Emergency Medicine Residency Curricular Innovations: Creating a Virtual Emergency Medicine Didactic Conference

Abstract

Currently, there is a pandemic forcing social distancing and, consequently, traditional in‐person education must shift to a virtual curriculum to protect all parties and continue professional development. Recognizing that not all emergency medicine (EM) content can be taught through a virtual platform, we propose a model for nearly all EM resident didactic conference adaptation to a virtual format to meet the needs of the adult learner while protecting all participants from the current coronavirus pandemic.

NEED FOR INNOVATION

Curricular change is prompted by content evolution, generational learning preferences, technological advances, and environmental factors such as the current pandemic. ¹ , ² , ³ , ⁴ Current recommendations for social distancing require an urgent shift of nearly all in‐person emergency medicine (EM) didactic conference to a virtual platform while maintaining rigorous standards and engaging faculty and learners. ⁵ , ⁶

BACKGROUND

Medical education must continuously evolve to meet the needs of adult learners and have flexibility to be delivered in a variety of settings. ³ , ⁴ , ⁷ , ⁸ Regardless of the environment, an innovative EM curriculum must engage learners and foster professional development while meeting Residency Review Committee/Accreditation Council for Graduate Medical Education (RRC/ACGME) standards. ² , ⁹

Critical factors that facilitate curricular changes include understanding the process, recognizing the need for change, and implementing the innovation. ¹⁰ , ¹¹ When adapting curricula to a virtual platform, there are additional logistic and academic considerations: educational impact, cost, time, user access and comfort with technology, and the stress of isolation. ⁷ , ¹² , ¹³ , ¹⁴ For many, virtual curricula pose barriers to engagement (waning enthusiasm, difficulty with open communication, diminished peer connection, limited technology accessibility) thus impacting the quality of education. ⁷ , ¹² , ¹⁵ , ¹⁶ , ¹⁷

OBJECTIVE OF INNOVATION

Our goal is to provide a guide for adaptation of nearly all in‐person EM education to an online learning platform that is concordant with ACGME standards, acknowledges the psychosocial impact of decreasing in‐person contact, and fosters continued resident and faculty engagement.

DEVELOPMENT PROCESS

Given that the content for our EM curriculum was already developed, in this section we describe the adaptation process of shifting to a virtual format. With drastic changes in the educational environment, participants may feel overwhelmed regarding the ability to learn or teach. ¹⁸ , ¹⁹ , ²⁰ To educate participants (residents and faculty) on the upcoming changes, our program implemented the following steps:

• Developed an asynchronous tutorial for Zoom instruction (including steps to operate the virtual classroom) and made real‐time training available for all participants.

• Designed an online color‐coded schedule (outlining the expected date/time of upcoming changes) allowing participants to prepare for curricular format and content changes (see Table 1).

• Adjusted the conference evaluation to gather feedback regarding content and technology alignment.

• Recognized technology inaccessibility (e.g., computer or Wi‐Fi access) for some users and designated available office space.

• Conducted a virtual Q&A session for residents and faculty prior to implementation to review the process, communicate expectations, and validate participants’ stress.

Table 1.

Sample Weekly EM Resident Didactic Schedule (University of Rochester, Department of Emergency Medicine)

Time			Min	Topic	Presenter
8:00	–	8:30	30	Virtual Conference Question & Answer Session*	Residency Leadership
8:30	–	9:00	30	Resident Briefing on Mock Orals*	Dr. A
9:00	–	9:30	30	CORE: Pediatric Upper Gastrointestinal Bleeding*	Dr. B
9:30	–	9:45	15	BREAK	—
9:45	–	10:00	15	Update: e‐Oral board exam*	Dr. C
10:00	–	11:00	60	Coaching and Debrief session: Effects of COVID‐19*	Dr. D, Department of Psychiatry
11:00	–	1:00	120	R1 Foundations—Toxicology*	EM Faculty Small group
11:00	–	1:00	120	R2/R3: ORTHO ALIEM†	https://www.aliem.com/air‐series‐orthopedics‐upper‐extremity/
2:00	–	5:00	180	Cadaver Lab Room XXX, Dr. E‡	Resident A, B, C, D

R1 = resident year 1; R2 = resident year 2; R3 = resident year 3; ALIEM = Academic Life in Emergency Medicine.

^*Zoom format.

^†Independent learning.

^‡In person.

Prior to COVID‐19, our weekly conference included up to 5 hours of 15‐, 30‐, or 45‐minute didactics; hands‐on sessions; and small‐group activities. Additionally, we incorporated a procedural curriculum in cadaver lab for one faculty and three to four residents per week after conference. Prior to shifting to a virtual curriculum, it was essential to assess applicability of each of the previously utilized didactic formats to an online platform. We performed a brief literature review of virtual education, Knowles’ continuum of pedagogy and andragogy, Mayer’s 12 principles of multimedia learning, Brookfield’s overview of experiential and self‐directed learning, and the impact of COVID‐19 and social isolation. ² , ³ , ⁴ , ⁵ , ¹⁰ , ¹¹ , ¹² , ¹³ , ²¹ , ²² , ²³ , ²⁴ , ²⁵ Based on residency leadership experience in curricular innovation and the literature review, we established a consensus for which didactic formats would be feasible in a virtual format.

