Pirbhat Shams1, Intisar Ahmed1, Hunaina Shahab1, Zehra Kadani2, Aisal Khan3, Saira Bokhari1, Aamir Hameed Khan1

1Aga Khan University Hospital, Karachi, Pakistan, 2National Institute of Cardiovascular Diseases, Karachi, Pakistan, 3Tabba Heart Institute, Karachi, Pakistan

Background:
COVID-19 pandemic has created huge training challenges in view of lack of physical meetings and reduced bedside clinical learning and this is especially true for cardiovascular Fellow-in-Training (FIT). Learning mechanism for health care workers (HCW) worldwide have been switched to online sessions in an effort to maximize social distancing and avoid inadvertent exposures among HCW. Virtual and simulator-based learning platforms are not widely available in Low to Middle Income Countries (LMIC) including ours. It is prudent to analyze feedback of FIT before implementing virtual cardiovascular in resource constraint settings like LMIC. However, this pandemic has highlighted importance of these platforms and have emerged as primary education tool in cardiovascular learning in Pakistan’s epicenter – Karachi- which hosts three major institutes for cardiovascular training including ours.

Method(s):
We conducted a multi centered survey about virtual cardiovascular learning experience in epicenter of Pakistan – Karachi. This study included three major centers of cardiovascular training in the city. Google Form survey was circulated to Program Directors and FIT via emails and/or WhatsApp. The survey included FIT from adult cardiology, cardio-thoracic surgery and interventional cardiology.

Result(s):
A total of 64 FIT from all three centers responded to the survey. 90.8 % (57) of FIT were in age group of 27-32 years. There were 36.8% (25) females and 63.2% (43) males. Adult cardiology FIT constituted 88.2% (60) of responders. 94.1% (64) FIT were concerned that COVID-19 pandemic is affecting their training with regard to less clinical and procedure related exposure. 85.3% (58) FIT experienced increase in their stress level, 64.7% (44) said that pandemic was affecting their mental health and 77.9% (53) were afraid to contract COVID-19 while on work. 75% (51) FIT agreed that it was easier for them to reach for online sessions than physical sessions. 60.3% (41) said that they were not afraid of being judged for their questions and comments during online sessions and 57.4 % (39) thought that cardiovascular imaging/illustration teaching (including electrocardiograms and echocardiograms) had become easier due to online platforms. 50% (34) FIT were confident that if online sessions had to continue, they shall have enough academic learning before they graduate from program and 54.4% (37) FIT wanted online sessions to continue even beyond pandemic days. 53.7 % (36) FIT believed that Facebook based cardiovascular forums had increased their access to and reading time of cardiovascular literature. However, the same poll for Twitter could attract 16.2 % (11) of FIT. 76.5 % (52) of FIT said that they missed the impact of physical sessions on their professional grooming. 37.5% (18 out of 48) FIT agreed that simulator-based teaching was helping them practice skills in times of less clinical exposure as this pandemic and 22.9% (11 out of 48) were neutral about it, however, 33.3% (16 out of 45) FIT said they had never experience simulator-based teaching.

Conclusion(s):
COVID-19 pandemic has affected cardiovascular FIT learning curve in terms of less clinical and procedure related exposure. It also has significantly contributed to FITs’ stress level. Thanks to pandemic that in setting of LMIC, virtual education has started gaining acceptance. FIT are now comfortable and more interested to reach for virtual sessions. If or not, virtual cardiovascular learning is impacting the objective scores of performances, needs further research. Additionally, this brings us to the importance of establishing robust virtual and simulator-based learning platforms in setting of LMIC for unfavorable days as these.