 Thank you very much to AIDEN organization for this webinar and thank you very much to all of you that are attending this webinar. My name is Elena Cadirola and I am acting here as the chair of this session and I am so glad to introduce you to this webinar in collaboration between AIDEN, European Distance and the Learning Network and the European Project Child Care, a project in order to foster education in medical field in the countries of Central Asia for children care. You are very welcome all of you. It is my pleasure to have you all here as both presenters and attendees of this webinar and now I will show you a very, very short presentation in order to introduce this webinar, the initiatives and the speakers. So just a very short presentation from myself and for the initiatives. Okay, can you see it? That's perfect, perfect. So I can start. As I said, this is an initiative in collaboration between two very important institutions, the European Distance and Education Network and the Project Child Care, capacity building project and the title of this project is improvement of children care teaching as a template for upgrading medical education in Central Asia. In order to do this and in order to build the best this cooperation between AIDEN and child care, a set of five webinars were planned. This is the third one, but a couple of them were launched and produced in the previous month. The first one had the title developing teaching and learning opportunities and facilities in children care. And the second one, medical faculties and digital education. So the idea for both of them were around medical education. The first one was an introducing webinar. In order to introduce the five meetings focused to build an interconnected multi-directional environment aimed to promote the interaction between students and teacher also from distant resources, just helping to update educational methodologies of course in the field of medicine. The second one organized mainly by the Jagiellonian universities was focused to give an answer to these following questions. Is the lecture-centred education out of date, pros and cons of synchronous tools at the faculty of medicine? And how to make curricular transformations? How to facilitate interactive learning activities among students? Are online examination useful not only during the pandemic? Very, very interesting and challenging questions. And you can, if you want, have a look and watch again the recordings of these webinars. And you can find it at this address at an online.org TAG webinar. So you can have a recap about the first two webinars, the first two of the set of five. So now we are introducing here the third one webinar about the collaboration between Ed and child care. And the third one, July the first, has this title. Faculty development and going beyond teaching, building experience. So the idea in these third webinars is how to prepare the faculties, the professors in order to be able to undertake experience and education with new technologies and in the new era with new methodologies. And to present very, very interesting experience on the field using particular and very sophisticated tools and instruments given by technology. So we have here with us today four excellent presenters and speakers from University of VIA. The first one, Professor Stefano Gugoni and Gabriella Cusella, Stefano Perlini and Guido Bastanelli. Please let me shortly introduce them to you. Stefano Gugoni is a professor Emeritus on Pharmacology, former factors delegate for teaching and learning activities, and guided the initial steps in the creation of a group in University of Pavia aimed to update and train the University of Pavia teachers. Gabriella Cusella is, of course, affiliated at the University of Pavia, is Associate Professor of Human Anatomy, is a director of the Institute of Human Anatomy, and she teaches in various degree courses. And Gabriella's goal is try to change her teaching method by transforming ex-cathedra lessons into an interactive experience in order to stimulate students' interest by involving them in practical activities, in which they use anatomic models, human perception, and digitized human anatomy, both in person or remotely. Stefano Perlini is currently in charge of the first aid and emergency medicine at the Polyclinical San Mateo Foundation as a full professor of the Department of Internal Medicine and Medical Therapy of the University of Pavia. Cardiologist, referenced since 2005-2001 for the center of the study of systemic amyloidosis of Pavia, and he spent several research periods abroad, London, UK, Oxford, or Chester, USA, and was visiting professor at Boston University. In relation instructor since 2002, he applies this teaching method with students and specialists in the teaching of psoriotics, medical cleanings, and emergency medicine. He participated in the drafting of the programmatic document and the dictionary of simulation in health of CMED. Finally, last but not least, Professor Guido Bastianelli, ER knows and throat surgeon, professor of the University of Aden, Faculty of Medicine, who here is a surgery advisor for Africa and the Middle East, a learning trainer in the EMT surgery, University of Aden, a learning teacher in International Health Cooperation, University of Florence, Honorary Council of the Republic of Yemen in Florence, Director of the Study Center of the Honorary Council's Union in Italy, Rome. Guido has a long experience here, looking for new languages and forms of communication to emanate geographical and social distances. Among his recent projects, curator of the e-learning project of cardiac resuscitation, the bridge, open new lands, in collaboration with the University of Pavia and Polyclinicosan Matteo Pavia, here and follow consultant at specific clinic in Florence. And Guido, like so much the University of Pavia and that a lot of experience in University of Pavia. So his heart is to say that he does prefer that his affiliation is of University of Pavia. So after this short presentation, it is my pleasure now to go back here to stop my chair. Okay, sorry. Stefano will introduce us. The Pavia experience. Gabriela Cusella, beyond the exercise in testing at a distance and in the anatomy lab, the anatomy experience. Clinical simulation on a dummy will be the title of the presentation of Stefano Perlini and for Guido at a distance demonstration in surgical disciplines. So I think that in this way, my role has finished here, and it is very, very my pleasure to leave the floor to the presenters and in specific to leave the floor to professor Stefano Govoni as first speaker of this webinar. Please, Stefano, the floor is yours. Thank you, Elena for the presentation and I start to share my slides. Okay. Open, you see them correctly. No, no, we don't see now. So my task today is to share with you, all of you, some of the experience that we had here in Pavia in building a faculty development program. And I'd like to start with the slider was showing in the previous seminar when we presented all the program, recalling us that for a distance teaching and the use of new technologies. And to renew the diet antics, the university, we do need a program for faculty skills development. So we not only have the task to train the participants, but you should, we should train also the professors. Also, because by using new