COMMENTARY

COVID-19: What's the Future for Societies, Education, and Practice?

Prof Mamas Mamas

Disclosures

May 29, 2020

This transcript has been edited for clarity.

Hi, welcome to Medscape UK. My name is Mamas Mamas, professor of cardiology based at Keele University.

It's many weeks since the COVID-19 pandemic started. And almost on a daily basis, the number of deaths reported and the number of new infections has declined.

Many governments have stopped the social isolation policies known as lockdown. And as a population, and as a profession, we're looking towards the return of normality.

Nevertheless, what has happened over the past couple of months, and the need to prevent a second wave of infections, will mean that the way that we practise will necessarily change. And there are several areas that will change in the future.

Over the next 15 minutes or so, this webcast involving three of my guests will focus around how delivery of services by professional societies, how educational content, and finally how we deliver health care as a profession, will change, and should change, during the COVID-19 pandemic.

Professional societies are the centre of our professional lives. They have several roles. They have roles of maintaining quality, improving cardiovascular health of the populations that they serve. But as well they provide guidelines important in providing education advocacy.

Many of the professional societies have been at the forefront and been very visible during the COVID-19 pandemic, providing leadership both to the community as well as us professionals.

My first guest, Dr Minnow Walsh, ex-president of the American College of Cardiology (ACC), discusses the role of professional societies during and after the COVID pandemic.

Dr Minnow Walsh

Dr Mary (Minnow) Walsh, medical director, heart failure and cardiac transplantation, St Vincent Heart Center, Indianapolis, USA. Past president, American College of Cardiology. Dr Walsh has no relevant disclosures.

I think one of the most important things that professional societies do for us has really been brought out with the COVID-19 pandemic. I'm exceptionally proud that the ACC science and quality staff members, and the scientific sessions committee, were able to continue forward in spite of the growing worldwide pandemic and put on a programme that was, within 3 weeks, able to go virtual for many of the important sessions, such as the opening session convocation, but really importantly, all the late breaking clinical trials that are really crucial for us to continue to be able to look at data as it comes out and be able to analyse it as a scientific community.

So very proud of the ACC, that within a few weeks, our staff and member volunteers were able to put that together and bring the science to us.

And I'm really pleased to see that other societies are doing the same for upcoming meetings: making the meetings virtual, making them accessible to all, and making certain that science, both COVID-related science and also other science, is available not just to members but to those who really want to stay in touch with the growing science and database from around the world.

So I think that's one thing that professional societies do.

I also think that our professional societies have done a fantastic job of keeping us up-to-date with regard to the COVID-19 pandemic and, specific to cardiologists and the team members, is how does this viral pandemic influence cardiovascular disease? What are its cardiac manifestations? And importantly, what therapies do we think we should be using? How are we going to go about evaluating therapies, such as some of the randomised trials that have started?

So again, particularly proud of the American College of Cardiology, because of the COVID-19 hub that was set up really within days of the pandemic beginning, so that we have someplace to go to look for answers. So that's another thing that I think our professional societies are contributing.

And lastly, I want to underscore the fact that advocacy is crucial.

So those are the really important ways that our professional societies have helped us during this very trying time of the global pandemic.

International Conferences

International conferences form the backbone of continuing professional development to healthcare professionals.

Their role is to deliver educational content, and most up-to-date literature, that will enable them to deliver optimum care to patients.

They provide a platform through which late breaking trials are delivered, through which guidelines are disseminated. And finally, they also apply the opportunity for healthcare professionals from across the globe to meet and interact, and discuss science in the practice of medicine.

By necessity, many of these professional meetings have been cancelled and have been replaced by meetings on digital platforms, through which talks and presentations can be delivered through the internet.

These have still allowed the exchange of instantaneous discussions, either through the platforms or through social media.

Certainly as we move out of the lockdown phase, and walk towards normality, a number of interesting questions are raised. How much will our educational content and delivery of educational content change from the lessons that we have learned during COVID-19?

My next guest, the CEO of the Cardiovascular Research Foundation (CRF), Dr Juan Granada discusses his thoughts on how educational contents will change in post COVID-19 era.

Dr Juan Granada

Dr Juan Granada, executive director and chief innovation officer, Cardiovascular Research Foundation, (CRF Skirball Research Center, New York, USA. Co-director of Transcatheter Cardiovascular Therapeutics (TCT), the annual scientific symposium of the CRF. Dr Granada has no relevant disclosures.

The way that I see it is not how the delivered content is going to change, it is how are we going to create a technological platform that is engaging enough to be able to cover all the needs that we have right now.

We're trying to reach populations that are different ages, populations that actually have different technological skills, able to essentially go into a computer and being able to work their way around.

We're also trying to reach the populations that have different interests and actually have short timespan. It's actually not really easy to put the same amount of content in a compressed way and be able essentially to deliver the same type of information to people of different ages and different levels of interest. There is also different levels of training. The amount of educational content and the quality and the type that you deliver to fellows is not the same thing that you actually want to deliver to clinicians who are actually sophisticated operators.

It is actually challenging to be able to have a one-size-fits-all type of a platform. And that's why all organisations really need to work hard into narrowing down the objectives, target the populations that actually they want, and be able to develop platforms that essentially can deliver the information that we all want to the target population.

One challenging population is actually the fellows, because while operators or people with more experience essentially want more data, and they're more interested in updates of the clinical field, a younger population essentially are more interested in case-based learning, or technique-based training. And this is something that is very challenging to be able to be delivered via web-based platforms.

There are ways to do it, there is virtual reality, there are actually a lot of visual-related learning platforms that one could use. But in reality, especially for the younger population of physicians, its going to be more challenging to be able to develop more practical, more hands-on type of training opportunities as we actually have for an older population or more established population.

