- Email: [email protected]
TF6 Implementation of the Flipped Classroom Model Using VirtualACEP to Teach a Cardiology Curriculum to Emergency Medicine Residents
Research Forum Abstracts
TF3
Medic 5 Calling: Teaching On-Line Medical Direction via Simulation
Nable JV/MedStar Georgetown University Hospital, Washington, DC
Introduction: Emergency physicians must be proficient at providing on-line medical command (OLMC) for out-of-hospital providers. Some emergency medicine (EM) residency programs, however, are located in jurisdictions in which local emergency medical services (EMS) protocols require relatively little OLMC, limiting training opportunities. An OLMC curriculum was developed utilizing simulation scenarios. The primary learners are residents at an EM residency. Study Objectives: The learners’ goals are to have an understanding of their local jurisdictional EMS protocols and to become competent at providing OLMC. Methods: This curriculum involves a self-instructional module to be completed by EM interns during their EMS rotation. In this module, the learners are introduced to the concepts of out-of-hospital protocol development and familiarized with the role of emergency physicians in providing real-time EMS medical control. The module teaches learners a standardized method of receiving out-of-hospital radio reports and providing OLMC. The interns also review their local jurisdictional EMS protocols. A protocol test at the conclusion of their EMS week assesses their knowledge of these protocols. During simulation sessions, EM residents are exposed to OLMC scenarios. In the course of a regular simulation setting (for example, managing an emergency department patient with rapid atrial fibrillation), a simulated nurse hands the resident a radio, noting that a out-of-hospital provider is requesting medical command. Each OLMC scenario has critical criteria that must be met in order for the resident to pass. At the conclusion of the scenario, a faculty preceptor discusses the case with the learner, providing immediate feedback and reinforcing key concepts. Conclusion: Providing OLMC is an important role of practicing emergency physicians. Many EMS protocols have reduced the need to contact physicians for medical orders, limiting opportunities for residents to learn this skill while in training. This novel curriculum introduces the concepts of OLMC through a self-instructional module. Various simulated OLMC scenarios are then utilized to provide exposure and feedback to learners.
TF4
Understanding and Navigating the Emergency Medicine Job Market: A Community Practice Perspective
Uller JK/UCSF-Fresno Medical Education Program, Fresno, CA
Introduction: While residency programs do a good job in clinical training of emergency medicine, there is often little to no formal curriculum teaching residents the business side of our specialty to help them find a job that is a good fit for their professional development and personal needs. This lack of formal training may partially account for the high rate of job turnover of recent graduates, with some residency directors estimating 60-70% of residents change jobs within 5 years. Frequent job turnover can delay professional development and advancement and comes with considerable economic cost as well. It may also contribute to early career burnout. Study Objectives: To provide the senior resident a better understanding of the business side of emergency medicine with emphasis on how to find a job that is the right fit for their professional and personal needs. To introduce financial planning topics frequently encountered during the first few years out of residency. Methods: A formalized job search curriculum done over 4 breakout interactive sessions. They are a mixture of lecture and small-group discussion, each about 55 minutes in length. The target audience is senior level residents who are about to begin their job search. The first session covers an introduction to EM group business structures and a general framework to the job search process. The second session involves a CV and cover letter creation workshop, as well as tips on how to prepare for job interviews. The third session focuses on how to compare jobs, including red flags to look out for, and sections on negotiating and contract issues. The final session covers financial planning topics commonly encountered by emergency physicians in their first few years out of residency. Participants will do a pre-course and post-course survey that reflects their comfort level with the material. Ultimately, success will be determined by their ability to find a job that is a good fit for them. Brief electronic email surveys will be sent out to graduates at 2 years and 5 years intervals to follow up on their overall job happiness as well as
Volume 66, no. 4s : October 2015
to measure job turnover rate. Participants will also give feedback regarding the curriculum, so the material can be updated and modified to their experiences in the job market. Conclusion: High job turnover remains a problem in emergency medicine. Formulation of a more structured job search curriculum may help residents choose jobs that better match their personal and professional needs and help decrease the chance of career burnout. Surveys at 2 and 5 years will measure curricular impact.
