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You’re on mute: obstetrics and gynecology perspectives on the transition to virtual grand rounds

Published:August 02, 2022DOI:https://doi.org/10.1016/j.ajog.2022.07.053

      Objective

      Grand rounds are a central component of medical education across specialties, with demonstrated benefits.
      • Hull A.L.
      • Cullen R.J.
      • Hekelman F.P.
      A retrospective analysis of grand rounds in continuing medical education.
      • Sparkes D.
      • Leong C.
      • Sharrocks K.
      • Wilson M.
      • Moore E.
      • Matheson N.J.
      Rebooting medical education with virtual grand rounds during the COVID-19 pandemic.
      • Mirza K.M.
      • Gonzalez R.S.
      • Jiang X.S.
      • Khanafshar E.
      • Wobker S.E.
      Excellence available everywhere.
      Obstetrics and gynecology (OB-GYN) departments across the country transitioned from in-person grand rounds (IPGR) to virtual grand rounds (VGR) during the COVID-19 pandemic.
      Knowledge gaps exist around OB-GYN educators’ and trainees’ perceptions of VGR. Single-center studies of faculty perspectives in other specialties have shown positive correlations with improved attendance.
      • Sparkes D.
      • Leong C.
      • Sharrocks K.
      • Wilson M.
      • Moore E.
      • Matheson N.J.
      Rebooting medical education with virtual grand rounds during the COVID-19 pandemic.
      ,
      • Mirza K.M.
      • Gonzalez R.S.
      • Jiang X.S.
      • Khanafshar E.
      • Wobker S.E.
      Excellence available everywhere.
      This multicenter observational study sought to explore the OB-GYN experience with VGR and to assess perceptions by role (educator vs trainee).

      Study Design

      After institutional review board exemption, a cross-sectional survey comparing VGR and IPGR was developed de novo using themes from the literature, and then reviewed and edited by subject matter experts.
      • Hull A.L.
      • Cullen R.J.
      • Hekelman F.P.
      A retrospective analysis of grand rounds in continuing medical education.
      ,
      • Mirza K.M.
      • Gonzalez R.S.
      • Jiang X.S.
      • Khanafshar E.
      • Wobker S.E.
      Excellence available everywhere.
      Likert-style questions asked about satisfaction, engagement, learning, and multitasking (Supplemental Material). The e-survey was deployed in May 2021 to all members of 5 academic OB-GYN departments, with a 2-week reminder email.
      Data were analyzed in aggregate. Trainee (resident or fellow) and educator responses were then compared, excluding research staff and emeritus faculty respondents. We used bivariate statistics and regression to control for confounders that were significant in bivariate analyses.

      Results

      Of the 591 potential participants, 306 (52%) responded. Among respondents, 69% were faculty, 21% residents, 7% fellows, and 3% others (research staff or emeritus faculty).
      Compared with IPGR, 91% felt satisfied with VGR; 90% reported being more likely to attend VGR. Presentation quality was assessed as the same or better by 91%, and 93% described presenter caliber as the same or better; 48% reported learning the same amount. However, 90% were more likely to multitask; 69% felt the sense of community was worse.
      The secondary analysis included 297 respondents. Response rates were 45% (86/193) for trainees and 53% (211/397) among educators. Compared with educators, trainees were more likely to be dissatisfied, less likely to attend, and reported learning less during VGR (Table). Almost all trainees were more likely to multitask (Table). After controlling for gender and institution, compared with educators, trainees remained less satisfied, less likely to attend, and perceived worse learning with VGR (Table).
      TableComparison of educator and trainee (resident and fellow) perspectives on virtual grand rounds
      PerspectivesEducators