technologies, you are introducing introducing new ways of presenting the material, the disciplines, and you need the specific pedagogical tools in addition to the technological tools. Moreover, and it's exactly the goal of these webinar today with the presentation of Cusella, Perlini, Bastianelli, is that to remember that the distance teaching is not to be limited to formal academic teaching, but may include the practice sections. Why teachers should be under go should undergo programs of updating. Obviously, the use of new available technology needs some training, but also, and I would say more importantly, the appropriate pedagogy and content organization. Today, the world ranking universities are favoring the development of the teaching abilities of their teachers through systematic actions. And this trend, fortunately, I would say is now expanding. And there are several universities in Europe that are adopting such programs and also in Italy. So it's something that is really growing. At this point, what did we do? Some three years ago, we started exploratory programs when I was still the time the right house to delegate for teaching activities. We started to explore some program of faculty development and then, later on, a group which is now headed by a professor of center, Zanetti and has in the group or the present that records delegates for teaching activity. Is a trying to build up within Pavia the experience of a faculty development programs. The name of the group is Mida. Mida stands for innovative methodologies for teaching and learning from the Italian. But remember, looking to the figure on the right, on the left, sorry, on the left in this slide, that Mida touch can create wealthness. But it is also dangerous in this illustration Mida has unfortunately transformed his daughter in a golden stanchion. So a great attention has to paid has to be paid to all the stakeholders. Attention to the background of the higher education institution you are belonging to attention to the needs to the expectations and to the impact on academic life or the program that you are developing. Faculty development program may be based on the grounds of existing literature and as you may appreciate from these very crowded slide and I will not have the time to go into the trade. There are many actually more than 15 16 points of attention when you're developing such a program. I want to drive your attention to the first one. Accent the challenge a faculty development program is a challenge for the university you are belonging to. So it needs attention, efforts, enthusiasm, otherwise it will fail. But the points are many, for example, what is the sustainability in time, what are the economical resources, what is the relationship relationship with the government governance of the university. From the silver 2014 paper I covered this list of the key message for a faculty development program. You should consider implementing a comprehensive faculty development program. This will be devoted to the needs of the teachers, the educators, the researchers and the administration and be student centered. You should have the participation also the students. You need theoretical theoretical approaches and models. Taking from the literature and taking from the experience that other universities have in your own country or in other countries. The programs have to be inserted within the strategic frame of the university, not be something apart. You should be able to create vision, mission values and you should make the participants happy to be there and to participate. And it's not just another task while I'm teaching and I have my duties. No, it's something you should enjoy for it. And I tell you, it can be that. So first, maybe obvious organized by paying attention to all those points in presence. And because, but not only because of COVID distance courses and webinars for the teachers. To start the continuous professional development programs to give a region to a community of practice of keeping the network, the people that are working with the dynamic innovation. To be prepared with technologies, the new technologies apply to the teachers and here you see the picture of our chair today. Because Elena is heading the directing innovation and communications in our university and the help of this center was extremely valuable and important to develop the program faculty development program. How we started this is the first three courses within two years and the last month finishes just yesterday afternoon and it was really enjoyable. All the people we are happy to have participated and because of the time now is more relaxed than COVID is less pressing. Next week we will have an in presence meeting and I assure you we are always waiting for it and just talking and seeing each other in front around a coffee or something like that. Oops. What to do next? Mapping. Mapping both the dynamic experimentation within your own institution and mapping the learning needs and the perceptions by people both students and professor on what you're going to do. There are metals, including structured questionnaires and the help you can ask for help and have the help of external expert consultants that can examine your institution from another point of view, which is very important. From mapping to intervention with at least three levels. Obviously, I start here from the center panel last second line the diffusion of the attention to the attic innovation but also basic training for an experience and newly recruited teachers. Targeted training with discipline specificity and expert in train and again discipline specific training for already experienced teachers. You should have in mind the whole panorama of the teachers in your institution and you should look for incentives. Either economic or something that you can put in your curriculum like the open badges, badges credit recognitions for the teachers participants to the program. Some universities in Italy in this case are putting resources in those courses that are introducing innovation and so on. This has to be built in time with the experience. I just added this slide here in Pavia, demand was growing from medicine. Just as a consequence of one of our seminars here in childcare seminars and I think that Jean-Baptiste Parigi started it but there are marvelous things around while we don't do something here in Pavia. Our School of Medicine and I think that every faculty development program should promote and also accompany the growth specific faculty board initiatives and this is what we are doing now. I'm almost at the end. Governance should be involved. This is very important. The faculty development is a strategic plan and should be within the university strategic planets. It should be linked to the evaluation. You should be able to imagine what the results will be, better credit acquisition, better votes, better success in the career, whatever. Something to be measured to monitor the advantages of the program. The whole university staff should be sensibilized and informed about what is growing on. I tell you this is not all this easy, not even a small university or medium university like in Pavia. This is the present media group. Silvana Rizzo is the Rettos Delegate for Teaching Activity present in the group and Maria Suntazanetti is a psychologist devoted to learning psychology. Maria Suntazanetti