Visiting clerkships have traditionally offered the opportunity for extended contact among medical student applicants and residency program representatives, allowing for enhanced assessment of mutual compatibility. Accordingly, visiting clerkships are consistently rated as an essential consideration among residency program leadership when reviewing applications, and among medical students, as they determine “fit” [1,2]. The COVID-19 pandemic has resulted in institutional restrictions on visiting clerkships. Despite the now limited opportunities for medical students to see residency programs of interest in-person, demand for these experiences remains high. Opportunities that allow for increased interaction among medical student applicants and residency programs that maintain compliance with COVID-19 restrictions are needed to fill this gap. Virtual rotations have previously been described in the literature in multiple other specialties [5]. Several emergency medicine programs have advertised a formal virtual rotation experience via the Council of Residency Directors’ (CORD) listserv that offers course credit to student rotators.
The Innovation
Our institution did not allow outside student rotators into the hospital system this year due to COVID-19. Therefore, we wanted to provide a chance for medical students to get to know our residency program and for us to get to know them. Thus, our “fauxtation” was born. We named this experience a “fauxtation” because it does not count formally as a rotation. Although there is no grade attached and no clinical credit offered, we understood that most students were already doing clinical rotations. We wanted this to be a lower-stakes, more comfortable environment to interact with people from our program.
The Learners
We invited 4th-year medical students who had previously applied for away rotations with us or had an interest in rotating with us to join the virtual rotation.
Equipment
SLACK [3]- virtual workspace platform
Zoom [4]- virtual conferencing platform
Description of the Innovation
Our virtual rotation aimed to provide small, digestible bits of daily interaction with our “fauxtating” medical students to highlight aspects of our residency while providing synchronous and asynchronous educational activities. We utilized a Slack workspace for participating students, faculty, and residents. Within the Slack workspace, we created different channels corresponding to different days of the week, where we featured various themed activities throughout a 4-week rotation. Before the start of the rotation, students were sent an email with instructions for how to access and use Slack; any moderator who had not been familiar with the platform was also debriefed. The free version of the workspace was used and moderated by the medical education fellows, EM chiefs, and GME leadership. The medical education fellows did daily check-ins to the Slack channel to upload information and interact with students. At the end of the rotation, students were removed from the workspace to allow the next group to join.
Figure 1: Slack Channels used in the Fauxtation
#MedicalMondays
On Mondays, we discussed interesting cases seen at our institution, using a CPC (clinical pathologic case competition) format. We gave the students a PowerPoint over the weekend, giving the initial history, exam, and labs for a patient case. We subsequently hosted a live Zoom session on the following Monday, featuring a moderating faculty member and resident to discuss the students’ differential diagnoses and justification for the ultimate most likely diagnosis selected. We reviewed the correct diagnosis and provided a brief presentation reviewing that particular disease.
#TalkShowTuesdays
On Tuesdays, we highlighted various faculty members with talk-show style interviews. The interviews focused upon their pathway to their current position, why they believed our program was a good place to train in emergency medicine and general advice about the application process. Various groups of faculty were highlighted that the students would have otherwise spent time with had they participated in the traditional rotation: ED leadership, ultrasound faculty, the Jefferson Design Team, etc.
#ConferenceWednesdays
At our institution, we have resident didactics on Wednesdays. We invited the virtual rotators to join our virtual conference and provided summaries on this SLACK channel to any students unable to make it that day so they could see typical conference topics and activities.
#TJUHthursdays
On Thursdays, we hosted activities with the students. We had a virtual mocktail hour with program leadership so students could meet the program director and associate program directors. Similarly, during other weeks we hosted a virtual happy hour with the residents so students could meet them and a “game night” to show off an example of one of our educational games and allow the students to learn and play with one of the residents.
#PhiladelphiaFridays
Fridays were devoted to introducing students to life in Philadelphia. Typically, experiencing a program’s geographic location has been an important component of in-person visiting clerkships and interview days. On this day, we posted photos and videos of our favorite things about our city to enhance students’ understanding of the living and training experience in Philadelphia.
Lessons Learned
- For #TalkShowTuesdays, we found that pre-recording and posting video interviews of faculty facilitated scheduling of interviews with faculty and allowed us to highlight a broader range of individuals.
- Having some flexibility for the timing of sessions was also important. Attendance for sessions greatly improved when a poll was sent out prior to identify the best time for an activity with the students.
- Additionally, sending out a calendar of live activities before the start of the rotation might help improve attendance by allowing students to make schedule arrangements.
Closing Thoughts
After our first round of the fauxtation, we sent out an anonymous survey to the participating students. While the response rate was low, the students who responded felt that SLACK worked well to hold the virtual rotation, they enjoyed the experience, they learned more about the program, gained medical knowledge, and did not find the time commitment overwhelming.
References
- Crane JT, Ferraro CM. Selection criteria for emergency medicine residency applicants. Acad Emerg Med. 2000;7:54–60. PMID: 10894243.
- National Resident Matching Program. Data release and research committee: results of the 2014 NRMP program director survey. 2014. [cited 22 December 2015] Available from: http://www.nrmp.org/wp-content/uploads/2014/09/PD-Survey-Report-2014.pdf.
- Slack. (n.d.). Where work happens. Retrieved August 03, 2020, from https://slack.com/
- Video Conferencing, Web Conferencing, Webinars, Screen Sharing. (n.d.). Retrieved August 03, 2020, from https://zoom.us/
- Chao TN, Frost AS, Brody RM, Byrnes YM, Cannady SB, Luu NN, Rajasekaran K, Shanti RM, Silberthau KR, Triantafillou V, Newman JG. Creation of an Interactive Virtual Surgical Rotation for Undergraduate Medical Education During the COVID-19 Pandemic. J Surg Educ. 2020:S1931-7204(20)30232-4. PMID: 32654999.
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