In 2018, pediatric hospitalists at several New England institutions established a regional pediatric hospital medicine conference to facilitate collaboration and communication of advances in the field of pediatric hospital medicine. Planning committee members were recruited from pediatric hospital medicine programs from all six New England states, including multiple community sites, to ensure adequate representation and breadth of impact. The first conference was held in person in June 2019 in Boston, Massachusetts, and contained a full day of original content, including several concurrent lectures and workshops, a keynote address, a poster session, and a clinicopathological conference sponsored by Massachusetts General Hospital. Supported by favorable feedback from >100 attendees of the first conference, the planning committee decided to establish the New England Pediatric Hospital Medicine (NEPHM) conference thereafter as an annual event. While we were planning the NEPHM 2020 conference, the novel coronavirus disease 2019 (COVID-19) became a global pandemic. After surveying members of the planning committee and the conference speakers, we elected to change the format of the conference to an entirely Web-based platform.

Various forms of virtual delivery have been successfully used in health care1,2  and medical education.3  Although there is some precedent for online health care conferences,4  organizing an entirely virtual forum was a novel and unfamiliar process for the planning committee. We describe here our experience with this transition and the challenges and opportunities it presented, including feedback from participants and presenters.

By early 2020, the planning committee had already completed the call for lecture and workshop proposals, and a final schedule for the in-person conference had been determined on the basis of a blinded peer review process. Once the format change was approved, the conference planners had just 2 months to prepare for transitioning to an online platform. All speakers were contacted to determine if they would be willing to convert their lectures or workshops to a virtual format. On the basis of their feedback, the planning committee decided to pursue a condensed 1-day online conference program, the format of which generally mirrored the structure of a typical in-person medical conference.

One of our regional institutions with significant experience delivering online content, University of Massachusetts Memorial Children’s Medical Center, hosted the conference on their Zoom platform (Zoom Video Communications, Inc, San Jose, CA) and closely coordinated with their local information technology support. There were three separate Zoom rooms (A, B, and C), each independently moderated by a pediatric hospitalist, as well as a fourth room (Zoom room D) staffed by an administrator who helped with logistic questions and technical difficulties during the day. Zoom room A served as the venue for the large group plenary sessions, including the welcoming remarks, keynote address, and the COVID-19 discussion panel. The remainder of the activities were hosted in rooms B and C. Throughout the day, participants could maneuver between concurrent lectures in the three Zoom rooms. During lunch, the rooms were restructured as breakout networking sessions with focused discussions on three different topics: medical education, research and quality improvement initiatives, and pediatric hospitalist fellowships and board certification. All sessions were recorded and available to registrants online for later viewing, and presenters and participants provided their feedback via an online survey in the weeks after the conference. Registration fees were reduced to reflect the decreased costs of online content while still being able to offer continuing medical education credits.

The innovative platform of a virtual conference provided several advantages over the traditional in-person setting with respect to cost, flexibility, inclusivity,5  and expanded reach. Without the typical costs associated with food and venue reservations, we were able to provide a 75% reduction in the registration fee. Participants could view the content from the comfort of their homes or offices without the inconveniences of traveling or parking. One participant viewed the conference from a “vacation home,” another did so from their primary home while “watching two kids,” and a different participant was able to listen to the audio during “commuting time.” The flexibility of an online platform also allowed for incorporation of new and timely content, such as a lecture on remote virtual medical education techniques and a COVID-19 discussion panel with several national experts. Participants could also choose to join select live sessions or view the entire day of content. Furthermore, we were able to broadcast the conference content to a much wider audience. The NEPHM 2019 conference was attended by 101 registrants, 96% of whom were from the six New England states. In contrast, the NEPHM 2020 virtual conference had 155 registrants, and less than half (44%) were from the New England region, with broad representation from a total of 32 states across the United States. The majority of participants indicated that the NEPHM 2020 conference was the first virtual academic medical conference they had ever attended, and 99% of attendees found the online platform to be effective in delivering the conference content.

