The Covid-19 pandemic has forced medical conference to go virtual. Scoliosis Research Society leaders describe their experience moving the society’s largest meetings online including benefits (such as increased access for far-flung attendees), challenges (such as maintaining engagement), and their vision of future hybrid in-person/virtual meetings.
With in-person medical conferences curtailed during the Covid-19 pandemic, physicians across specialties have struggled to continue the development and training they’ve historically relied on these meetings for. Procedural subspecialists such as surgeons, gastroenterologists, and cardiologists in particular have long depended on live courses that use cadavers or simulation exercises to maintain their skills and to learn new techniques. Curtailed as well has been the personal and professional satisfaction of interacting with colleagues at these events, and the face-to-face discussions that lead to new research and academic collaborations.
Responding to these losses, medical organizations have rushed to try to recreate them online, with varying success. As senior leaders in the Scoliosis Research Society (SRS), a worldwide group of spine surgeons, researchers, and associated professionals dedicated to improving the care of patients with spinal deformities, we have been closely involved in the planning and operations of the SRS’s largest meetings: The International Meeting on Advanced Spinal Techniques (IMAST) and the SRS Annual Meeting.
Before the pandemic, IMAST typically drew 750 or more attendees and the SRS 1,500 from dozens of countries. The pandemic forced a fundamental rethink of these meetings and how they could accomplish their goals in a virtual format. The experience we describe here captures the challenges conference leaders and participants faced, and opportunities we see for virtual medical meetings in the future.
Pivoting to Virtual
The 2020 IMAST was originally scheduled to be held in Athens, Greece and the SRS Annual Meeting in Phoenix, Arizona. IMAST was to take place two weeks after the pandemic was declared in mid-March. This was our most challenging pivot given the minimal time we had to prepare, and that SRS members were busy adapting to pandemic life at work and at home.
Historically, IMAST meetings have been held in major cities (Amsterdam, Cape Town, and Los Angeles most recently) with more than 100 presentations spread across three or four consecutive days. These talks are delivered in various formats including primary research abstract presentations, instructional course lectures, case-based discussions, debates, poster presentations, and industry workshops. For the 2020 meeting, leadership attempted to recreate the in-person meeting virtually by delaying the start by three months, allowing time to prepare, and then spreading the conference over five consecutive Saturdays in July and August. The course material combined live sessions and pre-recorded content. Each of the weekend sessions was kept relatively short, ranging from 30 minutes to three hours long.
Insight Center
For the 2020 SRS Annual Meeting, which has a similar format to IMAST, our leadership took a different route, holding the entire virtual conference on the originally scheduled four consecutive days in September, with two to four hours of content per day. Nearly half of the planned conference hours were presented live as concurrent sessions, and the remainder were available as recorded self-paced learning sessions.
While IMAST attendance and participation was excellent during the first weekend (about 75% higher than that at previous live-meeting opening sessions), it unfortunately declined significantly in subsequent weeks by approximately 25% per weekend, reaching its lowest on the final weekend.
Turnout during the SRS annual meeting live video sessions was somewhat less strong but still respectable, with attendance reaching nearly two-thirds the number of participants we’d see in a typical pre-pandemic year. Sessions garnered strong reviews and had high levels of participation via the chat option — a 10-fold increase over previous years in audience questions during each session, which faculty answered by text during the session.
Lessons Learned
While virtual meetings present challenges, there are clear benefits as well. Participants at both IMAST and the SRS Annual Meeting included many who might have had difficulty attending an in-person meeting because of geographic or financial constraints, among them residents, fellows, and surgeons from developing countries. Further, these learners may in fact be more engaged than they might have been at an in-person meeting because of the available interactive chat and Q&A functions. In years past, younger surgeons and those with language barriers have often been more reluctant than others to come to the microphone in a large auditorium, but this year they frequently engaged in the online discussion during presentations.
Another benefit of virtual meetings is that by eliminating the need for travel, attendance demands less time. In addition, virtual meetings facilitate asynchronous learning; while only some sessions at previous IMAST and SRS annual meetings were recorded, all sessions at this year’s meetings were, allowing participants to view them at their convenience. Content is cataloged so it can be accessed easily via advanced search mechanisms, allowing physicians to tailor their education to precisely the topics that interest them or to fill specific knowledge gaps as their schedules permit. While limited asynchronous engagement with medical conference content has been available for years, the pandemic has forced meetings to vastly increase the content they make available online — an innovation that we believe will continue after the pandemic subsides.