TF5
Teaching Effective Opioid Prescribing Through a Simulation Curriculum
Boyle KL/University of Massachusetts Medical School, Worcester, MA
Introduction: The epidemic of opioid-associated deaths poses a daily challenge for emergency medicine physicians as they strive to treat pain. The goal of this work is to develop an educational curriculum for residents regarding safe and evidence-based opioid prescribing. To assess the effectiveness of the curriculum, we will determine the number of prescriptions written by residents for specific diagnoses before and after implementation of the curriculum. These diagnoses were identified as conditions in which opioid prescribing was not recommended in the 2012 American College of Emergency Physicians (ACEP) Clinical Policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department. This curriculum was developed as part of a project supported by the 2014 Medical Toxicology Foundation Drug Abuse Prevention Award. Study Objectives: The goals of this curriculum are to: (1) Describe existing guidelines regarding prescription of opioid pain mediations upon patient discharge from the emergency department (ED); (2) Use a simulation curriculum to offer examples of how to navigate difficult patient conversations and teach residents how to provide effective counseling for patients receiving opioid prescriptions; and (3) Use small group discussion to develop lists of best practices, behaviors to avoid, and predictors of opioid misuse in the ED. The overall objective is to decrease the number of inappropriate opioid prescriptions written by EM residents for patients upon discharge from the ED as defined by the ACEP clinical policy. Methods: The curriculum begins with a short lecture to introduce the scope of the opioid abuse epidemic, as well as the prescribing guidelines that exist for EM providers, specifically the ACEP clinical policy. The majority of the curriculum focuses on a simulation encounter using a standardized patient with video recording, debriefing, and small group discussion. The encounter is conducted with a resident volunteer and standardized patient, and is projected for the entire group to watch. After the encounter, small group discussions are held using five discussion points focused on defining best practices for opioid prescribing by EM providers, as well as strategies for dealing with difficult encounters. At the end of the small group discussion, there is a final simulation encounter performed by the same resident, this time using strategies the group developed during their discussion. To measure the effectiveness of the curriculum, the number of opioid prescriptions written by the group of learners on patient discharge from the ED will be collected for a 3-month period prior to the delivery of the curriculum, and after completion of the curriculum. Additionally, the learners will be asked to complete surveys assessing the extent of their training regarding opioid prescribing and their comfort with prescribing opioids prior to data collection, directly after participation in the curriculum, and after completion of data collection. Conclusion: Safe and effective prescribing of opioid pain medications is an important skill for EM providers. Aside from published guidelines, there is still a paucity of formal educational training available regarding prescribing of opioid medications. This curriculum addresses the urgent need for formal training in residency education regarding opioid prescribing on patient discharge from the ED.
TF6
Implementation of the Flipped Classroom Model Using VirtualACEP to Teach a Cardiology Curriculum to Emergency Medicine Residents
Diller D/Oregon Health & Science University, Portland, OR
Introduction: The “flipped classroom” is an educational model that allows educators to deliver didactic content and new material to students outside the classroom, while using classroom time to address students’ questions and reinforce
Annals of Emergency Medicine S157
Research Forum Abstracts learning through higher order educational methods. VirtualACEP uses a Web-based synchronized audio and slide capture platform that allows for streaming content to be viewed on computers, smartphones, or tablet devices. VirtualACEP contains over 230 hours of educational content delivered at ACEP’s annual conference, and has been approved for AMA PRA Category 1 Credit. Study Objectives: The goals of this project are to demonstrate the feasibility of a flipped-classroom educational model using VirtualACEP to deliver a cardiology curriculum to an emergency medicine residency program and to assess learner satisfaction scores with regards to the curriculum. The objectives are to educate learners on topics including ACS, hypertension, aortic dissection, syncope, CHF, AICDs, LVADs, cardiac arrest care, and the diagnosis and management of cardiac arrhythmias. Methods: The cardiology curriculum will be delivered through the previously described flipped classroom model, using VirtualACEP to deliver new materials via didactic content to emergency medicine residents. Residents will take pre- and postlecture quizzes