Ward rounds teaching seemed impossible when COVID struck. Flo Mouy (Cardiac Teaching Fellow, South Bristol) used video conferencing software to bring students to the patients remotely. Despite some disadvantages, this worked so well that Flo thinks the approach will play a role alongside in-person ward rounds post-pandemic. The approach afforded more students to be taught (seven at once rather than two) and more time for debriefs and peer discussion post ward round. A majority of students surveyed wanted the approach to continue alongside in-person ward rounds.
Tools: COW (computer on wheels) Zoom, WebEx, microphone
COVID 19 introduced a number of difficulties for medical education. Flo faced the challenge of needing to teach practical skills to a group of third year students during a pandemic, many of whom were self-isolating. Whilst they could keep up with academic work, Flo Mouy (CTF South Bristol) was concerned these students were missing out on the chance to learn essential practical skills. Flo replaced real life ward rounds with a virtual ward round, where Flo and the ward doctor were the only doctors physically present, and the students joined them from their homes via Zoom.
For a successful virtual ward round, planning is key. Flo stressed the importance of sorting out consent forms and etiquette guides in advance, as well as discussing behavioural expectations. All patients and students need to consent for filming and recording. Similarly, she approached any relevant departments for approval and any other documentation where necessary. Flo also recommended checking your kit is up to scratch. She found a dummy run to be helpful to iron out any potential issues with WiFi, sound and general equipment. Flo altered her plans where necessary. She found that whilst an iPad offered mobility, it didn’t provide a sufficiently high-quality image. Flo therefore opted to use a computer on wheels (COW). She also ensured sound was optimised for patients, many of whom are frail and elderly with impaired hearing.
Flo worked hard to maintain the general structure of a conventional ward round. She opened the session by going through the notes and explaining the case to the students. She then turned the camera off and muted the microphone to wheel the COW into the bay. Filming was only carried out behind closed curtains.
Once behind the curtains, Flo and her students turned the cameras back on so patients and students could see each other. She used the microphone as sound in the big bay was poor. Flo then asked the students questions that enabled them to take a history, summarise the examination, make a differential diagnosis, make an investigation list and a structured management plan. As with a conventional ward round, she found that generally the diagnosis comes out organically, and leads to a chat about the condition itself. Flo then encouraged students and colleagues to offer feedback, before switching off the camera and thanking the patient. Then she offered a debrief to answer student questions at the end.
Flo stated that ideally students would be examining a patient in real life rather than receiving information. There is no substitute for the kinaesthetic experience of a physical examination and directly listening to heart sounds. She mentioned that some students enjoy writing in the notes, which is also impossible to replicate online.
The virtual ward rounds had the practical advantage of enabling more students to attend without the session becoming chaotic. Flo could take seven students rather than one or two. She noticed increased participation and found it easier to ensure that all students were involved in the session. Students’ history taking skills were also tested more thoroughly. Flo found the virtual ward rounds enabled her to give more time to students, both in planning sessions and in teaching. The students’ feedback was very positive, with three quarters of students saying they wanted these sessions to continue, either alone or in combination with face-to-face teaching.
Post-pandemic, Flo is considering offering three quarters of the ward rounds virtually. With the time that would free up, she could then arrange face-to-face teaching sessions to focus on those aspects which can’t be replicated online.
- Make sure you get consent from all those involved.
- Always consider etiquette and patient privacy.
- Ensure students understand the etiquette required to talk to patients in this medium.
- Test equipment.
- Have a dry run before the real session if possible.