By: Laura L. Avery, MD | Assistant Professor of Radiology; Harvard Medical School | Director of Radiology Clerkship; Massachusetts General Hospital

The COVID epidemic of spring 2020 swept through hospital-based medical student education like a tsunami. Fears of disease exposure, lack PPE, and the need for social distancing exiled medical students from their hospital-based education overnight.  With students quarantined and dispersed to remote locations, there was a need for a dramatic and immediate pivot to online education. Harvard Medical School called upon the radiology clerkship committee to provide a comprehensive 4-week virtual radiology clerkship for their students. 

With one week of preparation, the virtual radiology clerkship was designed to educate all clerkship-level medical students. 110 students were enrolled in the course–a combination of students midway through their clerkship year, some beginning their first clerkship, and even MD/PhDs retrieved from their labs. This presented the additional challenge of educating students of diverse educational levels virtually.

The construct of the clerkship was designed by the clerkship directors at our three teaching hospitals. The decision was made to organize the 4-week clerkship around the 19 online modules available through our institutional subscription to Aquifer Radiology and a combination of large group lectures and small group homerooms.

Homework & Homerooms with Residents as Teachers

All 19 Aquifer Radiology cases were assigned as pre-reading during the clerkship. The cases emphasize proper imaging utilization and patient safety while allowing students to work at their own pace through a patient-focused clinical scenario. 

To allow for small group interactive learning, a homeroom structure was designed. Homerooms included groups of 8-10 students. There were two homeroom sessions per day for each group of students, with a total of 24 per day across sites. Instructors were enthusiastic radiology residents who were known to enjoy medical student education. Two instructors were assigned to each homeroom. In addition to teaching, the residents acted as camp counselors and gave the students a sense of community. 

Aquifer Radiology Flipped Classroom Workshops were provided to homeroom instructors and performed daily via Zoom to each small group, with the corresponding case assigned as homework. The Flipped Classroom Workshop powerpoints are complete teaching resources, with annotated images, discussion questions, and defined speaker notes–perfect for early-year residents to gain comfort and enjoyment from teaching. Homeroom instructors were also provided with powerpoints of unknown cases for a case conference in their second daily session.

Large Lectures with Deep Expertise

In addition to the two homeroom sessions per day, a daily large group lecture schedule was constructed. These large group lectures were performed utilizing Zoom to the entire class of 110 students. A diverse group of lecturers from all three teaching hospitals were chosen, highlighting the extensive expertise available and giving retired doctors the opportunity to pitch in during the crisis. The result was a wonderful mix of established educational leaders entering the Zoom lecture hall along with young enthusiastic educators. 

The heterogeneous student knowledge base posed a challenge for learner engagement during large group lectures. In order to mitigate, students were encouraged to submit their questions during the lecture, and clerkship directors moderated the using the chat function on Zoom,  by either answering directly or collating questions and posing them to the speaker directly.  This moderator role allowed the speaker to react to the audience and maintain engagement without the distraction of reading chat questions while giving the lecture.

Outcomes & Lessons Learned

During challenging times, the value of an embedded radiology clerkship becomes apparent.  Radiology educators were able to quickly respond to the need for virtual education for a large number of students with successful outcomes and positive experiences for faculty and students.

The students enjoyed the continuity of education and the sense of community afforded by the small group homeroom construction. At the conclusion of the clerkship, all students passed the AMSER Standardized Final exam and reported high satisfaction with the virtual clerkship.

The residents enjoyed the small group sessions and felt confident in their teaching skills. As homeroom teachers, they were able to mentor students and create an educational diversion during a time of anxiety. The virtual clerkship also allowed a diverse range of radiologists to participate in furthering our educational mission during a crisis. Clerkship directors across our teaching hospitals felt confident that valuable educational experiences were delivered despite the extreme circumstances of the pandemic.

The author’s recent publication, Medical Student Education Roadblock Due to COVID-19: Virtual Radiology Core Clerkship to the Rescue (Academic Radiology; Durfee, Golderson, Gill, Rincon, Flower, Avery) provides full details on this virtual clerkship program, including methods, outcomes, and student evaluation data.