Faculty Bibliography

The COVID-19 pandemic drove a rapid transition to virtual care experiences for graduate medical trainees. Core training competencies have expanded to incorporate virtual contexts, however there is limited knowledge of the optimal design of virtual care training tools for learners. In this study, we describe the application of a Design Thinking approach to the identification and co-design of novel training tools to support residents and precepting attending physicians in virtual ambulatory care practice. We applied the model of "Empathize, Define, Ideate, Prototype, and Test" via a mixed methods approach to (1) explore the needs, preferences, and concerns of Internal Medicine residents and outpatient precepting attendings regarding virtual ambulatory care training environments, and (2) evaluate, prototype, and test potential training tools. Eleven residents and eight attending physicians participated. Identified learner needs and problem areas included: improving virtual visit technical skills; acquiring virtual communication skills; adapting to the loss of shared in-person learning space and optimizing virtual learning environments; remediating non-virtual procedural competencies; and educating on new documentation requirements. Key solution areas included: virtual precepting support tools; digital information and education dissemination tools; and strategies for management of technical issues. Several prototypes were proposed, with a single tool (a virtual preceptor tip sheet) deployed in clinical practice. Residents found the workshop program improved their understanding of Design Thinking and its relevance to healthcare. Ultimately, Design Thinking can be deployed to engage medical trainees and precepting attendings in the effective development of novel educational tools for the virtual care learning environment.

STATEMENT OF PROBLEM OR QUESTION (ONE SENTENCE): Can user-centered design (UCD) facilitate the development of novel and effective training tools for the virtual ambulatory learning environment LEARNING OBJECTIVES 1: To identify the needs, preferences, and concerns of resident trainees and attending preceptors regarding the current virtual ambulatory care learning environment. LEARNING OBJECTIVES 2: To apply user-centered design (UCD) strategies to the development of effective tools to enhance the virtual learning experience of trainees and preceptors. DESCRIPTION OF PROGRAM/INTERVENTION, INCLUDING ORGANIZATIONAL CONTEXT (E.G. INPATIENT VS. OUTPATIENT, PRACTICE OR COMMUNITY CHARACTERISTICS): The COVID-19 pandemic spurred a rapid transition to virtual learning environments, the design of which may impact learning experiences and competency development for trainees. User-centered design (UCD) offers a framework to iteratively and collaboratively incorporate needs, preferences, and concerns of users (e.g. trainees and preceptors) in the development of acceptable and effective educational tools. This study applied UCD strategies of empathize, define, ideate, prototype, and test among Internal Medicine residents and outpatient attending preceptors to develop innovations for the virtual ambulatory care learning environment. MEASURES OF SUCCESS (DISCUSS QUALITATIVE AND/OR QUANTITATIVEMETRICSWHICHWILL BEUSEDTOEVALUATE PROGRAM/INTERVENTION): Using the UCD framework, we identified: 1) needs, preferences, and concerns of residents and preceptors in current virtual precepting practices (empathize) 2) key problem areas and pain points (define) 3) potential solutions (ideate) 4) specific products to develop (prototype), deploy, and evaluate (test) in practice FINDINGS TO DATE (IT IS NOT SUFFICIENT TO STATE FINDINGS WILL BE DISCUSSED): Qualitative needs-assessment interviews were conducted among 8 residents and 10 preceptors, which identified key areas of learner need: technical and workflow competency; the virtual precepting experience; patient rapport-building and communication; and documentation requirements. Subsequently, a Design Thinking Workshop focusing on virtual precepting was developed, and 3 workshops were conducted with 12 participants (residents and attendings). Using a three-phase interactive sequence of explore, ideate, and create, participants were divided into 2-or 3-person virtual breakout groups and asked to 1) identify a key problem in current virtual precepting, 2) brainstorm possible solutions, and 3) design and present a low-fidelity prototype of one solution. Key problems identified included: management of technical issues, goal setting for precepting sessions, clinic-specific information dissemination practices, and the loss of shared learning space with colleagues. Potential solutions included: a digital shared-learning plan for residents, a real-time virtual clinical bulletin board, an integrated virtual team huddle, and just-in-time digital chalk talks. Two prototypes are being developed for testing in the live precepting environment. KEY LESSONS FOR DISSEMINATION (WHAT CAN OTHERS TAKE AWAY FOR IMPLEMENTATION TO THEIR PRACTICE OR COMMUNITY): User-centered design can be deployed as an effective strategy to engage learners and preceptors in the design and development of educational innovations for the virtual training environment. We recommend collaborating with residents, preceptors, and other stakeholders in the iterative design of virtual learning tools