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 |
|
|
Speakers |
|
|
Content |
|
|
Medium |
|
|
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.
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