How to Adapt Rheumatology Learning to a Virtual World

A Day at the Farmers Market (oil) by Ralph C. Williams Jr.

Sir William Osler, a pioneer of modern medical education, taught “medicine is learned by the bedside and not in the classroom.”¹ How, then, do we learn medicine in a world dominated by virtual interactions? This question was forced upon us in the era of the COVID-19 pandemic. From telemedicine to remote meetings, the rheumatology community adapted to paradigm shifts impacting both patients’ care and practitioners’ training.

As rheumatology education increasingly incorporates learning conducted via electronic media—eLearning, for short—integrating technology with evidence-based adult learning theory and best practices is paramount for effective virtual learning activities. The ARP eLearning Subcom­mittee offers these considerations to enhance your virtual learning experiences as both an educator and student.

Advantages of eLearning

Flexibility for the individual learner is one of the greatest benefits of eLearning. If leveraged properly, electronic media makes education both convenient and adaptable.^2,3 eLearning programs are typically accessible online, creating lower cost and time barriers than traveling for in-person learning.

Asynchronous experiences, in which activities are available on demand, allow participants to schedule their education around preferences or other time commitments. Thus, the same virtual program can seamlessly accommodate both a learner dedicating a day off to complete coursework before a certification exam as well as one who has just a few minutes of break time during shifts on the wards. Moreover, on-demand functionality accommodates personal proclivities and attention spans. Students can pace or rewind virtual learning activities to adjust to their particular needs for each presented concept.

Despite its virtual nature, eLearning can improve practical clinical skills in a low-risk environment. Integrating case-based learning and other simulations into an eLearning curriculum allows learners to practice advanced critical thinking while receiving near-instantaneous feedback, all without consequences to patients. Imagine scenarios where you can make choices about diagnosis or treatment plans in safe, non-threatening circumstances and know immediately if you made the best decisions for a patient. It’s no surprise that virtual care exercises positively enhance the development of problem-solving abilities and pragmatic decision-making skills.^2,4

Adult learners typically view eLearning positively. Published experiences report that most students rate virtual learning favorably and that even students initially apprehensive about eLearning often ultimately regard it positively.⁴

Drawbacks with eLearning

Do you remember taking a class with a professor who made 50 minutes seem like 15 or leading a session in which you were so engaged with your audience that no one noticed you forgot to stop for a break? These types of learner-teacher interactions are often undermined during virtual learning.

On an unconscious level, we process nonverbal communication as unspoken feedback, a task hampered by a computer screen.⁵ This interpersonal disconnect reaches beyond the classroom. A shy student who mustered the courage to engage a lecturer one on one after class may have trouble building a comparable relationship in a virtual environment.⁵ Organic professional interactions and minutes spent socializing after in-person didactics often fall to the wayside in cyberspace.

eLearning forces both learners and educators to make conscious efforts to recapture some of the interpersonal connection lost in a virtual forum.

Ironically, eLearning may be hindered by some of the same aspects that make it so valuable. Allowing on-demand access or adapting to the near-infinite audience capacity of a virtual seminar forces changes in teaching plans and materials. Educators may not yet feel comfortable leveraging technology effectively or modifying their existing teaching skills to the nuances of virtual learning. Developing these proficiencies takes preparation time, a resource often scarce when meeting the accelerating deadlines forced by the pandemic.⁵ Although eLearning can clearly build certain clinical competencies, it complicates the evaluation of other parts of that skill set.⁶

Moreover, eLearning also requires investments in equipment, bandwidth and accessibility.⁵