Feasibility of a Comprehensive Medical Knowledge Curriculum in Internal Medicine Using Team-Based Learning

Team-Based Learning as a Feasible, Acceptable, and Effective Educational Method for Internal Medicine Trainees - A Multi-phase Intervention and Cohort Comparison

BACKGROUND

Team-based learning (TBL) is an active learning strategy gaining traction in medical education. However, studies demonstrating successful incorporation into Graduate Medical Education (GME) curricula are limited.

OBJECTIVE

To assess the feasibility, acceptability and efficacy of Infectious Disease (ID) TBL sessions within an Internal Medicine (IM) residency curriculum as part of a traditional 60-minute conference.

DESIGN

We conducted a prospective cohort study of TBL implementation assessing acceptability and feasibility (Phase 1), and efficacy (Phase 2).

PARTICIPANTS

Phase 1 included 101 IM residents and eight TBL naïve faculty. Phase 2 included aggregate cohort IM In-Training Exam (ITE) data before (2008-2013) and after (2014-2019) TBL implementation.

INTERVENTIONS

Eight TBL sessions were delivered once or twice weekly during 60-minute noon conferences.

MAIN MEASURES

We assessed feasibility by measuring individual Readiness Assurance Test (iRAT) completion rates and inclusion of TBL elements in each session; acceptability through attendance, perceived effectiveness rating and attitudes about TBL; efficacy by comparing ITE data for the overall ID content and specific TBL associated learning objectives.

KEY RESULTS

Seventy-five of 93 (80%) residents attended at least one session. All TBL elements were successfully incorporated each session. Of those surveyed, 86% rated the TBL sessions as facilitating their learning "very (4)" or "extremely (5)" well on a 5-point Likert scale (p<0.001). ITE mean percent correct scores of total ID content as well as TBL associated learning objective performance were both significantly higher for the post-TBL cohort among PGY-2 (76.2 vs 62.3; 76.2 vs 62.6) and PGY-3 (73 vs 64.5; 76.2 vs 64.5) IM residents (p<0.05; p<0.001 respectively).

CONCLUSIONS

Implementing a complete TBL pedagogy within the traditional noontime conference hour in GME is feasible, acceptable to residents and faculty, and associated with improved learning efficacy demonstrated through improved ITE scores.

An Opportunity for Change: Principles for Reforming Internal Medicine Inpatient Conferences

Inpatient educational conferences are a key part of internal medicine residency training. Many residencies made conferences virtual during the COVID-19 pandemic, and are now returning to in-person sessions. As we navigate this change, we can seize this opportunity to re-evaluate the role that inpatient conferences serve in resident education. In this paper, we briefly review the history of inpatient educational conferences before offering five recommendations for improvement. Our recommendations include grounding conference formats in educational theory, leveraging the expertise of all potential educators, broadening content to include health equity and justice throughout all curricula, and explicitly focusing on cultivating community among participants. Recognizing that each residency program is different, we anticipate that these recommendations may be implemented differently based on program size, available resources, and current institutional practices. We also include examples of prior successful curricular reforms aligned with our principles. We hope these recommendations ensure inpatient conferences continue to be a central part of residency education for future generations of internal medicine residents.

Academic half days, noon conferences and classroom-based education in postgraduate medical education: a scoping review

BACKGROUND

Classroom-based education (CBE) is ubiquitous in postgraduate medical education (PGME), but to date no studies have synthesized the literature on the topic. We conducted a scoping review focusing on academic half days and noon conferences.

METHODS

We searched 4 databases (MEDLINE [OVID], Embase [OVID], ERIC [EBSCO] and Web of Science) from inception to December 2021, performed reference and citation harvesting, and applied predetermined inclusion and exclusion criteria to our screening. We used 2 frameworks for the analysis: "experiences, trajectories and reifications" and "description, justification and clarification."

RESULTS

We included 90 studies, of which 55 focused on resident experiences, 29 on trajectories and 6 on reification. We classified 44 studies as "description," 38 as "justification" and 8 as "clarification." In the description studies, 12 compared academic half days with noon conferences, 23 described specific teaching topics, and 9 focused on resources needed for CBE. Justification studies examined the effects of CBE on outcomes, such as examination scores (17) and use of teaching strategies in team-based learning, principles of adult learning and e-learning (15). Of the 8 clarification studies, topics included the role of CBE in PGME, stakeholder perspectives and transfer of knowledge between classroom and workplace.

INTERPRETATION

Much of the existing literature is either a description of various aspects of CBE or justification of particular teaching strategies. Few studies exist on how and why CBE works; future studies should aim to clarify how CBE facilitates resident learning within the sociocultural framework of PGME.

Curriculum Transition From Lecture-Based to Team-Based Learning is Associated With Improved Performance on Internal Medicine In-Training Examination

BACKGROUND

Team-based learning (TBL) is an alternative to traditional lectures in graduate medical education, but evidence is scarce regarding its impact on knowledge acquisition and standardized testing performance.

OBJECTIVE

We examined the association between resident performance on the Internal Medicine In-Training Examination (IM-ITE) and these 2 educational methods.

