Skip to main content
AEM Education and Training logoLink to AEM Education and Training
. 2020 Apr 27;4(3):313–317. doi: 10.1002/aet2.10449

Rethinking Residency Conferences in the Era of COVID‐19

Michael Gottlieb 1,, Adaira Landry 2, Daniel J Egan 3, Eric Shappell 4, John Bailitz 5, Russ Horowitz 6, Megan Fix 7
Editor: Wendy C Coates
PMCID: PMC7369491  PMID: 32704605

Abstract

The COVID‐19 pandemic requires a substantial change to the traditional approach to conference didactics. Switching to a virtual medium for conference sessions presents several challenges, particularly with regard to aspects that rely heavily on in‐person components (e.g., simulation, ultrasound). This paper will discuss the challenges and strategies to address them for conference planning in the era of COVID‐19.

Background

Conference attendance is an essential component of residency training and a requirement from the Accreditation Council for Graduate Medical Education (ACGME). 1 The ACGME specifically requires programs to hold 5 hours of planned conference each week, of which residents must attend greater than 70%. 1 In December 2019, a novel coronavirus (COVID‐19) was first identified in Wuhan, China. 2 By March 2020, there were over 100,000 cases worldwide. 3 It has been recommended to reduce exposure by avoiding large gatherings, particularly as people who are asymptomatic or presymptomatic may expose other people to COVID‐19. 2 , 3 This has led to the cancellation of numerous national health care conferences 4 as well as institutional changes for medical school and residency programs with a focus on limiting exposure, including those at traditional didactic conferences. Similar recommendations have been made for prior outbreaks (e.g., H1N1 influenza, 2004 severe acute respiratory syndrome–coronavirus) and may be necessary for future pandemics as well. 5 Therefore, it is important to identify strategies to reduce exposure while maintaining high‐quality resident education during pandemics such as COVID‐19. This paper will summarize these components using emergency medicine as an example. However, these strategies are relevant to other specialties, as well, and all program directors should consider similar applications for their specialties.

Didactic Planning

Residency conference planning requires robust time and personnel to deliver quality content that covers the core curriculum of emergency medicine. 6 The unexpected and sudden need for reformatting and potential rewriting of curricula due to COVID‐19 has understandably added pressure and challenges to conference organizers. Therefore, it is important to consider their available capacity when constructing a modified educational conference.

Strategic recruitment of personnel is important to temporize the increased workload. Recruitment should include both local and external faculty. Wide recruitment can generate deep reinforcements for your education team and help create connections across communities and institutions. To aid with recruitment, use social media applications (e.g., Twitter) and listservs to recruit guest lecturers, facilitators, and panelists. Consider reaching out to speakers who either recently delivered lectures at national meetings or had sessions prepared for cancelled meetings. The shift to a virtual conference will break prior geographic restrictions and allow shared content to be used for multiple programs at a time, thereby easing the planning burden on any individual conference organizer. 7 Organizers should also search for existing online educational resources (e.g., asynchronous modules, cases, board‐review questions) to help offload planning time and avoid re‐creation of existing content. 8 There is also an abundance of online resources available. Faculty should leverage these resources to avoid duplicating lectures already available.

To maximize engagement, live and prerecorded lectures should include real‐time facilitation through either video or written discussion forums. To maintain engagement of trainees during distance learning, consider incorporating various modalities for content delivery such as virtual chat rooms for small‐group case discussions, question‐and‐answer platforms for assessments and feedback, and virtual classroom software for larger didactics. Limit the number of large‐group didactics and focus on more active learning techniques, such as visual diagnosis sessions, expert panel discussions, imaging and ECG review, faculty or consultant interviews, and oral boards. 9 , 10 , 11 Some faculty or residents may not be as familiar with virtual conferencing technology, so planners should provide resources and training options for the platform used in advance of the session. Most platforms will include tutorials and a training guide for new users, as well as a help menu for specific questions. Planners may also consider asking residency or medical school faculty who are familiar with the technology to teach them how to use it and train future users. It is also important to plan ahead to ensure that you will continue to meet requirements of the ACGME, including attendance tracking. One group has described using Google Forms to track resident conference attendance. 12

Educators should consider regular incorporation of asynchronous learning (i.e., individualized interactive instruction) to the maximum 20% time allotment defined by ACGME. 13 Studies have found that residents enjoy these tools and they can be easily utilized as part of a virtual learning program. 14 , 15 , 16 However, programs need to be conscious to avoid exceeding the current ACGME asynchronous learning threshold. 1 A summary of strategies for a new conference paradigm is included in the Table 1.

