Discussion

Online learning platforms have become essential to disseminate new scientific ideas and maintain the necessary ongoing education of trainees and practicing physicians given the cancellation of international, national, and regional conferences. ^{Reference Tretter, Windram and Faulkner9,Reference Ma and Vervoort10} Heart University, a free educational online platform aiming to be “the go-to online resource” for e-learning in congenital and paediatric acquired heart disease, has become increasingly relevant during these changing times. ^{Reference Hermida11} Recognising the pressing need for not only enduring education, but also contemporary live educational events for both trainees and practicing providers, the editorial boards of the component sites for Heart University, that being the Pediatric Cardiac Learning Center and the Adult Congenital Heart Disease Learning Center, discussed and implemented the idea of holding a periodic Webinar covering the most up-to-date practice of CHD, appropriately titled the Heart University Contemporary Questions in Congenital Heart Disease Webinar Series. On Wednesday, 6 May, 2020, the first Webinar in this series was held, titled Tetralogy of Fallot: How can we avoid poor outcomes late after repair? This was a historical event in that it represents the largest gathering of CHD providers for which we are aware of ever to assemble outside of the Quadrennial World Congress of Pediatric Cardiology and Cardiac Surgery.

Webinar e-learning appeared to have a dramatic impact on stimulating deep learning for the participants involved with >70% agreeing or strongly agreeing that they derived greater depth of learning from each of the Webinar talks than a more traditional textbook or medical journal methods of learning. The reasons for such deep learning may relate to the high-quality speakers, talks providing the current state-of-the-art knowledge, but then delving into unanswered questions and trying to formulate new ways of addressing such questions, robust question and answer sessions, and finally a moderator who succinctly summed up the relevant 3–4 points from each talk and at the end of the Webinar provided an overall conclusion. The fact such a wealth of expertise and international audience experience could be harnessed within 2 hours is strongly supportive of this pedagogical strategy into the future.

Whilst the Webinar format clearly fills a need during the ongoing global pandemic, it also challenges the current paradigm of attending meetings physically, which may resume in the post-pandemic period. As such we believe that it represents a COVID-19-facilitated disruption to our current approach. Joseph Schumpeter first described the concept of “creative destruction” in 1942, a dismantling of traditional practices in order to facilitate innovation most commonly in the manufacturing process (Henry Ford assembly line). ^{Reference Schumpeter12} Clayton Christensen then went further in 1995 to describe the concept of “disruptive innovation”, which creates a new market and network which disrupts existing structures (e.g., Webinars displacing international conferences). ^{Reference Christensen13}

Like most disruptive technologies, it may not completely replace the traditional alternative (e.g., digital music versus vinyl), but it is difficult to envisage a complete return to pre-pandemic practices. There will be likely fewer in-person educational forums, they still will have a role. For example, a Webinar cannot replace the benefits of in-person networking, and the many other social, educational, and other benefits of a traditional in-person meeting. However, unlike some online learning experiences, an interactive Webinar can better address the dynamic social-educational needs for many providers and trainees, and provide the feeling of “inclusivity” and accessibility in the learning experience. At a more practical level, it facilitates interactive learning to those who may simply be unable to attend in-person meetings due to logistical barriers (i.e., being unable to free up the necessary time from their clinical duties). It also becomes increasingly relevant in low- and middle-income countries where monetary barriers related to travel and conference expenditures may additionally prohibit attending in-person conferences. ^{Reference Ma and Vervoort10} Additionally, providing such high-quality educational experiences addresses an additional deficiency in consistent quality education, especially in specialty and sub-specialty education in many low- and middle-income regions.

Climate change remains another pressing crisis of our times in the setting of the COVID-19 pandemic. ^{Reference Rossati14} Previous authors have called for a rationalisation of carbon footprint during conference attendances. ^{Reference Spinellis and Louridas15} It was perhaps surprising that only a small majority of participants expressed concern about the carbon footprint of conference attendance. However, this Webinar would have saved 18 million carbon kilometres had all those attendees travelled to Cincinnati for an in-person conference. Given there are 1500 + international medical conferences per year and greater than 3000 general conferences (theconferencewebsite.com), the carbon footprint savings through Webinar use would be astronomical, promoting a “sustainable academia”.