In this episode, Steve Elias meets with a panel of expert venous physicians to discuss the immediate and future challenges that COVID-19 has caused on venous and vascular education. Hear them relate the impact that COVID-19 has had on various interventional procedures and the effect it’s had on the organisation and timing of key educational meetings. Finally, they express their thoughts on the long-term changes on educational paradigms that the post-COVID era may bring such as: live meetings, hybrid meetings, eLearning and the use of webinar-based platforms. 

Submit your questions/feedback to Steve via: podcast@radcliffe-group.com. Hosted by @DrSteveElias. Produced by @RadcliffeVASCU. 

In this episode they discuss:

•[00.00] Introductions 

•[03.15] Logistical issues: eLearning 

•[04.40] Audience considerations: ideal attention span 

•[06.39] Impact on CX 2020 

•[10.40] Impact on the future of conference gatherings 

•Impact on the management venous patients now and in the future 

•[13.30] Impact on the Venous Symposium: virtual webinar 

•[15.00] Digital meetings: a hybrid approach

•[16.23] The future need for society meetings 

•[18.50] Long-term impact of COVID-19 on education, social engagements and mass gatherings

•[22.29] The value of social interaction. 

•[24.30] What have we learnt about digital education and what is the future for education, industry and practice? 

•[32.00] Summary and closing remarks

[Steve Elias] Hi I'm Doctor Steve Elias, and welcome to the VEIN podcast. Respect the elders, embrace the new, and encourage the improbable and impractical without bias. This podcast is one that probably none of us ever thought we were... What the hell are you doin' here, Toni? Those of us thought that we'd never really have to do. But because of the COVID crisis, we thought it's important to discuss an issue that we've had to deal with and maybe in the end this may have been a good thing in terms of what we're going to talk about. And what we're really talking about is going to be how has venous education been impacted? We've had postponed meetings, cancelled meetings, people are doing a lot of e-learning, and we're going to get into that as well. And we'll talk a little bit about maybe some future implications that may really permanently change what's goin' on. With us today is Toni Gasparis from Stony Brook University in New York. Nicos Labropoulos, also from Stony Brook. Kush Desai, Northwestern University in Chicago, and Stephen Black from London, St. Thomas and Guy's Hospital as well. And everybody here either runs meetings, such as Toni and Nicos, they're the co-directors of the Venous Symposium. Stephen Black has a big influence organising the whole venous section of Charing Cross. Kush is very involved with the SIR meetings. And then all of us help each other out at all the meetings and thus far guys, Charing Cross has been cancelled, Venous Symposium as of this date has been postponed, SIR was cancelled. But once we've kind of got over it, we do need other things. So first I want to ask Toni and Nicos, when you first had to deal with this in terms of not being able possibly to run the meeting certainly in April, but even you have it scheduled in July, what did you guys think in terms of how you can still educate people? What were some of your thought processes you went through?

[Nicos] Well first, Steve, all of us, we need to adapt in the new conditions. Having a meeting obviously is a public threat and it cannot go on. Therefore we have to go to the digital world and embrace the e-learning. And clearly, we've tried that in our medical school with great success, which formalised teaching. But I'm sure this is easily applicable to the rest of the planet. Therefore, within the best effort to the webinar, that some of you participated two weeks ago, and continue this way to educate people in an active manner and obviously the work is totally different, will it evolve more?

[Steve Elias] Yeah so Toni, take me a little bit through some of the actual technical, logistical issues when you move over to an e-learning rather than, you know, planning a live meeting.

[Toni] You know obviously it's easier for attendees to participate in these versus travelling and expenses of going to meetings. On the downside, I'm not sure how well attendees would, you know, be able to sit on a virtual meeting for a day or two continuously. That's one other challenge. I mean as far as technically, technology is there. Zoom and there's other platforms out there, exist that haven't been used as widely in the medical education field, but definitely in other fields it's being used. And actually we just need to educate ourselves and figure out how to utilise these in order to be able to get the material out to attendees, and in a format that they would be able to absorb that information easily.