Table 1.

Strategies for Conference Delivery During COVID‐19

Component Challenges Proposed Solutions
Organizers
  • Current faculty may not have sufficient time to redesign conference each week (particularly if there are staffing shortages)

  • It can be difficult to get consistent unpaid assistance

  • Consider small offers of gratitude for individuals who contribute

  • Invite others to help (e.g., alumni, other faculty, residents, medical students, residency and clerkship coordinators)

Speakers
  • Local speakers may not have sufficient time to create new lectures

  • Conference planners may not have an existing speaker list beyond the institution

  • Use social networks and established directories (e.g., Twitter, Facebook, FemInEM)

  • Engage alumni networks

  • Explore national, regional, or local meeting agendas (planned or recently cancelled) and ask speakers to give an already prepared lecture or let them select their area of interest

  • Consider sharing grand rounds or other sessions between institutions

  • Ask local or distant experts on the issue at hand (e.g., medical director for updates in times of COVID‐19)

  • Reach out to faculty who are currently on quarantine

Content
  • There may be insufficient local resources or asynchronous learning materials

  • When relying on an unknown educational resource, the quality can be variable

  • Use existing FOAM resources for supplemental learning (e.g., ALiEM, Life in the Fast Lane, RebelEM, emDocs.net, FOAMcast, EMCrit, EM Cases, EM:RAP HD, 5‐min Sono, ECG Weekly)

  • Utilize question banks (e.g., Rosh Review, PEER, EM Coach, HippoEM)

  • Create or borrow prerecorded lectures

  • Assess quality of blogs using established tools (e.g., METRIQ) 36

  • Assess speaker quality by asking for prior speaker evaluations or short prerecorded sample talks

  • Consider providing mentorship for junior speakers

Medium
  • Faculty need to ensure easy access and sufficient bandwidth for users

  • Users may be unfamiliar with the software

  • Ensuring active learning can be more challenging

  • It can be difficult to assess resident engagement

  • Ensure that all parties have reliable internet and consider recording sessions for those unable to attend

  • Create a short training module describing how to use the software for new users

  • Speak with faculty who have experience in digital innovation

  • Elicit local IT support

  • Be aware of different video stream options (e.g., Zoom, Google Meet, WebEx, Skype, FaceTime)

  • Use synchronous engagement tools (e.g., Slack, WhatsApp, Poll Everywhere, Kahoot)

FOAM = free open‐access medical education; IT = information technology

Journal Club

Journal club is an important aspect of residency education that traditionally occurs in a social setting (e.g., faculty member's home) with residents and faculty discussing articles. 17 However, to reduce the spread of infection, these large, in‐person gatherings are discouraged. To address this, faculty should consider running the journal club sessions remotely via an online platform. There are many resources available to help guide educators with creating an online journal club. 17 , 18 , 19 , 20 , 21 , 22 Similar to conference didactics, there should be a mechanism for engaging in real‐time discussion and the opportunity to ask questions of the journal club leaders. This can include using synchronous media (e.g., Slack, WhatsApp, chat functions of video software) or group polling (e.g., Poll Everywhere, Kahoot). One potential advantage of virtual journal clubs is that by removing the geographic limitations, residency programs may be able to recruit the original study authors to join the session and add unique insights into the analysis.

Simulation

Simulation is a key component of emergency medicine resident education and is included in the ACGME program requirements. 1 Traditionally, simulation is performed in a group setting in a simulation laboratory or in situ. However, this can be restricted during situations such as the COVID‐19 outbreak. Telesimulation has been increasingly utilized as an approach to provide education, training, or assessment of learners when they are at an off‐site location. 23 , 24 , 25 , 26 This can be run using standardized patients or faculty facilitators over an online platform. Simulated experiences can range from breaking bad news to leading a resuscitation, and some online platforms even allow virtual breakout sessions for debrief.