is the president. Maurizio Valli is from the School of Medicine. Elisa Temunotti is helping Maria Suntazanetti and particularly devoted to pedagogical province in childhood. Christina Rigoni and Maria Luisa Gallotti are from the School of Medicine, devoted to the nursery program. Gabriele Mussolini is from the School of Pharmacy. We should expand to also people from humanistic faculties and our courses are presently open to those. And for some, one of you interested, eventually these are some of the references were used for this presentation and thereafter we'll leave it to the other side. And thank you for the attention. Thank you very much, Stefano. Okay, you can, that's perfect. For your interesting presentation, maybe I have just a short question, but before this, I would highlight that at the end of this webinar for willing people. We will continue the experience of this webinar without further zoom room organized by me and people who wanted to stay with us will have the possibility to have some practical exercise together with a specialist on a two-mage table. We will have to go more in practice and experience in tools for education in medicine. So, who of you is wanted to dedicate more time, will have the opportunity to stay with us in a further section at the end of this webinar. I finished the link in the chat at the just before the end of this webinar, I will republish just to remind you what to meet online. So thank you very, very much question and post your question in the question and answer section if you want. So we will have the opportunity to answer to you. My very, very short questions to Stefano just before to give Gabrielle the floor is how do you think when will be the moment in your mind and in your planning to make this initiative as mandatory to all the professor of the University of Padilla, because you know, it is very fine to have a volunteer voluntary initiative from this level and it is the best to match the top level and the top down initiative at this point of the initiatives. But I think that it is not possible to have a scattered initiative inside the University and the best things at the end would be to have the same level with the certificate for all the professors in order to give to all the people the possibility to be aligned in an education methodology of the University of Padilla. What do you think about this, Stefano? We are not yet ready for that. It's a very interesting questions. In our national institution, for example, in the UK, they are requiring a certification and the entry in some USA University, they are requiring a yearly certification that you are attending the continuous professional education program for your teaching abilities. You know, one thing important, but this is relative just to Italy, is that the teaching activities should be more recognized than when you are competing for a professor position. This should start from the center from the Ministry of Education and University, but it is starting on board, very much discussed, but introduce also the evaluation of the teaching activities. So it will take place. We are not ready now to make it abruptly mandatory, but in time and with the competition among the University, it will grow in any case also on a voluntary basis. It should be very much supported by the University governance. That is the point. Extremely important. Thank you very much, Stefano. There is a notation in the chat from Don. Thank you very much, Don, for your suggestions. You noted the importance of incentives for faculty, say, Don, whoops, money, applicability to advancement, promotion and tenure, and release time. Can you discuss if these are being used in your institution or your institution are planning in order to reach these goals? Good question. We are not thinking because of the structure of the public work here in Italy to money incentives or salary incentives. That would be difficult. But we are thinking to the open benches as an instrument, providing you something, let's say, certifying that you are following a professional development program as a teacher. I think that this can be important for your CV. The other point will be to recognize the time you spent for this professional empowerment as a work time. That may be regulated even locally. You can put it in your own personal register and be recognized in there. So we are working on all these things. But I have to tell you one thing. When you introduce new techniques and when you use it with students and the students enjoying it, that is really rewarding. I have a student telling you that, thank you, Professor, because you changed it up. Our mind and our way of facing the teaching and teaching class, that is a really valuable reward. Thank you very much, Stefano, for your final comments. So inspiring for us and for the faculty communities. Thank you very much. And it is my pleasure now to give the floor to Gabriella Cusella as a second speaker of this webinar. Please, Gabriella, the floor is yours. Good morning, everybody. I'll try to share my, can you see the screen? Not yet. Let's see. That's perfect. Can you see it? Okay. Just one minute, okay. I have to manage to move away my, okay. This is actually the title of my short talk. But first of all, I would like to thank my guests. Elena Calderola, representative of BIDEN, Professor Giambattista Parigi, child CA project manager, and also Professor Gavoni, who invited me to this stimulating meeting. It's a pleasure to share my experience with you. But first of all, let me briefly introduce, really briefly, our university. And Pavia, you see, it's a small city, but it's also old and beautiful city. We are not far from them, about 30 kilometers. And our university is one of the oldest Italian academic institutions. It was promoted by King Lotera in 9th century, but it was enlarged by Galeazzo Visconti, Duke of Milan, and it became the University of the Dacia. And it was officially established as a studium generale, but Emperor Charles IV in 1361. The real rebirth of the Atinaeum took place in the second half of 1700. Thank you to Maria Teresa Vosta. So until the 20th century, this Atinaeum remained the only university in Lombardia. So we are really proud of that. But we are also proud that today Pavia is a nice university, which boasts about 20,000 students who came from other cities, regions of Italy, but also from abroad. And these students, they don't only enjoy beautiful courtyards, and our university is continuously growing with young people and trying to guarantee them a better, more inclusive future. So, a bit of history again. This is a beautiful lecture hall. Actually, the medical students are still graduated in this lecture hall, which is the Alla Scarpa. And it is a splendid anatomical theater, and it was built at the request of Professor Scarpa in 1786. But every year, about 400 doctors from the Gorgi course, which is the medical course in Italian language, and from the Harvard course, which is the medical course in English language, they have their degree in this room. But Pavia is not only history. Nowadays, we have very modern and beautiful libraries built within the historical structure of the old university. And besides that, we also have splendid multimedia classrooms. And so we are an ancient university, but we look very, very forward and we try to introduce future in our