Flipping the Classroom in Graduate Medical Education: A Systematic Review

Foundations of Emergency Medicine: Impact of a Standardized, Open-access, Core Content Curriculum on In-Training Exam Scores

Introduction

Learners frequently benefit from modalities such as small-group, case-based teaching and interactive didactic experiences rather than passive learning methods. These contemporary techniques are features of Foundations of Emergency Medicine (FoEM) curricula, and particularly the Foundations I (F1) course, which targets first-year resident (PGY-1) learners. The American Board of Emergency Medicine administers the in-training exam (ITE) that provides an annual assessment of EM-specific medical knowledge. We sought to assess the effect of F1 implementation on ITE scores.

Methods

We retrospectively analyzed data from interns at four EM residency programs accredited by the Accreditation Council for Graduate Medical Education. We collected data in 2021. Participating sites were geographically diverse and included three- and four-year training formats. We collected data from interns two years before (control group) and two years after (intervention group) implementation of F1 at each site. Year of F1 implementation ranged from 2015-2018 at participating sites. We abstracted data using a standard form including program, ITE raw score, year of ITE administration, US Medical Licensing Exam Step 1 score, Step 2 Clinical Knowledge (CK) score, and gender. We performed univariable and multivariable linear regression to explore differences between intervention and control groups.

Results

We collected data for 180 PGY-1s. Step 1 and Step 2 CK scores were significant predictors of ITE in univariable analyses (both with P < 0.001). After accounting for Step 1 and Step 2 CK scores, we did not find F1 implementation to be a significant predictor of ITE score, P = 0.83.

Conclusion

Implementation of F1 curricula did not show significant changes in performance on the ITE after controlling for important variables.

A Flipped Classroom Pilot in Neonatal Mechanical Ventilation

Background

Pediatric residents frequently manage critically ill neonates but have limited systematic training in mechanical ventilation (MV). Competing demands, varying learner levels, and topic complexity contribute to inconsistent education. A blended learning approach may be ideally suited to achieve meaningful learning but has not been described for this topic and learner.

Objective

To design, implement, and evaluate a flipped classroom for pediatric residents in neonatal MV.

Methods

We used Kern's six-step framework for curricular development to create a flipped classroom curriculum in neonatal MV. Individual prework included interaction with six prerecorded animated whiteboard videos, while in-person learning occurred in small groups at the bedside of a ventilated infant. A mixed-methods evaluation included surveys, quantitative knowledge test scores (before, immediately after, and six months after course completion), and qualitative analysis of participant focus groups.

Results

Twenty-six learners participated in the curriculum. Mean knowledge test scores rose and were sustained after course completion (51% baseline, 82% immediate posttest, 90% retention; P < 0.001). Learners identified various design elements, technology affordances, and instructor factors as meaningful, and they identified unexpected impacts of the curriculum beyond knowledge acquisition, including effects on professional identities, interdisciplinary communication skills, and contribution to the culture of safety.

Conclusion

This curriculum aligned with resident roles, was meaningful to learners, and led to long-term increases in knowledge scores and access to quality education; flipped classroom design using meaningful learning theory and leveraging animated whiteboard technology may be a useful strategy for other highly complex topics in graduate medical education.

From tradition to innovation: a comparison of the traditional 4-step approach versus a blended learning modification for technical skills teaching

BACKGROUND

This experimental study was performed to evaluate the role of blended learning for technical skill teaching on the European Trauma Course (ETC). While online modules are extensively used for theoretical teaching, their role in skills training remains less well explored. The ETC currently relies on the established 4-step technique for teaching technical skills. However, the required large cohort of skilled instructors and the time intensity prove increasingly challenging in a current climate of staff shortages and funding constraints. This study assesses if blended learning, combining pre-course online elements with face-to-face training matches the effectiveness of the traditional 4-step approach whilst being more time-efficient.

METHODS

In a randomised, multi-centre trial, the conventional face-to-face 4-step technique for teaching a skill of medium complexity, the application of a pelvic binder, was compared with an innovative blended approach. It was hypothesised that the blended approach was non-inferior for skill performance measured after the teaching session and after two days (skill retention) with the time needed for teaching and student/teacher satisfaction as secondary outcomes.

RESULTS

Ninety participants, divided into 44 traditional and 46 blended method students, were analysed. Independent-samples t-test showed no significant difference in performance scores and non-inferiority of the blended approach with a half of one standard deviation margin. A statistically significant difference in mean retention scores favored the blended approach. A Mann-Whitney U Test revealed no significant difference in candidate satisfaction levels but a statistically significant difference in instructors' satisfaction levels in favour of the blended approach. Analysis with Welch' t-test demonstrated that the face-to-face teaching time needed for the blended approach was significantly shorter (by 6 min).