      N=211 (%)
      Trainees

      N=86 (%)
      P value
      P values obtained by nonparametric bivariate statistics; Kruskal–Wallis and Wilcoxon rank-sum tests, as appropriate
      aOR (95% CI)
      adjusted for gender and site.
      Overall unsatisfied with virtual grand rounds11 (5.3)16 (18.8).0010.14 (0.05–0.40)
      Less likely to attend VGR than in-person grand rounds14 (5.7)18 (20.9)<.0010.17 (0.07–0.43)
      Learned less during VGR than during in-person grand rounds38 (18.1)26 (30.6).030.42 (0.22–0.82)
      Felt a loss of sense of community with VGR compared with in-person grand rounds142 (67.6)64 (74.4).19
      More likely to ask questions in VGR than in in-person grand rounds105 (50.5)38 (44.2).37
      More likely to multitask during VGR than during in-person grand rounds185 (88.9)80 (93.0).29
      aOR, adjusted odds ratio; CI, confidence interval; VGR, virtual grand rounds.
      Dotters-Katz. Obstetrics and gynecology perspectives on the transition to virtual grand rounds. Am J Obstet Gynecol 2022.
      a P values obtained by nonparametric bivariate statistics; Kruskal–Wallis and Wilcoxon rank-sum tests, as appropriate
      b adjusted for gender and site.

      Conclusion

      This multicenter study of academic OB-GYN educators and trainees found that VGR was well-received. However, improved attendance and presentation quality must be weighed against increased multitasking and lost sense of community. Perceptions varied greatly by role; trainees were more likely to be dissatisfied, were less likely to attend, and perceived worse learning.
      Lack of connection during virtual learning is well-described.
      • Mirza K.M.
      • Gonzalez R.S.
      • Jiang X.S.
      • Khanafshar E.
      • Wobker S.E.
      Excellence available everywhere.
      ,
      • Malik M.
      • Valiyaveettil D.
      • Joseph D.
      Optimizing e-learning in oncology during the COVID-19 pandemic and beyond.
      In this time of emotional stress and isolation, trainees, who rely on IPGR as a time to connect, may be disproportionally affected. Mind wandering and multitasking are well-described limitations to virtual learning and may more significantly affect trainees, especially those who are fatigued.
      • Malik M.
      • Valiyaveettil D.
      • Joseph D.
      Optimizing e-learning in oncology during the COVID-19 pandemic and beyond.
      ,
      • Ellaway R.H.
      • Fink P.
      • Graves L.
      • Campbell A.
      Left to their own devices: medical learners’ use of mobile technologies.
      This multicenter survey included several departments across the country; thus, the results are generalizable. However, the survey only included tertiary academic centers, had only a 52% response rate, and was subject to recall bias. Given that there have been limited data on satisfaction with VGR in OB-GYN, these findings can reassure department leaders that OB-GYN educators and trainees perceive advantages to VGR. A hybrid (virtual and in-person) grand rounds model may be best for meeting the needs of all department members.

