The "Flipped Classroom" Model for Teaching in the Intensive Care Unit

Flipping the Teachers: Impact of a Standardized Physiology Curriculum on Neonatology Medical Educators

OBJECTIVE

 Academic physicians must teach elements in an Accreditation Council for Graduate Medical Education (ACGME)-mandated curriculum while balancing career development and clinical workload. Exploring educator perceptions on the learning environment and comparing two instructional methods (traditional didactics [TD] vs. flipped classroom [FC]) in one pediatric subspecialty may elucidate current challenges, barriers, and strategies to optimize learning and educator satisfaction.

STUDY DESIGN

 A randomized trial comparing effectiveness and learner preference for FC versus TD physiology teaching was conducted in ACGME-accredited neonatal-perinatal medicine (NPM) fellowship programs in 2018 to 2019. Educator preferences were elicited through online surveys pre- and postintervention. Free-text comments were provided for questions exploring strengths, challenges, and opportunities in fellowship education. Statistical analysis included comparisons of demographics and pre-post-intervention educator responses between groups. Thematic analysis of text responses was conducted to identify common subthemes.

RESULTS

 From 61 participating programs, 114 FC educators and 130 TD educators completed surveys. At baseline, all educators experienced professional satisfaction from teaching fellows, but noted challenges with time available to create and/or deliver educational content, limited content expertise amongst faculty, colleagues' limited enthusiasm toward educating fellows, and lack of perceived value of education by institutions given limited protected time or credit toward promotion. Postintervention, educators in both groups noted a preference to teach physiology using FC due to interactivity, learner enthusiasm, and learner-centeredness. FC educators had a 17% increase in preference to teach using FC (p = 0.001). Challenges with FC included ensuring adequate trainee preparation, protecting educational time, and providing educators with opportunities to develop facilitation skills.

CONCLUSION

 Overall, NPM educators in a trial evaluating a standardized, peer-reviewed curriculum report professional satisfaction from teaching, but described logistical challenges with developing/delivering content. Educators preferred instruction using FC, but identified challenges with learner preparedness and ensuring adequate educator time and skill. Future efforts should be dedicated to addressing these barriers.

KEY POINTS

· Many challenges exist for educators teaching neonatal-perinatal medicine fellows, including time, support, and recognition.. · Many educators preferred using flipped classroom methodology with a standardized curriculum due to interactivity and learner-centeredness.. · Benefits of a standardized, peer-reviewed curriculum include reduced preparation time, adaptability of content, and learning environment enhancement..

Trainee-supervisor collaboration, progress-visualisation, and coaching: a survey on challenges in assessment of ICU trainees

BACKGROUND

Assessing trainees is crucial for development of their competence, yet it remains a challenging endeavour. Identifying contributing and influencing factors affecting this process is imperative for improvement.

METHODS

We surveyed residents, fellows, and intensivists working in an intensive care unit (ICU) at a large non-university hospital in Switzerland to investigate the challenges in assessing ICU trainees. Thematic analysis revealed three major themes.

RESULTS

Among 45 physicians, 37(82%) responded. The first theme identified is trainee-intensivist collaboration discontinuity. The limited duration of trainees' ICU rotations, large team size operating in a discordant three-shift system, and busy and unpredictable day-planning hinder sustained collaboration. Potential solutions include a concise pre-collaboration briefing, shared bedside care, and post-collaboration debriefing involving formative assessment and reflection on collaboration. The second theme is the lack of trainees' progress visualisation, which is caused by unsatisfactory familiarisation with the trainees' development. The lack of an overview of a trainee's previous achievements, activities, strengths, weaknesses, and goals may result in inappropriate assessments. Participants suggested implementing digital assessment tools, a competence committee, and dashboards to facilitate progress visualisation. The third theme we identified is insufficient coaching and feedback. Factors like personality traits, hierarchy, and competing interests can impede coaching, while high-quality feedback is essential for correct assessment. Skilled coaches can define short-term goals and may optimise trainee assessment by seeking feedback from multiple supervisors and assisting in both formative and summative assessment. Based on these three themes and the suggested solutions, we developed the acronym "ICU-STAR" representing a potentially powerful framework to enhance short-term trainee-supervisor collaboration in the workplace and to co-scaffold the principles of adequate assessment.