teaching. So, here you can see the Catania Hall and this whole lecture hall. It has almost 100 years. Generally, it hosts 200 first year medical students. Obviously, in the last year, the pandemic has almost completely prevented the delivery of in-person lessons. So, we all had to restart from Zoom or similar methodologies as a fallback solution. But, you know, this is a problem because with this modality, students are not anymore in the center of the lecture. It became just a small picture in the corner of your panel. So, in this picture, I was trying to mimic, you see, the blood circulation around the brain, which is not very nice, but also trying to explain a very complicated image of a brain slice is not the best. Also, because, you know, you have a very bird student attending to this lesson, instead to have a student involved and happy to be there. So, this problem has to be solved. And we took advance from an atomic table. For example, here we are playing with chronic nerves. You see this instrument hollow you to do whatever you want with the body, the human body. You can change your point of vision. You can show some structures, muscles. You can color them. You can annotate them. You can write on the feature. Also, you can, you see, remove some bones, change again your point of view and make transparent other structures and also Zoom, but very high level to structure and to show them. So, if you substitute your normal, your usual picture with this kind of films that you can customize by yourself, students are really much more happy and they awake. So, an atomic table is a digitalized anatomy table, which that means it's a very powerful computer in which are collected the database from four real colors. And each of these colors was the slice, very thin slices, about 0.2 or 0.6 millimeters. And each slice was digitalized and then the whole body were reconstructed again. So, now you can do with those data whatever you want. Also, for example, starting from the body, you can remove some structure layer by layer or by categories and using the scroll bars, you can do really a lot of different point of view and you can show the students whatever you want. Obviously, you can move also the body. For example, you can also try to show them in the best way structures or organs as the art. Here you see most of the structures of the body are transparent, a ventricle was removed and you can see the waves or you can obtain this kind of images in which you still have the matriculate and you covered the art, the arteria will feed the master tissue or the ventricles, but that's still a beautiful image, but it's not enough. So, an atomic table offer more. As you can see here, you can also offer to your students a site of the beating heart and you can connect it to the ECG and also you can cut the sample and you can still have it moving and you can look inside. So, you can study the physiology and the cardiac beating, also if this was a dead body, but with digitization, it was broke again to life. Well, I can tell you that when the students see this kind of lesson, instead of simple feature, their reaction is really enthusiastic. So, we are able to involve them and this is a very important point because if you are online or in cloud, or if you are in presence, to have the attention of students is the first objective to reach. But there is also another benefit. In the last year, we had a visiting professor and her name is Anne Giroi. She was here in Pavia for a few weeks. She was performing frontal lesson in the Catania Hall, but she was performing lesson using directly the atomic table and also performing exams and the practical teaching with small groups of students with the table. But because of the pandemic next year, we are frightened that it was not possible to have a teacher from abroad. So, we already spoke with Shobha Moyes from Primoz University. She used continuously the atomic table for lessons. So, if it would be possible, she would be here in presence, otherwise she will teach in cloud. So, I think this is very important because you can break down boundaries, the physical boundaries, and also you can mix the curricula coming from different institutions and you can create a transnational curricula for the students. Then, this year, we took advance by the university labor system to offer to our students a section in Zoom in which the tutors, which are older students of the medical course, will teach to the young students to use this database to try to improve the knowledge of the human body. But this support is a problem because these images are not real. I mean, these are reconstruction of structures of body structure, but they are not the same, they are not, they don't look like as a calendar because they are not. So, next year, we will overcome this problem because we saw that the students really liked this kind of activity, but we want to offer them something which is better. And the solution will be the anatomy on cloud because, in fact, we will try to take a step farther, to go a step farther. And using this support, it will be possible for students would be at the center of the lesson because you can involve students during the old Zoom session or if they are in the classroom and with their own computer, you can share the use of the table and they can be asked, for example, to perform a section of a particular part of the body that you asked them. So, for example, you could give them some material, they have to study, they will know what you are talking about in the next lecture, but they have to study. And then they have to be ready to answer to your question and to show to other students how they reach a structure, how they can section the body. So this will be... Gabriella, sorry, may I ask you to do today's conclusion because, unfortunately, we have a bit of lack of time. Okay, so I think this is a very, very important to share the knowledge with the students. And also, finally, next year, we will have the study of anatomical models, we will have the laboratory activity with the table in presence, but also we are trying to organize tournaments so that the students are stimulated in using the table. And after then, we will perform an exam with the quiz modality, which is inside the table. So, finally, what I have to say, these guys are the students, they should have their degree next July, so they want to say you their readings. And I think that digitization in terms of teaching, and I do believe that our young doctors will be protagonists in a world in which science and knowledge have to be without any borders. And I hope this can be possible for Pavia for all the universities which are in this fantastic network. So, thank you so much for your attention. Thank you. Thank you very much, Gabriella, for this really very interesting insight on what we can change educational methodologies using these kind of tools to see in the screen not only the heart beating, but can open the heart and see not only the principle of anatomy, but also of physiology in learning. And so to mix various disciplines was very very so interesting, anything that will be room in the next webinar for this to discuss and maybe have more practical section on this. Yes, also because the last thing I have to say that you can use in clinical stuff, you can use with the passion, because you can put your own images back on