Abstract

Background: Education by lectures has been standard for 100 years or more. Given the 21^st century technology, people can connect with others around the world instantly, electronically. With the pandemic, teaching changed to one-way information transfer with the loss of interpersonal learning experience. SNI^® and now SNI Digital^™ have been experimenting with different forms of communication to transfer information.

Methods: Using an interactive education model, a meeting for neurosurgeons in Baghdad was held for students, residents, and neurosurgeons, the first in Iraq for a number of years because of the disruption from the war there. A national and international faculty participated.

Results: This 15^th meeting of the series was described by 42 out of 60 participants as “The best conference I have ever attended.” That significant response highlights the importance of such meetings and how they can be at the highest level possible and be a recipe for success.

Conclusion: The 15th meeting provides a focused analysis of the underlying characteristics leading to its success so that it can be duplicated.

Keywords: Information exchange, Interactive education, Multigenerational, Neurosurgery

INTRODUCTION

Online learning from virtual meetings has increased dramatically over the past decade and remarkably during the COVID-19 pandemic era.[ 4 ] Theoretically, these meetings have a role in improving neurosurgery, training, and standards in low- and middle-income countries (Iraq as an example) by acquiring the experience of the developed countries. The rise in the number of online meetings through the different platforms has peculiar challenges.[ 9 ] Maintaining periodic online meetings with a repeated quality along with participants’ engagement is one of the challenges.[ 4 , 7 ] The Surgical Neurology International (SNI^®, SNI Digital^™)-Baghdad neurosurgery (SNI-B meeting) online meeting format has shown incomparable consistency in the quantity and quality of the virtual meetings for more than 1 year in our experience. Here, we will discuss the success factors of the special 15^th SNI-B meeting with the analysis of the attendees’ feedback.

PAST EXPERIENCE

Online meetings to discuss global and Iraqi neurosurgery are the common theme of such collaboration with SNI^® guiding the new generation interested in neurosurgery to excel in their potential future career. A total of 14 individual 2 h meetings utilizing the Zoom platform started in May 2021. The virtual meetings continued monthly between the panel of the SNI board headed by SNI Faculty Drs. J. Ausman, J. Lazareff, S. A. Khonsary, T. Aurora, and the Baghdad team led by Dr. Hoz. The audiences were predominantly residents and medical students from Iraq, the United States, Azerbaijan, and Romania. The meetings usually featured participants’ presentations followed by Q and A with excellent moderation and interactive discussion among the faculty and attendees. Meetings involve scientific lectures, research presentations, advice, and discussion of background social and organizational issues crucial to understanding the culture and patients. The attendees were encouraged over this period to feel free to participate in the meetings and became involved in the discussion and exchange of ideas over time.

The 15^th meeting had a unique quality. Its purpose was to provide the first Baghdad neurosurgical meeting in several years for the neurosurgical community with the ultimate goal of holding an international meeting for all in Iraq in 1 year. It is the goal to enable to neurosurgeons, residents, and students to appreciate that there are bright people everywhere with creative ideas who can help their patients achieve better health outcomes. In the future, more speakers will be invited from around the world.

MATERIALS AND METHODS

The SNI panel of Discussants included Drs. J. Ausman, J. Lazareff, S. A. Khonsary, and A. Bari. All have been involved in international educational experiences in over 80 countries. They have an awareness of and sensitivity to the cultural differences among people in many countries.

Before this live meeting, three online sessions occurred between SNI faculty and Dr. Hoz to plan different aspects of the meeting. All the extensive local arrangements were made by Dr. Hoz to conform to the culture of the country and to invite key speakers. The meeting took place online with the Zoom platform. The meeting was recorded to be available on SNI^®. SNI Digital^™ postmeeting for all to view. Copies of the mp4 of the meeting were sent to all neurosurgeons in Iraq and others in other specialties for their information. All the discussions occurred using the English language. Four speakers were selected to present their work, followed by a live, open, and interactive discussion with the panel and the participants.

