Abstract
Background
Effective communication is essential for patient care and physician development. Connect, Listen, Empathize, Align, Respect (C.L.E.A.R.) Conversations, developed at Henry Ford Health in 2012, is an evidence-based program using experiential learning methods—role play, feedback, and reflection—to build communication skills. During the COVID-19 pandemic, the program transitioned from in-person to virtual delivery. Few U.S. studies have explored challenges and opportunities from the perspectives of facilitators, graduate medical education (GME) partners, and administrators.
Objective
This exploratory qualitative study aimed to understand the experiences and perspectives of facilitators and administrators during the transition of C.L.E.A.R. Conversations to a virtual format. The purpose was to identify key opportunities, challenges, and strategies that supported this transition rather than to evaluate the benefits or compare virtual and in-person modalities, The study also sought to determine whether the adaptation process could inform a practical and scalable framework for other institutions, serving as both internal reflection and a foundation for hypothesis generation and future research in medical education.
Methods
Structured interviews with facilitators, GME partners, and administrators were conducted from April to June 2024 and analyzed through inductive content analysis by two independent coders.
Results
Eleven participants described the adaptation process, yielding five main themes: Modifying Content and Delivery, Adapting to Virtual Format, Challenges and Mitigations, Benefits and Surprises, and Recommendations and Insights.
Conclusion
Findings highlight how facilitator and administrator perspectives can inform the thoughtful adaptation of experiential learning programs to virtual environments, offering a replicable framework for scalable, learner-centered communication training in GME.
Keywords
Introduction
Effective communication has a significant impact on patient care and is a critical skill for physicians. 1 “Interpersonal and Communication Skills” is included as a core competency in medical training by the Accreditation Council for Graduate Medical Education, specifically the ability to “communicate effectively with patients, families, and the public, as appropriate, across a broad range of socioeconomic and cultural backgrounds.” 2 Several validated models such as the REDE Model, Critical Care Communication Project, and VitalTalk train physicians to facilitate serious clinical conversations with compassion and shared decision-making.3–5 Among these models is the Connect, Listen, Empathize, Align, and Respect Conversations (C.L.E.A.R.) curriculum.
C.L.E.A.R. Conversations was developed by palliative and critical care physicians at Henry Ford Health (HFH) in 2012. It is an evidenced-based learning model that draws on the work of VitalTalk 5 and provides clinical learners with a 5-part roadmap (Supplemental Figures 1 and 2) for having effective, empathetic goals of care conversations with patients and their families. Participants develop their communication skills through experiential learning methods, including role play with trained actors, peer feedback, and reflection. The C.L.E.A.R. Conversations curriculum was shown to be effective for improving patient satisfaction and enhancing trainee preparedness for difficult conversations. 6 Additionally, the simulation-based activities within C.L.E.A.R. allow physicians to gain self-confidence in discussing goals of care in high-stakes scenarios. 7 Between 2012 and 2019, C.L.E.A.R. Conversations curriculum held in-person workshops that provided participants with high-impact, hands-on learning opportunities. However, in March 2020 the onset of the COVID-19 pandemic halted all in-person HFH communication courses.
The COVID-19 pandemic caused unprecedented challenges for graduate medical education (GME) programs,8,9 and educational courses had to rapidly transition to virtual platforms. Necessary patient and visitor restrictions limited in-person interactions, and conducting effective conversations remotely became essential. The C.L.E.A.R. Conversations team transitioned the program to a virtual format over the summer of 2020, with the goal of maintaining its foundational features and benefits. Notably, the transition involved structured, repetitive practice with targeted feedback—a deliberate practice approach—that has been shown to effectively build communication skills in virtual settings.8,9 Although other HFH GME programs returned to in-person formats, the virtual C.L.E.A.R. Conversations facilitators and GME administrators have continued to offer the workshops online.
Existing studies on transitioning GME modules from in-person to virtual formats have focused primarily on learner outcomes, including performance evaluations and satisfaction.10–12 Globally, several studies have examined the challenges and strategies for delivering communication skills training virtually, particularly during the COVID-19 pandemic, highlighting diverse approaches and adaptations in medical education. 13 However, to our knowledge, no U.S. studies have examined the process of successfully transitioning GME communication skills courses to virtual formats from the perspective of course facilitators and administrators.