on the VirtualACEP online platform to demonstrate compliance with pre-conference material. In-conference activities will range from 1-2 hours each during weekly resident conference, and will include the following: team-based learning through EKG analysis, small group case-based discussions with faculty facilitators, team-based learning question and answer sessions featuring both Individual and Group Readiness Assurance Tests (IRAT and GRAT), mock oral boards, and simulation. At the completion of the cardiology curriculum, a mandatory formative assessment will be given to residents, in the form of a 20-30 question take-home multiple-choice quiz. Questions will be selected and modified from the VirtualACEP pre- and post-lecture quizzes. Accompanying the formative assessment will be a fivequestion evaluation on the curriculum itself. Evaluation will also be sought through resident focus group interviews and analysis, performed at the completion of the curriculum. Conclusion: Through a flipped classroom curriculum using VirtualACEP, emergency medicine residents will receive didactic content delivered by some of the country’s best speakers before arriving to conference. In-conference educational content would be delivered through instructional modalities that promote active learning, which has been associated with enhanced learner knowledge and improved standardized exam scores. The cardiology curriculum described in this project would serve as a pilot program for the implementation of an entire emergency medicine residency curriculum through a Web-based, asynchronous approach, using the flipped classroom model to promote further learning. If successful, future studies would look at resident in-service exam scores, and pre- and post-curricular change, to evaluate for differences in learner knowledge retention.
TF7
An Enhanced Deliberate Practice Approach to a Simulation-Based Learning Module
Rice JC/Johns Hopkins Hospital, Baltimore, MD
Background: Deliberate practice (DP) is a method of mastery learning, which employs participants’ full concentration during practice in an effort to continuously improve performance. The basic tenets of DP are described as having a well-defined goal, a motivated learner, feedback during practice and many opportunities for repetition. After learners master a brief task, the task should then be embedded in more complex contexts to fully integrate the skill into the learners’ repertoire. Studies show a DP approach to learning improves performance in procedural skills, resuscitation performance and teamwork dynamics in simulated scenarios, making DP a valued component of simulation-based learning. Recently Dr. William McGaghie, a leader in mastery education, challenged educators to stop reporting data that DP is superior to traditional methods of simulation-based education and to start investigating how to best engineer mastery learning environments. Our residency program currently uses DP in simulationbased modules during which emergency medicine residents repeat a case with a mentor until learning outcomes are met. Our first module is the management of supraventricular tachycardia (SVT). This approach employs the basic tenets of DP, but fails to place the resident in more complex contexts to test and master their skill. Study Objectives: The objective of this project is to create an enhanced DP style simulation-based learning module for the acquisition of mastery knowledge of SVT management. A secondary goal is to determine if the enhanced DP style leads to greater skill retention in resident learners. Methods: A review of emergency medicine practice guidelines and texts was performed for best practices in SVT management. Six case scenarios were created to
S158 Annals of Emergency Medicine
highlight important aspects management in different patient populations. Primary learning objectives were defined for each case and included successful termination of SVT. Secondary learning objectives included the initial approach to critically ill patients and communication skills with ancillary staff. The cases were ordered in increasing difficulty to form a 2-hour module. Residents complete assigned reading on the management of SVT before participating. An individual resident will begin the module with the first case scenario and repeat that case until all learning objectives are met. An instructor will provide feedback between each repetition of the case. They will then proceed to the next case and repeat this process until either they complete all 6 cases or 2 hours elapse. A 10-minute SVT management assessment case was developed with a corresponding checklist evaluation tool. Residents who participated in both the original simulation module and the enhanced DP module will complete the assessment 6-12 months after the SVT module to compare knowledge retention. Conclusion: Best methods for the use of deliberate practice to encourage mastery learning have not been well defined. By increasing the difficulty of cases in a simulation-based learning module, educators can provide more complex contexts for learners to apply newly acquired skills.
