What's New?
Physically distant pediatric residents developed a virtual journal club series on coronavirus disease 2019 between multiple residencies that improved perceived knowledge on the new disease and enhanced community building.
Alt-text: Unlabelled box
Coronavirus disease 2019 (COVID-19) is an unprecedented challenge to health care systems and poses unique challenges for trainees.1 , 2 At its peak, residency programs were forced to limit direct patient care by trainees to minimize exposures and preserve personal protective equipment.3 , 4 Additionally, physical distancing guidelines require suspending in-person education.2 Yet, there is an urgent need for a better understanding of this new disease. The surge in publications on COVID-19 has resulted in a large volume of rapidly evolving data.5 While initial reports suggested COVID-19 largely spared children, the recently described multisystem inflammatory syndrome in children has forced pediatricians to recalibrate their understanding.6 , 7 In addition to the loss of education, the COVID-19 physical distancing requirements have negatively affected trainee mental health and connectivity.1 , 2 , 4 To date, pediatric residents have proven creative in addressing these pandemic challenges.8 Here, we report on implementing and evaluating a resident-initiated virtual journal club series, initially in a single residency program, and ultimately scaled to include multiple residency programs.
Educational Approach and Innovation
Initial Journal Club
The virtual journal club was organized through the Academy of Basic and Translational Investigation (AOBTI), a scholarly community of resident physician-scientists and faculty leaders in the Boston Combined Residency Program (BCRP) in Pediatrics. AOBTI members volunteered to review recent publications on COVID-19 (focusing on basic science) in a preformatted 3-slide template (background, findings, conclusions) for brief presentations to address a specific question. Residents volunteered and either proposed their own article or chose from recent references collected by the resident facilitators. Ten residents presented 30 articles during the 60-minute session hosted on Zoom Videoconferencing using a joint Google Slides presentation advanced by the facilitator. On March 25, 2020, 73 people viewed the journal club, including 40 residents, 4 chief residents, 7 faculty members, and 22 recently matched medical students. Current resident and medical student participants received an anonymous, voluntary survey via quick response code on the last slide of the presentation, and 1 follow-up email.
Follow-Up Journal Club
The AOBTI hosted 2 more journal clubs (April 16; May 4, 2020), followed by a fourth journal club on June 1, 2020, that was scaled to include 7 residencies in the northeastern United States. For this fourth session, residents from the BCRP and New York-Presbyterian Hospital (Columbia Campus) presented using the same format as the initial journal club. One hundred fifteen participants viewed the virtual journal club, of which 104 were residents (Supplemental Methods). We asked residents to complete an anonymous, voluntary survey before and after the journal club via quick response code on the first and last slide of the presentation to assess how informed they feel about various topics related to COVID-19. The Boston Children's Hospital Institutional Review Boards reviewed the survey protocols and exempted them from full review.
Statistical Analysis
The survey of the initial journal club was summarized with descriptive statistics. For the fourth session (“Follow-up Journal Club”), respondents created unique identifiers to pair their pre- and postintervention surveys. Respondents rated how informed they felt about various aspects of COVID-19 disease on a 5-point scale from “Not at all” to “Extremely” informed. Responses to these questions were collapsed to 2 levels: very or extremely Informed versus less informed. The McNemar test for paired binary data was used to determine whether the proportion of participants who felt informed increased from the pre- to postintervention surveys.
Educational Framework
The intervention and analysis were informed by self-determination theory, which postulates that individuals’ autonomy, competence, and relatedness foster intrinsic motivation.9 Specifically, presenters were provided autonomy by choosing what topics to present, feeling and demonstrating competence by exhibiting their physician-scientist expertise, and afforded relatedness by collaborating with other physician-scientists. Additionally, learners could develop competence by learning the presented content and were similarly afforded relatedness with their physician-scientist colleagues and other residents within their program and regionally.
Results
Initial Journal Club
The survey response rate was 70% (44/63). Characteristics of the respondents are displayed in the Supplemental Data. The percent of respondents who strongly agreed with the following statements are noted in the subsequent text. The study participants found the session educational (82% [36/44]). Participants also felt more informed about basic science research related to COVID-19 (77% [34/44]) and novel therapeutic strategies as a result of the journal club (71% [31/44]). Participants felt more connected to their physician-scientist resident colleagues (71% [30/42]). Lastly, nearly all participants would strongly recommend this intervention to other residency programs (86% [38/44]).
Follow-Up Journal Club
In the subsequent journal club, there were 37 matched pre- and postintervention survey results from residents in all 7 participating residency programs (Supplemental Data). The matched response rate was 36% (37/104). Compared to the preintervention survey, residents were significantly more likely to describe themselves as very or extremely informed on topics related to COVID-19 in pediatrics (Table ). Of those respondents, 95% (35/37) and 92% (34/37) agreed or strongly agreed that the journal club was educational and that they would recommend a similar journal club to other programs, respectively.
Table.
