Henry Bair (@_HenryBair_) and Paul Horak
BEING MORTAL
Since our first year of medical school, we have directed three cycles of a highly interactive seminar course titled, Being Mortal. The course aims to address educational gaps in the standard medical school curriculum related to various aspects of aging, end-of-life care, and serious illness conversations. Over 10 weeks, we cover such topics as the health economics of long-term care, biochemical processes of aging, advance directives, palliative and hospice care, and the role of spirituality.
The course content is difficult for some students to process and discuss, requiring the development of a psychologically safe learning environment. There was a pressing concern for us to create a classroom space in which students felt comfortable to share and connect with one another. We therefore emphasized several deliberately-designed, community-building features of the course. We encouraged students to use reflective practice to link course content with their personal experiences and interests, and we included classroom activities that engaged students with our faculty guest speakers.
LESSONS OF VIRTUAL LEARNING
The shift to virtual learning left us debating the merits of offering the course at all. The COVID-19 pandemic led to rapid changes in medical education, most notably with a widespread shift to online learning. Educational experiences aimed at teaching interpersonal communication skills presented numerous challenges from virtual learning. Still, we forged ahead with an online version of our seminar, delivered through Zoom, the popular video conferencing platform.
We learned 5 important lessons about leading an online seminar course focused on interpersonal communication skills and peer learning. Virtual courses demand more from instructors. In our experience, the planning, execution, and follow-through necessary to teach a high-quality online course took more time and effort than our in-person seminars. These extra challenges required us to be very intentional—toward fostering community, keeping students engaged, using the many tools of Zoom, knowing one’s limits, and so much more.
1. Deliberately design your online ‘classroom’ experience to foster rich student connections.
- We wanted to avoid delivering our virtual course in the exact same way that we did in person.
- We chose to limit enrollment in our course to 15 students. The small class size facilitated student interactions and a classroom community.
- The first class session was dedicated to student introductions and reflections. Everyone had ample time to share their personal stories and interests, professional and otherwise.
- Students shared photos and bios with one another and the guest speakers. In addition, we asked them to explain their motivations for enrolling in a class on mortality.
- We kept the conversations going, with approximately half of each class session dedicated to guided group discussions. Engaging students early in the term had many positive effects in these subsequent sessions.
2. Prep your speakers for virtual teaching.
- We found our speakers to have varying comfort levels with virtual teaching, and thus devoted considerable time to coaching them in advance of their sessions.
- We worked closely with them to determine the ideal format for their sessions and the best teaching techniques to use. For example, a virtual session on how to discuss goals of care should differ notably from a session about the financial costs of long-term care.
- Virtual learning sometimes makes it more difficult for students to speak up during class, and it can also make it harder for speakers to leave ‘breathing room’ in their presentations. This was something we emphasized repeatedly to our guest speakers—to be at ease with silence online, not feel pressured to talk as filler, allow students to ask questions, and confirm understanding of the course material.
3. Adjust your teaching for the limitations of virtual platforms.
- Despite our best efforts to build engagement, virtual learning was intrinsically less engaging than an in-person class. Zoom fatigue is a well-documented phenomenon, therefore we limited the length of each class session to less than 1 hour and limited the use of slides.
- Tech issues arise that may interfere with class. To mitigate this, we rehearsed a dry run with each speaker and budgeted extra time ahead of each session to resolve any last-minute issues.
- We found that discussions on virtual platforms have to be well-planned in advance. With Zoom, it can often also be easy for students to ‘hide’ from conversations. We therefore spent time prior to each class crafting key takeaway points and then structuring in-class questions around those learning points.
- Finally, the design of Zoom is such that whoever is speaking instantly commands the screen and this renders spontaneous classroom discussions awkward or altogether impossible. Therefore, we normalized calling on students for questions/answers.
4. Embrace the experimental.
- Virtual courses can allow for more pedagogical diversity. An in-person seminar often establishes a regular cadence very early in the term, which then persists unless intentionally interrupted. With Zoom, it is easier for each session to be approached as a pedagogical tabula rasa.
- In our seminar, we had thematic continuity from session to session but experimented with session format.
- For instance, we presented a mix of didactic, Socratic, small group discussion, and story-telling formats.
5. Leverage the strengths of Zoom but keep it simple.
- Zoom has many great features that aren’t easily replicated with in-person instruction, such as breakout rooms; ease of sharing videos, documents, hyperlinks; polling; and screen sharing. Wise use of these features promoted increased engagement and student interactions.
- In our course, some students felt more comfortable using the chat function than speaking up or interrupting speakers. Used intentionally, chat offers productive backchanneling, elaboration of questions and course content, and a method for sharing links to additional resources.
- Zoom tools can be useful for instructors and may help students stay engaged… however, these functions come with some risk.
- We found it difficult to seamlessly use more than one Zoom feature in any individual session. For example, breakout rooms get students talking more, but polling or screen/video sharing is then lost.
FINAL REFLECTIONS
A virtual platform forced us to be more intentional in our teaching and fostered more experimentation in pedagogy than previous iterations of the course. By the end of our seminar, we were surprised that we could execute a complex, patient-centered course without ever meeting our students or the other lecturers in person.
Although we look forward to a return to in-person classes, our experience taught us that there may be benefits to virtual learning that should not be forgotten. For us, these included opportunities to experiment with different speakers and teaching styles, new discussion formats and community-building techniques, convenience, and scalability. In the future, we plan to have hybrid in-person and virtual seminars to leverage the best features of both ways of teaching.
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About the authors: Henry Bair and Paul Horak are medical students at Stanford School of Medicine. This piece was a writing assignment on curriculum design in the course, Advances in Medical Education.
Edited by: Michael A. Gisondi, MD is Vice Chair of Education in the Department of Emergency Medicine at Stanford School of Medicine. He teaches the course, Advances in Medical Education. Twitter: @MikeGisondi
Header image: Angel of Grief, Campus of Stanford University. Credit: M. Gisondi
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