Roles & Responsibilities:

We advise you to partner with a co-facilitator for VSR. No matter the size of your group, having a co-facilitator on hand can help foster conversation and keep things moving. We also recommend having a moderator to manage any technical issues and the chat function (see “Making Technology Work”). It can also be helpful to have additional support as described below. Depending on staff availability some of these roles can be combined if needed.

• Co-Facilitators:
  • Preps with panelists and each other
  • Prepares introduction, discussion prompts for session
  • Introduces and sets tone for session
  • Explains guidelines for participation
  • Offers discussion prompts and reflections during session
  • Helps identify “discussion boosters” (see this page) to prompt and model participation in discussion
  • Invites participation, closes session
  • Offers follow-up and additional support resources during session
  • Debriefs after session
  • Serves as the chat/technical moderator if needed

• Chat/Technical Moderator:
  • Prepares introductory slides and shares screen during session
  • Monitors and responds in writing to hand-raising, comments, and questions on chat
  • In partnership with co-facilitators, may call on participants to speak during session
  • Dismisses any participants who are disruptive to the session

• Pastoral Care/EAP/HR/Behavioral Health:
  • Shares support resources before and after each session and follow up with individuals as needed

• Coordinator:
  • Arranges for technical support from IT prior to session if needed
  • Coordinates communication and marketing of session

Making the Most of Your Platform

• Hold a tech rehearsal prior to each session. In the rehearsal, ensure that the introductory slides and screen sharing work correctly, and that all presenters have well-functioning audio and video capabilities and are comfortable using the platform.
• Have sufficient tech support during each session.
• Do not record or allow recording of sessions.

Duration: 60 minutes

Choosing Topics

We recommend selecting a broadly relevant, carefully framed topic rather than focusing on specific cases. When possible, we advise framing the topics through a trauma-informed lens. Examples of themes may include:

• Coping with uncertainty
• Appreciating our colleagues
• A patient I’ll never forget
• Navigating grief and loss
• Finding our best selves in stressful times
• Sustaining compassion in challenging times
• The complexity of “silver linings”
• How it feels to be a “hero”

Making Technology Work for You

• Suggest VSR participants log in from a private, quiet location if possible, and/or use headphones.
• Invite participants to show their video when possible to foster engagement and participation.
• Ask participants to mute when not speaking (and unmute when speaking).
• When participants wish to speak, they can use the “raise hand” function on the meeting platform (in a smaller group, they can simply raise their hands).
• The “chat” function can be used to invite comments from participants, which can be especially helpful for larger groups. You might wish to consider limiting chat functionality so that participants can comment only to the hosts or to the entire group, rather than directly to one another.
• You might wish to offer explicit guidance on how to use the chat productively, e.g. to make only supportive remarks, to avoid use of emojis, gifs, etc., and to avoid provocative or emotionally charged language.
• Your chat moderator or co-facilitator can read comments from the chat to help keep the conversation going.

Supporting Emotional Safety

• Offer EAP, behavioral health, and/or other support resources before and after each session. We strongly advise including a mental/behavioral health or pastoral care colleague or others with expertise in trauma-informed care in each Virtual Schwartz Rounds session to provide additional guidance and to follow up with anyone who appears to be in distress.
  • Keep in mind it’s harder to sense the emotions of the group online and to directly support someone who is having a strong reaction to the content.
  • You might consider inviting a Planning Committee member or another colleague to share a positive experience with peer support, EAP, or other supportive resources to help destigmatize the need for and model engagement with mental health services.
• Acknowledge at the beginning of each session the impossibility of ensuring total confidentiality on virtual meeting platforms. If available, use HIPAA-compliant platforms. Ask participants to respect the guidelines for standard Schwartz Rounds:
  • “What’s said here stays here.”
  • Avoid using proper names of patients and family members during sessions, and the names of colleagues when discussing the sessions later.
• Please do not record or allow participants or hosts to record the sessions. Let people know at the beginning of each session that it will not be recorded.

Preparing Panelists and Yourself

Preparing panelists for Virtual Schwartz Rounds is no different from preparing them for in-person Schwartz Rounds. A few things to keep in mind:

• Help panelists understand the purpose of Schwartz Rounds and their roles.
• Coach panelists to articulate their experience and hone the story they wish to tell in 3 to 5 minutes.
• Seek to establish a relationship of trust and address any questions or concerns.
• Ask questions:
  • “What did it feel like to care for this person?”
  • “What was it like to be you in that moment?”
  • “What has stayed with you about this experience?”
• Consider speaker order, key themes, nonverbal cues, and prompts for discussion.
• Prepare yourself and your co-facilitator for the session; coordinate the session flow and timing, as well as your respective roles, with your co-facilitator.
• Ensure everyone’s comfort with and access to your meeting platform.

Managing the Narrative Flow of VSR

• Setting the Tone 
  • Welcome everyone and acknowledge what’s happening at the present moment in your organization and globally, expressing appreciation and gratitude to all present.
  • Consider reading a brief reflective quote or poem; take a moment for a few deep breaths.
  • Explain the VSR safety guidelines with attention to confidentiality, offering empathy and compassion, focusing on creating a shared experience of support, honoring and appreciating the courage and presence of others during this shared time.
  • Remind participants that this is a time for collective restoration, not a time for problem-solving or addressing the many systemic and national challenges we face.
  • Ask that everyone approach the conversation with kindness and consideration for the range of emotions and experiences participants might be facing.
  • Consider establishing a “Parking Lot” — a figurative place where larger issues can be set aside for other groups or task forces to resolve.