images. Yes, yes. So it's very powerful also for students. That's perfect. In the next years. Yes. Thank you very much. And so I think that now it is the time of a Stefano Perlini with his presentation about the clinical experience. Please, Stefano, the floor is yours. Yeah. Thank you very much for the invitation and I congratulate all the organizer for such a stimulating possibility. Here is just to share with you some of the experience we have in different fields of our faculty, especially from the clinical side point. So basically this is the history. We had the idea that you study medicine with the teacher who is showing you what's going on, either in the anatomy or in the necropsy area or at the bed ward. This is what we are used to and this is in a way something that we cannot change because experience is passing through this area. Some innovation that are taking place in our university beyond the ones you were already exposed to. One is virtual reality by our colleague in vascular surgery. The fourth one is 3D reconstruction from our surgeons and our approach to try to see what the surgeon is going to work on after the presentation of the patient. Another one is technical skill in cardiac auscultation by which to introduce the students into the world of how to listen to and how to evaluate the patient. The fourth one is the interaction within clinical case that is possible either in presence or at the remote area. This is one example. This was one lesson that our colleagues in vascular surgery were using a few times with the students, giving them the possibility of actually entering in the operating room together with the surgeon. To try to understand and to see what's going on during surgery, what are the different steps? Obviously, this is not possible with huge numbers, but virtual reality can allow us to use a tool in order to make it available for many, many students at the same time in a very interactive way as you can see here. This is already possible. Obviously, surgery is one possibility and many other possibilities can be developed. Obviously, this is also very prone to the students who may interact with the teacher and ask different points during the actual presentation. Another example, 3D reconstruction. One of the problems the surgeon has is that he has to figure out what will be the table, what will be the anatomical situation in the real patient. We have the possibility of having all the images that we can reconstruct from our imaging techniques, but obviously we need a 3D reconstruction. In these areas, one possibility is given by the 3D reconstruction. And this is also another option by which it is possible to reconstruct from the patient from the CT scan as an example or any other imaging technique. What is the 3D reconstruction of the organ? This can be shown either on the screen so that the student may try to change and to dislocate the organ or in the real thing. This is the surgeon that is just helping the fellow and the student to understand where to go when you go with your lung set to the patient himself. Obviously, this can be very useful in order to plan surgery or to plan minimally invasive surgery or any other field. And this has been applied in general surgery as well as in vascular surgery or in other areas like orthopedics or dentistry. This is another important innovation and another important tool we can give our students in order to learn more. And if I may say so also to us to understand a little bit more what we are going to do. My colleague, Professor Cusella, was wonderful in explaining us how 3D reconstruction may be useful for anatomy teaching. And obviously this is a field in which we use and we may use a lot these tools because anatomy is always something that is difficult to reconstruct in your mind as a 3D. And these instruments allow us to do so. Another option and the third part of example I wanted to share with you was how to learn cardiac auscultation with the students. Normally this is something that is cumbersome, difficult, I will never be able to listen to my heart, it's a magic thing. I had the chance in the past to meet this man who was a cardiologist and who developed this mannequin. This mannequin basically is a dummy on which they recorded several findings of real patients and made it possible for a student to visit the patient and to listen to this. This tool has been used in our university since the last 12 years. And they can say that the students really love it just because it gives them the opportunity of entering the clinical evaluation in a very simple way and in a very realistic way. This is one example by which you can go with the students, teach to them, make them listen to what's going on with the mannequin itself. And once again I would like to stress that this is taken from real patients. As you can see here the pulsation gives you the idea that you are visiting a patient and not a dummy. And this is just introducing them to the better life experience they will have soon after when they enter the medical world. One option we can have with this is the following. We can use it for remote lessons. This is one example by which it is possible to listen to the actual presentation. One example I want to share with you, I hope it's possible to listen also to the presentation. I'm sorry that this is in Italian but we will translate it in English. But I wanted just to show you that we can go there and listen actually to what's going on and maybe translate this in this way so that you can have also a visual representation. Obviously it is important for the students to make them understand that there is a pulsation, there is change there and the murmur is changing according to where you put your status code as in the real patient. This is not substituting clinical practice but giving the students the possibility to be introduced in clinical practice and this is of utmost importance as you very well may know. Obviously you can ask yourself whether this is improving the capability of our students to learn medicine. This was an example that we published few years ago with the first experience up to now more than 2,500 patients underwent this course and basically this is the situation at the beginning. If I show to the students, to a 30-year student, five different murmurs, their capability of recognizing them is expectably very low because they have no experience. It's a little bit embarrassing that also the 60-year students have got some trouble but that's another story. After training with this mannequin for a 10-hour session by which they can have a general lecture and a training on site or a training in small groups that as you can see can be also delivered by the web, this is the improvement in their performance. So really they can recognize more and this is very rewarding for them because they know that they can do that so they will go to the patient with a self-idea that following very simple rules it is possible to learn and is learned by doing in a safe environment like simulation one in which you don't hurt anybody, it's a dummy, but at the same time give you the possibility to go to the real patient in the best possible way. The last part is related to the possibility of giving to the patient the clinical case that are interactive. This is one example of the many programs that you may have on the web or that you can have and