Despite these advantages, hosting the conference virtually presented some unique challenges. The original in-person conference included eight didactic lectures and eight workshops. Six of the original workshops were postponed because the presenters felt audience participation would be limited in the virtual setting. Two of the original lectures were also postponed, and two lecture topics were changed. Several presenters felt the online structure would “hinder the ability to engage participants” and make it “challenging to do an interactive session,” such as a debate between two pediatric infectious disease hospitalists. The lectures and workshops eventually presented were converted to a virtual format, and the two workshops had to “cut back on some interactive portions.” For instance, a workshop discussing ethical dilemmas was ultimately presented as a didactic lecture, and the presenters solicited comments from the larger group in the chat box rather than breaking out into small group discussions as originally intended. Because of limited planning time, we also had to postpone the poster session and the clinicopathological conference until next year’s conference.

Furthermore, video conferences lack the face-to-face networking interactions and casual conversations that provide personal satisfaction among conference participants. These serendipitous encounters often encourage future collaboration.6,7  One participant noted that they missed conversing “one-on-one during breaks as you would in a live conference.” Presenters also found participants harder to engage and, as one presenter stated, “not as talkative as they may have been in person.” Attendees were reluctant to turn on their video cameras or unmute themselves to ask questions or participate in discussions. This made the lunch networking sessions particularly challenging and sometimes minimally interactive. Both presenters and attendees noted that participation would be improved if groups were kept small and participants were required to be visible on camera. Some presenters used virtual avenues to improve participation, such as the thumbs up button to show support or the chat box to solicit questions. One speaker used an audience response system with multiple choice questions to facilitate the discussion of infectious disease cases, and another used virtual breakout rooms to discuss the management of challenging clinical scenarios in small groups. Although hardly a substitute for the physical presence of an in-person conference, expanded use of these digital modalities could help improve the interactive component of virtual meetings.

Although all conferences require technical expertise and troubleshooting, the success of our virtual conference required intensive preparation, including the testing of speakers’ Internet connections, practice runs of all presentations, and redundant sources of remote technical support during the live conference. Fortunately, we did not experience significant technical difficulties, and our extensive preparations ensured a problem-free conference day.

Despite our relative inexperience with virtual technology in this setting and an abbreviated planning time, we were able to complete a well-received conference, which conveniently delivered pediatric hospital medicine–related educational content to a broader audience with basic information technology support and nominal registration fees. Additional planning time and increased familiarity with virtual conference tools will address many of the limitations we encountered.

After attending the NEPHM 2020 conference, 30% of our registrants preferred an all-virtual future conference and 52% would opt for a hybrid conference with the option to attend in person or participate virtually. Regardless of the length of the pandemic, we now see virtual platforms, at least in part, as the way of the future for continuing medical education activities. Further experience using technology to encourage audience interaction should broaden the scope of presentations going forward.

We greatly appreciate the contributions of the members of the NEPHM 2020 Conference Planning Committee, including Abigail Adler, MD, The University of Vermont Children’s Hospital; Amanda Begley, MD, Connecticut Children’s Medical Center; Jamie Fey, MD, The Barbara Bush Children’s Hospital at Maine Medical Center; Lindsay Fox, MD, Tufts Children’s Hospital; Ilyssa Greenberg, DO, Baystate Children’s Hospital; Samantha House, DO, MPH, Children’s Hospital at Dartmouth-Hitchcock Medical Center; Elizabeth Hutton, MD, Boston Medical Center; Matthew Lorenz, MD, Hasbro Children’s Hospital; Allison Mariani, MD, Newton-Wellesley Hospital, Massachusetts General Hospital for Children, and St Elizabeth’s Medical Center; and Patricia Stoeck, MD, Boston Children’s Hospital.

Drs El Saleeby and Niro drafted the initial manuscript; Drs Gibson, Rauch, and Zanger reviewed the manuscript, introducing significant edits; and all authors participated in the concept of this work and approved the final manuscript as submitted.

FUNDING: No external funding.

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Competing Interests

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.