Advertisement

Novel Educational Responses to COVID-19: What is Here to Stay?

  • Michael B. Pitt
    Correspondence
    Address correspondence to Michael B. Pitt, MD, Department of Pediatrics, University of Minnesota School of Medicine & Masonic Children's Hospital, |6th Floor S Bldg, 657 | 2450 Riverside Ave, Minneapolis, MN 55454
    Affiliations
    Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Minnesota School of Medicine & Masonic Children's Hospital (MB Pitt), Minneapolis, Minn
    Search for articles by this author
  • Su-Ting Terry Li
    Affiliations
    Division of Pediatric Hospital Medicine, Department of Pediatrics, University of California Davis (S-T Terry), Sacramento, Calif
    Search for articles by this author
  • Melissa Klein
    Affiliations
    Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center (M Klein), Cincinnati, Ohio

    Department of Pediatrics, University of Cincinnati College of Medicine (M Klein), Cincinnati, Ohio
    Search for articles by this author

      Keywords

      In this issue of Academic Pediatrics, we feature 10 innovations that highlight novel educational responses to the COVID-19 pandemic. Our recent call for educational innovations resulted in 172 submitted manuscripts from 82 institutions in four countries (97% from the United States). Submissions were reviewed for innovation, outcome, and sustainability after the COVID-19 pandemic by 3 educational researchers blinded to author name and institution. The innovations encompassed the pediatric medical education continuum, with the majority (n = 96; 56%) targeting residents, followed by medical students (n = 42; 24%), fellows (n = 13; 8%), and faculty (n = 3; 2%). Several papers (n = 18; 10%) described approaches targeting multiple levels of learners. As expected, given the urgency to respond, many outcomes related to feasibility, participation and completion rates, and perceptions of learning.
      Four themes emerged from submissions 1) virtual learning (n = 118; 68%); 2) telehealth/telerounding (n = 27; 16%); 3) administrative responses (n = 18; 10%); and 4) wellness (n = 9; 5%). Papers describing virtual learning included modifications to existing conferences (e.g., morning report, grand rounds, and boot camp) (n = 55; 47%), conversion of electives (n = 22; 19%) or clerkships (n = 16; 14%), virtual simulation (n = 18; 15%), and approaches to equip learners to advocate for patients and populations during the COVID-19 pandemic (n = 7; 4%). Submissions describing remote patient care via telehealth included the rapid implementation of outpatient telehealth (n = 16; 59%), inpatient telerounding (n = 8; 30%), and inpatient teleconsultation by specialists (n = 3; 11%). Administrative responses included staffing modifications or clinic management (n = 8; 44%), development of clinical practice guidelines (n = 6; 33%), and leveraging economies of scale via cross-institutional sharing of resources (n = 4; 22%). Submissions describing approaches to learner wellness described initiatives aimed at coming together virtually for support, with storytelling events (n = 5; 56%) being the most common approach.

      Punctuated Equilibrium – Innovations That Will Outlast the COVID-19 Pandemic

      While all submissions originated in response to the unique circumstance of COVID-19, papers selected for publication highlight modifications to pediatric education which we believe may change future educational practice. Here, we highlight innovations that we think will have long-lasting impact.

      Teaching and Learning From Home – Approach to Virtual Education

      The COVID-19 pandemic has made the corporate world realize that not all meetings need to be in person to return to business as usual.

      Khazan O. Work from home is here to stay: the future of jobs after the pandemic is a blurry mix of work, life, pajamas, and Zoom. Atlantic. Published 2020. Available at:https://www.theatlantic.com/health/archive/2020/05/work-from-home-pandemic/611098/. Accessed June 29, 2020.