To address this gap, we conducted an interview study with the facilitators and administrators who played critical roles before, during, and after the transitioning of the C.L.E.A.R. Conversations program online. This study was designed as an exploratory study to understand the experiences and perspectives of facilitators and administrators focused on lived experiences and contextual realities during the transition. Our goal was to identify the key opportunities and effective strategies in converting in-person communication courses to a virtual format and to explore whether the process of adapting the C.L.E.A.R. Conversations program could serve as a practical, adaptable framework for facilitators and GME administrators at other institutions. It was beyond the scope of this study to compare virtual and in person training effectiveness or to interrogate the benefits and drawbacks of the process. Beyond serving as an internal quality review and reflection, the findings provide valuable insights for other smaller programs and act as a foundation for hypothesis generation and future, larger-scale studies in medical education. Online education, now recognized as a cornerstone of medical training, has advanced significantly during the pandemic, closing the gap between GME and contemporary technological capabilities. 14 This shift represents a pivotal moment for innovation in medical education.
Methods
Study Design
This qualitative, interview-based study was approved by the Henry Ford Health (HFH) Institutional Review Board (IRB number 16866). The reporting of this study conforms to the COREQ checklist 15 (Supplemental File 1). Interviews were conducted between April and June 2024 by a pulmonary and critical care fellow identifying as a female with a Doctor of Medicine and a foundational, basic experience conducting qualitative research. The interviewer had participated in the course as a resident and was personally motivated in studying the perspectives of the facilitators, GME educators, administrators to better understand what is required for rapid transitions in curriculum delivery. The interviewer's specific values, such as beliefs regarding communication training, hierarchical structures, and facilitator–learner relationships, as well as any underlying assumptions or potential implicit biases, were not formally examined or reported. The study included individuals with direct involvement in the design, facilitation, or administration of the C.L.E.A.R. Conversations program recruited through convenience sampling from HFH facilitators and administrative staff engaged before, during, and after the online transition, and excluded those without substantive experience or responsibility in these core activities. Partners from external institutions who played an integral role in the inception of the program and its transition to a virtual format were also included. Facilitators included those who conducted the workshops, and administrative partners were responsible for the day-to-day duties of program operation, such as course scheduling, managing the technology of the virtual platform, working with program directors to ensure protected trainee and faculty learning time. Administrative partners in GME also were responsible for identifying learners to participate in the program, obtaining continuing medical education credit for the program, and cross-referencing the educational goals and objectives of C.L.E.A.R. with the larger institutional curriculum. Participants were informed of the study's rationale and provided a process of consent for their involvement. All invited participants agreed to take part in the study. A formal sample size analysis was not conducted.
Interview Guide
An interview guide was developed (Supplemental File 2), which included sections on the introduction, written informed consent, study overview, in-person format, virtual program, instructional design, considerations and facilitation features to optimize learning, lessons learned, challenges, strategies employed to overcome barriers, perceived benefits, things to avoid, and advice for others. The interview guide was created by the study team specifically for this project and was not subjected to a formal validation process. Participants, who were primarily clinicians, were offered the choice of email 16 or one-on-one live video interviews to accommodate their schedules and allow for thoughtful, reflective responses. All video interviews were conducted one-on-one, with no individuals present other than the interviewer. Most participants opted for email interviews, while some participated via video interviews lasting approximately 1 h. Video recordings were shared with participants for validation and served as field notes; no separate field notes were collected. Email participants were asked to respond at a time that fit their clinical responsibilities, allowing space for reflection. Participants were asked to respond to interview sections relevant to their involvement with C.L.E.A.R. Conversations before, during, and after the transition to the virtual format. No repeat interviews were conducted.
