Rethinking Residency Education During The COVID-19 Pandemic: Keys To Incorporating Teleconferencing And Virtual Learning

(Editor’s note: This blog was co-written with Rona W. Law, DPM and Dominick Casciato, DPM)

In the midst of this pandemic, the Council on Podiatric Medical Education (CPME) has recognized the immediate disruption of podiatric residency training and accordingly decreased the minimum activity volume (MAV) by 15 percent across all categories for the residency graduating class of 2020.¹ 

Nonetheless, required non-clinical contact hours, in the form of academic meetings, journal clubs, cadaver labs, research projects or other scholarly activity, have not been thoroughly addressed. Research shows that these non-clinical contact hours are effective and necessary for the podiatric resident learner.^2-5 Though not anticipated, the suspension of hands-on activity secondary to the cancellation of surgeries through illness, scheduling conflicts or other unforeseen disruptions affects portions of each resident’s education. 

Moreover, as was our experience with the COVID-19 pandemic, limitations on gatherings further restrict attendance to academic meetings. At our residency program, participants at these weekly academic meetings include attending physicians, fellows, residents and medical student externs. To address this occurrence and limit its impact on surgical education and training, our residency program quickly adapted to web-based virtual learning opportunities. 

Although collaborative learning via teleconferencing is not a new idea, previous reports do not exist as to the content outline of online web-based residency education. Currently used in many medical subspecialties, specifically in circumstances in which residents and faculty are spread across multiple distant training sites, teleconferencing can be a powerful tool in clinical and surgical education.⁶ 

That said, there are certain keys to maximizing the effectiveness of web conferencing. Accordingly, we adapted some best practice tips on web conferencing from the Harvard Business Review and Stanford University, and modified them to suit the size of our residency program.^6,7 

Prior to a meeting …

• When using equipment or locations not regularly used for Web conferencing, test your meeting connections in advance.
• Establish online video conferencing connections //several// minutes before the meeting start time.
• Create a backup communication plan in case there is trouble connecting with remote participants. A backup plan can include asking on-site participants to connect to the meeting through their cell phones or via speaker phones

During a meeting …

• Have all participants share their video and audio. This prevents lurking residents and disengagement.
• Ensure all participants can see and hear all other participants as appropriate.
• Ensure location lighting does not limit a participant’s visibility (e.g., avoid backlighting from windows or lamps). 
• Have participants mute their microphones if their location has excessive background noise or they will not be speaking.
• Have a meeting facilitator. This is often the person who called the meeting, whether it is the chief resident or the residency program director.
• The facilitator is responsible for providing an agenda to participants. Sending the agenda prior to the meeting is not absolutely necessary but should at least be distributed at the start of the meeting.
• The facilitator should allow verbal or visual cues, such as raising a hand (a feature on Cisco Webex), to indicate politely when someone wants to actively contribute verbally to the meeting.
• The facilitator should engage participants at all locations to ensure discussion understanding and alignment, limiting “side conversations” and multitasking to ensure all participants are made aware of that content.
• Make sure all participants have equal access to content by sharing all content within the video conferencing connection and using online tools (e.g., Google docs) whenever possible.
• Maintain an interactive environment by calling on resident participants and capture real-time feedback via polling systems as necessary to make sure all voices are heard.

In many ways, virtual web-based education may allow more robust discussion and question and answer sessions as participants may not feel the stress of speaking in front of a large group as they might in person. On that premise, there should be an allotted time for audience questions, which is typically designated by the presenter at the end of a series of slides. The presenter should reiterate the relevance of learning points to each audience member. When a presenter displays content with a specific reference, the resident should be able distribute the content reference (i.e. websites, hyperlinks or journal citations) to all participants. 

Open discussion allows residents, attending physicians and students to discuss the presented content and cases. It is crucial to remind residents to practice professionalism and challenge team members without humiliation at all times. The goal as educators is to teach and guide residents, not to discourage them from learning. Upon the conclusion of the open discussion, the facilitator should ask the audience if there are any questions, problems or concerns. This reinforces the commitment to teaching and the commitment to the team. It also allows an opportunity to revisit any forgotten questions or topics.⁸

Dr. Law is a Chief Resident at the OhioHealth Grant Medical Center in Columbus, Ohio.

Dr. Casciato is a first-year resident at the OhioHealth Grant Medical Center in Columbus, Ohio. 

Dr. Hyer is the Podiatry Residency Program Director at the OhioHealth Grant Medical Center in Columbus, Ohio. He is the Director for the Advanced Foot and Ankle Surgical Fellowship at the Orthopedic Foot and Ankle Center in Worthington, Ohio. He is a Fellow of the American College of Foot and Ankle Surgeons.

References

1. Council on Podiatric Medical Education. CPME guidance on COVID-19 for residency and fellowship education.  Available at: https://www.cpme.org/files/CPME/Guidance%20on%20COVID19%20-%20Residency%20and%20Fellowship%20Education.pdf . Published March 16, 2020. Accessed April 13, 2020.
2. Shofler D, Chuang T, Argade N. The residency training experience in podiatric medicine and surgery. J Foot Ankle Surg. 2015;54(4):607-614.
3. So E, Hyer CF, Richardson MP, Thomas RC. What is the current role and factors for success of the journal club in podiatric foot and ankle surgery residency training programs? J Foot Ankle Surg. 2017;56(5):1009-1018. 
4. Chu AK, Law RW, Greschner JM, Hyer CF. Effectiveness of the cadaver lab in podiatric surgery residency programs. J Foot Ankle Surg. 2020;59(2):246-252. 
5. Casciato DJ, Ead JK, Rushing CJ, et al. Podiatric medicine and surgery resident authored publications in the journal of foot and ankle surgery: a systematic review. J Foot Ankle Surg. 2020;59(3):550-555.
6. Frisch B, Greene C. What it takes to run a great virtual meeting. Available at: https://hbr.org/2020/03/what-it-takes-to-run-a-great-virtual-meeting . Published March 5, 2020. Accessed April 13, 2020.
7. Stanford University. Best practices for effective video conferencing. Available at: https://uit.stanford.edu/videoconferencing/best-practices . Published March 8, 2019. Accessed April 13, 2020.
8. Cook KD, Gutowski RB. Teaching during rounds. Clin Podiatr Med Surg. 2007;24(1):27-36.

Editor’s note: This blog is has been excerpted from an upcoming online-exclusive feature, “How A Residency Program Transitioned To Web-Based Academic Meetings During The COVID-19 Pandemic,” which will be published in May at www.podiatrytoday.com .