A Nationwide Survey of Educational Resource Utilization and Perception Among Internal Medicine Residents

A Rapid Response Mobile Application Improves First-Year Resident Clinical Performance During Simulated Care Events: A Randomized Controlled Trial

BACKGROUND

Rapid response teams (RRTs) are critical to the timely and appropriate management of acutely decompensating patients. In the academic setting, the vital role of RRT leader is often filled by a junior resident physician who may lack the necessary medical knowledge and experience. Cognitive aids help improve guideline adherence and may support resident performance as they transition into leadership roles.

OBJECTIVE

This study evaluated the impact of a rapid response mobile application on intern performance during simulated rapid response events.

DESIGN

This randomized controlled trial compared the performance of interns in two simulated rapid response scenarios with and without access to the rapid response mobile application. The scenarios included anaphylaxis and supraventricular tachycardia (SVT). Simulations were video recorded and coded by trained raters.

PARTICIPANTS

Interns in all specialties at our institution.

MAIN MEASURES

Outcomes included (1) time to ordering critical medications (epinephrine and adenosine), (2) overall clinical performance using a checklist-based performance measure, and (3) usability of the mobile application. Enrollment and data collection occurred between November 2022 and February 2023.

KEY RESULTS

Forty-four interns from 12 specialties were randomized to the intervention group (N = 22) and the control group (N = 22). Time to order critical medications was significantly reduced in the intervention group compared to control for anaphylaxis (P < 0.005) and SVT (P < 0.005). The intervention group had significantly higher performance scores compared to the control group for the anaphylaxis portion (P < 0.006). Usability scores for the rapid response toolkit were good.

CONCLUSIONS

Access to a rapid response mobile application improved the quality of care administered by interns during two simulated rapid response scenarios as determined by a decrease in time to ordering critical medications and improved performance scores. The intervention group found the mobile application to be usable. This work adds to existing literature supporting the use of technology-based cognitive aids to improve patient care.

Embracing the (r)evolution of social media and digital scholarship in pediatric nephrology education

Free Open-Access Medical Education (FOAMed) has transformed medical education in the past decade by complementing and substituting for traditional medical education when needed. The attractiveness of FOAMed resources is due to their inexpensive nature, wide availability, and user ability to access on demand across a variety of devices, making it easy to create, share, and participate. The subject of nephrology is complex, fascinating, and challenging. Traditional didactic lectures can be passive and ineffective in uncovering these difficult concepts and may need frequent revisions. Active teaching methods like flipped classrooms have shown some benefits, and these benefits can only be multifold with current social media tools. Social media will inspire the involvement of students and allow them to create and share educational content in a "trendy way," encouraging the participation of their peers and thus building an educational environment more conducive to them while promoting revision and retainment. FOAMed also promotes asynchronous learning, spaced learning, microlearning, and multimodal presentation with a meaningful variation. This article discusses the evolution of digital education, social media platforms, tools for creating and developing FOAMed resources, and digital scholarship.

Piloting a Mobile Clinical Decision Support Application for Pediatric Clinical Guidelines

Mobile Clinical Decision Support Systems (CDSSs) represent an increasingly utilized technology to promote clinical guideline use. We sought to explore clinician guideline use and access preferences during implementation of a mobile guideline app at a free-standing children's hospital integrating 23 guidelines. Surveys included demographic variables and access preferences among anonymous onboarded clinicians in January 2022. Response rate was 21.8% (57/261) among onboarded users, mostly attending (59.6%) and resident/fellow physicians (21.1%) in inpatient (42.1%) and emergency department (31.6%) settings. Onboarded users accessed guidelines on over half of shifts (68.4%) and quickly (80.7%, <1 minute). Overall, most users reported favorable patterns for adoption of mobile CDSSs as useful adjuncts to existing formats. Users reported more ease of access and frequent guideline usage, particularly for younger clinicians. Guidelines related to antibiotic decision-making or newer disease processes were most useful. Further study is needed on electronic health record incorporation, adherence, and patient outcomes.

