LAUSR

To the editor, As medical students based at The University of Manchester, we welcome the article “Telemedicine in the era of coronavirus 19: Implications for postoperative care in cardiac surgery” with great interest. Telemedicine has rapidly expanded to become an integral component of health‐care delivery during the coronavirus disease 2019 (COVID‐19) pandemic, following unprecedented restrictions on social contact. During our medical education, we have observed the impact of telemedicine first‐hand during clinical practice with respect to maintaining social distancing measures, maximizing resource efficiency, and expanding connectivity. This study is commendable in being the first to evaluate the use of telemedicine in postoperative care following cardiac surgery, during an era where simulation‐based training is essential for cardiac surgery trainees. The study was appropriately designed through its inclusion of specific questions, which have been frequently validated in previous studies evaluating wider implications of telemedicine. It examined a number of relevant issues pertinent to telemedicine, including perceived utility, patient satisfaction, and efficiency. Furthermore, the combined use of the Likert scale and qualitative measures allowed for stronger and clearer conclusions to be drawn. Significantly, the use of a secure platform for recording responses was an appropriate means of ensuring that patient confidentiality remains protected. A particular limitation within this study was the absence of a control group. In accordance with the hierarchy of evidence, results from a cross‐sectional study are generally weaker in quality as compared with a case–control study. The resulting sampling bias and low response rate limits the external validity of this study's findings. Furthermore, the interviewer bias and possible recall bias presents a challenge to the internal validity of the study. Notably, similar findings were found in other studies evaluating the impact of telemedicine in the context of postoperative care during the COVID‐19 pandemic. This includes those relating to laparoscopic surgery and neurosurgery. Strikingly, while the outcomes of these studies demonstrated the safe, effective, and patient‐ preferred use of telemedicine, this could not be applied in the context of cardiac surgery, as per the study by Sallam et al. A potential reason for the preference of in‐person follow‐up may be due to the multidisciplinary, lengthy, and complex nature of postoperative care programs after cardiac surgery. Furthermore, the studies highlighted the well‐established barriers associated with telemedicine, such as technical issues, which may also contribute as a significant factor. To conclude, this article highlights that the recent use of telemedicine in postoperative care following cardiac surgery can result in high patient satisfaction. However, there remain doubts over its long‐ term integration into standard practice for cardiac surgery after the pandemic, particularly as a significant proportion of patients still prefer face‐to‐face consultations for postoperative care. Further studies are needed to address patient hesitancy surrounding telemedicine in this field and should account for the aforementioned limitations of this study. Regardless, telemedicine retains the potential to be a significant aspect of future postoperative care following cardiac surgery. If so, we maintain that it is imperative that the curriculum at medical school is adjusted accordingly to prepare cardiac surgery trainees for this.