      Appendix

      Virtual Grand Rounds

      Q9 You are being asked to complete a brief anonymous survey designed to better understand the pros and cons of virtual grand rounds. The survey should take less than 5 minutes to complete and is completely voluntary. You may skip any questions you do not wish to answer.
      By clicking to the next section below, you will be taken directly to the survey. Please answer each question carefully. No personal or health information will be collected or linked to your survey results. For questions about the study, or if you have concerns, questions or suggestions about the research, contact Dr. Dotters-Katz at (919) 681-5220 during regular business hours. For questions about your rights as a research participant, or to discuss problems, concerns or suggestions related to the research, or to obtain information or offer input about the research, contact the Duke University Health System Institutional Review Board (IRB) Office at (919) 668-5111.
      • Q1 In general, how satisfied are you with virtual grand rounds?
        • o Extremely satisfied (
          • Hull A.L.
          • Cullen R.J.
          • Hekelman F.P.
          A retrospective analysis of grand rounds in continuing medical education.
          )
        • o Somewhat satisfied (
          • Sparkes D.
          • Leong C.
          • Sharrocks K.
          • Wilson M.
          • Moore E.
          • Matheson N.J.
          Rebooting medical education with virtual grand rounds during the COVID-19 pandemic.
          )
        • o Somewhat dissatisfied (
          • Mirza K.M.
          • Gonzalez R.S.
          • Jiang X.S.
          • Khanafshar E.
          • Wobker S.E.
          Excellence available everywhere.
          )
        • o Extremely dissatisfied (
          • Malik M.
          • Valiyaveettil D.
          • Joseph D.
          Optimizing e-learning in oncology during the COVID-19 pandemic and beyond.
          )
      Tabled 1Q2 For the following questions, please ask yourself: compared to in person grand rounds...
      A lot more likely (
      • Hull A.L.
      • Cullen R.J.
      • Hekelman F.P.
      A retrospective analysis of grand rounds in continuing medical education.
      )
      Somewhat more likely (
      • Sparkes D.
      • Leong C.
      • Sharrocks K.
      • Wilson M.
      • Moore E.
      • Matheson N.J.
      Rebooting medical education with virtual grand rounds during the COVID-19 pandemic.
      )
      Less likely (
      • Mirza K.M.
      • Gonzalez R.S.
      • Jiang X.S.
      • Khanafshar E.
      • Wobker S.E.
      Excellence available everywhere.
      )
      A lot less likely (
      • Malik M.
      • Valiyaveettil D.
      • Joseph D.
      Optimizing e-learning in oncology during the COVID-19 pandemic and beyond.
      )
      How likely are you to attend virtual grand rounds? (
      • Hull A.L.
      • Cullen R.J.
      • Hekelman F.P.
      A retrospective analysis of grand rounds in continuing medical education.
      )
      oooo
      How likely are you to multitask during virtual grand rounds? (this is anonymous) (
      • Sparkes D.
      • Leong C.
      • Sharrocks K.
      • Wilson M.
      • Moore E.
      • Matheson N.J.
      Rebooting medical education with virtual grand rounds during the COVID-19 pandemic.
      )
      oooo
      How likely are you to ask a question of the presenter during virtual grand rounds? (
      • Mirza K.M.
      • Gonzalez R.S.
      • Jiang X.S.
      • Khanafshar E.
      • Wobker S.E.
      Excellence available everywhere.
      )
      oooo
      How likely are you to give kudos without asking a question in virtual grand rounds? (
      • Malik M.
      • Valiyaveettil D.
      • Joseph D.
      Optimizing e-learning in oncology during the COVID-19 pandemic and beyond.
      )
      oooo
      Dotters-Katz. Obstetrics and gynecology perspectives on the transition to virtual grand rounds. Am J Obstet Gynecol 2022.
      Tabled 1Q3 Compared to inperson grand rounds, how would you rate the following with respect to virtual grand rounds?
      A lot better with virtual (
      • Hull A.L.
      • Cullen R.J.
      • Hekelman F.P.
      A retrospective analysis of grand rounds in continuing medical education.
      )
      Somewhat better with virtual (
      • Sparkes D.
      • Leong C.
      • Sharrocks K.
      • Wilson M.
      • Moore E.
      • Matheson N.J.
      Rebooting medical education with virtual grand rounds during the COVID-19 pandemic.
      )
      No difference (
      • Mirza K.M.
      • Gonzalez R.S.
      • Jiang X.S.
      • Khanafshar E.
      • Wobker S.E.
      Excellence available everywhere.
      )
      Somewhat worse with virtual (
      • Malik M.
      • Valiyaveettil D.
      • Joseph D.
      Optimizing e-learning in oncology during the COVID-19 pandemic and beyond.