Statistical Analysis
The study was guided by a phenomenological framework, focusing on exploring and understanding the lived experiences of clinicians within their professional and educational contexts. Responses were analyzed by two independent coders who used content analysis to identify emergent themes. Formal thematic methods or analytic software were not used; instead, the authors held discussion meetings and reached consensus to derive themes inductively from the data rather than from predetermined categories. Given the small sample size, data saturation was not applicable. Supporting statements, including participant quotations, were extracted from the interviews to provide context and illustrate the themes identified. Particular attention was given to anticipated versus actualized benefits and difficulties, as well as strategies employed to mitigate challenges. Responses from facilitators and administrators were first analyzed separately and then subsequently aggregated to identify overarching themes across both groups. Finally, participants were invited to provide feedback on the findings. To ensure the trustworthiness of our study, we employed strategies such as participant validation, peer debriefing, and maintaining a systematic record, aligning with established practices in qualitative medical education research.
Results
Description of Participants
A total of 11 participants were interviewed—9 via email and 2 via video. They included 6 C.L.E.A.R. Conversations facilitators (F1-F6), 2 administrative partners (A1, A2), and 3 GME partners (G1-G3), all of whom contributed significantly to the program’s success. The facilitators consisted of 2 physicians in pulmonary and critical care, 2 in hospice and palliative care, 1 in emergency medicine, and 1 academic consultant with a PhD in English and expertise in health humanities (Table 1). One GME partner (G1) contributed prior to the transition and retired in 2020. Five facilitators (F1-F5) and one GME partner (G2) were involved before, during, and after the transition, while one facilitator (F6), one GME partner (G3), and two administrators (A1, A2) joined after 2020.
Description of Interview Participants.
Thematic Analysis
Participants provided a range of rich responses about the process of transitioning the program to a virtual format as reported below with additional quotations in Table 2. A total of 13 emergent sub-themes were identified under 5 main overarching themes: (1) Modifying Content and Delivery, (2) Adapting to the Virtual Format, (3) Challenges and Mitigations, (4) Benefits and Surprises, and (5) Recommendations and Insights.
Themes and Additional Quotations Describing the Transition of C.L.E.A.R. to a Virtual Format.
Modifying Content and Delivery
The first overarching theme considered how in-person C.L.E.A.R. program content and delivery were initially modified for a virtual format. Interview participants identified three priorities that guided the adaptation process: (1) preserving the pedagogical integrity of C.L.E.A.R., (2) ensuring that course materials and activities were oriented towards communication in virtual settings, and (3) limiting learner screen fatigue. The key elements of the in-person C.L.E.A.R that the transition team strove to preserve were those that prior research and learner feedback had indicated were the most effective: It was important to preserve the model of experiential learning where learners practice communication skills and get real-time feedback from their peers. It was important to keep high quality actors so that the cases are realistic and learners can envision translating the skills to real practice. Group engagement, note-taking, and peer feedback was important to preserve as well as keeping a safe learning space for learners to feel comfortable taking risks and trying new skills. Maximizing time for learner practice was important to preserve because that is where most of the learning happens. [F3]
At the same time, however, the transition team did not seek to duplicate the in-person courses exactly. Rather, they modified course content, so it better matched the virtual learning environment and focused on skills needed by learners in real-world virtual communications with patients and family members. As one interview subject explains: [We redrafted] our case scenarios to involve a meeting with a family member who lived a distance away and was meeting with the team by video conference. This made the mode of learning (virtual) consistent with the case scenario. ie, it would not have worked nearly as well to continue to role play that we were meeting in person, but act that out on a zoom/Webex call, for example. [F2]
Actors also adapted their character roles to simulate video calls rather than in-person meetings with family members. They modified verbal responses and facial and physical gestures to be clearly visible through video.
Specific modifications to limit screen fatigue mentioned in interviews included reducing workshop lengths by 30 to 60 min to accommodate the shorter attention spans typically experienced by learners during online learning. New content and activities to streamline reinforcement of core skills were created, including pre-recorded didactic videos and short interactive polls and drills. Facilitation guides were expanded to include pedagogical scripts to promote efficiency and consistency in workshop delivery.
Adapting to the Virtual Format
The second overarching theme emerging from interview subjects’ comments was Adapting to the Virtual Format. These comments referred to changes made to optimize the online experience both before and after learners began participating in the courses. Interview subjects identified specific technical considerations that needed to be addressed and the employment of strategies to enhance learners’ online engagement.
