Many of us are finding that we are being thrust into the world of remote medical education without the training or the experience to feel that we are likely to do this effectively.  There is a huge lack of adequate training for non-experts in this field that is designed to be pragmatic and useful for those of us who are more comfortable delivering face to face medical education.  I have looked for resources that might facilitate learning for a clinician who considers themselves a novice in remote or online medical education and have found none.

To help get people started, I’ve to put together some of the things I have learned about being an effective educator in the world of online and remote medical education.

Core Principles

You are the most important educational resource.  If you are delivering the education, your learners haven’t come to get a textbook or a list of facts.  They want to know what you know and what they don’t.  Forget some of the habits of traditional medical education.  Bring more of your experience and less of what you can find in a textbook.

Online and remote medical education has many advantages.  It is more accessible and has benefits for many people’s learning styles.  You can get a greater diversity of learners involved which can also be a powerful tool.  The educator can have more control of the virtual classroom.  

Online and remote medical education also carries many risks.  IT failures and audience disengagement are probably the greatest risks.  Preparation, planning and rehearsal are key elements in overcoming these challenges.

Problems	Solutions
IT failure (connectivity, software limitations)	Good signal (WiFi or mobile data) Educator’s device must be up to the task Choose the best software application for the job
Lack of connection from the audience to the educator.  Educator less able to read the audience.	Where possible, have the audience visible (e.g. all on video) Maximise interactive content Have questions via audio as well as via chat
Audience disengagement and loss of attention	Maximal interactive content Chunks of delivered education should be brief and broken up by interactive elements Use of breakout rooms Polls Virtual flipcharts Injections of humour Changes of pace Music
Educator’s unfamiliarity with online teaching as a modality	Rehearsal Visual aids (session map) Repetition of session to multiple audiences
Learner’s unfamiliarity with online learning	Pre-session briefing and joining instructions Start meeting with an explanation of what the session will involve and explain the functions
Security	Use of required password for Zoom sessions Link to meeting sent with clear ground rules for whether it can be shared and with whom

A Step by Step Guide

Choosing a software application

There are various packages that are available.  The decision as to which to use will depend on various factors including ease of access, user friendliness, functions available, familiarity and permissions within an organisation.

Application	Pros	Cons
Zoom	Good range of functions including hand raising, chat, screen sharing, polling and breakout rooms User friendly Most people are familiar with Zoom Works well across a range of audience sizes	Breakout rooms are only available in pro package (cost) Software is not permitted by some organisations, requiring users to access via personal devices People have to know how to use functions such as chat Basic and entry level package limit audience size to 100 but this can be increased at further cost Users need to set up Zoom on their device prior to the session (very straightforward)
Microsoft Teams	Good range of functions Permitted by organisations	Functions are often clunky and poorly designed e.g. breakout rooms Less user friendly than many other packages Users need to set up Teams on their device prior to the session (more complicated)
Google Meet	Use is possible within most organisations Simplicity	Very limited functions – essentially it is a conferencing software package
Facebook rooms	Simplicity Use is possible within most organisations	Users may not have a Facebook account
Skype	Permitted by organisations	Limited functions
YouTube	Able to reach an unlimited audience	Unable to see audience Interaction only possible via chat or third party applications (e.g. polling and virtual flipchart via mentimeter) Security and governance is more difficult to manage

There are many other software packages available.  It is worth trying the different packages to see what is the best fit for the teaching that you want to deliver.  I would recommend Zoom Pro for simplicity and functionality.

Every package will have settings that you should configure to your needs. For example, in Zoom, you can set defaults such as whether people are automatically muted when they join a meeting. Tutorials and guides for how to do configure settings are available online.

Hardware and connectivity

As the person delivering the session, you do not want to be let down by the tech on the day.  You need a device which is able to run the application smoothly.  Old or underpowered devices that let you down on the day need to be avoided.  You need to have a good broadband signal.  If you are using mobile data, you need a good signal.

The best way to make sure that it all works is to try out with the device you intend to use, in the place that you will be on the day, with the software that you will using.  Don’t assume that everything will work, make sure it will.

Time and Location

You should choose a time which is well protected.  You should have no other commitments that might encroach on the session.  You should be ready and set up about 30 minutes before the official start time so you need to build that into your schedule.

The space that you use for the session should be quiet and secure.  Think about what is in your background and aim to have nothing in view than yourself if possible.  Make sure that your lighting is in front of you and that you are not backlit.

The way that you intend to deliver the session will depend on the topic, the size of the audience and the teaching style.  A large audience lends itself to a webinar style.  A medium size group best suits a classroom style session and a small group session can be delivered more like a tutorial.

You should think about what resources and teaching aids you wish to use.  These are a really important part of your planning as they help with audience engagement. Many people will choose to use a PowerPoint presentation via the screen share facility in Zoom or Teams.  If you do use a PowerPoint, make sure that it is minimal.  The number of slides should be very few and the content very limited.  Remember that your audience may be viewing the session on a hand held device and thus wordy slides simply will not be easily readable.  If you have too many slides, this will lead you to talk too much and your audience will not be able to maintain interest.