      )
      A lot worse with virtual (
      • Ellaway R.H.
      • Fink P.
      • Graves L.
      • Campbell A.
      Left to their own devices: medical learners’ use of mobile technologies.
      )
      The sense of community (
      • Hull A.L.
      • Cullen R.J.
      • Hekelman F.P.
      A retrospective analysis of grand rounds in continuing medical education.
      )
      ooooo
      The quality of the presentations (
      • Sparkes D.
      • Leong C.
      • Sharrocks K.
      • Wilson M.
      • Moore E.
      • Matheson N.J.
      Rebooting medical education with virtual grand rounds during the COVID-19 pandemic.
      )
      ooooo
      The amount you learn (
      • Mirza K.M.
      • Gonzalez R.S.
      • Jiang X.S.
      • Khanafshar E.
      • Wobker S.E.
      Excellence available everywhere.
      )
      ooooo
      The caliber/prominence of presenters (
      • Malik M.
      • Valiyaveettil D.
      • Joseph D.
      Optimizing e-learning in oncology during the COVID-19 pandemic and beyond.
      )
      ooooo
      Dotters-Katz. Obstetrics and gynecology perspectives on the transition to virtual grand rounds. Am J Obstet Gynecol 2022.
      • Q7 What do you see as the biggest advantage of virtual grand rounds?________________________________
      • Q8 What do you see as the biggest disadvantage to virtual grand rounds?________________________________
      • Q4 What is your gender?
        • o Male (
          • Hull A.L.
          • Cullen R.J.
          • Hekelman F.P.
          A retrospective analysis of grand rounds in continuing medical education.
          )
        • o Female (
          • Sparkes D.
          • Leong C.
          • Sharrocks K.
          • Wilson M.
          • Moore E.
          • Matheson N.J.
          Rebooting medical education with virtual grand rounds during the COVID-19 pandemic.
          )
        • o Non-binary / third gender (
          • Mirza K.M.
          • Gonzalez R.S.
          • Jiang X.S.
          • Khanafshar E.
          • Wobker S.E.
          Excellence available everywhere.
          )
        • o Prefer not to say (
          • Malik M.
          • Valiyaveettil D.
          • Joseph D.
          Optimizing e-learning in oncology during the COVID-19 pandemic and beyond.
          )
      • Q5 What is your position?
        • o Faculty (
          • Hull A.L.
          • Cullen R.J.
          • Hekelman F.P.
          A retrospective analysis of grand rounds in continuing medical education.
          )
        • o Fellow (
          • Sparkes D.
          • Leong C.
          • Sharrocks K.
          • Wilson M.
          • Moore E.
          • Matheson N.J.
          Rebooting medical education with virtual grand rounds during the COVID-19 pandemic.
          )
        • o APP (
          • Malik M.
          • Valiyaveettil D.
          • Joseph D.
          Optimizing e-learning in oncology during the COVID-19 pandemic and beyond.
          )
        • o Resident (
          • Mirza K.M.
          • Gonzalez R.S.
          • Jiang X.S.
          • Khanafshar E.
          • Wobker S.E.
          Excellence available everywhere.
          )
        • o Other (
          • Ellaway R.H.
          • Fink P.
          • Graves L.
          • Campbell A.
          Left to their own devices: medical learners’ use of mobile technologies.
          )
      • Q6 When we come out of COVID-19 restrictions, what would the ideal grand rounds look like for you?
        • o Remain all virtual (
          • Hull A.L.
          • Cullen R.J.
          • Hekelman F.P.
          A retrospective analysis of grand rounds in continuing medical education.
          )
        • o Some in-person, with the rest virtual (
          • Sparkes D.
          • Leong C.
          • Sharrocks K.
          • Wilson M.
          • Moore E.
          • Matheson N.J.
          Rebooting medical education with virtual grand rounds during the COVID-19 pandemic.
          )
        • o In-person, with a virtual option (
          • Mirza K.M.
          • Gonzalez R.S.
          • Jiang X.S.
          • Khanafshar E.
          • Wobker S.E.
          Excellence available everywhere.
          )
        • o In-person, no virtual option (
          • Malik M.
          • Valiyaveettil D.
          • Joseph D.
          Optimizing e-learning in oncology during the COVID-19 pandemic and beyond.
          )
        • o Check out my idea: (
          • Ellaway R.H.
          • Fink P.
          • Graves L.
          • Campbell A.
          Left to their own devices: medical learners’ use of mobile technologies.
          ) ____________________________________________________

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        Excellence available everywhere.
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