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BACKGROUND: The COVID-19 pandemic posed several challenges for surgical training, including the suspension of many in-person teaching sessions in lieu of webinars. As restrictions have eased, both prepandemic and postpandemic training methods should be used. OBJECTIVE: This study investigates trainees' experiences of webinars during the COVID-19 pandemic to develop recommendations for their effective integration into surgical training going forward. METHODS: This project was led by the Association of Surgeons in Training and used an iterative process with mixed qualitative methods to consolidate arguments for and against webinars, and the drivers and barriers to their effective delivery, into recommendations. This involved 3 phases: (1) a web-based survey, (2) focus group interviews, and (3) a consensus session using a nominal group technique. RESULTS: Trainees (N=281) from across specialties and grades confirmed that the COVID-19 pandemic led to an increase in webinars for surgical training. While there were concerns, particularly around the utility for practical training (80.9%), the majority agreed that webinars had a role in training following the COVID-19 pandemic (90.2%). The cited benefits included improved access or flexibility and potential standardization of training. The majority of limitations were technical. These perspectives were refined through focus group interviews (n=18) into 25 recommendations, 23 of which were ratified at a consensus meeting, which was held at the Association of Surgeons in Training 2021 conference. CONCLUSIONS: Webinars have a role in surgical training following the COVID-19 pandemic. The 23 recommendations encompass indications and technical considerations but also discuss important knowledge gaps. They should serve as an initial framework for ensuring that webinars add value and continue to evolve as a tool for training. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR2200055325; http://www.chictr.org.cn/showprojen.aspx?proj=142802.
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INTRODUCTION: In this case series, different modalities of treatment for patients with ischaemic symptoms of subclavian stenosis are described, including the different operative strategies that can be adopted in more challenging cases. This is the first case series describing these four management options. PRESENTATION: Case 1: A seventy-one year-old female presented with acute on chronic ischaemia of her left arm following a fall and developed dry gangrene of her left thumb. This was initially managed with a heparin infusion followed by stenting of the subclavian artery which relieved her symptoms. Case 2: A fifty-nine year-old male presented with chronic ischemia of the left arm secondary to an occlusion of the left subclavian artery. This was managed by transposition of the left subclavian artery onto the left common carotid artery. Case 3: A sixty-four year-old female presented with left subclavian steal syndrome secondary to subclavian artery stenosis. She underwent carotid subclavian artery bypass. Case 4: A fifty-six year-old female presented with acute left upper limb ischaemia secondary to acutely thrombosed subclavian artery on a CT-angiography. She underwent a carotid to axillary bypass. DISCUSSION AND CONCLUSION: This case series demonstrates the treatment options available to vascular surgeons when managing symptomatic subclavian artery disease. Symptomatic subclavian artery occlusive disease should be treated with endovascular stenting and angioplasty as first line management. If it is not successful then open surgery should be considered. Bypassing the carotid to the subclavian or to the axillary artery are both good treatment modalities.