Discussion

Online webinars have emerged as an important learning tool during the COVID-19 pandemic. They allowed, in the absence of in-person medical conferences, to facilitate the training process of young paediatric cardiologists worldwide. ^{Reference Tretter, Windram and Faulkner2,Reference McMahon, Tretter and Faulkner3} The Association for European Paediatric and Congenital Cardiology has favoured this process with the creation of a webinar series dedicated to paediatric cardiology and cardiac surgery topics, serving towards preparation for the Association for European Paediatric and Congenital Cardiology exam, as part of the Association for European Paediatric and Congenital Cardiology certification as paediatric cardiologist. The principle was covering all the basic paediatric cardiology topics for junior paediatric cardiologists, trying to standardise knowledge throughout European Countries. This series has obtained considerable success among the junior members of the society. This article highlights the impact of webinars as e-online learning educational tools in the post-pandemic era. Most of the interviewed junior members appreciated the high level of interaction and inclusivity of this web-based platform, highlighting the possibility of worldwide participation, breaking down the logistical and economic barriers resulting from an in-person international conference. ^{Reference Ma and Vervoort4,Reference Feldacker, Jacob, Chung, Nartker and Kim5}

Moreover, the introduction of the online version of the Association for European Paediatric and Congenital Cardiology exam in paediatric and congenital cardiology for trainees in paediatric cardiology and trained paediatric cardiologists has the potential to attract and increase international participation. These activities may play a role in reducing the educational inequalities among different training programmes throughout the world. Indeed, the majority of participants emphasised the benefit of this series, probably due to the high quality of the speakers providing the current state-of-the-art knowledge, the accurate topic choice by the Association for European Paediatric and Congenital Cardiology Education Committee and Association for European Paediatric and Congenital Cardiology Working Groups and the high interaction. The last was possibly feasible due to the online format and the active participation of junior members as case presenters and/or moderators, which reduced the social and emotional barriers possible during the live medical talks. Indeed, the Association for European Paediatric and Congenital Cardiology junior members played a crucial role in this initiative, actively organising the webinars and taking the responsibility for presenting cases and moderate sessions. Furthermore, e-/online learning platforms have a significant impact on the environment by reducing the environmental costs of conferences such as travel, accommodation and conference venue. ^{Reference Duane, Lyne and Faulkner6} This aspect is acquiring a crucial role in terms of promoting “sustainable academia” and rationalisation of carbon footprint during conference attendance. ^{Reference McMahon, Tretter and Faulkner3,Reference Moss, Edmonds, Hibbard, Manning and Rose7,Reference Spinellis and Louridas8} Finally, junior members expressed their satisfaction with the availability of recordings on the Association for European Paediatric and Congenital Cardiology website, which allowed full resource access for those who were unable to participate in the live events.

However, interviewed Association for European Paediatric and Congenital Cardiology junior members highlighted also several drawbacks of online webinars. Surprisingly, none of them pointed out the limited chance of networking in comparison to in-person conferences or the more impersonal teaching method. On the contrary, they focused on the excessive use of abbreviations and the use of factual knowledge in some talks, which is reasonably not different from in-person meetings. Some expressed doubts about the timing, duration, and format of the webinars, which depend on personal preferences and are often overcome by the possibility of reviewing website recordings. Finally, only 12% expressed fatigue due to a large number of available webinars, probably due to a confirmation bias towards webinar participation and the restarting of in-person meetings after the COVID-19 pandemic.

With regard to the training programmes, an enormous heterogeneity emerged across Europe and worldwide. Most of the programmes appeared department-dependent with wide variability in the duration, teaching approach, assessments, or feedback. Also, the number of fellows and access to different paediatric cardiology sub-specialities varied extensively. These data could be explained by the different provenance of junior members, with some of them coming from tertiary care centres and others from local hospitals. Therefore, it is essential to standardise training programmes throughout Europe to guarantee the highest standards in patient care. The role of the Association for European Paediatric and Congenital Cardiology should be crucial in this process, aided by appropriate tools such as the webinar series and the Association for European Paediatric and Congenital Cardiology exam in paediatric and congenital cardiology. However, these resources cannot replace in-person meetings and training courses, which remain fundamental activities for our association. This study confirmed the role of webinars and E-learning in supporting learning in a small community such as paediatric cardiology with heterogeneous backgrounds and centre-dependent clinical and surgical management. We believe that junior paediatric cardiologists can benefit from these E-learning platforms as an integration of the traditional learning approach, to standardise knowledge as training programmes appeared highly variables.

Future directions

Online-based learning resources such as webinars and podcasts are judged valid pedagogical methods in addition to textbooks, medical journals, and bedside learning. E-learning appeared to have a dramatic impact on stimulating deep learning for the participants involved in webinars, even more than a more traditional textbook or medical journal methods of learning. ^{Reference McMahon, Tretter and Faulkner3} The role that webinars have played in times of pandemic is undeniable, allowing continuous education despite the impossibility of attending in-person meetings. Even after the COVID-19 pandemic webinars are well attended and considered of high value, however, their definitive space will be defined over the next years. Certainly, webinars cannot replace the benefits of networking at a (traditional) in-person conference. Finally, artificial intelligence algorithms might impact even more on the traditional ways of learning, opening new scenarios that should be further explored in the future.

Limitations

Only 27 Association for European Paediatric and Congenital Cardiology junior members completed the survey despite repeated invitations for webinar participants to join the study. The study population was also heterogeneous, consisting of both trainees in paediatric cardiology and junior consultants. Confirmation bias towards webinar participation may be possible in this setting and the results of this study should be considered carefully. The effectiveness of the webinars was tested just by the feedback and satisfaction level of participants. Better learning outcome was not assessed as beyond the scope of this article.