CONCLUSIONS

According to ICU physicians, trainee-supervisor collaboration discontinuity, the lack of visualisation of trainee's development, and insufficient coaching and feedback skills of supervisors are the major factors hampering trainees' assessment in the workplace. Based on suggestions by the survey participants, we propose the acronym "ICU-STAR" as a framework including briefing, shared bedside care, and debriefing of the trainee-supervisor collaboration at the workplace as its core components. With the attending intensivists acting as coaches, progress visualisation can be enhanced by actively collecting more data points.

TRIAL REGISTRATION

N/A.

Can you teach a hands-on skill online? A scoping review of e-learning for point-of-care ultrasound in medical education

Background

There is an increasing need and interest in teaching point-of-care ultrasound (POCUS) online. The objective of this study was to systematically review the literature regarding e-learning as a method for teaching POCUS in medical education, to assess the benefits and limitations of various styles of e-learning for POCUS, and to identify gaps in the literature that could help guide future research in this field.

Methods

A literature search was conducted on three databases including MEDLINE (Ovid), EMBASE and Cochrane Central Register of Controlled Clinical Trials on October 12, 2021, retrieving a total of 1630 studies. 31 studies met the inclusion and exclusion criteria. These studies were separated into different styles of e-learning and learner outcomes were analyzed based on Kirkpatrick's hierarchy.

Results

The studies were categorized into three styles of e-learning: a) blended learning b) online-only (asynchronous or synchronous) and c) use of handheld machines or telesonography. POCUS knowledge and image interpretation were successfully taught online, however online-only learning for image acquisition was not as consistently effective. Blended learning and telesonography were beneficial for learning image acquisition skills. Generally, novice learners benefited most from e-learning.

Conclusion

E-learning for POCUS is gaining in popularity in recent years. POCUS is a complex technical skill, and depending on the individual task being taught, different styles of e-learning may be more successful. These findings can inform future POCUS educational programs.

The Resident Learning Journey in the Medical Intensive Care Unit

Background

The medical intensive care unit (MICU) offers rich resident learning opportunities, but traditional teaching strategies can be difficult to employ in this fast-paced, high-acuity environment. Resident perspectives of learning within this environment may improve our understanding of the common challenges residents face and inform novel approaches to transform the MICU educational experience.

Objective

We conducted a qualitative study of internal medicine residents to better understand their approach to learning the critical care activities that they are entrusted to perform in the MICU.

Methods

Using a thematic analysis approach, we conducted six focus group interviews with 15 internal medicine residents, separated by postgraduate year. A trained investigator led each interview, which was audio-recorded and transcribed verbatim for analysis. Our diverse research team, representing different career stages across the continuum of learning to minimize interpretive bias, identified codes and subsequent themes inductively. We refined these themes through group discussion and sensitizing social learning theory concepts using Wenger's community of practice and organized them to create learner archetypes and a conceptual framework of resident learning in the MICU.

Results

We identified three thematic resident learning categories: learning goals and motivation, clinical engagement, and interprofessional collaboration. We distinguished three learner archetypes, the novice, experiential learner, and practicing member, to describe progressive resident development within the interprofessional MICU team, the challenges they frequently encounter, and potential teaching strategies to facilitate learning.

Conclusion

We developed a conceptual framework that describes the resident's journey to becoming a trusted, collaborating member of the interprofessional MICU team. We identified common developmental challenges residents face and offer educational strategies that may support their progress. These findings should inform future efforts to develop novel teaching strategies to promote resident learning in the MICU.

Evidence-based teaching in contact lenses education: Teaching and learning strategies

INTRODUCTION

Contact lens (CL) practice is an ever-changing field with clinical knowledge, techniques and equipment continuously evolving. These new developments are backed with clinical trials and research to ensure that practitioners feel confident that there is an evidence base to support these advances. Evidence-based practice is now a crucial part of CL practice, and its importance also filters down to CL education. For example, lectures are one of the most popular tools for an educator but, is standing at the front of a lecture theatre full of students a more effective way of teaching than providing the same material for students to read by themselves? What evidence exists specific to CL education?