CONCLUSIONS

The integration of a blended approach with the 4-step technique for teaching pelvic binder application in the ETC streamlined teaching without compromising skill acquisition quality. This innovative approach addresses traditional limitations and shows promise in adapting medical education to modern learning and teaching demands. We suggest that blended learning could also be applied for other skills taught on life support courses.

TRIAL REGISTRATION

University of Dundee (Schools of Medicine and Life sciences Research Ethics Committee, REC number 22/59, 28th June 2022).

Medical students' perception of online intensive pediatric review: an experimental cross-sectional study

BACKGROUND

Despite regular pediatric education, pediatric instructors regularly provide an on-site intensive pediatric review course (IPR) as per medical students (MS)' request, to summarize pediatric knowledge for fifth-year MS in preparation for their externship. However, considering the coronavirus disease 2019 (COVID-19) pandemic restrictions (e.g., social distancing), an online intensive pediatric review (OIPR) is required instead. Unfortunately, the relationship between MS' perception and outcome of OIPR remains unclear.

METHODS

We developed the OIPR and an online mock pediatric examination (OMPE), aligning it with the essential pediatric components of the Medical Council curriculum. The OIPR comprised of two parts: self-paced online learning and in-class online discussions. The self-paced online learning materials were electronically distributed via Google Classroom to MS ten days priors to the one-day course, which included a pretest, in-class online discussions, posttest, and satisfactory survey. The constructed and validated satisfactory survey was categorized into two parts: demographic data and self-perceived satisfaction with OIPR. For data collection, an anonymous self-administered survey was used and was distributed to MS in April 2022. These data were then analyzed by Wilcoxon signed rank test.

RESULTS

Of the 80 eligible fifth-year MS, 45 agreed to participate (56.3%), of which 24 (53.3%) were females. The mean ± standard deviation (SD) of MS' age was 23 ± 0.6 years. All (100%) concurred that OIPR is beneficial and recommended it to junior students who were planning to take the examination. The mean ± SD of OMPE significantly increased, from 20.9 ± 3.8 to 22.9 ± 3.3 (p = 0.001).

CONCLUSION

During the peak of the COVID-19 pandemic, which required social distancing, OIPR has helped MS summarize and enhance their knowledge in preparation for externship and the examination.

Flipping the Otolaryngology Didactics Curriculum: Results of a Novel Resident Course Structure

OBJECTIVE

To assess the impact of a novel flipped-classroom (FC) otolaryngology resident didactic curriculum on resident learning.

METHODS

Based on the preferences elicited in a survey of preferred learning styles of residents, a hybrid web-based and in-person FC otolaryngology didactic curriculum was implemented over a 6-month period in 2020-2021. Resident reactions to the new curriculum were assessed via a second survey. Kruskal Wallis tests were used to compare mean stanine scores on the Otolaryngology Training Examination (OTE) exam for topics taught in the new format with topics delivered in the old format.

RESULTS

After instituting the curriculum reform, engagement in at least a moderate amount of the pre-didactic work and synchronous case discussions was reported by 67% and 88% of the residents, respectively. After the curriculum change, residents in years PGY2 and above reported statistically significant increases in self-reported ability to retain information from didactics, to feel prepared for the OTE, and to feel confident in fund of knowledge (p < 0.001, p = 0.004, and p = 0.004, respectively). Compared to the prior year, mean stanine increased on OTE scores for residents in years PGY2-PGY5 to a statistically significant degree (5.45 vs. 4.41, p = 0.001) for the topics delivered in the new format compared to topics delivered in the traditional format (5.13 vs. 4.70, p = 0.07).

CONCLUSION

By organizing a didactic curriculum through online modules that incorporate pre-recorded lectures and external resources, residents reported and demonstrated improved knowledge retention.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:2129-2134, 2023.

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.

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.

Flipped classroom applied to Neurosurgery in undergraduate medical education

PURPOSE

To compare the academic achievement obtained in Neurosurgery in a class of undergraduate students according to the pedagogical methodology employed: flipped classroom (FC) versus traditional lecture. Students' satisfaction with the FC model is also analyzed.

METHODS

A quasi-experimental study was designed. The traditional lecture was the pedagogical method employed in teaching units (TUs) 1, 2, and 3 (61, 60, and 66 enrolled students, respectively), whereas TU 4 (69 enrolled students) used the FC methodology.

RESULTS

The dropout rate was lower, whereas the academic achievement and the rate of correct answers were higher in TU 4 compared to the rest of the TUs, but these results were not statistically significant. However, the mean score obtained in Neurosurgery was significantly higher in TU 4 compared to the rest of the TUs (p = 0.042). Active learning activities based on clinical cases were positively emphasized. The main weakness was with the time consumed for video-recorded lecture viewing.

