The Problem

Residents continually face the challenge of keeping up to date with relevant medical literature in the midst of the rigors of completing medical residency. In addition, application of new medical knowledge obtained from reviewing recent research can be challenging and is a difficult skill to teach.

Residency provides a unique experience for individual learners based on each learner’s personal interests, interactions with other learners and faculty, and patient encounters. Often, residents achieve their best research and article discovery when prompted by specific patient encounters. A forum for individual residents to share knowledge gained from research prompted by these encounters is needed.

The Innovation: The Knowledge Bomb

The Knowledge Bomb is a session incorporated into conference that is aimed at disseminating individual residents’ new knowledge gained from recent, clinically relevant literature to the rest of the residency. It includes a brief presentation by a resident of a recent research article and its relevance to a real patient encounter, an attending perspective on the article and case, a group discussion, and a blog post summarizing the session.

Learners Targeted

The Knowledge Bomb session targets all resident learners, from PGY-1 to PGY-4, as well as faculty who are present at conference.

Detailed Description of the Innovation

Knowledge Bomb sessions are centered around recently published journal articles that challenge or guide patient care.

The resident selects an appropriate article relevant to a recent patient encounter and subsequently creates a brief 10-15-minute presentation of the article focused on the following items:

• Background/Motivation
• Article
• Design
• Outcomes/Findings
• Application to Practice

These presentations are then delivered by individual residents at weekly conference. The Knowledge Bomb differs from traditional journal club in that it is not intended to provide an in-depth discussion of the article. Rather, the Knowledge Bomb highlights the major points that the resident presenter finds relevant to patient care, and provides an opportunity to apply the article to clinical practice by discussing it in the context of a real patient scenario.

An attending (ideally the attending involved in the patient’s care) will also provide perspective on the article and its clinical applications. After the presentation of the article, the Knowledge Bomb session transitions into an open forum where other residents and attendings can offer perspective.

At the end of the session, a blog post is then crafted based on the presentation and ensuing discussion and made available for review by the residency and other learners (examples).

The Knowledge Bomb session is incorporated once into each residency block, of which there are 13 per year.

In order to select resident presenters, the innovation utilizes a tagging system. The current presenter “tags” the resident who will present two blocks from now, which provides ample time (approximately two months) for the upcoming presenters to identify a clinical case, attending discussant, and an article to highlight.

Materials Needed

The following documents have been created to facilitate the workload of creating a Knowledge Bomb session:

• Welcome Email (sent to the resident who has been “tagged” as the next presenter)
• Knowledge Bomb How-To Guide
• Powerpoint Presentation Template
• Blog Post Template

Goals of the Innovation

The goals and objectives behind the development of the Knowledge Bomb session are as follows:

• To create a valuable opportunity outside of a shift to discuss decisions related to patient care with an attending based on evidence
• To provide opportunities for residents to improve skills required to effectively practice evidence-based medicine: searching for and identifying appropriate articles, interpreting research data, applying conclusions from the articles to clinical practice
• To expose the remainder of the residency to current, relevant research that has the potential to change practice or address clinical questions that arise
• To illustrate that faculty may interpret and apply research differently than residents
• To generate an open discussion where multiple attendings and residents can provide perspective to demonstrate how the same research can be interpreted and applied in more than one way

Lessons Learned

A survey was also sent to all EM residents (n=45) and IM/EM Residents (n=14) at University of Illinois at Chicago (UIC). Of the residents who received the survey, 21 responded. The survey included yes or no questions with responses given on a 9 point scale (1=no, 5= neutral, 9=yes)

• When asked “Did you like the knowledge bomb sessions?”, the mean response was 8.57 (out of 9).
• When asked if each of the individual five objectives of this innovation (included above under “Goals of the Innovation”) were important and whether or not the Knowledge Bomb effectively achieved them, all mean responses were >8 (out of 9).
• The majority of respondents (70%) thought the tagging system to pass on the presentation to the next block resident was a good system, with 22% responding that they did not know. The remaining 8% responded “no” and provided different ideas, such as having residents sign up for the sessions at the same time that they sign up to give CPC presentations.
• In the free-text comments of the survey, one person suggested holding a 5-10 minute session after the Knowledge Bomb presentation to further discuss the paper with a smaller group of 5 peers and an attending.

Residents additionally provided the following feedback:

• The short presentation format maintains the attention of the audience and provides new information that residents may not have encountered independently.
• Residents who prepared Knowledge Bomb sessions found that the process was worthwhile and meaningful to their education.
• The templates eased the workload of preparing the presentation and increased resident buy-in.
• Overall, preparing a Knowledge Bomb session requires approximately 4 hours.

In summary, the Knowledge Bomb sessions provided an effective solution for creating a forum to foster discussion of recent provocative or practice-changing research.

Read more about the IDEA Series.

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