New Media Platforms for Teaching and Networking: Emerging Global Opportunities for Breast Surgeons Free

Breast surgery is a joint subspecialty of general, reconstructive, and gynecological surgery based on the regulations in different countries. Apart from being an official surgical subspecialty, in most parts of the world, it is being performed by surgeons with a personal dedication [1]. In recent years, the context of breast surgery expanded in multiple dimensions including oncoplastic reconstructive surgery and imaging-guided interventions [2]. Moreover, personalized targeted systemic treatments accelerated the de-escalation in the surgical treatment of breast cancer patients along with its impact on prolonging the survival rates. Under these developments, maintaining the patient’s quality of life became one of the main priorities [3]. Along with these, there is a constant demand for specialized breast surgeons in the community. However, the rate of change in the clinical understanding of breast cancer and its management is increasing with the help of new technologies. So, these bring many challenges for the training bodies and their surgical trainees [4].

Competencies for a breast surgeon include engaging to acquire adequate medical knowledge, applying the knowledge to the clinical practice by performing cognitive skills such as decision-making and critical-thinking as well as executing safe surgical procedures and, finally, adopting professional attitudes such as shared decision-making, showing respect to patient expectations and collaborating with other colleagues to provide an inter and multidisciplinary teamwork [5]. Today breast surgeons are expected to play a central role as the master physician who is capable of understanding all aspects of the oncological approach, not limited to surgery only, as well as the management of benign conditions and breast cancer risk.

Current surgical training programs are not without gaps. Lack of adequate number of trainers, lack of time, the excess workload in clinical assignments, inability to follow all the reliable sources for new developments, unapproved information from internet/online sources, lack of appraisal tools for new information, too many journals to follow, too many publications to read, lack of proper mentorship and role modeling are among the current problems of contemporary training platforms/programs for breast surgeons. The implementation of duty-hour restrictions has translated to trainees having limited time in hospitals, clinics, and operating rooms. The demand for higher patient safety combined with extensive documentation limits the time the trainers have to mentor trainees. In addition, the concentration of complex procedures to certain high-burden centers along with the heterogenous spectrum of training in various centers across the globe creates an inequity in surgical training. During the COVID pandemic, residents were transitioned from surgical rotations to pandemic-related service activities (emergency medicine, intensive care) and required off time (quarantine) at home which further disrupted their training [6]. The aim of this review was to describe the role of emerging virtual platforms in training and networking by using web 2.0 media tools.

Learning opportunities have now expanded beyond the confines of the hospital environment. Trainees and trainers alike are adopting emerging digital technologies to transform the surgical learning process by making knowledge more accessible, time zone independent, low-cost, interactive, and on the go-as these platforms seamlessly integrate into their existing social media life. A systematic review performed by Cheston et al. [7] included 14 studies that assessed interventions using social media tools in medical education and found that these tools were associated with improved knowledge (examination scores), attitude (empathy), skill (reflective writing), promote learner engagement, feedback, collaboration, and professional development.

Surgical education has embraced a variety of digital tools which enable real-time discussions and advice, live presentations, archived educational content, and rapid dissemination of manuscripts, including preprint versions during COVID. Studies have shown that “web-based teaching platforms for residents and medical students are equally as effective as in-person teaching modalities in various situations,” including simulated patient encounters, ultrasound training, and procedural training [8‒12]. In breast surgery, an innovative web-based platform that helped surgeons to practice virtually for breast surgical skills is Virtual Breast Oncoplastic Surgical Simulator (VBOSS) [13]. Simulation-based training with immediate feedback for skills has been used for a long time, especially for endoscopic and laparoscopic skills. For this various apps developed for smart devices are being used for common use [14]. In this free platform of VBOSS, surgeons may simulate various oncoplastic techniques with real-time feedback. This online tool is a reflective learning method that helps breast surgeons to have independent training apart from this example, there are many applications developed for the surgeons to make them surgical exposure to various interventions in almost all available stores under smart device and software providers [15].

One of the early web-based platforms, Wikipedia, has been demonstrated to be an appropriate educational tool for improving learning outcomes and short-term knowledge acquisition in medical students [16]. Societies like the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) have created a “SAGES wiki,” where members can log in and access the resource created by other members. SAGES actively encourages its members to participate and contribute to the wiki by either creating a new topic, improving an existing topic, or participating in an online discussion about a specific topic. This ever-expanding resource is accessed by more than 2,500 people per month seeking information about minimally invasive surgery. Regardless of the level of training, this is a great educational tool that allows for knowledge acquisition of disease processes, as well as technical tips pertaining to an operation [17].