Twelve tips for integrating podcasts into medical education curricula

Engagement with medical education podcasts among health professions learners has been increasing steadily over the last several years. Prior '12 Tips' publications have focused on helping medical educators create and publish their own podcasts. However, there is a gap in available resources to help educators incorporate an already existing and growing library of medical education podcasts into their curriculum rather than create their own. In this paper, the authors provide medical educators '12 Tips' on how to integrate podcasts into their teaching sessions grounded in fundamental principles of curriculum development, cognitive science, and accessibility.

Understanding Internal Medicine Residents' Rheumatology Knowledge Base

Rheumatology is one of the internal medicine subspecialties that residents train to become proficient in during their internal medicine training. Our study sought to understand how residents across all postgraduate year levels felt in terms of comfortability and exposure to rheumatology. We focused on the subjective measurement of resident knowledge and exposure rather than objective data. A five-question survey was distributed to all 75 residents of Lenox Hill Hospital's Internal Medicine categorical residency program, from PGY1 to PGY3. When asked if they get enough exposure or feel confident treating patients with rheumatology diseases, 96% of residents responded no. When asked about their confidence in boards, the average response was a 3/10. The residents at our program voiced a strong concern for lack of exposure and education. Other studies and institutions have shown this to be a problem that has also been seen with poor test performance on the subject. We explore educational modalities to help improve this gap in education.

Utility of a Novel Trainee-Level Hematology/Oncology Podcast in Graduate Medical Education: a Pilot Study

Asynchronous learning continues to gain popularity in medical education. One medium to facilitate asynchronous learning is the podcast. Currently, there are a limited number of hematology/oncology (H/O) podcasts geared towards residents and fellows ("trainees"). To address this need, we created a series of podcasts covering fundamental H/O topics for H/O fellows and internal medicine residents rotating on H/O services. We evaluate the effectiveness of this approach in this pilot study. Between September 2022 and February 2023, residents received recommended episodes via email prior to their rotation. Following their rotation, they received a survey. H/O fellows were encouraged to listen to any available episodes during the study period, after which they also received a survey. The survey collected baseline user information and included a 5-point Likert scale to determine if the podcast episodes were effective educational tools. Summary description was performed by the authors. In total 7 internal medicine residents (27 eligible) and 13 H/O fellows (18 eligible) completed the survey, for a total group of 20 respondents. The trainees found that the podcast helped with inpatient and outpatient management, was clinically relevant, and helped with clinical decision-making. They also agreed that the fundamentals of H/O are amenable to the podcast platform and are likely to continue to use podcasts as learning tools in H/O. This pilot study suggests that podcasts are an effective supplemental learning tool for the fundamentals of H/O in graduate medical education. The use of podcasts as educational tools should be encouraged for trainees.

General surgery textbooks and surgical disparities

INTRODUCTION

Some academic textbooks have previously disseminated simplistic or even incorrect conceptions of race. Propagation of such ideas in General Surgery could contribute to gaps in quality of care received by minority patients. This study aims to determine whether General Surgery textbooks provide a thorough understanding of racial disparities.

METHODS

General Surgery texts were drawn from Doody's list, an industry-standard list of textbooks for medical education. Technical guides, atlases, and books for non-General Surgery professionals were excluded. Passages mentioning medical differences amongst racial and ethnic groups were extracted. Six binary classifications were made, based on whether passages (a) described interventions to alleviate difference; (b) addressed environmental mediators of difference; (c) described the contribution of racism or discrimination; (d) used causal language to connect race to difference; (e) referred to known, heritable genetic mechanisms; and (f) directly provided a reference. Types of intervention were also extracted. A heuristic scale was calculated granting one point each for classifications a-c and losing one point for classification d. Three authors performed classifications, and raw agreement and Cohen's kappa were used to assess inter-rater reliability.

RESULTS

Thirteen textbooks from Doody's list contained 511 passages discussing medical differences among racial/ethnic groups. Among passages, 25% discussed white people, 22% Black people/African Americans, 19% Asians, 9% Latinos, 4% Jewish/Ashkenazi people, 3% Native Americans, and 18% other. Fifteen passages (2.9%) used language indicating race was the cause of medical difference, and only two explicitly discussed racism or discrimination. Most passages (370, 72.3%) received a scale of 0. 120 (23.5%) received a scale of 1, eight (1.2%) received a scale of 2, and zero received a scale of 3. The mean passage scale was 0.24 and is not changing with time (regression coefficient -0.006/year, p = 0.538). Agreement was 91.2% across all categories and overall Kappa was 0.62.

