Re-thinking conferences in medicine: opportunities and challenges of virtual delivery
As the COVID-19 pandemic underscores the need for physical distancing, an opportunity to reimagine conference design and delivery has emerged. Conferences should consider widespread adoption of virtual strategies to support professional connection and knowledge exchange driven by thoughtful design and implementation. Although virtual conferences represent a significant paradigm shift, opportunities to improve systemic inclusivity, increase financial accessibility, reduce environmental impact, and increase engagement and interactivity present compelling arguments for change. Challenges include minimizing digital exclusion, providing technical support, supporting participant wellness, and facilitating opportunities for networking. We reflect on these themes through experiences and lessons learned when transitioning the inaugural Conference on Health Advocacy Toronto to a virtual model during the COVID-19 pandemic.
KEY WORDS: virtual conference, medicine, opportunities, challenges, professional development, collaboration
CITATION: Pang H, Wiercigroch D, Sriharan A. Re-thinking conferences in medicine: opportunities and challenges of virtual delivery. Can J Physician Leadersh 2020;7(1):52-56.
Accelerated adoption of virtual communications will be a legacy of the COVID-19 pandemic. As physical distancing measures preclude us from large in-person meetings, many academic conferences have been cancelled or postponed. Although we must act collectively to “flatten the curve,” virtual conference design and delivery emerges as a promising and enduring approach to supporting professional connection and idea sharing. Experiences have been positive so far: more than 80% of attendees of a recent virtual conference were willing to attend another one in the future.1 Top
Recently, the Conference on Health Advocacy Toronto (CHAT)2 fully transitioned from an in-person meeting in Toronto to a virtual forum within two weeks. CHAT was launched by University of Toronto medical students to highlight initiative- and research-based advocacy at the local, provincial, and national levels.3 This grassroots academic forum brought together almost 200 medical students, students in allied health programs, and physician leaders from across the country to establish a community of support, share best practices, and identify opportunities for collaboration.
Here we discuss the opportunities and challenges of virtual conferences informed by our personal experience and broader consideration of pertinent literature. Top
Virtual conferences are markedly less cost-prohibitive than physical meetings. Many virtual conferencing platforms, including Zoom, Cisco WebEx, Google Hangouts, and Skype, have basic packages that are available free-of-charge. Expanded features required for larger meetings, such as hosting more than 100 attendees, may require payment of a monthly, but still cost-friendly, subscription fee. For example, CHAT 2020 spent less than $200 for two virtual conferencing packages that allowed a maximum of 500 participants. In comparison, upwards of $5000 is needed for a 100-participant in-person meeting with estimates of $1000 for the venue rental fee and $4000 in food expenses. These significant cost-savings can be transferred to the sponsors and attendees so that registration fees for various major conferences can be reduced or waived.4,5 A low cost also makes the conference financially viable at a broad range of registrant volumes, thus providing certainty to the conference team early in the planning process.
Further, there are no added costs for participants to physically attend a virtual meeting, such as travel, accommodation, food, or poster-printing expenses that could otherwise add up to hundreds or thousands of dollars across the group. Top
Virtual conferences not only increase financial inclusion, but also break down geographic, health, and social barriers. Current in-person conference design may be a systemic barrier that excludes certain groups, including people with physical disabilities,6 acute or chronic health considerations, travel restrictions, or caregiving responsibilities.7,8 Women are disproportionately affected by family inclusion policies, which vary among medical conferences; dedicated lactation spaces, free childcare, and admission of children into conference venues is often not available.9 Allowing participants to attend virtually, from the comfort of their selected space, presents a solution that addresses these barriers and aligns with objectives to achieve equitable representation in academia. Conference attendance has critical implications for career advancement, professional networking and mentorship, and knowledge sharing. Using virtual technology as a vehicle to improve accessibility at professional academic forums is a strategic move toward fostering diversity and inclusion in medicine. Top
Virtual conference delivery is eco-friendly. The adverse consequences of climate change on health are widely recognized and, as leaders in our communities, physicians should take action in environmental stewardship and emission reduction. Given their substantial environmental footprint, conferences should not be exempted.10-13 Event materials, such as printed programs, conference merchandise, non-reusable dining utensils, and uneaten food, result in unnecessary added waste. In addition, frequent work-related air travel among ecologists and conservation scientists has been shown to be associated with carbon footprints 10 times the global average.14 Conferences have an inherent role in facilitating career advancement, but increased air travel has been shown to not be associated with academic productivity in terms of H-index.15
Frameworks to design greener conferences have been developed. The Nearly Carbon-Neutral conference model16 is one approach that recommends prerecorded talks with interactive online discussion over a 2–3 week period. This model produces less than 1% of greenhouse gas emissions of traditional fly-in conferences. During the COVID-19 pandemic, webinar models via videoconferencing software have emerged as another popular approach. At CHAT, the move to a virtual interactive seminar model eliminated printing needs and food catering and minimized any need for air or ground travel to a physical venue. Top
Hosting a virtual conference holds great potential to increase engagement and attendance. For CHAT, registration volume increased 4.5-fold after the announcement that it would be adapted to a virtual format. Major international conferences have also seen registrations soar.17 Virtual delivery expands the breadth of interest and expertise in attendance, which can allow for richer discussions and more satisfying networking opportunities.
