Beginning in March 2020, the COVID-19 pandemic disrupted1 in-person medical education programming and required a rapid change in program delivery formats to ensure resident and faculty access to education programs.2 In this article we describe the experience and lessons learned by one institution, the Michigan State University College of Osteopathic Medicine (COM) Statewide Campus System (SCS) or MSUCOM SCS, as it transitioned from traditional in-person educational course offerings to a virtual format.
Since 1989, MSUCOM SCS has delivered educational lectures, skills labs, and simulation training for community-based hospital graduate medical education (GME) residency programs.3–5 Within 72 hours of the pandemic shutdown of university, hospitality, and simulation facilities, like many other teaching institutions across the nation, MSUCOM SCS was able to transition resident and faculty education programs to the virtual learning environment, with little disruption to the content delivered. This article will review specific case examples that provide guidance for the transition to a virtual platform.
With the onset of the pandemic, educational programming has been largely either postponed or converted to online formats to ensure compliance with COVID-19 safety requirements. Our experience with this transition has suggested that the pandemic is driving a paradigm shift in GME for both future education programming and required staffing needs, and that these changes will likely persist, even when restrictions to in-person learning are lifted. Although challenges remain, it is important to evaluate the efficacy of newly transitioned programming and the impact of these changes on learner engagement and perceptions of outcomes.
This article aims to: (1) identify strategies to mitigate the loss of face-to-face instruction and to create the robust learning communities generated through such interactions, and (2) outline lessons learned in successful conversion of programming to online formats. In this article, the term “virtual learner environment” refers to the environment in which the learner is connected to the instructor virtually. The learner could be alone at a computer station or in a COVID-19-safe, appropriately distanced, classroom environment. “Virtual” will refer to synchronous learning and online will refer to asynchronous accessibility to learning tools, videos, or snippets.
Moving Programs to a Virtual Environment During COVID-19 Pandemic
The rapid global spread of COVID-19 in late 2019 and early 2020 within the United States resulted in a profound disruption of MSUCOM SCS's traditional in-person GME programming to our community-based hospital partners. These educational programs are integral parts of many residency programs and, without the lab and didactic components of these offerings, many risk not meeting Accreditation Council for Graduate Medical Education (ACGME) residency, faculty development, and assessment requirements. Further, many MSUCOM SCS programs help meet licensing, maintenance of certification, and continuing medical education requirements. Special dispensations6–9 offered through accrediting bodies mitigated risks to accreditation through the close of the 2019–2020 academic year. However, the 2020–2021 academic year comes with expectations of continued programming and enhanced faculty development to ensure that graduating residents and fellows are validly and reliably assessed in all general competencies. Therefore, it was crucial that the Statewide Campus System, as the GME arm of the College of Osteopathic Medicine, adapt to this “new normal” by developing robust, engaging, virtual educational programming.
Why didn't I know about the frameworks for history taking, shared decision making, etc? I feel like those kinds of tools should be universally used! I want ACGME to promote the tools they have more. Maybe I wasn't aware because I'm not a program director and this is my first “medical education” conference. But I would expect each specialty to promote these as well... for instance, I would love to see these on the American College of OBGYN website under their education section. Maybe ACGME could do more to promote and disseminate their tools to the various specialty societies.
Zoom format actually worked!!
The adaptation to a virtual format is challenging and I feel the team handled it well.
Overall, I think the virtual format was executed very well. It was organized in a good way to keep us engaged (despite the Zoom fatigue by the end).
Maybe some pre-reading to catch us up to speed on concepts we may not know (Miller's Pyramid, Dreyfuss Model, etc).
In mid-academic year 2020, the MSUCOM SCS was required to rethink the delivery of at least 2 GME-based educational offerings: ACGME Regional Hub Faculty Development Course, “Developing Faculty Competency in Assessment,” and Chief Resident Leadership Skills Conference. The process of transitioning these offerings to a virtual format is discussed below.
ACGME Regional Hub Faculty Development
MSU is currently one of 17 international ACGME regional faculty development sites. The ACGME Regional Hub Faculty Development Initiative, launched in 2014,10 was designed to increase access for the GME community to faculty development in the basics of assessment. By Winter 2020, 17 international regional hubs had delivered live, highly interactive, faculty development courses to approximately 600 GME program directors, administrators, and faculty. The standard Regional Hub program consisted of an in-person 3-day workshop that included hands-on simulation experiences and frequent large and small group discussions designed to engage participants in the application of course content. When the live programs were halted due to the pandemic, the MSUCOM SCS Director of Faculty Development initiated a transition of the in-person regional hub format to a fully virtual environment.
In late July 2020, course faculty who had agreed to deliver live regional hub course content scheduled for August participated in a 2-hour session to prepare for the transition to a virtual course format. This session involved reviewing technology requirements and a simulated walk-through of all components of the virtual course. Topics of discussion included instruction in balancing workshop content with small group breakout activities, virtual facilitation of both large and small groups of learners, and the use of the virtual platform for content delivery (Zoom). Individual faculty were encouraged to participate in one-on-one training sessions. Approximately half of the teaching faculty participated in these sessions, based on their comfort and familiarity with presenting virtually. The Zoom audio and web conferencing platform supported large group discussions using both chat and verbal communication, created multiple virtual breakout rooms populated with preidentified individuals, and allowed the faculty learner to participate in real-time scripted role-playing of clinical encounters. The participants provided feedback immediately following the encounters.
This training was critical to the success of the course as all questions, technology issues, and troubleshooting of logistical concerns of the course faculty were addressed prior to going live. In early August 2020, the first virtual regional hub course was delivered by MSUCOM SCS. The course enrolled 30 GME educators and provided essential training in assessment that included the interactive small group and simulation activities essential to the success of the previously offered live regional hub programs.
