“Can everyone see my screen?”

I wait for someone to politely reply to the faceless voice coming through the speakers while I sorted through some e-mails that accumulated during the morning. After several seconds of long silence a hesitant “yes” echoes back to the voice, providing affirmation they 1) have effectively navigated the first steps in this new world of virtual presentations and 2) are in fact communicating to someone on the other end. I briefly click over to the Zoom screen to be sure that yes, I can see the screen, and also to ensure my microphone and camera are off to allow me to watch the lecture from the comfort of my own anonymity. I can see many of the other co-fellows and faculty have opted for the same. Then we begin.

 

Remote Reflections

The change to virtual conferences and curricula in response to the COVID pandemic has been one of necessity, consequence, and opportunity. I trust my fellowship. While I would not question the safety-minded decision to hold all educational conferences as virtual, I can’t help but reflect on the impact of this change on my fellowship education.

Without a desire to be pessimistic, there are plenty of reasons a virtual platform may not be as efficacious for learning. There are innumerable examples of technology glitches, screens not sharing, choppy internet stability, and presenters demonstrating the growing pains of trying to learn this new technology in real time. The impact of these points is likely relatively minor, a distraction from the content at most. This is not to mention the distraction that is the allure of multi-tasking with my microphone and camera off, truly present for the conference in name only. The ‘distractor factor’ of remote conferences is real.

Another aspect lost, or at least challenged by, the virtual platform is interactivity. I can hardly recall the last time I was asked to think-pair-share. Techniques once used for active learning in person now require more effort, intentionality, and creativity. Additionally, new barriers exist for the presenter to gauge the interest, thoughts, and energy of the audience. All of these points can lead to a very different, overall less engaged, learning experience from what once was.

Seeded in the decline of interaction, an insidious influence of virtual conferences has spread into the ever-important area of fellow wellness. As computer and phone screens provide a safer barrier than eyewear and masks, this barrier has also had untoward bearing on the relational component of fellow conferences. We live in remarkable times with technology able to connect people all over in one place at one time. However, by and large, this is connection without community. “Participants” who don’t participate.

This isolation has limited the bonding of fellowship that forms the network of support we all need at various times through the challenges of training. I was still introducing myself to first year fellows six months into the year who I had never seen in person to that point. Also gone were the informal, off-ward interactions with faculty who would attend conference. In total, there has been a breakdown in the ability to build the comradery and community that helps generate a sense of belonging and culture to the program and division.

 

Lessons Learned

As a fellow in this time, I’ve had the fortune to experience the spectrum of education as it was before the pandemic, the various and sometimes uneasy stages of the virtual transition, and finally now nearly a year later the “new normal” of fellow education. Through this transition, there has been an evolution of improvement based on lessons learned.

Limiting Distrac… Sorry, I just got an e-mail

Limiting distractions goes both ways, for presenters and participants. As a presenter, there are simple steps to not let the technology take away from the work you put into your presentation. To start, do your best to remember to quit or silence e-mail and calendar reminders during the presentation. While it may give your audience an appreciation for the busyness of your daily inbox, it will distract from the content of the presentation. Perhaps the most important tip though is to be familiar with the virtual conference platform. For example, spending time to make sure you know how to share your screen in a way that doesn’t show the audience your PowerPoint notes section that outlines the whole presentation will go a long way.

By self-reflection though, I’m my own worst enemy when it comes to distractions. With the mic muted and camera covered, there’s a sense of significantly less accountability to the presenter or others in attendance to actively engage. The pull to catch up on work, make sure I’m up to date on e-mails, or scroll the limitless diversions available on my phone can often prove too much. Rather, I need to spend more time preparing to be present (mentally, of course) for these valuable educational sessions. This means e-mail off, phone away, camera on, and commit to the time. When possible, it also helps to find a quiet location to view conference. While this can at times be challenging for those in an inpatient setting, finding a call room, unused office, or asking program leadership to provide a quiet location dedicated to the video conference can help limit the distractions of a busy hospital environment.

