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664       TSANG et al.
mistakes by medical students, and (d) clinical relevance. Second, we re-
corded a video of a clinical teacher demonstrating the techniques on a
surrogate patient. We uploaded both written material and videos on the
e-learning platform of our medical school. Third, after going through
the online materials, the students were split into small groups of 30
students for a single 60-minute tutorial with a clinical teacher on the
Zoom cloud-based video conference platform. During the tutorial, the
teacher went through each key ophthalmic clinical skill and highlighted
important points, pitfalls and clinical knowledge. The last 10 minutes
were reserved for questions from students. Using the private message
function, students were able to send live questions as they maintained
anonymity. Assessment was conducted at the end of the block in the
form of objective structured clinical examination (OSCE) stations.
3 |  W H AT LE S S O N S W E R E LE A R N E D?
Our three-pronged approach was designed to both enhance knowl-
edge acquisition and increase competency attainment in ophthalmic
clinical skills. By introducing an element of self-directed learning
(SDL) to precede our tutorials, the students took a proactive role in
the learning experience. The tutorials themselves further served as
an opportunity for critical reinforcement of self-directed learning.
We noted that the students were able to better follow the online
clinical demonstration with the help of the pre-tutorial materials.
One major revelation resulting from the introduction of Zoom tutori-
als was the ability for students to send live questions to the clinical tutor
anonymously via private message. It allowed the tutor to read out loud
and address questions for the entire group's benefit without the student
DOI: 10.1111/medu.14194
Learning at home during COVID-19: A multi-institutional virtual
learning collaboration
Leila Zuo  | Dawn Dillman | Amy Miller Juvé
Department of Anesthesiology and Perioperative Medicine, School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
Correspondence: Leila Zuo, Department of Anesthesiology and Perioperative Medicine, School of Medicine, Oregon Health & Science University, 3181 South-
West Sam Jackson Park Road, Portland, Oregon 97239-3098, USA.
Email: zuo@ohsu.edu
1 |  W H AT PRO B LE M S W E R E A D D R E S S E D?
Given the cancellation of all elective procedures with the coronavi-
rus disease 2019 (COVID-19) crisis, many anaesthesiology learners are
https://www.kotterinc.com/8-steps-process-for-leading-change/
having to reveal his or her identity. This is a unique advantage in Asian
medical schools, where due to cultural upbringings, students are usually
uncomfortable asking questions in public during tutorials and lectures
fearing embarrassment. They prefer instead to email teachers later to ad-
dress their questions. Furthermore, another significant advantage of our
adaption was that recordings of the Zoom tutorials were made available
to students to re-watch later at their own pace. However, one important
limitation we encountered in our tutorials was the difficulty in effectively
teaching direct ophthalmoscopy online. To learn this technique, students
first needed available simulated patients to practice on. Furthermore,
much of the difficulty in this particular skill is in understanding the cor-
rect angle of approach and the necessary adjustments to be made when
examining the fundus. Face to face tutorials are still a more effective
means of teaching for this particular skill. In conclusion, the COVID-19
outbreak is an opportunity for a re-evaluation of our teaching methods.
The lessons learned from the use of video and online-based teaching
provide feedback to clinical teachers on how undergraduate medical
students acquire knowledge and express themselves best.
ORCID
Kendrick Co Shih  https://orcid.org/0000-0001-6255-2941
Jonathan Cheuk-Hung Chan  https://orcid.org/0000-0002-0177-8178
Julie Yun Chen  https://orcid.org/0000-0002-7444-6182
Jimmy Shiu-Ming Lai  https://orcid.org/0000-0002-1367-6953
REFERENCE
1. Hogg HDJ, Pereira M, Purdy J, Frearson RJR, Lau GB. A non-ran-
domised trial of video and written educational adjuncts in undergrad-
uate ophthalmology. BMC Med Educ. 2020;20(1):10.
assigned to stay at home, limiting opportunities to learn in the clinical envi-
ronment. We report on a novel use of existing resources to structure a daily
nationwide learning experience, using Kotter's change management model
(KCMM) to drive the process: (a) create urgency; (b) form a guiding coali-
tion; (c) create a vision; (d) communicate the vision; (e) remove obstacles;
(f) create short-term wins; (g) build on the change, and (h) institutionalise
TSANG et al.
new approaches. In the field of anaesthesiology, we describe the use of the
1
Anesthesia Education Toolbox, an online learning management system
with resources for in-person and asynchronous learning.
