The shift to tele-education during the COVID-19 pandemic dramatically transformed medical education. It allowed students and residents to continue their training despite difficult circumstances and remains a staple of learning models today. But while virtual learning provides better access and flexibility, it can also take away from the camaraderie and interactive nature of in-person learning.
Matthew Schelke, M.D., a neurologist at NewYork-Presbyterian and Columbia, recently published an article in the New England Journal of Medicine discussing the impact that face-to-face interaction has on the brain and how people process information. Below, he and Jonathan Amiel, M.D., director of the Office of Professionalism and Inclusion in the Learning Environment at NewYork-Presbyterian, discuss the benefits and limitations of tele-education, and why a hybrid model offers the best of both worlds for physicians and trainees.
How Face-to-Face Interactions Impact Cognitive Processes
As a third-year neurology resident when the pandemic hit, Dr. Schelke remembers the dramatic shift from in-person to virtual, and how he missed the insights that came from interacting with his peers and attendings. Now an educator himself, his experience prompted him to explore the impact of tele-education on the brain’s learning processes.
“I started thinking about whether there is actually a difference for the brain when someone is interacting over Zoom versus interacting in person,” he says. “There are small things, like facial expressions, that we are missing over the camera.”
There are very robust networks in the brain that pick up on ostensive signals and can influence our behavior and responses to others. However, those signals are often lost in video-based education.
— Dr. Matthew Schelke
In his paper, Dr. Schelke explores how neural networks process and interpret ostensive signals, which are primarily nonverbal cues used to direct someone to pay attention to something. “There are very robust networks in the brain, especially in the temporal lobe and the medial frontal lobe, that pick up on those signals and can influence our behavior and responses to others,” he says. “However, those signals are often lost or dampened in video-based education, leading to reduced engagement and comprehension.”
The brain’s rapid, unconscious processing of social cues are essential for communication and learning and help students better absorb what instructors are doing and saying. This process can be hindered by delayed video feeds and limited visibility of gestures. Beyond that, face-to-face interactions foster community — which is especially critical for medical trainees who want to develop relationships with their peers and instructors early in their careers. “There is a palpable experiential difference,” Schelke says. “In-person sessions are more engaging and livelier, and they create more connection than those on Zoom.”
The Benefits of Tele-education
Dr. Schelke recognizes, however, that there are times when tele-education is preferable, particularly when it comes to visual presentations. “There is a lot of engaging visual and multimedia content that is better suited for tele-education,” he says. “For example, we do a lot of video-based training for movement disorders or patients who have abnormal findings on exam. That type of content is better suited for tele-education than in-person.”
He also acknowledges the opportunities that tele-education has created to expand access to experts. “In our neurology department, we bring in people virtually from around the world who have crucial perspectives and essential expertise who are unable to come in-person,” he says. “That’s been huge for us.”
Dr. Amiel adds that tele-education offers busy trainees more options for how and when they want to learn. “The ability for medical trainees to engage in didactic sessions and scholarly sessions hosted by their departments has increased with hybrid engagement,” he says. “Residents and fellows are balancing their clinical responsibilities and identities with their identities as learners. They might be at different sites, they might be on different schedules, and so allowing them to participate both virtually and in-person has been key.”
Optimizing a Hybrid Approach
Both tele-education and in-person education have a role in medical training and continuing education, so finding the right balance of both is essential. For example, Dr. Amiel, who is a psychiatrist by training, says that tele-education can be useful in teaching communication and interpersonal skills, but for teaching the physical exam and technically complex procedures, nothing can replace onsite learning.
Even when the virtual environment is preferable, there are still some improvements that clinicians should consider to make the experience better, adds Dr. Amiel. “If it’s synchronous learning, getting really facile at active learning and using interactive techniques to engage learners and improve understanding is important,” he says. “For large group, asynchronous learning, it’s important to break things up into chunks that learners can take in gradually; also allow for pauses for self-assessment and reflection.”
Dr. Schelke also believes the best set up would be to start with an in-person session before transitioning to virtual learning. “Once you encounter someone, the brain processes their cues, and you learn what their personality is and how they react to things,” he says. “I think you can almost infer those cues over tele-education after you’ve met them in person.”
He suggests these strategies for improving presentation over tele-education to better facilitate learning:
- Using high-quality audio and video to improve clarity and engagement.
- Employing chat, polls, breakout rooms, and other interactive techniques to maintain participation.
- Incorporating strong visual content to supplement verbal instruction.
- Being more expressive in tone and body language to compensate for lost social cues.
“This is a call to adjust one’s style and content to really maximize the virtual environment,” Dr. Schelke says. “But we also need to be mindful of learning beyond the content and provide opportunities that allow for the facilitation of interpersonal relationships.”
Dr. Amiel also reminds instructors and trainees that a virtual environment “doesn’t mean being constantly on, always available, and not having boundaries,” he says. “I think that sometimes because it’s so accessible, people let virtual learning incur into their family and sleep time. We should be mindful from a planning perspective to keep the boundaries there.”
