According to the 47th China Statistical Report on Internet Development (data available at http://www.cnnic.net.cn/hlwfzyj/hlwxzbg/hlwtjbg/202102/P020210203334633480104.pdf), by the end of 2020, the amount of online education users in China has increased 109 million compared with that in the year of 2019. The Covid-19 pandemic is forcing medical educators to re-evaluate how to educates learners of all levels [9]. Travel restrictions have brought about a preference towards online meetings in urogenital associations despite the irreplaceability of the face-to-face manner [10]. Therefore, continuing education in the time of social distancing aroused our attentions to social media such as Twitter, which have been widely used in education and conferences sharing among global urogenital communities [11]. Urogenital online learning was inevitably forced to rapidly adapt to the Covid-19 situation, urologists as well as andrologists adopted web-based platforms to develop virtual education programs to fill the gap [12]. Young and junior physicians need to learn more, while expert and senior specialists want to show more, so they get together and communicate online through social media, especially in the era of Covid-19.
As one of the most popular social media applications in China, WeChat has been playing an import role in medical education [13]. According to the backend database of Jiujing, one of the most well-known WeChat public platforms in Chinese urogenital community, online learning through WeChat became more fervent during the Covid-19 pandemic. Afterwards, we conducted an online questionnaire survey to explore the significances and determinants of urogenital online learning though WeChat during the Covid-19 pandemic. As expected, the majority of the respondents experienced decreased face-to-face learning opportunities during the Covid-19 pandemic and consequently triggered increased online learning demands. It was reassuring that most urologists and andrologists have benefited from online learning including those who have directly participated in the battle against Covid-19. However, compared with veteran senior physicians (director physicians), online learning was significantly more beneficial for the juniors (primary and attending physicians).
A systematic review indicated that Internet and software-based platforms for surgical training was as effective as other methods of training, but technical and infrastructural resources might be a major challenge for implementing online learning [14, 15]. Understanding various demands of the users with different backgrounds is particularly important when building an online learning platform. Whether from teaching hospital or working as frontline staffs against Covid-19 had no effect on the attitudes of the respondents. Given that medical students used to be engaged and motivated when being taught with a video-feedback and visual manner [16], surgery videos and academic lectures were the most popular sections in either Jiujing platform or questionnaire survey. Consistent with a previous study, the subscribers tended to pay more attention to surgical videos sections, which resulted from the decreased quantity of operations during the Covid-19 epidemic [12]. Since most users of social medias are young adults, the decreased quantity of operations is supposed to cause decreased practice opportunities especially for the inexperienced surgeons. However, the imbalance of learning resources owing to regional discrepancy has led to different attitudes towards online education [17]. Investigated benefits from surgery videos and literature express sections decreased with the hierarchical ascending of respondents’ affiliations. As surgery videos and literature resources were less accessible for the physicians from grass-root hospitals, urologists and andrologists in these institutions might benefit more from online learning than that in provincial or national hospitals.
With the rapid development of medical science, online learning from literature is a complementary and essential way to update knowledge for continuing education [18]. Compared to natural science courses, dreary teaching style and limited attention are placed on medical humanities in Chinese medical education system although it has some merits: meeting basic needs, early exposure and mandatory [19]. When faced with the tension between doctors and patients, we are required to optimize our professional knowledge as well as humanistic care. Our study uncovered that online learning of literature and medical humanities were considered significantly beneficial among attending doctors and assistant director physicians, who usually took the main responsibilities to communicate with the patients in Chinese hospitals.
In order to meet the huge demand for doctors while ensure a basic minimum of quality, medical education in China used to be classified into different program durations: associate with 3 years (licensed assistant doctors), bachelor with 5 years (licensed general practitioner), master with 3 more years (licensed residency) and doctor with another 3 more years (licensed specialist physicians) [20, 21]. In the earlier years, medical undergraduates in China got access to work as licensed doctors in hospitals without systematic education and training as specialist physicians, so they obtained specialty knowledge in urology and andrology mainly relied on self-learning and communication with colleagues. It is no wonder that in our investigation, benefits from online interaction were associated with the degree of respondents: urologists and andrologists with a bachelor degree exhibited the most enthusiasms. A previous systematic review and meta-analysis revealed that face-to-face learning was no better than online learning in undergraduate medical education, but online learning had advantages to enhance undergraduates' knowledge and skills [22].
Admittedly, our work existed some limitations. There are some other WeChat platforms for urogenital online learning in China, but consistent and comparable backend data of these platforms have not been obtained and included. On the other hand, the online questionnaires were randomly given out through WeChat and collected from the target respondents. All these factors modestly restricted the representativeness of the data.