Practical tips and/or guidelines
Open Access

Practical tips for faculty development workforce training under pressure in the time of COVID-19 pandemic

Rahim Kachra[1][a], Irene Wai Yan Ma[1][b]

Institution: 1. University of Calgary
Corresponding Author: Dr Irene Wai Yan Ma ([email protected])
Categories: Curriculum Planning, Educational Strategies, Continuing Professional Development
Published Date: 27/04/2020

Abstract

The COVID-19 pandemic has been a stimulus for innovation in medicine. It has inspired a re-imagination of the traditional delivery of healthcare, as providers explore novel approaches to patient care and medical educators navigate how to rapidly rollout educational materials to prepare the workforce for front-line care. Although there is a plethora of literature about creating medical curricula in general, there is a dearth of resources directing educators how to deliver education in a time and resource limited setting. The following practical tips will help medical educators identify gaps, create materials, and deliver education under pressure.

Keywords: Continuing medical education; COVID-19; Online education; Education, professional, retraining; Medical education

Introduction

A novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its resultant coronavirus disease 2019 (COVID-19), has brought about an unprecedented change in the way healthcare is delivered throughout the world. In short order, clinicians worldwide have grappled with the need to rapidly learn about the disease, its diagnosis, manifestations, complications, transmission patterns, and how best to protect themselves from contracting the disease. Concurrently, they are responding to recommendations of physical distancing (Centers for Disease Control and Prevention. Social Distancing, Quarantine, and Isolation, 2020) and adapting to the implications of these recommendations on how to deliver care, ranging from implementing telemedicine (Hollander and Carr, 2020) to curtailing many elective diagnostic and imaging practices that were once considered routine care (American Society of Echocardiography. ASE statement on protection of patients and echocardiolography service providers during the 2019 novel coronavirus outbreak, 2020; Rubin et al., 2020). As the demand for our health system continues to be overwhelmed, to deal with the shortage in healthcare providers, some retired clinicians are re-joining the workforce, and others are deployed to practice either in unfamiliar environments or in new clinical roles (Ehrlich, McKenney and Elkbuli, 2020; Willan et al., 2020). The demand for the rapid delivery of education has never been more pressing. This article offers 12 tips for educators to consider in delivering education in such times. While the focus of the article is on the current pandemic, many of these tips apply to settings where education needs to be delivered under pressure.

Tip 1

Conduct rapid reviews to distil relevant educational content and identify key gaps

 

Educators need to critically but rapidly evaluate existing literature and identify key domains of relevance for addressing gaps in content knowledge, skills, or processes. Educators need to also recognize that evidence may or may not exist initially, therefore ongoing review is integral to identify new evidence when available. Working closely with those with the requisite content expertise and information specialists well versed in conducting rapid reviews is critical.

Tip 2

Don’t reinvent the wheel, at least not right away

 

Whenever possible, use developed content that is already available from reputable external sources, including regional, national, or international society guidelines, or primary literature. This content can be identified during your rapid review. As the goal is to make content available quickly, direct your learners to these sources early and solicit feedback. Once the scaffolding is built for your overall curriculum, then repackage this information to better fit within your dissemination platform. 

Tip 3

Target educational content to the right setting

 

Educators need to recognize that content must be targeted appropriately to the right setting. While existing content fulfils many educational gaps, some local adaptation may be necessary. For example, teaching infection prevention and control measures at a local level may differ in content from that of teaching at a regional, national, or international level, as availability and types of personal protective equipment (PPE) may differ significantly. Careful attention to these relevant contextual differences will help determine what educational content can be reused, and what content needs to be adapted or even created de novo.

Tip 4

Anticipate different learning needs depending on the target audience

 

More important than ever is the need to know the learning needs of the target audience and learners. Re-training of retired clinicians may require a refresher of not only content but also practice-based processes, which may differ from the training needs of practicing clinicians who need to perform outside their usual scope of practice but in a similar hospital environment, (e.g. training hospitalists to practice in the intensive care setting). There may not be time to conduct a comprehensive needs assessment (Kern et al., 2009). In some settings, the target audience may not even be known to the educator until the educational content is developed. Being able to anticipate their needs and creating materials that address these will optimize workforce recruitment efforts. Subsequently, resources can be directed towards refining your educational content based on feedback.

Tip 5

Determine an optimal knowledge dissemination strategy

 

In the context of physical distancing, the learning format will likely need to be online. Within this setting, educators should work with their institution’s experts in learning management systems and user interface design to optimize the delivery of educational content. House the educational content within a familiar online setting in order to minimize perceived and actual barriers to access. Use the best type of media available to support your message. For example, a series of short videos, podcasts, or interactive modules may be more effective in many settings than simply offering links to documents.

Tip 6

Anticipate rapid and frequent changes to content

 

In an environment of pervasive uncertainty, educators no longer have the luxury of perfecting their curricular content prior to delivery. Educators must do the best they can with the evidence available to them, recognizing that perfection is the enemy of good. Not providing guidance where guidance is needed may do more harm than providing best available guidance that may need to be modified later. Educators need to be nimble and anticipate that changes will need to be made. Recognizing ahead of time that change will be inevitable will allow for a built-in mechanism to address these changes, both in establishing contingency plans and in ensuring a viable method exists with which to communicate necessary changes.