Low‐fidelity cases are available through multiple resources (e.g., MedEdPORTAL, JETem, Foundations of Emergency Medicine). Facilitators can also utilize simulation applications to enhance the real‐time experience (https://full‐code.com/) or practice asynchronously and debrief as a group afterward (http://emgladiators.com/resus/). Procedures can even be practiced remotely using low cost models from household products. 27 , 28 , 29

Ultrasound

Point‐of‐care ultrasound (POCUS) training requires knowledge of the indications, skills for image acquisition and interpretation, and the ability to incorporate findings into medical decision making. 30 Traditionally, this has been accomplished with a combination of in‐person didactics, hands‐on workshops, scanning patients in the emergency department, and image review quality assurance sessions. 31 In light of the need for social distancing, each of these educational methods needs to be reconsidered.

Fortunately, there is a wide array of free open‐access medical education resources on POCUS already available to reduce the didactic needs, including prerecorded online video lectures (e.g., the SAEM AEUS series), podcasts (e.g., The Ultrasound Podcast), blogs (e.g., 5‐Minute Sono), and image banks (e.g., The POCUS Atlas). Similar to the didactic sessions, POCUS faculty should utilize these resources to avoid replicating content that is already freely available. Facilitators can supplement this with live streaming of case‐based presentations and image review sessions with synchronous chat discussions for questions and online audience response applications to increase learner engagement.

The opportunities to learn the skills of image acquisition are also more finite due to limitations with group scanning and access to cart‐based POCUS machines. If possible, programs could provide learners with handheld POCUS machines to practice on themselves or family members at home. Faculty could review their hand positioning and images using an online virtual platform (e.g., FaceTime, Zoom). 32 , 33 , 34 , 35 Software‐based guidance instruction can assist POCUS users in obtaining and optimizing sonographic views (e.g., Caption Health) and can even perform autointerpretation of images (e.g., Butterfly IQ, GE Healthcare, Phillips). Some handheld POCUS machines even have built‐in feedback options. Faculty could also utilize simulation‐based platforms (e.g., SonoSim), wherein residents can practice with normal and abnormal pathology. These platforms can be used for individual learning or in a virtual group environment.

Summary

The COVID‐19 pandemic requires a dramatic shift in the delivery of traditional residency education including conferences, simulation, and ultrasound education. Given the rise of affordable video conferencing and high‐quality educational online resources over the past decade, residency training programs are poised to meet this challenge. Likewise, online communication and social media have created rich collaborative networks of educators within and across countries. Grand rounds speakers may now “virtually travel” to not just one but numerous institutions simultaneously to provide engaging educational sessions. These factors are favorable, but the load of completely redesigning residency conferences remains heavy. Given the unprecedented demands of the COVID‐19 pandemic, the ACGME may need to reconsider the percentage of conferences that may be delivered asynchronously. COVID‐19 will undoubtedly drive innovation within residency education as we continue our efforts to train the next generation of emergency physicians. Further research will need to be completed to gauge the effect of new delivery models on resident engagement and learning.

AEM Education and Training 2020;4:305–309

MG is the Chief Academic Officer of ALiEM Faculty Incubator and a Senior Content Editor for PEER. AL is a Senior Advisor for ALiEM and founder of emdocs.net. DJE is a question writer for RoshReview.com and unpaid consultant to full-code.com. ES is a PEER Item Editor and Senior Strategy Officer for Analytics. JB is the PEER Strategic Director. MF is a PEER Item Editor, EM:RAP CorePendium Associate Editor, and EM Coach Item Writer.

The authors have no relevant financial information to disclose.

Author contributions: MG, AL, DJE, ES, JB, RH, and MF all contributed to the study concept and design, acquisition of the data, analysis and interpretation of the data, drafting of the manuscript, and critical revision of the manuscript for important intellectual content.

