Intra‐COVID collaboration: Lessons for a post‐COVID world

The COVID-19 pandemic has dramatically changed the landscape of medical education. For example, the sudden shift to remote working and online communication has redefined collaboration, which had already become somewhat of a buzzword within the field's lexicon. Its popularity is understandable, as facilitating collaborative expertise within healthcare graduates leads to improved patient outcomes.1 Within education, collaboration facilitates learning and identity formation; within research, it can help address a variety of complex issues.1-3 The sudden shift to remote working and online communication has redefined collaboration Although there is no consensus definition of ‘collaboration’, Morley and Cashell suggest most definitions involve an ‘integration of activities and knowledge that require partnership of shared authority and responsibility’.1 Sociocultural perspectives emphasise the collaborative nature of knowledge, and so are well suited to the exploration of collaborative expertise. Given the social origins of mental functioning within sociocultural circles, theories focusing on the role of ‘communities’ are prominent, including the communities of inquiry theory (CoIs). CoIs are online spaces structured around learning, where media supports collaborative knowledge acquisition.4, 5 Within CoIs, there are three domains of learner interaction or types of ‘presence’. Social presence—‘the ability of participants to identify with [a] community’—involves open communication, affective expression and group cohesion.4 Cognitive presence concerns the ways in which learners create ‘meaning’ through reflection and discourse.4 Finally, teaching presence encompasses the design and facilitation of cognitive and social processes.4, 5 Another community-focused sociocultural theory relevant to collaboration is ‘communities of practice’ theory (CoP). Within CoPs, individuals with a shared interest interact regularly, learning through collaboration.6 CoPs are defined through mutual engagement, joint enterprise and shared repertoire.6 Recently, Medical Education's ‘Medical Education Adaptations’ series published articles describing rapid innovations in response to COVID-19 restrictions. The need for rapidity necessitated compromise given that, as Eachempati and Ramnarayan suggest, emergency remote teaching is ‘quite different’ from ‘meaningfully structured’ online experiences.7 Collaborative innovations that have emerged may, therefore, fall prey to ‘solutionism’—the flawed idea that every problem has a technological solution, which can ‘mask…complex issues’.8 To guard against this, the shortcomings of collaborative adaptations and directions for future development require consideration. As such, this paper evaluates adaptations explicitly considering collaboration within the Adaptations series. Three articles which centre collaboration were identified as relevant exploratory case studies. This article reflects on their breadth, strengths and limitations. Examining the unintended consequences of COVID compromises, we will also consider the lasting legacy of these innovations in a post-COVID world, so we ‘do not slip backwards into old habits’.7 The shortcomings of collaborative adaptations and directions for future development warrant consideration Case 1 (‘Virtual workshops to preserve interprofessional collaboration when physical distancing’)9 describes an online interprofessional workshop, where medical and pharmacy students work through a virtual asthma patient case. Case 2 (‘Online team-based learning sessions as interactive methodologies during the pandemic’)10 describes the adaptations made to pre-existing team-based learning (TBL) sessions to allow one institutions’ medical students to partake in TBL virtually using peer facilitators. Case 3 (‘A virtual postgraduate community of practice’) 11 describes adaptations made to facilitate the support of PhD students within a research unit. These included virtual meetings and asynchronous instant messaging team and peer support. During our analysis of these cases, theory was read abductively, with CoI and CoP theories identified as relevant ‘sensitising’ concepts. Feedback from an external researcher was solicited to ensure analytic justness as case 3 was written by this commentary's authors. Two approaches to online collaboration were evident within the cases: (a) establishing online communities of inquiry (CoIs), occurring when the focus of collaborative adaptations was to encourage student knowledge acquisition (cases 1 and 2), and (b) establishing an online community of practice (CoP), occurring when the primary focus of online collaboration was student support (case 3). Both approaches seem positively received, although formal evaluation to this point is scant. Communication appears to have been a key to success within all cases. Within CoI theory, there are three facilitators of social presence—open communication, affective expression and group cohesion.4 Open communication was the most frequently considered facilitator within cases 1 and 2. Utilising virtual ‘breakout rooms’ and encouraging the use of the chat function within meetings improved group communication. Akyol et al suggest social presence is ‘an important antecedent to collaboration’ within CoIs as it supports critical thinking and acts as a means for learners to share views and feelings.4 As such, attending to open communication is an important strength of cases 1 and 2. Within case 3’s postgraduate CoP, communication encouraged by senior team members strengthened peer research collaborations. Perhaps obviously, mutual engagement within a CoP requires communication between community members, and this communication fosters joint enterprise.6 Ascertaining the need for