Tip 7

Manage information overload

 

In times of rapidly changing data and processes, information overload will be inevitable. Educators can facilitate the management of information by providing a framework for learners and creating clear pathways to access just-in-time learning. For example, if admission processes change frequently, teaching learners where to look for protocols will be more valuable than teaching them details of current processes.

Tip 8

Maintain open channels of communication

 

Early and frequent communication to increase awareness and understanding in key stakeholders is critical in disaster management (Perko, 2011). Addressing urgent educational needs of your learners is no different at these times. While establishing a single source of communication is important, it is equally important to recognize that communication is a bi-directional pathway. Updates in content and processes must be communicated to learners rapidly and reliably, and feedback from learners must also be obtained rapidly so that urgent educational needs can be addressed in a timely fashion.

Tip 9

Be sensitive to your learners’ emotions

 

These are challenging times. It is imperative that educators recognize that the emotional state of the learner may negatively impact their learning, such that educational strategies that previously demonstrated effectiveness may no longer be as effective (Vogel and Schwabe, 2016). Educators may need to modify curriculum implementation strategies to accommodate. Allowing learners to complete modules at their own pace, or in a repeated manner until mastery is achieved will help learners achieve the competency needed.

Tip 10

Adhere to sound educational principles

 

Despite the volume of content and the urgency of delivery, adherence to sound educational principles can help optimize the educational experience during the instructional design stage, such as incorporating features of deliberate practice (Ericsson 2004), building in assessments for mastery-based learning (McGaghie et al., 2014), careful use of technology-enhanced education (Cook et al., 2011), and paying attention to cognitive load issues (Sweller et al., 2011).

Tip 11

Celebrate early successes

 

These are challenging times for the educators as well, as content development alone may seem like a never-ending task. It is helpful to build in measurable educational outcomes (e.g. number of learners who successfully completed the module) such that early successes can be celebrated. Share these outcomes with your education team, learners, and administrators. Content revisions should not be viewed as a failure.

Tip 12

Build in redundancy

 

Many educators may also be deployed as frontline workers. Redundancy should therefore be built into the educational leadership team such that ongoing educational efforts are not halted as educators are called to the frontline. In these unprecedented times, a team-based approach allows for educators from different backgrounds to pool best-practices and trial novel interventions early. This redundancy will also facilitate rapid iterations in response to feedback.

Conclusions

Education leaders are integral in training physicians to work in unfamiliar territory. There are many skills that require refinement for working during a pandemic, including building familiarity with new hospital processes, understanding the use of electronic medical records, and mastering infection prevention and control, amongst others. The burden of acquiring large amounts of new knowledge in a limited time frame can be overwhelming for both learners and educators. However, with some specific strategies and a structured approach, medical educators can help curtail fears and anxieties by creating and delivering educational content quickly and effectively.

Take Home Messages

  • The COVID-19 pandemic has resulted in significant changes in the way healthcare is delivered. To deal with the shortage in healthcare providers, significant workforce retraining is needed.
  • The educational needs at these times are vast and urgent, which can be overwhelming both for educators and for learners alike.
  • This article offers practical tips on how to manage content, anticipate needs and changes, and adhere to educational principles so that instructional designs can be optimized in these challenging times.

Notes On Contributors

Rahim Kachra, MD, EdM is a clinical associate professor, Department of Medicine, University of Calgary and is the co-MD Training Officer of the Calgary Zone Medical Emergency Pandemic Operational Command.

Irene W. Y. Ma, MD, PhD is an associate professor, Department of Medicine, University of Calgary and is the co-MD Training Officer of the Calgary Zone Medical Emergency Pandemic Operational Command.

Acknowledgements

None.

Bibliography/References

American Society of Echocardiography. (2020) ASE statement on protection of patients and echocardiolography service providers during the 2019 novel coronavirus outbreak. Available at: https://www.asecho.org/ase-statement-covid-19/ (Accessed: 21 April 2020).

Centers for Disease Control and Prevention. Social Distancing, Quarantine, and Isolation (2020). Available at: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/social-distancing.html (Accessed: 21 April 2020).

 

Cook, D. A., Hatala, R., Brydges, R., Zendejas, B., et al. (2011) 'Technology-enhanced simulation for health professions education: a systematic review and meta-analysis', JAMA, 306(9), pp. 978-88. https://doi.org/10.1001/jama.2011.1234

 

Ehrlich, H., McKenney, M. and Elkbuli, A. (2020). 'Strategic planning and recommendations for healthcare workers during the COVID-19 pandemic', The American Journal of Emergency Medicine. https://doi.org/10.1016/j.ajem.2020.03.057

 

Ericsson, K. A. (2004) 'Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains', Academic Medicine, 79(10 Suppl), pp. S70-81.