We're working really hard in trying to develop different platforms, different ways to deliver these educational materials, but it's going to take time and I really think that is going to take several years before we have an equation, we have a formula, that can actually work to achieve all the objectives that we all want.

Service Delivery

Social isolation and government lockdowns have by necessity meant that we have to change our practice in delivery of health care to the population.

The purpose of social isolation is to protect the most vulnerable, those with greatest comorbidity, and exactly those patients that we see on a day-to-day practice.

We have been innovative in our solutions in assessing these patients and managing these patients in an outpatient perspective using telehealth. This has allowed us to develop and use many technologies that were available in the past but perhaps were not being used.

I think that the COVID-19 pandemic has given us an opportunity to reappraise how we deliver services to patients.

My next guest, Dr Andrew Watson, a past-president of the American Telemedicine Association, will focus on how he believes the importance of the role of these technologies will change post-COVID and how we can utilise these technologies in managing patients.

Dr Andrew Watson

Dr Andrew Watson, Department of Surgery, vice president, University of Pittsburgh Medical Center, Pittsburgh, USA. Dr Watson has no relevant disclosures.

COVID brought to the forefront this question about telemedicine and e-health: Do we really need to have a face-to-face visit? And this question has been around for a while. But right now we really have to confront this and digital health offers a lot of promise.

There are three key areas within digital health that I'd like to briefly talk about.

The first one I've already mentioned is e-health or telemedicine or telehealth. It goes by a number of names. It's been around for a while. We've seen radiology, dermatology, pathology, ophthalmology, but right now there's been a tremendous focus on live video visits to the homes. This replaces our clinic visits. We can actually come into hospitals using video to do consults. It's a whole new way to rethink healthcare about how we see patients and actually how we access care in hospitals. And it's a very powerful force. And it's coming to us very quickly right now.

COVID-19 made us recognise immediately that this is a viable way for us to practise healthcare.

Another area in digital healthcare is apps. And apps, as we know, are very personalised, and they're very niche applications. Many times, they can focus on COVID-19 symptoms, or testing or tracking, likely in the future. But apps in digital health, many times are third party: it's not from a healthcare system, or not from your providers, but it's from an independent group. They're usually very well done. They're focused on niche solutions, like diabetes or behavioural health, or COPD. But these apps go right to the patients or right to the consumers. And it's a way for them to get education and also get care. And so apps are another solution that are coming to the forefront right now.

The third area that we're seeing right now, on the digital healthcare solution are portals. It's a way of getting access to your hospitals and your doctors through electronic health records. And it's a way to communicate securely to get lab results, other types of results. But again, it can be interactive and very educational.

And so COVID-19 has really forced us to rethink how we look at e-health or telemedicine, how we use apps, and how we interface with our patients, or how they interface with us through portals.

And what's behind this is quite fascinating, actually, it's consumer electronics. Companies like Google, Apple, Samsung, and in the United States we have Verizon. These are large, heavily-capitalised companies that are forcing consumer electronics and smartphones to a new area that it's almost very hard for us to imagine. I can take a phone call from my watch these days, which was a dream 10 years ago.

So it's hard to know what consumer electronics will look like in the future. But COVID-19 in digital healthcare has forced us to rethink how we look at consumer electronics. And those companies, likewise, are saying, hey, how can we develop solutions or products or healthcare on our platforms? So there's much to come in this area right now.

In the future also, digital health will be transformed through artificial intelligence (AI). The data coming from COVID-19, new quick research, new types of symptoms, new types of diseases that we're seeing or variations. We have to react very quickly, and AI will be a key part of that. And I think it may be interfacing directly with patients in the future.

And as I said, consumer electronics in the future, it's very hard to predict, but I think it will only further enable us to work with our patients, or for them to work with us as physicians or nurses, or work with hospitals.

And fundamental to all of this, this whole digital transformation, is patient expectations. Patients are coming to expect that they want to have digital access. It's safer as, many times, they don't have to drive; it's cheaper, and it's frankly easier. And COVID-19 pushed us over the hump here and showed us that yes, that we can do this.

Conclusions

I think in conclusion that we have learned many lessons from the COVID-19 pandemic, and it will certainly change how we practice as professionals from a number of different perspectives.

First and foremost, I think that the pandemic has really brought to the forefront the importance of the professional society. The professional society has provided a nidus for educational content, has been reactive and produced guidelines for managing patients for conditions that perhaps we have little knowledge of.

And furthermore, it has provided a forum for advocacies, particularly around the challenges of PPE.

With regards to educational content, we've seen an explosion of digital educational content delivered from individuals' living rooms across the globe.

This has been very useful. And I think certainly going forwards the way that we deliver educational content will by necessity change.

Whilst there are certain advantages in physically being at a meeting, which digital solutions can never replace, I think that the explosion of meetings will by necessity mean the many physical meetings will require a strong digital component, particularly around the challenges of funding, to go into all these huge numbers of meetings.

And finally, the way we interact with our patients. By necessity we've had to adopt telemedicine and digital solutions in interaction with our patients. And certainly whilst these cannot replace a physical exam, and the social cues that can only really be appreciated by face-to-face interactions. I think the lessons that we have learned from telemedicine are important. And certainly, I feel that a number of patients that we currently see in clinic we could easily follow up virtually.

So in conclusion, I think that one of the few upsides of the COVID-19 pandemic is that it has really made us focus by necessity on how we can change the profession, in both delivery of educational content and delivery of care of our patients, and many of the lessons that we have learned during this period of time will be utilised going forward.

I'd like to thank my guests for taking the time to record their segments, and I'd like to thank you for joining me.

You can follow Mamas Mamas on  Twitter

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