SPEAKERS

The speakers of the 15^th meeting are a combination of different generations of neurosurgeons. The first speaker was Dr. A. Hadi Al Khalili, one of the founders of the neurosurgery in Iraq.[ 1 ] His career in Iraq extends from the 1970s to 2004, when he performed a diverse range of important scientific research and clinical practice. Another speaker is Dr. Moneer K. Faraj, the local director committee of the Arabian Board of Neurosurgery-Iraq. After his presentation, Dr. Hiba AbdulAmeer is an active functional neurosurgeon in Iraq and the youngest Arabic neurosurgeon to date. She was followed by the presentation of Dr. Ausaf A. Bari, a functional neurosurgeon-scientist from the University of California, Los Angeles (UCLA), United States.

RESULTS

Dr. Hoz introduced Dr. Ausman to give the first introductory talk. Dr. Ausman mentioned that 10,000 years ago, Baghdad and Iraq were located in the center of the development of the first major agricultural and farming settlement of humanity along the Tigris and Euphrates Rivers. This civilization has become the longest surviving civilization in world history. It became the center of the development of farming which flourished because of the adjacent water supply. It produced an abundance of food which was also stored, advanced architecture, irrigation, astronomy, and developed a social structure. Baghdad was the location of great libraries and the first medical school in the world. Iraq was the crossroads of many cultures over time, leaving a great legacy to the peoples there and the rest of the world.

SNI is an internet neurosurgical journal that is free to all people everywhere and accepts fact-based discussions. Its sole interest is in providing information to the doctor for the benefit of patients all over the world. There is no characteristic by which it judges people or papers except for fact-based discussions. SNI’s goal is to “help people around the world,” and its editors understand that there are bright people everywhere with creative ideas who can help their patients achieve better health outcomes. SNI works with people everywhere to provide all forms of education. This meeting is an example of those principles.

The theme of this meeting is a confluence of the past, present, and future. Dr. Al Khalili presented the history of neurosurgery in Iraq. He mentioned that Victor Horsley, one of the major founders of neurosurgery from the UK, was in Iraq in 1916 and became ill from Heat Stroke; died in Amara, South of Baghdad, and was buried there. Horsley pioneered removing spinal tumors through laminectomy, carotid ligation for aneurysm treatment, a transcranial approach to pituitary tumors, section of the trigeminal nerve for trigeminal neuralgia, stimulated the cortex, internal capsule, and spinal cord to explore the neural activity and developed the initial work for the treatment of epilepsy. Although he was a Giant in Neurosurgery, he was dedicated to the common man and accessible healthcare for all. Dr. Khalili then described the neurosurgeons who had come back to Iraq after advanced training in the UK, France, Germany, Canada, and the USA. These neurosurgeons then began to establish practices in Psychosurgery (Dr. Yaqouby), Spine (Dr. Parhard), and General Neurosurgery (Dr. Sadik, Dr. AlWitry, and Dr. Khalili). Dr. Khalili also became interested in research. By 2000, there were 48 neurosurgeons in 12 neurosurgical centers in Iraq, serving 27 million people, with one neurosurgeon for every 500,000 people. During the Iraq war, many left the country. Dr. Khalili also described his unique systematic and encyclopedic approach and how he applied “doing more with less” to attain significant achievements at that time in Iraq. Although the resources were very limited in his epoch in his country due to wars and sanctions, he led creative and distinctive research projects, some of which were published. He described some research work on spinal cord repair; he did with a woman who was the Head of Veterinary Medicine in Baghdad. After sectioning the spinal cord in dogs, they were able to show complete recovery of function after bridging the small gap between the ends of the severed spinal cord in animals with a mixture of a sural nerve solution and then with omentum laid over the approximated spinal cord segments. The work was not published because of the death of the woman veterinarian and her daughter during the war. This outstanding and pioneering work will be published in SNI soon. All his work created an atmosphere of an important tradition that should be passed on to the next generation and described the meaning of making innovations in spite of limited resources. Unfortunately, he had to leave Iraq because of a threat to his life.

