The medical community has faced many challenges as a result of the COVID-19 pandemic, including ensuring continued medical education in the face of social distancing guidelines and the increased workloads of faculty and trainees. This Concise Critical Appraisal explores an article published in ATS Scholar that sought to outline distance learning options and develop a practical framework for transitioning content to a virtual platform.
The medical community has faced many challenges as a result of the COVID-19 pandemic, including ensuring continued medical education in the face of social distancing guidelines and the increased workloads of faculty and trainees. Although data are limited, distance education, even before the pandemic, was not entirely new to graduate medical education (GME). The Emergency Medicine Residency Review Committee of the Accreditation Council for Graduate Medical Education allows 20% of emergency medicine residency didactic time to be spent in asynchronous learning.
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Brady et al sought to outline distance learning options within GME and develop a practical framework for transitioning content to a virtual platform.
2 The authors define synchronous (occurring at the same time) and asynchronous (occurring at different times) learning, share the challenges they identified with each format, and offer helpful advice and examples of ways their institutions utilized virtual formats. The authors point out that, although 70% of residents and fellows prefer asynchronous learning because it allows easier academic scheduling, nearly one-third of trainees admitted that they never access available resources.
Brady et al emphasize that, while a variety of videoconferencing platforms are readily available, costs to the institution, security features, limitations on number of participants and presentation length, and recording and storage features should all be considered. Challenges include making sure everyone has access to the necessary equipment and software and ensuring that both learners and presenters are familiar with the software functionality. The authors suggest the use of a moderator to assist the learners and presenters with software functionality, such as screen sharing, muting, and unmuting. The environment in which learners access the content can also present obstacles, such as distractions or lack of privacy, particularly when content may include protected health information. Consideration should be given to allowing time and space free of noise and interruptions for learners to obtain the most benefit.
Ensuring participation, particularly with asynchronous learning, requires additional planning and creativity on the part of the educator. The authors suggest using tools such as question banks and discussion boards to encourage learner engagement. With synchronous education, the presenter should allow time for questions and seek opportunities to engage the learners in an active, rather than a passive, experience.
When choosing content to present via remote learning, the authors suggest focusing on high-yield subjects and evaluating resources for curated content. While they acknowledge that some curricula, such as labs, require in-person content, they suggest the use of recorded didactics to limit time in the lab. They recommend having the curriculum evaluated by content and education experts. And, as always, outcomes assessment and feedback ensure quality of content and delivery.
The authors predict that distance learning in medical education will transcend the pandemic. Virtual platforms will allow greater participation by minimizing the constraints of time and distance. To ensure ongoing utilization of this valuable education modality, medical educators must continue to perfect online curricula, acclimate to technology, and develop appropriate outcomes assessments.
The article has several limitations. It does not mention the administrative hurdles that exist when trying to broadcast medical education topics to an online audience. Academic institutions often retain intellectual property rights to all information, which complicates distribution. Additionally, delivering education online often requires double, if not triple, the time dedication per hour of lecture. This further constrains global use due to time conflicts in busy institutions.
Distance learning is a proven commodity as a supplement to in-person educational curricula. And in the era of a global pandemic, distance learning, whether synchronous or asynchronous, is a viable substitute for complete GME education.
Coauthors of this installment of Concise Critical Appraisal:
Kimberly Barker, ACNP, is a critical care nurse practitioner at Inova Fairfax Hospital.
Jim H. Lantry III, MD, is an assistant professor of emergency and critical care medicine and the associate program director of the critical care fellowship at the University of Maryland Medical Center in Baltimore, Maryland, USA. Dr. Lantry is an editor of Concise Critical Appraisal.
References
- Estes M, Gopal P, Siegelman JN, Bailitz J, Gottlieb M. Individualized interactive instruction: a guide to best practices from the Council of Emergency Medicine Residency Directors. West J Emerg Med. 2019 Mar;20(2):363-368. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404705/
- Brady AK, Pradhan D. Learning without borders: asynchronous and distance learning in the age of COVID-19 and beyond. ATS Scholar. 2020 April 10;1(3):233-242. https://doi.org/10.34197/ats-scholar.2020-0046PS
