October 27, 2023
7 min read
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The COVID-19 pandemic ushered in, among other things, a debate that almost no one could have anticipated prior to late 2019 — the value and necessity of in-person gatherings for medical conferences.
There is no question that virtual formats helped individual practitioners and medical societies communicate and navigate the early years of the pandemic.
For this exercise, Michael Putman, MD, MSci, was assigned the side of in-person conferences, while Jean Liew, MD, was given the task of supporting hybrid formats. Image: Adobe Stock
Then, as the world began to open up again and restrictions relaxed, hybrid formats took over, allowing attendees to make decisions about travel based on their own risk assessment and comfort levels.
In May, WHO declared the end of the COVID-19 public health emergency. Gallup polling from June indicates that two out of three Americans believe the pandemic is over.
Michael Putman
Jean Liew
The question now is whether medical conferences should continue to offer virtual options, or whether the virtual format should effectively go into retirement in favor of in-person-only meetings once again.
Healio enlisted Jean Liew, MD, a clinical researcher and rheumatologist at Boston University, and Michael Putman, MD, MSci, an assistant professor of medicine at the Medical College of Wisconsin, where he also serves as medical director of the Vasculitis Program, to provide a point-counterpoint on the subject.
For this exercise, Putman was assigned the side of in-person conferences, while Liew was given the task of supporting hybrid formats. Each argument addressed the importance and necessity of being in the room as topics are discussed and research is presented, of accommodating individuals who are unable to travel, and the costs associated with both formats.
As both participants have been assigned their positions, the opinions expressed by Liew and Putman may or may not reflect their actual beliefs. Their statements have been lightly edited for grammar and flow. They are presented in alphabetical order by last name.
Liew: The case for hybrid options
I write in defense of retaining a virtual option for conferences such that they remain hybrid. I will focus on large international conferences such as ACR and EULAR. Topic-focused meetings, working groups or initiatives require further nuance and additional consideration, and are beyond the scope of this piece.
The last few years have clearly demonstrated the strengths and weaknesses of different conference types, whether they are fully in-person, fully virtual or hybrid. Rheumatology organizations have tried to adapt to changing needs, and their attempts at innovation and flexibility are commended.
After all of this experimentation, it does a great disservice to the rheumatology community to conclude that the fully in-person conference experience was the best that we could do. Instead, we need to consider the lessons learned with virtual and then hybrid experiences and understand that although there is no one-size-fits-all option, that we need to continue to work to be inclusionary.
Being inclusionary means finding balances — especially financial — and giving users a choice. A return to fully in-person conferences strips us of options.
Prior to the pandemic, large rheumatology conferences served the needs of the standard user, with caveats. We made assumptions for the standard user, that attending talks in-person was best for learning and engagement, that networking in-person could be prioritized, and that full involvement within the rheumatology community required an in-person presence. However, many of us in the rheumatology community diverge from that standard user definition.
Whether we fit that definition can also depend on the time of year and the stage of our careers and personal lives. At some point, many of us would benefit from having the flexibility of a well-conceived and carefully curated virtual choice within a hybrid conference.
Whether it is better to attend in-person vs. virtually to facilitate learning and engagement varies by the individual, by their needs at a specific time and place, and by the content of the talk.
Attending full days completely virtually may be fraught with distractions and be mentally and physically draining. Conversely, attending full days completely in-person can carry the same issues. How often have you found yourself distracted and on your phone or laptop while sitting in the middle of a large space for a session that could not capture your attention? And how often did you realize that it was easier to pay attention and take notes while reviewing similar material online? Again, these are choices we should be able to make, and we should have different options, within financial constraints.
In-person networking is important, for both individual and group benefit. However, if there is no virtual option whatsoever, those who cannot attend a conference in-person miss out completely on the discussion.
Acknowledging the limitations of including virtual attendees in real time, at the very least they should have timely access to conference recordings. Not everyone who wants to attend conferences has the time, finances or ability to travel. Even those of us who can travel to most conferences that have relevance to our interests have difficulty making it to all of them in a given year. We would all benefit from some type of virtual option, even if these are on-demand recordings.