METHODS

In 2013, the internal medicine residency program at Albany Medical College transitioned from a lecture-based curriculum to TBL. Residents enrolled in academic years 2011-2012 and 2012-2013 comprised the lecture cohort, and those enrolled in 2015-2016 and 2016-2017 the TBL cohort. Covariates included the type of medical school attended, gender, and United States Medical Licensing Examination Step 2 Clinical Knowledge scores. We performed univariate analysis and multivariable regression to determine the association between covariates and ITE scores.

RESULTS

Of 120 residents, 60 were in the lecture cohort and 60 in the TBL cohort. The IM-ITE percent correct scores were higher with TBL than lecture (PGY-1 61.0% vs 55.0%, P < .001; PGY-2 69.0% vs 59.7%, P < .001; PGY-3 73.2% vs 61.7%, P < .001). In a multivariable regression analysis of 3 PGYs combined, the transition from lecture to TBL resulted in an increase in IM-ITE Z-score of 0.415 (P < .001), equivalent to 0.415 SD, when including the effects of all covariates.

CONCLUSIONS

Compared to a lecture-based curriculum, TBL was associated with improved resident medical knowledge acquisition as evidenced by higher IM-ITE scores.

A Multicenter VA Study of the Format and Content of Internal Medicine Morning Report

BACKGROUND

There are more than five hundred internal medicine residency programs in the USA, involving 27,000 residents. Morning report is a central educational activity in resident education, but no recent studies describe its format or content.

OBJECTIVE

To describe the format and content of internal medicine morning reports.

DESIGN AND PARTICIPANTS

Prospective observational study of morning reports occurring between September 1, 2018, and April 30, 2019, in ten different VA academic medical centers in the USA.

MAIN MEASURES

Report format, number and type of learner, number and background of attending, frequency of learner participation, and the type of media used. Content areas including quality and safety, high-value care, social determinants of health, evidence-based medicine, ethics, and bedside teaching. For case-based reports, the duration of different aspects of the case was recorded, the ultimate diagnosis when known, and if the case was scripted or unscripted.

RESULTS

A total of 225 morning reports were observed. Reports were predominantly case-based, moderated by a chief resident, utilized digital presentation slides, and involved a range of learners including medicine residents, medical students, and non-physician learners. The most common attending physician present was a hospitalist. Reports typically involved a single case, which the chief resident reviewed prior to report and prepared a teaching presentation using digital presentation slides. One-half of cases were categorized as either rare or life-threatening. The most common category of diagnosis was medication side effects. Quality and safety, high-value care, social determinants of health, and evidence-based medicine were commonly discussed. Medical ethics was rarely addressed.

CONCLUSIONS

Although a wide range of formats and content were described, internal medicine morning report most commonly involves a single case that is prepared ahead of time by the chief resident, uses digital presentation slides, and emphasizes history, differential diagnosis, didactics, and rare or life-threatening diseases.

Exploring Pediatric Resident Attitudes and Preferences for Board Exam Preparation

Objective The American Board of Pediatrics Certifying Exam (ABP CE) is a high stakes exam and is important for employment and fellowship opportunities in pediatrics. Although research has suggested interventions which may improve scores, little research has focused on resident perception of preparation for the ABP CE. In this study, we aimed to better define pediatric residents' attitudes and preferences regarding preparation for the ABP CE. Methods Pediatric residents from one residency program were invited to participate in focus groups to discuss their attitudes and preferences on board exam preparation for the ABP CE. Focus groups were audio recorded and transcribed. Conventional content analysis was used to analyze qualitative data. From the transcripts, authors developed codes through an iterative process, which were then organized into categories. These categories were then grouped into themes. Results Nineteen residents participated in three focus groups. Focus group transcription analysis resulted in 49 codes, which were sorted into 26 categories. The categories were then grouped into four key themes: 1) the ABP CE is not immediately important early in residency; 2) more personalized guidance is preferred; 3) consistent board preparation focus from the residency program is valued; 4) learning format is important. Conclusions Residents believe preparation for the ABP CE increases in importance as they progress through residency, and they desire more personalized, consistent, and structured focus from their training program related to ABP CE preparation. Attention to these perceptions can help guide pediatric residency program leadership in developing effective board exam preparation strategies and curricula for their residents.

About the association of a lecture-based learning and team-based learning in a pathology course

BACKGROUND

Team-based learning (TBL) is an active method of learning aiming to the promotion of the teamwork and improvement of critical thinking. Students of our university weren't used to TBL. We tried to implement a learning session combining TBL and lectures.

METHODS

The study included residents in pathology. The learning scenario consisted in lectures followed by a TBL. Four steps characterized the learning scenario: an individual preparation based on resources made available in the internet by the tutors, an individual readiness assurance test (iRAT) performed during the first 15minutes of the session, a team readiness assurance test (tRAT) and a peer evaluation step. The final students' score was calculated by summing score A (iRAT weighted to 70%) and score C (derived by multiplying the score B [tRAT weighted to 30%] with percentage of peer evaluation). Anova test and Pearson coefficient were used to perform the statistical analyses.

RESULTS

Forty-one residents were included. We assessed an improvement of the tRAT in comparison to iRAT. The only correlations established were between the iRAT and the tRAT and the tRAT and the students' scores.

CONCLUSION

Implementing TBL in medical universities may induce an improvement of the individual knowledge and a change in behaviourism.