METHOD

An expert panel of educators completed a comprehensive literature review of current evidence of teaching methods in CL training, or if not available then what can be learnt from other health care professional training that could be potentially applicable to CL education.

RESULTS

Due to the amount of evidence available in the overall subject area relating to healthcare education, the initial plan of compiling evidence into one narrative review paper was discarded in favour of producing two linked papers. Here, the first paper details definitions of terminology, and also teaching methods. The second paper focuses on assessment and specific clinical training required to attain CL practice competency. In this first paper, no direct evidence of the spreading and benefit of new education strategies evidence such as flipped classrooms, spaced learning, test-enhanced learning, group work, CBL, PBL, TBL, and reflective practice in CL education was found. The only technique that was widely used in the CL field was case reports and the group discussion of them. Nevertheless, the authors found a consensus of opinion from other disciplines that are transferable to CL teaching and could help students meet the intended learning outcomes.

CONCLUSION

There is a small amount of evidence supporting CL education, but most of this seems to be related to the practical element of the training. However, there is a lot of evidence in the field of healthcare education from related disciplines which provides additional but important learning tools that may be effectively implemented in CL education.

Online educational interventions in pediatric intensive care medicine

Background

Online education has experienced explosive growth, particularly in the wake of the COVID-19 pandemic. We explored the current state of the evidence base for online education targeted towards healthcare professionals working in pediatric intensive care units (PICUs), to report how we are using online education in our field.

Materials and Methods

We performed a literature review by systematically generating a list of publications indexed in PubMed describing online educational interventions in the PICU, using Medical Subject Header (MeSH)-based search terms and the following inclusion criteria: studies published after 2005 that describe online educational interventions aimed at healthcare professional working in the PICU. We reviewed the full text of all included articles, and summarized the study aims, design, and results.

Results

Our initial search yielded 1,071 unique articles. After screening abstracts and titles, then full texts, eight articles were included in the review. Many online learning modalities are represented, including websites, self-study modules, videos, videoconferencing, online self-assessment with feedback, virtual patient cases, screen-based simulation, and podcasts. Three studies focused on residents, two studies on nurses, two studies on a multidisciplinary team, and one study on transport nurses and paramedics. Most studies utilized participant surveys to assess satisfaction, and half included pre- and post-intervention multiple-choice question tests. Only one study included a patient-related outcome measure.

Conclusions

Despite growth in online medical educational intervention research, there are relatively few published studies in pediatric critical care, and only one study evaluated the impact of online learning on patient outcomes. There remain significant opportunities for PICU educators to assess the impact of online educational interventions, especially related to clinician behaviors and patient outcomes.

Comparison of knowledge acquisition and retention following traditional didactic vs. flipped classroom education utilizing a standardized national curriculum: a randomized controlled trial

OBJECTIVE

Measure the effectiveness of and preference for a standardized, national curriculum utilizing flipped classrooms (FC) in neonatal-perinatal medicine (NPM) fellowships.

STUDY DESIGN

Multicentered equivalence, cluster randomized controlled trial of NPM fellowship programs randomized to receive standardized physiology education as in-class lectures (traditional didactic, TD arm) or as pre-class online videos followed by in-class discussions (FC arm). Four multiple-choice question quizzes and three surveys were administered to measure knowledge acquisition, retention, and educational preferences.

RESULTS

530 fellows from 61 NPM fellowships participated. Quiz performance was comparable between groups at all time points (p = NS, TD vs FC at 4 time points). Post intervention, more fellows in both groups preferred group discussions (pre/post FC 42% vs. 58%, P = 0.002; pre/post TD 43% vs. 60%, P = < 0.001). FC fellows were more likely to rate classroom effectiveness positively (FC/TD, 70% vs. 36%, P < 0.001).

CONCLUSIONS

FCs promote knowledge acquisition and retention equivalent to TD and FC modalities are preferred by fellows.