[Steve Elias] Yeah so Kush, what do you think is the, kind of the attention span if someone's motivated to listen and learn. You know when you're sitting in your office or your home, what do you think we have to think about if we're going to be moving to obviously e-learning in some manner or means?

[Kush] You know it's a great question. You know when you have a captive audience in front of you live, there's a natural moderation to who's at the podium, who's at the microphone, and there is some interactivity to it. And that's probably a little bit more difficult in the digital realm, where you have people from all over the world, different time zones, not adapted, and you know it's hard to know who's asking the questions and who's not, and then really just capturing everyone's attention. But I think what's playing in the favour, and specifically to answer your question, what's playing in our favour, is that there really is one thing occupying most of our minds and the news cycle, which is the COVID crisis. And getting back to what we love: venous disease, and educating about venous disease, is a respite. It's a way for people to kind of escape the monotony, sometimes the tragedy, of what's going on every day in our lives, and come back to what they love and what they want to get back to once life gets back to a little bit normal. So I think we can play on that and we provide an outlet for people to really continue their venous education and to think about something different than what may be going on at work.

[Steve Elias] Alright, but Kush, you didn't answer the question I had. Which was, though that was a good answer, but what do you think is the attention span? When do you think, if we're going to do this, how long do you think people can take in information, and then you got to stop and then say, okay come back tomorrow if you'd like to hear more information.

[Kush] Yeah so I don't think you can do the normal five talks and then a question answer. That's just not going to work. I think attention span in a digital space is probably a little bit more limited. And you know people are doing it at home and with kids or whatever, it's a little bit more difficult. So maybe one talk, and then a lot of interactivity to keep people engaged.

[Steve Elias] Yeah so Stephen, Charing Cross. It took them a while to decide they weren't having it. Can you give us some idea about, they kind of like went all the way to the very end, until it was like all right it's obvious we just can't do it. So, one, what made that decision? And I know maybe you weren't involved completely in that decision. And then secondly, what are you guys planning in terms of online learning?

[Stephen Black] So, to be totally clear, I had zero involvement in the decision making on when Charing Cross was suspended or postponed. You know Charing Cross is a unique meeting, it's always been very much run by Roger and the central team and their decision making is important. And I think at this junction it's also useful to acknowledge that Roger's wife passed in the last week, and obviously my thoughts are with him and his family. She died from COVID-related disease. So you know, it's a difficult time for everybody and I think that when you're running a big meeting and you're trying to make decisions about cancelling and so forth, when you committed to the finances and the logistics that are involved, I think it's exceptionally difficult to know what timing and what judgements need to be made. I think the other thing we do need to understand in the world at the moment, regardless of whether we're running virtual symposiums or actual meetings, is the moral tone of what we're trying to set. It's quite clear that virtually everybody is dragged into fighting a global pandemic disease. And it's disrupted teams, it's disrupted everybody from managers to nurses to staff. And I think very few people right now are thinking to themselves, "Gosh what I'd really like to be doing is being in a meeting." What they are thinking is, "how do we get out of this actually disaster that we are facing?" And I think whatever we deliver at the moment has got to be conscious and cognizant of the tone that we're setting about how are we supporting people through this as leaders in the field, not necessarily driving an agenda that is about sustaining a meeting or sustaining a business or anything else. Because everybody is going to suffer. So Charing Cross, I'm not entirely clear on what the next step is. There's been some talk of trying to run the meeting as a virtual meeting, but I think it's quite obviously clear that very few people have the time to record their talks and submit those to Charing Cross. And I for one, this is probably the first day, now that it's Good Friday, that we've had pause for thought in four weeks of full-scale change. You know our hospital, like you guys in New York, has been you know significantly hit by COVID. We're doing no vascular surgery at all. I mean that's including large aneurysms, you know the only things we're doing are acute limb threatening ischaemia in COIVD negative patients with some considerable difficulty. We've done six vascular operations in the larger facilities in the UK in four weeks. So I think the difficulty of organising a large meeting is how do you transfer what was, I think, Charing Cross had a really good programme, from that to a meeting. You know we've taken decisions on EVF HOW, which I run which is in October, to cancel that for this year. 'Cause I personally don't think we're going to be back to normal by the end of the year, you know.

