key: cord-0025512-wl115cha authors: Haring, R. Sterling; Rydberg, Leslie K.; Mallow, Michael K.; Kortebein, Patrick; Verduzco-Gutierrez, Monica title: Development and Implementation of an International Virtual Didactic Series for Physical Medicine and Rehabilitation Graduate Medical Education During COVID-19 date: 2021-11-17 journal: Am J Phys Med Rehabil DOI: 10.1097/phm.0000000000001926 sha: 5d469fa84669365a45cb09197dcbeef76d29eb38 doc_id: 25512 cord_uid: wl115cha Coronavirus disease of 2019 presented significant challenges to residency and fellowship programs. Didactic lectures were particularly affected as redeployment of faculty and trainees, limitations on in-person gathering, and other barriers limited opportunities for educational engagement. We sought to develop an online didactic series to address this gap in graduate medical education. Lecturers were recruited via convenience sample and from previous Association of Academic Physiatrists presenters from across the United States and Canada; these presented via Zoom during April and May 2020. Lecturers and content reflected the diverse nature of the specialty. Learning objectives were adapted from the list of board examination topics provided by the American Board of Physical Medicine and Rehabilitation. Fifty-nine lectures were presented. Maximum concurrent live viewership totaled 4272 and recorded lecture viewership accounted for an additional 6849 views, for a total of at least 11,208 views between the date of the first lecture (April 9, 2020) and May 1, 2021. Live viewers of one of the lectures reported participating from several states and 16 countries. The Association of Academic Physiatrists–led virtual didactics augmented graduate medical education during the coronavirus disease of 2019 pandemic, and data confirm that the lectures have continued to enjoy a high level of viewership after the cessation of live lectures. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) associated coronavirus disease of 2019 (COVID- 19) significantly impacted medical education, particularly during the Spring of 2020. 1, 2 Suspending surgical operations and outpatient procedures reduced medical student and resident physician clinical educational opportunities in operating rooms and procedure suites. 3 Outpatient clinics were commonly closed or deemed off-limits to trainees, both limiting clinical education and causing logistical difficulties with regard to shuffling and rescheduling rotations. 4 Furthermore, faculty and residents were commonly redeployed to help address the pandemic in other parts of overstretched medical institutions. 5 For many residency programs, these logistical challenges translated to the cancellation or curtailment of structured didactic sessions. 6(p19) Physical medicine and rehabilitation (PM&R) programs were not spared from these effects. Many trainees and faculty were redeployed by local and institutional demands, creating logistical challenges and limiting PM&R-specific learning opportunities. 7, 8 To address these new hurdles, programs relied on a number of alternative educational tools, including online question banks, teleconferencing, procedural simulation, and prerecorded video presentations. 9 Many of these options are less than ideal for clinical training, as they provide only one-way communication and limit opportunities for questions, feedback, and other meaningful educational interaction. To meet the challenges associated with this pandemic, we sought to develop a format by which the greater PM&R community might collaborate to provide adjunctive educational opportunities to supplement PM&R residency and medical student training program efforts. An online PM&R educational program, entitled "Virtual Didactics," was developed by PM&R resident physicians and formatted as a lecture series provided via the video conferencing platform Zoom (http://www.zoom.us). Members of the Association of Academic Physiatrists (AAP) Education Committee oversaw the design and rollout of the project and provided support in addressing issues such as topic selection and lecturer recruitment. Lecturers were chosen based on a convenience sample of individuals known to have expertise in PM&R-relevant topics. Prospective lecturers were recruited via e-mail invitation, facilitated by introductions from faculty colleagues at AAP and from each of the authors' institutions. These online lectures were initially presented in real-time at 12:00 p.m. Central Daylight Time (CDT) to facilitate participation as widely as possible across the United States (i.e., to accommodate participants on both the East [1:00 p.m.] and West [10:00 a.m.] coasts). Sessions were recorded for delayed access by those unable to participate in the live session. After 8 days of daily lectures, lectures were changed to twice daily. Lectures were formatted to last 1 hour, beginning with a short introduction by a resident lecture facilitator, followed by the educational lecture. Because known occurrences of traumatic and disruptive incidences of "Zoombombing," only the primary lecturer and the facilitator were allowed to have audio, video, and/or screen sharing privileges. 