The Virtual Visiting Professor: A Step Toward a Parasocial Common Curriculum?

The Curious Case of the Traveling Intellectual

In 1977 Eiseman and Thompson published a special article in the New England Journal of Medicine commenting on the odd, largely American legacy of “The Visiting Professor.”¹ The authors traced the history of inviting distinguished lecturers from A-list East Coast medical schools to far-flung outposts somewhere west of New York City to a bygone era when cross-country travel meant slow-moving trains and when few medical journals were published. In those simpler times, movies were silent, and the closest equivalent of modern social media required Morse code translators.²

Although the personal conveyance of special knowledge to outlying provinces might have served an educational need in the sepia-toned pre-Depression 1920s, Eiseman and Thompson questioned the functional importance of the exalted visiting professor a half century later when communications had become streamlined, writing with inimitable sangfroid:

In the 1970s, scarcely can a metabolic, pharmacologic or surgical grape fall, whether in the United States, Europe, Asia or Africa, that the vine does not quiver and the signal be read worldwide.¹

Fast-forward 40-plus years, and the pomp and circumstance of the visiting professor tradition carry on even to this day, when it would be all but impossible to suppress medical news of any value from nearly instantaneous global dissemination via Twitter. Of course, nowadays, the true higher purpose of an in-person visitation by an itinerant scholar is the opportunity to engage him or her in informal conversations, nurture personal relationships, and develop a sense of community via bonhomie. Professional networks are created and sustained by these contacts.

[Progress] isn't made by early risers—progress is made by lazy men trying to find easier ways to do something.³

The forum now called the Virtual Visiting Professor Network (VVPN; Twitter handle, @RadOncVVPN) was born of slothfulness and serendipity in prepandemic May 2019. A faculty member at the University of Colorado who shall go nameless—let us call him B.K.—realized he was scheduled to give a didactic on lung cancer to the department’s residents a few weeks later. Spending more time and energy shirking his responsibility than he would have spent preparing the lecture, B.K. managed to engage the services of Dr Clifford Robinson of Washington University, who had recently posted on social media an image of himself giving a talk remotely to an audience in Japan. An affable and adventurous gent, Dr Robinson graciously agreed to give not one but two 30-minute talks via Zoom, one on lung SBRT and another on cardiac radiation for ventricular tachycardia.

The next installment of the VVPN was from Dr Jacob Scott of the Cleveland Clinic. Dr Scott was originally invited to deliver a lecture on campus, but travel restrictions mandated by the COVID-19 pandemic prevented him from appearing in person. However, with bounteous elan he agreed to a remote performance. The online meeting address was shared widely, and an engaged audience from around the country enjoyed a lively discussion after the presentation. Emboldened by the positive feedback, we pressed on, next inviting the marvelous Dr Malika Siker, who gave a warm meditation infused with personal experiences and insights.⁴ Figure 1 shows the advertising images distributed via social media for Dr Malika’s talk and those of the VVPs who followed, Drs Tracy Balboni, Anthony Nichols, and David Palma.

Fig. 1.

Advertising images for the Virtual Visiting Professor Lectures of (A) Dr Malika Siker, (B) Dr Tracy Balboni, and (C) Drs Anthony Nichols and David Palma.

Remote Relationship “Reality”

The ideal visiting professor lecture is part didactic and part performance art that not only educates but also lets the audience feast on the speaker’s own passion for the topic and joy of giving knowledge. Although there is the capacity for some viewer interaction with most online meeting software, the lack of an in-person audience can be disorienting—verbal and nonverbal cues from others in the room provide the speaker a barometer of how well the communication is going and guide real-time adjustments if the material is unclear, the pace is too slow, or the jokes are simply not funny.

