The Problem
Delivering a curriculum of core content to interns is both a priority and a challenge. Weekly conference provides time to deliver such a curriculum; however, varied rotation schedules limit consistent conference attendance, and intern-targeted content is inappropriate for upper-level residents. We addressed these challenges by implementing a flipped-classroom intern curriculum using training level-specific breakout sessions and a dedicated resource for asynchronous learning.
The Innovation
EM Fundamentals is a free and open-access asynchronous curriculum featuring third-party FOAM content, primary literature, and institutional protocols. We use EM Fundamentals to support a flipped-classroom approach to small-group breakout sessions at weekly conference.
Learners
Our curriculum was developed for emergency medicine (EM) interns at the University of Chicago;Â however, we hope that our materials and strategy will be readily adapted to fit the needs of EMÂ interns across the country.
Group Size
While our online asynchronous resources are available to anyone at any time, we have 16 interns who participate in the weekly small-group breakout sessions.
Materials
- Asynchronous Content: Our web curriculum targets 25 topics, each of which have customized goals, objectives, and resources for asynchronous learning. Resources are identified by way of topic searches, past experience, and recommendations from faculty and residents (both local and remote — each page includes a link to suggest additional content). Promising resources are reviewed for quality by the creators prior to posting.
- Flipped-Classroom Sessions: We dedicate 1Â hour of weekly conference to case-based, small-group sessions led by a member of the faculty or fellow. Many facilitators run sessions with off-the-cuff cases to stimulate discussion so no additional materials are required once a knowledgeable facilitator and time to meet are established.
Curriculum Development
A group of educators identified a need to provide consistent core content for interns, the breadth of which required a year-long design.
We conducted a needs assessment across all 6Â Chicago EM residency programs (n = 300, 51% response rate) that confirmed the need for an intern curriculum (80% stated this would improve education) and learner interest in our proposed format (75% in favor of dedicated conference time, 71% in favor of dedicated asynchronous resources). This same survey was used to create a pool of the highest-yield topics as assessed by learners. For content validity, the final 25 topics were hand-picked by a team of expert educators using this pool for reference.
We created a website to host the asynchronous resources (EMFundamentals.blogspot.com) with content pages tailored to include topic-specific goals, objectives, and educational resources (e.g. journal articles, podcasts, institutional guidelines). For interns attending conference, faculty- or fellow-led small-group sessions reinforce key concepts. For interns unable to attend, this web-based content delivery ensured a baseline knowledge. Current assessment methods include a post-curriculum attitudinal survey and pre/post knowledge quiz.
Outcomes
This is our first year with full deployment of the curriculum. Feedback from our pilot year is promising. Each year, 100% of the interns (n = 32 over 2 years) have participated in the program. Our attitudinal survey showed 75% of learners preferred the flipped-classroom model (versus traditional lecture), and 100% of users reported a positive impact from the asynchronous resources. A knowledge test for Kirkpatrick level 2 data has begun this year and plans to collect Kirkpatrick level 3 data via simulation are in development.
Lessons Learned
This intervention has been well-received by both our residents and program leadership. Ensuring that learners consistently reference the web resources each week continues to be a challenge; however, we have seen significant improvement in weekly references to the site since developing weekly automated email reminders that include the details of the next breakout session and a link to the web curriculum for easy reference. We believe this additional reminder is particularly important for learners that will be unable to attend conference. We have also created a Twitter account (@EMFundamentals) to further engage learners prior to conference.
Upkeep of the website has also proven to be a non-trivial task. After the substantial activation energy of getting the site online and populated with initial content, reassessment of each page and its content is undertaken 2 weeks prior to the respective live session. This ensures revisions for content updates and removal of dead links at least once per year. Content pages are also updated out of rotation whenever a major release occurs in one of the topic areas (e.g. Sepsis-3 paper added to the sepsis page this spring). Those planning to develop similar resources should also factor these tasks into the webmaster’s workload.
Educational Theory
Our curriculum was developed using Kern’s 6-step approach to curriculum development and leverages the popularity of flipped-classroom teaching amongst our target learners. A log of our progress throughout the development of this resource is available on the curriculum design page of the EM Fundamentals website.
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