[Steve Elias] No, and Stephen, and I agree with you. And that was going to be one of my things about forget about even being back to normal, what are we all think about how long, and I think it's going to as you say, we are all so terribly effected. Some personally unfortunately like Roger, and obviously all of us taking care of patients. When do we think people might even consider getting together en mass and standing you know, less than six feet away from someone at a meeting? I mean honestly, I think it's going to be a long time that people are going to feel comfortable. I believe people like you're in London, we're in the New York New Jersey area, Kush is in Chicago, there's a lot of people there that have been getting sick. And I just think that there's going to be skittishness of people wanting to come back together for a meeting. And I think we need to plan for that, be sensitive to it like you said Steve, but plan for it because I think meetings are going to be a little different going forward for quite awhile, Nicos?

[Stephen Black] I think that's something that's completely right, yeah? So I don't think we're changing any time soon. And I think we need to realistically look at all the modelling is about on off, on off restrictions for a long time, until a vaccine is genuinely developed. And so there's opportunities of course for research and for engaged ideas about what we do with venous patients, because the first thing that was hit was the venous patients, you know. A non-life threatening disease, stop doing it. So you know our acute DVT stopped immediately, CLEAR-DVT which is a big trial that Kush and I are involved in was stopped immediately. But if we're clever about it we can cohort all the patients that are not getting treatment now and make sure that we follow them and at the end of it we'll have an actual patient group that we can talk about, and we can talk about how we managed this disease that we're all very enthusiastic to treat in an environment where that's very difficult. It's quite clear that patients who undergo intervention and get COVID do very very badly. So in our hospital, we've seen patients really struggle after getting disease. That's a good message to get out and talk about. I think we've got to catch that in the time that people can manage the messaging as well, that they're not just getting home and collapsing in a heap. That they're receptive to education. And there are clearly a cohort of people who do nothing right now, so there's a lot of people whose entire hospital has come to a grinding halt, they're not able to do anything, but they're not involved in the front line. So there are people with time who we need to harness those people to do things creatively, and the people without time, leave alone.

[Steve Elias] All right so Tony talk to us a little bit about, I mean, Kush and I and Nicos and you were on the Venous Symposium first virtual webinar. How many people did you have and obviously you're planning on more?

[Tony] Yeah so I mean, I understand, you know what Steve's talking about, being conscientious about what everybody's going through, but I think you know there's pockets of areas that people are getting hit really bad, like the UK, Italy, Spain, and New York, but there's pockets that still are doing elective procedures. And as educators, we love to teach. And this VS virtual was developed in order to be able to have a platform to get some education out there and get people's minds off a little bit of this craziness that we're going through. So you know, we launched our first event a couple weeks ago and we had Kush and Mike Ebgedino and the three of us involved on iliofemoral DVT. We had about 450 people register and sign up, which shows there is interest out there for education, even though things are going kind of crazy like we said.

[Steve Elias] So let's, do you think that this... Nicos, do you think this is going to become a model going forward that, in terms of education, there's going to be much more of a hybrid model? Meaning some in-person meetings, but maybe complementering virtual, you know, education through those meetings just like you guys have done already.

[Nicos] Yes, it's very likely because this pandemic is teaching us, by default, new approaches to education. The meeting we did last two weeks ago was very encouraging because as you saw, there are multiple questions and we addressed most of them live through the meeting. The advantage of things like that, it went recorded like the session we're doing right now, that people can watch the event at their own time at a later stage. Making it what I think is a huge advantage that you don't have in many of the live meetings.

[Steve Elias] Right.

[Nicos] Obviously, like Kush mentioned, you cannot put people staying forever in front of a TV screen, but like the major meetings, I think that people can go back and forth. Watching the topics that they really care about but definitely there is a limit to this as well.

