“You need [webcam] setup. You could point the webcam away from you but still see the screen. That is what I would change for the next session.”

Clarity of instruction

Instructors commented on the need for clear and concise teaching instructions when leading the break-out group practicals; they could not rely on tactile feedback and non-verbal communication, which would have occurred during a face-to-face session.

“I felt that I had to make sure that my instructions were a lot clearer because there wasn’t the ability to use tactile cues to assist the students.”

Two instructors suggested capping the instructor-to-student ratio (to four students) in each breakout room and to reconvene with the same instructor for each practice to build relationships with students and gain a better understanding of their learning needs in order to better support them. Instructors also reported a relationship between student motivation and student acquisition of skills.

“If you have the same group you build up a bit more rapport and [students] get to know you.”

“[Acquisition of skills] depended on how motivated each candidate was. Some were very motivated and got on with the activity and acquired the skills but some were maybe not motivated enough or maybe feeling frustrated that they were not getting it, and it was difficult for me to motivate them virtually.”

Accessibility and individualized learning

Students were able to attend and engage in the session remotely, even those who were not based in the UK. An important feature of online learning is that the view of the demonstration is the same for all students, which is not always possible in face-to-face teaching.

“Because we created videos for them to watch, and as they can ‘pin’ my video when I’m doing live demonstrations, the view is much more equitable for everyone.”

“It meant that fewer students were left out…we were able to have a global reach with many of the [students] taking the module outside of the UK.”

“[Students] were provided with equipment and resources to keep at home and so they have the opportunity for more hours of practice.”

Individualized learning describes an instructor’s ability to respond to an individual student’s learning needs. This was achieved with the use of the ‘pin video’ function on Zoom® to enlarge the view, and observe and instruct students one at a time. A student’s individual concerns and identified learning needs were more easily addressed in small group breakout practical sessions.

“Having breakout room facility [was comparable to face-to-face instruction] to help students on a more individual basis, and to help them acquire the skills.”

Discussion

The UCL Ophthalmology Masters curriculum was transferred to predominantly online teaching in response to the COVID-19 outbreak. Lecture-based teaching was easily transferable for online delivery however, virtual teaching of clinical and surgical skills sessions required significant pedagogical consideration and planning. A recent editorial stressed the importance of in-person ophthalmic simulation training for the maintenance of surgical skills and competence [10]. Here we discuss the findings from our virtual ophthalmic surgical skills session and the purposeful steps taken to ensure successful online delivery to a diverse interprofessional student group. We note that these steps can also be utilized to teach generic surgical skills and are not exclusive to ophthalmic surgical skills training. General tips for course preparation and delivery are outlined in Table 2.

Overall, students rated the session 8.85 (±1.19) out of a scale from 0 to 10 (10 being most satisfied). Student perceptions of their ability to interact with tutors, level of supervision, and view of demonstrations positively changed following the teaching session, as did their confidence in instrument handling, knot tying, and suturing. In addition, students could continue to practice the skills after their session, as they had the surgical kit with them at home.

95% of our students were ‘very satisfied’ or ‘satisfied’ with the Zoom® platform used to deliver the teaching session. Other medical educators have also successfully used this platform to deliver surgical skills teaching [11, 12]. For our session, the Zoom® platform was used to deliver presentations, play instructional videos, as well as watching students perform the skills via breakout rooms. However, any online platform with similar capabilities would suffice.