In Case of a Pandemic, Pivot: Moving the National Kidney Foundation Spring Clinical Meeting Online.

During the first week of March, the United States found itself facing the worst pandemic in more than 100 years due to the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19). The total number of COVID-19 cases was overall low in the United States during the first week of March, but the vulnerability of patients treated with kidney replacement therapy to poor outcomes with COVID-19 was becoming more apparent. A growing number of cases of COVID-19 began to emerge in dialysis units in Seattle, New York, Chicago, and Detroit. The first known US death due to COVID-19 at that time was a patient receiving maintenance hemodialysis at the Northwest Kidney Center in the state of Washington. In addition, the epidemiology of the spread of the SARS-CoV-2 now included the risk for asymptomatic spread between individuals.

The National Kidney Foundation (NKF) was in its last few weeks of preparation for the annual Spring Clinical Meeting (SCM) to be held in New Orleans, LA. More than 3,000 people had registered for the meeting and more than 300 faculty members were scheduled to provide educational content. During this period, employers began implementing travel bans, which prohibited a growing number of faculty members from attending the SCM. Several scientific meetings to be held around the same time as the NKF SCM were being cancelled. Implementing the NKF SCM as a face-to-face meeting looked less and less possible. The NKF faced a choice of either cancelling the meeting or making a dramatic pivot and moving the NKF 2020 SCM completely online.

Pivoting to something new is never easy. First, success is never guaranteed, and when breaking new ground, there is no opportunity to learn from the mistakes of others. Second, the lack of certainty that innovations will be accepted can be unnerving. There is no guarantee that stakeholders will approve of subtle changes, let alone dramatic ones, and forging ahead risks losing the confidence of the audience. Third, the financial implications cannot be reliably estimated because there is no precedent or any way to ensure success. In such times of large-scale ambiguity, leaders must rely on their mission statement or organizational purpose to help them steer the ship in uncertain waters. When it is unclear what an organization should do, the question should pivot to “What is the right thing to do?”

The mission of the NKF is dedicated to preventing kidney and urinary tract diseases and improving the health and well-being of individuals and families affected by kidney disease. Educating professionals on the most recent research and advances in clinical care for patients with all stages of kidney disease remains one of the most important tasks for the NKF. Every spring, the NKF provides one of the largest multidisciplinary educational meetings for all clinicians who treat patients with kidney disease. These educational offerings help maintain the highest standards of practice for professionals treating patients with kidney disease and help them obtain needed continuing educational credits to maintain their licenses. The NKF SCM offers learning tracks for nephrologists, dialysis nurses and technicians, physician assistants, nurse practitioners, pharmacists, social workers, transplant coordinators, and renal dietitians and is the one of the very few meetings to offer interprofessional educational opportunities for credit. Hundreds of new and established investigators also present research in poster presentations.

The NKF SCM also provides a forum for young investigators to showcase research funded by the NKF and for fellows, residents, and medical students to present interesting cases and research projects on kidney disease. During this meeting, professionals can also interact with industry and nonprofit sponsors to learn about the latest products and services to advance kidney disease care. Last, the NKF recognizes nephrology leaders for their contributions to research, teaching, and advocacy during the past year. These awards help the nephrology community celebrate its leaders and their accomplishments. Porting all of the educational content, poster presentations, and awards to an online platform seemed impossible. Many other organizations with scheduled in-person conferences during March decided not to move a conference completely online. NKF, with its long history of taking risk, simply decided that a pandemic could not halt its mission; it could only force NKF to pivot.

The NKF staff began working on making the SCM completely virtual in March but the change to an online format was not announced until March 10 because staff needed to ensure the feasibility of a completely virtual conference. Details of the virtual SCM planning have been previously discussed. When the decision was made to go virtual, NKF staff first notified the SCM20 Program Committee and then faculty despite multiple logistical unknowns in the planning.

Zoom webinars were used for the conference because staff was familiar with the technology. NKF staff set up a call with the Zoom account representatives to discuss options and ensure that 16 concurrent sessions could be held simultaneously during the course of a week. Multiple Zoom webinar licenses were then obtained and all participating faculty were individually contacted and trained on Zoom technology. Each SCM session was assigned a Zoom account and speakers were provided with a unique panelist link to access the Zoom webinars by email calendar invite. This Zoom link would bring speakers and panelists into a practice session similar to a “backstage,” in which they could prepare and converse with NKF staff, the session chair, and other speakers.

