When the world was thrown into disarray earlier this year due to the COVID-19 pandemic, ENDO 2020 in San Francisco was one of the many casualties. All was not lost, however, as the Endocrine Society quickly regrouped and rebounded and hosted the all new, completely virtual ENDO Online 2020 taking place over two weeks in June and reached thousands of endocrine scientists and clinicians around the world.
The morning of Game 5 of the 1997 NBA Finals, Michael Jordan called his personal trainer to his hotel room, complaining of stomach pains and fatigue so severe he couldn’t get out of bed, and he was diagnosed with the flu. Game 5 was crucial – Jordan’s Chicago Bulls were tied with the Utah Jazz at two games each. Jordan had already established himself as one of the all-time greats; he had led his team this far, and now the Bulls’ championship run was in jeopardy because of a virus.
When the Endocrine Society made the difficult decision to cancel its annual conference ENDO 2020 – the first time that’s happened since World War II – as COVID-19 began to jeopardize much of modern life, it definitely threw things into disarray for a time. Hotel reservations and plane tickets had to be canceled, concrete plans now shattered into dust.
“We have been clear all along that the health and safety of ENDO attendees, staff, exhibitors and the San Francisco community are our highest priority,” Society then-president E. Dale Abel, MD, PhD, of the University of Iowa, Carver College of Medicine, Iowa City, Iowa said at the time. “By holding the meeting at this time, we might not only put attendees at risk, but could displace healthcare workers during a public health crisis, by forcing them into self-quarantine upon their return or potentially contributing to further spreading the virus to our attendees’ hometowns.”
Indeed, the first action was ensuring the safety of everyone who would step into San Francisco’s Moscone Center from March 28 – 31. Next was anyone’s guess. Should the Society just stay in its proverbial hotel room or on the bench and sit this one out? Try again next year? Or take risks, take shots, and see it through, one way or the other.
One thing that the novel coronavirus shed light on was a relatively novel way of working, of staying in contact with loved ones, of even treating patients – over a webcam. Zoom suddenly became a household name. So, Society leadership made the bold move to hold a new scientific conference in a similar fashion.
“Completely suspending ENDO 2020 was never an option for us,” says Christopher Urena, MBA, CAE, the Society’s chief learning officer. “As the leading endocrine-focused organization, the world looks to us for continuity, guidance, and direction. We’re uniquely empowered with the human talent, resources, and resilience that made it possible to quickly pivot and mobilize forward with alternative plans for for a new, virtual conference. What’s more, we didn’t want there to be a significant education gap for our members, which could negatively impact the individuals they serve, and that was not something we were willing to accept.”
Then came the really difficult questions, the tough choices. Ultimately, leadership decided the best step forward was to make this program free, with the goal of creating as few obstacles for attendees as possible. Bringing something like this to fruition is not inexpensive, nor is it an easy task for any team to pull off, but the Society puts its mission in front of money.
“When we made the necessary but difficult decision to cancel our in-person ENDO 2020 in light of the coronavirus pandemic, our annual meeting steering committee and Society staff rapidly pivoted to shift some of our ENDO 2020 content online and create a virtual conference,” Abel says “We made the strategic decision to share this with the world free of cost as our contribution to the global endocrine community during these challenging times.”
Reaching More Attendees
To bring something like this to life, Society members and staff had to not only unpack and deconstruct everything that had been carefully and meticulously planned for the in-person meeting, but quickly find a platform and environment that would be an attractive experience for the (then) 25,000 people who had registered. “There were real world constraints,” Urena says. “Time, money, and the fact that our faculty and attendees were being called to the front lines to combat COVID-19.”
“We curated to the extent that we could, a good representation of endocrinology and really compressed that into a digestible, but still robust enough, curriculum for our learners,” he continues. “We did not want any barriers to access.”
Society leadership stretched the meeting to two weeks – since no one wants to sit in front of a computer listening to sessions for eight hours a day, and to give attendees much more flexibility. “Having a blend of on-demand, but also live experiences peppered throughout over two weeks, we thought it was an appropriate way to move this forward,” Urena says.
Then there’s the question of whether attendees can communicate and collaborate virtually, at least simulating an in-person meeting. “One of the challenges with a virtual platform is that the speakers cannot interact directly with the participants,” says Sally Camper, PhD, Margery Shaw Distinguished University Professor of Human Genetics and professor of Internal Medicine at the University of Michigan in Ann Arbor. “In a classroom or conference room setting, speakers can take cues from the participants body language and facial expressions to gauge where more explanation may be helpful. Despite this challenge, we had more people listen to the virtual platform than we typically have in the room at in person meetings. This makes me think the virtual platform reached more people.”
And, with anything like this, there are bound to be some technical difficulties. No technological platform is immune – TV streaming services, social media, they are simply unavailable from time to time. Zoom and FaceTime have their glitches. How would this platform perform when thousands of people from all over the world logged on to see a session at once?