Percentage of Residents That Feel Very or Extremely Informed about Various Topics Related to COVID-19 at the Follow-Up Journal Club
| Topics | Pre n (%) N = 37 | Post n (%) N = 37 | P |
|---|---|---|---|
| The overall rapidly evolving research on COVID-19 in pediatric populations | 6 (16%) | 15 (41%) | .013 |
| The different clinical manifestations of Multisystem Inflammatory Syndrome in Children (MIS-C) | 12 (32%) | 27 (73%) | .0001 |
| Basic science research on the immune response to COVID-19 | 1 (3%) | 9 (24%) | .005 |
| Mechanisms that increase the risk for complications from COVID-19 in pediatric subpopulations | 4 (11%) | 8 (22%) | .05 |
| Basic science research on targets for potential therapies | 0 (0%) | 12 (32%) | .0005 |
Discussion and Next Steps
The rapid evolution of data on COVID-19 in peer-reviewed and non-peer-reviewed journals, coupled with constraints in pediatric education by physical distancing, has led to challenges in disseminating valid and contextualized education for trainees. We present a resident-led virtual journal club format that rapidly synthesized and disseminated up-to-date information on COVID-19 while fostering connectivity. Our approach is novel beyond reports of online journal clubs by leveraging the collective expertise of resident pediatrician-scientists, rather than a professional educator, for teaching COVID-19 to an audience of clinical trainees.10 , 11 Whereas conventional journal clubs focus on analysis of methodology and critical assessment of results and conclusions, ours allowed for close to real-time dissemination of a large body of evolving information, developing residents as educators when presenting, cross-residency collaboration, and community-building during times of societal stress. The format was also scalable to participation by large numbers of residents across multiple institutions, which demonstrated the generalizability and the potential to partially replace the loss of inter-residency interaction from canceled professional conferences.
Limitations include a lack of a control group, selection bias for residents choosing to attend these conferences, nonresponse bias (particularly in large programs with lower response rates), and an inability to assess knowledge retention. Further, knowledge self-assessment is an imperfect proxy for objective knowledge gain. Lastly, some of the effects were modest. Next steps include iterating and improving this model to lead to further improvements. Future studies should incorporate objective assessments of material and explore extending to topics beyond COVID-19. We propose resident-led virtual journal clubs as easy-to-implement, inexpensive, and community-building educational interventions during the COVID-19 pandemic and beyond.
Acknowledgments
Financial statement: The Fred Lovejoy Housestaff Research and Education Fund (intramural fund at Boston Children's Hospital) supported the analysis of this research project.
Authorship statement: M.R., G.S., and A.W. carried out the analyses, drafted, and revised the initial manuscript. A.D.D. and J.A.M. reviewed and revised the manuscript for important intellectual content. All authors conceptualized and designed the study. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
We thank Peter Forbes for statistical analysis, the members of the BCRP AOBTI, especially Maria Sacta, Jessica Ruiz, Christina Theodoris, Walter Chen, Alissa D'Gama, Max Horlbeck, David Hoytema van Konijneburg, Michael Duyzend, and Daniel Echelman, as well as Alexandra Power-Hays (BCRP) and Jonathan Steinman (Columbia Pediatrics) for preparing and presenting. We also thank Jiska van der Reest (Brigham and Women's Hospital, Harvard Medical School) for scientific discussion and support in preparing the journal club. We also thank Samuel Lux, Vijay Sankaran (Boston Children's Hospital, Department of Pediatric Hematology and Oncology), Wolfram Goessling (Massachusetts General Hospital, Harvard-MIT Division of Health Sciences and Technology), and Farhad Rezvani (University Medical Center Hamburg Medical, Germany) for discussion. We thank Theodore Sectish (Boston Children's Hospital) and Catherine Michelson (Boston Medical Center) as BCRP directors for supporting this project.
Footnotes
The authors have no conflicts to interest to report.
Supplementary data related to this article can be found online at https://doi.org/10.1016/j.acap.2021.02.010.
Appendix. SUPPLEMENTARY DATA
References
- 1.Gallagher TH, Schleyer AM. “We signed up for this!”—student and trainee responses to the COVID-19 pandemic. N Engl J Med. 2020;382:e96. doi: 10.1056/nejmp2005234. [DOI] [PubMed] [Google Scholar]
- 2.Rakowsky S, Flashner BM, Doolin J. Five questions for residency leadership in the time of COVID-19: reflections of chief medical residents from an internal medicine program. Acad Med. 2020;95:1152–1154. doi: 10.1097/acm.0000000000003419. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Chidini G, Villa C, Calderini E. SARS-CoV-2 infection in a pediatric department in Milan: a logistic rather than a clinical emergency. Pediatr Infect Dis J. 2020;39:e79–e80. doi: 10.1097/inf.0000000000002687. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Weiss PG, Li S-TT. Leading change to address the needs and well-being of trainees during the COVID-19 pandemic. Acad Pediatr. 2020;20:735–741. doi: 10.1016/j.acap.2020.06.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Brainard J. Scientists are drowning in COVID-19 papers. Can new tools keep them afloat? Science. 2020. Available at:https://www.sciencemag.org/news/2020/05/scientists-are-drowning-covid-19-papers-can-new-tools-keep-them-afloat. Accessed March 8, 2021.
- 6.Verdoni L, Mazza A, Gervasoni A. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395:1771–1778. doi: 10.1016/s0140-6736(20)31103-x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Feldstein LR, Rose EB, Horwitz SM. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med. 2020 doi: 10.1056/nejmoa2021680. [DOI] [PubMed] [Google Scholar]
- 8.Rabinowitz DG, Sundheim KM. Trainee-directed educational pursuits and advocacy during the COVID-19 pandemic. Pediatrics. 2020 doi: 10.1542/peds.2020-1564. [DOI] [PubMed] [Google Scholar]
- 9.Ryan RM, Deci EL. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am Psychol. 2000;55:68–78. doi: 10.1037/0003-066x.55.1.68. [DOI] [PubMed] [Google Scholar]
- 10.Akhund S, Kadir MM. Do community medicine residency trainees learn through journal club? An experience from a developing country. BMC Med Educ. 2006;6:1–8. doi: 10.1186/1472-6920-6-43. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Arora VM, Auerbach AD. The adoption of an online journal club to improve research dissemination and social media engagement among hospitalists. J Hosp Med. 2018;13 doi: 10.12788/jhm.2987. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.