CONCLUSIONS

General Surgery textbooks do not provide readers with scientifically thorough understanding of health disparities. Teaching more comprehensive conceptions, including systemic causes and the role of racism, may prevent reflexive association of minority patients with poor outcomes. Future editions should include these details where disparities are discussed in an independent, comprehensive section.

Impact of the Febrile Podcast and Learning Resource as an Infectious Diseases Education Platform

Background

Febrile is an infectious diseases (ID) podcast and learning platform with the aim of providing high-quality and accessible ID content for learners. We describe the use of Febrile as a resource for learning and teaching ID as well as learner satisfaction and perceived impact on clinical practice.

Methods

The Febrile platform was launched in December 2020 and includes audio podcast episodes, infographics, and detailed online summaries of adult and pediatric ID topics. Production and contributor information is summarized. Podcast, website, and social media engagement is reported from available quantitative analytics. An online anonymous survey was conducted to assess educational impact.

Results

After 3 years of operation, Febrile has produced 90 episodes and has been downloaded >460 000 times in 196 countries, with the majority of its audience (58.9%) listening from within the United States. A total of 230 participants from 30 countries and 38 US states completed the survey, of whom 79 (34.5%) were ID fellows in training and 78 (34.2%) were ID faculty physicians. Seventy-two percent of survey respondents reported visiting the website, and 82% had seen an infographic. Enhancing core ID knowledge was the primary driver for listening. Two-thirds of respondents indicated that information learned from Febrile has changed their practice, and 50% have used Febrile as a way to teach others. Febrile also led to favorable impressions of ID for those considering ID as a career.

Conclusions

Febrile is an engaging platform for ID medical education and provides a unique resource within the global ID community.

Finding the right combination for self-directed learning: A focus group study of residents' choice and use of digital resources to support their learning

BACKGROUND

There has been a shift in postgraduate medical education towards digital educational resources-podcasts, videos, social media and other formats consumed asynchronously and apart from formal curricula. It is unclear what drives residents to select and use these resources. Understanding how and why residents choose digital resources can aid programme directors, faculty and residents in optimising residents' informal learning time.

METHOD

This focus group study was conducted with residents at two US internal medicine residency programmes. The authors used the framework approach to content analysis using self-determination theory as guide for deductive coding and iteratively assessing connections among codes and identifying themes. Trustworthiness was addressed through use of analytic memos, reflexive practice and member checking.

RESULTS

The authors conducted eight virtual focus groups (n = 23) from 5/27/20 to 6/11/20. Residents described that a feeling of 'should know' drove initial choices towards self-directed learning outside of work. Regular use of a resource was influenced by how the resource fit into a resident's lifestyle, the personal cognitive energy and the perceived 'activation energy' of using a particular resource. Familiarity, increased confidence and in-person social networks gained from digital resources served to reinforce and further guide resource choice.

CONCLUSIONS

The selection of digital resources for self-directed learning is driven by multiple factors, suggesting an interdependent relationship between the learning environment and a residents' cognitive capacity. Understanding these interconnections can help residents and clinical educators explicitly choose resources that fit their lifestyle and learning needs.

Learning Theories Versus Practice: How Do Internal Medicine Residents Study for Licensing Examinations?

OBJECTIVE

 The ability to recall relevant medical knowledge within clinical contexts is a critical aspect of effective and efficient patient diagnosis and management. The ever-growing and changing body of medical literature requires learners to develop effective life-long learning techniques. Learners can more successfully build their fund of knowledge and ability to retrieve it by using evidence-based learning strategies. Our objective was to evaluate the study habits of internal medicine (IM) residents at an academic institution to understand if they apply key learning strategies for the American Board of Internal Medicine (ABIM) exam preparation. We also briefly review various learning strategies that can be applied to IM residency curricula.

METHODS

A web-based survey consisting of 16 multiple-response questions on study habits was filled out by the IM residents in 2019 at Tufts Medical Center.