Virtual conferences can be delivered interactively. Novel approaches to engage participants can be harnessed to stimulate conversation, networking, and connections. Video conferencing platforms allow for group discussions via video, audio, and chat functions. Likewise, groups can be divided into breakout rooms or separate meetings to facilitate more intimate, focused conversations.
Setting an interactive tone and encouraging video participation are important ways to engage participants in a virtual setting. In an email sent to guests before CHAT, we asked them to consider enabling their audio and video for a full, interactive experience. We also addressed possible participant anxieties over participation, including conference dress code in a virtual setting, and highlighted the opportunity to use virtual backgrounds if desired. Our opening keynote speaker also encouraged interactivity by asking participants to contribute ideas and experiences verbally or through the chat box. Top
Approachable poster sessions
The traditional conference poster session can be greatly improved with virtual delivery. Many conferences typically include a large volume of poster presentations in condensed sessions set in large, noisy, busy halls — a challenging environment for participants to navigate. At CHAT, we adapted the poster session to take place in virtual “breakout rooms” with a variety of research and advocacy initiative presentations in each room. Presenters were scheduled a specific time to present their project followed by a moderated question-and-answer period.
Rather than printing expensive single-use posters, presenters produced slide decks that were displayed via the screen-sharing function on our conferencing platform. Slide decks can also be uploaded to an online repository where the audience can download and view them on their screens.
At CHAT, despite more than 40 slide decks and speakers, clear instructions at the beginning of each session and the availability of a preconference audiovisual check allowed for smooth transitions throughout the conference with minimal technical challenges.
Flexible document sharing
Cloud storage, widely recognized and accessible to participants, can be leveraged to support virtual conference delivery. A conference “drive” on Google Drive, Dropbox, or other open-access cloud system can be distributed to participants with changes made in real time, allowing the organizing committee the flexibility to make last-minute program changes, modify schedules, and share resources in real-time. Collection and dissemination of contact information among participants is also possible.
For CHAT 2020, we created a conference drive that included the conference program, presentation schedules, and conference meeting links. Feedback forms and online resources shared by attendees could also be easily accessed after the conference, enabling longitudinal communication and knowledge sharing. We displayed web links to this drive and associated QR codes at the start of each session for easy access. We also created a second drive for presentation judges only, which included a modifiable scoring spreadsheet and presentation rubric. Judging scores were inputted in real time directly onto this spreadsheet. This allowed for a quick turnaround time of only a few minutes to announce the competition winners after the conclusion of the last presentation session. Top
Virtual conferences represent a novel approach with many opportunities. Although there are challenges, they are surmountable with careful planning.
Minimizing digital exclusion and providing technical support
As not all participants may be comfortable using a virtual platform, digital exclusion may be a barrier to access.18,19 The COVID-19 situation has challenged academics and physician leaders across the world to familiarize themselves with virtual tools.20 Although use is broadly increasing, CHAT 2020 was the first time some participants used our conferencing platform. To address this, an instructional package was emailed before the conference and a primer was provided at the beginning, during opening remarks, in anticipation of possible technical concerns during the day.
