The Problem
Most academic conferences are run as one-room school houses, with an audience that includes a wide variety of learners ranging from interns to highly experienced attending physicians. Engaging a group of 30 to 40 learners simultaneously can be difficult, especially when covering a particularly dense topic. Although this teaching environment presents unique challenges, it also provides an opportunity to pilot innovative techniques.
The Innovation: Team-Based Learning
During conference, team-based learning (as outlined in ALiEM) was utilized to teach the topic of “Fever in the Returning Traveller.” High-quality resources, including a recorded lecture, were gathered and distributed to the residents in advance. They began the session with a readiness assessment quiz, which they then reviewed in teams to determine consensus answers. Finally, each team ran through a clinical case on a key topic related to “Fever in the Returning Traveller,” answering challenging questions and presenting 4 key learning points to the larger group.
Total time: 90 minutes
Learners
PGY1-PGY5 Emergency Medicine residents
ACGME Milestones/CANMEDS Competencies
- Royal College Objective of Training Requirements/CanMEDS Roles: Medical Expert 2.1.4.5., Collaborator, Communicator, Scholar
- ACGME Milestones: PC2, PC3, PC4, MK, ICS2
Required Materials
- Preparation: Audio recorded slide-based presentation on key points in “Fever in the Returning Traveller” (approximately 45 minutes long)
- Email to residents: Email containing learning objectives, link to lecture, as well as supplementary materials (key textbook chapters, related podcast on EMCases.com, cdc.gov website)
- Pre-quiz: Short answer quiz containing 15 items, printed for residents. Blank pre-quiz available here with answer key available here
- Cases: Four clinical cases (one for each group of ~8 residents), each on a key presentation (Malaria, Dengue, Typhoid, and Rocky Mountain Spotted Fever)
Description of the Innovation
- Pre-Class Preparation: Prior to the session, learners were provided with materials to review that addressed the specific learning objectives. In this case, a recorded slide-based presentation on “Fever in the Returning Traveller” was created and uploaded to YouTube. This was mandatory preparation for the residents. Additional resources including an EM Cases podcast on this topic, key textbook chapters, and helpful websites were provided in the email.
- In-Class Overview: The agenda for the session was explained and residents were divided into groups of 8 with a balanced mix of senior and junior residents.
- Individual Readiness Assurance Test (iRAT): A 15 item, short-answer quiz was created to assess the residents’ preparation for the session. The quiz included 6 items related to the previous week’s topics as they were relevant to the current session. 15 minutes was allocated for this activity.
- Group Readiness Assurance Test (gRAT): The residents then came together in their teams to discuss the quiz and develop consensus answers. 10 minutes was allocated for this activity.
- Instructor Clarification and Review: The answers to the quiz were provided, and each item was quickly reviewed to address any confusion or questions before moving onto the application exercise.
- Team Application Exercise: Each team was provided with a clinical case on a key topic related to “Fever in the Returning Traveller.” The case was given to a senior resident and they were instructed to take the team through the case much like an oral exam. The team asked questions, ordered investigations, and formulated a differential diagnosis. Each case was designed to correspond to key learning objectives. Challenging questions were incorporated into the handout provided. Residents were encouraged to use their computers to access guidelines and other resources to ensure evidence-based answers. 25 minutes was allocated for this activity.
- Review & Summary: Each team was asked to compile 3-4 key learning points from their case and present them to the group. 15 minutes was allocated for this activity.
Lessons Learned
- This method requires significant preparation, but is easy to execute during the in-class session. The preparation time would be significantly reduced once the lecture is pre-recorded, or if a high-quality resource that already exists is utilized.
- The iRAT took less time and the gRAT considerably more time than anticipated. This may indicate both that residents were somewhat under-prepared, and that the topic was challenging. The gRAT portion was extremely valuable as it led to stimulating discussion and peer teaching in every team.
- It was difficult for residents to appreciate take-home points from cases discussed by other groups. A suggestion from one learner was to provide all 4 cases to residents ahead of time (without spoiling the diagnosis) in order to familiarize the entire group with the progression of each of the four cases. This may result in a more engaging final review and summary phase.
Theory behind the innovation
- Spaced Repetition & Active Recall: When information is learned, the ability to recall that information declines exponentially over time. When a learner is forced to actively recall information (rather than passively re-read it), retention is improved and decay occurs at a slower rate. The pre-quiz forces learners to engage in both of these techniques.
- Social constructivism: Information cannot be passively transferred from teacher to learner. All learners must actively construct information based on their social, historical and individual contexts. In this case, the social context includes the team of emergency medicine colleagues learning together to create a shared understanding of the concepts involved.
- Team-based learning: In medicine at large, and particularly in emergency medicine, we work in diverse teams. These can include multidisciplinary teams of health-care providers, but also teams of physicians at various levels of training. Learning in a team helps build the skills that will be essential to practicing in a team.
- Case-based learning: This technique allows learners to investigate, discuss and explore a relevant clinical case in a goal-directed manner. The clinical questions provided, as well as guidance from a facilitator, keep learners on track to solidify key learning points.
Closing Thoughts
This was a high-yield instructional technique. It required a significant degree of preparation to initially create the recorded lecture and learning materials. In the future, however, it would require minimal work to execute now that the learning materials already exist. The activity engaged residents throughout each phase as they were forced to recall what they had learned this week as well as the previous week. Significant amounts of peer teaching and role-modelling occurred when the residents came together to solve clinically relevant problems as a team. This method can be applied to other topics and utilized regularly.
Additional Reading
- Lin M. JGME-ALiEM Hot Topics in Medical Education. Acad Life in Emerg Med. 2016.
- CDC Website. Sections on: Malaria, Dengue Fever, Zika virus, Chikungunya, Typhoid, Rocky Mountain Spotted Fever.
- Helman A. Episode 77 Fever in the Returning Traveler. Emergency Medicine Cases. 2016.
Read more about the IDEA Series.
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Mosquito (Public Domain Image)
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