January 2021 The New Normal

Virtual CME Experience: Both Sides of the Coin

By Dr. Steven Anderson, MD

Dr. Steven Anderson, a revered faculty member for Symposia Medicus over the last decade, has spoken at countless live conferences throughout his career (and has attended even more). Whilst we remain in the thick of this global pandemic, the CME/CNE world has embraced a shift from in-person to online events. Like anything else, this shift has its pros and cons. It offers an opportunity to obtain CME/CNE credit from the comfort of your own home, but it significantly impacts the interactions between speakers and attendees. Speakers must adapt how they engage with their audience, as they are no longer seated directly in front of them but rather scattered thousands of miles away. Learners must adjust how they participate and work to remain attentive, as the ability to turn off their cameras and mute their microphones allows more freedom than a usual meeting room. In this article, Dr. Anderson examines these differences, shares his own experiences as both an educator and participant in virtual CME, and offers tips, tricks, and bits of etiquette to speakers and attendees alike.  

I’ve had an opportunity to see virtual CME from the perspective of both the teacher and the student. This dual experience comes in handy because, when I hear criticism or frustrations directed toward either the teachers or the students, I can conveniently change hats to get on the correct side of the finger pointing. That said, virtual learning presents real challenges, real benefits, and real opportunities to optimize the experience for both teacher and student. 

On the plus side of being a virtual CME teacher, I certainly don’t have to worry about disruptions from a cellphone or pager going off in the middle of my lecture. The late arrivals and early departures also don’t disrupt the experience for others who are still listening (nor do they make me wonder if my lecture is something other than compelling). I also don’t have to worry whether the attendees’ learning experience was somehow compromised by having a lecture hall that was “too hot” or “too cold” or if the attendees’ brains shut down because they ran out of coffee or Danishes at the break. Trust me—comments along these lines are a regular part of in-person course and speaker evaluation forms. Complaints about not being able to see the screen or hear the speaker can also be reduced by the virtual experience. Score one for the teachers!

With these observations, it may sound as if having the teacher being separated from the audience is a good thing. From my perspective, I’m not sure these small benefits and conveniences offset the negative effects of the separation. For me, lecturing from my laptop, to my laptop, is like trying to play golf in the dark. You have a general sense of where you want to go. You can take your best swing and hope the ball goes the right distance and the right direction. If you go too long or too short or if you go out of bounds, you may not find out until the next morning—at which time you certainly can’t make any adjustments or corrections. Your audience, as well as the opportunity to get back on track, is also long gone by that time.

Personally, I prefer my golf in the daylight and I prefer my lectures to a live audience. If someone in a live audience is nodding off or scratching their head, there is at least a chance that I will perceive they are bored or lost—and hopefully adjust my game accordingly. Similarly, if someone in the audience is checking social media or doing online shopping, I can gently attempt to re-engage them by asking a pointed question, perhaps suggest a good online purchase, or at least try to make myself more interesting. The virtual environment provides little opportunity to redirect or re-engage. Post-lecture Q&A sessions can help fill in the gaps but there are some questions that need to be asked during the course of the lecture in order to get everyone back on track. The best speakers, just like the best actors or performers, are able to connect with their audience. Virtual learning environments aren’t conducive to making these connections or making the adjustments to the pace of delivery or level of detail that best resonates with the listeners.

From the virtual CME student perspective, it is certainly nice to be able to roll out of bed, get a full cup of coffee, and turn on the computer. No rush hour traffic, plane flights, missed connections, expensive hotels, time away from family, time away from the office, need to find someone to take calls or cross-cover, need to find a dog sitter, or wonder if my tee time at a resort golf course will conflict with a lecture I want to hear. When I’m learning from the comfort of my own home, I don’t have to worry if my phone rings and I don’t have to worry about disrupting the lecture if I need to get more coffee or put in a load of laundry in the middle of a session. With virtual CME, there may also be a chance to record the lecture in order to playback crucial or confusing sections or simply listen at another time.

What I don’t like as a virtual CME student is the sense of detachment. Yes, students and teachers agree on this point. If I have a question or if the lecturer needs to clarify a major foundational point in order for the rest of the lecture to make sense, that can’t happen in real time.  Lectures are launched like a ballistic missile with little opportunity to slow, adjust, or redirect after the launch. It is conceivable that a virtual CME lecturer in Boston could be telling his audience how important it is for their patients to get a flu shot while their virtual CME student in Seattle could be in the middle of an earthquake.

“Hey!  I’m in the room!” is a frequent refrain that is heard when the person talking is not aware of the people listening or when the audience feels invisible. Unfortunately, with virtual CME, the audience truly is “not in the room” and is “not visible” to the speaker. As such, the prospects for optimal communication and interactive learning are diminished in the virtual environment. The potential for distraction is further heightened when e-mails, social media, and online shopping opportunities are delivered on the same screen that is delivering my CME.

So, virtual CME clearly has plusses and minuses for both teacher and student. As a result of the limitations and frustrations, we could all put our CME on hold until we get back to the good old days or we could try to build on the opportunities presented by the “new normal.” Based on the observations noted above, there are some things that might help both the teachers and the students have a more valuable virtual CME experience. The list below has a few tips for both speakers and students.  Hopefully, they will be really helpful virtually all of the time.

  1. Establish a good, clean (non-distracting) background with appropriate front lighting (no bright lights or windows behind); have the camera at eye-level (as opposed to tilted up at the ceiling)
  2. Consider having a free-standing video camera and a small live audience (so it looks like you are actually talking to someone)
  3. Encourage your audience (virtual students) to keep their video cameras on in order to read their level of interest/engagement
  4. Use audience response systems (ARS), if possible, to get feedback during the course of the lecture, or if the audience size permits, recognize questions or a “raised hand” during the lecture
  5. Consider activating a chat room for questions that come up during the lecture (and have a designated assistant to monitor the chat room and/or forward questions during and after the lecture)
for students:
  1. Carve out a protected time to be available and present for the CME program
  2. Plan what you might need to be comfortable before the lecture to minimize disruptions or the need to get up during the lecture
  3. Use any and all opportunities to provide live feedback and ask questions. Keep your video camera turned on (if allowed) so that the speaker can get non-verbal feedback.
  4. Calculate all of the time you are saving by not traveling to a live lecture and use that extra time to check e-mails, social media, and do your online shopping before the CME program begins
  5. Take the time to fill out course evaluations in order to help improve future programs and make a better experience for online learners—yourself included

Dr. Steven Anderson is a Clinical Professor at the University of Washington. He lives in Seattle, Washington.