Despite best efforts, virtual conferencing may still be affected by technical issues, such as muted microphones, malfunctioning cameras, low Internet bandwidth, or platform crashing. These issues can be mitigated by having a telephone (dial-in) option as an alternative to a poor Internet connection, having multiple team members available for back-up to take over moderating and other event-management tasks, and having a dedicated audiovisual check for participants and presenters before the conference start time. At CHAT, we also had a dedicated IT lead to whom participants could reach out privately to resolve IT challenges.
Facilitating networking and unstructured conversation
The temptation to structure all components of a virtual conference can limit self-directed opportunities for informal discussion, which is an important benefit of physical meetings. However, organizers can facilitate small breakout sessions that allow for unstructured conversations. As participants get more comfortable with virtual sessions, there may be interest and acceptance of virtual breakout groups for mealtime, allowing informal dialogue among colleagues. In addition, encouraging use of the text chat function, which can be used for whole group or private conversations, may allow discussion to continue throughout the conference. Top
Supporting virtual wellness
In recent months, increased reliance on virtual tools for professional and social communication has precipitated widespread wellness concerns related to “Zoom fatigue.”21 Physician wellness is a national priority: the Canadian Medical Association’s 2019 data show that one in three Canadian physicians is experiencing burnout and more than one in three screen positive for depression.22
Principles of design thinking should be applied when developing virtual conferences. Thoughtful consideration of flexible programming, event duration, and rest breaks are strategies to promote engagement and wellness. During CHAT, we incorporated a few structured breaks into the program, but also recognized that participants might wish to take additional breaks throughout the day. We limited the conference duration to less than six hours and encouraged participants to join for as much of the program as they were able to but normalized the option to take additional breaks if required.
Timing of a real-time event is an important consideration, as participants may be located in multiple time zones. However, virtual conferences allow sessions to be recorded (with the consent of presenters) and watched at a later time. One conference, designed under a flipped classroom model, pre-uploaded recorded talks, and participants joined an online conversation afterward to discuss the content.23
In-person conferences have been the norm in medicine for many years. However, technological innovations allow academic collaboration to be more resilient against the constraints of physical distancing. With likely gains in equitable and inclusive access, it is time to consider the opportunities for virtual conferences in medicine. Top
1.Woolston C. Learning to love virtual conferences in the coronavirus era. Nature 2020;582:135-6. doi: 10.1038/d41586-020-01489-0
3.Parsons C. Medical students organize health advocacy conference. Toronto: University of Toronto MD Program; 2020. https://tinyurl.com/y329wokm (accessed 10 May 2020).
4.Canadian Conference on Medical Education. Ottawa: Association of Faculties of Medicine of Canada, Canadian Association for Medical Education, College of Family Physicians of Canada, Medical Council of Canada, and Royal College of Physicians and Surgeons of Canada; 2020. https://tinyurl.com/y56x4o72 (accessed 5 May 2020).
8.A planning guide for accessible conferences: how to organize an inclusive and accessible event. Toronto: Council of Ontario Universities; 2016. https://tinyurl.com/y5757exa (accessed 14 May 2020).
9.Kass D, Datta P, Goumeniouk NL, Thomas K, Berger ZD. Are children allowed? A survey of childcare and family policies at academic medical conferences. Acad Emerg Med 2019;26(3). https://doi.org/10.1111/acem.13693
22.CMA National Physician Health Survey: a national snapshot. Ottawa: Canadian Medical Association; 2018. https://tinyurl.com/ubtd4s3 (accessed 10 April 2020).
23.Space science in context: a virtual conference. London: University College London; 2020. https://tinyurl.com/u9mss45 (accessed 5 May 2020).
Hilary Pang, MSc, is a CHAT co-chair and a medical student at the University of Toronto (class of ’21).
David Wiercigroch, MPA, is a CHAT co-chair and a medical student at the University of Toronto (class of ’21).
Abi Sriharan, DPhil, is a CHAT faculty advisor, an associate professor at the Institute of Health Policy, Management and Evaluation, and program director of the System Leadership and Innovation program, University of Toronto.
Author attestation: Hilary Pang and David Wiercigroch led the conception, design, interpretation, and writing of this paper. Abi Sriharan was involved in its review. All authors approved the final version. The authors declare no financial conflicts of interest.