this is what we normally use to administer to the students different cases in which they can visit the patient, have the parameters, try to ask different things, try to write a real chart of the patient in order to make a diagnosis. Also this is a chance we have. So I come now to my conclusion, new teaching in medicine is possible and we have many different tools, we have just to learn how to use them and how to deliver them in the best possible way. Having said that I want to stress one point, the interaction between the teacher and the students is still fundamental, thanks God, because no tool can exchange the possibility of the real interaction we may have with the students. The students need the interaction with us and we need the interaction with them. In the past it was with the let's say old and never ending way of teaching. Nowadays we have several tools that cannot but improve our possibility of teaching the wonderful job of being a doctor or a medical resource. Thank you very much indeed for your attention. Thank you very much, Stefano, for your so rich and the concise presentation was able to show us a lot of interactive and so powerful tools for students in medicine. Very, very interesting and you demonstrated so useful also in order to arise the level of learning and achievement of concept from your students. I would like to say that we can move at the end the questions from participants and now is the time to give the floor to the last, please the presenter in the list, Professor Guido Bastionelli, please Guido the floor is yours. Yes, yes, you are online. Okay, good morning everybody. 20 minutes first connection that we must learn today is that the learning on general surgery or whenever surgery you have is not one surgeon and one anesthesiologist, but is a workforce. I mean, again, workforce is means surgeon, anesthesiologist, this is an engineer, biomedical engineer from the University of Florence. And this is my chief of the staff for the nurses. So when we talk about training, it's not to train one surgeon, it's to train in the workforce. This is important lecture that we learned from the past. Now we are now in, thank you very much. We are now in one of my operative theater you see as a sophisticated operative theater. Today we discuss in 20 minutes about the new, the new development, but I will stay into the two hands. Now, and, okay, Sylvia and Claudia, okay, go ahead. What we have learned today, the COVID pandemic has restricted in person international training opportunities in a presidential way, but high and low middle income counties. So in the future will be not the same. And the virtual learning is already a significant component of medical education in low and middle income counties. What happens in the last year, the COVID pandemic has changed the way we provide surgical training, particularly affecting regions of the world where the training programs rely heavily on out of the country specialist. But the most important lecture in my opinion is that Rachel papers in upcoming articles have clearly demonstrated that absolutely scientific and teaching variety of distance learning in surgery. Why this one? Because up to one year ago, we do not have feedback about our learning when we learn in low middle income counties. But now we were obliged last year to teach each other from high sophisticated and we have known that the system is up. Go ahead. Just very briefly, 70% of the world population has access to less than 25% of some of the systems. And then to the initiative that I strongly recommend to check is the SDG, the Substantial Development Goal, and the Global Surgery 2030 by the Lancet Commission Global Surgery. So if someone of you is interested to go deeply into the field, please check these two main papers, articles, and of course issues. Okay. Now, one of the barriers to delivery in high quality and effective surgical care, positive search. So we must teach the search. For example, between Canada and Central Africa Republic, there is, you see how much difference. And also improving access to surgery by focusing on specialist workforce density and surgical volumes to system and partnership between high income and countries. Because it may be a way to build our capacity. Okay. Now, go ahead. Okay. The surgical mission of volunteers. This year is 43 years that I am in international cooperation. So when I was younger, the surgical volunteers was the only way to do missions to go in Africa, wherever you like. And then you provide direct service delivery. But we see now a proliferation organize like this project today or structure partnership between well established academic institution and LMIC. But the multiplication of initiatives can lead to duplication of efforts, redundancy, inefficiency, and partner fatigue. Okay. The role and governance in my opinion is important because when I start my career, normally, all the initiatives are from the governments of WTO. I was a team leader about my future. But now you see that you can utilize the new donors, like final product organization with interest in community disease and imagine it can represent untapped financial opportunities. Like Professor Cardinola knows very well for surgery within the global funds. Okay. Go back, please. Go ahead. Now, what was my beginning of the career 45 years ago? Professor Aus was my master in Los Angeles. Here you see everything 45 years ago. What do you see here? You see a microscope? You see a monocular for the hundreds of surgeons that coming all over the world to Los Angeles to watch the surgery. You see here this camera and you see here this virtual, not virtual, is a temporal bone. And now if you go back. Okay. I'll show you when I start my career. The only way was to have this 35 millimeter camera with the flesh. I put on the microscope here and then I have a picture. And what happens? The process was very static because I'm very sorry that my master, Professor Rao, never have seen my surgeon because you go to Los Angeles. You watch the surgery and what remains remains that you come back and you must try to cook the beautiful outstanding surgery that you see. And if you talk about the moment, if you can see on the microscope here, and this is exactly that. I'm very happy that the owner of this temporal bone. I'm sure that is very happy now in the disguise that he useful after 50 years. This is that our technical system. You can see on the picture here, but the manual to decide the brain and so far. Okay. Okay. Go ahead. And now the mission that I perform in Africa and in there is this was a lot of limitation because you go there to stay one month. You do outstanding surgery, surgery, sorry, but sometimes nothing remain. That was the intervention that we call range. So not sustainable many times. Beautiful people, very big hearts, but nothing remain. And was my mission in the betrayer and my mission in India. So go ahead. And this is, you know, a pediatric just that you can see that this operating room is not the same that we are here. But many times we must concentrate also to the rule of surgery, not to teach only by university or sophisticated to similar sophisticated. But the future we learn is to transmit these images that not sophisticated and to adapt. So the message is, okay. You see here, this is one conference in 1982, 40 years from now. You see my session and you see