Faculty attendance and perception of virtual educational conferences in pediatric emergency medicine during the COVID-19 pandemic

Background: Attendance of in-person didactic conferences is a key component of graduate medical education and training in pediatric emergency medicine. Faculty participation in didactic conferences is important, although challenges to attendance exist. The SARS CoV-2 global pandemic disrupted in-person medical education and forced migration to virtual learning. Our goal was to describe how the change to virtual learning affected pediatric emergency medicine conference attendance by faculty in the division at a large academic medical center. Participants were also surveyed to provide insight into perceptions of virtual conferences. Methods: Faculty of (fellow was compared to Conference participants were surveyed to assess attitudes towards the format. Descriptive statistics were used to describe variables.

Faculty attendance of in-person conferences (fellow conference from 2017-2020, resident conference from 2019-2020) was compared to attendance of virtual conferences (April -June 2020). Conference participants were surveyed to assess attitudes towards the virtual format. Descriptive statistics were used to describe variables.

Results:
The transition to virtual learning increased pediatric emergency medicine faculty attendance of all conferences. Fellows conference attendance increased from 11.8-49.2% of available faculty (3.3 to 13.8 out of 28) (95% CI -14.0 to -9.09 p < 0.001). Resident conference attendance increased from 18.3-58.9% of available faculty (5.12 to 16.5 out of 28) (95% CI -20.89 to -8.60 p < 0.001). Survey response rate including fellows and residents was 67.5% (52/77), with 88.2% of faculty members responding to the survey (30/34). Most respondents (75%) regarded the virtual format as better or equal to in-person. All respondents (100%) indicated they would keep the option to virtually attend conference in the future.

Conclusions:
Virtual conferences increased faculty attendance in both fellow and resident pediatric emergency medicine educational conferences. It was well received by participants, and most would like to continue virtual learning in the future.

Background
Formal didactic conferences are an essential component of pediatric emergency medicine (PEM) education, particularly given the unpredictable clinical load unique to emergency medicine 1-3 . Faculty engagement enhances this type of education, although previous study has demonstrated that faculty attendance of such conferences may be limited by clinical, administrative, and familial duties, as well as time and distance 3 .
On March 12th, 2020, with the social distancing necessity of the SARS CoV-2 global pandemic, all educational in-person gatherings at our university were suspended. The didactic conferences for fellows and residents transitioned to virtual conferences, a pattern that re ects the broader medical education landscape as a result of the pandemic [4][5][6][7][8][9][10][11] . Virtual learning in pediatric emergency medicine has been studied previously and shown to have success, and the virtual conference format has been shown to be as effective as in-person didactic conferences for some specialties 2, 12-15 . We therefore looked to understand how the virtual conference format affected attendance patterns by our faculty.
We tracked data on faculty, fellow, and resident attendance of our fellow and resident conferences, analyzed patterns of faculty attendance before and after virtual conferences, and surveyed participants of this new format. We hypothesized that the virtual conference format, by removing some barriers of time and distance to attendance, would increase overall faculty attendance of these educational conferences.

Research Setting and Participants
The University of Texas Southwestern Medical Center, Division of Pediatric Emergency Medicine, has an active fellowship program and is the primary acute care pediatric experience for six independent residency programs across North Texas.
The fellowship program hosts a half-day weekly conference, with mandatory attendance for fellows. Changes were made to the conference over the years in order to improve faculty attendance: one hour of continuing medical education (CME) credit was added in academic year (AY) 2018-2019, and the conference day was changed from Wednesday to Tuesday in AY 2019-2020 to align with other educational activities in the department.
In September 2019, the division also created a weekly resident conference. Rotating residents on shift (3-6 per session) were provided a protected two-hour block of time in order to attend resident conference.

Intervention
On March 12, 2020, fellow and resident conferences were paused for two weeks to make adjustments to accommodate social distancing mandates. The fellow conference resumed on March 24, 2020 and the resident conference resumed on April 8, 2020, both using a virtual conference format on the software platform Zoom™. Zoom™ was chosen for its user-friendly features, cross-platform capabilities, and low cost. The fellow and resident conference Zoom™ links were distributed to faculty, fellows, and residents.
Attendance was opened to resident conference by sharing the Zoom™ link with the rotating residency programs.