CONCLUSIONS

The FC approach showed better academic results than traditional lectures when comparing students in the same Medical School during the same academic year undergoing the same exam. The students rated the FC approach positively, considering it stimulating and useful for learning.

The effect of flipped classroom in multiple clinical skills training for clinical interns on Objective Structured Clinical Examinations (OSCE)

AIMS

The flipped classroom (FC) is a hybrid approach, combining online learning and face-to-face classroom activities. To comprehensively evaluate the role of the Flipped Classroom (FC) model in clinical skills teaching of medical interns and investigate the acceptance and recognition of FC and Objective Structured Clinical Examinations (OSCE).

METHODS

In the teaching of clinical skills, the students were further grouped into two groups- A and B (A = 37, B = 42), using a computer-based random digital method. group A adopted the traditional classroom (TC) model, and group B adopted the FC model. OSCE was used to assess the clinical skills of the two groups of interns. Two independent sample t-test was used to analyze the difference of participant's demographic data and OSCE scores between the two different teaching model. We sent FC questionnaires to group A and OSCE questionnaires to groups A and B.

RESULTS

The score of OSCE in group B was higher than that in group A (P = 0.024), especially in the heart physical examination (P < 0.050), lung physical examination (P < 0.050), and abdominal physical examination (P < 0.050). The result of the FC questionnaires showed that regarding online courses, most students in group B thought watching videos was a good way to prepare for class (97.6%), For offline courses, most medical interns said that it enhanced their learning ability (88.1%), and they could accept this form of teaching (85.7%). As for the form of OSCE questionnaires, most people in group A and B said that they knew more about this form of assessment (81.0%), that it truly reflected the clinical ability (82.3%).

CONCLUSIONS

FC model has shown good results in clinical skills training, while FC and OSCE can be further promoted in future teaching and assessment.

Integration of a Simulation Curriculum Across Semesters in an Acute Care Pediatric Nurse Practitioner Program

INTRODUCTION

Simulation is a common strategy for health care education. Research regarding simulation for nurse practitioner education is sparse. This paper describes the integration of a nine simulation session curriculum into a nurse practitioner program, including motivating factors, process description, and lessons learned.

RESULTS

Students report high satisfaction and improved perception of confidence and competence of knowledge, skills, and performance.

DISCUSSION

Integrated learning experiences and outcomes that span an educational program are needed in thetransition to competency-based education. This description serves as a guide for other programs seeking to incorporate simulation-based education.

A comparative analysis of the impact of online, blended, and face-to-face learning on medical students' clinical competency in the affective, cognitive, and psychomotor domains

BACKGROUND

The Coronavirus Disease-2019 (COVID-19) pandemic in South Africa compelled medical schools to switch to a purely online curriculum. The innovative changes transformed the standard clinical skills curriculum to increase learning transfer to bridge the theory-practice gap. The efficacy of this intervention remains unknown. This study aims to measure medical students' clinical competency in the affective, cognitive, and psychomotor domains by assessing clinical skills knowledge retention and transfer from the online platform compared to face-to-face and blended learning.

METHODS

A non-random cross-sectional quasi-experimental study assessed third-year medical students' knowledge retention and learning transfer in three domains of clinical skills competence. Data were obtained using a score sheet during a directly observed formative and a trial online summative assessment. One hundred and one third-year medical students volunteered for the formative onsite assessment that tested the psychomotor domain. Two hundred and thirty-nine students were evaluated on the affective and cognitive domains in the summative online trial mini-objective structured clinical examination (tm-OSCE). The OSCE scores were analysed using descriptive statistics. The significance of the findings was evaluated by comparing OSCE scores with the pre-pandemic 2019 third-year medical students.

RESULTS

Statistically significant differences were found between the two cohorts of medical students from both years (p < 0.05). The 2021 blended group's (n = 101) medians were 90%, 95%CI [86, 92], 82%, 95%CI [80, 85], and 87%, 95% CI [84, 90] for the psychomotor, affective, and cognitive skills, respectively. The e-learning group's affective and cognitive skills medians were 78%, 95%CI [73, 79] and 76%, 95%CI [71, 78], respectively. The 2019 face-to-face cohort (n = 249) achieved medians of 70%, 95% CI [69, 72] and 84%, 95%CI [82, 86] for the affective and psychomotor skills, respectively.

CONCLUSION

Medical students demonstrated near and far transfer bridging the theory-practice gap in three clinical skills domains. The blended group performed significantly better than the e-learning and face-to-face groups. Medical schools and educators play a vital role in overcoming learning challenges and achieving higher transfer levels by adopting multiple student-centered teaching delivery approaches and arranging immediate application opportunities. This study offers medical educators suggestions that encourage the transfer of online learning to face-to-face practice, decentralising medical education with a revised blended learning strategy.