TF8
A Team-Based Learning Curriculum Incorporating Simulation for Emergency Medicine Residents
Desmond C/University of Chicago, Chicago, IL
Introduction: Team-based learning (TBL) has been used extensively in undergraduate medical education to various successes. In TBL, education is learner directed, with direct faculty facilitation. One of the objectives of graduate medical education (GME) is to assist trainees in the development of self-directed learning habits and techniques. TBL would be an ideal method for resident learning, but has been rarely studied as a GME-level educational modality. One of the challenges of implementing TBL is dedicated time allocation for the educational activities. Emergency medicine would be the ideal place to test and use TBL. Emergency medicine is one of the few GME programs with 4-5 hours of weekly dedicated conference time, which is ideal to implement this modality. TBL usually has a home learning component followed by an individual and then a team assessment in the classroom. A group discussion and sometimes debate is used to cement the subjects the assessments covered. The last step of TBL is usually an application of the learning. Traditionally this has been another type of assessment with an essay or MCT quiz. However, with the popularity of simulation increasing in medical education it was thought the application portion of the TBL would be the ideal situation to utilize simulation. Study Objectives: The objectives of the program will be to use TBL to help emergency medicine residents: (1) discuss assigned readings in a team environment, (2) interpret and analyze problems related to the assigned topic, and (3) demonstrate what they have learned in a team-based simulation. Methods: The residents will be divided into six teams of 8 participants per group which could be adjusted based on the size of the residency. Each team has an even division of interns, PGY2s and PGY3s. With resident schedules, it is unlikely that each team will have a full eight participants and all activities will be done with whoever is present that day. Every team will have the same reading assignment based on a specific topic related to the module. The reading assignments are shorter readings from blogs or other FOAMed (free open access medicine education) sources to introduce new and efficient learning. At the beginning of each session, there is a short individual assessment followed by a team assessment. Subsequently, a faculty member will facilitate a discussion and directed learning based on the assessment. Finally, each team performed a relevant simulation case with debriefing based on the subject matter. A checklist assessment based on critical actions of the team will be done by a faculty member during the simulation case to assess TBL effectiveness. At the end of the educational year the residents will complete an evaluation. Conclusion: In emergency medicine resident education there is always a need and desire to change the traditional lecture format while also encouraging selfdirected learning to create lifelong learners outside of residency. TBL is an ideal format to do both of these things by introducing the learner to new educational resources, encouraging home learning, and also utilizing simulation to practice new learning. So far, residents have enjoyed and found the TBL sessions interesting and useful.
Volume 66, no. 4s : October 2015
TF3
Medic 5 Calling: Teaching On-Line Medical Direction via Simulation
Nable JV/MedStar Georgetown University Hospital, Washington, DC
Introduction: Emergency physicians must be proficient at providing on-line medical command (OLMC) for out-of-hospital providers. Some emergency medicine (EM) residency programs, however, are located in jurisdictions in which local emergency medical services (EMS) protocols require relatively little OLMC, limiting training opportunities. An OLMC curriculum was developed utilizing simulation scenarios. The primary learners are residents at an EM residency. Study Objectives: The learners’ goals are to have an understanding of their local jurisdictional EMS protocols and to become competent at providing OLMC. Methods: This curriculum involves a self-instructional module to be completed by EM interns during their EMS rotation. In this module, the learners are introduced to the concepts of out-of-hospital protocol development and familiarized with the role of emergency physicians in providing real-time EMS medical control. The module teaches learners a standardized method of receiving out-of-hospital radio reports and providing OLMC. The interns also review their local jurisdictional EMS protocols. A protocol test at the conclusion of their EMS week assesses their knowledge of these protocols. During simulation sessions, EM residents are exposed to OLMC scenarios. In the course of a regular simulation setting (for example, managing an emergency department patient with rapid atrial fibrillation), a simulated nurse hands the resident a radio, noting that a out-of-hospital provider is requesting medical command. Each OLMC scenario has critical criteria that must be met in order for the resident to pass. At the conclusion of the scenario, a faculty preceptor discusses the case with the learner, providing immediate feedback and reinforcing key concepts. Conclusion: Providing OLMC is an important role of practicing emergency physicians. Many EMS protocols have reduced the need to contact physicians for medical orders, limiting opportunities for residents to learn this skill while in training. This novel curriculum introduces the concepts of OLMC through a self-instructional module. Various simulated OLMC scenarios are then utilized to provide exposure and feedback to learners.
