Integrating Virtual Teaching in a New Era of Medical Education: Lessons from a Neurology Course

Figures & data

Table 1 Risks and Benefits of Virtual Learning

Risks

Impersonal, isolating learning environment for students

Uncertainty about how, when to participate and ask questions

Lack of hands-on practice (eg cadaveric dissection for neuroanatomy instruction, examination of patients)

Lack of comfort and experience among faculty with using virtual technologies

Time required to create new material

Learners may lack the focus or self-discipline to remain actively engaged

Benefits

Students prefer mixed modality instruction, utilizing technology and some virtual formats

Virtual formats allow for dissemination of educational material to a broader audience

Opportunities for cross-institutional and even international collaborations

When used appropriate, virtual methods can improve educational quality

Creates learner-centered experiences

Table 2 Key Strategies to Avoid Pitfalls in Virtual Teaching

Balance synchronous teaching sessions and asynchronous material

Instead of delivering traditional lecture formats via live teleconferences, rely on asynchronous formats to introduce new material

Focus on interactive application of material in synchronous sessions

Match expectations for asynchronous pre-work to the needs and competing demands of your learners

Divide recorded sessions (eg lecture) into shorter segments, each focused on 1–2 learning points

Give yourself plenty of time to practice with new virtual tools before relying on them in your teaching

Establish clear norms for participation

Use tools such as annotation, polling, and breakout rooms to foster student participation and engagement

Focus on the learning environment – ensure learners get to know you and have opportunities to interact with one another

Respect learners’ personal circumstances in virtual sessions

Acknowledge the difference between Emergency Remote Teaching (ERT), a temporary shift to the delivery of content, and e-Learning, where content is designed for online learning^Citation17

Figure 1 Use Annotation to Facilitate Student Participation and Encourage More In-Depth Class Discussions. Two examples are provided to highlight the use of annotation during synchronous sessions delivered over teleconferencing software (Zoom, Inc.). (A) In a breakout room, a small group of students has independently drawn out the two ascending sensory systems. This active form of learning allows more students to test their current understanding of the material accurately. (B) A review question is delivered to students using PollEverywhere^® software. Instead of fielding individual questions from students one at a time, the instructor has asked students to provide the rationale if they answered correctly or to ask a question if they do not understand the correct answer. Using simple reactions over annotation, students can emphasize questions they share, clearly and efficiently demonstrating to the instructor where to devote time to providing their own explanations.

Table 3 Example of the Development of a Virtual Learning Program Focused on the Teleneurology for Neurology Residents, Using the 5-Step Framework

Step	Curricular Example
Identify learning goals	Build comfort with the virtual neurologic exam Improve communication for virtual neurologic visits Understand remote assessment limits Comfortably use all technology Familiarize with billing and licensure issues Recognize telehealth’s impact on healthcare disparities
Determine the scope and structure of content	Asynchronous learning objectives: Recognize limitations of teleneurology Develop comfort with technology Become familiar with billing and licensure Synchronous learning objectives: Practice virtual performance of the neurologic exam Practice communication in teleneurology Practice use of technology
Select assessments	Test knowledge and attitudes before and after Assess participation in sessions Review clinical vignettes with faculty Practice clinical skills with standardized patient observation
Select teaching methods	Asynchronous learning activities: Readings on professionalism in telemedicine, conversion of the neurologic exam, and technology and healthcare disparities Pre-recorded videos demonstrating the virtual exam and discussing medicolegal aspects of teleneurology Synchronous learning activities: Case vignette review/group case-based learning Peer practice of the exam Observed clinical skills examination with standardized patient
Develop schedule and content	Asynchronous content	Module 1: Historical background Module 2: Medicolegal and licensure expectations Module 3: Webside manner Module 4: Privacy considerations and informed consent Module 5: Teleneurology skills
	Synchronous active learning	● Outpatient teleneurology observations ● Exam practice ● Teleneurology in continuity clinic
	Assessments	● Pre- and post-assessments (MCQ) ● Clinic feedback ● Virtual OSCE

Table 4 Matching Teaching Methods to Desired Outcomes in the Creation of Virtual Teaching Activities

Outcome	Optimal Teaching Methods
Knowledge acquisition	Reading Lecture or video review Case-based learning
Skills acquisition	Video review Simulation Real-world application
Critical Thinking	Reading Case-based learning Team-based activities

Fuchs K. The difference between emergency remote teaching and e-learning. Frontiers. 2022;7:921332.

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