Virtual didactics exchanges to enhance trainee education.

To the Editor: The outbreak of COVID-19 has fundamentally disrupted medical education, including the broad shift from in-person to virtual didactics. Although many find virtual didactics cumbersome, one of its major strengths is the ability to render physical distance nearly irrelevant. We created a didactics exchange with a group of Mohs micrographic surgery and dermatologic oncology programs as a proof of principle to show that this type of partnership has the potential to improve fellow and resident education.

A convenience consortium of 9 fellowship programs located in the same time zone collaborated to offer live, virtual, attending-led didactic sessions on a full breadth of procedural dermatology, including lasers, cosmetics, and surgery. The videoconferencing software also supported discussion-based reconstruction sessions, where fellows could draw on images of surgical defects and discuss and design repairs. One coordinating faculty member offered technical support in setting up the meeting link, moderating questions, and recording if desired. When appropriate for larger audiences, lectures were posted online and shared with other programs nationally.

Fellows were given a preintervention survey in mid-April 2020 and postintervention survey in early May 2020 to assess their satisfaction with this initiative. All involved states had active stay-at-home recommendations during this time. Fourteen of 14 and 11 of 14 fellows completed the preintervention and postintervention surveys, respectively. With the combined efforts of our programs, we were able to offer live, faculty-led didactics sessions every weekday.

All fellows noted decreased surgical volume because of COVID-19. Thirteen of 14 fellows had a greater than 50% decrease in volume, with 5 of those having a 75% to 100% decrease. Before the exchange, 9 of 14 fellows were interested in more formal didactic sessions than currently available, with 12 of 14 interested in sessions by outside faculty.

Fellows generally did not have weekly didactic sessions before COVID-19. After COVID-19 started to lead to reductions in clinical volume, they participated in a median of 1 didactic session weekly before the exchange compared to 4 sessions weekly after. After rollout, satisfaction with the availability of didactics sessions went from a mean of 3.2 to 4.9 on a 5-point scale (with 5 indicating very satisfied). All fellows (100%) participated in sessions by extramural faculty, found outside faculty lectures valuable, found the didactics exchange valuable, thought the exchange improved his/her education, and would recommend that other programs set up similar exchanges for their fellows. One fellow commented, “The exchange felt like having the benefits of a national conference without the travel time and expenses typically needed. It also immediately connected all of the fellows and fellowship programs.”

Given that virtual education has become our current reality, this educational model can facilitate social support and augment medical education by congregating expertise and multiplying the number of didactic sessions offered to trainees. Software that allows fellows to draw on images can also be a better way to teach reconstruction than a traditional lecture. The idea of didactic exchanges and virtual lecture series can be applied to both residency and fellowship programs regionally, nationally, or internationally to train our next generation of dermatologists.