As the COVID‐19 pandemic roars into its second spring, it has wreaked havoc on nearly every aspect of personal and professional life. For cytopathology, the pandemic has presented a particularly difficult challenge for training, networking, and continuing medical education. Medical societies around the world have repeatedly canceled, delayed, or overhauled meetings, conferences, and tutorials. For the first time ever, organizations such as the American Society of Cytopathology (ASC), the United States and Canadian Academy of Pathology (USCAP), and the International Academy of Cytology (IAC) have been forced to move their major events online.

Distance learning programs such as Africa Calls have proven that complex cytopathology training can be conducted from afar (See “Africa Calls: A Phone‐Based Training Program Aids a Continent’s Rising Stars,” CytoSource, May 2020). However, multi‐day conferences that attract hundreds or even thousands of attendees can increase the complexity by an order of magnitude. In effect, virtual meetings have become huge new experiments in online learning. The trial‐and‐error efforts, though, have given medical societies an unprecedented opportunity to try out alternative teaching methods, share hard‐earned lessons with their peers, and smooth out the rough edges of subsequent iterations. At the same time, some meeting organizers are discovering that the creative tools they have had to deploy may help them enhance all events, whether in‐person or online, long after the pandemic’s end.

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“Virtual meetings will never be as good as the face‐to‐face meetings,” says Andrew S. Field, MBBS, FRCPA, FIAC, associate professor at the medical schools of the University of New South Wales and The University of Notre Dame and director of anatomical pathology at St. Vincent’s Hospital Sydney. But the pandemic has provided a big impetus to improve and refine training and educational platforms that can yield additional tools for cytopathologists, cytotechnologists, and trainees. “I don’t see it as a negative outcome at all,” Dr. Field says. “I think it’s going to be a positive outcome because we’ve been pushed to really drive these new teaching mechanisms.”

A Lesson in Reprogramming

The IAC, of which Dr. Field is president, postponed 2 in‐person tutorials slated for 2020. For a third, scheduled for December 2020 in Mexico, the academy instead held a virtual conference run by an information technology provider in cooperation with the Mexican Academy of Cytopathology. The tutorial included a blend of prerecorded lectures, live question‐and‐answer sessions, and extensive engagement on both Zoom and Twitter, the last of which “gave it an immediacy” by allowing participants to ask questions, make comments, and engage with their peers in real time, Dr. Field says. With approximately 550 registrants, the tutorial was well attended and received excellent feedback, he says.

The time and expense required for normal conference travel, which can create a high barrier for many would‐be attendees, has been largely eliminated by virtual events. Making lectures and other recorded content available for several months after a virtual meeting has ended—a trend that may become a more permanent feature—can further increase the potential reach. Beth Jenkins, executive director of the ASC, says that approximately 660 people registered for the society’s November 2020 meeting, a relatively normal turnout. However, attendees hailed from 28 countries—up considerably from the typical 6 to 8—and the international registrants made up a significantly higher percentage of the total in comparison with previous years. Because the society decided to leave its registration open for several months after the meeting—not a possibility for an in‐person meeting—another 30 to 40 people accessed course materials on the online platform.

The time and expense required for normal conference travel, which can create a high barrier for many would‐be attendees, has been largely eliminated by virtual events.

Claire Kilfoyle, director of education for USCAP, says that most of the association’s March 2021 meeting content will be presented on demand so that attendees can watch at their own convenience. The USCAP meeting normally attracts approximately 4000 participants, but Kilfoyle and her colleagues are anticipating that significantly more people, including a larger international contingent, will register for the all‐virtual format. “Our faculty have asked more international educators to participate because they don’t have to travel, so I’m hoping that will also translate to the learners as well,” she says.

One big question, though, has been how much programming to include. For the November 2020 meeting, ASC staff decided to retain most of the conference program, paring back only a few sessions, roundtables, and a hands‐on workshop. They then decided which should be prerecorded and which could be offered live. All of the meeting’s scientific sessions and approximately half of its workshops and special courses were held live, while the rest were prerecorded.

USCAP based its virtual format on the expectation that most attendees wouldn’t be taking time off from work to watch the sessions. The 3‐hour‐long courses and companion meetings held in conjunction with the conference have been cut in half, with each speaker talking for approximately 30 minutes, plus additional time for introductions and questions. Dr. Field plans to take time off to virtually attend the USCAP meeting and present at 2 companion meetings. He does not have a problem sitting through full‐length sessions. “If you shorten it too much, then you’re just giving a webinar,” he says, although he is preparing for some early mornings given the time difference.

Virtual Interactions

Technical issues have the potential to completely derail virtual meetings. To help to ensure high‐quality videos, USCAP sent out recording kits with a camera, a microphone, and a light to many of its speakers, whereas others recorded their presentations through a virtual platform. One benefit of needing the recordings and presentations in advance, Kilfoyle says, is that attendees will have the material “right at their fingertips” during the sessions.

The ASC’s Jenkins admits she was “scared to death” that a technical problem would knock out her meeting’s internet connection. “Surprisingly, we had no glitches; we were very happy with that and very pleased with the end product,” she says. Investing in a reliable platform and meeting provider is paramount, although Dr. Field cautions that virtual meetings can be nearly as expensive as live ones due to the thirdparty IT costs. Even if the conference is flawless, he notes, the sound and image quality can differ significantly according to each participant’s own internet access. It is another reason why he contends that face‐to‐face tutorials will always be better than virtual ones.

Format considerations extend beyond main sessions. For its online poster sessions, the ASC displayed high‐resolution versions of each poster and 10‐minute video summaries by the presenters. Although Jenkins was happy with the attendance, she is considering tweaking the format so that poster presenters can be in a virtual room to answer attendees’ questions. For the USCAP meeting, poster presenters will instead upload a short PowerPoint presentation and a 3‐minute explanatory video. The full abstract text will be available, and each presenter will be assigned a 1‐hour time slot in a virtual room to answer questions. “We’re hoping that it still kind of gives them the interaction that they would get on a poster hall fl oor,” Kilfoyle says. If the format works, aspects such as the uploaded poster summary may be retained for all future meetings.

So far, conference organizers have had less success in approximating the experience of an exhibition hall or reception. To partially compensate for the loss of hallway conversations, the USCAP meeting will have virtual networking and social rooms open throughout the meeting and staffed at certain hours by members of the education committee. “I’m not sure how successful it will be, but I know that it was one thing people really missed about the live meeting,” Kilfoyle says. The platform also allows people to search for other attendees and chat with them. For more social events, a sommelier based in the Palm Springs region will hold a virtual wine‐tasting event in USCAP’s film studio, and the academy will broadcast morning yoga and meditation sessions taught by a local instructor. For its own meeting, ASC offered 3 “Yoga at Your Desk” sessions as well as a virtual wine tasting and an art demonstration, both hosted by society members.

“We’re all in a learning curve about how to use the virtual meetings,” Dr. Field says. If COVID‐19 vaccinations make travel possible in the latter half of 2021, he and others say that hybrid meetings with a mix of prerecorded lectures and scaled‐back live sessions could become the new normal. The ASC is already working on that hybrid approach for its 2021 meeting in Las Vegas, Jenkins says, by, for example, having attendees ask questions virtually (eg, by texting them to a session moderator) to encourage more interaction.

Although face‐to‐face meetings may not be completely replaceable, Dr. Field says that virtual agendas and formats will undoubtedly continue to evolve and improve as organizers find what works and what does not. One overall change, he adds, is likely to stick: “I don’t think we’re ever going to go back to holding every meeting as a fly‐in, face‐to‐face meeting.”