Attendees were notified of the pivot to a virtual SCM through a series of email announcements, social media, and NKF’s website. Buttons to access and register for each Zoom webinar were placed on the program schedule on the SCM website, as well within the SCM20 mobile app. When a session ended, the link/button was replaced with an updated “on-demand” link to access the recorded session. All attendees had to register their name and email address for every session (live and recorded). At the end of each day, attendee reports were downloaded and compared with the SCM20 registration report. Individuals who registered and paid for the conference were granted continuing medical education/continuing education credit. Abstracts and posters were presented through an e-poster platform that had been used for past meetings. Attendees could view these e-posters through the SCM20 mobile app or through NKF’s website. NKF encouraged attendees to view the posters and provide feedback to the poster authors through an evaluation form in the app, which enabled attendees to rate the posters’ design and content, as well as provide any open-ended feedback to poster authors. Box 1 lists some of the salient lessons learned from conducting a completely virtual SCM.

Be flexible when planning and executing virtual events

Technical issues may limit length of lectures during sessions

Best practices may be different for virtual events than for in-person events, eg, consider allowing audience to ask questions (through chat box) throughout the lecture in virtual meetings

Be proactive to minimize technical problems

Encourage all speakers and attendees to use a hardline internet connection instead of wifi when possible

Ensure at least 2 staff members to support each webinar; one person to deal with technical issues and the other to support speakers with slide sharing, launching poll questions, or other needs

Before the virtual session, provide faculty with basic training to bolster competence and comfort when navigating the virtual technology

Before sessions, have short practices in which connections and technology can be tested

Have 1 person read chat box questions from audience to ensure that all attendees are aware what is being asked

Consider incorporating active engagement strategies to keep attendees focused and engaged

Use hand-raise tools to engage audience in virtual meetings

Use polling software throughout the presentation to measure knowledge

Consider offering smaller interactive sessions in which all attendees are on screen and can interact with each other

Use various learning formats such as debates, panel discussions, case-based presentations, or a flipped classroom approach

Despite being in the midst of a growing pandemic, with daily lives of faculty, staff, and attendees being rapidly disrupted and many feeling distracted, the NKF virtual SCM exceeded participation expectations. The plenary session was viewed synchronously by more than 900 attendees and many other sessions had more than 300 attendees. Every session had strong participation from attendees with questions submitted through Zoom chat boxes. Active audience engagement strategies were implemented by more than half the conference sessions using Zoom’s polling feature. Multiple participating faculty reported a higher number of questions from audience members compared with in-person lectures at previous NKF meetings. Attendees reported strong satisfaction with the meeting and industry-sponsored talks showed higher numbers of participants compared with previous in-person lectures at previous NKF SCM. Plus, the recording of all sessions facilitated additional participation of other viewers outside the scheduled meeting time. The meeting also increased equity and accessibility. Persons without financial support for travel or who could not take time off from work could now participate in virtually all sessions, and this flexibility enhanced NKF’s ability to meet its mission. Overall (live and on-demand) participation exceeded 3,800 and was 24% higher than the previous year. The virtual format included 130 sessions and 338 presenters and included Deputy Secretary Eric D. Hargan of the US Department of Health and Human Services as the Plenary Speaker who presented the KidneyX Patient Innovator Awards. Most importantly, the meeting allowed participants a chance to distance themselves from the COVID-19 pandemic for a few hours and focus on learning new aspects on the care of patients with kidney disease.

In summary, NKF’s virtual SCM served as an early demonstration that large-scale virtual medical conferences can be successful. Participation in virtual conferences can exceed participation in conventional conferences and overall satisfaction. Virtual conferences lack multiple social aspects of in-person meetings. However, the heightened access for attendees who could not travel for in-person meetings exemplifies the efficiency and equity of virtual conferences and may balance these social setbacks. We thank the NKF staff, Program Committee, and entire faculty for their courage in helping NKF successfully conduct its very first virtual SCM.