During the initial 2020 rollout of the C.L.E.A.R virtual format, learners, facilitators, and administrators were all unfamiliar with video platforms. Facilitators built in time before learners joined each course to familiarize themselves with updates to the virtual platform and troubleshoot any technical issues. To ensure that all learners were prepared to participate, a 10-min “tech prep” section was added at the beginning of each course to orient learners to key platform features such as using the chat function and hiding non-video participants. Another key adaptation was assigning a course administrator to manage all of the online sessions, including working with learners experiencing technical difficulties. This adaptation was repeatedly identified by interview subjects as key to the success of the virtual courses. As one interview subject asserted: Having a person dedicated to administering the virtual meeting tool during the workshop allows the facilitators to focus on delivering the content and ensuring the participants have a successful learning experience. [A1]
Another interview subject also emphasized the value of having a dedicated person who managed the online delivery of all course sessions and who “can troubleshoot pretty much anything and then can get back to the powers that be” about developing problems. This subject also noted “I think it's very helpful because she is the one that's going to be able to see patterns because she's seen all of [the sessions]” [G3].
In addition to technical adaptations, interview subjects spoke about strategies employed to promote learners’ online engagement. These included “keeping a very structured course that requires explicit learner participation at every step” [F3]. Before beginning with didactic materials, at the start of the courses facilitators and learners engaged in an introductory activity to foster a sense of community. Breakout rooms were used extensively to promote small group interaction and individual practice. This enabled more learners to alternate between role-playing, leading a goals-of-care conversation and providing peer feedback. Utilization of chat functions facilitated real-time feedback and shared learning resources.
Challenges and Mitigations
The third theme that arose was Challenges and Mitigations. Some reported challenges were anticipated while others developed as learners became more familiar with virtual coursework. Technical difficulties such as connectivity issues for learners, facilitators, and/or actors or problems with video or audio feeds continued to occur. Some learners joined on computers without cameras or joined on their phones, either preventing or hampering their engagement. Another challenge that arose was “[l]earners not having optimal space in the hospital/clinic to participate in virtual course—e.g., [they] shared space with other learners in course leading to echoes, shared space with others doing clinical work” [F3]. Screen fatigue emerged as a challenge despite design efforts to limit session lengths. This was especially the case at the beginning of the pandemic when all learners’ curriculums were being delivered online. Another challenge arose as learners gained experience with online learning environments: One of the new difficulties that arose as everyone became more accustomed to virtual platforms was learners’ expectation that they could log on, tune out, and multitask. Unlike other types of virtual education, C.L.E.A.R. is attention- and participation-driven. Not understanding the nature of the courses, learners have logged on while driving, while in clinic, while boarding planes, while having extended conversations with other people in their physical spaces, and so forth. [F4]
To mitigate these challenges GME administrators worked to ensure learners had protected time by emailing coordinators ahead of time to schedule sessions and clarify tech requirements. The course administrators and facilitators created crisis plans for what to do if anyone from the team or learners in various stages of participation in the course dropped off signal or if their video/audio froze. Facilitators also generated re-engagement strategies, such as: … non-judgmental statements or requests to the learners to directly address issues like participants who leave their cameras off or become passive participants. Generating specific language and having easy access (post it notes on my wall behind my laptop, for example) to the statements for use if learners are talking/texting/eating/distracted/ disengaged to emphasize what we need from them while maintaining respect and their dignity in front of the group. [F2]
Successful mitigations were documented in administration and facilitation guides. Facilitators reported that a trial-and-error approach during the transition allowed them to refine the virtual model. Engaged participants provided valuable real-time feedback, contributing new ideas and helping shape a successful online training framework.
Other challenges that arose were identified by interview subjects as more intractable. These included that the shortened course times meant that not all learners were guaranteed a chance to take the lead in role play. In general, interview subjects asserted that the shortened virtual courses meant there was just less time and physical opportunity to build community than there had been in the longer in-person courses. Another unavoidable challenge was that “some people don’t learn well on an online learning format. So, there were definitely some people who struggle” [G2].
