In this issue of Academic Pediatrics, we feature ten 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 three 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/tele-rounding
(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, 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 tele-rounding
(n=8; 30%), and inpatient tele-consultation 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 be 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.
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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.
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Lang and colleagues described creation of a novel website to curate multi-institutional
standardized resources for pediatric providers caring for adults.
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Both papers showcased the ability to use virtual platforms to rapidly leverage networks
and disseminate information. Beer and colleagues 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.
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The ability for programs to leverage expertise beyond their intuitional 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 inter-disciplinary
primary care clinic mock code training to online simulations.
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Programs with remote clinical sites may opt to trial virtual simulation in the post-COVID-19
era. Lara and colleagues described standardized patient encounters via teleconferencing
to accommodate remote assessment of learners using a virtual observed structured clinical
encounter (OSCE).
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Their results suggest a comparable ability to assess students, making virtual OSCEs
a potentially feasible option for institutions with learners at distant sites or limited
access to simulation centers. Babel and colleagues described addressing wellness via
a remote storytelling activity with faculty sharing vulnerable narratives with learners.
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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 and colleagues shared a curriculum to equip students
as advocates for science at the virtual frontlines via their social media presence.
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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.
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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.
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Patients, institutions, accrediting bodies, and insurance providers have rapidly adopted
telehealth, providing future opportunities to evaluate care provision, supervision,
and outcome comparison.
While inpatient tele-rounding was developed to minimize personal protective equipment
usage, a critical, but short-term necessity, this innovation has accelerated incorporation
of tele-consultation, which may be useful for smaller programs to provide subspecialty
advice when a specialist is not locally available. In addition, as Roger and colleagues
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.
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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.