Distribution of core content coverage among three popular emergency medicine podcasts: A 10-year analysis

Objective

Podcasts are increasingly utilized as educational tools within emergency medicine (EM). As EM residency programs seek to incorporate asynchronous educational material, it is important to ensure we are covering the full breadth of EM core content. This study sought to describe the distribution of EM core content among three popular EM podcasts.

Methods

We performed a retrospective study of the distribution of podcast topics among three popular EM podcasts from July 2011 to June 2021. We evaluated the podcast episode content and alignment with the EM core content, as defined by the Model of the Clinical Practice of Emergency Medicine (MCPEM) and American Board of Emergency Medicine (ABEM) examination distribution. Data are presented descriptively.

Results

We identified 2759 podcast episodes, consisting of 7413 total topics and 2498.7 hours of content. The most frequently covered topics were "signs, symptoms, and presentations" (20.1% of total hours vs. 7.9% of MCPEM and 10.0% of ABEM exam) and "procedures and skills integral to the practice of emergency medicine" (14.8% of total hours vs. 8.1% of MCPEM and 8.0% of ABEM exam). The least frequently covered topics was were "immune system disorders"(0.5% of total hours vs. 2.0% of MCPEM and 2.0% of ABEM exam),"environmental disorders"(0.8% of total hours vs. 2.4% of MCPEM and 2.0% of ABEM exam), "obstetrics and gynecology" (1.0% of total hours vs. 5.4% of MCPEM and 3.0% of ABEM exam), and "cutaneous disorders" (0.9% of total hours vs. 4.3% of MCPEM and 3.0% of ABEM exam).

Conclusions

Our findings suggest an imbalance of MCPEM core content in three popular EM podcasts.

Comparison between two asynchronous teaching methods in an undergraduate dental course: a pilot study

BACKGROUND

Properly designed and implemented eLearning can lead to improvement of dental teaching quality. Various strategies have been proposed to increase the effectiveness of eLearning in dental education, however, there is a lack of research to assess the effectiveness of these strategies.

OBJECTIVE

To investigate dental students' learning performance and perception of a virtual flipped learning format compared to a virtual traditional learning method.

METHODS

A crossover pilot study was conducted at the College of Dentistry, Princes Sattam Bin Abdulaziz University, Saudi Arabia. Computer-generated randomization, blinded from researchers who analyzed the results, was performed to allocate 32 participants (aged 23.27 ± 0.86 years) to one of two groups. Participants in the control group were taught through the virtual traditional learning method (VTL) using live video lectures. In contrast, participants in the intervention group were taught through the virtual flipped learning method (VFL) using recorded online lectures and post-lecture virtual discussions. Learning gain and preference were measured by pre- and post-test average score differences and a modified validated survey, respectively.

RESULTS

There was no significant difference in learning performance between VFL and VTL groups (P > 0.05). However, students preferred VFL over VTL and the differences were significant among all survey items, except for the opportunity to ask questions.

CONCLUSION

Health professions educators are encouraged to carefully design online curricula with efficient learning strategies that help students improve learning performance and foster self-directed learning skills while valuing active learning in an online environment.

TRIAL REGISTRATION

NCT04692142 , 31/12/2020.

Impact of Simulation on Critical Care Fellows’ Electroencephalography Learning

Introduction

Continuous electroencephalography (EEG) is an important monitoring modality in the intensive care unit and a key skill for critical care fellows (CCFs) to learn. Our objective was to evaluate with CCFs an EEG educational curriculum on a web-based simulator.

Methods

This prospective cohort study was conducted at a major academic medical center in Florida. After Institutional Review Board approval, 13 CCFs from anesthesiology, surgery, and pulmonary medicine consented to take an EEG curriculum. A 25-item EEG assessment was completed at baseline, after 10 EEG interpretations with a neurophysiologist, and after 10 clinically relevant EEG-based simulations providing clinical EEG interpretation hints. A 50-minute tutorial podcast was viewed after the baseline assessment. Main assessment outcomes included multiple outcomes related to web-based simulator performance: percent of hints used, percent of first words on EEG interpretation correct, and percent hint-based EEG interpretation score correct, with higher scores indicating more correct answers. Participants completed a 25-item EEG assessment before (baseline) and after the web-based simulator.

Results

All 13 CCFs completed the curriculum. Between scenarios, there were differences in percent of hints used (F_9,108 = 11.7, p < 0.001), percent of first words correct (F_9,108 = 13.6, p < 0.001), and overall percent hint-based score (F_9,108 = 14.0, p < 0.001). Nonconvulsive status epilepticus had the lowest percent of hints used (15%) and the highest hint-based score (87%). Overall percent hint-based score (mean across all scenarios) was positively correlated with change in performance as the number of correct answers on the 25-item EEG assessment from before to after the web-based simulator activity (Spearman’s rho = 0.67, p = 0.023).