Benefits and Surprises
Despite these challenges, interview subjects asserted that adapting the C.L.E.A.R. curriculum to the virtual format offered substantial benefits—as well as some surprises. Cost savings were realized through reduced need for physical spaces, travel, and printed materials. GME administrators reported that not having to coordinate multiple physical spaces also made course scheduling easier. Having the ability to utilize computers while teaching courses meant that facilitators could keep guides and other materials readily available for their reference without diverting their attention from the learners: “I didn’t have to memorize as many things or look down at my paper as often. This decreased the cognitive load of facilitating …” [F2]. Another benefit came from the standardization of course delivery due to the creation of scripts and other resources in the facilitation guide. Facilitators reported this “has allowed us to be more thoughtful and efficient in training new facilitators” [F4]. By far the most common benefit identified by interview subjects was the increased access the online programming provided. Geographically remote facilitators, actors, and learners could now participate, significantly increasing program accessibility and diversity by allowing for “more equitable distribution of quality educational content across a health system or across multiple health systems” [F3].
Along with these benefits, interview subjects also identified things that surprised them about the transition from in-person to virtual delivery of C.L.E.A.R. conversations. The first of these was that the online learner role play “is more ‘real’” and “may be less stressful and require less imagination to buy into” [F2]. This was attributed to the utilization of tech features that were both identical to the tech features of real-world online conversations with patients and families and enabled the learners to minimize role play distractions by hiding non-video participants rather than being able to see their fellow learners observing them while they tried new skills. While one interview subject asserted that “a bit of spark is lost without the in-person interactions” [F5], other interview subjects indicated surprise that the virtual format “is not ‘less than’ but different. It offers advantages and would be just as effective as in person” [F1].
Recommendations and Insights
The fifth theme, Recommendations and Insights, reflects answers interview subjects gave when asked what advice they had for other for other administrators and facilitators considering transitioning in-person communication course to a virtual format and what they wished they knew at the start of the adaptation process that they knew now. One recommendation was for curriculum designers to start by focusing on how build a virtual course that can produce the desired communication outcomes rather than on how to duplicate an existing in-person course or curriculum in a virtual modality. When designing the virtual curriculum, interview subjects emphasized the importance of paying close attention to the length of programming and “changing the delivery (video/role play/demonstration) frequently enough to keep people engaged” [F1]. Another factor institutions should keep in mind at the beginning is the potential need for training: I also think that it's useful to keep in mind that effective teaching online is not the same as effective teaching in-person, and that the transition for educators may require additional training and trials and errors. That may sound incredibly obvious, but transitioning to the virtual formats is not just as a matter of “good teachers” now using virtual platforms, but of teachers developing effective virtual teaching strategies that produce good results for learners on those platforms. [F4]
Other key upfront investments that interview subjects identified as critical were creating very thorough facilitator and administrator guides and, as mentioned above, having a dedicated person to host the online sessions and manage the tech features of course in order to free up facilitators and learners to focus on course content and activities. More than one team member should be able to serve in this role.
When offering online communication courses, interview subjects recommended piloting the program with groups of learners who “are already enthusiastic” and “then after you have more experience to see what works well and have boosted what is going well and reduced what isn’t as successful, then broaden to groups that might be less enthusiastic taking your workshops as requirements of their program, for example” [F2]. Such learners can also be asked for feedback and what they found helpful or what could be changed or added to improve the course. Planning for where facilitators, learners, and actors will participate in virtual courses and ensuring the needed technology tools (camera, computer, speakers, microphones, internet) are well functioning are also necessary.
Other advice interview subjects offered was to remember a single communication course or curriculum “is a start for communication education and no matter if the session was in person, it would not be sufficient enough without deliberate practice. Engagement will vary among learners and those that are interactive get the most out of the sessions” [F6]. Finally, another interview subject suggested, “Treat yourself with grace and courtesy with a mindset that things won’t go smoothly from the beginning, however with persistence and continuous improvement you can build something powerful” [F2].
Discussion
The shift to online education required preserving the C.L.E.A.R. Conversations program's effectiveness and fidelity while addressing barriers such as technological limitations, participant engagement, and maintaining the dynamic, interactive nature of the workshops.