      Similarly, COVID-19 affords us an opportunity to decide which elements of medical education should continue in virtual or hybrid formats. Virtual learning can overcome the barrier of travel and increase attendance. While next steps must evaluate educational outcomes associated with virtual learning, we suspect that some conferences (e.g., grand rounds) may continue to offer an easily accessible, virtual option.
      Virtual learning also provides opportunities for cross-institutional collaboration. Blankenburg et al described how to leverage a national organization (Association of Pediatric Program Directors) as a platform for real-time collaboration, sharing evolving approaches to administrative and educational challenges.

      Blankenburg R, Poitevien P, Gonzalez del Rey J, et al. Virtual cafes: an innovative way for rapidly disseminating educational best practices and building community during COVID-19. Acad Pediatr. 2020;20:757–759.

      Lang et al described creation of a novel website to curate multi-institutional standardized resources for pediatric providers caring for adults.

      Lang A, Burger B, Doraiswamy V, et al. POPCoRN one-pagers: educational materials for pediatric providers caring for adults. Acad Pediatr. 2020;20:760–761.

      Both papers showcased the ability to use virtual platforms to rapidly leverage networks and disseminate information. Beer et al described converting an open source flipped classroom model, previously available for educators within their institutions, to a nationwide flipped classroom where fellows from multiple institutions could learn from each other.

      Beer L, Gray M, Carbajal M, et al. “Megaflip”, a novel approach to national collaboration for flipped classroom education. Acad Pediatr. 2020;20:762–763

      The ability for programs to leverage expertise beyond their institutional faculty provides a replicable model to standardize learners’ exposure to experts regardless of institutional faculty size.
      Some traditionally in-person educational experiences have demonstrated feasibility when converted to a virtual format. Huang et al described transitioning their interdisciplinary primary care clinic mock code training to online simulations.

      Huang E, Pulice C, Sullivan A. Primary care mock codes during a pandemic: interprofessional team-based emergency education while maintaining social distance. Acad Pediatr. 2020;20:764–765

      Programs with remote clinical sites may opt to trial virtual simulation in the post-COVID-19 era. Lara et al described standardized patient encounters via teleconferencing to accommodate remote assessment of learners using a virtual observed structured clinical encounter.

      Lara S, Foster C, Hawks M, et al. Remote assessment of clinical skills during COVID-19:a virtual, high- stakes, summative pediatric OSCE. Acad Pediatr. 2020;20:766–767

      Their results suggest a comparable ability to assess students, making virtual observed structured clinical encounters a potentially feasible option for institutions with learners at distant sites or limited access to simulation centers. Babal et al described addressing wellness via a remote storytelling activity with faculty sharing vulnerable narratives with learners.

      Babal J, Webber S, Ruedinger E. First, do no harm: lessons learned from a storytelling event for pediatric residents during the COVID-19 pandemic. Acad Pediatr. 2020;20:768–769

      This work highlighted the ability to convey powerful emotions and form connections despite the virtual format, suggesting that future sessions need not occur via an in-person format.

      Students as Agents of Change

      As medical students were barred from direct patient care, educators developed meaningful strategies to engage students. From outside medical centers, students were empowered to tackle disinformation. Quadri et al shared a curriculum to equip students as advocates for science at the virtual frontlines via their social media presence.

      Quadri N, Thielen BK, Erayil SE, et al. Deploying medical students to combat misinformation during the COVID-19 andemic. Acad Pediatr. 2020;20:770–771.

      Reardon et al described how students created a virtual COVID-19 classroom to teach school-aged children age-appropriate and accurate information about the pandemic.

      Reardon R, Beyer L, Carpenter K, et al. Medical student development of K-12 educational resources during the COVID-19 pandemic. Acad Pediatr. 2020;20:772

      Both showcase the impact of tapping into students’ experience and skill with social media to develop future pediatric advocates, more critical now, post-COVID-19, than ever.

      Telehealth as an Adjunct to Care

      Our ability to connect with patients virtually will undoubtedly be an enduring element of the COVID-19 pandemic. As educators, we will need to determine the competencies necessary to provide effective care via telehealth. Huffman et al described one approach of how to teach and observe fellows providing outpatient telehealth encounters.

