Results

Of the 21 students enrolled in the MSc program 2020/2021, 20 students participated in the virtual surgical skills session. All students completed the pre-and post-session questionnaires. There was a preponderance of female (57%), postgraduate (67%), and students studying within the UK (67%) (see Table 1). 25% of students had previously attended a face-to-face surgical skills course.

Pre-session student concerns

Thematic analysis of open-ended questions regarding pre-session student concerns was examined and themes of instructor supervision, feedback, and surgical kit emerged. In particular, there were concerns regarding the ability of instructors to guide students through a skill, student ability to clearly view live demonstrations, as well as the instructor’s view of students performing the task.

“It could be difficult to supervise my technique, i.e. how I’m using my hands, the amount of pressure used, which way round I’m tying the sutures”

“Not getting a good view. Not getting feedback. Not being able to properly show what I’m doing”.

Pre-session instructor concerns

The thematic analysis highlighted the difficulty in articulation of instructions, visualization and instructor to student ratio as possible challenges perceived by instructors in holding the skills session online.

“I had a couple of concerns … the quality of the video … [and] not being able to visualize what the student is doing.”

“The main concern that I had was being able to describe everything adequately and not being able to show students or have that tactile element of teaching.”

Student confidence in surgical skills and attitude towards virtual surgical skills session

Teaching flexibility

Teaching flexibility emerged as a theme with regard to session preparation and decision-making. Additional resources to supplement the session were created such as the instructional videos and pre-course reading material. Flexibility was also mentioned in the context of adapting the pace of learning for students and modifying the skills covered in the allotted time. For instance, the schedule and content were revised to accommodate different learning styles and paces and to also take into account the challenges that online facilitation may present.

“A lot of additional planning that we had to do in the lead up to [the session]: create instruction sheets for students; create instruction sheets for tutors; we had a briefing session for all tutors to make sure that everybody knew and understood how to teach; I created some videos for the students which were done in surgeon’s view”.

Visualization

Instructors reported on the inability to view students’ non-verbal cues whilst they were practicing the surgical skills, and how this reduced the human factor of teaching. Furthermore, whilst the instructor was demonstrating the skill in ‘Surgeon’s View’ they were unable to view their student group. A suggested solution was to use an adjustable web camera so that the instructor can demonstrate and view the panel of students simultaneously.