Reflections on a new way of reaching consensus in an age without travel

Having secured funding and planned a June 2020 face-to-face consensus meeting, where global concussion and disability sports experts would travel to the United Kingdom, COVID-19 provided a “curveball”!

Typically, consensus process includes establishing an expert group, conducting preparatory/planning work, and reaching consensus in person during a several-day, face-to-face event (e.g. Bahr et al, 2020¹). As organisers we had two real options:

1. Cancel/postpone the consensus meeting
2. Move the meeting online

The latter was chosen, and this blog outlines our experiences and reflections.

The solution:

• Going digital– An online 2-day consensus meeting was held on the same dates to minimise disturbance to the schedules of all participants for time they had already allocated.
• Keeping the framework similar– As per a “traditional” consensus meeting, pre-work was allocated to each of the participants in subgroups (who also held pre-meetings via Zoom). This maximised productivity during the main online consensus meeting
• Lean and tight: A structured timetable was prepared which ensured a shorter 2-day online meeting. This tighter programme was more in keeping with the Zoom format.
• Platform selected– Zoom was chosen as the host platform. Most individuals were already familiar with Zoom, and importantly it allows meetings to be recorded.

What worked well online:

• Inclusivity: Those with childcare/children home schooling/care duties were able to attend. One of the participants was blind and participated in the online consensus meeting effectively (although instances when participants “shared screen” were an issue).
• Wider reach: As direct costs (i.e. transport, food and accommodation) were eliminated, it became possible to extend the invite list to a larger group of experts from a wider geographical area.
• Environmental gains: Whilst having more experts in attendance, a large carbon footprint was saved and the funding that was secured for this meeting was able to be reallocated.
• Catering: Regular coffee and comfort breaks were built into the programme. Whilst we all had to make our own lunches and coffees, this meant all diets and tastes were easily accommodated!

Challenges in conducting the meeting online:

• Loss of ‘non-meeting’ meetings, depth of communication and engagement: Face-to-face networking and informal chat were lost. It was recognised that in-person communications enhance meetings by introducing participants who do not know each other and may make meeting discussions less formal and more productive. Consequently Day 1 was notably quieter than Day 2, when there was palpably much more engagement.
• Technical issues: As is often the case, technical issues (e.g. webcam/WiFi issues and many participants forgetting to turn off ‘unmute’ at some point) were occasionally a stumbling block.
• Focus: Naturally there were home distractions for all, which may have detracted from focus compared to a face-to-face meeting. Not being present in the same room also meant that perhaps it was naturally easier for the mind to wander and could potentially be linked to “Zoom fatigue”².

Engaging differently in online meetings:

• Functionality: The “chat” facility on Zoom (where comments can be synchronously posted) and digital “hand raising” (where participants select an emoji to state they want to speak next) was used well.
• Chairing: Although online meetings run differently to face-to-face meetings, the role of the chair is still crucial (arguably even more crucial) to maintain the flow and structure of the meeting. The chair prepared accordingly, and handled the verbal questions, “chat” function, and running order effectively.

Conclusions- Our reflections/recommendations:

Our online adventures confirmed that with extensive planning, the initial goals of the consensus meeting were achieved (namely having an in-depth discussion of the clinical issues and progression was made towards generating a position statement). Given that not all participants in the consensus meeting knew each other, then perhaps spending more time with warm-up activities to encourage greater engagement from the start might have been useful. Encouraging smaller groups (different groups each time) to spend the “break” sessions together may have also helped to recreate some of the face-to-face social interactions that a traditional consensus meeting allows.

Whilst the “chat” function enabled the chair to manage the questions effectively, conversely perhaps that same functionality meant that our group did not speak out verbally as much as they would have if they were in the same room. Different groups of individuals may have different experiences however, and there is unlikely to be a “one-size fits all” solution for how to best conduct online consensus meetings such as these.

Author names and affiliations:

Dr Osman Hassan Ahmed (Bournemouth University, Bournemouth, England)

Professor Evert Verhagen (Amsterdam UMC, Amsterdam, The Netherlands)

Professor Wayne Derman (Stellenbosch University, Cape Town, South Africa)

Dr Richard Weiler (Fortius Clinic, London, England)

Acknowledgements:

The authors would like to thank all of the attendees of this inaugural “Concussion in Para Sport” group meeting and Mr Jeff Davis at The Football Association for his pre-COVID support with this work:

Dr Cheri Blauert, Mr David Clarke, Dr Kristine Dalton, Dr Kristina Fagher, Dr Vincent Gouttebarge, Dr Jamie Kissick, Dr Kenneth Lee, Professor Jan Lexell, Dr Peter Van de Vliet, Professor Nick Webborn.

References:

1. Bahr R, Clarsen B, Derman W, et al. International Olympic Committee consensus statement: methods for recording and reporting of epidemiological data on injury and illness in sport 2020 (including STROBE Extension for Sport Injury and Illness Surveillance (STROBE-SIIS)). British Journal of Sports Medicine 2020;54:372-389.
2. Zoom fatigue is real — here’s why video calls are so draining. Available from: https://ideas.ted.com/zoom-fatigue-is-real-heres-why-video-calls-are-so-draining/ (Retrieved 19^th July 2020).