Course attendees reported that the virtual format for delivery (Zoom) was highly effective. Of participants completing the post-course survey (18 of 30, 60%), all reported the course completely or mostly met all course learning objectives. Relevant open-ended course evaluation comments are provided in Box 1. This commentary verifies that transitioning to the virtual learning platform continued to meet the intended outcome of the course.
Chief Resident Training
Another program that was immediately transitioned to synchronous online delivery was the Chief Resident Training program. Different from the ACGME Regional Hub Faculty Development program, this session was a single day program designed to outline the expectations and responsibilities of a chief resident. This program included, reviewed, and allowed methods for giving effective feedback, the 5 dysfunctions of a team,11 and discussion of leadership styles appropriate to the role.
Transitioning this program to a virtual delivery platform required the same preparation described for the ACGME Regional Hub Program. As with the ACGME course, program attendees reported that the virtual environment and Zoom delivery platform was highly effective. The course evaluation form was completed by 60% (69 of 116) of participants. All 69 reported the course was both evidence-based and balanced. Although instructors from the 2019 program differed from the 2020 program, the reported “per-topic” scores were comparable from one year to the next and did not indicate a deficit in learning as a result of the transition to the virtual environment.
Creating an Effective Virtual Learning Environment
Initial concerns discussed in the referenced planning meetings for both the ACGME course and the Chief Resident Training program highlighted the fear that transitioning to virtual education would be less effective than face-to-face programming because learners would not be as engaged and that negotiating the virtual platform would be technically challenging. Prior to the COVID-19 pandemic and the need for social distancing, the percentage of live vs virtual educational programs reflected a general hesitancy to adopt virtual course delivery. A major reason for this hesitancy appears to be the challenges associated with the implementation of virtually delivered course content and the perception that the robust learning communities created through in-person interaction would be diminished in the virtual environment. To address these concerns, we established required orientation sessions for all course faculty that identified specific roles and responsibilities for key stakeholders (Table 1) associated with the virtual course format designed to enhance engagement of course participants.
Based on participant and faculty feedback and our lessons learned in transitioning to a virtual environment, developing an interactive, single, or multi-day educational program can be successful. However, such transitions require focused attention on several essential activities, including:
developing clear roles and responsibilities for course director, faculty, staff, and tech support, etc;
establishing comfort with technology platform and capabilities;
outlining virtual etiquette for participants and speakers; and
hosting dry runs of the virtual conference and workshop sessions.
It was also apparent that the virtual platform can be designed to bridge the gap between just viewing a program on a screen to actively interacting with other participants and instructors. Forming engaged learning communities in the virtual environment was a critical component of the success of these programs.
Throughout this journey, transitioning from live to virtual learning, numerous pros and cons for each presentation format were identified (Table 2). Careful planning with attention to program design and delivery mitigated many of the cons to delivering a virtual course. The experience was reported to be relevant, well-received, engaging, and interactive.
Educators involved in the transition to virtual learning, in turn, learned lessons through the process (Box 2). Programs that were once local, or at most, regional, provided the means to reach out-of-state participants who were less encumbered by the expense and time traditionally associated with travel. Additionally, invited speakers, course directors, and administrative support personnel also benefited from the elimination of travel. Finally, the adoption of the virtual format allowed the local development team to meet and plan course content and delivery safely.
While virtual learning may not have been a preferred delivery platform for GME educational programing prior to the COVID-19 pandemic, necessity mandated the transition. Our experience has demonstrated that the transition to virtual faculty and resident development is an excellent option for future educational programming, regardless of the status of the pandemic.
Conducted “trial” presentations of content with small group breakout room discussions, refined the logistics of moving participants to virtual breakout rooms using virtual technology (Zoom) including screen sharing, reaction button usage, chat, and meeting vs webinar capabilities.
Most presenters for a live/in-person educational events are chosen based on their content, knowledge, and/or being a dynamic presenter. Engagement in the virtual space is challenging for presenters. Consider having presenters introduce critical content in short bursts followed by small group breakouts to allow for discussion of content to actively engage participants.
Speakers may or may not be accustomed to presenting an interactive workshop in the virtual space. It is recommended to work with individual speakers a minimum of 2 weeks prior to the live event in the virtual platform. This gives speakers an opportunity to practice sharing their screen, review screen optimizing options for video sharing, and see the different views of the participants when you share the document vs a computer screen.
The first course activity is also essential to setting the tone for the entire program.
If hosting multi-day sessions, the start of each subsequent day's education events must start with a recap of the prior day's activities. Additional points to consider from the MSUCOM SCS experience include:
Use the same Zoom link for all days of the conference.
Send conference packets via email or weblink so that participants have all handouts, resources.
Carefully plan opening introductions and time accordingly. Suggestions include:
Review agenda and course content that was received.
Review Zoom instructions and walking through how to modify your settings (Figure).
If using breakout rooms, consider preassigning participants to the same breakout groups to promote a sense of community within the group and to facilitate discussions.
Provide introductions within small groups. For example:
Identifying health systems, programs, roles.
One thing participants hope to get out of the conference.
One area they feel their program does well (assessment, direct observation, feedback, milestone mapping, etc).
Abbreviations: MSUCOM SCS, Michigan State University College of Osteopathic Medicine Statewide Campus System. Note: Based on feedback and input from the course director, faculty presenters and facilitators, participants, technology coordinators, and residents. Information was gathered through debriefing sessions, course surveys, and evaluations.
Editor's Note: The ACGME News and Views section of JGME includes data reports, updates, and perspectives from the ACGME and its review committees. The decision to publish the article is made by the ACGME.