the video cassette, the video's rights, video's rights session. So absolutely beautiful, but absolutely sad. You can imagine with this process to stay seven hours, watch VHS is something really hard and sometimes not really good. Okay. Go ahead, Sylvia. Now, what do we have? What do we have here? I just to show you. You're looking at the sophistication of this. The microflop with all the camera inside and then the system in every normal high sophistication room in every year. And here, if you see here, the records and so far about all this. So this is normal for every high level operating room. But some important thing. While we teach we learn. The gap between states development. This is important. For instance, the disease that is vanished in Italy may still represent an important issue on the medical profile. So when I teach, but I've seen many cases in Africa. And I'm very happy that also Professor Pariuji is there on the line here is one more expert on traditional cooperation. And we see cases that we don't see more in sophisticated time. Like for example, in the year of communication. So this is a big research is a venture also for us to teach not only for the Chinese. Go ahead. And then one of the most critical aspects of the surgeons, the lack of tools and the technologies. In order to accomplish this project in the low income country, a bad internet connection, low information transmission, the lack of surgical services that represent a niche. For example, what we say solve the problem. You can solve the problem. Just to create. I create in a them. My university in Yemen. Just one room devoted for, of course, a day you learn distance. You learn. Go ahead. And this you see the record university director of pediatric hospital surgeon and everything. And we established this integration day so you can have just one room with a good connection. This is maybe also a good step to establish this. Go ahead. Now, three important points. The new surgical technique that on particular and the situation particular products. They are momentary. This is interesting. Why? Because if you see now, for example, this one is when I utilize this for a simple surgery of the year, but it's quite difficult. Maybe that in one lobby, you have only one of this. So if you do beautiful surgery with the medium of instruments, it's not so simple for the trainees to understand how to be to be to reproduce this. So you must think also the project to utilize implementation that have the same possibility in your trains. So for example, for example, I specialized to pose, of course, in Africa and in the, in the, in the, in the low and middle income countries. Sometimes you can have problem with anesthesia, general surgery so far. So we develop a local anesthesia 25 years ago. But now also the high income countries, for example, France, they have the problem to have the day surgery patients because the money is a short amount. So this creation is a feedback. Creation is bilateral. What I want to say, your friends, that when I learned 45 years ago, the international cooperation was a status. Now the world that we, we can have is, for example, interactive, immersive, creativity, dynamic, syntactic and new world. And I will go ahead and repeat. Let's go ahead. For example, another problem. Remember in surgery, training of trainers. It's a way to engage muscle training, coaching new trainers that are less experienced with particular type of skill. And then, of course, you can build a pool of competitive structure and can teach the material for the team. This is another important problem, not only the first level, but also the people that are just experienced. And this is my opinion about the new way of teaching. Everything we believe it was essential to be done in presence was found to be possible and removed. And e-surgery may be remotely effective due to the possibility for others to participate in a full-life surgical performance, understanding complications and its potential obstacles. This is important because if you think to the past, when you prepare a video from here, you prepare a beautiful video and you try to show your best. But sometimes having the possibility to see the normal routine surgery, you can see sometimes not the high level surgery, but the surgery is high level, but the complications are many problems. And that, of course, most important point, the increase of the possibility to check the favorable results of the surgery, that can be stressed by academic study and publication. And a full-life surgical performance allows the new surgeon to learn all the steps, the real duration of the surgery and the tricky phase because surgery is a tricky move. We must learn from the other, from all the tricks and traps to the surgery. So, one way. Which means these lines. Okay, go back to the class. You remember, in search of the people coming six months in Padilla or wherever you are, stay there, not a moment. They start from scratch with the students. It's not good. What do we have to learn? You can, for example, three months of training with the student remotely. And then the next three months, the student operates controlled by the trainer remotely. So, the bilateral. And then three months, the student operates independently and sends the surgery to the trainer. I never had the possibility 45 years ago to send my results to the trainer. And I'm very sorry about this. So, I do not have any control of the feed. But now that I feel the aid, you can imagine how much time you save. Okay, go ahead. And now the final. The blended learning. This is the message. Blended learning is a combination of face-to-face that, of course, in surgery is the only way in the surgery in the world, but computer media destruction. And many papers now for QZ on blended learning identify the principle effectiveness this kind of teaching. And online teaching platform, the application, are going to affect the future academic education and professional surgery. So, online platform, you know, what are the comparison between students and teachers. May I ask you, sorry, may I ask you to finish in five minutes? Okay, one minute is okay. I think the future is not only a tool of medical cooperation, but is irrepressible and valuable pillar of the medical arts. Thank you very much. Thank you very much, Guido, for this very excellent living theater demonstration of surgery coming from your own experience. And so articulated an international experience in the field of medicine and surgery. And we had the opportunity to learn a lot in how you, in practical, was able to learn, teach and have experience and create a community with your students and people with other countries. So, really, thank you very much for your presentation. We really appreciate it. Thank you very much to you for this opportunity. I want to go back to some question on comments coming from the chat. And from Albert Schrampp, KGD, he noticed that from Maryland University Global Campus, the State Education Center in Italy, and he said that we went completely online and with a top one-on-one meeting with all our students during the first weeks of the course, on Zoom. I think that Albert introduces us to, I think, a problem that we can highlight in this discussion. We had the opportunity now to see a lot of students that require many interactions between instruction, surgeons, practitioners, people