[Steve Elias] So let me ask you here, let's talk about societies first of all going forward. Why do we need, if we can make this work in this way, why do we need annual society meetings? Or why do we need annual society meetings to be as long as they are in general? Can this serve as some way that we can learn, get a lot of the work done, and a lot of the education done not physically together and then do the business and the socialising part. I'm talking about society meetings, not the Venous Symposium or Charing Cross. What do you think of that idea?

[Kush] I think that we're social animals, so we're still going to need the large meetings to network and there is a business side and a social side. But even just the personal interaction and feeling like you left with a personal answer to your question that the speaker may have posed or that you can ask a speaker. But I mean your point is well taken. I think that there's probably going to be a re-imagination of how large society meetings like SIR, 7,000 attendees, is going to be organised. And maybe we don't need quite as much and maybe we can truncate it a little bit and maybe we think about how it's organised. So that remains to be seen, but I don't doubt that what we have in the future is going to be different than what we've had in the past. But I still do think we will end up eventually, as Steve points out with the vaccine, having large gatherings because we just, we really are social animals.

[Tony] I mean if you look at previous pandemics, I mean this is something that hasn't happened for 100 years. But the question is, how soon can we get the vaccine? How soon can we get some type of cure? Not a cure, but something that would prevent you from going to the ends of intubation and mortality. And you know, if a different strain or a different virus pops up. If those things don't happen, then it's going to be a different world. Otherwise you know, it may take two, three, five years to get back to normalcy.

[Steve Elias] And again, I'm bringing up, I'm not saying this is what I think we should do. I'm bringing up ideas for us to discuss. So Steve, do you think that there will be any long lasting impact in terms of education? We know there's long term impact on society and everything else, but is our goal to get back to educating the same way we were prior to COVID? Or is there something we can take away from COVID, how can we educate in a little more hybrid manner, so to speak?

[Stephen Black] I think our goal is not to get back, we shouldn't go back to business as usual. I think we take this opportunity where, you know from a personal level I have to say that my travel schedule being severely truncated has been a massive boom to my family. So we've had probably the best family time we've had for years in the last four weeks. So I think we, in this pause in life, we have the opportunity to do things different when we re-emerge, and I think we find the right balance. I totally agree with Kush, we're social animals. And much of the learning and meetings that I'm involved in is not necessarily the lecture you deliver, but the informal conversation you have afterwards with people who are learning from you, but also from a personal point of view, I have learned an enormous amount that has influenced my own practise from the informal conversations we have with all of you in this room. So you know my entire practise has been shaped by all four of the other people on this call by the chats I've had on a variety of topics out of hours, smoking cigars that Nicos organised at his meeting before with Kush, you know? My whole DVT practise changed, right? So, I think those opportunities, and I don't smoke cigars that often, this is a rarity, you know? So the social engagement is an important part of learning and the informality of things helps. And a lot of the kind of, you know, you think about setting up a trial or setting up a study, it's important to have face-to-face contact with people to build that level of trust you need in the groups that you're doing. So we can't go away completely from physical meetings. And humans are not beings that live in isolation. You only have to look and see what's happening around the world where social isolation is four weeks, five weeks in, where people are totally losing their minds. We are not isolation, or we are not beings that practise in isolation. But finding a way to balance those two things; I think there are too many meetings undoubtedly. There's meetings all over the world. But finding a package that delivers across the year with the kind of things you guys achieved in the podcast a couple of weeks back which was great. I saw it afterwards, so you know, you don't have to be live to see stuff like that, you still get some of the learning out of it. Balancing that between actually physically having to travel but delivering education in a consistent, accessible way. I think that's where we're going to go. And we've all got much better with Zoom, you know. Nobody's left to go to the toilet yet with the camera in tow, you know. So we know how to be on these things.

[Nicos] The perfect example here.

[Steve Elias] We don't know what's going on below the waist of any of us right now.

