Enhancing engagement during live virtual learning using interactive quizzes

The coronavirus disease 2019 (COVID-19) pandemic has foisted unprecedented changes upon graduate medical education ranging from adjustments to patient care practices to adaptive modifications to educational activities. To comply with social distancing guidelines, in-person conferences and didactics have been suspended in most, if not all, residency programmes throughout the country. Many programmes, however, have transitioned to live virtual platforms such as Zoom™ (Zoom Video Communications Inc., San Jose, CA, USA) to continue educational activities. Although live virtual learning has allowed for continued education, it presents its unique challenges. The impersonal nature of the virtual learning environment creates a propensity for detachment and disengagement. Though with the video function turned off and the microphone muted, a participant can completely disengage from virtual learning and still appear to be present. To facilitate audience engagement and active learning during live virtual learning via Zoom in our neurology residency programme, we utilised the evidence-based principle of retrieval practice1 using Poll Everywhere (Poll Everywhere, San Francisco, CA, USA) in two different modes. Poll Everywhere is a commercially available online polling platform (www.polleverywhere.com). The two modes we used in Poll Everywhere were: (a) individual-based anonymous quiz competitions, and (b) non-competitive audience polling quizzes. The individual-based anonymous quiz competition is a feature in Poll Everywhere that randomly assigns a name to each participant and awards scores based on speed and correctness. For example, if two participants choose the correct answer, the faster participant gets a higher score. The scores are displayed on a leaderboard, which is adjusted after each response round to reflect current standing amongst participants. The assigned names are arbitrary and only known to individual participants. For the non-competitive audience polling quizzes, we used the basic polling feature of Poll Everywhere to allow participants to answer questions anonymously before unveiling the response of the audience and revealing the true answers. A third active learning technique we used did not involve Poll Everywhere but was a group-based quiz competition (inpatient versus outpatient residents) with manual score recording. Questions used were pulled from various neurology question banks. A total of 8-10 residents participated in these 50-minute sessions. Anonymised individual-based competitions, group-based quiz competitions, and audience polling stimulated and sustained learner interests and resulted in active engagement. The low-stakes competition component visibly motivated learners to participate, and the active retrieval paradigm of quizzing likely facilitated learning. The described interactive features on Poll Everywhere are also intuitive, and easy to set-up and deploy. One challenge with the individual-based quiz competition is the potential to focus on scoring higher on the leaderboard rather than learning content. We mitigated this by having a brief discussion on questions that generated a dispersed response as this would indicate that a significant number of residents needed more conceptual knowledge to tackle the question. Though quizzes are not unique to the COVID-19 pandemic, our article identifies the greater propensity for learners to disengage during live virtual learning and highlights the increased need for deliberate incorporation of mitigating activities. Overall, low-stakes quiz competitions and audience polling can facilitate active learning and engagement in the live virtual learning environment during the COVID-19 pandemic and beyond.