In 1956, Horton and Wohl coined the term “parasocial” to characterize the interaction between an audience member at home and a performer seen or heard via remote communication technology.⁵ The authors encapsulated their central thesis as follows:

One of the striking characteristics of the new mass media—radio, television, and the movies—is that they give the illusion of face-to-face relationship with the performer… The most remote and illustrious men are met as if they were in the circle of one’s peers; the same is true of a character in a story who comes to life in these media in an especially vivid and arresting way. We propose to call this seeming face-to-face relationship between spectator and performer a para-social [sic] relationship.

Horton and Wohl’s paper has been cited nearly 4000 times since its publication and has laid the foundation for an entire subfield of psychology. The rise of nouveau Internet celebrity and nonstop screen time provides unlimited fodder for studies of parasocial interactions in all of their protean modern forms (eg, Sokolova and Kefi⁶ and Sherman-Morris⁷). A key takeaway point is that although there are obvious downsides to the performer–audience distance, there are also opportunities for creativity that might not be realized in a traditional podium-auditorium setting.

First of all, Horton and Wohl offered numerous techniques that can create what they call an “illusion of intimacy” between a performer and the remote audience. For example, the performer can purposefully carry on in a very conversational tone, as would be experienced in a face-to-face encounter. Another might be the use of the so-called “subjective camera,” a device whereby what is seen by the audience is identical to what is seen by the performer (think wearing a Go-Pro on a hat). This device is easier for a televised performance but not impossible for an online slideshow: Figures or text could be enlarged and moved around in a way that only selected elements were displayed in the shared screen, permitting the audience to see only what the performer chooses to focus on.

But this is just a starting point in the departure from the dreaded “Death by Powerpoint” trap into which so many are lured.⁸ Especially for a field like radiation oncology, in which dazzling technology and software abound in preclinical studies and everyday clinical practice, there is no reason not to exploit the freedoms afforded by having any amount of computer power at your fingertips during a remote presentation for the purpose of creating visually scintillating displays.

Convergent Evolution Toward an Aspirational Common Goal?

Other academic groups have also recently initiated shared virtual educational platforms. For example, the “Virtual Oncology—Global Conference” series was launched by a consortium of centers around the country and aims to offer monthly lectures (Fig. 2 ). This program and the VVPN and other similar efforts sprouting up here and there raise the question of where we as a field could really go with this idea.

Fig. 2.

Advertising material for a virtualoncology.org presentation.

Well-informed stakeholders have argued reasonably and passionately that trainees in radiation oncology, and by extension the field as a whole, would benefit greatly from the establishment of a common curriculum across all programs that would eliminate the wide variability currently seen in residency education from institution to institution.^{9 , 10} The benefits would be more efficient and better focused studying for board certification examinations and a uniformly higher level of clinically valuable knowledge provided to graduates entering practice. Leaders from the Radiation Oncology Education Study Collaborative Group are taking steps to begin the process of providing such a curriculum (D. Golden, E. JEand, and E. Fields, personal communication).

The VVPN and other similar projects were born of necessity and opportunity with the goal of serving as a forum for freely sharing educational presentations of interest to radiation oncologists and other stakeholders in the cancer treatment space, with special consideration of the needs and interests of trainees. We expect that the longer-term popularity of these lecture series postpandemic will hinge on the continued identification of speakers who present compelling material in a charismatic style. It is hard to know how much appetite will remain for virtual visiting professors once there is a vaccine for COVID-19 that allows for safer travel and resumption of in-person presentations and face-to-face schmoozing.

However, at the very least it can be confidently concluded that these efforts confirmed what we suspected all along: There really is no barrier to shared educational opportunities among residency programs, among practicing radiation oncologists, and among colleagues in related disciplines. Once we have better consensus on what we need to teach all residents in all radiation oncology programs, it should be a trivial matter to engage topic experts from across the universe of radiation oncology to provide didactics that cover material and broadcast and record the presentations to serve as a common educational resource for large and small training programs and clinicians in practice. This type of coordination should improve board test performances and, more importantly, raise the overall quality of care rendered to our patients.