 

Hollander, J. E. and Carr, B. G. (2020) 'Virtually perfect? Telemedicine for Covid-19', New England Journal of Medicine. https://doi.org/10.1056/NEJMp2003539

 

Kern, D. E., Thomas, P. A. and Hughes, M. T. (2009) Curriculum Development for Medical Education. A Six-Step Approach. 2nd edn. Baltimore, MD: The Johns Hopkins University Press.

 

McGaghie, W. C., Issenberg, S. B., Barsuk, J. H. and Wayne, D. B. (2014) 'A critical review of simulation-based mastery learning with translational outcomes', Medical Education, 48(4), pp. 375-85. https://doi.org/10.1111/medu.12391

 

Perko, T. (2011) 'Importance of risk communication during and after a nuclear accident', Integrated Environmental Assessment and Management, 7(3), pp. 388-392. https://doi.org/10.1002/ieam.230

 

Rubin, G. D., Ryerson, C. J., Haramati, L. B., Sverzellati, N., et al. (2020) 'The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society', CHEST. https://doi.org/10.1016/j.chest.2020.04.003

 

Sweller, J., Ayres, P. and Kalyuga, S. (2011) Cognitive Load Theory. New York: Springer Science+Business Media, LLC.

 

Vogel, S. and Schwabe, L. (2016) 'Learning and memory under stress: implications for the classroom', NPJ Science Learn, 1(1), pp. 1-10, https://doi.org/10.1038/npjscilearn.2016.11

 

Willan, J., King, A. J., Jeffery, K. and Bienz, N. (2020) 'Challenges for NHS hospitals during covid-19 epidemic', BMJ, 368, p. m1117. https://doi.org/10.1136/bmj.m1117

Appendices

None.

Declarations

There are some conflicts of interest:
Dr. Ma is the chair holder of the John A. Buchanan Chair in General Internal Medicine, University of Calgary. Dr. Kachra reports no conflicts of interest. The views expressed in this manuscript are those of the authors and do not necessarily reflect the position or policy of the Calgary Zone Medical Emergency Pandemic Operational Command or University of Calgary.
This has been published under Creative Commons "CC BY-SA 4.0" (https://creativecommons.org/licenses/by-sa/4.0/)

Ethics Statement

Not applicable (practical tips article, no research subjects).

External Funding

The publication cost of this article is funded by the John A. Buchanan Chair of General Internal Medicine at the University of Calgary. The funder has no role in the design, preparation, review, or approval of the manuscript; and the decision to submit the manuscript for publication.

Reviews

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Mohamed Al-Eraky - (18/05/2020) Panel Member Icon
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We really need articles like this one to adjust faculty development practices according to emerging challenges. Yet, not all of the listed tips are practical or evidence-based, but rather than based on personal opinions that need to be supported with proper citations. Some of them need more elaboration, such as: Tip #7. While I see Tip #2 and Tip #3 contradict each other. This might need clarification.

Good luck.
Manuel Joao Costa - (13/05/2020) Panel Member Icon
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I think there is relevance for a paper of tips for the redesign faculty development under unexpected circumstances.
This particular paper is very vague and, as precious reviewers pointed out, the tips are too general and do not really add good ideas for times of unpredictability. Some of them are odd in the sense that they require time and resources to implement, which might not be available under critical circumstances (for example, "evaluate existing literature and identify key domains of relevance for addressing gaps in content knowledge, skills, or processes." in TIP1). I would suggest a more thorough reflection about what would de the tips specific to reconfiguring faculty development in times of crisis. Grounding these tips in literature on training in other areas in times fo uncertainty might be important.
Dujeepa D. Samarasekera - (30/04/2020) Panel Member Icon
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Yes, agree with Samar's comments above. Apart from that, I see that except for Tip 5 and Tip 9 the rest are generic and can be applied to any setting, not focussed to current COVID 19. What would be very specific to the current setting, what areas we should be focussing during this time? What skills we should be targeting and how would have been more appropriate.
Samar Ahmed - (27/04/2020)
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Thank you for the lovely write up and good luck with your work. I like the idea if having a toolbox to help design faculty development during this rough time. I do have some questions and clarifications.
your first tip: Conduct rapid reviews to distil relevant educational content and identify key gaps

I failed to understand what educational content you were referring to. Is this the educational content to be delivered to faculty? What kind of content still needs proof and research results?

Your second tip encourages educators to depend on already existing material. I wonder if you have any evidence to prove that using existing material is as useful and effective as designing targeted material for the sake if the training?
I personally relate to tip 8 and 9 and am happy that at this point if time it has become evident that dealing with faculty in training as you would with a one time customer does nit really work. Maintaining communication and relating to faculty mixed emotions is an added virtue to any faculty development plan.
I do not agree though to the concept of building in redundancy in order to keep faculty engaged even when they have clinical obligations. I think this needs further study from your side and proof before it can be formulated into a tip for others to follow. Our finding is that availability of material and continuous remediation efforts are the best approach to keep faculty engaged even if they are in and out of the program. Our findings also prove that the the more focused the content, the easier for faculty to maintain their adherence to the program. Congratulations on the great work