The COVID-19 outbreak has brought about a myriad of changes in how hospitals operate and in how medical education is conducted, including the way fellows in geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai receive training.

Previously, fellows would take time away from their rotations at hospitals throughout the Mount Sinai Health System and gather one afternoon a week for a half day of formal learning and sessions with medical and education specialists. When, during the pandemic, that was deemed a health risk for fellows and educators, the curriculum was adapted to an online format via Zoom.

Fellows still listen to lectures, but they also meet in virtual breakout rooms to analyze medical evidence and present their findings to their peers. They ask and answer questions in real time. They observe their peers in role-playing situations and critique their diagnoses and case management skills. Board-review preparation is interactive. They also give immediate feedback to educators via chat, which allows for more targeted teaching.

Although this approach was a forced change, it has brought many initially unforeseen benefits.

“We are able to engage our fellows in different ways,” says Helen M. Fernandez, MD, Director of the Geriatrics Fellowship and Professor of Medicine, Medical Education, and Geriatrics and Palliative Medicine at the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai. “It is less passive learning and more interactive. This format also allows us to bring in a wider range of speakers from across the Health System who no longer have to block out travel time since they can address the group from wherever they are.”

In small group chats, fellows focus on their communication skills and discuss a range of topics from health inequities to what the medical community has learned from COVID-19. Trained faculty observe the discussions remotely and offer feedback. Virtual education allows for case-based learning that may address medication reconciliation and assessments, including those related to falls or gait, followed by diagnosis and management recommendations. Telehealth technology is used to deliver prognoses to mock patients. Second-year fellows act as mentors to first-year fellows.

The transition to virtual learning for the Department’s 21 fellows has been an adjustment for educators, but one that they mastered quickly, from using Zoom for detailed presentations to making the most of virtual breakout rooms.

“This new format allows for greater creativity, more in-depth teaching, and enables us to deliver care and education in innovative ways,” says Dr. Fernandez.

Educators realized that for the optimal learning experience, virtual sessions couldn’t be too long, so they schedule frequent breaks and added a much-needed wellness component that incorporates literature, poetry, and art to encourage more reflection on the fellows’ relationship to medicine and about the meaning of health or what it means to be a caregiver. One result is that fellows are more relaxed with each other.

This new learning environment has also created more opportunities for social interaction among fellows, including virtual “happy hours” and sessions on transferring art interpretation skills to medical practice, led by an arts educator who works with The Metropolitan Museum of Art.

Although virtual learning grew out of a need created by the pandemic, it has proven so successful—and has been so well received by fellows—that Dr. Fernandez says some elements will continue to be part of the curriculum even after the program can return to in-person learning.

“Telehealth training is here to stay, and there are pieces of the program that we will definitely keep,” she says.

IN THE NEWS: A paper published recently in the Journal of the American Geriatrics Society shows our new LEAP into Geriatrics Leadership Fellowship is filling the gaps by training clinicians in geriatrics and health care leadership in order to meet the needs of the aging population. Click here to read the study.