Practicalities of running the virtual 2020 NPSS

Psychiatry summer schools are one of the UK's Choose Psychiatry initiatives and one of many enrichment activities encouraging students to choose psychiatry.^{Reference Halder and Mulliez4} The first UK psychiatry summer school took place in 2009, organised by King's College London.^{Reference Greening, Tarn and Purkis5} These free-of-charge educational experiences have since expanded nationally (hosts have included Liverpool, Wessex and Leeds), ranging from one day to full week programmes.

The 2020 NPSS was not designed to make a profit, and funding for the online platform was provided by the RCPsych. The event was instigated, co-organised and co-hosted by the two medical student authors (P.V and N.N), who were PsychSoc Presidents at their respective universities, Queen's University Belfast and the University of Manchester, during this period. The programme was organised within approximately 1 month. It featured 18 diverse, eminent and award-winning doctors from a range of UK geographical locations, including RCPsych faculty staff. Thought was given to selecting speakers from subspecialties typically underrepresented on the undergraduate medical curriculum, such as eating disorders and global forensic psychiatry (Fig. 2). Speakers were ultimately recruited based on the organisers’ personal professional networks and experience of seeing speakers at previous face-to-face events. No speaker charges were incurred. The decision to use Zoom Video Webinar was made based on the hosts’ previous experience using the platform, which has control functions and security that allow attendees and panellists different privileges (speakers can share slides, sound and video without risk of interruption from the audience and it protects against the new phenomenon of ‘Zoom bombing’). For the NPSS, a 500-participant webinar license (£134.40 for that month) was added onto a pre-existing PsychSoc Zoom Pro meetings account (£14.39 a month).

Fig. 2 National Psychiatry Summer School 2020 programme.

Before the programme's release the event was advertised on Facebook, Twitter and Instagram using Queen's University Belfast and Manchester PsychSoc social media accounts. The event was open to all interested, including sixth formers as well as medical students. In total, 480 tickets, all free of charge, were available per day, with no restrictions or limitations in numbers by university or school. In total, 1029 expressed initial ‘interest’ in attending on Facebook, and the Eventbrite event page had 9747 views. Tickets were limited by Zoom platform capacity, and on both occasions all tickets were ‘sold out’ within 12 h. Tickets were released in two batches: the first on 29 June and the second 13 July 2020. The full programme was released on 11 July.

The 2020 NPSS had a total of 434 attendees log in overall on day 1 and 412 attendees on day 2.

The online format: digital advantages and challenges

The 2020 NPSS has demonstrated that moving conferences online creates new challenges to overcome but can provide exciting novel opportunities. Organising a successful online conference can typically be achieved in a shorter time frame than similar in-person events. Once a suitable platform is chosen, there is no need to book a venue, catering, accommodation and so forth, and focus is solely on assembling the best possible programme. In comparison, the annual National Student Psychiatry Conference receives a minimum funding of £1500. Organisers are no longer constrained by geographical barriers (travel reimbursement costs and far greater time commitments) and the speaker pool is therefore much wider, time-zone permitting.

Moving conferences online can increase medical student and sixth form attendance and early career engagement, both nationally and internationally. Attendance at the NPSS overall was higher than at previous in-person National Student Psychiatry Conferences. Virtual forums can hold a greater capacity than a physical space at a much lower cost. The NPSS ‘sold’ 480 tickets. In comparison, previous National Student Psychiatry Conferences have sold approximately 122 tickets (Brighton and Sussex, 2018), 130 (Cardiff, 2019) and 156 (Bristol, 2020); historically, medical students from the host institution form the largest proportion of attendees at these face-to-face events. Cost access barriers to events are also overcome; attendees no longer incur travel expenses and can instead attend from the comfort of their own homes (theme 1 in Table 2), and attendance was particularly high for students from all three devolved nations when compared with the aforementioned conferences. The removal of travel costs, alongside the cost of accommodation, tickets and so forth contributes to an overall cost reduction for each attendee, helping to reach prospective doctors and future psychiatrists, especially in hard-to-recruit areas, and students from less advantaged backgrounds.

Attendees valued having medical student hosts and organisers (Table 2, theme 2). Prior to COVID-19 restrictions, collaboration between PsychSocs from two different countries was rare; but collaboration pooled perspectives from two institutions and networks, for both advertising and speaker recruitment. Consequently, there was an overall increased awareness of PsychSocs as a whole, and we predict future increase in medical student engagement with their local PsychSocs.

The quality and standard of an in-person event does not appear to have been lost – as reported in feedback (Table 2, theme 3). This included appreciation of keeping to programme timings, day structure and excellent organisation (theme 4). The hosts prompted the speakers on their available time and the appropriate number of audience questions, which was greatly valued by the audience, with comments such as ‘The event was incredibly well organised and done so much more professionally and with fewer technical problems than other virtual conferences arranged by larger organisations with more qualified staff’ (theme 3).