2 |  W H AT WA S TR I E D?
1. The COVID-19 pandemic created a clear sense of urgency to
develop and collate shared educational resources to support
non-clinical learning.
2. Educational leaders of institutions subscribed to the toolbox were
asked to join a task force to prioritise learning needs.
3. We aimed to create an engaging virtual learning curriculum for
anaesthesia residents that would provide at-home learning.
4. We promoted sessions and solicited participants, content experts
and facilitators by email and posting to social media.
5. We were able to collaborate effectively using videoconferencing.
6. We developed a daily virtual learning session, allowing resi-
dents from across the country to engage with peers and subject
matter experts. We used existing resources in the toolbox and
structured them into a schedule covering 1 hour of content per
day, considering active learning, sequencing and Bloom's taxon-
omy. Content experts and facilitators could present their own
material if desired. Participant engagement occurred by using
the chat or polling feature, or asking questions via microphones.
Participation has averaged from 40 to 160 people from more
than 10 institutions in the USA and Canada. The sessions are
recorded and catalogued in the toolbox for future use.
7. We are in the process of expanding the daily content, with the
goal of developing an enduring curriculum.
DOI: 10.1111/medu.14190
Online faculty development using cognitive apprenticeship in
response to COVID-19
Ayat Nabil Eltayar  | Noha Ibrahim Eldesoky | Hoda Khalifa | Soha Rashed
Correspondence: Ayat Nabil Eltayar, Department of Medical Education, Alexandria Faculty of Medicine, Alexandria University, Champollion Street, El-
Khartoum Square, Azarita Medical Campus, Alexandria, Egypt.
Email: dr.ayateltayar@yahoo.com
1 | W H AT PRO B LE M S W E R E A D D R E S S E D?
Despite the coronavirus disease 2019 (COVID-19) pandemic, it is
still necessary to develop good assessment tools to evaluate the
|
      665
8. This innovation is now a required part of the curriculum for our
learners.
3 | W H AT LE S S O N S W E R E LE A R N E D?
Rather than individual programmes transitioning their in-person teaching
to an online platform, it is possible to quickly and efficiently restructure
existing resources from multiple institutions to create an online synchro-
nous educational experience. The innovation lies with coordinating mul-
tiple institutions to share resources to support resident learning. Doing so
takes someone to assess available resources and resident needs, identify
an accessible online platform, and organise the curriculum and faculty
members. Presenters are encouraged to gain experience with the online
platform prior to their lecture. Having an experienced moderator for
each session helps them run smoothly. The time of 13.00 hours Pacific
Standard Time has worked well for learners in all time zones. Access to
resources was enhanced by making the toolbox free for all programmes
across the country. Initial feedback indicates content is more robust and
better received by having faculty members from multiple institutions
who are national leaders in the specialty. Thus far, 63% of participants
have attended more than one session.
ORCID
Leila Zuo  https://orcid.org/0000-0001-7808-2745
REFERENCE
1. Woodworth G, Juve AM, Swide CE, Maniker R. An innovative
approach to avoid reinventing the wheel: the anesthesia education
toolbox. J Grad Med Educ. 2015;7(2):270-271.
competence of our students. Our medical education department,
therefore, changed its face to face workshops on 'how to create mul-
tiple choice questions (MCQs)' into online ones. It was the first time
our medical education department had created questions online.