Communication Patterns During Routine Patient Care in a Pediatric Intensive Care Unit: The Behavioral Impact of In Situ Simulation

OBJECTIVE

Effective communication minimizes medical errors and leads to improved team performance while treating critically ill patients. Closed-loop communication is routinely applied in high-risk industries but remains underutilized in healthcare. Simulation serves as an educational tool to introduce, practice, and appreciate the efficacy of closed-loop communication.

METHODS

This observational before-and-after study investigates behavioral changes in communication among nurses brought on by simulation team training in a pediatric intensive care unit (PICU). The communication patterns of PICU nurses, who had no prior simulation experience, were observed during routine bedside care before and after undergoing in situ simulation.One month before and 1 and 3 months after simulation (intervention), 2 trained raters recorded nurse communications relative to callouts, uttered by the sender, and callbacks, reciprocated by the recipient. The impact of simulation on communication patterns was analyzed quantitatively.

RESULTS

Among the 15 PICU nurses included in this study, significant changes in communication behavior were observed during patient care after communication-focused in situ simulation. The PICU nurses were significantly less likely to let a callout go unanswered during clinical routine. The effect prevailed both 1 month (P = 0.039) and 3 months (P = 0.033) after the educational exposure.

CONCLUSIONS

This observational before-and-after study describes the prevalence and pattern of communication among PICU nurses during routine patient care and documents PICU nurses transferring simulation-acquired communication skills into their clinical environment after a single afternoon of in situ simulation. This successful transfer of simulation-acquired skills has the potential to improve patient safety and outcome.

The flipped classroom in medical education: A new standard in teaching

Many medical educators, out of necessity imposed by the COVID-19 pandemic, had to flip their classrooms. However, instead of adapting to this new teaching style, many have proceeded in the manner that they have always used to create content, opening a slide deck and inserting content until they are satisfied with the result. When in fact, we know based on evidence and our own experience, that educators should first plan, organize, and storyboard before collecting information into a presentation [1,2]. If educators need to replace real-world teaching and interaction, we believe the next best option is video education, although there are other forms of prework that can be utilized to flip medical classrooms, including short readings and exercises. We discuss the case for flipping medical classrooms, the limitations, and how educators can get started flipping their classrooms today.

Twelve tips for teaching in the ICU

The intensive care unit (ICU) provides unique educational opportunities for both undergraduate and postgraduate learners, including procedural training, ventilator management guidance, complex communication scenarios, and didactic lectures on dynamic topics like multi-system organ failure. However, certain challenges are inherent in this setting that can make teaching difficult. Different trainee educational backgrounds, variability in disease states, time limitations and urgent patient care considerations highlight some challenges that limit teaching opportunities. The following twelve tips address these unique aspects of the ICU environment and provide strategies to optimize teaching. These tips focus on three main goals: creating an optimal learning environment, increasing learner engagement, and critically challenging learners.

Projeto de desenvolvimento sustentável regional e local: um caso de ensino

O presente caso de ensino tem por objetivo aplicar um método didático-pedagógico que permita elaborar um projeto de desenvolvimento sustentável regional e local como solução para os problemas enfrentados por uma Região Integrada de Desenvolvimento (RIDE) brasileira. Neste caso de ensino, foi utilizado o método de ensino denominado PBL (Problem Based Learning), considerado inovador, e uma relevante alternativa ao modelo de ensino tradicional. O caso de ensino é uma situação hipotética que representa a realidade de várias regiões do Brasil. O caso de ensino foi aplicado em uma disciplina do Programa de Pós-Graduação Stricto Sensu em Sustentabilidade de uma universidade da Região Sudeste do Brasil. Utilizando o método PBL, buscou-se nessa disciplina, analisar o problema e propor soluções para o projeto de desenvolvimento sustentável regional e local da RIDE-Plus Ultra. O estudo aponta a necessidade de se estabelecer consórcios municipais, a integração da sociedade local, a formação e capacitação tecnopolítica dos atores sociais e públicos para fundamentar a implementação das ações e obras voltadas ao desenvolvimento sustentável do território. Conclui-se que um pacto social e político, com participação da população em projetos de curto, médio e longo prazo, é fundamental para se alcançar um imprescindível desenvolvimento sustentável regional e local.

