Oct 21, 2020
By Richard L. Martin III, MD, MPH; Jennifer R. Green, MD; Elizabeth Henry, MD; and Martina Murphy, MD
From the moment the COVID-19 pandemic emerged in the United States in early 2020, it impacted all aspects of life, including medical practice and education. Hospitals in disease epicenters quickly exceeded capacity. Health care professionals, including trainees, found themselves suddenly covering entirely new roles to fill staffing shortages and patient care needs. Feeling wholly unprepared and ill equipped to manage a novel pandemic, health care professionals desired urgent cross-disciplinary training in COVID-19. However, with social distancing precautions and heterogeneous regional pandemic experiences, standard educational platforms struggled to fulfill these learning needs.
To overcome these barriers, the Hematology Oncology Collaborative Videoconferencing (Heme/Onc COVID) Learning Initiative—a trainee-driven multi-institutional virtual learning platform—was created with the aim of rapidly disseminating emerging COVID-19 knowledge. Leadership members were initially recruited through the ASCO myConnection community platform and ASCO’s network of training program directors, and consisted of clinical fellows and faculty from 13 U.S. hematology/oncology training programs. The concept was inspired by several prior successful education innovations, including peer-to-peer mentoring,1 remote surgical mentoring,2 virtual tumor boards,3 and continuing medical education videoconferencing, but it was unique in its attempt to integrate all of these components into a single learning model.
The Heme/Onc COVID Learning Initiative was also novel in identifying clinical trainees as the premier group to lead such an initiative. Prior educational literature has shown millennial cohort trainees to be experientially advanced users of educational technology,4 and trainees were also suffering from potential gaps in their current medical education due to the pandemic. Confronted by a moment of shared crisis and realizing an unmet need in their current educational curricula, we hypothesized that hematology/oncology trainees would not only attend, but could also build and lead a collaborative, multi-institutional educational coalition during the COVID-19 disaster—and we were right.
Demonstrating the Initiative’s Success
To prove the success of the learning initiative (a non-classical hypothesis), a voluntary, mixed methods REDCap survey5,6 was distributed to leadership trainees and faculty at the beginning and conclusion of the project. The survey was designed by an evaluation tools subcommittee which included leadership members with experience developing and applying educational research tools. Survey sections consisted of demographic data, past COVID-19 and educational leadership experiences, comfort with educational leadership roles, and open-ended questions on motivations, goals, and expectations for participation in the collaborative. Participants were informed that de-identified responses would be used for educational research purposes. All educational research components were reviewed and approved by an Institutional Review Board (IRB).
The median age of the 17 leadership trainees was 33. The group included 10 men and seven women; eight identified as Asian and eight as white. Four trainees were from community programs, and 8 trainees had already provided care to a patient with COVID-19.
At the project’s onset, trainee volunteer leaders had little prior experience leading in disasters (two of 17), medical education (four of 17), multi-institutional collaborations (zero of 17), or medical committees (three of 17). Compared to faculty leaders, trainees reported significantly lower initial confidence leading a multi-institutional collaborative; they rated their median comfort as 34 on a 100-point scale. They rated their median comfort in serving in committee leadership as 65, and conducting educational research as 50.
Qualitative Responses: Finding a Sense of Purpose Amidst Disaster
In the trainee responses to the open-ended survey questions, described below, a number of heartening themes coalesced around the concepts of collaboration, altruism, interpersonal connection, and humanism. When the Heme/Onc COVID Learning Initiative was initially conceived, the hope was that it could deliver tangible learning objectives in the absence of a functioning standard educational system. What these trainee responses reveal, however, is the capacity for shared education to fulfill a sense of purpose among individuals struggling to maintain their identity during an international disaster.
Despite very realistic concerns and minimal prior educational leadership experience, in just 6 weeks, the rapid voluntary leadership of the Hem/Onc COVID Learning Initiative members helped bring together 11 trainees and 26 faculty, representing 19 institutions and seven medical specialties, to produce five cross-disciplinary trainee-led videoconferences on COVID-19 management. The sessions averaged over 100 attendees, including trainees and faculty from both academic and community training programs.
Envisioning a More Collaborative Medical Education Model for the Future
The COVID-19 pandemic shook our identities as healers and lifelong learners. Galvanizing trainees behind a common educational purpose, the Heme/Onc COVID Learning Initiative provided an outlet to regain these medical professional identities. While the value of shared learning during non-disaster conditions remains unclear, many Heme/Onc COVID Learning Initiative trainees repeatedly referenced a broader need to reform medical education and increase general collaborative learning opportunities. Given these requests, further exploration of the potential of shared multi-institutional learning models in standard medical education is warranted.
Response Themes to Question 1: What prompted you to get involved with this project?
- Fulfill an emergent need and a duty to patients
- Meet, learn, share, and network with others
- “Appreciate the varying impact” of COVID-19 among colleagues
- Contribute, teach, and reform medical education to meet its potential
Collectively, the themes suggest that while trainees did, in fact, identify an emergent need to obtain COVID-19 knowledge on behalf of their patients, they were also drawn to the project by an opportunity to be part of something bigger and by an aspiration to improve medical education. While some trainees used individual framing for their motivations, most expressed their motivations through communal language, using words and phrases like “each other,” “inter-institution,” “we learn,” “me and my co-fellows,” “our institution,” “different places,” “shared nationwide,” and “be a part of something bigger.”