Twitter has been a very popular microblogging platform, allowing surgical societies and individual surgeons to share short text messages, pictures, and links worldwide [18]. Surgical trainees have to be more efficient in their time management and cope with an ever-increasing volume of knowledge while concurrently obtaining procedural experience. This has led to the rise in the popularity of microlearning and microblogging. Bannister and colleagues found a 100-fold increase in participation when sharing a traditional eLearning module in continuing medical education to social media in a microlearning format [19]. The social networking portal Facebook has provided a mechanism for healthcare professionals to share their experiences and discussions in restricted “closed groups.” The closed Facebook group as a tool for medical education has been previously reported and is increasingly utilized. The “International Hernia Collaboration” facilitates discussion of techniques and challenges in the field of hernia surgery [20]. The Society of American Gastrointestinal and Endoscopic Surgeons created a series of Facebook groups to educate, improve outcomes, and share clinical information [21, 22]. It is similarly leveraged by the “International Microsurgeons Club” [23] and the “Robotic Surgery Collaboration” [24]. These groups include content on operative techniques, patient management, discussion of challenging cases, professional networking, sharing resources, and research collaboration. On Snapchat, trainees can see preoperative work, clinics, and operative videos, permitting trainees to gain an understanding of preparing for surgery and recovery/follow-up from experts in different parts of the world on a platform that they already have access to. They can interact with these experts who are delighted to engage and respond to these queries.

Of all the medical specialties, plastic surgery is the one most present on social media with major journals like Plastic and Reconstructive Surgery and PRS Global Open widely using Twitter, Facebook, and Instagram as a major conduit as a teaching tool for young plastic surgeons to participate in and learn from PRS Grand Rounds, PRS Journal Club Q&A and Podcasts, and “PRS Resident Chronicles” blog [25]. The Young Retina Forum uses Telegram as a platform to improve education, clinical practice, and patient care [26].

Laurentino et al. [27] conducted an online survey among 219 medical students, residents, and practicing surgeons to evaluate the use of social media platforms for surgical education during the COVID pandemic and found that almost 90% reported utilizing social media for surgical education either daily or weekly, for an average of 1–5 h per week. They most prefer the video-sharing site YouTube, the messaging app WhatsApp, and live videoconferencing sites. Other institutional studies have also demonstrated a 90% utilization rate of digital platforms by surgical medical students and residents [18, 28]. Further, a recent consensus summary has promoted an even greater academic use of social media platforms for surgical research, including #SoMe4Surgery (Social Media for Surgery) [29].

Moreover, as mentorship is fundamental for professional development, virtual mentor-mentee interaction was held in various disciplines within a pragmatic context of training overall, especially under late COVID restrictions [30]. Therefore, a less identified strength of social media is to bring networking and mentorship for women in surgery who otherwise may lack mentors locally. With many female students feeling discouraged by the lack of visibility of female role models, movements on Twitter such as #ILookLikeASurgeon have brought strong female faces and names to the forefront, offering trainees the opportunity to see themselves in such roles. This was followed by #NYerORCoverChallenge, the overwhelming response fueled by a cover of The New Yorker, in which the four faces of the surgical team looking down upon a patient were exclusively women. This social media movement brought women together across surgical fields, dissolving hierarchical relationships, in a communal excitement to shatter stereotypes and represent the amazing identity of women surgeons [31].

Surgical trainees are expected to be well-prepared prior to undertaking an operation. Access to an extensive video library with accurate, high-quality videos from experts allows learners to visualize and learn the key steps of a procedure at their own pace, with the ability to rewind or pause the video to capture important steps (surgical replay). Learners can revisit the steps of an operation as many times as needed until it is well understood without any time constraints or pressures that may arise in the operating room. This is key because this type of learning cannot be done live in the operating room. A survey by Rapp et al. [18] evaluated surgical preparation methods of medical students, residents, and faculty and found that most respondents reported using videos as their preferred way of preparing for surgery with YouTube being the preferred source. However, with any open source of education come certain drawbacks, such as quality control of the content that is often not peer-reviewed or referenced as well as failure to disclose the source of the data or any conflict of interest [32]. In addition, there are issues of lacking the ability for dynamic interaction and co-learning that can be integral to a meaningful learning experience [33, 34]. A particular predilection for YouTube as a learning video source was already evidenced by other authors in previous reports, concerning other surgical fields than breast surgery [35‒37].

Collaborative learning web platforms like iBreastBook, BreastGlobal, Oncoplastic Academy-Brazil, Breastics24h, Virtual Breast Oncoplastic Surgery Simulator (VBOSS), CluBreast, etc., combat these limitations by enabling quality content being posted by renowned experts/expert groups which ensure some degree of peer-review and verification of source. These platforms also ensure dynamic interaction where surgeons and trainees from all over the world can actively participate interacting with leaders and experts in the field who discuss current hot topics as well as teach techniques for new surgical procedures. For example, BreastGlobal.org is putting together a member-driven network of experts who will not enable high-quality video content for surgeons but also provide valuable webinars that provide interactive engagement with experts [38]. Event-based learning is another format that is emerging through the collaboration of organizations and digital platforms. Breastics24h, which stands for “Breast Oncoplastic Surgery around 24 h,” is an excellent example of such a model put together by the Group for Reconstructive and Therapeutic Advancements (GReTA, Italy), iBreastBook (UK), Oncoplastic Academy (OA)-Brazil, American Society of Breast Surgeons (ASBrS), Breast Surgeons of Australia & New Zealand (BreastSurgANZ), Chinese Breast Cancer Society (CBCS), Association of Breast Surgeons of India (ABSI) and Senology Academy-Turkiye (SENATURK). Breastics24h focused on enabling a well-rounded web-based program for new trainees entering breast surgery [39]. Global breast hub is a virtually based platform to promote, standardize and advance safe and effective breast care to communicate, educate, advocate, and advance the specialty of breast surgery globally [4].