Current State of Nutrition Education in Pediatric Critical Care Medicine Fellowship Programs in the United States and Canada

OBJECTIVES

To assess the current state of nutrition education provided during pediatric critical care medicine fellowship.

DESIGN

Cross-sectional survey.

SETTING

Program directors and fellows from pediatric critical care medicine fellowship programs in America and Canada.

SUBJECTS

Seventy current pediatric critical care medicine fellows and twenty-five pediatric critical care medicine fellowship program directors were invited to participate.

INTERVENTIONS

Participants were asked demographic questions related to their fellowship programs, currently utilized teaching methods, perceptions regarding adequacy and effectiveness of current nutrition education, and levels of fellow independence, comfort, confidence, and expectations in caring for the nutritional needs of patients.

MEASUREMENTS AND MAIN RESULTS

Surveys were sent to randomly selected program directors and fellows enrolled in pediatric critical care medicine fellowship programs in America and Canada. Twenty program directors (80%) and 60 fellows (86%) responded. Ninety-five percent of programs (19/20) delivered a formal nutrition curriculum; no curriculum was longer than 5 hours per academic year. Self-reported fellow comfort with nutrition topics did not improve over the course of fellowship (p = 0.03), with the exception of nutritional aspects of special diets. Sixty-five percent of programs did not hold fellows responsible for writing daily parenteral nutrition prescriptions. There was an inverse relationship between total number of fellows in a pediatric critical care medicine program and levels of comfort in ability to provide parenteral nutrition support (p = 0.01). Program directors perceived their nutritional curriculum to be more effective than did their fellows (p ≤ 0.001).

CONCLUSIONS

Nutrition education was reported as highly underrepresented in pediatric critical care medicine fellowship curricula. The majority of programs rely on allied health care professionals to prescribe parenteral nutrition, which may influence trainee independence in the provision of nutritional therapies. Improving the format of current nutrition curriculums, by relying on more active teaching methods, may improve the delivery and efficacy of nutrition education. The impact of novel training interventions on improving the competency and safety of enteral and parenteral nutrition delivery in the PICU must be further examined.

Online Learning and Residents' Acquisition of Mechanical Ventilation Knowledge: Sequencing Matters

OBJECTIVE

Rapid advancements in medicine and changing standards in medical education require new, efficient educational strategies. We investigated whether an online intervention could increase residents' knowledge and improve knowledge retention in mechanical ventilation when compared with a clinical rotation and whether the timing of intervention had an impact on overall knowledge gains.

DESIGN

A prospective, interventional crossover study conducted from October 2015 to December 2017.

SETTING

Multicenter study conducted in 33 PICUs across eight countries.

SUBJECTS

Pediatric categorical residents rotating through the PICU for the first time. We allocated 483 residents into two arms based on rotation date to use an online intervention either before or after the clinical rotation.

INTERVENTIONS

Residents completed an online virtual mechanical ventilation simulator either before or after a 1-month clinical rotation with a 2-month period between interventions.

MEASUREMENTS AND MAIN RESULTS

Performance on case-based, multiple-choice question tests before and after each intervention was used to quantify knowledge gains and knowledge retention. Initial knowledge gains in residents who completed the online intervention (average knowledge gain, 6.9%; SD, 18.2) were noninferior compared with those who completed 1 month of a clinical rotation (average knowledge gain, 6.1%; SD, 18.9; difference, 0.8%; 95% CI, -5.05 to 6.47; p = 0.81). Knowledge retention was greater following completion of the online intervention when compared with the clinical rotation when controlling for time (difference, 7.6%; 95% CI, 0.7-14.5; p = 0.03). When the online intervention was sequenced before (average knowledge gain, 14.6%; SD, 15.4) rather than after (average knowledge gain, 7.0%; SD, 19.1) the clinical rotation, residents had superior overall knowledge acquisition (difference, 7.6%; 95% CI, 2.01-12.97;p = 0.008).

CONCLUSIONS

Incorporating an interactive online educational intervention prior to a clinical rotation may offer a strategy to prime learners for the upcoming rotation, augmenting clinical learning in graduate medical education.

