Raising the bar: pain fellowship alumni engagement and the lifelong learner in the post covid era

The coronavirus disease (COVID) pandemic has ushered in an era of unparalleled access to virtual education content for medical personnel. One largely unreported area is in the area of alumni engagement. Prior to COVID in many residency and fellowship training programs, alumni would have little contact with their training program if they left the program at the completion of their training. However, the increased use of virtual conferencing and social networking has allowed alumni to continue to access these educational resources from anywhere in the country. Alumni engagement can not only help connect a former trainee back to their institution, but it can also provide a form of continuing medical education. At the same time, an alumni’s perspective can enrich the learning conditions for trainees by providing them context outside of a single academic medical center. At the University of Pittsburgh Medical Center Department of Anesthesiology and Perioperative Medicine, our Chronic Pain Medicine fellowship alumni and trainees have opportunities to interact through virtual alumni webinars for current fellows, a private alumni communication smartphone application for mentorship and discussion, and virtual journal clubs that were previously just open to current trainees and faculty. Journal club at academic institutions should involve alumni in this post-COVID era of virtual educational content delivery. The Journal club has been a part of medical education since the late 19th century. The first journal club was founded in 1875 by a physician named Sir William Osler, a proponent of medical education. Since those days, medicine has moved by leaps and bounds, and journal clubs have taken many different forms; however, the essence of journal club remains the same. At its very core, the journal club provides a forum for like-minded individuals getting together to keep themselves abreast of knowledge, appraise and critique the evidence presented in various articles/journals and build upon their understanding of research methodology.1,2 Journal clubs have been shown to be an important and effective component of medical education, especially for teaching topics like critical appraisal, biostatistics, and epidemiology.3,4 Sharing ideas at journal club meetings often spawn new research ideas to improve upon the evidence at hand. The main objectives of the journal club are to promote awareness of current research, provide a bridge between research and practice, and promote an evidence-based framework for clinical care. In chronic pain medicine, journal clubs are vital as far as trainees and quality of evidence are concerned. In this field, where market forces mainly drive research, the journal club allows participants to collectively differentiate genuine recent advances from clever but outright misleading conclusions. The trainees should be proficient in selecting veritable articles, presenting the evidence in a lucid and concise manner, and debating logically and respectfully. A journal club is enhanced by a diversity of participants from various practice settings with varying clinical experiences. Moreover, in academics, newer technology is usually adopted at a slower pace, and it might be well established in a practice, where the trainee seeks employment. It creates a significant strain for the trainee to start a career in the private sector, without knowledge and experience with newer technologies. This knowledge and practical experience can be brought to the journal club by alumni who have adopted these new technologies into their practice. However, the half-life of medical knowledge is thought to be less than five years, which is especially true in a field as rapidly changing as chronic pain medicine.5 This continual change makes participating in a regular journal club beneficial for alumni as well. Discussions during journal club are enhanced by alumni’s’ perspective, and these discussions often involve points, counterpoints, and a real-world point of view that otherwise may not be clear to the trainee. Since the COVID pandemic, our journal clubs have stayed in a virtual format. Our quarterly virtual journal club involves nine chronic pain medicine fellows, one to three invited alumni guests (alternating from a list of alumni graduates from the last 5 years that have expressed interest in attending virtually), and chronic pain division faculty as well. The current fellows and alumni interaction can also potentially set up career guidance, mentorship, collaboration, and networking opportunities. The joint alumni-trainee journal club is held once every quarter for a total of four journal clubs in a year. The article or articles are presented by a current fellow in pain medicine. The articles are chosen from the recently published literature based on the impact or relevancy to pain medicine on the article. The chosen article is then sent to all current fellows, pain medicine faculty, and alumni 1–2 months in advance of the journal club date. Alumni are asked to RSVP at this time on the likelihood they will be able to join that quarter. The journal club begins by the fellow discussing the article. This is followed by an open discussion between the current fellows, faculty, and alumni present. The duration of journal club is typically between 1 and 1.5 hours depending on discussion of the article. Continuing medical education credits are provided for faculty and alumni present. This journal club format of regularly scheduled meetings, choosing relevant, high-yield articles, circulating material to participants in advance, and completing each meeting in a timely manner has been shown to be an effective structure.6 The idea behind this type of journal club is provide benefit to both alumni and current fellows. To determine if this format for journal club is actually beneficial, a survey was sent to current fellows and alumni who have previously participated. The survey sent is shown in Figure 1. To evaluate the potential benefits of each group individually, the participants were asked to identify themselves as current fellows or alumni before answering the survey questions. The survey was sent to nine current fellows and eight alumni. All those who were sent a survey completed the survey (Figure 2). While the sample size is admittedly small, this is a pilot program and given a desire to disseminate the information, it was felt that the points are still important and relevant to other pain physicians, trainees, and instructors. The combined responses of the current fellows and alumni can be seen in Table 1. Given some of the response results, it is important to note that this alumni involvement represents not a complete restructuring of journal club but an iterative change to its structure. Therefore, the survey results may not be a complete reflection of the journal club format and benefits may also depend on the actual articles and topics being discussed at any given journal club. Survey given to current fellows and alumni. Fellow and alumni participation. Combined survey responses of current fellows and alumni. An alumni webinar is a convenient yet effective approach to expose trainees to their life and career path after fellowship graduation. Our fellowship currently has hosted this annual one hour webinar for the last three years, and a rotating panel of one to three alumni from diverse backgrounds and practice types have participated. Topics covered include areas that alumni wish they would have focused more on as a trainee, including finances, onboarding, surgical neuromodulation experience after graduation, and transitioning to the attending role. A growing number of pain fellowship alumni and current trainees are also involved with a private alumni network using a communication application. Social networks like these between health professionals have been shown to be beneficial because they are easy and fast tools to exchange information and makes meeting colleagues easier which helps to expand their professional network.7 This interaction between alumni also allows trainees to see future issues they will face and provide continued mentorship and collaboration for alumni. All discussions involve general questions and comments such as “what steroid are you using since methylprednisolone is on back-order?” or “is this diagnosis appropriate for spinal cord stimulation?” This is invaluable real-time training for our fellows and helpful to our alumni as well. In this era of social networking, the connection with past learners can benefit the institution socially, academically, and professionally. The alumni can continue to be significant stakeholders and be active participants in the institution’s developmental activities, feeding a nostalgic impulse to give back to the department that trained them. Leveraging the alumni’s fresh perspective, working in the private sector, to the journal club conducted in an academic setting is a win-win for both the institution and alumni. Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US government. The authors received no external financial support for the research or authorship of this article. Conflicts of interest: Trent Emerick—Stock/equity—Vanish Therapeutics, Inc.