References

  • 1. Accreditation Council for Graduate Medical Education . ACGME Program Requirements for Graduate Medical Education in Emergency Medicine. Available at: https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/110_EmergencyMedicine_2019_TCC.pdf?ver=2019‐06‐11‐153018‐223. Accessed Mar 18, 2020.
  • 2. Guan WJ, Ni ZY, Hu Y, Liang WH, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020. 10.1056/NEJMoa2002032. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3. World Health Organization . WHO Statement on Cases of COVID‐19 Surpassing 100,000. Available at: https://www.who.int/news‐room/detail/07‐03‐2020‐who‐statement‐on‐cases‐of‐covid‐19‐surpassing‐100‐000. Accessed Mar 18, 2020.
  • 4. STAT's Guide to Health Care Conferences Disrupted by the Coronavirus Crisis. Available at: https://www.statnews.com/2020/03/07/stats‐guide‐health‐care‐conferences‐disrupted‐covid‐19/. Accessed Mar 18, 2020.
  • 5. Pasquini‐Descomps H, Brender N, Maradan D. Value for money in H1N1 influenza: a systematic review of the cost‐effectiveness of pandemic interventions. Value Health 2017;20:819–827. [DOI] [PubMed] [Google Scholar]
  • 6. Counselman FL, Babu K, Edens MA, et al. The 2016 Model of the Clinical Practice of Emergency Medicine. J Emerg Med 2017;52:846–9. [DOI] [PubMed] [Google Scholar]
  • 7. Staats K, Mercer MP, Bosson N, et al. The digital EMS California academy of learning. AEM Educ Train 2018;3:96–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 8. Thoma B, Joshi N, Trueger S, Chan TM, Lin M. Five strategies to effectively use online resources in emergency medicine. Ann Emerg Med 2014;64:392–5. [DOI] [PubMed] [Google Scholar]
  • 9. Wray A, Wolff M, Boysen‐Osborn M, et al. Not another boring resident didactic conference. AEM Educ Train 2019;4:S113–21. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10. Gottlieb M, Riddell J, Crager SE. Alternatives to the conference status quo: addressing the learning needs of emergency medicine residents. Ann Emerg Med 2016;68:423–30. [DOI] [PubMed] [Google Scholar]
  • 11. Wolff M, Wagner MJ, Poznanski S, Schiller J, Santen S. Not another boring lecture: engaging learners with active learning techniques. J Emerg Med 2015;48:85–93. [DOI] [PubMed] [Google Scholar]
  • 12. Kalnow A, Lloyd C, Casey J, Little A. Google forms ‐ a novel solution to blended learning. JETem 2019;4:I13–20. [Google Scholar]
  • 13. Estes M, Gopal P, Siegelman JN, Bailitz J, Gottlieb M. Individualized interactive instruction: a guide to best practices from the council of emergency medicine residency directors. West J Emerg Med 2019;20:363–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14. Mallin M, Schlein S, Doctor S, Stroud S, Dawson M, Fix M. A survey of the current utilization of asynchronous education among emergency medicine residents in the United States. Acad Med 2014;89:598–601. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 15. Purdy E, Thoma B, Bednarczyk J, Migneault D, Sherbino J. The use of free online educational resources by Canadian emergency medicine residents and program directors. CJEM 2015;17:101–6. [DOI] [PubMed] [Google Scholar]
  • 16. Kornegay JG, Leone KA, Wallner C, Hansen M, Yarris LM. Development and implementation of an asynchronous emergency medicine residency curriculum using a web‐based platform. Intern Emerg Med 2016;11:1115–20. [DOI] [PubMed] [Google Scholar]
  • 17. Gottlieb M, King A, Byyny R, Parsons M, Bailitz J. Journal club in residency education: an evidence‐based guide to best practices from the Council of Emergency Medicine Residency Directors. West J Emerg Med 2018;19:746–55. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 18. Lin M, Joshi N, Hayes BD, Chan TM. Accelerating knowledge translation: reflections from the online ALiEM‐Annals Global Emergency Medicine Journal Club experience. Ann Emerg Med 2017;69:469–74. [DOI] [PubMed] [Google Scholar]
  • 19. Chetlen AL, Dell CM, Solberg AO, et al. Another time, another space: the evolution of the virtual journal club. Acad Radiol 2017;24:273–85. [DOI] [PubMed] [Google Scholar]