The present neurosurgeon who was carrying the torch of creativity and excellence in Iraq following Dr. Khalili is Dr. Moneer Faraj. Dr. Moneer talked about his work establishing the first deep brain stimulation (DBS) program in Iraq. The war had left the country with DBS supplies but no one to use them. He had to learn himself, as he could not expect anyone to come to Baghdad during wartime to develop this program, including stereotactic engineers. With determination, he overcame the many difficulties he encountered, adapted the frame to an MR unit, developed software to make everything work, and performed his first DBS surgery in Iraq. The first case took 13 h. With more clinical cases, the operative time was reduced to 3.5 h with good results. He is training others to do this work with the assistance of physicists and bioengineers who are in Iraq so that more patients can be treated for their functional diseases. Dr. Faraj also did an outstanding job creating and designing new low-cost surgical tools based on the core principles of ergonomics as a practical solution for underdeveloped countries, of which the low-cost navigation device is an example.[ 2 ] During his talk, Dr. Bari texted all who were at the meeting, stating, “This is Incredible!” All of this work, he supported with his own funds. He also applied his intellect, determination, and dedication to improve the education of the students so that their achievement in examinations rose from 20% to 80%. Dr. Faraj’s work was eye opening and highlighted a new era of innovation in neurosurgery from Iraq. He leads the new generation by example and motivates them to carry that courage and vision for the future. A more detailed explanation of his trials and accomplishments will soon be published in SNI as an example to the whole world that creative people exist everywhere and can succeed under challenging circumstances. Money is not the solution to all problems.

The last two topics were about functional neurosurgery. Dr. Hiba abudlAmeer Nasir and Dr. Ausaf Bari each presented their works in functional neurosurgery with their experiences from Iraq and the United States, respectively. Dr. Hiba showed her approaches to treating a large number of patients with dystonia, movement disorders, Parkinson’s disease, spasticity, and others with a high success rate. Her videos displayed outstanding results. Dr. Bari commented that her work was at the top level of neurosurgical centers in the world.

Dr. Bari then presented his futuristic research in dealing with patients who have back pain that is unresponsive to standard treatments using functional neurosurgical technology. He located areas in the cingulum with MR fiber tract imaging that appeared abnormal in selected patients with back pain unresponsive to treatment. Using a DBS unit with a special electrode, he was able to stimulate the brain and to eliminate the disabling pain for the patient. His research showed the potential of neurosurgery working with the complex brain structures to treat the cellular and fiber tract disorders behind pain, mental and emotional disorders, and loss of motor function, as in stroke.

Exchange of ideas took place between the speakers and discussants to share knowledge and experiences. Those presentations and the following discussion represent the zoom out view of functional neurosurgery’s status and future as a specialty and futuristic science.

The end of the meeting was devoted to questions and answers with the discussants, faculty, and students. Passion for learning about neurosurgery is the primary motive for most of the attendees. Participants included 17 neurosurgeons, 15 residents, and 28 medical students interested in neurosurgery. A wide range of interactive questions, answers, and pieces of advice were circulating among the attendees and discussed at the end of the meeting. These questions are attractive because of their diverse background, from experienced neurosurgeons to early staged medical students. All these levels form a constellation of questions that can enrich everyone listening.

The feedback from the participants was outstanding for this meeting. Most participants concluded that the 15^th SNI-Baghdad neurosurgery online meeting was a meeting that changed their point of view on neurosurgery.

Social media comments from the attendees follow:

“Such a highly scientific meeting! It was very inspiring and literally it made me looking for new dreams!”