RESULTS

Of the 75 residents invited to participate in the study, 69 responded (response rate = 92%). Of the responders, n=25 (36.2%) were post-graduate year (PGY)-1, n=20 (29.0%) were PGY-2, and n=24 (34.8%) were PGY-3 residents. More than half the residents (n=40, 58%) had Step 2 Clinical Knowledge (CK) scores > 250. Residents self-reported applying spaced learning (67%), interleaving (64%), retrieval (64%), and elaboration practices (46%) for exam preparation. There was a significant association between the Step 2 CK score and elaboration (p=0.017) technique but not with spaced learning, interleaving, or retrieval. The majority of residents felt not at all prepared (n=42, 60.9%) for the ABIM exam.

CONCLUSIONS

Despite two years of clinical training, 33% of the third-year residents felt inadequately prepared for the board certification exam. Incorporating evidence-based learning strategies into their daily curriculum may help them better prepare for the ABIM exam.

Continuing Education Evaluations of an Internal Medicine and a Pediatric Podcast

INTRODUCTION

This study aimed to characterize practitioners who use podcasts as a form of continuing education (CE), evaluate attitudes regarding podcasting as a medium for CE, and assess intended practice change after listening to podcasts for CE.

METHODS

We examined CE data from a mandatory postpodcast evaluation collected between February 2021 and August 2021 for two free podcasts. We analyzed linked episode data containing podcast downloads.

RESULTS

Listeners downloaded 972,691 episodes and claimed 8182 CE credits (less than 1% of total downloads) over 7 months. CE credit was claimed by physicians, physician assistants, nurses, and pharmacists. Most listeners claiming CE credit were not affiliated with an academic institution. Motivation for listening to episodes included a topic of interest, relevance to a patient, and a topic of less comfort. Of individuals obtaining CE, 98% intended to implement change after listening.

DISCUSSION

Although only a small number of podcast listeners claim CE credit, those who claim credit represent a diverse and interprofessional audience. Listeners select podcasts to fill self-identified learning needs. Overwhelmingly, listeners report podcast CE changes intended practice. Podcasts may be an effective modality for CE and practice change; further research should focus on facilitators and barriers to CE uptake and on patient health outcomes.

Be in the Digital Room Where it Happens, Part II: Social Media for Neurology Educators

Social media has changed the way we communicate and interact. Unsurprisingly, it has also changed how we teach and learn. Younger generations of learners have transitioned from traditional educational sources to digital ones. Medical educators need to adapt to trends in medical education and develop fluency in the digital methods used by medical learners today. This is part two of a two-part series on social media and digital education in neurology. This article provides an overview of how social media can be used as a teaching tool in medical education and provides an overview in which it is grounded. We offer practical strategies on how social media can promote lifelong learning, educator development, educator support, and foster educator identity with accompanying neurology-specific examples. We also review considerations for incorporating social media into teaching and learning practices and future directions for integrating these tools in neurology education.

An Evaluation of Emergency Medicine Core Content Covered by Podcasts

INTRODUCTION

Podcasts are used broadly for learning in emergency medicine (EM); however, there is concern about the potential for knowledge gaps for learners who rely on podcasts for their learning. The extent to which EM podcasts cover the core curriculum of EM is not known; thus, we sought to quantify the extent to which podcasts represent the core content of our specialty.

METHODS

We performed a retrospective review of all EM podcast episodes published in 2019. All podcasts were given credit for the content they covered as it related to the 2016 American Board of Emergency Medicine (ABEM) Model of Clinical Practice in Emergency Medicine (EM Model). The primary outcome was a description of how podcasts represented the ABEM EM Model content topics compared to the topic representation of the ABEM Qualifying Exam.

RESULTS

We included 54 unique EM podcast programs and 1,193 podcast episodes. They covered 2,965 total EM Model core content topics. The topics most covered were "other" (which includes interpersonal skills and professionalism), procedures, and signs and symptoms. Musculoskeletal, hematology, and environmental each accounted for less than 1% of all topics covered. Almost three-quarters of podcast episodes covered other core competencies of the practice of EM.

CONCLUSION

Podcasts had a broad yet imbalanced coverage of the ABEM EM Model core content subtopics in 2019, with a notable coverage of other core competencies of the practice of EM. Learners, educators, and scholars should be mindful of these gaps and focus future work on exploring how podcasts should best be used in EM education.