Conclusions

A self-paced EEG interpretation curriculum involving a flipped classroom and screen-based simulation each requiring less than an hour to complete significantly improved CCF scores on the EEG assessment compared to baseline.

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.

Development, Implementation, and Evaluation of an Open Access, Level-Specific, Core Content Curriculum for Emergency Medicine Residents

BACKGROUND

Leaders in graduate medical education must provide robust clinical and didactic experiences to prepare residents for independent practice. Programs traditionally create didactic experiences individually, requiring tremendous resources with variable content exposure and quality.

OBJECTIVE

We sought to create and implement a free, open access, learner-centric, level-specific, emergency medicine (EM) residency curriculum.

METHODS

We developed Foundations of Emergency Medicine (FoEM) Foundations I and II courses using Kern's model of curriculum development. Fundamental topics were identified through content guidelines from the American Board of Emergency Medicine. We incorporated learner-centric strategies into 2 flipped classroom, case-based courses targeting postgraduate year (PGY) 1 and PGY-2 residents. The curriculum was made freely available online in 2016. Faculty and resident users were surveyed annually for feedback, which informed iterative refinement of the curriculum.

RESULTS

Between 2016 and 2020, registration for FoEM expanded from 2 sites with 36 learners to 154 sites and 4453 learners. In 2019, 98 of 102 (96%) site leaders and 1618 of 2996 (54%) learners completed the evaluative survey. One hundred percent of responding leaders and 93% of learners were "satisfied" or "very satisfied" with FoEM content. Faculty and residents valued FoEM's usability, large volume of content, quality, adaptability, organization, resident-faculty interaction, and resident-as-teacher opportunities. Challenges to implementation included resident attendance, conference structure, technology limitations, and faculty engagement.

CONCLUSIONS

We developed and implemented a learner-centric, level-specific, national EM curriculum that has been widely adopted in the United States.

Massive Open Online Courses Combined with Flipped Classroom: An Approach to Promote Training of Resident Physicians in Rheumatology

Background

This study aims to evaluate the feasibility, acceptability, and effectiveness of massive open online courses (MOOCs) in combination with flipped classroom teaching in the standard training of resident physicians (resident physician trainees).

Methods

A total of 110 resident physician trainees enrolled in 2018, with a major in Internal Medicine, were selected and divided into a control group (n = 55) who experienced traditional teaching methods and an experimental group (n = 55) who experienced MOOCs plus flipped classroom teaching. Their post-class test scores and satisfaction questionnaires were compared.

Results

The test scores (80.60 ± 7.65) of resident physician trainees in the experimental group were higher than those of the control group (77.05 ± 8.08), and the difference was statistically significant (P < 0.05). The experimental group trainees were highly satisfied with the MOOC + flipped classroom program.

Conclusion

MOOCs in combination with flipped classroom teaching can increase the effectiveness of teaching in the standard training for resident physicians and trainees' comprehensive clinical diagnosis and treatment ability.

Value, Strengths, and Challenges of e-Learning Modules Paired with the Flipped Classroom for Graduate Medical Education: A Survey from the National Neonatology Curriculum

OBJECTIVE

This study aimed to determine the value, strengths, and challenges of implementing an e-learning based flipped classroom (FC) educational modality as part of the standardized physiology National Neonatology Curriculum (NNC), created for neonatal-perinatal medicine (NPM) fellow learners and faculty educators.

STUDY DESIGN

This is a cross-sectional study of NPM fellows and faculty educators who utilized at least one of the e-learning based NNC FC respiratory physiology programs between May and September 2018. Participants were surveyed anonymously regarding their experiences participating in the NNC, including measures of preparation time. A combination of descriptive statistics and proportion comparisons were used for data analysis.

RESULTS

Among 172 respondents, the majority of fellow and faculty respondents reported positive attitudes toward the educational content and case discussions, and the majority supported national standardization of NPM physiology education (92%). Fellows reported greater preclass preparation for their FC compared with previous didactic lectures (30-60 vs. 0-15 minutes, p < 0.01). Faculty facilitators reported less preparation time before facilitating a FC compared with the time required for creating a new didactic lecture (median: 60 vs. 240 minutes, p < 0.01). Both fellows and faculty respondents preferred the FC approach to traditional didactics, with fellows showing a greater degree of preference than faculty (68 vs. 52%, respectively, p = 0.04).

CONCLUSION

Fellows and faculty educators supported the FC learning, reporting peer-to-peer learning, and the establishment of a learning community which promotes adult learning and critical thinking skills. A national physiology curriculum creates equitable and engaging educational experiences for all NPM fellows while reducing individual program burden of content creation. Our findings further supported the development of an NNC using a flipped classroom modality.