Preparing undergraduate students for clinical work in a complex environment: evaluation of an e-learning module on physiotherapy in the intensive care unit

BACKGROUND

Intensive Care Units (ICUs) are daunting environments for physiotherapy (PT) students performing clinical rotations. To prepare students for this environment, a newly developed, evidence-based e-learning module was designed and implemented in the undergraduate curriculum. The aim of this study was to investigate whether e-learning is a feasible method in preparing PT students for clinical work in complex ICU environments, as perceived by students and experts.

METHODS

A mixed methods proof of concept study was undertaken. Participants were final-year students of an international curriculum, and experts from didactic and clinical fields. An e-learning module consisting of 7 separate chapters based on the latest scientific evidence and clinical expertise was developed, piloted and incorporated into the undergraduate curriculum as a compulsory course to be completed prior to clinical ICU rotations. Data were collected through 3 focus group meetings and 5 semi-structured interviews; these meetings and interviews were audio recorded, transcribed verbatim and analyzed.

RESULTS

The study sample comprised of 14 students and 5 experts. Thematic analysis revealed three themes: expected competencies of PT students in ICU, feeling prepared for ICU clinical work and dealing with local variety. The e-learning module enabled students to anticipate clinical situations and PT tasks in the ICU. Higher level clinical reasoning skills, handling of lines and wires and dealing with out-of-textbook situations could not be achieved with the e-learning module alone.

CONCLUSIONS

An e-learning module can sufficiently prepare PT students for their clinical tasks in the ICU, as long as it is integrated with, or closely connected to, the students' clinical placement.

Why Flip the Medical Resident Classroom? A Pilot Study in Singapore

This chapter on the flipped classroom in Residency teaching was written before the the outbreak of the COVID-19 pandemic. Technology in teaching can no longer take a backseat. As software and tools evolve , they provide for greater interactivity and authenticity in remote learning. Although medical education in the acute care setting is now even more challenging, here is an example of effectively flipping the classroom and recommended best practices for teachers and learners.

Strategic Considerations for Applying the Flipped Classroom to Neurology Education

Nowadays, the "flipped classroom" approach is taking the center stage within medical education. However, very few reports on the implementation of the flipped classroom in neurology have been published to date, and this educational model still represents a challenge for students and educators alike. In this article, neurology educators from the American Academy of Neurology's A. B. Baker Section on Neurological Education analyze reports of flipped classroom in other medical/surgical subspecialties, review the current implementation in neurology, and discuss future strategies to flip the neurology curriculum through contextualization of the benefits and the consequences. ANN NEUROL 2020;87:4-9.

A New Educational Framework to Improve Lifelong Learning for Cardiologists

Lifelong learning is essential for the practicing cardiologist. Present lifelong learning mechanisms are stagnant and at risk for not meeting the needs of currently practicing cardiologists. With the increasing burden of cardiovascular disease, growing complexity of patient care, and ongoing pressures of nonclinical responsibilities, educational programming must evolve to meet the demands of the contemporary cardiovascular professional. A paradigm shift, replete with modern and practical educational tools, is needed in the lifelong learning armamentarium. Emerging evidence of novel educational strategies in graduate medical education supports the promise of broader application of these tools to different stages of professional life. In this commentary from the Fellows-in-Training Section Leadership Council, the authors propose 3 novel educational tools-personalized learning, adaptive learning, and the flipped classroom-to improve lifelong learning to meet the educational needs of fellows-in-training to practicing cardiologists alike.

Learning echocardiography- what are the challenges and what may favour learning? A qualitative study

BACKGROUND

Echocardiography is a frequently used imaging modality requiring extensive training to master. In order to develop curriculums and teaching material fully favouring students learning within echocardiography, this study aims to investigate students' experiences of learning echocardiography, focusing on that which is perceived as the main challenges as well as what might aid learning within the area. The findings could serve as a foundation in the development of new teaching material or curriculums.

METHODS

A qualitative study was performed with data gathered through two audio-recorded focus group interviews with four third year students from the biomedical laboratory programme at Malmö University in each group. Data was analysed by manifest content analysis.

