Online trainer-simulation pre-prepared case scenarios followed by discussion, was our chosen solution during the current crisis. Technology-enhanced training was planned using Zoom meeting application. The proposed training plan of TET was presented to the department council and an approval was obtained. This was followed by constructing a detailed plan with the expected timeline and obtaining the approval of the department's research committee.
The proposed plan consists of two phases as follow:
This phase started by assigning the training team from the department's lecturers and assistant lecturers (trainers) and residents (organizers and trainers).
Cases scenarios preparation (with role player instructions and scientific background attached), and role-play training of the team were the next steps in this phase, which were semi-ready as training using simulation and role-play with discussions was part of the conventional training in the family medicine department.
The next very crucial step was to train the trainers, organizers and house officers on the use of the application that will be used in the training program, Zoom meeting application with the option of break-out rooms was the chosen application for online family medicine training. Because it is freely available on the web with no need for an official or institutional account, also its free basic package was enough for us to implement our training with no need to subscribe to the premium version. Technology training included 3 educational videos produced by the IT committee of the department (consists of lecturer and an assistant professor). The videos explained in detail how to download, sign in, host, and join a meeting. Also, how to use the break-out room option of the Zoom meeting application with an average length of 10- 15 minutes. Then several Zoom meetings were held with the use of break out rooms to get familiar with the application.
The last step of this phase was dividing the current cohort of house officers into 5 groups and each organizing resident was responsible for a group of house officers. Each organizer continuously communicated with his assigned group through a WhatsApp group to address any inquiries and to provide them with the 3 educational videos to ensure they were trained on the used technology too.
The previously designed family medicine online training via role-playing and cases discussion using Zoom application and break out rooms were applied to the current cohort of house officers (50 house officers). The team organized several simultaneous Zoom meetings where the house officers were distributed over the trainers' rooms, then shifted to another breakout room after finishing the discussion. In the same zoom meeting, each house officer was trained on several case scenarios with different trainers in the presence of residents as observers of the training.
The virtual training sessions were conducted in a systematic order (Figure 1). During the sessions, the trainers showed special interest to conduct of the interview, patient’s hidden agenda, ICE (ideas, concerns, and expectations) of the patient and the importance of adopting the biopsychosocial approach.
After this training experience, the feedback was obtained from the house officers and trainers. Although the house officers' feedback was positive, 83% of the trainers prefer to work individually with their assigned group of house officers and they felt that there was no need to work simultaneously and use break out rooms.
After the next cohort of house officers (49 house officers) joined family medicine training, we made some modifications on the training program guided by the tutor's feedback while keeping the main core of the training. The joined group was divided into 5 groups, each group has its responsible lecturer, assistant lecturer and resident. Each group had 2 weekly Zoom online meetings to get trained on the cases scenarios through role-play and discussions which enables us to provide more case scenarios but at a more eased pace to avoid burdening our trainers. At the end of the family medicine rotation, each house officer completed 4 online training sessions.
All participants of the training program including the training team and house officers consented on recording the training sessions. This allows for having a repository of videos of the recorded sessions and this will be used in building an online family medicine training bank, for future training of house officers and even undergraduate training.
It was difficult to assess the house officers' feedback regarding what they preferred and what was more useful for them from the 2 tried methods (one zoom meeting with multiple case scenarios or multiple online meetings) because each step was performed on a different cohort of house officers.
Structured trainers and house officers feedback form was designed and sent to all the participants, as feedback is crucial to enable us to continuously improve our training.