[Nicos] But Steve, a real story to show you exactly what you said is correct. I met Steve in the American Venous Forum, and saw his presentation on the MR data about the fibre inload on the front. I had done work 10 years earlier and just forget about it. Then I talk to Steve after the presentation, and he activated my interest. I went back to our hospital, few years later I'm in my lab, working on this project, having done already very important discoveries. And I can tell you Steve from London, this would not have happened unless we accidentally met to reactivate my interest on this topic.

[Steve Elias] Yeah now that's great, and we all have stories like that. And yes, no we need to be together for sure. We definitely need to be together, but I'm thinking you know, some of the basic work can be done online so to speak for a meeting, and then when you get together after the meeting, the socialisation and the interactive part can occur. But you know, many meetings are not so interactive. Venous Symposium is very interactive, and the SIR was going to be interactive on terms of the vein side, Charing Cross you have, Steve, the whole you know day of the hands-on workshops as well. So those are the interactive parts. But the parts where people are just sitting and listen to someone give a lecture and then a few questions are asked, maybe some of that work can be done beforehand so to speak, and then when you get to the meeting, it's the interactive part of the meeting, the social part of the meeting, that is really highlighted and people can shorten their time away, and Steve I agree with you. From a family viewpoint if people are doing it right now when they've had to be not going to work everyday, this could be a great thing. It's either it's going to be a really great thing or people are going to say, "forget it, I'm out of here once this COVID thing goes away." But most of us are having a good experience. So I'm just bringing this up 'cause I really would like to move a little bit more about where we see the future in terms of education and what have we learned and we're learning a lot, look we're just starting into this thing, we've got a couple more months I'm sure. And even maybe a whole year of where people are not going to feel comfortable being together. But where do you see us going, Kush? Going in terms of the education aspect?

[Kush] I mean I think you've hit it right on the head. I see us maybe doing a lot more, or even some more, pre-preparation. Meaning there will be modules online that attendees will take a look at and go through, and then there will be a little bit of a brief refresher at the actual in-face meeting, and then just a lot of discussion. Because that's why your really there. To have that discussion, to have the debate, to have the back and forth. It's really hard to have that back and forth in this online form.

[Steve Elias] I'm sorry, go ahead, finish Kush.

[Kush] I just think that you know, for example as faculty we may have to do more of the work beforehand, upload talks in a curated manner. People can familiarise themselves with the subject matter and then we have much more of a discussion when we are actually face to face.

[Steve Elias] Toni, what do you think industry is going to be doing with this? Do you think that they are pining for the good old days where they had all these different meetings? Or do you think this is something that we can partner with industry to make something different that may be more palatable to industry but also accomplishes what we want to accomplish?

[Tony] Well I mean there's obviously, industry's interest is interaction with attendees. So I think if we go virtual 100%...

[Steve Elias] No no no.

[Tony] There's really going to be a problem as far as supporting these events. Unless we find a way where they have a benefit through these virtual meetings for them to support them. But I think part of it is they're probably somewhat happy to not have to go to them. I mean if Steve's schedule is crazy, I can imagine some of these companies where they're going to all these meetings that they have to support and attend. And I do agree that it should be some combination where maybe you know, unfortunately the material keeps on expanding and we keep on adding things, even in our own meetings. [Inaudible] session, a small veins session, this year was going to be almost a four day meeting. AVLS and AVS, it's like a four five day meeting. It's very tiring and it's a lot of time away from work and away from your family. So there is probably going to be some combination and I think to make the physical part of the meeting maybe a one or two day event, and that would still, industry will get the exposure to those attendees and I think they would be happier.

[Steve Elias] Yeah, no I agree and that's, I know I'm leading you guys on a little bit with my questions, but that's kind of where I think we are going to wind up with this. Is a shortened meeting with a hybrid thing. Steve, what, you know, there's going to be a lag time here in terms of our meetings. Once we even get going again. And do you think we need to plan for that? Meaning a meeting that would normally carry 2,000 people or SIR: 7,000 people, that next time your going to physically get together, do you think anyone who's running the meeting's got to think about this is going to be a downsized meeting. Even though we can say we can all get together, it's not going to be the same volume.

