Because webinars are relatively easy to produce, inexpensive to host, and bring geographically far-flung participants together with the click of a mouse, they have become ubiquitous in the world of continuing medical education. But when poorly designed and executed, they run the risk of failing at the very thing they are designed to achieve—changing behavior. A disembodied voice accompanying a deluge of uninteresting slides becomes an open invitation for participants to check e-mail, complete charts, read their Twitter feed, or surf the Web, while remaining somewhat tuned in to the content at hand.

To overcome the passivity that is inherent in a webinar format, it’s critical to design and plan for interactivity so that participants engage directly with the content you want them to absorb. You want webinar participants to actively discuss, write about, adapt, and practice what you’re attempting to teach.
Here are some best practices, based on our own experiences using the Cisco WebEx Training Center online conferencing application. (These guiding principles are based on WebEx simply because that is the application our organization uses—we do not promote or recommend any particular webinar platform.)

Create a Dialogue

Use your attendees’ wealth of knowledge in their field of expertise as much as possible during your presentation. Getting them to assist in teaching the content enhances everyone’s learning, and enriches the experience for all.

In addition, present the content through dialogue as much as possible. Recruit a partner to foster discussion, and address questions as they are asked to break up the single-voice monotony. Consider presenting your information as an interview, in which the facilitator poses questions that elicit the presenter’s important points. The facilitator can also provide color commentary, calling attention to main points, and adding information or reinforcement.

While this dialogue is not, strictly speaking, interaction on the part of the participants, it does make the presentation more engaging and interesting. It also frees the presenter to teach, because the facilitator is handling all the technical details of the webinar, such as monitoring chats, launching polls, muting and unmuting, and so on.

Interact Early and Often

Start the interaction early in your webinar, and continue it throughout the session. People become more willing to interact as they practice doing it and gain confidence over time. This is especially true with Regularly Scheduled Series (RSS), in which the audience can be developed as the program progresses.

Base the types of interaction and the way you use them on your educational objectives. For example, here are a few guidelines for using chat to facilitate interaction:

The Chat Feature

• Make it possible for participants to chat with each other, see each other’s chats, and send comments to host and presenter. This may require changing participants’ privileges, according to your platform’s capabilities.

• Model the use of chat by sending quick messages of reinforcement or explanation accompanying the presentation. Comments such as, “Are any of you already trying this?” or “This is especially useful in cases of ___” can get the ball rolling.

• Encourage participants to post questions that everyone can see, and to respond to questions if they can.

Caveat: Because chat can be distracting, use it with discretion.

Start Small

The best way to ease faculty and participants into interaction is to begin with small, non-threatening techniques such as hand-raising, quick polling, and the use of emoticons.

Hand-raising:

Most frequently used to notify the host or presenter of questions, “hand-raising” can also be used for a quick poll, such as, “Raise your hand (i.e., click the hand-raising icon) if you have ever designed or hosted an educational webinar.”

Hand-raising is not anonymous, so try to ask value-neutral questions, or questions designed to increase confidence. Participants may worry about being seen to answer incorrectly, and so may not respond at all.

Caveat: Remind people to put their hands down again after the exercise.

Quick Polling:

Many platforms have simple ways to stage a quick yes/no poll (in WebEx Training Center, it’s a green check/red X). For example, “If you’ve ever navigated away from an educational webinar to check your e-mail, click the green check. If you haven’t, red X.”

Quick polling is great for doing an on-the-spot needs assessment, checking comprehension, and judging level and pace. For example: “If this level of discussion of ACL tears is right for you, click the green check. If you would like a quick review of anatomy before we move on, click the red X.”

Because quick polls are anonymous, at least to other participants, you can put participants on the spot a bit more to answer truthfully. In WebEx, these responses can be tabulated instantly into a bar graph, allowing you to see and share the results of the entire group, in graphic form.

Emoticons:

Some platforms have ways to publish or share feelings via emoticons. For example, Training Center on WebEx features smiley faces, sleepy faces, confused faces, or “I’ve gone on a coffee break.” There are also “Go Faster” and “Slow Down” emoticons.

Caveat: Employ emoticons only if you are interested in seeing the participants’ responses.

Employ a Q&A Format

Webinar hosts and presenters sometimes talk on forever, as if speaking in a void, pausing only at set intervals to solicit questions from the audience. This approach to interactivity is better than nothing, but once the discussion has moved on to other topics, it can be difficult for participants to ask questions about points made earlier. Try to find ways to weave questions organically into the flow, using chat, hand-raising, speaking out, or having the facilitator ask questions.

Chat

• Participants can direct questions to the facilitator via chat, which the facilitator can weave into the presentation as time allows.

• If all the participants can see the chat, they may be encouraged to answer each other’s questions, effectively tapping into the knowledge of the group.

Caveat: The facilitator must monitor the chat to be sure any information shared by the group is correct.

Hand-Raising

Participants can raise their virtual hands, requesting to be unmuted so that they can voice their questions.

Speaking Out

At set times, you can unmute participants and allow them to pose their questions verbally. This works better for small groups, because they can pause and take turns in a way that’s hard when the group is large.

Facilitator Asks the Questions

The facilitator can reverse the usual flow by posing questions to the participants. Note:

• Specific, open-ended questions yield the best responses.

