Problem

The COVID-19 pandemic left two options for the two-week interdisciplinary advocacy course we organize annually for 25 pediatrics, internal medicine, and medicine-pediatrics residents in their last year of training: (1) cancel the course like all other electives or (2) rapidly adapt it for remote learning. Advocacy education empowers trainees to amplify their voices and equips them with tools to translate their ideas into meaningful change. Given that our course is the last opportunity during training for residents to develop these essential skills, we opted for the latter option.

 

Approach

In translating the course online, our goal was to retain its core goal: increase residents’ capacity to effectively advocate for patients and policies through experiential learning. We recruited a diverse group of speakers to cover topics related to legislative, media, and community advocacy. Using Zoom, residents learned about governmental structure and how bills are passed, wrote legislative letters in support of bills prioritized by the American Academy of Pediatrics, partnered with a community organization working to reduce disparities in COVID-19 outcomes, emailed and called their Congresspeople, and prepared and critiqued op-eds. In past rotations, in-person legislative visits gave residents an opportunity to craft and communicate pitches for legislative priorities, and we retained this essential experience by recruiting legislative aides to engage with residents virtually.

 

We implemented several strategies to optimize the online format. We intentionally limited sessions to mornings only to minimize eye strain and maximize participation. We coached session leaders on optimal use of Zoom and logged on prior to each session to set up speakers and address technical difficulties. In moving the course online, we risked losing interaction between session leaders and participants, so we encouraged participants to use their cameras while keeping microphones off unless actively speaking. We enabled the chat functionality on Zoom to enhance interaction, and residents shared websites, resources, comments, reflections, and questions in real-time. We incorporated small group breakout sessions to facilitate problem solving and discussion. These strategies allowed all residents, even those hesitant to share verbally, to participate actively and gave speakers real-time visual and written feedback. All sessions were recorded and uploaded to the course website, creating an accessible repository of the curriculum. 

 

Outcomes to Date

Results of an anonymous online evaluation completed by 16 residents at the end of the rotation revealed that 81% of residents found the online format to be an adequate substitute for an in-person rotation. Most residents agreed that incorporating video (63%), chat (95%), and breakout room (88%) functionalities increased interaction. All agreed that Zoom was easy to use. Sixty-three percent planned to use recorded sessions after the rotation. Ninety percent reported feeling more confident in their ability to write an opinion piece, contact legislative representatives, and deliver an advocacy message.   

                                               

Next Steps / Planned Curricular Adaptations

We developed and delivered an innovative course to residents in the safety of their homes, promoting physical, but not intellectual, distancing. Given the positive response, we anticipate incorporating virtual sessions into future iterations of this course.

 

1 Howell BA, Kristal RB, Whitmire LR, Gentry M, Rabin TL, Rosenbaum J. 2019. A Systematic Review of Advocacy Curricula in Graduate Medical Education. Journal of General Internal Medicine. 34:2592–2601.

2 Lichtenstein C, Hoffman BD, Moon RY. 2017. How Do US Pediatric Residency Programs Teach and Evaluate Community Pediatrics and Advocacy Training?Academic Pediatrics. 17:544-549. 10.1016/j.acap.2017.02.011