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All videos and live-demonstrations on our course were performed in ‘Surgeon’s view’ (Fig. 1b). This reduces cognitive overload as the student is able to directly emulate the steps of the skill rather than needing to mentally invert the process prior to task execution. Several authors have discussed the benefits of ‘Surgeon’s view’ camera angle for teaching of surgical skills and procedures [11, 14,15,16]. Co and Chu  placed their camera device behind the instructor when demonstrating the skill live. Out of the 30 students who participated in their study, 21 rated their view of surgical knot tying demonstrations between 7-10 out of 10 (Likert scale). Bizzotoo et al. , Nair et al.  and Chao et al.  discuss the utility of a head-mounted, commercially available camera device for teaching surgical procedures (GoPro®). Bizzotoo et al.  and Nair et al.  used their device to record surgical procedures and then edited the videos for the purposes of teaching. Both reported head-mounted camera angles as ideal for teaching, as the field of view of the surgeon was reproduced in the video recordings. A downside however, was that when the surgeon changed positions, for instance bending or stooping, the view could be compromised . Chao et al.  utilised live-streaming of surgical procedures to create a virtual elective during the pandemic. Students were able to interact with the operating team during the procedures, promoting learning through engagement.
Our study has some limitations. Firstly, our results are based on the online delivery of an ophthalmic surgical skills session delivered to a small student cohort. We did not directly compare online delivery with face-to-face delivery of surgical skills teaching to see if one method is superior to the other in terms of gaining skills competency. Due to the pandemic, the majority of the teaching delivered was virtual, synchronous and didactic teaching and so a virtual interactive practical skills session may have been rated more favourably by the students. To account for this, we collected pre- and post- session questionnaires. We were also not able to formally assess student competency in the skills taught to provide a more objective measure of skills attainment. The majority of students in this cohort are pursuing an ophthalmic career and therefore may be more motivated to acquire surgical skills than a more generalised audience. However, the skills taught ranged from basic (tying a reef knot) to advanced (trabeculectomy releasable suture), indicating that online delivery can be utilised to teach a range of skills to students of varying levels; including those in postgraduate ophthalmic residency training.
In conclusion, we demonstrate the successful delivery of a virtual ophthalmic surgical skills session in terms of attainment of skills and student satisfaction. Detailed preparation of teaching and high instructor-to-student ratios are required for success. By conducting this session online we were able to widen accessibility and participation, which has future implications for surgical skills teaching and its reach.