      Huffman L, Feldman H, Hubner L. Fellows front and center: tele-training and telehealth. Acad Pediatr. 2020;20:773–774

      Patients, institutions, accrediting bodies, and insurance providers have rapidly adopted telehealth, providing future opportunities to evaluate care provision, supervision, and outcome comparison.
      While inpatient telerounding was developed to minimize personal protective equipment usage, a critical, but short-term necessity, this innovation has accelerated incorporation of teleconsultation, which may be useful for smaller programs to provide subspecialty advice when a specialist is not locally available. In addition, as Rogers et al describe, the ability to conference in family members who are not available during inpatient rounds may serve as a key strategy to keep families at the center of family-centered rounds.

      Rogers A, Lynch K, Toth H, et al. Patient and family centered (Tele)rounds: the use of video conferencing to maintain family and resident involvement in rounds. Acad Pediatr. 2020;20:775–776

      COVID-19 presented unprecedented challenges, requiring educational innovations to ensure trainees continue to learn to provide high-quality, evidence-based care, advocate for patients and populations, and maintain wellness. We believe the papers featured in this issue highlight innovative educational responses to the COVID-19 pandemic and serve as a foundation for shaping future medical education. Next steps will need to include expanded evaluation to determine which innovations have greatest effectiveness necessitating their continuation.

      Acknowledgments

      We want to thank the panel of reviewers (Maneesh Batra, Rebecca Blankenburg, Caroline Paul, Pattie Quigley, Michael Ryan, Daniel Schumacher, and Teri Turner) who generously gave their time to review the blinded submissions. We appreciate the extent of educational innovations occurring in so many settings and all of the authors that took the time to submit their work.

      References

      1. Khazan O. Work from home is here to stay: the future of jobs after the pandemic is a blurry mix of work, life, pajamas, and Zoom. Atlantic. Published 2020. Available at:https://www.theatlantic.com/health/archive/2020/05/work-from-home-pandemic/611098/. Accessed June 29, 2020.

      2. Blankenburg R, Poitevien P, Gonzalez del Rey J, et al. Virtual cafes: an innovative way for rapidly disseminating educational best practices and building community during COVID-19. Acad Pediatr. 2020;20:757–759.

      3. Lang A, Burger B, Doraiswamy V, et al. POPCoRN one-pagers: educational materials for pediatric providers caring for adults. Acad Pediatr. 2020;20:760–761.

      4. Beer L, Gray M, Carbajal M, et al. “Megaflip”, a novel approach to national collaboration for flipped classroom education. Acad Pediatr. 2020;20:762–763

      5. Huang E, Pulice C, Sullivan A. Primary care mock codes during a pandemic: interprofessional team-based emergency education while maintaining social distance. Acad Pediatr. 2020;20:764–765

      6. Lara S, Foster C, Hawks M, et al. Remote assessment of clinical skills during COVID-19:a virtual, high- stakes, summative pediatric OSCE. Acad Pediatr. 2020;20:766–767

      7. Babal J, Webber S, Ruedinger E. First, do no harm: lessons learned from a storytelling event for pediatric residents during the COVID-19 pandemic. Acad Pediatr. 2020;20:768–769

      8. Quadri N, Thielen BK, Erayil SE, et al. Deploying medical students to combat misinformation during the COVID-19 andemic. Acad Pediatr. 2020;20:770–771.

      9. Reardon R, Beyer L, Carpenter K, et al. Medical student development of K-12 educational resources during the COVID-19 pandemic. Acad Pediatr. 2020;20:772

      10. Huffman L, Feldman H, Hubner L. Fellows front and center: tele-training and telehealth. Acad Pediatr. 2020;20:773–774

      11. Rogers A, Lynch K, Toth H, et al. Patient and family centered (Tele)rounds: the use of video conferencing to maintain family and resident involvement in rounds. Acad Pediatr. 2020;20:775–776