RESULTS

Findings were clustered into two categories reflecting the main findings in the text - practical skills and bridging the theory-practice-gap. Students expressed that main challenges when initially learning echocardiography were the projections and handling the probe as well as connecting ultrasound physics and measurements to practical application. Things that aided their learning were immediate feedback, "playing" with the ultrasound machine, video lectures, the possibility to swiftly alternate between practice and theory as well as the learning by their mistakes in a risk-free environment.

CONCLUSIONS

This study shows the main challenges when initially learning echocardiography and what might be helpful during the learning process. These findings may be useful when developing curriculums or new teaching material within echocardiography. One suggestion might be to develop digital resources such as virtual laboratories (vLABs).

Effects of a Flipped Classroom Curriculum on Inpatient Cardiology Resident Education

BACKGROUND

The flipped classroom is designed to reinvigorate education and utilizes "at-home" time to learn concepts and "in-class" time for clinical application. While some studies have shown positive effects of the flipped classroom in undergraduate medical education, there is a paucity of data on its use in graduate medical education.

OBJECTIVE

We hypothesized that a flipped classroom curriculum of Medical Knowledge Self-Assessment Program (MKSAP) content with group case discussions could improve resident knowledge and preparedness in cardiology.

METHODS

Ninety-eight internal medicine residents who rotated on the inpatient cardiology service from March to October 2017 were quasi-randomized into control and intervention groups, with the intervention group assigned MKSAP readings and cases to review on their own, accompanied by weekly case discussion. Pre-post surveys evaluated for change in knowledge and preparedness, quantity of teaching received, and use of MKSAP.

RESULTS

A total of 93 of 98 residents (95%) participated in the curriculum. There were 37 of 51 residents (73%) in the control group and 37 of 47 residents (79%) in the intervention group who responded to pre-post assessments. In paired analysis, knowledge score did not improve significantly between the groups, nor did self-reported preparedness, number of teaching sessions per week, or reported MKSAP use. However, all participants had positive perceptions of the curriculum, and the majority felt it should be continued.

CONCLUSIONS

This flipped classroom curriculum did not affect knowledge, preparedness, or number of teaching sessions for internal medicine residents on a cardiology rotation when compared to usual teaching, although residents experiencing the new model expressed high satisfaction.

Flipping the Classroom in Graduate Medical Education: A Systematic Review

BACKGROUND

Flipped classroom (FC) instruction has become increasingly common in graduate medical education (GME).

OBJECTIVE

The purpose of this study was to profile the use of FC in the GME setting and assess the current status of research quality.

METHODS

We conducted a systematic literature search of major health and social science databases from July 2017 to July 2018. Articles were screened to ensure they described use of the FC method in an Accreditation Council for Graduate Medical Education-accredited residency program and included research outcomes. Resulting articles were analyzed, described, and evaluated for research quality using the Kirkpatrick framework and the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

Twenty-two articles were identified, all of which were recently published. Five were only indirectly related to FC methods. Most studies reported Kirkpatrick-level outcomes. Studies involving resident learner opinions were generally positive. Pre-posttest studies resulted in large positive improvements in knowledge or skills attainment. Control group study results ranged from large positive (1.56) to negative effects (-0.51). Average MERSQI scores of 12.1 (range, 8.5-15.5) were comparable to GME research norms.

CONCLUSIONS

Varying methods for implementing and studying the FC in GME has led to variable results. While residents expressed a positive attitude toward FC learning, shortcomings were reported. Approximately half of the studies comparing the flipped to the traditional classroom reported better achievement under the FC design. As indicated by the MERSQI score, studies captured by this review, on average, were as rigorous as typical research on residency education.