  • 20. Plante TB, Iberri DJ, Coderre EL. Building a modern journal club: the Wiki journal club experience. J Grad Med Educ 2015;7:341–3. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21. Chan TM, Thoma B, Radecki R, et al. Ten steps for setting up an online journal club. J Contin Educ Health Prof 2015;35:148–54. [DOI] [PubMed] [Google Scholar]
  • 22. Bounds R, Boone S. The flipped journal club. West J Emerg Med 2018. 19:23–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23. McCoy CE, Sayegh J, Alrabah R, Yarris LM. Telesimulation: an innovative tool for health professions education. AEM Educ Train 2017;1:132–6. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24. McCoy CE, Sayegh J, Rahman A, Landgorf M, Anderson C, Lotfipour S. Prospective randomized crossover study of telesimulation versus standard simulation for teaching medical students the management of critically Ill patients. AEM Educ Train 2017;1:287–92. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. McCoy CE, Alrabah R, Weichmann W, et al. Feasibility of telesimulation and Google glass for mass casualty triage education and training. West J Emerg Med 2019;20:512–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 26. Hayden EM, Khatri A, Kelly HR, Yager PH, Salazar GM. Mannequin‐based telesimulation: increasing access to simulation‐based education. Acad Emerg Med 2018;25:144–7. [DOI] [PubMed] [Google Scholar]
  • 27. Aho JM, Thiels CA, AlJamal YN, et al. Every surgical resident should know how to perform a cricothyrotomy: an inexpensive cricothyrotomy task trainer for teaching and assessing surgical trainees. J Surg Educ 2015;72:658–61. [DOI] [PubMed] [Google Scholar]
  • 28. Bryant RJ, Morgan MH, Youngquist ST, Fix ML. Edible cricothyrotomy model: a low‐cost alternative to pig tracheas and plastic models for teaching cricothyrotomy. JETem 2017;2:I1–6. [Google Scholar]
  • 29. Ford T, Fix ML, Madsen TE, Stroud S. The eyes have it: a low‐cost model for corneal foreign body removal training. JETem 2020;5:I10–14. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30. Bahner DP, Hughes D, Royall NA. I‐AIM: a novel model for teaching and performing focused sonography. J Ultrasound Med 2012;31:295–300. [DOI] [PubMed] [Google Scholar]
  • 31. ACEP Policy Statement: Ultrasound Guidelines: Emergency, Point‐of‐Care, and Clinical Ultrasound Guidelines in Medicine. 2016. Available at: https://www.acep.org/globalassets/new‐pdfs/policy‐statements/ultrasound‐guidelines—emergency‐point‐of‐care‐and‐clinical‐ultrasound‐guidelines‐in‐medicine.pdf. Accessed Mar 18, 2020.
  • 32. Brisson AM, Steinmetz P, Oleskevich S, Lewis J, Reid A. A comparison of telemedicine teaching to in‐person teaching for the acquisition of an ultrasound skill ‐ a pilot project. J Telemed Telecare 2015;21:235–9. [DOI] [PubMed] [Google Scholar]
  • 33. Smith A, Addison R, Rogers P, et al. Remote mentoring of point‐of‐care ultrasound skills to inexperienced operators using multiple telemedicine platforms: is a cell phone good enough? J Ultrasound Med 2018;37:2517–25. [DOI] [PubMed] [Google Scholar]
  • 34. Ramsingh D, Ma M, Le DQ, et al. Feasibility evaluation of commercially available video conferencing devices to technically direct untrained nonmedical personnel to perform a rapid trauma ultrasound examination. Diagnostics (Basel) 2019;9:E188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 35. Damewood S, Leo M, Bailitz J, et al. Tools for measuring competency in clinical ultrasound: recommendations from the ultrasound competency work group. AEM Educ Train 2019;4:S106–12. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 36. Colmers‐Gray IN, Krishnan K, Chan TM, et al. The revised METRIQ score: a quality evaluation tool for online educational resources. AEM Educ Train 2019;3:387–92. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from AEM Education and Training are provided here courtesy of Wiley

RESOURCES