Outcomes
For in-person conferences from 2017-2019, faculty attendance of fellow and resident conference was obtained on paper. Conference attendance was de-identi ed and entered in MedHub™, a personnel and scheduling program. For virtual conferences from April 2020 -June 2020, faculty attendance was taken from the participant list provided by Zoom™, de-identi ed and entered into MedHub™. The authors created a brief survey to assess attitudes towards virtual conferences (Appendix A). The anonymous survey link was distributed via e-mail to all virtual conference participants in July 2020 via RedCap™.

Statistical Analyses
Descriptive statistics were used to describe all variables such as rates of conference attendance. Students t-tests were used to compare faculty conference attendance between academic years. Paired Ttests were used to compare conference attendance before and after the institution of virtual learning format. Survey results were collected via RedCap™ and results collated. A p-value less than 0.05 in analysis was considered statistically signi cant. All statistical analyses were performed using JASP v0.12.2.0.
Institutional Review Board of University of Texas Southwestern Medical Center reviewed the study proposal and determined it to be exempt. An implied consent form was given to all participants when completing the survey.
Fellow attendance did not vary, as expected due to mandatory attendance, which is contrasted with faculty attendance in Fig. 4.
Of all respondents, 75% felt that virtual lectures were equal to or better than in-person in terms of meeting their educational needs, and 11.5% felt that the virtual format made no difference for them. Out of the 75%, 40.4% (21/77) selected that virtual was better than in-person, and 100% of these (21/21) cited the convenience of virtual attendance, with additional selections of decreased travel and childcare burden (85.7% and 19%, respectively). Out of those who felt virtual was worse than in-person (11.5%), some cited a preference for social interaction (83%) and perception of better in-person performance (50%). A total of 98.1% of respondents had no signi cant technical problems, and 100% of all respondents signi ed that if given the option, they would like to continue attending conference virtually in the future.

Discussion
Faculty attendance at all pediatric emergency medicine educational conferences increased after the transition to virtual conferences. Attendance corresponded with survey results, which showed most faculty respondents would select the virtual option if given a choice. Our experience with previous years of faculty attendance of conference had revealed a consistent attendance trend regardless of modi cations such as offering CME credit. This contrasts with the study by Lefebvre et al that demonstrated offering CME increased faculty attendance of weekly in-person emergency medicine conferences 3 . However, faculty in the same study cited clinical and family obligation as reasons not to attend, and we did notice a modest increase in faculty attendance at fellow conference after switching the conference day to align with other departmental activities.
These are the types of obstacles overcome by virtual learning, as identi ed by our survey respondents. The increase in attendance by faculty of our educational conferences appears due to the convenient nature of virtual learning. This is also demonstrated by the increase in faculty attendance of resident conference, for which no CME credit is offered, once the conference was made virtual. In our study, the virtual conference format also did not appear to come at a sacri ce to perceived educational value, with the majority (88.5%) of respondents noting that virtual lectures were equal to, no different from, or better than in-person lecture.
Virtual learning was also well received by fellows and residents, and anecdotally, resident and fellow satisfaction in conference increased in part due to increased faculty participation and discussion.
Our study has several limitations. The onset of SARS CoV-2 and shelter-in-place orders also correlated with a decrease in patient volume and therefore shift reductions amongst staff. While this was not signi cant at our institution, this may have increased the number of attendings available to participate in virtual conferences. The virtual format was also accompanied by technical di culties such as internet connectivity, audio/video problems, and user error, although most participants surveyed did not encounter signi cant problems. The study authors also had no way to ensure attendance meant active participation. Finally, this is an experience at a single institution, and experiences at other institutions may vary.

Conclusion
Faculty participation is important for educational conferences, and the virtual conference format has increased faculty attendance. On-going assessment is necessary to ensure sustained interest in this modality and incorporate virtual conferences into a post-pandemic future, and further investigation evaluating outcomes for fellows and residents are needed.
Abbreviations PEM = pediatric emergency medicine CME = continuing medical education AY = academic year Declarations Ethics approval and consent to participate: Institutional Review Board of University of Texas Southwestern Medical Center reviewed the study proposal and determined it to be exempt. An implied consent form was given to all participants when completing the survey. Informed consent was obtained from all participants. All methods were performed in accordance with the relevant guidelines and regulations.
Consent for publication: Informed consent was obtained from all participants.
Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. In-person faculty attendance changes after CME credit added to fellow conference In-person faculty attendance changes after conference day-of-the-week changed     Faculty attendance of resident conference before and after virtual learning Faculty response to Survey Question 7

Supplementary Files
This is a list of supplementary les associated with this preprint. Click to download. AppendixA.docx