Turns out, pretty smoothly. “The ENDO Online 2020 virtual platform was so easy to use!” says Lori Raetzman, PhD, associate professor of Molecular and Integrative Physiology at the University of Illinois at Urbana-Champaign. “All the presenters in the session were able to see each other before the start of the session and ask questions through the chat function as the session went on.”
“I loved the accessibility of the ENDO online platform,” she continues. “It reached more people than a session at ENDO and I could see questions coming into the speakers from all over the world.”
In Case You Missed It
The main theme of last year’s ENDO annual meeting in New Orleans was collaboration – sharing science with as many as possible, so that new therapies can be developed, studies further investigated, with the hope of curing or at least managing all disease by the year 2100. But when COVID-19 spread across the world, the virus threatened to move that timetable back quite a bit, as groundbreaking research, work that may have taken years, was suddenly in danger of being postponed and even abandoned.
And it can be difficult to share science that’s ready for others to build upon when most of the world is practicing physical distancing or under stay-at-home orders. Again, the Society recognized this potential gap and acted quickly to remedy it, but that took changing some mindsets. “One of the things that’s been great to see is people’s excitement and eagerness to share information,” Urena says. “During Basic Science Day, we were still able to expose new science. Traditionally, there has been some reluctance to showcase new and/or unpublished science in digital environments. But, if you think about it, you could take an iPhone and go into a poster gallery, record everything and share it online, too. It’s all about modernizing and socializing new codes of conduct that are contemporary and compatible with our new environment. I was elated to see our community’s enthusiastic commitment to sharing late-breaking information and knowledge at ENDO Online 2020.”
“The ENDO Online 2020 Basic Science Day is an excellent example of the Endocrine Society’s commitment to basic scienceIt allowed trainees to present their cutting-edge work that just couldn’t wait to be shared until the next ENDO.” – Lori Raetzman, PhD, associate professor, Molecular and Integrative Physiology, University of Illinois at Urbana-Champaign, Champaign, Ill.
The second day of ENDO Online 2020 was Basic Science Day, a day of live programming dedicated to all those working at the bench – five 60-minute sessions covering everything from reproduction or nuclear receptor biology. “The ENDO Online 2020 basic science day is an excellent example of the Endocrine Society’s commitment to basic science,” says Raetzman, who moderated the session, “From the Brain to the Belly – Insights into Pituitary and Adrenal Physiology”. “It allowed trainees to present their cutting-edge work that just couldn’t wait to be shared until the next ENDO.”
“The Basic Science day at ENDO Online 2020 was an amazing showcase of trainee research and a great ‘from the start of the field to the future’ keynote talk by Dr. Donald McDonell,” she continues. “Attendees saw the best and brightest talk about their groundbreaking research and hopefully got excited to submit an abstract for the next ENDO meeting.”
And the theme of collaboration continued this year. During a live session titled “What Else You Should Know About Resiliency, Communications, Collaborations, and Teaching Strategies: A Live Question and Answer Session with Faculty,” speakers presented their pro tips and best practices for facilitating conversations in classrooms, for using social media, and even for virtual etiquette. “One of the most important things about communication is paying attention to your body language — even on Zoom,” said Cecilia Low Wang, MD, professor of Internal Medicine at the University of Colorado Anschutz Medical Campus School of Medicine in Aurora, during her talk.
Camper also spoke during this session, focusing on inclusivity in the classroom, especially when it comes to non-native English speakers and how they many approach things like essay questions. “I believe that writing short essays is an excellent way for trainees to consolidate information and gain experience in scientific writing,” she says. “Often teachers avoid this approach because the grading is more difficult than other formats. Trainees may find it difficult to write the best essay that they are capable of during a timed testing format. Non-native English speakers may be at a particular disadvantage. I would encourage teachers to consider assigning essays as take home assignments because of the educational value of writing for consolidating learning and to allow time to produce a strong document.”
“You have a heart attack, your risk of severe hypoglycemia is greater in the next year. [We need to help clinicians] recognize that these people are vulnerable, and we need to recognize that hypoglycemia is such a common adverse event. Clinicians don’t think about it. Patients don’t take it seriously.” – Elizabeth Seaquist, MD, professor of Medicine, Pennock Family Chair in Diabetes Research, Division of Diabetes, Endocrinology and Metabolism, University of Minnesota, Minneapolis, Minn.
Another important mission of the Endocrine Society is its Hypoglycemia Prevention Initiative (HPI), and ENDO Online 2020 reflected that. A live session held on June 17 featured informative talks on different aspects of diabetes technology, followed by a case workshop. For her contribution to this session, Elizabeth Seaquist, MD, professor of Medicine and Pennock Family Chair in Diabetes Research, Division of Diabetes, Endocrinology and Metabolism at the University of Minnesota in Minneapolis, reviewed studies on hypoglycemia and heart disease risk. She explains that these studies point to how hypoglycemia can strain the heart. And vice versa.