[Stephen Black] I would agree with that but I think there's also some things that are out of our control, you know. So this is going to have a global impact. Right, so, there are going to be people where airlines are going to shut, travel is not going to be as easy, there are going to be people, for example all of us, where our income has been significantly impacted on by all of this. People may not be in a financial position to travel as freely as they were before. Hospitals are shutting things down where, I know my hospital has banned all study leave for the remainder of the year until we're out of this. So, I think there are going to be, to Toni's point earlier on, is that there are areas that have been more or less affected by this. So, if you take somebody who's coming out of NYU Langone, right now nobody there is thinking of anything apart from, 'holy crap how do we get out of this total disaster?' You know my hospital's in the centre of the area with the highest infection rates in the UK and we've gone from 50 odd ITU beds to 110 patients intubated in four weeks with around us thousands of patients with COVID. So all of those factors are going to play on people's minds. So when we're scheduling meetings to come out of this, industry is also taking a hammering right now. If you consider, I have a friend who runs a small distribution company that is a purely elective based distribution practise in medicine. His entire business has gone up in smoke in two weeks. These guys can't survive it. So the kind of small sponsors we relied on, the larger companies, Boston Scientific, Medtronic, Cook, Bard, all of them are taking a battering right now because nobody is doing elective angioplasty or whatever. So, I think all those things that contribute to how meetings get put together are going to be impacted on. So, I think none of us really know what that's going to look like but if we can prepare ourselves for a much more malleable, dynamic, and able to cope with the different things that are going to be thrown at us in the next year and a half while the world gets out of this, we're going to be in a strong place. And finding ways to educate people about how to recover from COVID. We're going to find a whole bunch of patients who are far more complicated to treat because they've had nothing for six months. So, how do we manage those people, how do we deal with it, you know? Those are the education things I think will be really really helpful for extrication strategy. Even things, not just treating patients, but how does your practise recover from COVID? How do you take a practise that's been on pause for six months and rebuild it? I think things like that will be helpful to people.

[Steve Elias] Right, and I agree with you. And I think that that's going to be one of our biggest challenges, is that what you've already said and companies will not have significant amounts of monies to spend on meetings like they used to for awhile, physicians are not going to have that money to spend, physicians are not going to want to be away from their practise. They need to make money, they need to catch up for what they have lost. So, yeah four minutes, I got it Toni. I'm watchin', thank you. Yeah we have four more minutes, that's why I was coming to a summary here. And so the long-lasting impact is going to be, not yet, it's only 1:30 here Steven! We're waiting, we're waiting, tonight we're going to drink. The point is that the economic impact is going to be driving, I think, a lot of the education choices that people are going to make and that people running meetings are going to have to decide upon how can they make their meeting as lean as possible, as relatively short as possible, and so it's not going to cost people a lot of time and a lot of money. So as Toni pointed out, we have now three minutes for summing up. Anyone have anything else? This is the beginning of a conversation, as Steven said, we're at the beginning of the new educational road that we're going down and I'm sure three months from now, six months from now, this conversation's going to be a little bit different and we'll hopefully come back and rejoin it.

[Tony] Hopefully better.

[Steve Elias] Yeah, as long as we're all here and we're healthy, that's the most important thing.

[Stephen Black] I'm looking at who is most at risk in this case, Kush is the safest of all of us right?

[Steve Elias] Yeah, that's right. All right, so all right. I want to thank you guys. I hope everybody enjoyed the conversation that's just the beginning of the conversation. More questions and answers, but as we go along we're all learning together. So I want to thank all of you guys. Thanks a lot.

[All] Thank you guys, bye!

[Steve Elias] We hope you enjoyed today's Vein podcast in association with Radcliffe Vascular. We aim to bring you important topics from the vein world. Either topics that we ourselves feel are important or you, our listeners, feel are important. So review us on your favourite podcast app or send your thoughts, comments, and questions to podcast@radcliffe-group.com. That's podcast@radcliffe-group.com. You could also register to access newsletters, videos, and peer reviewed journal articles. Thank you, glad you listened, this is Doctor Steve Elias and we'll see you on the next Vein podcast.