These benefits are balanced by new challenges. For example, our spinal surgery society has a global membership, and coordinating a live virtual meeting across many time zones proved difficult. While asynchronous learning has clear upsides, there are unique advantages to participating in a live digital presentation, chief among them the ability to interact with speakers in real-time. However, as our meetings were often built around an Eastern Standard Time schedule, many members from around the world struggled with the timing of presentations that occurred in the very early morning (U.S. West Coast) or late at night (Asia and Australia) in their time zones, reducing their engagement. Finally, as anyone who has attended even small virtual meetings knows, “technical difficulties” are common, and perhaps more so as meeting size scales.
Perhaps the biggest barrier with the transition to virtual education is the difficulty of sustaining attendees’ undivided attention. While an in-person conference requires physicians to set aside patient care and administrative tasks for travel and focused, multi-day attendance, there is no equivalent process with virtual learning. Physicians, accustomed to multi-tasking, often schedule the activities of their on-going day-to-day lives simultaneously with the virtual sessions, with the result of constant personal and professional distractions. Ultimately, the learning commitment in virtual formats may not be as strong as it is in face-to-face meetings. Measures such as requiring participants to turn on their cameras, offering two-way interactive sessions, and facilitating frequent participation through direct questions to participants can help to an extent but fall short with large groups.
Even these measures probably can’t fully address the loss of face-to-face contact that in-person meetings provide, connections that are critical in breeding new research collaborations and for early-career doctors in establishing the new personal and professional relationships that are so important, particularly for those in academic medicine.
The Future
With these benefits and limitations in mind, we anticipate the future will encompass a more limited, but still highly influential in-person educational world mixed with an optimal amount of virtual educational content. During the past six months, virtual conferences have largely tried to reproduce in-person meetings online, with mixed success. We expect that the majority of conferences held over at least the coming six months will continue to be held virtually.
Drawing on our experience this year, be believe that the keys to increased attendance and engagement in a virtual format are to keep session lengths brief (no longer than three to four hours per day); to time live sessions to accommodate the schedules of the largest number of participants; and to run the full meeting over several consecutive days rather than spread over several weeks. Multiple concurrent Q&A chat rooms on sub-topics relevant to the main subject matter also facilitate more engagement and focused discussion.
For surgeons such as ourselves, the transition to a virtual education format has been particularly challenging. Surgeons continue to learn new and advanced techniques after their residency and fellowship training through hands-on learning experiences, and their proficiency can be assessed partially during this training. The virtual world currently lacks an accepted way of assessing surgeons’ skill. Because of this, we believe that surgical and procedural training will mostly continue with live, in-person courses after the pandemic.
Nonetheless, the push toward virtual training presents great opportunity for innovation. Virtual reality, augmented reality, and 3D procedural simulation will allow for remote teaching and assessment of a new surgeon’s skill with a variety of techniques, thus enhancing safety and value in care delivery. Indeed, technologies such as these could revolutionize residency and fellowship training by providing a mechanism for surgeons at smaller training programs or in developing countries to learn techniques virtually from master surgeons around the world.
As the population is vaccinated and Covid-related risks decrease, the goal for physician education should be to capitalize on the virtual format and provide an enhanced hybrid in-person/virtual experience. Based on our experience this year we believe that the largest meetings with an international group of attendees will be most valuable when hosted live rather than fully virtual, to avoid time-zone difficulties with scheduling presentations and panel discussions. However, routine live-streaming and recording of these in-person conferences, which was done inconsistently before, should become standard to allow learners who cannot physically attend to join virtually to the extent possible and engage asynchronously.
While in-person meetings are valuable in launching research collaborations, we believe that that these can benefit substantially from the virtual-only format as well, as this allows for more frequent meetings to brainstorm, discuss, and finalize research projects and analyze their outcomes. We also speculate that the virtual format will help to engage other medical subspecialists who might not travel for an in-person meeting only tangentially related to their specialty. This will certainly help foster interdisciplinary education and collaboration between medical specialties that would otherwise have limited interaction, and facilitate partnerships and new directions for research that are certain to improve medical care.
Ultimately, creating a culture and tradition in continuing medical education of committing time to virtual learning will be needed to derive the greatest benefit from virtual and virtual-plus-in-person meetings. While it’s difficult to find silver linings in the current pandemic, perhaps the emergence of hybrid learning models, which can potentially yield benefits greater than either alone, will be one.