Remote Medical Education: Adapting Kern's Curriculum Design to Tele-teaching

COVID-19 has necessitated a rapid shift to the remote delivery of medical education. We present a timely collection of tips, techniques, and strategies for the facilitation of remote teaching sessions and modification of curriculum design, assessment, and evaluation. We step through Kern's six-step curriculum design, recommending to (1) consider session necessity and a variety of teaching models; (2) inform your session with surveys and polls; (3) keep session endpoints consistent; (4) make the most of technology and translate in-person strategies to virtual forms; (5) engage with individual learners and eliminate distractions; and (6) consider online methods of assessment and evaluation methods.

Educating Anesthesiologists During the Coronavirus Disease 2019 Pandemic and Beyond

The coronavirus disease 2019 (COVID-19) pandemic has altered approaches to anesthesiology education by shifting educational paradigms. This vision article discusses pre-COVID-19 educational methodologies and best evidence, adaptations required under COVID-19, and evidence for these modifications, and suggests future directions for anesthesiology education. Learning management systems provide structure to online learning. They have been increasingly utilized to improve access to didactic materials asynchronously. Despite some historic reservations, the pandemic has necessitated a rapid uptake across programs. Commercially available systems offer a wide range of peer-reviewed curricular options. The flipped classroom promotes learning foundational knowledge before teaching sessions with a focus on application during structured didactics. There is growing evidence that this approach is preferred by learners and may increase knowledge gain. The flipped classroom works well with learning management systems to disseminate focused preclass work. Care must be taken to keep virtual sessions interactive. Simulation, already used in anesthesiology, has been critical in preparation for the care of COVID-19 patients. Multidisciplinary, in situ simulations allow for rapid dissemination of new team workflows. Physical distancing and reduced availability of providers have required more sessions. Early pandemic decreases in operating volumes have allowed for this; future planning will have to incorporate smaller groups, sanitizing of equipment, and attention to use of personal protective equipment. Effective technical skills training requires instruction to mastery levels, use of deliberate practice, and high-quality feedback. Reduced sizes of skill-training workshops and approaches for feedback that are not in-person will be required. Mock oral and objective structured clinical examination (OSCE) allow for training and assessment of competencies often not addressed otherwise. They provide formative and summative data and objective measurements of Accreditation Council for Graduate Medical Education (ACGME) milestones. They also allow for preparation for the American Board of Anesthesiology (ABA) APPLIED examination. Adaptations to teleconferencing or videoconferencing can allow for continued use. Benefits of teaching in this new era include enhanced availability of asynchronous learning and opportunities to apply universal, expert-driven curricula. Burdens include decreased social interactions and potential need for an increased amount of smaller, live sessions. Acquiring learning management systems and holding more frequent simulation and skills sessions with fewer learners may increase cost. With the increasing dependency on multimedia and technology support for teaching and learning, one important focus of educational research is on the development and evaluation of strategies that reduce extraneous processing and manage essential and generative processing in virtual learning environments. Collaboration to identify and implement best practices has the potential to improve education for all learners.

The use of virtual physician mentoring to enhance home dialysis knowledge and uptake

Home dialysis therapies are flexible kidney replacement strategies with documented clinical benefits. While the incidence of end-stage kidney disease continues to increase globally, the use of home dialysis remains low in most developed countries. Multiple barriers to providing home dialysis have been noted in the published literature. Among known challenges, gaps in clinician knowledge are potentially addressable with a focused education strategy. Recent national surveys in the United States and Australia have highlighted the need for enhanced home dialysis knowledge especially among nephrologists who have recently completed training. Traditional in-person continuing professional educational programmes have had modest success in promoting home dialysis and are limited by scale and the present global COVID-19 pandemic. We hypothesize that the use of a 'Hub and Spoke' model of virtual home dialysis mentorship for nephrologists based on project ECHO would support home dialysis growth. We review the home dialysis literature, known educational gaps and plausible educational interventions to address current limitations in physician education.

One Room Schoolhouse: A Novel Intervention for Inspired Academic Half-Day Learning in Distributed Campus Settings

INTRODUCTION

Some studies on academic half days (AHDs) suggest that learning in this context is associated with a lack of educational engagement. This challenge may be amplified in distributed campus settings, where geographical disadvantages demand reliance on videoconferencing or considerable time spent travelling to in-person learning events. Concerns about the educational effectiveness of AHDs by learners within our distributed campus setting led to the development and evaluation of the One Room Schoolhouse (ORS), a unique, evidence-informed, community-based curriculum that partially replaced the AHD sessions delivered at the main campus. It was hypothesized that creating an AHD experience that was clinically reflective of the community in which residents practiced and where residents were given the autonomy to implement novel pedagogical elements would result in better test scores and improved learner satisfaction among ORS learners.