For trainees and those early in their careers, in-person conference attendance is imperative. This would be ideal. However, consider that for many trainees in-person conference attendance was not a given, pre-pandemic or now. Most training programs cannot send all their trainees, whether due to limited financial support or clinical coverage needs. In these situations, it will never be completely fair to those left behind. However, a virtual option at least allows them access to educational materials and other talks.
For those more established in our careers, we juggle a lot with our daily and monthly schedules. Some are primary caregivers to small children or other family members. Sometimes we just need to make the choice to skip a meeting, but virtual options may mean we don’t have to skip it entirely. We just need that choice.
In rheumatology, we do not want to be exclusionary, especially now at a pivotal time in our field, when we face workforce shortages and a leaky research pipeline. We are global; we include clinicians, researchers, and patient partners. It takes all of these diverse voices to understand how to enact change for the rheumatology community, both now and for the future. This community needs to move forward. Going back to in-person only conferences is a huge step backward. Rheumatology needs to find a cost-effective way to retain virtual options for conferences.
Putman: The case for in-person medical conferences
Rheumatology conferences bring the community of rheumatologists together in a common location, where they can share knowledge and learn about the latest advancements in our field. Both functions seem readily amenable to a virtual format, where attendees can listen to talks on their computer and engage via social media from the comfort of their own home. Because of the money and time saved, many rheumatologists have become enthusiastic fans of virtual options.
However, relatively few have also grappled with their intangible costs, which include a distracted learning environment, the loss of opportunities for networking, and the stifling of professional identity formation.
First, the experience. The audio and video quality of virtual conferences has improved, but the potential for learning has plateaued. Watching from home may be comfortable, but it is also distracting. When attending virtually, I find myself checking email, responding to patient queries, and stepping out to run errands. Not having, quite literally, “skin in the game” reduces my engagement with the content. It also lowers the threshold to quit early on a talk, which I first saw as an advantage. Who wants to stick around if a speaker does not immediately grab their attention? Click click, and you are in another room!
Upon reflection, I have realized that many of the most important presentations I have seen — guideline committees, content that challenged my preconceptions, speakers who needed to warm up before hitting their stride — would have been missed had I not been firmly planted in a real seat in a real conference hall.
More importantly, however, the virtual option removes the chance for genuine networking. Q&A boxes and frantic tweeting cannot replace the spontaneity and depth of face-to-face interactions.
At the last American College of Rheumatology conference, I shared birria tacos with old friends and new acquaintances. I walked a beautiful city with colleagues from across the globe. I had the joyful experience of meeting online/Zoom friends in real life, with whom I shared real hugs and real lunches. I enjoyed a dinner out with my division, caught up with mentors from training, and continued to build conference friendships that I expect to become lifelong friendships. None of this would have happened from the beguiling comfort of my couch.
Such experiences have helped form my professional identity. Like many people, I am many things. I am an adventurer and outdoorsman, a part-time craftsman of traditional Neapolitan pizza, and a dedicated gardener and orchard keeper. However, above my hobbies I am a rheumatologist, and I am a rheumatologist who sees rheumatology as central to my identity.
Building that identity took sacrifice in training. Maintaining it takes sacrifice still. Prioritizing rheumatology conference attendance means something. It means that I am willing to not camp and not hike and not garden for a weekend, because spending precious time and money on a rheumatology conference is worth it. Identity is built in many ways, but I would argue that it is hard to truly become something until you have chosen to sacrifice for it.
Virtual virtuosos will argue that social media can replace in-person interactions, but we all know social media to be a dark and inadequate shadow of reality. Others will say that trainees benefit from the flexibility, but ask yourself who most requires engagement, networking, and professional identify formation?
Like many, I find the argument for cost savings compelling, but virtual options, in my experience, mean that the oligarchic business majors who run health care organizations now have the option to provide less professional development funding. A virtual option is not just an option for us; it is an option for others to degrade what it means to be a rheumatologist and to build a career in the specialty.
In-person conferences will never be perfect. The talks may sometimes start slow, the cities may not always be glamorous and the costs have been inexorably rising. They will also always be necessary. The in-person experience is more engaging and better for learning. Few can truly network through social media, and foregoing in-person conferences is forsaking in-person meetings with friends and colleagues.
Medical conferences are more than just a gathering; they are a celebration of the rheumatology community, a place for growth, learning and, most importantly, human connection and identify formation. We need those now more than ever, and certainly more than we need a virtual option.
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