Fostering Connection with Community

I would advocate that a best practice would be to require cameras to be turned on for all participants to the degree possible, setting the expectation by program or division leadership. Not only to improve accountability and provide guiderails to my own distractibility, but to take a step towards promoting a sense of community that isn’t offered by a group of empty named boxes on a screen. Leadership can also help lower the barrier to turning cameras on by normalizing that fact that when working from home, home may find its way into work. Kids or pets coming into frame or calling out shouldn’t be a source of embarrassment, but rather serve as humanizing details about colleagues that in fact bring a greater sense of connection. That said, aside from commitment from attendees to be participants who participate, there are certain practices presenters can do to help not only create active learning sessions, but build elements of needed social interaction into fellow training, as well.

As I mentioned, creating interactivity virtually takes more creativity and intentionality than when you could ask your participants to turn to the person next to them and discuss. Many teleconferencing platforms though have virtualized that idea with the use of “breakout rooms” in which participants are moved from the main video conference to one consisting of a smaller subset of participants. It may be logistically challenging to pair off in breakout rooms for a think-pair-share, but it certainly allows the opportunity for cluster group-style engagement. In these smaller groups with a specific task, conversation is encouraged and the social barrier to switching on a camera is lowered. This also lends itself to incorporation of team-based or problem-based learning style presentations.

Additional ways to help promote engagement and interaction is through polling with case-based presentations. Many platforms have internal polling systems, or externally through programs like PollEverywhere. Lastly, one opportunity to allow the technology to work with you rather than against you is to embrace the chat box as place for open question and discussion. To combat the challenge of monitoring the chat box at the same time as presenting, consider asking a trusted colleague or fellow to act as a facilitator for the chat box, bringing useful points and questions to your attention during the presentation.

Fighting Fatigue

These techniques to promote engagement may help to combat the ever-growing concern for “Zoom fatigue,” an idea born of monotony-induced decreasing effectiveness of Zoom and other virtual conference platforms. Additionally, as the pandemic and social distancing have gone on, increasing numbers of education and patient care conferences have shifted to a virtual format, meaning fellows can log in and view from any location. The convenience of eliminating geographic barriers to attendance however also has a cost. Numerous in person conferences and meetings that fellows may have been previously unable to attend due to clinical location, are now viable opportunities that compete for their time.

In this regard, it’s valuable to set your own limits. Certainly, fellows should plan to attend all core educational conferences as required by their programs, but other invitations are just that, invitations. For example, it may not be necessary to RSVP “Yes” to conferences outside your own division or department.

 

Table 1: Quick Tips to Enhance Virtual Learning

 

Presenter
Participant
  • Practice with your virtual learning platform before your presentation
  • Limit distractions: Turn off or silence e-mail and phone, and find a quiet location when possible
  • Limit screens and computer programs only what is essential while presention
  • Mentally commit to the conference and time
  • Ask for participant cameras to be turned on when possible
  • Turn on your camera to help increase accountability to be truly present and build community
  • Audience Engagement: Utilize polls, breakout rooms, and the chat box to increase participation
  • Embrace interaction with the presenter and your co-participant

 

 

 

 

 

 

 

 

 

 

 

 

I’ll close by inviting you to consider the ideal. To image joining a virtual conference, after setting aside a dedicated hour, closing out your e-mail and silencing your phone. The speaker begins by thanking all those with cameras on, and invites others to do the same. Slowly, more and more colleagues’ faces come into view, and with each one a sense of community grows within the group. The presenter brings people together with early use of polling, goes on to ask a fellow to interpret a radiology image, and finally breaks the participants into breakout rooms to discuss a difficult management decision. Meanwhile, during the presentation, participants discuss their thoughts and propose questions through a lively, facilitated chat box.

In the end, I’ve decided this technology and virtual teaching doesn’t in fact need to be good or bad for my education, but rather is simply different. If embraced, it has capacity to actively engage fellows in education and bring people together in a time of social distance. It starts with each of us, and I’m no exception, to commit to being truly present, so that maybe next time I might give a face to the voice as I answer…

“Yes, we can see your screen.”

 

Rick Koubek, MD is an Associate Chief Pulmonary and Critical Care Medicine Fellow at Mayo Clinic in Rochester, MN. He is interested in pursuing a career as a clinician-educator and has specific interest in curriculum design, simulation-based learning, and procedural teaching.