There are a number of other ways to add dimensions and variety to your session.  Features within zoom and teams allow polling and breakout rooms (with zoom, breakout rooms is only available in the pro version).  It is also worth considering using external resources.

External resource	Possible uses
Mentimeter www.mentimeter.com	Polling, Agenda setting, Idea sharing , Sharing learning outcomes
Fun Retro https://funretro.io/	Agenda setting, Idea sharing, Sharing learning outcomes
Google Docs https://drive.google.com	Case studies, Handouts, Links

Using external resources is a great way of facilitating learning in a way that changes the pace and keeps the audience engaged.  For example, you could get your learners to go into a breakout room having first sent them a link to a google doc that has a case study and the tasks for that exercise.  You can also give them a link and code for the mentimeter that allows them to share what they think (virtual flipchart).  While they are in the breakout room, they are engaged in the learning in a different way and you get a few minutes to do whatever you need or want to do.

If you are using external resources, it is well worth putting together a list of links for your learners and sending these to your audience ahead of time.  Proactive learners will have those resources open and ready for the session.

If you deliver a really simple session, there is little risk that you will miss bits or find that elements get lost along the way.  If you have planned a more complicated session, giving yourself a visual aid-memoire in the form of a session map can be really useful.  Unless you are using a second device screen, you will need to have this on paper and placed just above your webcam for ease.  Even for simple sessions, having checklists can be really useful.  When you are thrown a curveball in an online session (someone having technical difficulties at the start) it can easily throw you and make you forget to do something essential such as introduce yourself.

You need to decide how you want your audience to be.  Will they have cameras on or off?  Will they be muted throughout and only use chat?  Will they be unmuting to speak and then muting themselves?  Will they be unmuted throughout because it’s a very small group?

It is essential that your learners know these parameters ahead of time.  If not you may find that they have assumed that they will be passive listeners and when you ask them to turn on video you see them five minutes later in a moderately damp dressing gown!

I would recommend that you send joining instructions which include the technical things like which platform and links will be needed, along with a few key bits of information such as the need to have video and audio for the session if that’s what you want.  You should ask if anyone has access or ability issues to let you know ahead of the session.

If your session is really high level, and particularly if you are doing complicated functions, consider having a second person supporting you.  This person does not have to be in the room with you but it does help if they are.  A second person can watch the session from another device and therefore sees what your audience sees.  They can therefore tell you when something isn’t going to plan.  The second person can also monitor chat, which can be difficult to do for the main facilitator when they are focused on delivering the session.

Rehearsal is really important.  You need to familiarise yourself with the software and by trying the different features, you will discover the potential glitches.  At the very least as preparation, have a meeting with friend or family using the platform that you intend to use and play with the different functions.

If your session is complicated or your audience is of high value in some way, you really want to run the whole session fully with a test audience.  This allows you to find out the time it takes and you are very likely to find that you need to crop something.  It also helps you to work out any practicalities that will make things run smoothly.

Setting up

Make sure that you are comfortable in every way.  Have some water available to drink.

Get everything set up and open the session before you expect people to join.  It is worth having a PowerPoint slide with some sort of greeting or session title so that people know that they are in the right place and that the video feed is working.  Your audience will also want to know that their audio is working.  A simple way of doing that is to play some music through your device and share that via the screen share function on the platform you are using.

You need to look at how you appear on video.  Check that you have optimal lighting.

Depending on the platform and settings that you have chosen, you may need to let people into the session.  If not, you can leave the session running and people can join and wait for the session to start.  If you have a second support person, brief them on what you want them to do.

About five minutes before the official start time, I recommend saying hello to your audience (so far) and letting them know that the session will start on time.  You can also remind them of any settings or preparation that they need to do.

Starting the session

At the beginning of the session it is important to cover some practical points.  Some of your audience may be unfamiliar with the software and despite having sent them specific instructions, people may not have read or understood these fully.

Things to tell your audience at the beginning of a session

• Introduce yourself.
• Tell people what you will be doing and how long the session will last.
• Set ground rules as appropriate.
• Tell people whether you want them to have video on or off.
• Tell people how you want them to let you know when they have a question.  If you want them to use a “raise hand” function, tell them that you won’t always see their video feed so if they raise their hand on camera, you might not see that.
• Explain any special functions that you want them to use.  That includes chat.
• Tell your audience to let you know if something is wrong.

If you have any elements to your session other than your face and a PowerPoint, I find that it is good to start by giving the audience a low-level opportunity to practice using these features at the beginning so that they can try these out safely.  For example, if you plan to use breakout rooms with information on an online document and interactive software such as mentimeter you could do the following:

Explain these elements and ask them to open the menti.com site and the linked document.  The document could be instructions for a starter task such as “Find out what everyone wants to learn in this session” and the menti.com ideas board would be one where they will write their learning objectives for the session.  Then send them to breakout rooms to complete the task.