Building connections with patients and families and mastering effective communication skills are essential for shared decision-making in medicine. In this interview study, we explored the transition of a successful medical communication program to an online format, building upon previous research regarding the importance of communication in healthcare and the effectiveness of structured training programs in enhancing these skills.1–5 This curriculum format shift relied upon significant adaptability and innovation in GME, highlighting the program’s ability to preserve core experiential learning elements such as role play, peer feedback, and reflection. Key adaptations, including pre-recorded didactic videos, breakout sessions, virtual role-plays, and shortened session lengths, addressed challenges such as screen fatigue and engagement. Benefits of the transition, such as increased accessibility and reduced costs, emerged alongside challenges, such as maintaining collegiality and managing distractions. A comparison with other GME programs revealed the unique, fully virtual design of C.L.E.A.R., which intentionally chose to remain virtual.
Studies have collectively suggested that transitioning communication skills courses from in-person to virtual formats can be effective, feasible, and well-received by participants, with potential benefits in accessibility and scalability, similar to our findings.10–12 For example, a study by Rivet et al 8 explored the adaptation of a program on compassionate conversations to a virtual platform, echoing the C.L.E.A.R. program's emphasis on authenticity in virtual role-play scenarios. Similarly, another study described the effectiveness of online training for improving clinician communication skills in serious illness discussions, supporting the feasibility and impact of virtual education models. 9 Notably, the fully virtual design of C.L.E.A.R. distinguishes it from other GME programs that retained some in-person components, as seen in the DigiMed study, 14 which documented the shift to hybrid online learning in medical education during COVID-19. Unlike these hybrid approaches, C.L.E.A.R. was reformatted to be entirely virtual, emphasizing its distinctiveness and innovation in adapting to pandemic-related constraints. A Swedish qualitative interview study of 7 course leaders responsible for residency courses during the first year of the pandemic revealed both affordances and constraints of digital conference technologies, highlighting how course leaders adapted their pedagogical strategies to cope with the transition and innovate their teaching methods. 17
While our findings align with previous research, our study contributes to the growing body of literature on the viability of virtual formats for skill-based education in GME by emphasizing and exploring the perspectives of facilitators and GME administrators. One key takeaway of our study is the paramount importance of prioritizing the unique capabilities of the virtual format that are not accessible through the in-person format. Thus, rather than trying to replicate the in-person experience online, the focus should be on leveraging the new possibilities provided by the virtual setting while maintaining critical original program elements, such as role play, respect, and elements of surprise and challenge that enhance the experience. The strengths of our process include the comprehensive adaptation of the curriculum, successful retention of key program components, and the exploration of real-time feedback to refine delivery. However, challenges such as screen fatigue and maintaining engagement warrant further investigation. By leveraging robust institutional support and an innovative design, the C.L.E.A.R. Conversations program transition to a virtual framework demonstrates how GME can adapt to evolving educational needs. Its success provides a valuable model for fully virtual training programs and highlights the potential for scalable, cost-effective, and impactful education in the post-pandemic era.
Limitations
This qualitative interview study provides valuable, in-depth insights into participant experiences within the medical education program; however, it is subject to several limitations. The small sample size may restrict the transferability of findings, and the time- and resource-intensive nature of qualitative data collection and analysis may have constrained broader participation. A formal sample size calculation was not conducted, as the study employed a qualitative and exploratory design focused on understanding participants’ experiences. Accordingly, the sample comprised all stakeholders identified as essential to addressing the study objectives. Although strategies to enhance methodological rigor—such as participant validation, peer debriefing, and maintaining a systematic audit trail—were employed, the findings may still have been influenced by researcher perspective, and not all participants completed the full interview due to varying levels of engagement across program phases, including prior to, during, and following the transition from in-person to virtual formats.
We recognize that there is limited information in the literature regarding the experiences and perspectives of clinicians who serve as facilitators and administrators in medical education, particularly in providing insight into their contextual realities. To preserve this exploratory design and to elicit rich, unconstrained descriptions of participants’ experiences and perceptions, the questionnaire was developed by the authors and was not subjected to formal validation. As such, the absence of a validated instrument may limit the rigor and generalizability of the data collected. Ours is a small-scale exploratory study, and we hope it contributes meaningful insights in this underexplored area and serves as a foundation for future, larger-scale research. Findings may also be useful as internal quality feedback and may provide context for other smaller programs based on lived experiences. As a qualitative study, the focus was on exploring lived experiences rather than measuring quantitative outcomes; therefore, any inferences about the comparative effectiveness of in-person versus virtual formats are based primarily on participants’ subjective perceptions.