TF4
Understanding and Navigating the Emergency Medicine Job Market: A Community Practice Perspective
Uller JK/UCSF-Fresno Medical Education Program, Fresno, CA
Introduction: While residency programs do a good job in clinical training of emergency medicine, there is often little to no formal curriculum teaching residents the business side of our specialty to help them find a job that is a good fit for their professional development and personal needs. This lack of formal training may partially account for the high rate of job turnover of recent graduates, with some residency directors estimating 60-70% of residents change jobs within 5 years. Frequent job turnover can delay professional development and advancement and comes with considerable economic cost as well. It may also contribute to early career burnout. Study Objectives: To provide the senior resident a better understanding of the business side of emergency medicine with emphasis on how to find a job that is the right fit for their professional and personal needs. To introduce financial planning topics frequently encountered during the first few years out of residency. Methods: A formalized job search curriculum done over 4 breakout interactive sessions. They are a mixture of lecture and small-group discussion, each about 55 minutes in length. The target audience is senior level residents who are about to begin their job search. The first session covers an introduction to EM group business structures and a general framework to the job search process. The second session involves a CV and cover letter creation workshop, as well as tips on how to prepare for job interviews. The third session focuses on how to compare jobs, including red flags to look out for, and sections on negotiating and contract issues. The final session covers financial planning topics commonly encountered by emergency physicians in their first few years out of residency. Participants will do a pre-course and post-course survey that reflects their comfort level with the material. Ultimately, success will be determined by their ability to find a job that is a good fit for them. Brief electronic email surveys will be sent out to graduates at 2 years and 5 years intervals to follow up on their overall job happiness as well as
Volume 66, no. 4s : October 2015
to measure job turnover rate. Participants will also give feedback regarding the curriculum, so the material can be updated and modified to their experiences in the job market. Conclusion: High job turnover remains a problem in emergency medicine. Formulation of a more structured job search curriculum may help residents choose jobs that better match their personal and professional needs and help decrease the chance of career burnout. Surveys at 2 and 5 years will measure curricular impact.
TF5
Teaching Effective Opioid Prescribing Through a Simulation Curriculum
Boyle KL/University of Massachusetts Medical School, Worcester, MA
Introduction: The epidemic of opioid-associated deaths poses a daily challenge for emergency medicine physicians as they strive to treat pain. The goal of this work is to develop an educational curriculum for residents regarding safe and evidence-based opioid prescribing. To assess the effectiveness of the curriculum, we will determine the number of prescriptions written by residents for specific diagnoses before and after implementation of the curriculum. These diagnoses were identified as conditions in which opioid prescribing was not recommended in the 2012 American College of Emergency Physicians (ACEP) Clinical Policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department. This curriculum was developed as part of a project supported by the 2014 Medical Toxicology Foundation Drug Abuse Prevention Award. Study Objectives: The goals of this curriculum are to: (1) Describe existing guidelines regarding prescription of opioid pain mediations upon patient discharge from the emergency department (ED); (2) Use a simulation curriculum to offer examples of how to navigate difficult patient conversations and teach residents how to provide effective counseling for patients receiving opioid prescriptions; and (3) Use small group discussion to develop lists of best practices, behaviors to avoid, and predictors of opioid misuse in the ED. The overall objective is to decrease the number of inappropriate opioid prescriptions written by EM residents for patients upon discharge from the ED as defined by the ACEP clinical policy. Methods: The curriculum begins with a short lecture to introduce the scope of the opioid abuse epidemic, as well as the prescribing guidelines that exist for EM providers, specifically the ACEP clinical policy. The majority of the curriculum focuses on a simulation encounter using a standardized patient with video recording, debriefing, and small group discussion. The encounter is conducted with a resident volunteer and standardized patient, and is projected for the entire group to watch. After the encounter, small group discussions are held using five discussion points focused on defining best practices for opioid prescribing by EM providers, as well as strategies for dealing with difficult encounters. At the end of the small group discussion, there is a final simulation encounter performed by the same resident, this time using strategies the group developed during their discussion. To measure the effectiveness of the curriculum, the number of opioid prescriptions written by the group of learners on patient discharge from the ED will be collected for a 3-month period prior to the delivery of the curriculum, and after completion of the curriculum. Additionally, the learners will be asked to complete surveys assessing the extent of their training regarding opioid prescribing and their comfort with prescribing opioids prior to data collection, directly after participation in the curriculum, and after completion of data collection. Conclusion: Safe and effective prescribing of opioid pain medications is an important skill for EM providers. Aside from published guidelines, there is still a paucity of formal educational training available regarding prescribing of opioid medications. This curriculum addresses the urgent need for formal training in residency education regarding opioid prescribing on patient discharge from the ED.
