New AIR Series: ALiEM Approved Instructional Resources

On behalf of the AIR Executive Board, we are excited to introduce the Approved Instructional Resources (AIR) series! The AIR series was conceived to provide a credible method by which an U.S. Emergency Medicine resident can receive academic credit for using Free Open Access Meducation (FOAM) resources. The Executive Board will release a list of high-quality FOAM educational posts and podcasts specially selected by our Executive Board, in parallel with the CORD residency training curriculum. We will have an accompanying quiz for each list and track who completes it. EM residents who complete the quiz can hopefully receive credit for Individualized Interactive Instruction (III) from their EM residency for training purposes.

Why do this?

We created this series because we have observed residencies struggle in evaluating which blog posts and podcasts are appropriate and high quality for resident education. Often residents independently access FOAM resources available online, but do not receive training credit for this. We seek to use our expertise to bridge this divide by assisting residency programs to promote asynchronous learning, online education, as well as reward residents who already effectively utilize FOAM resources.

Who is our sponsor?

The Council of EM Residency Directors (CORD), who shares our vision for improving graduate medical education through digital learning platforms, has generously offered to help sponsor our efforts. This helps toward sustaining the ALiEM AIR Series on the blog and eventually making a major move to our custom learning management platform ALiEMU (anticipated starting February-March 2016).

How do we select the articles?

The 9-person Executive Board reviews numerous FOAM resources and scores each on an objective grading system designed for this series. We curate relevant posts from top blogs and podcasts, as graded by the Social Media Index, with the inclusion criteria of publication date within the past 12 months. If this list of posts is insufficient, we broaden to a longer time interval. We do not claim an exhaustively comprehensive search, but feel that we ultimately highlight quality posts for residency education.

The cumulative highest scoring 6-10 posts from each module are selected. To decrease any obvious bias, members of the Executive Board recuse themselves from evaluating posts they wrote or were directly involved in writing. Our scoring tool looks at five measurement outcomes, each using a Likert 7-point scale:

• BEEM Score
• Content Accuracy
• Educational Utility
• Evidence Based Medicine
• Referenced

The actual grading instrument can be viewed in this AIR Series Grading Tool PDF.

What is III?

In 2008, the Residency Review Committee (RRC) in Emergency Medicine as well as the Accreditation Council for Graduate Medical Education (ACGME) endorsed a change in the education hours requirements for residencies. Previously, five hours of educational conference time was required per week. The new recommendation allows residencies to decrease their conference time to four hours per week with an additional one hour of documented asynchronous learning outside the classroom. This series abides by the CORD and ACGME’s requirements for III. Upon request, all EM program directors will have access to our master read-only list of residents who complete the quiz. In addition, faculty on our Executive Board will engage with residents in the blog comment section for questions and comments that arise during reading.

How does this count for III credit?

Per the ACGME and EM RRC [PDF, pg 4-5], III credit depends on fulfilling all 4 of the following criteria, and this is how we address them:

1. The program director must monitor resident participation. – We give read-access to PDs.
2. There must be an evaluation component. – We have a post-module quiz.
3. There must be faculty oversight. – We have faculty not only screening the content for accuracy and value, but also monitoring the blog comments section if there are questions to reply in a timely fashion.
4. The activity must be monitored for effectiveness. – We have an internal QI process as well as a post-module survey to incorporate learner feedback.

I am an EM resident desiring III credit

As of June 2017, we now have over 125 US EM residency programs registered with over 1200 residents completing at least one module. Please speak with your program director about the possibility of your program joining the ALiEM AIR Series. If it is approved for credit at your residency, complete the end-of-module quiz and your participation will be tracked. Of course, you are always welcome to take the quiz for your own learning purposes.

I am an EM residency program interested in implementing this series for III credit

Please contact us for a log-in access to the read-only Google Drive document with all resident participants who have taken the quiz who self identify with your residency program. Please give us the email that is linked to your Google Drive account. This list is sortable by program and date. We recommend that each module of curated posts count for 2 hours of III.

Frequency of AIR series modules

We plan to release new curated lists to correspond with the EM modular curriculum.

AIR Modules

Module	Date	Link	Recommended III
24	November 2016	Toxicology Module	2 hours
23	October 2016	Trauma Module	7 Hours
22	September 2016	Respiratory Module	4 Hours
21	August 2016	Infectious Disease Module	6 Hours
20	July 2016	Procedure	4 Hours
19	May 2016	Ortho (Lower Extremities)	1 Hour
18	April 2016	Ortho (Upper Extremities)	5 Hours
17	March 2016	Cutaneous	1 Hour
16	February 2016	Neurology 2 (headaches, Seizures, and Other)	6 Hours
15	January 2016	Neurology (bleeds and strokes)	6 hours
14	November 2015	Environmental Module 2	1 Hour
13	September 2015	Environmental Module (Bites, Temp, Stings)	1 Hour
12	August 2015	Cardiology 2 (CHF and others)	4 Hours
11	July 2015	Cardiology 1 (ACS) Module	5 Hours
10	June 2015	Respiratory 2 (PE) Module	5 Hours
09	May 2015	Respiratory 1 (General) Module	5 Hours
08	April 2015	GU/Renal Module	4 Hours
07	March 2015	Ob/Gyn Module	3 Hours
06	January 2015	Toxicology Module	4 Hours
05	December 2014	Psychiatry Module	2 Hours
04	November 2014	Peripheral Vascular Disease Module	3 Hours
03	September 2014	Endocrinology Module	3 Hours
02	August 2014	HEENT Module	2 Hours
01	July 2014	ID/Heme/Onc Module	2 Hours

Members of AIR Executive Board

• Felix Ankel MD, Vice President and Executive Director of Health Professional Education, HealthPartners Institute for Education and Research; Associate Professor of EM; University of Minnesota
• Jeremy Branzetti MD, Associate Program Director and Assistant Professor of EM; University of Washington Department of EM
• Andrew Grock MD, Associate Director AIR Executive Board, EM Resident at Kings County EM Program
• Nikita Joshi MD, Associate Director AIR Executive Board, ALiEM Associate Editor; Clinical Instructor, Stanford University, Division of EM
• Michelle Lin MD, Associate Director AIR Executive Board, ALiEM Editor-in-Chief, UCSF Associate Professor and Academy Endowed Chair for EM Education, San Francisco General Hospital
• Eric Morley MD, Associate Director AIR Executive Board, Associate Program Director of EM; Stony Brook University
• Anand Swaminathan MD MPH, Assistant Program Director and Assistant Professor of EM, NYU Medical Center; Faculty Reviewer of EMLyceum.com
• Taku Taira MD, Associate Program Director and Assistant Professor of EM, USC School of Medicine
• Lalena Yarris MD MCR, Program Director and Associate Professor of EM; Oregon Health Sciences University

Additional Reading

1. Mallin M, Schlein S, Doctor S, Stroud S, Dawson M, Fix M. A Survey of the current utilization of asynchronous education among emergency medicine residents in the United States. Acad Med. 2014 Apr;89(4):598-601. PMID: 24556776.
2. Reiter DA, Lakoff DJ, Trueger NS, Shah KH. Individual interactive instruction: an innovative enhancement to resident education. Ann Emerg Med. 2013 Jan;61(1):110-3. PMID: 25520994.

Updated 7/25/14: Added the ACGME/RRC criteria for III credit.

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