willing to learn. But this is quite an extensive process in order to involve more people and requires more time. The idea is, how can we cope the problem when we have, like Gabriela highlighted in your answers to Albert, we have more than 400 students and more than 10 or 20 courses in which we are teaching. So the problem is, interesting techniques, the problem is interesting techniques with interaction and large numbers. Maybe the speaker's presenter can release short comments to finish this very, very interesting webinar or to comment this. Stepanol, you arise your end. One thing is, honestly, for a distance teaching, you learned the use of tutors. Gabriela was also mentioning the activity of the tutors. So, somewhat, the figure of the teacher is important and central, but it needs also to break down rooms in smaller groups. Just yesterday we had one demonstration on what you can do in the case of team-based learning, breaking down classes of 60 and over students in groups of six. So there is a hierarchy of the breaking down and having people that are entitled to refer to the group, to the interior group. So there are techniques there that can be implemented. But definitely the university and governance level should pay more attention to the role of the tutors. Thank you very much, Stepanol. So other academic assistants in order to support this system. A question from Giambattista Parigi, could we give some rough indication about the budget needed to implement the various activities presented today? Maybe some speakers want to answer to Giambattista. Something about budget. Gabriela? Actually, the cost of an atom age table was 100,000 euros two years and a half ago. But I think prices, something we can change, I think, according to what you decide with an atom age. There is also the possibility to collaborate with them. They are always implementing the peculiar stuff they have on the table. So you can also collaborate and give them, for example, interesting clinical passions or other things. And you can share with them your data. And this can be a collaboration and if you collaborate instead of simply to buy it, you know, it's easier. So we will ask, it's possible to ask to them in the next breakout room for people who are interested. It's not really expensive because when you have a database in the system of our library, the database costs 15,000 euros a year. So, you know, it's not the same. It's less powerful and it's not suitable. We will discuss in the next room. Maybe Stefano, you had a comment on this. I don't know if Stefano Perlini, sorry, maybe wanted to step in. Now, in my opinion, there is investment that has to be made for the technical as well as the human resources. I just agree with what was said before. And we want to drive this process of changing teaching. We have to invest in people, training and instruments. Instruments are in a way the least part in my opinion, because I mean, you can find resources for them, but you need people trained to use them in the best possible way. And I think this pandemic also gave us the opportunity just to challenge ourselves in order to see how can we improve our capability of adapting to the situations. Stefano, thank you very much, Stefano Perlini. There is just another question specific for you. Sorry, there is a microphone open. Can you please close your microphone because we are disturbed. Please close your microphone. Who has the microphone open? Please close. A question from Stefano from Donald. Whether you are a fighter pilot on Formula Uno driver at Monza, simulation are not the real deal per se. The learning value is critical, of course, but they don't prepare the student for calm under fire, dealing with the pressure, emergencies and the unexpected. How do you compensate for this student learning? This question is for everyone on the panel within their own specialization area about the use of simulation as a teaching practice. Stefano or Gabriela or both Stefano or also Guido, please open your microphone. I do not agree with this statement because in simulation you can also simulate a very tense situation. If I have an emergency room in which I am showing the patient what is happening when a patient is having a cardiac arrest or anything like that, I can stress the student in order to adapt himself. So simulation is really something that is helping them to tune not only to the technical skills but also to the capability of adapting to a situation. And you can use many dummies from that, many resources. You can put some pressure related to time, related to situation, related to the interaction between the people. And this is not a substitute for reality. It's just an introduction to reality. Because if a student knows and understands how to deal with this anxiety in a simulated environment, he will be much better when he will be in the real life. Literature is full of several examples of this. Under many aspects, from surgery, to emergency, to internal medicine, to interviewing the patient, to the most powerful things. As far as, as an example, the training tools without consultation is concerned, I realize how the students go to the world much more relaxed and much more willing to visit the patients because they understood that it's possible, that they can do it. So simulation in my way is something that we have to relate. In Formula One, they normally use simulation in order to tune in the best possible way the teamwork of changing tires, as an example, or anything like that. Because if you go wrong during the simulation, you can learn how not to go wrong in the real situation. Thank you very much, Stefano. And maybe, Gabriela? Yes, in my experience, for example, the exam, the quiz mode, the students can start using it very relaxing way, so simply playing, but then you can short the time they get to answer. And I'm sure this is a big pressure over them, but we have to teach at the beginning. So they have to relax and learn. Then they can be pushed to be more reactive. And then they are reactive if they had the time to learn. This is not a race, not from the beginning. They have to understand, they have to know where to look for, and then they will have also the quicker answer. I think. The last comment from Donald was, thank you. Terrific answer, Professor Perlini, about your answer, Stefano. Okay. Thank you to Donald for the question. So are there any other comments or from your speakers or from attendees? So if not, I can only really thank all the people that participated in this very, very interesting and challenging webinar. Can I remind you that we can have a continuation of this webinar with a practical exercise and an expert of an atomic table available for us in the room that I have highlighted in the slide. So please, now we quit this virtual room. Thank to you all for your participating, both as speakers, both as attendees. And we will step in the next virtual room to continue with more practical and engaging session with presenters, other attendees, and more interactive modality. Thank you very much. Thank you to Eden, as usual, for the great organization. And see you soon to the next Eden webinar focused and devoted to the childcare project, Children's Care in Central Asia. Thank you very much to all of you. Thank you very much. Thank you very much. Bye and see you in the next lecture. Thank you very much.