THE IMPLEMENTATION PHASE

The curriculum has four didactic formats: 1) faculty‐moderated virtual large group sessions, 2) faculty and chief resident‐moderated virtual small‐group sessions, 3) independent (asynchronous) learning activities, and 4) limited in‐person critical procedure labs. Using the Zoom platform, large‐group sessions consisted of approximately 40 learners and two or more faculty. One faculty member presented EM core content while another moderated questions in the chat function. The moderator also shared relevant articles or multimedia learning materials to augment the presentation. This format also allowed for inclusion of national speakers. Additionally, the large‐group format was used for board review where residents were divided into one of four “virtual teams.” They answered questions through an online response system and individual scores contributed to an annual team total. These sessions encouraged team learning, supported resident and faculty interaction, and fostered a sense of community aimed at simulating an in‐person setting. ¹⁶ , ²⁶ The large‐group format was conducive to sharing the rapidly changing COVID‐19 institutional policies. We also included optional debriefings with a mental health professional during conference time. ⁴

Additionally, the small‐group format offered a more targeted experience with emphasis on team learning, resident interaction, and connection with faculty. ²⁶ Examples included case‐based learning, journal clubs, and one‐on‐one oral board practice with a faculty member. We set up Zoom breakout rooms allowing us to better engage individuals. For example, residency administration created breakout rooms including a chief resident and at least one faculty member with a group of 12 to 15 residents for a challenging ethical case discussion. Using the same breakout room model for oral board practice, residents were paired on a rotating basis with one of six faculty members who conducted six concurrent one‐on‐one cases. During the cases, faculty intermittently shared a screen that displayed relevant information (e.g., labs, imaging). Subsequently, the breakout rooms allowed for private debriefings to emphasize the learner’s strengths and areas for improvement.

Independent learning activities were critical for successful virtual conference implementation as they emphasized flexibility, allowing learners to work at their own pace and focus on knowledge gaps. ²⁷ , ²⁸ The activities consisted of multimodal content that included oversight with dashboards and testing functions allowing leadership to hold residents accountable. ⁹ , ²⁹ , ³⁰ Examples included Academic Life in EM, Foundations of EM, and Rosh Review Journal Club.

Finally, it was necessary to continue critical procedural education (such as airway management in COVID patients) in person through cadaver lab while emphasizing safety with daily online symptom screening, social distancing, limited size (three to four residents and one faculty), and appropriate PPE.

EVALUATION

This article presents a roadmap for conference adaptation with preliminary feedback that provides a window into the success of our conference adaptations to COVID; however, there was no evaluation of knowledge learned or skills gained through a postintervention evaluation. Through an anonymous REDCap survey, we gathered weekly faculty and resident feedback related to content, delivery, and use of technology. ³¹ We had a total of 41 residents with varying numbers of faculty each week. Over the first 6 weeks, we had a mean resident response rate of 94.6% (range = 93%–100%). Of the 208 total virtual conference–related comments, 199 of 208 (95.6%) were positive.

In reviewing the preliminary resident and faculty feedback, the following themes emerged:

• The initial Q&A session was critical to outline the process.

• Participants appreciated the investment in change and were forgiving of glitches in implementation.

• The debriefing sessions were helpful to reduce stress.

• Participants were interested in continuing virtual conference even when social distancing is no longer required.

• Residents felt that faculty were accessible, invested, and engaged.

REFLECTIVE DISCUSSION

During the implementation process, several lessons regarding technology integration, content adaptation, and faculty development were learned. Regarding technology, aligning conference needs with the functionality and limitations of the virtual platform was imperative. For example, we initially struggled with appropriate screen sharing, mute functionality, and document sharing in a large group setting. Test runs of the chosen platform helped to avoid future technical issues.

With regard to content adaptation, we recognized that all EM education cannot be taught online. Subsequently, it was important to continuously review which content was conducive to online delivery. Also, a variable format was critical to maximize participant engagement without magnifying the cognitive fatigue and disconnect that occurs with online learning. ¹⁷ , ²⁷ , ³² Based on feedback, we adjusted the duration of certain didactics (e.g., board review, journal club) as some required more time given the need for audience participation in a virtual setting. Finally, it was crucial to acknowledge the psychosocial impact of virtual learning and current pandemic by providing recurring updated pandemic‐related content and debriefing time within conference.

For faculty development, we recognized early on that all presenters were familiar with Zoom as a meeting tool; however, the vast majority were uncomfortable using Zoom as a teaching tool. Consequently, we created a tutorial and offered real‐time training with a superuser who was available by e‐mail, phone, or video chat (Zoom) to troubleshoot issues.

As a backup plan for unforeseen issues with technology, we created a bank of alternate content. We pooled asynchronous content from FOAMed resources (e.g., Academic Life in EM, Foundations in EM, JETem), provided residents with access to question banks, and recommended other streaming content. Programs with limited personnel/resources for technologic advancement should appoint a single lead to become proficient in the use of online education platforms while using some of the aforementioned resources as a temporary bridge.

Our model is applicable in other institutions that have adequate access to technology and financial/administrative support for virtual platform integration. This model can be used with faculty or senior residents leading the small‐group discussions and case‐based learning. The independent learning content is also easily modifiable and applicable in other settings.

Expanding educational delivery beyond the physical classroom by shifting didactic conference to a virtual platform has diversified the way we teach. Additionally, participants viewed the new format positively. With early program leadership engagement, we developed innovative ways to virtually educate learners while acknowledging participant stress in the face of drastic change. Future investigation is needed to objectively assess the educational impact of a virtual EM conference format.

AEM Education and Training 2020;4:270–274