10 Questions from lecture attendees were submitted via direct chat messaging to the lecture facilitator, who then provided them to the lecturer at convenient times (e.g., natural breaks in the lecture, or at the end of the presentation). Alternatively, lecturers interacted with learners via in-lecture questions, with answers provided via third-party polling applications (e.g., Poll Everywhere, http://www.polleverywhere.com) or via the general Zoom chat function. Lectures were password protected, and the videoconference links and passwords were hosted on the AAP website. Widespread dissemination of the lecture series details was achieved via AAP social media platforms, the AAP e-newsletter e-mails, and e-mail listservs to PM&R residency program directors and department chairs nationwide. Links to the lectures were posted on the AAP Twitter account, and the details of the lecture series were featured in the organization's monthly newsletter. Residency program directors and department chairs were informed of the series and invited to participate by members of the AAP Education Committee via e-mail. After the initial few lectures, the AAP Education Committee developed a framework for lecture topic selection and speaker recruitment. Prospective topics were selected from the board review topic list published by the American Board of PM&R, adapted to maximize clarity and minimize the likelihood of topic overlap between lecturers. 11 Prospective lecturers were identified via the expanded collegial network of members of the AAP Education Committee (e.g., from previous interaction or from presentations witnessed at national or international conferences). The planning committee specifically sought out lecturers that reflect the diversity of the specialty to facilitate the representation shown to improve outcomes in graduate medical education. [12] [13] [14] [15] [16] At the request of resident physicians in areas particularly affected by COVID-19, all lecture videos were made available for the benefit of those trainees otherwise unable to participate in the live presentations; the AAP agreed to host the videos on their website. As this was part of a quality improvement project, institutional review board approval was not sought, and participant consent was not required. Over the course of 6 wks, 59 lectures were presented by 52 faculty from PM&R residency programs and institutions across the United States and Canada. More than half of lecturers (60.8%) were male, and 62.7% identified as White. At the time of their presentation, six lecturers (11.8%) were division or department chairs, 4 (7.8%) had achieved the rank of professor but were not division or department chairs, 14 (27.5%) were associate professors, and 19 (37.3%) were assistant professors. Content domains included brain injury rehabilitation, rehabilitation issues specific to COVID-19, neuromuscular medicine, pediatric rehabilitation, pain medicine/interventional spine care, prosthetics and orthotics, sports medicine/musculoskeletal medicine, spinal cord injury, stroke, and others (Fig. 1) . A sum total of 4,272 computer connections viewed the lectures at the time of each lecture's live broadcast; this number only reflects the peak viewership for each lecture and not necessarily the comprehensive count of individuals watching during the live broadcast. Although some participants reported that many trainees were watching the lectures over a single connection, the exact number of individuals viewing each live lecture is unknown (or could not be determined definitively). Similarly, peak viewership would not take into account any instances, wherein multiples viewers participated in nonoverlapping portions of a single lecture. During one presentation, 15 US states and several international locations were self-identified in response to a query by the lecturer. During a later lecture, participants self-identified as viewing the lecture live from 16 countries. The geographic distribution of participants who viewed the lectures in their recorded form is unknown. From the beginning of the lectures in April 2020 thru May 2021, these recorded lectures were viewed 6894 times, for a total of 11,208 live or recorded viewings of the 59 lectures, or an average of 190 views per lecture, although some were viewed more than 500 times. Most viewed topics included sports and musculoskeletal medicine, followed by brain injury medicine and interventional spine/pain medicine, whereas subjects specific to prosthetics and orthotics, stroke, and COVID-19 were viewed less frequently (Fig. 1) . These trends seem to reflect the fellowship training preferences of graduating PM&R residents. 