Response Themes to Question 2: What do you hope to learn?
- How to provide the best care to patients
- Build multi-institutional collaborations and appreciate other institutional experiences
- Identify and adapt to evolving data and stay up to date
- Guidance and evidence on navigating a pandemic
- Conduct educational research
Trainee learning goals mirrored their reasons for joining the project. Among these themes, however, collaborating with others and “breaking down siloed learning” were the most cited learning goals, suggesting that more than specific knowledge, trainees wanted to learn a new and integrated educational approach.
Response Themes to Question 3: In what ways do you hope this project can demonstrate success?
- Process measures: Rapid output, feasibility, sustained participation, lectures viewed
- Outcome measures: Improved comfort, knowledge acquired, positive impact on patient care
- Diversity of participants, institutions, and peer-to-peer perspectives
- Shared purpose, understanding, and connection by “fostering an educational culture”
- Engaging a new medical education model with ongoing educational partnerships and research opportunities
Trainees had broad hopes for success. Many trainees considered program success as achieving various process and outcome measures and/or generating new publishable medical education tools—similar responses to those of the faculty members surveyed. In contrast to faculty, however, many trainees also hoped success could be realized through less measurable humanistic qualities like “fostering education,” “harmonizing,” “creating shared purpose and connection,” and “community.” On several occasions, trainees also felt that incorporating a “variety of backgrounds” and involving “more heme/onc programs” would demonstrate success. Together, these themes suggest that fellows were not only hoping to better integrate inter-institutional learning, they were also hoping to improve trainee and program diversity and inclusivity.
Response Themes to Question 4: What are your concerns (i.e., limitations, barriers, etc.)?
- Lack of experience
- Balancing time with fellowship and clinical duties
- Content too limited: “Redundancy with other COVID lectures” should apply to standard lectures
- Program too broad: “Too complex to sustain or duplicate” with multiple fellows and faculty
- Organizing schedules, meeting times, and coordinating tasks remotely
- Faculty, institutional, organizational buy-in and broader funding and IRB
Trainees concerned about content and scope felt that the program would be easier to sustain if it simply recruited faculty members to give standard-of-care videoconferences made accessible to multiple institutions. Similarly, trainees worried that faculty would rather give a prepackaged talk than be asked to collaborate with multiple clinical fellows from outside institutions. With little prior experience and several competing demands, trainees were also concerned about their ability to commit time to the program, especially in the absence of any formal institutional supports.
Dr. Martin recently completed his chief clinical fellowship in hematology-oncology at the Vanderbilt University Medical Center. Dr. Martin is an assistant professor of medicine in hematology-oncology, co-director of oncology clinical trials, and medical director of the Sickle Cell Disease Program at Meharry Medical College in Nashville, TN. His research focuses on medical education and health equity in cancer care. Follow him on Twitter @DocMartinTN. Disclosure.
Dr. Green is the medical director of the Vanderbilt Hemostasis Treatment Center and associate program director for the Hematology/Oncology Fellowship Program at Vanderbilt University Medical Center. Dr. Green’s areas of professional interest include hemostasis/thrombosis, nonmalignant and systems-based hematology, and medical education. Disclosure.
Dr. Henry is a genitourinary medical oncologist and hematology/oncology training program director at Loyola University and Hines VA Medical Center. Dr. Henry participates in medical education research, evaluating the impact and use of social media for subspecialty medical education, and evaluating strategies for supporting residents and fellows through difficult clinical events in hematology/oncology. Follow her on Twitter @DocLHenry. Disclosure.
Dr. Murphy is a clinical investigator and medical educator specializing in gynecologic cancer. Her research focuses on the study and reduction of health care disparities and inequity as it pertains to patient-related outcomes in cancer care as well as workplace and training environments. She is the program director for the hematology/oncology fellowship program at the University of Florida, where she also directs the longitudinal clinical medicine course for first-year medical students. Follow her on Twitter @DrMMurphy. Disclosure.
- Chiu AS, Pei KY, Jean RA. Mentoring Sideways-A Model of Resident-to-Resident Research Mentorship. J Surg Educ. 2019;76:1-3.
- Huang EY, Knight S, Guetter CR, et al. Telemedicine and telementoring in the surgical specialties: A narrative review. Am J Surg. 2019;218:760-6.
- Rao S, Pitel B, Wagner AH, et al. Collaborative, Multidisciplinary Evaluation of Cancer Variants Through Virtual Molecular Tumor Boards Informs Local Clinical Practices. JCO Clin Cancer Inform. 2020;4:602-13.
- Hopkins L, Hampton BS, Abbott JF, et al. To the point: medical education, technology, and the millennial learner. Am J Obstet Gynecol. 2018;218:188-92.
- Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377-81.
- Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: Building an international community of software platform partners. J Biomed Inform. 2019;95:103208.