• Opening the Discussion
  • Explain the theme and introduce panelists.
  • Following panelists’ stories, invite participants to share a story or experience related to the theme:
    • What resonates as they listen to others speak?
    • What’s uppermost in their hearts and minds as it relates to the theme?
    • What are they thinking or feeling right now?
  • If you know in advance who will be participating in the VSR, you might invite one or two people to serve as “discussion catalysts” by modeling participation in the Rounds discussion.

• Building the Discussion
  • Stress engenders many different psychological and emotional reactions, including frustration, anger, a sense of moral duty, moral distress, anxiety and grief. Convey the message that while our common humanity and the challenges of the moment unite us, each of us responds in unique ways to stressful events.
  • Reflect in clear, brief statements what you’re hearing from participants, selecting words and phrases that moderate or reduce their emotional intensity, (e.g., “These are challenging times for us all,” rather than “We’re facing the apocalypse!”).
  • Acknowledge, validate and support the emotions expressed (e.g., “You are not alone in feeling this way.”)
  • Express and reinforce expressions of compassion, respect and appreciation.

• Managing Digressions 
  • If participants raise issues related to systemic or organizational challenges, acknowledge the frustration you hear.
  • Respectfully note that Virtual Schwartz Rounds is not a forum to resolve these issues.
  • You might say, “Let’s set that aside in our ‘Parking Lot’ for others to address later if they wish.”

• Deepening the Discussion
  • Summarize overarching themes as you go.
  • Acknowledge differences in perspectives if they are expressed.
  • You might ask participants to share an experience in which such differences were resolved with positive intentions.
  • You don’t have to help the group resolve differences but ask participants to maintain a respectful tone.

• Supporting the Community
  • Ask participants to voice how they find support and solace for themselves. Who do they turn to?
  • How have they found support in the workplace? What has helped?
  • How have they supported others?

• Closing the Discussion
  • Summarize key themes that have emerged from participants’ comments.
  • Thank those present and any co-facilitators, acknowledging the unique context of the moment and the diversion from the usual format of Schwartz Rounds, and for making the session work.
  • Close with whatever rituals you have used in your in-person Schwartz Rounds, if any. Examples include offering a reflection, poem, or brief meditation. This will help people feel a sense of continuity.
  • If you can, let participants know when the next Virtual Schwartz Rounds will take place.

These are five facilitation strategies that you can reach for as you navigate the opening of your session and as you transition and move through the discussion. During the discussion, help participants access, within themselves or with others, some of the five evidence-based factors that people need to recover from adversity and stress¹. Whenever you can reinforce these five elements, you will be helping to support your participants as they move through difficult conversations.

• Sense of Safety
  • Many caregivers have felt unsafe at times over the course of their careers – feelings which were especially heightened during the pandemic.
  • Encourage them to reflect on the fact that they are safe right now, in the present moment, in the virtual “room” they are sharing.
  • Ask participants: What is helping you feel safe right now?

• Calming
  • Help people reframe their assumptions about stressful or challenging circumstances to: “What can I learn about myself?”, “How might I grow from this experience?”, and “What can we learn as an organization about how to work and be with each other?”
  • Ask participants: What helps you feel calm? 

• Connection
  • Reiterate that even when we are physically separated, we can find ways to avoid isolation. We can find new ways to be together.
  • Ask participants: What have you done to stay connected to friends and family? In what ways do you feel connected with your colleagues?

• Self-Efficacy
  • Self-efficacy is the belief in one’s ability to succeed in specific situations, or to accomplish a task.
  • Ask participants: Who is one person you feel comfortable turning to for questions and advice? If they have been assigned new roles, ask: What has helped you gain confidence performing unfamiliar tasks?

• Hope
  • Remind clinicians that many of them have conversations with patients about realistic hope, including with patients at the end of life. Helping others find hope may not be unfamiliar territory. There is always something to hope for: a moment of sunshine, a FaceTime call with children that makes them smile, time off, etc.
  • Ask participants: Where do you find hope? What helps you sustain optimism in dark days?

¹ Hobfoll E, Watson P, Bell CC, Bryant RA, Brymer MJ, et al. Five Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence. Psychiatry; 2007;70(4):283-315.

• Extend a purposeful welcome to your gathering.
  • Acknowledge what is and is not possible in VSR.
  • Introduce participants to the platform – invite them to mute themselves, join in the chat, etc.
  • Offer additional support resources before the session.
  • Reiterate confidentiality guidelines; acknowledge impossibility of ensuring total confidentiality.
  • Reassure participants that sessions will not be recorded.

• Online engagement can be challenging.
  • Acknowledge the challenge: Let participants know you can’t do this alone.
  • Be prepared: Co-facilitate. Have discussion prompts and person anecdotes ready.
  • Prep some friends: Invite Planning Committee members or others to arrive prepared to model participation.
  • Invite participation by chat: Have a chat moderator read comments to keep the conversation flowing.
  • Use video to focus the session: Show panelists on screen first, then invite others to turn video on for discussion.

• Bring the session to an intentional close.
  • Signal when time is almost up by acknowledging the last one or two comments as such.
  • Acknowledge that not everything will have been said and encourage participants to keep connecting offline.
  • Express gratitude to panelists and participants.
  • Reinforce opportunities to access additional support resources.
  • Capture feedback with an online poll or follow-up survey – remind participants to look out for it.

• Please take time to debrief the VSR with your co-facilitators or member(s) of your Schwartz Rounds Planning Committee.
• Complete the evaluation (link to form)
• We welcome your feedback and are happy to provide support for your program. Please send your reflections and comments to the Membership Team or reach out with any questions.
  • Stephanie Adler Yuan, MA
  • Casey Kudesia, MA
  • Leah Rybarczyk, LCSW
  • Kathy Scopin, BSN, PHN, RN

• Guidance for Virtual Schwartz Rounds
• Slide Template for Virtual Schwartz Rounds 
• Evaluation for Virtual Schwartz Rounds