“There’s been two different studies from two different populations looking at younger people, some with type one, where we see that you have an episode of severe hypoglycemia, your risk for heart disease is greater in the next year,” Seaquist tells Endocrine News. “You have a heart attack, your risk of severe hypoglycemia is greater in the next year. [We need to help clinicians] recognize that these people are vulnerable, and we need to recognize that hypoglycemia is such a common adverse event. Clinicians don’t think about it. Patients don’t take it seriously.”
Michael T. McDermott, MD, director of Endocrinology and Diabetes Practice at the University of Colorado Hospital in Aurora, pointed out that patients don’t take it seriously because they might not be aware of just how much low blood sugar can impact their lives. In fact, 20% of adults with type 1 diabetes have impaired awareness of hypoglycemia. “What we find is that frequent hypoglycemia often results in blunting of the symptoms that warn you of hypoglycemia,” he says. “That makes it dangerous because they don’t have the warning symptoms.”
HPI is such a high priority for the Society because, according to McDermott, hypoglycemia is the leading cause of reduced quality of life in these patients. But things are looking up, as technology rises to meet these patients’ needs. “Anything that reduces hypoglycemia [correlates with quality of life] — especially something like continuous glucose monitoring which really reduces it dramatically because of the alarms it gives you — and when it’s combined with a pump, it’ll reduce the basal rate or shut it off completely,” he says. “We’re seeing remarkable reductions in hypoglycemia with the technology that’s developed over the last two years.”
“Frequent hypoglycemia often results in blunting of the symptoms that warn you of hypoglycemia. That makes it dangerous because they don’t have the warning symptoms.” – Michael T. McDermott, MD, director, Endocrinology and Diabetes Practice, University of Colorado Hospital, Aurora, Colorado
Indeed, this ENDO Online 2020 wrapup piece could fill the rest of these pages with coverage of the conference. Instead, in case you missed it, you can access recordings of the live and on-demand sessions any time in the Society’s Center for Learning, at education.endocrine.org/content/endo-online-2020-session-recordings#group-tabs-node-course-default1.
Most Valuable Player
When Michael Jordan stepped on the court for Game 5 of the 1997 NBA Finals, he was at first uncharacteristically slow, visibly sick with the flu. But he began to take more risks, more shots, and he finished the game with 38 points, more than any other individual player in that game, including the three-point shot that put the Bulls ahead 88 to 85 with 25 seconds left. The Bulls held onto their lead and went on to win the NBA Championship the next game. Jordan was named NBA Finals Most Valuable Player.
ENDO Online 2020 was an incredible success by any metric. More than 27,000 people registered to attend and attendance for the meeting topped 17,000, a new record in the Society’s 100-year history. More than 2,300 abstracts were published in a supplemental issue of the Journal of the Endocrine Society. In recognition of the Society’s contribution to global education, ENDO Online 2020 was endorsed by 19 international endocrine societies.
“One of the challenges with a virtual platform is that the speakers cannot interact directly with the participants. Despite this challenge, we had more people listen to the virtual platform than we typically have in the room at in person meetings. This makes me think the virtual platform reached more people.” – Sally Camper, PhD, Margery Shaw Distinguished University Professor of Human Genetics; professor, Internal Medicine, University of Michigan, Ann Arbor, Mich.
“The Endocrine Society is committed to being a global leader in endocrine research, clinical care, and education. ENDO Online took that commitment to a new level, attracting an audience of over 17,000 people from over 110 countries,” says Rob Lash, MD, interim chief executive officer of the Endocrine Society. “The Society’s staff was just days away from starting on-site preparations for ENDO in San Francisco. As we pivoted to an online meeting, we knew that colleagues around the world were dealing with COVID-19 and looking for the latest information to help them provide the best care for their patients during this challenging time.”
“In addition to our member-leaders and staff, I want to thank the international societies who endorsed ENDO Online and particularly our colleagues in the European Society of Endocrinology, who joined us in sessions on the endocrine manifestations of COVID and the use of telehealth during the pandemic,” Lash continues.
COVID-19 may have disrupted much about modern life, but it’s provided some opportunity for innovation, and the Endocrine Society has proven that it was up to the task of being the most valuable player in the world of endocrinology, and that means virtual meetings could be here to stay, something that could be welcome in this brave new world.
“ENDO Online 2020 was a great introduction to online meetings,” Raetzman says. “There is huge value in maintaining a portion of the ENDO meeting in the online space to be able to reach the broader Endocrine community. Recorded talks with live question and answer sessions that worked so well for the Career Development Workshop talks, [that’s] a model for the future.”
“The feedback that I received was tremendous,” Abel says. “It was a heavy lift and I congratulate the entire Endocrine Society team for such a successful outcome. We learned a lot from this experiment, and we are well-positioned to offer future educational and conference programming in a virtual format, which may represent the new normal for the foreseeable feature.”
— Bagley is the senior editor of Endocrine News. He wrote the cover story on the meteoric rise of telehealth and telemedicine in the July issue.