TF6
Implementation of the Flipped Classroom Model Using VirtualACEP to Teach a Cardiology Curriculum to Emergency Medicine Residents
Diller D/Oregon Health & Science University, Portland, OR
Introduction: The “flipped classroom” is an educational model that allows educators to deliver didactic content and new material to students outside the classroom, while using classroom time to address students’ questions and reinforce
Annals of Emergency Medicine S157
Research Forum Abstracts learning through higher order educational methods. VirtualACEP uses a Web-based synchronized audio and slide capture platform that allows for streaming content to be viewed on computers, smartphones, or tablet devices. VirtualACEP contains over 230 hours of educational content delivered at ACEP’s annual conference, and has been approved for AMA PRA Category 1 Credit. Study Objectives: The goals of this project are to demonstrate the feasibility of a flipped-classroom educational model using VirtualACEP to deliver a cardiology curriculum to an emergency medicine residency program and to assess learner satisfaction scores with regards to the curriculum. The objectives are to educate learners on topics including ACS, hypertension, aortic dissection, syncope, CHF, AICDs, LVADs, cardiac arrest care, and the diagnosis and management of cardiac arrhythmias. Methods: The cardiology curriculum will be delivered through the previously described flipped classroom model, using VirtualACEP to deliver new materials via didactic content to emergency medicine residents. Residents will take pre- and postlecture quizzes on the VirtualACEP online platform to demonstrate compliance with pre-conference material. In-conference activities will range from 1-2 hours each during weekly resident conference, and will include the following: team-based learning through EKG analysis, small group case-based discussions with faculty facilitators, team-based learning question and answer sessions featuring both Individual and Group Readiness Assurance Tests (IRAT and GRAT), mock oral boards, and simulation. At the completion of the cardiology curriculum, a mandatory formative assessment will be given to residents, in the form of a 20-30 question take-home multiple-choice quiz. Questions will be selected and modified from the VirtualACEP pre- and post-lecture quizzes. Accompanying the formative assessment will be a fivequestion evaluation on the curriculum itself. Evaluation will also be sought through resident focus group interviews and analysis, performed at the completion of the curriculum. Conclusion: Through a flipped classroom curriculum using VirtualACEP, emergency medicine residents will receive didactic content delivered by some of the country’s best speakers before arriving to conference. In-conference educational content would be delivered through instructional modalities that promote active learning, which has been associated with enhanced learner knowledge and improved standardized exam scores. The cardiology curriculum described in this project would serve as a pilot program for the implementation of an entire emergency medicine residency curriculum through a Web-based, asynchronous approach, using the flipped classroom model to promote further learning. If successful, future studies would look at resident in-service exam scores, and pre- and post-curricular change, to evaluate for differences in learner knowledge retention.
