Practicing communication, with good feedback, helps us get better at our jobs in healthcare. This is especially important for ‘high stakes communication’ (but really is there any other kind 😊). In this episode of the HMI podcast, Vic speaks with Laura Rock about her recent paper: Communication as a High-Stakes Clinical Skill: "Just-in-Time" Simulation and Vicarious Observational Learning to Promote Patient- and Family-Centered Care and to Improve Trainee Skill.

Her key messages are about the power of rehearsal with feedback for better communication, and the need to practice the actual words we will use. We highlight that this approach appropriately elevates the status of communication as a critical skill, along with other procedural skills. Laura describes strategies like the use of scripts, and developing the ‘microskills’ of communication, as well as recognising the fundamental role of recognizing and responding to emotions in both patients and learners.

Why did I use a chameleon to illustrate this blog post? Chameleons have a unique ability to adapt to changes in their environment. The illustration relates to how during COVID-19 all educators and learners had to rapidly adapt and introduce some makeshift changes to teaching and learning. The lack of any face-face interactions with learners was especially mindboggling! As an educator who appreciates “connection” between teacher and learner, I endeavored to find ways to connect to my learners. During the same period Zoom emerged as a “technology” defining the time. Although technology is sometimes deemed to lose the human touch, I found that during pandemic time the use of technology emerged as a powerful way to connect to my learners. In this post, I share my practical experience with using the Zoom annotation tool in a first year medical school anatomy course. I describe why I used the Zoom annotation tool, where the tool is found, and how students used the tool? I also offer a theoretical framework to support the use of technology in teaching.

Pre- COVID-19 pandemic, many faculty members arrived to committee meetings late, perhaps rushing from clinic or a prior meeting across campus that ran over the expected time. The entry door was at the front of the room, near the presenter, so each late attendee disrupted the speaker and participants as they sifted through the attendance sign in sheet and collected document copies. At the end, meeting attendance documentation sometimes indicated high absences from voting-members of the committee, with sometimes barely over half of the voting members having attended. This might have been due to distance to travel or inconvenience of work flow to get to another part of campus. The meeting room was arranged with traditional small rectangular tables in rows facing the speaker at the front of the room, so questions from the group were directed at the speaker.

Dr. Lara Varpio challenged educators and thought leaders in health professions education (HPE) to rethink the impossible during her Generalists in Medical Education plenary talk entitled “When the Earth Moved Under Our Feet.” In reflecting on changes in health professions education during the COVID-19 pandemic, Dr. Varpio suggested that there were “earthquakes” in our thinking—seismic events that shook the very foundations of our core as educators and thought leaders. She helped the audience reflect on changes to our normal every day practices that we once knew to be true. Speaking of change…

Encompassing 240 beds across multiple care units, VA Bedford is one of the largest long-term care facilities in the VA healthcare system. Normally the geriatrics rotation at VA Bedford took place on the Geriatrics Evaluation and Management Unit, a 24-bed inpatient subacute rehabilitation and skilled nursing unit specifically designed to manage older Veteran patients in need of post-acute or community-dwelling veterans in need of complex geriatrics care.

Prior to the pandemic onset, residents came from 3 internal medicine and family medicine residency programs and rotated on two- or four-week blocks. Two residents, working under the supervision of an attending physician, are typically on rotation at any one time. To fulfill geriatrics training requirements, the residents participated in patient care and regularly structured didactic, active-learning, and self-directed experiences.

We thus sought to maintain a core geriatrics education program while adhering to restrictions imposed by the need to minimize exposure and transmission of SARS-CoV-2, the causative agent of COVID-19. From the onset of the pandemic in March 2020 until October 2020, several months following a surge in the U.S. Northeast, we converted the geriatrics rotation at VA Bedford to a fully virtual non-clinical GME experience.

Our overarching goal was to deploy the original curriculum, including its learning objectives and provided educational resources, virtually so that even with COVID-19 restrictions residents could complete the rotation with core tools needed to care for older adults. The topics covered fell under the major themes of geriatric syndromes, comprehensive geriatric assessment, and serious illness and end of life conversations.

We structured the rotation as much as an intensive graduate course as a clinical rotation, with the expectation that the resident would put in vigorous effort to engage with the material. We provided an orientation packet that detailed the curriculum, a robust set of educational resources, a guide for self-directed learning, and a schedule of daily learning activities, all accessible either on a shared website or in a physical binder. Learning sessions were typically conducted via video conferencing using secure Skype or Microsoft Teams platforms. Both have features that enable video conferencing and include a range of built-in tools that allow for screen sharing, file sharing, breakout rooms, and slide presentations. These video communication platforms created an interactive virtual environment that enhanced engagement between the instructor and learners.