Competence and training in interventional pulmonology

Interventional pulmonology (IP) is experiencing a rapid evolution of new technologies. There is a need to develop structured training programs, organized in high volume expert centers in order to improve trainee education, and including the development of validated metrics for their competency assessment. Concerning teaching methods, a gradual progression from theory to practice, using new teaching techniques, including live sessions and low and high-fidelity simulation, flipped classroom models and problem-based learning (PBL) exercises would provide a training setting more suitable for our current need to improve skills and update professionals. Training programs should be learner-centered and competence-oriented, as well as being based on a spiral-shaped approach in which the same subject is addressed many times, from new and different perspectives of knowledge, ability, behavior and attitude, until the trainee has demonstrated a high degree of skill and professionalism. Furthermore there is a need to standardize the training programs as guide for physicians wishing to undertake a gradual and voluntary improvement of their own competencies, and assist those planning and organizing training programs in IP. The article includes a general part on core curriculum contents, innovative training methods and simulation, and introduces the following articles on the skills that the Interventional Pulmonologist must master in order to perform the different procedures. This monography should be considered a starting point that will evolve over time and results in better training for practitioners and better care for our patients. The task of establishing a trainee's competence to practice independently as an Interventional Pulmonologist remains the responsibility of the IP fellowship program director and faculty, who validate logbooks and assess competence for each procedure. These standards need to be reviewed and approved by national and International Scientific Societies and Healthcare Institutions with the aim to improve, disseminate and incorporate them in healthcare programs.

Implementation of a “Flipped Classroom” for Neurosurgery Resident Education

Introduction: Engaging residents across a multiyear training spectrum is challenging given the heterogeneity of experience and limited time available for educational activities. A “flipped classroom” model, in which residents prepare ahead of time for mentored topic discussions, has potential advantages. Methods: We implemented a curriculum consisting of topics distributed across the specialty. Weekly, each resident was randomly assigned to research a specific aspect of an assigned topic appropriate to his or her level of experience: junior residents about what characterizes each clinical entity, midlevel residents about when to intervene, and chief residents about how to administer treatment. Residents completed an anonymous survey 6 months after implementation. Board examination performance was assessed before and after implementation. Results: A total of 12 residents participated in the program. Weekly, 1.75±0.40 hours were spent in preparation, with senior residents reporting less time than junior residents. All residents indicated that the accumulation of experience across 7 years of residency was a major advantage of this program, and all preferred it to lectures. Performance on the board examination significantly increased after implementation (from 316±36 to 468±45, p<0.05). Conclusions: The flipped classroom is a viable approach to resident education and is associated with increased engagement and improved performance using validated knowledge-assessment tools.

Teaching Residents Clinical Practice Guidelines Using a Flipped Classroom Model

INTRODUCTION

Prior studies have demonstrated poor guideline compliance by pediatricians, and there is no published curriculum on how to teach clinical guidelines. Furthermore, in a national survey of pediatric residency training programs conducted in 2015, only two had a formal curriculum for teaching clinical guidelines. This module provides a framework for teaching residents clinical guidelines through a modified flipped classroom approach. Associated materials include a guide for faculty facilitators, sample slides and worksheet, and pictures of the classroom setup.

METHODS

In this module, the guidelines for acute otitis media (AOM), obstructive sleep apnea syndrome (OSAS), and attention deficit-hyperactivity disorder (ADHD) are taught in three sessions and evaluated with a pre-/posttest assessing knowledge, attitudes, self-efficacy, and satisfaction. Each guideline is delivered in a 30-minute session, with five learners per group. Faculty training requires approximately 30 minutes of preparation. The intervention groups (n = 9 for OSAS, 10 each for AOM and ADHD) received three weekly, half-hour flipped classroom lessons. The control group (n = 19) had no formal guideline education.

RESULTS

Pre-/posttests showed a statistically significant improvement in knowledge and attitudes in the group of interns who received this educational intervention over the control group. The learners rated the sessions as highly effective.

DISCUSSION

This module provides an efficient and effective way of utilizing a modified flipped classroom approach to teach learners the correct use of clinical guidelines, a skill residents must master to provide evidence-based care. This curriculum has been successfully incorporated into our pediatric residency program.

Practical strategies for increasing efficiency and effectiveness in critical care education

Technological advances and evolving demands in medical care have led to challenges in ensuring adequate training for providers of critical care. Reliance on the traditional experience-based training model alone is insufficient for ensuring quality and safety in patient care. This article provides a brief overview of the existing educational practice within the critical care environment. Challenges to education within common daily activities of critical care practice are reviewed. Some practical evidence-based educational approaches are then described which can be incorporated into the daily practice of critical care without disrupting workflow or compromising the quality of patient care. It is hoped that such approaches for improving the efficiency and efficacy of critical care education will be integrated into training programs.