Webinar Education in Ophthalmology during the COVID-19 Pandemic: A Survey Study

Background: Ophthalmology education is changing amidst the COVID-19 pandemic. The purpose of this study is to describe and evaluate the implementation of webinars combined with online resources for review for ophthalmology trainees. Methods: This is a single-center descriptive survey study. A validated survey tool was distributed 2 months after implementation of webinar education. The survey population comprised residents, fellows, and faculty in a Chicago ophthalmology training program. Results: Eighteen residents (100% response rate), 9 fellows (81.8% response rate) and 20 faculty members (44.4% response rate) responded to the survey. Barriers to webinar education and limitations to learning during webinars were rated as low in both groups (avg. 1.98 ± 2.04 and 2.16 ± 1.82, respectively). The educational value of the webinars was moderately well rated (avg. 7.35 ± 1.66). Interest in webinars replacing in-person lectures was neutral (avg. 5.45 ± 2.54). Faculty expressed fewer barriers (p = 0.005), and a higher preference to use webinar education frequently (p = 0.003) and instead of in-person lectures (p = 0.009), compared to trainees. Conclusions: The ndings of this survey suggest that webinars in ophthalmology education are effective and feasible, with some perceived limitations.


Introduction
Medical education is undergoing a transformative change amidst the COVID-19 pandemic. With social distancing measures, educators have transitioned to web-based learning platforms, to train future physicians globally. [1][2][3][4][5] Given the unknown time course of the pandemic, adaptations to the medical curriculum are being made quickly and evaluated to maintain high-quality education. 6 Live interactive webinars have been shown to be well perceived and effective for ophthalmology resident education. 7,8 The ipped classroom, a form of blended learning includes pre-class learning followed by discussion, has also been shown to be preferred by ophthalmology residents. 9 However, the literature regarding an entirely online ipped classroom approach for ophthalmology training remains scarce.
In this study, we describe and evaluate the implementation of webinars using the ipped classroom for ophthalmology education at the Department of Ophthalmology, University of Illinois at Chicago (UIC) during the COVID-19 pandemic. The purpose was to assess the accessibility, effectiveness, and feasibility of this educational technique based on participant feedback through a survey tool.

Methods
This was a single-center survey study conducted at UIC was approved by the UIC Institutional Review Board. Participants included all UIC ophthalmology residents, fellows, and several faculty (many who taught and attended webinars given by other faculty). The survey was based on 43 webinars, 23 of which had online resources available for review prior to the webinar between April 2020 and May 2020. Cisco WebEx (Milpitas, California) was used for webinars, and Box (Redwood City, California) was used for cloud storage of online resources. The anonymized survey was administered online (www.qualtrics.com).
Electronic informed consent was obtained from participants. Survey questions were modi ed from previously validated questionnaires, speci cally the Medical E-learning Evaluation Survey (MEES) 10  The survey was distributed to participants via email 2 months after the implementation of webinar education. Data collected from surveys was analyzed by SPSS (version 26). Fellows' and residents' responses were grouped together as "trainees" for analysis. Quantitative and qualitative data was analyzed with descriptive statistics. Student's T-test and Wilcoxon test were used to compare means between trainees and faculty. A signi cance level of p ≤ 0.05 was used for all statistical analysis.

Discussion
The COVID-19 pandemic and social distancing measures have shifted in-person education to E-learning and webinars, 5, 12 often in ipped classroom approach. 13 This survey study aimed to evaluate trainees' and faculty's perceptions of recently implemented of web-based education.
E-learning resource sharing and webinar accessibility was well perceived by participants. Barriers to Elearning resources appeared to be higher with trainees than faculty, as the resources shared were felt to be lengthy/excessive. Since faculty did not attend many webinars in which they were not the educators, and likely did not need to review shared material prior to webinars as much as trainees, their perceived barriers were lower. Sharing of E-learning material that are focused and concise might help improve ratings. Learning limitations were primarily related to the technical issues with WebEx, although WebEx usability was rated overall favorably based on SUS statements -being easy to use, quick to learn, and having well integrated functions. Finding a stable internet connection, removing background noise, and using a headset can help optimize video and audio. In addition, preparation, such as running a test session by webinar hosts is recommended to ensure adequate internet connection, screen sharing, and ability to mute/unmute participants. 14 The educational value of webinars was rated highly, and most participants were interested in using WebEx more frequently, however interest in having webinars replaced in-person lectures was neutral.
Interestingly, trainees preferred in-person lectures slightly more than webinars, while faculty preferred webinars instead of in-person lectures. Faculty also preferred using WebEx more than trainees. These ndings may re ect differing values of participants; for example, residents may value in-person interactive discussion while faculty may value the increased exibility that web-based education permits. Inclusion of more interactive components such as quizzes/polls and personal anecdotes may improve participant engagement. Recorded sessions may further increase trainees' perception of webinars. 14 The study limitations include its relatively small sample size and single-center study population, though we feel that the number of webinars provided to this group was adequate to get reasonable feedback from both trainees and educators. A longitudinal multi-institutional webinar series with periodic surveys may provide additional insight on the utility of webinars in post-graduate medical education in ophthalmology.

Conclusions
Online education is being using for ophthalmology training worldwide during the COVID-19 pandemic. [15][16][17] Although this survey study was based in the United States, we believe that the ndings are applicable globally. Overall, we found that sharing E-learning resources and webinar education in ophthalmology was well perceived by both trainees and faculty during the COVID-19 pandemic. This study showed that online ipped-classroom education was rated moderately high in terms of accessibility, educational value, and usability. Future improvements by providing focused E-learning resources, pre-planning webinars with interactive components, improved familiarity with technology involved, and recording webinars may enhance webinar-based education as the preferred tool for some aspects of ophthalmic education.