Table 1 Summary of Kotter and Changes During COVID-19

Establish a Sense of Urgency

● Consider potential future scenarios and untapped opportunities

● Urgency palpable

● Imperative for change was obvious

● Level of clinical and personal danger prevalent

● Make the need for change clearly known

● Imperiled educational goals and metrics

Form a Powerful Guiding Coalition

● Assemble a strong group of individuals

● Coalition emerges through differential engagement of participants

● Self-organized frontline coalition formed with technology adept teachers and learners in the lead efforts

● Ensure the coalition will work well as a team towards the shared goal

● Co-creation prevalent

● Facility with technology ability a key differentiator initially

Create a Strategic Vision

● Build a vision to guide change efforts

● Initial lack of strategic vision

● Initial focus reactionary rather than aligned

Cross-disciplinary themes emerged

● Envision and share a strategy for success

● Vision emerges as needs and goals identified through top-down communication

● Settling out process

Communicate the Vision

● Communicate expectations ten times more than expected

● Bilateral communication including trickle-up of what was working

● Regular communications channels established both within and across specialties

● Vary communication strategies

● Communicating uncertainty was reassuring

● Guiding coalition role models new behaviors

Empower Others to Act on the Vision

● Remove or alter organizational obstacles

● New telemedicine, information management, and education roles for clinical trainees

● Co-creation of educational work designed to support rapidly identified clinical need

● Support experimentation and rapid improvement cycles

● More self-regulated and self-directed learning

● More flipped classroom implementations

● Medical students identify need for and implement educational sessions

● Increase in learner ownership

● Allocate designated roles by best fit helps flatten hierarchy

Plan for and Generate Short-Term Wins

● Showcase short term, visible improvements

● Initially maintain moral through “non-losses”

● Continue educational mission without lapse

● Publicly reward those who enable and support wins

● Level of engagement an important early guiding indicator of success

● Celebrate trial, error, and growth

● Inclusive participation of teachers and learners within sessions

● Realize advantages of online learning

Consolidate Improvements and Produce Still More Change

● Promote those who are effective change agents

● Identify what is working

● Increase in attendance at rounds and conferences

● Challenge long-held assumptions about how clinical education should occur

● Use of chat, poll, and screenshare features

● Energize the change by offering resources and supporting new projects

● Engage discussant, moderator, and reviewer roles to support integrated learning

Institutionalize New Approaches

● Sustain change by ensuring new approaches are understood by all

● Organizational change requires a predisposition to accepting change as a constant

● Accept iteration and ambiguity inherent in educational process

● Trial new methods, learn from failures, and share what worked

● Vocalize connections between new changes and organizational success

● Adaptation integrated into the clinician-educator role

● Recognize fallibility and humanize education