did it then transform?

When COVID-19 hit, obviously everything changed. I have been involved in medical education, and specifically interventional device education, for my entire career—more than 25 years now—and so it is part of who I am.

We have now moved towards using virtual platforms. Typically, a virtual platform will feature a video monitor that has several inputs and cameras. What this creates is a remote, immersive environment, and, in many respects, I think it is better than what we used to have. Rather than trying to see what is going on in a busy procedure room, where you are trying to find the optimal positioning to look at the monitors and look at what you are doing, you can now focus more on the patient. In addition, the user can control the inputs, and so there are no wasted efforts in teaching, and this has created a much better flow and a much more curated experience for the people who log in.

There are other advantages as well. Remote learning makes scheduling easier, both for us and for the attendees, who instead of having to set aside a day or longer, they can just log in for specific cases or specific portions of cases, and we can of course record portions of those as well.

Moving forward, I think this is going to be a new paradigm, and we have platforms that are expanding their capabilities with more inputs and more cameras, so we can really make this even more of a comprehensive environment and make the remote user feel like they are in the room.

How do virtual platforms change local training and have they maintained their value when tested for international training as well?

We have actually done some international training already with Avail, the technology that we have chosen for remote virtual training. We have had people who have logged in from Europe so far to watch us during our training and our courses. That is one of the beautiful things about remote learning—by training in a virtual or digital environment, distance is no longer a concern. The challenges of mobilising or disrupting your practice to go and learn, are completely resolved. Furthermore, not only can we potentially educate more people, but from the trainee’s point of view, you can train more often. You cannot necessarily understand everything the first time you go through it but, but remote training gives you the opportunity to participate in a number of different procedures until you reach a comfort level. That would be impossible if trainees had to repeatedly travel to a remote location to try to accomplish the same goal.

What is your lucky guess on the shape of training in the next couple of years?

I think that in the future device and procedural training is going to be 80:20, utilising a virtual platform more often than actual onsite or hands-on training. I think a big part of training is understanding the procedural steps, the cognitive processes behind that and the troubleshooting associated with getting through a case. That is actually 80% of it. Often interventionalists have the skills—the haptic skills, the hands-on skills—and so translating them into your own practice, actually being able to touch the devices and utilise them, is a much smaller part of the training.

In addition, we are increasingly getting a workforce for whom a virtual platform is a familiar and comfortable environment, and actually a preferred way of learning. We are getting people who have been raised during the digital revolution and this is how they interact with the world. So, I think in the future this is going to be the predominant mode of education.

I have heard quite a lot of people talking about this idea of there being a move to a more hybrid model of some being in-person and some being virtual in terms of conferences, and so it is interesting that training will also follow this path, but it does make sense in terms of getting the advantages of physical meetings and also the advantages you get from remote learning.

The reception on the personal interaction during online learning has been lukewarm. Is there a way this can be replicated online?

I think another part of millennial learning is that they very much engage with one another to further their knowledge and to further their comfort level. I think that still happens online. During the virtual live classes there is a conversation that is going on in the background. There is generally a Q&A portal as well so there is interaction there. I know just from my participation that Zoom meetings can be an effective way to share ideas.

Clearly, you lose something in terms of the personal interaction, but again there is the ability for students to see me, if not for me to see them. There was a professor at Harvard who was working in a virtual classroom model where not only could the students see the professor, but there was a video display where the professor could see the students as they spoke. Maybe that would be a nice addition—a separate monitor off to the side so that as people are talking, they can actually have a face-to-face conversation and of course where the students or trainees can also see each other. I think that will be the next evolution as digital advances allow.

Disclosures: John Rundback is a consultant for Avail Medsystems


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