When they come back you can talk about their learning objectives but also deal with any user or technical difficulties encountered.

Even if you are delivering a bare-bones session, get your audience to use the simple features such as chat or hand raising right at the start.

The main event

Now go for it.  In order to be as effective as possible, you want to engage your audience and maintain their attention and enthusiasm.  There are lots of ways to help you achieve this.

• Have your audience put their video feeds on. It can help you as a teacher to see people.  More importantly, it makes it less likely that they will be engaged in other tasks.  The classroom equivalent of an invisible online audience is a room full of people texting or checking emails while you talk.  
• When your video feed is on, look at the webcam.  Eye contact is very important.  If you are looking anywhere else, your gaze is tangential which is subconsciously disengaging for your audience.  If you have a thumbnail of your own webcam feed on the screen, place this as close to the webcam as possible as your tendency will be to look at your own face much of the time.
• Smile.
• Be animated, including the use of hand gestures.
• Use humour.
• Limit the amount of time that you speak continually.  Even if you are going to continue speaking again, every few minutes ask the audience a question and leave time for them to think and answer.
• Make your session about three quarters interactive in whatever way fits the modality.
• Vary things as much as possible. You can switch from PowerPoint to webcam, then video.  Using interactive elements such as polling, breakout rooms or large group discussions are all possible ways to keep the session varied.

Managing the question and answer element

Q&A is one of the most basic yet effective means that is available for an educator to engage their audience and improve the depth of learning.  It helps the session facilitator to find the level needed for the teaching and meet the specific needs of the audience.  If you are delivering an online session with more than a few people, it is a very different experience from a face-to-face setting.

Q&A in a remote teaching session is often the element that requires the most management.  You should be prepared for the possibility that your audience has already become disengaged or distracted by other things.  It can be useful to give people a warning that a question is coming, “I hope you’re all paying close attention, because I’m going to ask you all a question in a moment.”  This might result in a few people putting away their phones (on which they were commenting on something on social media or answering an email) in time to be fully engaged when you need them to be interactive.

If your audience is muted when you ask a question, you can manage that in a number of ways.  Remember that regardless of audience size, it may be difficult to get your participants to answer, so encourage them as much as possible.

Method 1 – answer via chat

This is most likely to get responses as people won’t be worried about interrupting someone and they may feel safer in terms of constructing an answer when they can review and edit it before sending it.  The facilitator needs to allow enough time for people to do this, so don’t ask a question and assume that no-one is answering after a few seconds.

If you use chat as the means for answering questions, it can be a really good way of engaging people more if you invite individuals to expand their question verbally.  “Mohammed, you’ve put ‘what about POPs scores?’ in the chat.  Could you please unmute your mic and tell me what you’ve been told about POPs scores and how they are used?”

Method 2 – hand raising

Software such as Zoom allows participants to hit a button called “raise hand” which comes up as an alert to the host.  The facilitator can then invite that person to unmute their mic in order to ask their question.

Method 3 – Verbal free for all

Most platforms give the host the opportunity to unmute everyone’s microphones at once.  This can be used to create something closer to a classroom experience where people can just start talking.  There is a risk that more than one person will talk at once, which becomes greater with large groups.  There is also the risk that any background noise from other participants becomes audible.

It is worth trying different methods to see which works well.  Within any session, if you find that one method isn’t getting any or much response, you can see if a different method works better as all audiences are different.

Other Top Tips and Resources

Here’s a list of tips and tricks that may help:

• Use headphones to avoid feedback and a microphone to reduce background noise.  A standard mobile phone microphone earpiece set works well.
• If you have a second device logged into the same meeting in the same room, one of them must always be muted and have speakers off otherwise there will be an echo.
• Remember that even when your video feed is off, people can hear you if you are not muted.
• Remember to stop screen sharing when you have finished showing something to your audience.
• Backgrounds are a fun way to inject humour into a session but you need to have a plain backdrop and there is a risk that it affects the applications function.
• Your software may allow you to record the session which can then be used as a resource for you to review what went well and what could be improved.
• Recordings of webinar or lecture-style sessions can be recorded and used as an educational resource.
• Most conference software has multiple views to choose from.  Try using each view both in rehearsal and when delivering a session.
• Each time you deliver a session, you will become more familiar with the technical and educational aspects of online learning.  Delivering the same session multiple times in a short period of time will help you to learn and improve.

DFTB are proud to share with you our first 15 remote education modules that you can pluck off the virtual shelf.

Finally, a short list of other resources that have explored the issue of becoming an effective educator in an online setting:

https://dontforgetthebubbles.com/teaching-virtually-anywhere/

https://www.aliem.com/teaching-age-covid19-real-time-video-conferencing/

https://icenetblog.royalcollege.ca/2020/03/17/teaching-remotely-in-response-to-covid-19-10-tips-to-improve-your-digital-classroom/

https://www.youtube.com/watch?v=HCK_1ydMhiE