Given the participants’ primarily clinical and educational roles, offering both email and video interview options was necessary to maximize participation and allow reflective responses without imposing on clinical duties. Insights into effectiveness of email interviews in qualitative studies have been studied. 16 While email interviews may provide less interactive depth than video interviews, potentially influencing the richness of data, careful qualitative analysis, participant validation of transcripts, and coder discussions were employed to mitigate potential impacts on interpretation.
Conclusions
This study offers an exploratory understanding of how a communication training program was successfully adapted from in-person to virtual delivery through the perspectives of facilitators, GME partners, and administrators. Rather than evaluating outcomes or comparing formats, it focuses on uncovering the lived experiences, contextual realities, and strategies that supported this transition.
The findings illustrate that effective virtual adaptation depends on preserving experiential learning elements such as role play, feedback, and reflection, while embracing the advantages of virtual platforms, such as accessibility, efficiency, and scalability. Institutional support, dedicated facilitation, and iterative refinement emerged as central to sustaining quality and engagement.
Beyond its role as an internal quality review, this work provides a practical framework for others seeking to adapt communication curricula to virtual settings. It also serves as a foundation for hypothesis generation and future research exploring how educator and administrator perspectives can shape the design of innovative, learner-centered, and sustainable models in graduate medical education.
Supplemental Material
sj-docx-1-mde-10.1177_23821205251404583 - Supplemental material for Challenges and Benefits to Adapting the C.L.E.A.R. Conversations Curriculum for Physician–Patient Communication to an Online Format: A Qualitative Interview Study
Supplemental material, sj-docx-1-mde-10.1177_23821205251404583 for Challenges and Benefits to Adapting the C.L.E.A.R. Conversations Curriculum for Physician–Patient Communication to an Online Format: A Qualitative Interview Study by Medha R. Cherabuddi and Rana L.A. Awdish in Journal of Medical Education and Curricular Development
Supplemental Material
sj-docx-2-mde-10.1177_23821205251404583 - Supplemental material for Challenges and Benefits to Adapting the C.L.E.A.R. Conversations Curriculum for Physician–Patient Communication to an Online Format: A Qualitative Interview Study
Supplemental material, sj-docx-2-mde-10.1177_23821205251404583 for Challenges and Benefits to Adapting the C.L.E.A.R. Conversations Curriculum for Physician–Patient Communication to an Online Format: A Qualitative Interview Study by Medha R. Cherabuddi and Rana L.A. Awdish in Journal of Medical Education and Curricular Development
Footnotes
Acknowledgments
The authors thank the C.L.E.A.R. Conversations team for their support, all participants—Rana L.A. Awdish, Dana Buick, Kristen Chasteen, Rosemary Weatherston, Erin Zimny, Patrick Bradley, John Bollinger, Robin Lewis-Bedz, Maria Kokas, Mara Hoffert, and Jennifer Newman—for their contributions, Rosemary Weatherston for manuscript consulting, Karla Passalacqua for qualitative methodology guidance, and Stephanie Stebens for editing and formatting assistance.
Ethical Considerations
This study was reviewed and approved by the Henry Ford Health Institutional Review Board, approval number 16866.
Consent to Participate
All participants provided informed consent to participate in the study.
Consent for Publication
All participants provided consent for publication and acknowledgments.
Author Contributions
Medha Cherabuddi contributed to conceptualization, methodology, investigation, formal analysis, and writing—original draft. Rana L.A. Awdish contributed to conceptualization, methodology, formal analysis, supervision, and writing—review and editing. Both authors reviewed and approved the final manuscript.
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability
The data generated and analyzed during this study are not publicly available due to confidentiality considerations but are available from the corresponding author on reasonable request.
Supplemental Material
Supplemental material for this paper is available online.
References
Supplementary Material
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