TF7
An Enhanced Deliberate Practice Approach to a Simulation-Based Learning Module
Rice JC/Johns Hopkins Hospital, Baltimore, MD
Background: Deliberate practice (DP) is a method of mastery learning, which employs participants’ full concentration during practice in an effort to continuously improve performance. The basic tenets of DP are described as having a well-defined goal, a motivated learner, feedback during practice and many opportunities for repetition. After learners master a brief task, the task should then be embedded in more complex contexts to fully integrate the skill into the learners’ repertoire. Studies show a DP approach to learning improves performance in procedural skills, resuscitation performance and teamwork dynamics in simulated scenarios, making DP a valued component of simulation-based learning. Recently Dr. William McGaghie, a leader in mastery education, challenged educators to stop reporting data that DP is superior to traditional methods of simulation-based education and to start investigating how to best engineer mastery learning environments. Our residency program currently uses DP in simulationbased modules during which emergency medicine residents repeat a case with a mentor until learning outcomes are met. Our first module is the management of supraventricular tachycardia (SVT). This approach employs the basic tenets of DP, but fails to place the resident in more complex contexts to test and master their skill. Study Objectives: The objective of this project is to create an enhanced DP style simulation-based learning module for the acquisition of mastery knowledge of SVT management. A secondary goal is to determine if the enhanced DP style leads to greater skill retention in resident learners. Methods: A review of emergency medicine practice guidelines and texts was performed for best practices in SVT management. Six case scenarios were created to
S158 Annals of Emergency Medicine
highlight important aspects management in different patient populations. Primary learning objectives were defined for each case and included successful termination of SVT. Secondary learning objectives included the initial approach to critically ill patients and communication skills with ancillary staff. The cases were ordered in increasing difficulty to form a 2-hour module. Residents complete assigned reading on the management of SVT before participating. An individual resident will begin the module with the first case scenario and repeat that case until all learning objectives are met. An instructor will provide feedback between each repetition of the case. They will then proceed to the next case and repeat this process until either they complete all 6 cases or 2 hours elapse. A 10-minute SVT management assessment case was developed with a corresponding checklist evaluation tool. Residents who participated in both the original simulation module and the enhanced DP module will complete the assessment 6-12 months after the SVT module to compare knowledge retention. Conclusion: Best methods for the use of deliberate practice to encourage mastery learning have not been well defined. By increasing the difficulty of cases in a simulation-based learning module, educators can provide more complex contexts for learners to apply newly acquired skills.
TF8
A Team-Based Learning Curriculum Incorporating Simulation for Emergency Medicine Residents
Desmond C/University of Chicago, Chicago, IL
Introduction: Team-based learning (TBL) has been used extensively in undergraduate medical education to various successes. In TBL, education is learner directed, with direct faculty facilitation. One of the objectives of graduate medical education (GME) is to assist trainees in the development of self-directed learning habits and techniques. TBL would be an ideal method for resident learning, but has been rarely studied as a GME-level educational modality. One of the challenges of implementing TBL is dedicated time allocation for the educational activities. Emergency medicine would be the ideal place to test and use TBL. Emergency medicine is one of the few GME programs with 4-5 hours of weekly dedicated conference time, which is ideal to implement this modality. TBL usually has a home learning component followed by an individual and then a team assessment in the classroom. A group discussion and sometimes debate is used to cement the subjects the assessments covered. The last step of TBL is usually an application of the learning. Traditionally this has been another type of assessment with an essay or MCT quiz. However, with the popularity of simulation increasing in medical education it was thought the application portion of the TBL would be the ideal situation to utilize simulation. Study Objectives: The objectives of the program will be to use TBL to help emergency medicine residents: (1) discuss assigned readings in a team environment, (2) interpret and analyze problems related to the assigned topic, and (3) demonstrate what they have learned in a team-based simulation. Methods: The residents will be divided into six teams of 8 participants per group which could be adjusted based on the size of the residency. Each team has an even division of interns, PGY2s and PGY3s. With resident schedules, it is unlikely that each team will have a full eight participants and all activities will be done with whoever is present that day. Every team will have the same reading assignment based on a specific topic related to the module. The reading assignments are shorter readings from blogs or other FOAMed (free open access medicine education) sources to introduce new and efficient learning. At the beginning of each session, there is a short individual assessment followed by a team assessment. Subsequently, a faculty member will facilitate a discussion and directed learning based on the assessment. Finally, each team performed a relevant simulation case with debriefing based on the subject matter. A checklist assessment based on critical actions of the team will be done by a faculty member during the simulation case to assess TBL effectiveness. At the end of the educational year the residents will complete an evaluation. Conclusion: In emergency medicine resident education there is always a need and desire to change the traditional lecture format while also encouraging selfdirected learning to create lifelong learners outside of residency. TBL is an ideal format to do both of these things by introducing the learner to new educational resources, encouraging home learning, and also utilizing simulation to practice new learning. So far, residents have enjoyed and found the TBL sessions interesting and useful.
Volume 66, no. 4s : October 2015