How podcasts teach: A comprehensive analysis of the didactic methods of the top hundred medical podcasts

PURPOSE

Medical podcasts have grown in popularity, but little is known about their didactic methods. This study sought to systemically describe the pedagogical approach employed by the 100 most popular medical podcasts in the United States. This study also aimed to assess factors related to quality control and conflicts of interest in podcasting.

METHODS

The authors averaged the rank positions for Apple podcasts in the Medicine category in the United States from 06/01/18 to 09/30/20 to generate a list of the 100 highest-ranked medical podcasts. They developed and validated a categorization system of didactic methods based on Bloom's taxonomy and collected data on didactic methods, as well as podcast affiliation, target audience, format, advertising, continuing medical education (CME) offerings, and presence of a reference list or review process.

RESULTS

Of the 100 most popular medical podcasts, 91 are educational. Of those, 51 are podcasts intended for physician education (PIPEs) while 40 are intended for other audiences, including the general public, nurses, and physical therapists. Compared with podcasts intended for other audiences, PIPEs engage higher levels of Bloom's taxonomy (p < 0.001). Among PIPEs, 18 (35.2%) are affiliated with an individual, 16 (31.4%) with a company, and 12 (23.5%) with a professional journal. 38 PIPEs (74.5%) are targeted toward all levels of medical learners. PIPEs are significantly more likely to list references or have a peer review process in place (n = 37, 72.5% vs. n = 15, 37.5%, p = 0.001) and offer CME credits (n = 20, 39.2% vs. n = 2, 5.0%, p < 0.001) than podcasts intended for other audiences.

CONCLUSIONS

Medical podcasts employ a variety of didactic methods, including those ranked highly on Bloom's taxonomy. Unlike traditional medical education, PIPEs are commonly produced by individuals or companies and targeted to all levels of medical learners.

Learning Through Listening: A Scoping Review of Podcast Use in Medical Education

PURPOSE

To improve understanding of podcast use in medical education by examining current research on descriptive attributes and educational outcomes, highlighting implications of the current evidence base for educational practices, and identifying research gaps to guide future investigation.

METHOD

The authors conducted a scoping review, searching PubMed and Embase databases in June-July 2020 for English-language studies of audio-only medical education podcast use in undergraduate, graduate, and continuing medical education. The authors excluded studies without original data or with nonphysician data that could not be separated from physician data. From included studies, the authors extracted data regarding descriptive outcomes (e.g., podcast use, content areas, structure) and educational outcomes (classified using Kirkpatrick's 4 levels of evaluation).

RESULTS

Of 491 unique articles, 62 met inclusion criteria. Descriptive outcomes were reported in 44 studies. Analysis of these studies revealed podcast use has increased over time, podcasts are a top resource for resident education, and podcasts are being incorporated into formal medical curricula. Educational outcomes were reported in 38 studies. The 29 studies that assessed learner reaction and attitudes to podcasts (Kirkpatrick level 1) showed learners value podcasts for their portability, efficiency, and combined educational and entertainment value. The 10 studies that assessed knowledge retention (Kirkpatrick level 2) showed podcasts to be noninferior to traditional teaching methods. The 11 studies that assessed behavior change (Kirkpatrick level 3) showed improved documentation skills in medical students and self-reported practice change in residents and practicing physicians after listening to podcasts. None of the studies reported system change or patient outcomes (Kirkpatrick level 4).

CONCLUSIONS

Future research should focus on the optimal structure of podcasts for learning, higher-level outcomes of podcasts, and the implementation of podcasts into formal curricula. Podcasts may prove to be essential tools for disseminating and implementing the most current, evidence-based practices.

Consume, Contribute, and Create: Succeeding as a Learner and Educator in the Digital Era

From medical student to professorship, the practice of medicine requires lifelong learning. The unforgivingly rapid expansion of medical literature often renders traditional educational resources quickly outdated if not altogether obsolete. Conversely, increasingly popular digital platforms are easily accessible and quickly updated, offering vital adjuncts to traditional resources for the modern student. Further, platforms such as podcasts and social media may be particularly well suited for adult learners who tend to be problem centered, self-directed, internally motivated, and time constrained. Social media empowers all participants, thereby blurring the boundaries between learners and educators. Here we review novel digital educational platforms, discussing both potential benefits and pitfalls, and then provide a three-pillared approach-consume, contribute, and create-to help the modern medical professional harness the potential of both traditional and novel resources to succeed as both a learner and educator.