METHODS

The ORS was implemented at McMaster University's Waterloo Regional Campus in 2017. Residents across training cohorts (N = 9) engaged in co-learning based on scenarios co-developed from clinical experiences within the region. The learning approach relied on multiple, evidence-informed pedagogical strategies. A multi-method approach was used to evaluate the ORS curriculum. Between-subject analyses of variance were used to compare scores on practice exams (COPE and PRITE), in-training assessment reports (ITARs), and objective structured clinical exams (OSCEs) between learners who took part in the ORS and learners at the main campus. A semi-structured focus group probing residents' experiences with the ORS was analyzed using interpretive description.

RESULTS

ORS learners significantly outperformed learners at the main campus on the November OSCE (p = .02), but not on the COPE, PRITE, ITARs, or September OSCE (p's < .05). Qualitative themes suggested advantages of the ORS in inspiring learning, engaging learners, and improving self-confidence in knowledge acquisition. These findings are aligned with the broader literature on learner agency, social development, and communities of practice.

CONCLUSION

While the quantitative data only showed a significant difference between the 2 curricula on 1 measure (ie, the November OSCE), the qualitative findings offered an opportunity for educators to reimagine what medical education might consist of beyond the confines of a "traditional" AHD. Creating opportunities to enhance personal agency when acquiring knowledge, inspiring engagement about patient-related problems, and incorporating interdisciplinary learning through community engagement were critical pedagogical elements that were attributed to the success of the ORS.

Consideraciones acerca del aula invertida AI (FLIPPED CLASSROOM)

La necesidad de mejorar las competencias de los futuros profesionales en salud ha conducido a repensar la manera como se imparten los conocimientos a los estudiantes y de cómo ellos podrían aprender de manera significativa. Actualmente, el aula invertida (AI) o flipped classroom (FC) se convierte en una estrategia de enseñanza alternativa en el campo de la educación en salud. Incentiva el aprendizaje del estudiante al promover la autonomía en el abordaje de los conocimientos antes de cada clase, favorece la motivación, el aprendizaje activo, colaborativo y significativo durante las sesiones presenciales, de tal manera que permite desarrollar el pensamiento crítico para una formación profesional idónea. Al realizar una revisión de la literatura se evidenció un amplio uso del AI en educación en salud con resultados positivos frente a la educación tradicional. Además, las tecnologías juegan un papel importante para presentar contenidos y ejecutar actividades fuera y dentro del aula. Se presentan algunas evidencias de la efectividad del AI en educación médica, cómo podría implementarse en nuestras aulas y la diversidad de recursos disponibles para usar en los diferentes escenarios que plantea esta estrategia.

Pilot Study of an Online Self-Directed Learning Module for Medical Decision-Making Capacity

OBJECTIVE

This study assessed the impact of an online, self-directed learning module on medical student knowledge and attitudes regarding decision-making capacity.

METHODS

The authors created a 15-min didactic video on decision-making capacity and sorted medical students on the psychiatry clerkship to teaching as usual or teaching as usual plus watching the video. The authors assessed student knowledge about and attitudes toward decisional capacity assessment using a pre/posttest design.

RESULTS

Thirty-eight students completed the study (24% of all psychiatry clerkship students in one academic year). Students who watched the video (n = 14) achieved higher scores on the posttest compared with students who did not watch the video (n = 24) (90% vs 84% on general knowledge and case examples), though this difference was small and not statistically significant. The degree of improvement from pretest to posttest was higher for students who watched the video but did not reach statistical significance.

CONCLUSIONS

Overall, students found the online teaching module to be a helpful augmentation strategy for learning decisional capacity assessment. The authors incorporated student feedback and additional review to create an enhanced video, which is available on ADMSEP's Clinical Simulation Initiative website.

Conference Didactic Planning and Structure: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors

Emergency medicine residency programs around the country develop didactic conferences to prepare residents for board exams and independent practice. To our knowledge, there is not currently an evidence-based set of guidelines for programs to follow to ensure maximal benefit of didactics for learners. This paper offers expert guidelines for didactic instruction from members of the Council of Emergency Medicine Residency Directors Best Practices Subcommittee, based on best available evidence. Programs can use these recommendations to further optimize their resident conference structure and content. Recommendations in this manuscript include best practices in formatting didactics, selection of facilitators and instructors, and duration of individual sessions. Authors also recommend following the Model of Clinical Practice of Emergency Medicine when developing content, while incorporating sessions dedicated to morbidity and mortality, research methodology, journal article review, administration, wellness, and professionalism.

