Avatars: colleagues in the time of the pandemic

“Mark, do you think that once this is all over, we’ll go back to having meetings like journal club face‐to‐face?” My senior colleague is starting to wind down toward retirement and hasn’t fully adjusted to having our department meetings on Zoom. He’s worked as a specialist physician in this department for over 30 years. He taught me (and countless other trainees) bronchoscopy and is the physician with whom I’ve shared the longest period working. On and off, it’s been over 15 years in several stretches, but I remember him from when I was a medical student well before that.

“I don’t know, John. The videoconferencing facility has enabled those among us on smaller fractional appointments to join the meeting remotely. We have trainees and medical students attending from several campuses who couldn’t have attended before. Attendance has actually gone up since we started doing this at the start of the pandemic.”

I was giving a talk to my department on the preparation and delivery of virtual teaching. I had reached out to a colleague who permitted me to screen one of the instructional videos from his YouTube channel,1 and then I discussed strategies to make virtual sessions more engaging. A multimedia journal club with nary a journal article to be seen. John wanted to hearken back to the days before Zoom, the days before PowerPoint. When he could highlight a physical copy of a journal article and project that on the screen, or even earlier when we used acetate overhead projection sheets. You had to choose your words carefully as those sheets weren’t cheap, acetate being more expensive than electrons. The content was king, the message all‐important, and the delivery didn’t need to be complicated.

Before the pandemic, we would have up to eight or nine of our department of 15 or so specialist physicians physically present each week, along with the rest of our teams. We met, we chatted, we debated the meaning of the article under discussion. We reviewed our morbidity and mortality cases. It was a comfortable and comforting routine, although not always; sometimes we would argue, but we were together, which meant we tried to be collegial. Although there are now more of us online for our journal club, most of our cameras are turned off and microphones muted, which exacerbates the sense of distance. It isn’t the same.

My training and experience as a clinician educator tell me we need to adapt to the post‐pandemic world. Medicine is changing, and the way we participate in ongoing education will change with it. Many of the changes are both necessary and overdue; I accept this and will embrace them. However, as John mentions the “old days” when we would gather before the meeting started, drink coffee and catch up, I begin to realise that I miss those days as well.

Many times, John and I shared a brief conversation about the tribulations of our respective football teams. Sometimes he gave news of his children; later, we talked of mine. When I purchased my first new car, he told me I had chosen the wrong colour (black: “it will never be clean again”, he said; and he was right!). Often, I asked to pick his brain about a clinical problem, but not before we shared a laugh. I’ve tried to simulate this experience when I see him waiting among the participants on the video call. It feels awkward, artificial. Sitting at his laptop in his practice, he could be reviewing patient notes or correcting his dictation — the very definition of the modern multitasking physician. When we would meet in the corridor before journal club, I knew he was there for the meeting, and I wouldn’t interrupt anything else. Now, I’m not sure, and I hesitate to intrude.

If the practice of medicine is about connections between physicians and their patients, it is enriched by relationships between physicians and our colleagues. Other physicians, our trainees, the nurses with whom we often work longer than anyone else. I’ve been lucky to meet many wonderful and varied people during my career whom I still call friends. There is something about working with people and sharing physical space that forms bonds that are not easily replicated virtually.

Videoconferencing technology is the main innovation that has allowed my teaching during the pandemic to continue. My participation in international professional societies and at conferences is facilitated by videoconferencing. I’ve made valuable friendships and learnt a lot from my interactions with colleagues over the medium. But I long to return to an in‐person conference and see those people again. I can’t wait to teach alongside these friends again; physically, rather than virtually.

On what will we miss out by conducting our daily work as avatars? Will we still form meaningful connections with our colleagues? Our trainees? I don’t know the answer. Perhaps it is different if you have grown up with technology as an ever‐present part of your schooling and workplace. Or maybe not.

Maybe the next generation won’t make friends in their teams; they will be colleagues on screen, but their friends will remain outside of their professional practice. I don’t know if that’s a good thing.

John and I frequently disagree. I enjoy nothing more than to make him laugh at himself with a joke at his expense, or debate him for the sake of debate. We can do so because of a longstanding relationship built on journal club, morning coffee and shared presence. I can make fun of his reluctance to participate in the information age, but only because we know each other so well.

Perhaps, on reflection, I might have answered: “I don’t know, John. But I sure hope so.”