innovation is important in avoiding ‘solution-ism’ during times of rapid change.7 Circulation of COVID-19 impact assessment forms, as in case 3, offers a quick way to establish need and may allow for more considered innovations that best serve the needs of an individual institution. Herrmann reports that students engage more readily with cooperative learning they perceive to be of direct personal benefit.12 Targeting topics or skills students identify as requiring development and outlining how collaborative learning activities align with assessment criteria, may, therefore, increase engagement within online communities. Given the shifting COVID-19 situation, regular needs reappraisal may help sustain engagement. Ascertaining the need for innovation is important in avoiding “solution-ism” during times of rapid change It is also noteworthy that online collaborations utilising interprofessional education (IPE), such as within cases 1 and 3, have been of particular benefit. Such collaborative opportunities future-proof students for interprofessional teamwork.1 Case 1’s online workshop encouraged discussion of multidisciplinary team roles, understanding of which reduces negative stereotyping and aids collaborative skill development.1 Educators wishing to establish CoIs, therefore, should seek to incorporate IPE. Communities of practice are most often, by nature, interprofessional. Case 3’s virtual CoP is no different, and inclusion of a ‘broad church’ of team members widened postgraduates’ support network.11 However, case 3 also highlights the value of peer support, as a confidential student messaging group was well-received. Educators planning CoP support systems would do well to also provide space for intra-professional discussion. An impressive testimony to the effort and ability of staff is the speed with which online transformation has occurred. However, this necessary rapidity has meant sacrifices have been made that may render current online collaborative innovations insufficient for long term use. Continuity within educational settings facilitates learning.13 Within CoIs, peer continuity increases comfort and aids group cohesion.4 Yet, continuity appears to have been overlooked (cases 1 and 2) during the initial stages of adaptation, with sessions convened as standalone seminars. A series of sessions where participants learn within a stable peer group would better foster social presence through group cohesion. As participants’ comfort increases, space for affective expression that is currently lacking may also open within teaching groups. Facilitators who can develop more interpersonal relationships with trainees through longitudinal contact are likely best placed to provide student support when affective experiences are volunteered. Although group cohesion may be more easily established face-to-face, intentional virtual planning, such as establishing stable peer groups, may improve the continuity of intra- and post-COVID communities of inquiry. Continuity appears to have been overlooked during the initial stages of adaptation Also of concern, as alluded to earlier, is that robust evaluation of online communities to this point has been sparse. Evaluation has been limited in scope (all cases), anecdotal (cases 1 and 3), and has struggled to attain high response rates (case 2). Planned, purposeful evaluation aligned with the aims of online adaptations facilitating collaboration is necessary to advance scholarship within this field. Scrutiny of interventions through sociocultural lenses, akin to this commentary, may provide a framework for critique. Completion of online evaluations during CoI sessions may increase response rates. Further, feedback should be sought from students absent from sessions, to gather data regarding the barriers to online collaboration; none of the cases actively considered this. Planned, purposeful evaluation aligned with the aims of online adaptations facilitating collaboration is necessary to advance scholarship within this field Finally, as we continue to transition education practices, we must consider how the concept of power can govern and shape online interactions. Although online collaboration is often touted as learner-centred, the ‘emphasis on participation in online discussions’ leads to tutor-defined conformity and acts as a method of organisational control.14 Educators must consider the impact of mandatory CoI participation on students. Student involvement in the design of these communities and providing opportunities for peer or near-peer facilitation may go some way to redressing this power imbalance. When IPE is a central aim of online collaboration (case 1), ensuring each profession is well-represented within the faculty of the session (through clinicians or peer facilitators) is important, as representation sends tacit messages regarding power. Within CoPs, participation and engagement should remain voluntary.15 Shared e-leadership of meetings could be considered to increase peripheral participant engagement within online CoPs. Although uncertainty shrouds exactly how education will change in the wake of COVID-19, this synthesis of collaborative innovations offers potential lessons for the world to come. Early innovations have successfully preserved the delivery of collaborative learning sessions, transforming face-to-face content into online communities of inquiry, whilst virtual communities of practice have improved student connectivity and support. Yet, the imperative to rapidly transform medical education has necessitated sacrifice. Continuity of online collaboration and robust evaluation warrant consideration moving forwards. Whatever change the next academic year brings, educators must embrace the lessons of intra-COVID collaborative adaptations to create a more collaborative tomorrow.