Impact of a case-based collaborative learning curriculum on knowledge and learning preferences of dermatology residents

Objective

Case-based collaborative learning (CBCL) models that incorporate learner-guided content review, structured preparatory assessment, and interactive case-based classroom sessions have been shown to promote content mastery among medical students. However, limited research has explored the viability of CBCL in resident populations, particularly in dermatology. We therefore sought to investigate the impact of a CBCL curriculum covering complex medical dermatology topics on resident knowledge and learning preferences.

Methods

This prospective cohort study included dermatology and combined internal medicine-dermatology resident trainees of all levels (postgraduate years 2–5) in a single residency program in Boston, Massachusetts. Four CBCL sessions covering complex medical dermatology topics were delivered to program residents between March and April 2019. Preparatory material for each session included a 20-minute concept video and a multiple-choice readiness assessment. During the sessions, residents applied their nascent understanding to newly introduced clinical vignettes and cases covering the preassigned materials. To assess knowledge and learner preferences, 15-question surveys were administered before and immediately after curriculum delivery. Changes in knowledge and learner preferences were determined using Student t tests to compare means and χ² tests to compare proportions.

Results

Of the 30 residents, 29 (96.7%) completed the precurriculum survey and 17 (56.7%) completed the postcurriculum survey. Mean content scores improved significantly (p < .01) from presession (x̅ 5.70; σ 1.88) to postsession (x̅ 9.71; σ 1.88). The majority of respondents indicated a preference for future CBCL sessions, with learning preferences remaining stable over time.

Conclusion

In this single-center prospective cohort study, resident knowledge improved significantly after CBCL curriculum delivery. Most resident learners viewed the curriculum as worthwhile and preferred it to traditional lecture-based didactics. Collectively, our findings suggest that CBCL models can be feasibly implemented and durably convey complex content to resident learners.

Emergency Medicine Education Research Since the 2012 Consensus Conference: How Far Have We Come and What's Next?

In 2012, the Society for Academic Emergency Medicine convened a consensus conference on the state of medical education research with goals of defining and advancing a future research agenda. Since that time, emergency medicine (EM) education research has grown significantly. A task force of EM education experts was assembled and sought to understand the current state of EM education research and future directions. Among the advances are increases in medical education fellowships, advanced degree and certification programs, faculty development programs, publication venues, and funding. These findings are discussed in light of the prior objectives from the 2012 consensus conference, and recommendations for future directions are provided.

Case-Based Curriculum With Integrated Smartphone Applications Improves Internal Medicine Resident Knowledge Of Contraceptive Care

BACKGROUND

Contraception is an essential preventive service for all women. However, the literature suggests that internal medicine residents have low levels of confidence and knowledge of contraceptive care.

OBJECTIVE

We designed and implemented a novel contraception curriculum promoting active, collaborative learning. We sought to evaluate whether this curriculum improved internal medicine resident knowledge of and comfort with contraceptive care through the administration of pre-/post-surveys.

METHODS

Our curriculum was delivered in a two-hour session as part of the mandatory ambulatory curriculum for internal medicine interns at our institution in the academic year 2017-2018. Interns were provided with select online resources and two smartphone applications at the beginning of the session, which they then used in case-based small group work. Small group work was followed by a large group case review, co-facilitated by OB/GYN and internal medicine faculty.

RESULTS

Thirty-eight participants completed surveys assessing knowledge of and comfort with contraceptive care immediately before and after the curriculum; 20 participants completed surveys assessing the same domains 4-6 months after the curriculum. Data from surveys administered immediately post-curriculum demonstrated significant improvements in knowledge about and comfort with counseling about, assessing medical eligibility for, and initiating multiple forms of contraception. Many of these improvements in knowledge and comfort were maintained on follow-up surveys 4-6 months following the curriculum.

CONCLUSION

Our case-based curriculum with integrated smartphone applications resulted in significant improvements in internal medicine resident knowledge of and comfort with the key skills of contraceptive care. In contrast to active, collaborative learning methodologies such as the flipped classroom, our methodology supports active, collaborative learning without requiring advance learner preparation, and is thus well suited to the time constraints of the graduate medical education setting. Our methodology is readily translatable to other clinical topics and residency curricula.

Flipping the Classroom: How to Optimize Learning in the Didactic Setting

Classic classroom education emphasizes the teacher imparting knowledge, experience, or wisdom (pedagogy). Adult educational theory indicates learning is optimized in an experiential setting, where the learner prepares, the session is case based, and the responsibility of the educator is to teach what the learner does not know. This is referred to as "flipping the classroom." Flipping the classroom is not simple, as the historical educational culture often changes; and, at least early in the transition process, different expectations, preparation, or training are essential for both the learner and educator for this approach to be effective.