• Design the questions to reinforce and support your educational goals. Try not to embarrass anyone by putting them on the spot unnecessarily.

Interactivity Through Polling

Polling can be used to pre-test and post-test participants to assess changes in knowledge, but it also has other uses. Well-designed polls can lead participants to practice clinical decision-making, understand the consequences of those decisions, or help them understand what they still need to learn to be able to adopt the behavior change. Remember to:

• Allow time to discuss the results of a poll, so that participants can understand the reasoning underlying the correct answer.

• Incorporate polling with the familiar case format to engage people more deeply.

• Use a progressive, linked series of polls to help participants see how the clinical picture plays out.

Example Case: Musculoskeletal Medicine

A 45-year-old woman was involved in a low-speed bike accident two days ago. Initially she thinks she has just an abrasion on her right knee, and so she is able to ride another five miles. Then her knee swells markedly and she can no longer bear any weight on that knee, and her range of motion is significantly restricted. She is healthy with no prior knee problems. There is tense effusion. She is holding her knee in 30-degree flexion. On initial exam, her range of motion is limited by pain. Her skin is clear, except for a small, healing abrasion.

 

Poll 1: Would you aspirate her knee?

A. Yes, in a tense effusion, aspiration can be therapeutic.

B. Yes, and if she has a bloody effusion, I will be more likely to order advanced imaging.

C. Yes, and then inject lidocaine to check her range of motion.

D. No, the risk of infection outweighs any potential benefit.

To engage participants after the poll:

The presenter can use discussion between polls to explore participants’ thinking and reasons for choosing a particular option. For example, “Someone who picked A, can you share your thinking?” And then, “Someone who picked B?”

Be sure to explore all the options.

Learning is enhanced through polling only when none of the answers is either right or wrong. Instead each offers some genuine value. As a result, the poll is less about passing a test and more about practicing clinical decision-making.

The case continues. The knee was aspirated, producing 80 cc of bloody fluid with no fat globules. Post-aspiration, the patient has almost full extension, and flexion to 90 degrees, with no apparent laxity. There is some posterior-medial joint line tenderness.

 

Poll 2: What would you do now?

A. Protect her knee in an immobilizer and re-evaluate in a week.

B. Order an MRI to determine whether there is internal derangement.

C. Order a CT scan to look for radiographically occult fracture.

Faculty should again lead the discussion of the reasons for and against choosing each option.

Suppose the group chose Option A—to re-evaluate in one week. The case continues. After one week, there is minimal improvement. The MRI shows a displaced bucket-handle tear, and the patient is scheduled for surgery. Two days before surgery, she calls stating she felt a pop while changing her position in bed, and now she can move and straighten her knee without pain. She’s wondering whether she still needs to go ahead with surgery.

 

Poll 3: What would you tell her?

A. She should still have surgery to attempt repair of the tear or shave back to a stable base.

B. At this point she can take a wait-and-see approach.

Telling the story using linked polls, one result feeding into another, increases participants’ investment in the discussion. Participants want to know what happens to our patient as a result of the decisions we have made! The learning points underlying the case become clearer, more memorable, and more actionable.

Use Breakout Groups

Some webinar platforms allow the host to send participants into breakout groups, in which they can hear the other people in their group but not the participants in other breakout groups. This can be useful when you want people to work as a team, or come up with a solution together, which can ultimately be shared by the larger group.

When employing breakout groups, make sure you provide enough time for participants to talk to each other. With too little time, not all members will be able to talk, while too much time may make participants inattentive or bored. Plan on dropping in on the breakout groups to ensure they are on track, and to see if they need help or clarification. In addition, allow time to debrief when participants return to the large group.

Working with Faculty to Increase their Use of Interactive Techniques

Clinical medical education planners and consultants must often work with presenters who are not familiar with using interactive techniques in webinars. Because the traditional way of delivering content involves presenting a lecture accompanied by slides, these presenters all too frequently translate this same technique into the webinar format, where it is even less effective. Here are a few tips for encouraging presenters to try interactivity:

• Apply the principles outlined in this article, beginning with the Start Small section. Let the faculty know you may be receiving questions via chat, and you hope to insert them into the conversation.

• Ask the faculty if there is any form of participation he or she would feel comfortable with. Cases are commonly used as teaching tools, and can be adapted to use the polling feature, guided by the suggestions above.

• Practice the webinar at least once in advance, to help the faculty become familiar with your platform and its features. Give them a little time to play around so it seems less threatening.

Best Practices for Slides

• Use images that illustrate your point in a dramatic, memorable way (graphs, pictures, drawings, etc.)

• Don't rely on too much text, and whatever you do, don’t read slides aloud word for word.

• Use a maximum of three or four bullet points per slide.

• Use slides to compare and contrast data.

• Use your pointer to highlight key points on the slide.

By planning ahead and engaging your audience with the content, many online webinar conferencing tools such as chat, polling, and breakout rooms will provide additional interaction among your participants and enrich their learning and experience with your goals and objectives in mind. There certainly are other techniques for fostering interactivity, such as annotating and using a whiteboard. Do you have other effective methods? We would like to learn from you.

Amy Osterholm, MPH, MSW, is senior training and development consultant, and Karen Olivar Mariano is administrative services supervisor, with The Permanente Medical Group.