There are, however, challenges with online learning. Practice runs increased speaker confidence and minimised technical difficulties on the day, but the schedule was also purposefully designed to allow for some speaker delays and yet remain on time (Table 2, theme 5). Even with such precautions we experienced some technical difficulties on the day, including joining an online platform with inadequate internet connection or from a hospital/clinical trust from which access was blocked.

The attendees also appreciated the ‘buzz’ the conference had on Twitter (Table 2, theme 6). The NPSS ensured that all the speakers’ Twitter handles were made available to the attendees by displaying them on the screen in breaks.

Audience capacity varies across online platforms and payment schemes. Online free events may attract higher rates of ticket reservation, as attendees face no financial loss in not attending. Some who booked tickets did not attend and, conversely, some wished to attend but were not able to as all tickets had ‘sold out’. Organisers may wish to oversell ticket capacity, but to what extent this should be done is debatable, as there may be a risk of reaching attendee capacity on your platform and leaving some disappointed, particularly if there are some more popular talks from high-profile speakers. Several organisations livestream events across platforms but this may not be suitable for all. Interaction between attendees was limited, as the ‘chat’ function was disabled (Table 2, theme 7) because neither organiser had enough time to monitor this while managing other tasks.

We propose that recordings and slides should be made available to attendees following an event, but permission from each speaker must be sought and sensitive information removed (Table 2, theme 8). It has been suggested that distributing recordings post-event may reduce live attendance, but the extent of this is unknown. The use of breakout rooms and opportunities they can provide are limitless: perhaps icebreaker games, debates or concurrent workshops, which can allow for interactivity between attendees (but require a larger organisation committee to manage). Breakout rooms can target specific audiences, for example ‘psychiatry at medical school’ or ‘psychiatry within the foundation programme’ (Table 2, theme 9). Overall, we recommend targeting medical student and sixth form students separately to help meet the differing expectations and knowledge of these two groups while maintaining relevance, as shown by Wyke and colleagues.^{Reference Wyke, de Bernier, Lam, Holt, Butler and Rajamani6}

The length of the day and sessions should be considered: day 2 feedback suggests that sufficient activity-free breaks are welcomed and should be scheduled within the event programme (we had one additional break on the day 2 programme) to prevent ‘Zoom fatigue’ (Table 2, theme 10). Overall, attendance reduced throughout the day, but joining remotely provides attendees with flexibility to ‘dip in and out’ of the event, only attending for speakers they wish to hear.

The content: maintaining quality speakers and topics in a ‘saturated marketplace’

Diverse, passionate and knowledgeable speakers are essential to convey the ethos of Choose Psychiatry (Table 3, theme 11). Attendees noted and appreciated the importance of the presented topics, including lived experience (theme 14), topics less commonly addressed (such as Islamophobia, race and equality) (theme 12) and subspecialties neglected on many medical schools’ psychiatry curriculums (theme 13). Attendees highlighted appreciation for the two medical student presentations (by P.V and N.N.), which were described as ‘more relatable’ and ‘easier to digest’. Virtual conferences may offer junior colleagues significantly more opportunities to present, and raising the voices of doctors from a variety of clinical standings and locations is equally important. Interactivity throughout the course of the two days included several speakers opting to include audience polls, as well as taking questions from the audience both during and after their talks. In addition, there was patient simulation, where Dr Fernando had invited an actor to play the patient while a medical student took their history (theme 15). Varying the options for student interaction, utilising audience polling, question platforms, chat features and the previously discussed breakout rooms are reported to maximise student engagement online.^{Reference Gordon, Patricio, Horne, Muston, Alston and Pammi7}

Feedback further highlighted the importance of patients’ mental health problems for all healthcare workers, not just prospective psychiatrists (Table 3, theme 16). For any medical specialty, it is vital for medical students to consider the mental health of their patients: parity of esteem and valuing mental health equally with physical health were key takeaway messages from the NPSS.

The 2020 NPSS was for some their first experience of psychiatry and/or medical education as a whole, as noted by the unanticipated but welcome large sixth form presence (not seen at past National Student Psychiatry Conferences). Feedback demonstrated how virtual events compensated for lost work experience and provided support for applications to medical school (Table 3, theme 17). Further support included providing medical students (a proportion of whom had psychiatry rotations cancelled or reduced because of COVID-19) with an insight into the specialty. Furthermore, the NPSS provided earlier, accessible psychiatry education to medical students who otherwise experience psychiatry rotations later in undergraduate clinical years (theme 18). Virtual psychiatry events may therefore help to mitigate the concerns regarding reduced psychiatry teaching and in turn engender future interest and boost recruitment.^{Reference Sharma, Sharma and Ogle8}

Lastly, the NPSS helped some students to consider pursuing psychiatry as a career (Table 3, theme 19), a notion further strengthened by ‘before and after’ ratings (Fig. 2). Following the event, there was a clear demand for future similar events and maintaining accessibility. Advertising these opportunities (such as becoming an associate member of the RCPsych) during programme breaks might sustain engagement and long-term recruitment (theme 20).