Virtual Insanity: Adapting Curriculum to the Virtual Environment

Image credit: Pexels

Author: Ryan Gibney, MD
AEM/RSA Editor
Originally published: Common Sense
November/December 2020

The sun peaks over the bay, as the crispness evaporates from the morning air to greet, what — in any other normal time — would be the start of a new school year. The traditional morning routine of packing lunch, gathering supplies, and a haphazard scurry to the front door to make it to class on time, has all but disappeared. The start of a new school year as a parent has brought a new face to education across the board. In my home, we have set up a dedicated learning space for both my daughter and I, complete with paper, pens, computers, reference books, and any other tool that may be needed. As I watch my daughter dive into the realm digital learning, I wonder how this generation is going to adapt. How are they going to apply their knowledge? Is this the new norm for education (please, God I hope not)? More importantly, how will the lack of social interaction shape her future? It has been shown that peer education with regards to emotional resiliency, empathy, and problem solving, are attained through social interactions. I believe that the same is true in medical education.

At the same time my daughter embarked on another year in her quest for knowledge, so did a new class of medical students and residents across the nation. However, this time was starkly different from the years before — in-person activities and orientations, social gatherings with colleagues, family and friends, and the time-honored white coat ceremony were noticeably missing. As my colleague Dr. Alexandria Gregory mentioned in the May/June issue of Common Sense, the transition of Step 1 to pass/fail, the myriad of quality supplemental resources, and question of lecture based teaching’s utility, traditional medical education is rapidly evolving, and the advent of distance learning has introduced a new set of complex problems. What do we, as clinical educators, do to make these sessions valuable? How do we incorporate peer learning to hone intangible skills such as empathy? How do we make it better than before?

Virtual learning can be challenging for even the most skilled clinical educators. The content must be clearly developed and delivered in a way that engages the learner and maintains the quality standards of medical education. Falling back into a purely lecture driven curriculum is an easy way to navigate the virtual realm, but offers little to the learner and has been proven ineffective time and time again. Hands on, group format is limited by many institutions mandated social distancing and distance learning policies. With a little bit of creativity and a bit more backend effort, educational interactions can be extremely effective, interactive, and fun within the virtual space.

Ways to Augment Your Virtual Learning Environment

As an academic chief, the responsibility of curating our weekly conference content is no simple task. The addition of a predominantly virtual learning environment added unique challenges to development of quality content that engages the learner. Through the help of our educational fellows, we have been able to develop many interactive learning modules that translate very well to the virtual learning environment. Here are a few of those ideas.

The flipped classroom model has long been a staple in MedEd, and works incredibly well in the virtual environment. The flipped classroom focuses on the individual learner gaining and applying new knowledge. Prior to the sessions material is distributed for learning and understanding via email or assigned reading. Within the digital session application of the new material can be done through case based learning, iRAT-gRAT model, or other TBL/PBL methods. There is little work that needs to be done to translate this to the virtual learning space making it an ideal methodology for quick content integration.

Choose your own adventure is another method that can be a great addition to the virtual curriculum. This allows the learners to engage in breakout rooms and solve a series of problems and clinical scenarios, expanding on the team based and problem based learning approaches. Web-based platforms, such as Google Forms, can be used to develop logic based clinical games, taking advantage of the sections feature, allowing for variant pathways through clinical scenarios. Adding a theme based on the topic can augment the engagement. For example, a Zombie Apocalypse themed game on toxidromes, or a digital escape room can increase the challenge level. Integration of puzzles requiring application of clinical knowledge allows for stronger memory association and retention. These builds can be customized to fill any amount of time and there are many online resources and how-to videos for creation. Although these are incredibly engaging and can cover broad swaths of material, there are some considerations when building these. They can be very laborious, so it’s best to start small to get the hang of the logic flow — for example a 90 minute game can take upwards of 12-16 hours to build out the content. Once you have developed a good logic flow, you can readapt it to varied content. Secondly, the platform can become unstable when the logic of the form becomes too large—around 70-80 branch points can slow it down significantly. To circumvent this plan small or break it into two smaller branch forms that run in succession. Finally, this platform allows for integration of robust video and image content making the experience that much more engaging, however this can also contribute to slowing. Overall, this has been well received by learners and builders alike, and offers a change to the traditional learning platforms.

Simulation has become an integral part of medical education as it allows for hands on application of clinical knowledge in low pressure, low stakes environments, focused on team-based learning in the patient care setting. This can be accomplished in a variety of ways digitally as well. Using the above described Google build out with sections tied to the user choices, provides a direct feedback component based on their choices. Integration of the image and video components can increase the reality of the simulation experience. Also, simulation can be facilitated by an operator through shared PowerPoint documents with hyperlinks that correlate to clinical decisions and physiologic changes. The key is to provide a similar experience to the in-person simulation environment, engaging learners of all levels, and providing integration of clinical decision making with focused learning objectives. There are excellent resources for sim cases such as EM Sim Cases, JetEM, and ACEP, to name a few.

Integration of high quality asynchronous resources provides a way to focus on the learning and evaluation process, rather than creating anew. In medical education and emergency medicine there already exists a plethora of excellent resources, such as HIPPO-EM, EMRAP, ROSH, PEER, and others. Integrating these into the digital curriculum can allow for the content developers to focus more on application of these principles. The fact that most learners already use these resources independently, makes the transition and integration more palatable.

How do you teach soft skills virtually? Many institutions have integrated empathy and communication curricula into their standards and goals. The challenge is that applying these principles virtually becomes difficult for several reasons—body language is often obscured, tonality doesn’t always translate across video conferencing, and there are a lot of distractions that often don’t exist in-person. Having a focused wellness portion of your virtual programming, where learners can gather to discuss relevant social topics, challenges they are currently facing, difficult clinical cases, and process groups can bring about a true human component to the virtual realm effectively. Expanding this beyond the virtual realm to the workroom, rounds, and other in-person settings can further emphasize these skills.

The key to any virtual learning space is adaptability. The truth of the matter is that you will try many different approaches and some of them will just not work. Being flexible and ready to change at a moment’s notice is crucial to effectively delivering your content. Focusing on embracing the virtual environment and making it an enjoyable space for learning is critical for its success. We are truly living through an unprecedented time socially; however, there is real opportunity to innovate in education right now. These are only a few suggestions to augment the digital learning space, and I hope that provides some new ideas to improve the quality of education we provide to our learners.