DISCUSSION

SNI^® is an internet journal. SNI Digital^™ is an audiovisual format used for the transmission of medical information. SNI^® has been publishing for 12 years. SNI Digital^™ was formed more than 2 years ago and had experience with its interactive form of teaching with over 150 sessions of all kinds to people of a variety of ages. SNI Digital^™ also sponsored an interactive international meeting in June 2022, which 600 people attended online from 100 countries with 57 speakers from around the world. We always ask for feedback from our audiences and participants. Although the evaluations were 90% positive for our interactive meetings, neither SNI^®/SNI Digital^™ has ever seen this type of overwhelming approval of its programs as in this 15^th SNI-Baghdad meeting. Thus, an analysis of the responses is necessary.

There are two parts to this meeting to which the attendees responded. The first was related to the medical information transmitted, which was described as “fantastic presentations,” “inspirational” and “best meeting ever,” “extraordinary ideas,” “brilliant talks,” and “highly scientific.” The other category of responses were best stated as, Life Changing: “it changed my perspective on neurosurgery,” “full of inspiration and creativity,” “proud to be mentored by you,” “inspiring,” “made me look for new dreams,” “motivation for us from a female Iraqi neurosurgeon,” ‘different generations with different aspect,” “Speechless,” “MIND BLOWING,” “amazing collaboration,” “creative minds can make a difference anywhere in the world,” “amazing,” and “inspirational doses of hope”…. These responses tell me (JIA) that in a region that has suffered war, and many tragedies, the attendees found the Hope, Inspiration, and saw the Creativity of Iraqi neurosurgeons overcoming adversity to reach levels equal to that in the developed world. They saw that people of different generations could discuss issues reasonably and respectfully and come to an agreement. They saw that their great heritage of 10,000 years had meaning. It was their future which they saw.

This is the purpose of interactive meetings SNI Digital™ supports. It is what education should be. It is a life experience. It is communication that makes the information essential and meaningful. It is about life with people and not with screens. It is learning from successes and failures. It is having hopes and dreams and the inspiration to keep fighting for what you want to achieve and pride in achieving it. That was the total message from this meeting to me.

Zoom meetings have been popular, particularly while people were isolated because of the virus pandemic. Yet, there is “Zoom Fatigue”[ 5 ] and Zoom failure in educating the young.[ 6 ] The fatigue is not a problem with the technology but with the people using it. It is primarily one-way teaching with little audience interaction, which can be boring. Young people learn by being with one another, meeting challenges, playing games, and studying together but always interacting in ways for which there is no way to quantitate its value.[ 3 , 8 ] There are some Zoom education presentations which are not useful and which do not contain practical information that has become a means of selling one’s own product. Such approaches do not consider what the audience wants. Now, there are more and more of Zoom lectures. No one knows what information is more or less valuable or if it is true. There is no peer review. There are some fundamental issues that need to change for this type of education to succeed. This report is about such an approach.

Interactive education involves an understanding or the needs of the audience and providing the information for those needs. It involves an empathetic concern for students of all ages. It should be fun and friendly so that education becomes a positive experience one has lifelong, which will make reading, learning, and investigation continuously interesting. It is based on the principle, “Never forget what it was to be a medical student.,” as everyone is a colleague at different stages of learning. It is all based on the principle of doing what is best for the patient.

We did encounter problems in the meeting, but they did not matter to the audience. Technical problems to which people have become accustomed are challenges, as well as some of today’s technology, which is not user-friendly. The speakers spoke longer than was planned. Yet, it did not matter from the responses but needs to be fixed going forward.

We need to experiment with new ways to transmit information in the future. Just putting 20^th century teaching on the internet for the 21^st century will not succeed.

CONCLUSION

This 15^th meeting of the series was described by 42 out of 60 participants as “The best conference I have ever attended.” It is a significant response which highlights the importance of such meetings and how they can be at the highest level possible and be a recipe for success. This meeting provides a focused dissection and analysis of its underlying characteristics leading to its success so that it can be duplicated.

Declaration of patient consent

Patients’ consent not required as patients’ identities were not disclosed or compromised.

Financial support and sponsorship

Publication of this article was made possible by the James I. and Carolyn R. Ausman Educational Foundation.

Conflicts of interest

There are no conflicts of interest.

References

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