A key feature in the new age of digital platforms is that most platforms emerge from the collaboration of established senior breast surgeons with a mission to share knowledge, strengthen their global community, and enable new trainees who are entering the field. The Oncoplastic Academy-Brazil is a prominent example of such leadership from senior surgeons [40]. The vision to share knowledge and scale together is visible in the way these platforms collaborate such as in the Breastics24h. The rising participation of surgeons is also visible in the breadth and depth of the knowledge repositories such as iBreastBook that have gained popularity. iBreastBook not only offers excellent learning videos for surgeons but also has valuable content for patients. The webpage has already clocked over 70,000 visits [41].

Another online media platform type that should be underlined is virtual journal clubs. These platforms provide a significant interactive forum for evidence-based discussions on a multidisciplinary basis [42]. CluBreast is a virtual journal club provided by SENATURK in collaboration with EUBREAST is a unique opportunity for breast care professionals to hear the latest papers from their authors. This program enables the attendees to catch the updated evidence with the opportunity to interact with their investigators in real time. This brings knowledge and experience to their homes or offices without any extra cost.

Mostly due to the unfortunate COVID outbreak in recent years, web-based learning platforms have gained popularity among breast surgeons with acceleration. All stakeholders agreed that digital and wireless technology had a significant impact on high-quality training for medical professionals as well as breast surgeons. In part, social- and other-related media brought opportunities for sharing knowledge and experience [43, 44]. Platforms using web-based social media gathered clusters of professionals independent from where they reside. Most people stated that they were overwhelmingly satisfied and engaged in teaching technical as well as nontechnical skills [45].

Virtual free platforms such as iBreastBook, Breastics 24h, BreastGlobal, Global Breast Hub, Oncoplastic Academy-Brazil, CluBreast, and VBOSS use English as their language attracted thousands of enthusiastic surgeons at all levels. In addition, the European Society of Surgical Oncology, the Breast Surgery International, and the American Society of Breast Surgeons ASBrS as eminent societies continue to hold virtual meetings on breast surgery such as courses, symposia, panels, and forums for their members. Notwithstanding, online breast meetings in other local languages are being organized by other societies and institutions to meet the needs of their members and pupils. Societies from Latin American countries seem to be very active in organizing comprehensive events such as congresses, meetings, and workshops aiming to reach a population who speaks Spanish and Portuguese.

In near future, surgical communities are expected to embrace the notion that a virtual format blended with in-person education would be the new normal. With the emerging technology, knowledge and experience transfer with online classes and live surgery transmissions, decision-making, as well as critical-thinking sessions will be easier to transfer to those who need them. Simulation games and applications will supplement the coaching efforts for skills development. Nevertheless, mixed reality in which physical and virtual realities are blended will be one of the mainstays of learning in which virtual input can be provided from distance. Metaverse might be one of the settings to provide an efficient learning environment. So, customized learning that is based on artificial intelligence will accelerate the acquisition of knowledge and ability by filling the personal gaps mostly directed by a work-based portfolio.

On the other hand, there still remain particular downsides of the virtual world. It is reasonable to say that web-based meetings may not bring the benefits of face-to-face meetings. However, those e-learning platforms may be used as preparatory settings for on-site training as significant support for the learner. Furthermore, role modeling cannot be done as it can be face-to-face. Hands-on training is not feasible so, this may pose some problems in achieving satisfactory success when learning advanced technical skills. Therefore, on-site meetings look like better settings for direct and live coaching. Hence, credits and certifications provided by web-based training and assessment should not replace the ones obtained from those performed in person. Also, networking efforts would not be productive in a virtual setting. Finally, it depends on the provision of wireless technology and this may continue to stay as a root problem for underdeveloped regions [44].

New media related to web 2.0 contributes significantly to the continuous education of breast surgeons. In order to improve the teaching of breast surgery, authorized bodies such as societies, universities, and institutions should systematically screen and understand the needs of a trainee. They have a crucial role to review the available media tools provided by the industry. Easy-access tools and eminent content providers are the key points of reliable media for learning. Therefore, the new technology of information provides equity in education which in turn results in higher quality breast care service.

The authors have no financial or other substantive conflicts of interest that might influence the writing of this manuscript.

None.

A.K. and B.M.G. devised the main conceptual ideas and were in charge of overall planning and design. M.K., R.V., and B.M.G. wrote the manuscript. All authors provided critical feedback and helped shape the manuscript. B.M.G. was the supervisor of writing the manuscript.