Orthopaedic Sports Medicine Podcasts Should Tailor Characteristics Such as Episode Length and Social Media Utilization for Best Audience Engagement

Purpose

To describe the growth and characteristics of active orthopaedic sports medicine podcasts.

Methods

Three common podcasting platforms (Apple, Google, and Spotify) were queried July 24, 2021 using the search term “sports medicine.” For each unique active podcast hosted by an orthopaedic surgeon, data were collected on year of the first episode, number of episodes, frequency of episodes, types of guests, topics discussed, episode length, and social media presence. Descriptive characteristics were then calculated.

Results

15 podcasts met inclusion criteria. Seven (46.7%) of these podcasts were started within 12 months of July 24, 2021. The most common episode release schedule was weekly, and podcast lengths averaged 21 minutes, 47 seconds (SD 17:17, range: 11:02–1:49:13). All podcasts featured guests, most often from a variety of sports medicine backgrounds. Social media platforms were commonly used by podcast hosts, with social media account follower numbers as high as over 100,000, and consistent engagement across three major social media platforms for most podcasts.

Conclusions

This study found that episodes are typically released weekly and average 21 minutes, 47 seconds long, with most covering a wide array of topics in sports medicine. The Facebook accounts of these podcasts displayed higher numbers of followers compared to other social media platforms; however, Instagram was superior for engagement.

Clinical Relevance

Orthopaedic sports medicine podcasts have an increasing presence and can be used to increase trainee engagement and public exposure via tailoring of podcast episode lengths and selection of social media platforms with high audience interaction.

The current role of telehealth in the management of patients with osteoporosis

INTRODUCTION

Telehealth is the use of electronic technologies for communication, storage, and analysis of health-related information. Telemedicine is a form of telehealth that involves remote patient care. This is a review and update of the use of these modalities as they apply to the education of healthcare professionals who provide care for patients with osteoporosis and the delivery of their care.

AREAS COVERED

This review focuses on technology-enabled collaborative learning and its prototype model, Project ECHO (Extension for Community Healthcare Outcomes). Bone Health TeleECHO and similar programs apply the ECHO model of learning to mentor healthcare professionals on implementation of best practice care for patients with osteoporosis and other skeletal diseases. Telemedicine, which has seen widespread uptake during the COVID-19 pandemic, is an alternative to in-person visits for patients with osteoporosis as well as for those with other conditions.

EXPERT OPINION

Remote education of healthcare professionals and the remote delivery of patient care provides opportunities, as well as challenges, for achieving the goal of reducing the global burden of osteoporotic fractures.

Health Care Professional and Caregiver Attitudes Toward and Usage of Medical Podcasting: Questionnaire Study

BACKGROUND

Podcasts are used increasingly in medicine. There is growing research into the role of podcasts in medical education, but the use of podcasting as a tool for pediatric parent/caregiver health education is largely unexplored. As parents/caregivers seek medical information online, an understanding of parental preferences is needed.

OBJECTIVE

We sought to explore health care professional and parent/caregiver awareness and views on podcasting as a health education tool.

METHODS

This survey study was conducted and distributed via in-person collection from parents/caregivers (≥18 years old) in the waiting room of an academic pediatric primary care clinic, targeted social media promotion, and professional listservs for health care professionals in pediatrics. Statistical analysis included chi-square tests of independence between categorical variables.

RESULTS

In total, 125 health care professionals and 126 caregivers completed the survey. Of those surveyed, 81% (101/125) of health care professionals and 55% (69/126) of parents/caregivers listened to podcasts (P<.001). Health care professionals and parents/caregivers listed the same top 3 quality indicators for medical podcasts. Podcast listeners were more likely to have higher incomes and use professional websites for information. The survey elicited a variety of reasons for podcast nonengagement.

CONCLUSIONS

Health care professionals appear to be more engaged in medical education podcasts than parents/caregivers. However, similar factors were valued when evaluating the quality of a pediatric podcast: accuracy, transparency, and credibility. Professional websites may be one avenue to increase podcast uptake. More needs to be done to explore the use of podcasts and digital media for medical information.