Virtual Morning Report during COVID-19: A novel model for case-based teaching conferences.

WHAT PROBLEMS WERE ADDRESSED?

Case‐based teaching conferences, such as morning report, offer trainees forums in which to refine their clinical reasoning skills. The need for physical distancing during the coronavirus disease 2019 (COVID‐19) pandemic has shifted medical education towards virtual learning. Educators must now leverage digital tools to support the ongoing education of medical trainees. To meet this need, the Clinical Problem Solvers developed and implemented a multi‐institution online model for morning report called the ‘Virtual Morning Report’ (VMR).

WHAT WAS TRIED?

The VMR was conducted on the videoconferencing platform Zoom TM (Zoom Video Communications Inc., San Jose, CA, USA). Each VMR included one or two clinician‐educators as facilitators, two to four volunteer medical students and residents as audiovisual ‘active participants’ and an unlimited number of medical students, residents, fellows and faculty staff as non‐audiovisual ‘passive participants’ who supported case discussions using Zoom’s chat function. One or two trainees served as scribes, recording case details and teaching points on a ‘virtual whiteboard’ that could be viewed by all participants. One participant volunteered to present a case at the start of each VMR. To increase synchronous communication between active and passive participants, facilitators solicited and shared contributions from the chat. We recorded and posted each VMR online for asynchronous viewing.

WHAT LESSONS WERE LEARNED?

The median number of participants during 15 VMRs was 100 (range: 58‐135). Across two randomly polled VMRs, medical students, residents, fellows and attending physicians represented 56%‐63%, 28%‐32%, 3%‐6% and 3%‐9% of participants, respectively. Active participants represented over 10 institutions. Passive participants contributed a median of 224 comments per VMR.

Offering value to all participants, not just active participants, is a cornerstone of the VMR. By asking specific questions in the chat, facilitators can engage passive participants and elicit a robust conversation that includes differential diagnoses, problem representations and diagnostic reasoning. Ongoing priorities include minimising inaccurate information and encouraging participants not to focus too heavily on naming the final diagnosis as quickly as possible. We have attempted to achieve these aims by sharing key learning points at the conclusion of each VMR and emphasising to participants that an objective of the VMR is to practise clinical reasoning, not to be the first to get the correct diagnosis.

Fostering a supportive learning environment on a virtual platform requires special attention. Open‐access platforms are vulnerable to unwanted participants. On multiple occasions, hackers invaded VMRs and shared explicit comments and images, an activity known as ‘Zoom‐bombing.’ Hosting password‐protected Zoom sessions shared through a moderated email listserv ensures the integrity of the VMR. Additionally, having a large number of participants makes it difficult to ensure all exchanges are supportive. Indeed, comments from passive participants were occasionally critical or disrespectful. After sharing at the start of each VMR the expectation that participants communicate with respect and assigning a senior faculty member to moderate chat content, negative comments fell.

Our experience supports the VMR as a viable model for virtual case‐based teaching conferences. Advantages include its adaptability during physical distancing, its accessibility via asynchronous viewing, and opportunities for multi‐institution participation. Future work will include evaluation of the impact of the VMR on clinical reasoning practices in trainees and exploration of the utility of integrating the VMR into clinical reasoning curricula.