17 The COVID-19 pandemic disrupted every aspect of graduate medical training by varying mechanisms, ranging from social distancing requirements to redeployment and extension of clinical responsibilities for both attending physicians and trainees. The AAP Virtual Didactics campaign, initiated by resident physicians, sought to address this critical gap in education; the end result was 59 lectures by PM&R experts from across the United States and Canada. These lectures covered the breadth of PM&R, although the most viewed lectures were in the areas of sports/musculoskeletal medicine, brain injury, and interventional spine/pain medicine. Viewership of recorded lectures (6894) reflected the total count of all lecture views, whereas viewership of live lectures (4314) reflected only peak viewership; however, based on viewer reports, we believe that both live and total viewership were higher. For instance, the extent to which multiple end users shared a single computer connection is unclear. This novel virtual lecture series was designed to fill an educational gap during a time of particular need, and the production and broadcast of live lectures ceased when viewer feedback suggested that training programs were returning to their regular didactic schedule. The series' value, however, extended well beyond the live presentations, as 51 of the 59 lectures had more delayed than live views. Although the ongoing role of virtual series such as ours is not yet clear, we have shown that there is interest in virtual learning opportunities. Engagement with this series reflected broader interest in virtual educational offerings across medicine; a virtual lecture series aimed at a general surgery audience not only garnered slightly lower numbers of live viewers but also reported increased engagement with recorded versions of the lectures. 18 A variety of online didactics were developed for urologic trainees with the support of individual institutions, state associations, and professional societies; as with our series, participants in these programs came from a wide geographic distribution, with positive feedback over approximately a 2mo period. 19, 20 As a result of the COVID-19 pandemic, virtual lectures play a growing role in resident and fellow education across medical specialties. 18, 19, [21] [22] [23] [24] Virtual components have been shown to increase retention and satisfaction with lecture-based medical training curricula, suggesting that hybrid approaches (i.e., combination virtual and in-person educational offerings) may be an effective option well after the COVID pandemic has passed. 25 Limitations of this project stem from the rapid response necessitated by the onset of the pandemic in Spring 2020. A short window between initial planning and rollout was designed to quickly respond to an urgent need in graduate medical education but did not allow for a comprehensive approach to data collection. Available viewership data were limited to number of computer connections and did not reflect individual viewers. Future projects, including ongoing virtual medical student lectures, will seek build on this series by establishing a set of key lecture topics and educational objectives at the outset and gathering structured feedback and outcomes data. Collectively, we created a resident-initiated virtual didactic lecture series to meet the needs of PM&R residency training programs during the extenuating educational circumstances caused by the COVID-19 pandemic. Our data indicate that the series was well received, with more than 4300 live views from at least 15 states and 16 countries, as well as nearly 6900 delayed (recorded) views, for a total of 11,208 views. Such virtual approaches show promise to augment existing residency and training programs or incorporated into board review programs. Impact of the COVID-19 pandemic on medical education: medical students' knowledge, attitudes, and practices regarding electronic learning Medicine and surgery residents' perspectives on the impact of COVID-19 on graduate medical education Medical education: COVID-19 and surgery Medical student education in the time of COVID-19 22% of physician assistants furloughed, others redeployed COVID-19 and medical education Rehabilitation medicine response to the COVID-19 pandemic The immediate impact of the coronavirus pandemic and resulting adaptations in physical medicine and rehabilitation medical education and practice Using technology to maintain the education of residents during the COVID-19 pandemic Rapid supportive response to a traumatic "Zoombombing" during the COVID-19 pandemic American Board of Physical Medicine and Rehabilitation: Part I Certification Examination Outline Women's representation among members and leaders of national medical specialty societies They don't see a lot of people my color: a mixed methods study of racial/ethnic stereotype threat among medical students on core clerkships Minority resident physicians' views on the role of race/ethnicity in their training experiences in the workplace Bridging the gap: holistic review to increase diversity in graduate medical education Beyond a hashtag: strategies to move toward a more inclusive physiatry workforce Factors influencing fellowship decision making during physical medicine & rehabilitation residency Multi-institutional collaborative surgery education didactics: virtual adaptations during a global pandemic Urology virtual education programs during the COVID-19 pandemic Well-being and education of urology residents during the COVID-19 pandemic: results of an American National Survey Virtual education in neurosurgery during the COVID-19 pandemic Experiential learning: giving didactics in the virtual world A virtual COVID-19 ophthalmology rotation Virtual didactics exchanges to enhance trainee education Impact of virtual learning environment on students' satisfaction, engagement, recall, and retention