Virtual Etiquette: a Closer Look at Emergency Medicine Didactics in the Age of COVID

Document Type

Conference Proceeding - Restricted Access

Publication Date


Publication Title

Annals of Emergency Medicine


Study Objectives

Covid derailed multiple facets of emergency medicine (EM) residency training, including the need to move from in-person to online weekly didactics. While online education has been used within 90% of medical schools, it has not traditionally been used for residency education. Recent studies evaluating post-graduate residents' perception of online education found a receptive audience eager to incorporate the modality. To date, no study has analyzed how EM programs are approaching online education, including content, efficacy, and attendance etiquette.


As part of a process improvement project, an online Survey Monkey questionnaire was sent out to 180 EM residency program directors and coordinators. The survey was open from November 2020 to March 2021.


We received 52 responses from program directors and coordinators from all regions of the United States with a majority from academic or university-affiliated programs. Due to COVID-19, over 90% of programs shifted to an online didactic platform with only 10% maintaining in-person didactics. Zoom has been the preferred modality utilized at 89% of programs we surveyed with minimal security and techinical issues. Program consensus was that residents should be on time or no more than 5-minutes late for credit (42% of programs), have video cameras on (52% of programs), and appear attentive (44% of programs). Virtual etiquette was also examined, including screen presence: upright posture (less than 18% of programs reported accountable), background (less than 10%), and lighting (less than 6%). A majority of programs had not set expectations for screen presence. If not presenting, the dress code is generally at the resident’s discretion and was noted to be casual (52%). Sixty percent of programs reported increased faculty attendance since moving to a virtal conference_restricted. Programs also reported maintiaing consistency in content (62% of programs), increased utilization of guest speakers (50% of programs), use of national platforms (21% of programs), and maintaing small group sessions (77% of programs). Many residency programs do not record didactics, and only 15% offer credit if lectures are watched at a later date. When safely able, over 65% of programs plan to return to in-person didactics.


The online learning platform provides opportunities and proves challenges. Many programs have shifted to online learning and diversified their curriculum. EM residency training requires a strong foundation in core content, which may not entirely be suited for an online platform. This coupled with the loss of face-to-face learning may reflected in the desire for programs to return to in-person learning. The benefits of online learning, which include accessibility, flexibility, and broader reach of topics should not be neglected. Further exploration of the efficacy of knowledge acquisition within online didactics would aid in decisions regarding next steps for return to a potential hybrid teaching model.




4 suppl.

First Page



American College of Emergency Physicians Research Forum, Boston, MA, October 25-28, 2021.