Online Otolaryngology: A Comprehensive Model for Medical Student Engagement in the Virtual Era and Beyond

Abstract

When in-person experiences were taken away from medical students and residency applicants during the COVID-19 pandemic, institutions had to pivot to virtual experiences. We present here a comprehensive overview of virtual engagement for medical students. As we increasingly embrace virtual opportunities, it may be possible to continue utilizing these programs for many years to come.

Introduction

Sub-internships, visiting rotations, and networking play a major role in the residency application and interview processes, yet incur a large personal and financial burden to students. When the COVID-19 pandemic hit the United States in the Spring of 2020, visiting medical student rotations were halted, and the decision was made to conduct residency interviews virtually. ^1,2 Medical students during the pandemic have increasingly used remote learning and have noted benefits such as flexibility of learning and the time and money saved from lack of travel. ^3,4 Although initially thought to be restrictive, these opportunities open entirely new realms of possibilities by removing personal and socioeconomic barriers to education. So, are they here to stay? We present one department’s model for a comprehensive, multifaceted approach to mentor, educate, and recruit applicants in the virtual era and beyond.

Interventions: A Multifaceted Approach to Virtual Student Engagement

Virtual Visiting Student Rotations

We created a virtual, 4-week supplement to scheduled rotations, comprising participation in resident weekly didactic courses, didactic debrief question and answer sessions, weekly departmental grand rounds, faculty small group sessions, a social with the residents, and 2 “call shifts” to discuss otolaryngology cases in airway and facial trauma emergencies. Students were offered 10 to 15 hours of virtual activities over the course of the month. Applications were accepted on a rolling basis with special consideration for students without a home program.

Over the course of 4 months, we had 49 students participate. As each block concluded, our education coordinator met with the students for feedback; participants also completed an optional, anonymous survey. Preliminary feedback indicates all students attended over 50% of offered experiences and cited resident interactions as the most valuable aspect of the virtual experience.

This flexible schedule without strict requirements encouraged students to participate when able, and repeating events provided ample opportunity to interact with residents and faculty and to learn about the department.

Departmental Website

Even prior to COVID-19, many students relied on departmental websites to get information about residency programs. Our website was updated so it is easier to navigate, with headings and dropdown boxes that link to additional pages and provide a plethora of information that is easy to digest. The website was also made more visually appealing with candid photographs in addition to standard professional headshots of faculty, fellows, and residents. Photos of working in clinics and operating rooms, socializing, and enjoying life outside of work provide a more global sense of the people who make up our department and convey collegiality and personality.

Recruitment Videos

Perhaps most importantly, we wanted to showcase our current residents. Because our website already conveys program details, this video could focus more on personality and the natural collaboration in our residency program and department. By interviewing small groups together, we were able to capture their friendships, pride, and enthusiasm for their cohort, department, and geographic location. We include background footage of residents and faculty interacting with each other to show their teamwork and collegiality. Since this video is not widely applicable to nonapplicants, it was shared on a smaller scale and sent directly to interviewees. By January 2021, it had over 350 views on YouTube and Instagram.

Town Hall Meeting

Prior to the submission of applications, otolaryngology programs began to host virtual open forums with applicants, and our department embraced this communication modality. Our 2-hour Virtual Town Hall included opening remarks from the department chair, a brief overview of the residency program from our program director, and a discussion of educational courses and didactics from our education director. Additionally, residents presented highlights of our lifestyle, city, and interactions with each other and faculty. During these presentations, students could post anonymous questions in the chat. We had 111 students register, and up to 80 were logged in at a given time. We used a webinar format, so students did not have to show their faces and their names were not recorded.

Virtual Facilities Tour

Virtual tours provide an interactive and realistic experience for users. The technology is well established in the real-estate realm and is featured in various applications such as Google Maps. To our knowledge, virtual 3-dimensional tours have not been readily utilized in the residency application process, so we sought to create this opportunity. We utilized a Ricoh Theta SC2 4K 360 spherical camera to capture virtual tour content. The software links the camera to a mobile app and then to the online web. Instructions are easy to follow and require no prior experience in tour production. The software additionally provides analytic information on tour utilization. Approximately 2.5 hours were spent capturing tour footage and the total edit time for both tours was 0.5 hours. Tours are currently housed on our departmental website and have compiled over 850 unique views (1300 in total). The greatest number of views occurred on the day of launch (75 unique views).

Social Media

Social media has proven to be a surprisingly effective method of communication with medical students. In the last year, social media usage has surged in the medical community. ⁵ Many otolaryngology programs which did not have accounts are now creating them on multiple platforms and gaining followers rapidly. In our preliminary evaluation, we found that the 2 main platforms used are Twitter and Instagram.

In 2015, we were one of the first otolaryngology departments to establish a Twitter account, so we had a healthy following well before the pandemic began. Our follower counts have always gradually increased, but during the pandemic, they nearly doubled. Our Instagram account was created in 2019 and was less utilized, but had the most growth during the pandemic. In May 2020, we had approximately 320 followers; by March 2021 we were approaching 1000, and these numbers continue to grow.

Each account plays a different role. Twitter represents our entire department, is staff-run, and has a broader audience for research and clinical endeavors. The Instagram account is specific to our residents, with a resident as the primary content generator. This content includes permanent posts, temporary “stories,” interactive polls, and resident features. Although we do share information about our department, the focus is on human interest, local culture, and fun stories about the residents’ day-to-day activities. Our department also utilizes a YouTube channel, where we upload our grand rounds and other educational presentations from residents, fellows, and faculty.

Discussion

As we learn more about this pandemic and hope that in-person opportunities will soon return, we may find that these virtual programs can continue long after COVID-19 has been eradicated. However, we must first identify the effectiveness of virtual programming. Preliminary studies at our institution have demonstrated that otolaryngology residency applicants found our virtual visiting rotation an effective way to learn about the culture of our program and interact with residents and that social media use to investigate otolaryngology residency programs had a positive impact on applicants’ rank lists. Further analysis is pending, and investigation into other programs’ interventions may help to elucidate the effectiveness of these virtual opportunities.

In-person experiences, while important, incur a large personal and financial cost to students who are already burdened by the stresses of their medical education. Virtual opportunities partially eliminate these burdens, and may be an effective way to even the playing field for applicants with socioeconomic, geographic, or personal limitations. There are of course their own costs to virtual learning, which requires reliable internet connectivity, adequate quality computers and webcams, and an appropriate location from which to participate. Yet these costs are often minimal compared to the thousands of dollars that student spend to attend interviews, away rotations, and national conferences.

Although virtual opportunities may be more affordable, there is anecdotal evidence from applicants, residents, and faculty members across the country that they are not an adequate substitute for the real thing. As there is limited information on the impact of virtual programs, further investigation may be warranted to evaluate the effectiveness of in-person versus virtual opportunities for medical students. Measuring the success of virtual programs. Perhaps a hybrid approach with both in-person and virtual experiences offers the best of both worlds and is the way of the future.

Conclusion

Subinternships, visiting rotations, and national meetings are a vital part of the fourth-year medical student’s experience and residency application process. When these were largely taken away by the COVID-19 pandemic, residency programs had to pivot to virtual platforms to provide these opportunities to prospective residents. We present here a comprehensive form of “online otolaryngology” to mentor, teach, and recruit senior medical students. Further investigation into the utility of these programs is worthwhile, but the preliminary investigation has demonstrated their effectiveness. In providing virtual programs such as these, residencies can provide opportunities for economically disadvantaged candidates to match into competitive subspecialties like otolaryngology. This model of an adaptable and multifaceted approach to virtual engagement can meet the goals of both residency programs and applicants in providing education, networking, and mentorship that is effective and may continue to be utilized for years to come.