The Millennial Generation and "the lecture"

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.

Needs Assessment for a Resuscitative Thoracotomy Curriculum for General Surgery Residents in the Northeast Region

INTRODUCTION

Resuscitative thoracotomy (RT) is a high-acuity low occurrence (HALO) procedure with which general surgical resident (GSR) experience and confidence are unknown. We sought to identify and describe this educational gap by conducting a targeted needs assessment for an RT curriculum for GSRs.

METHODS

An online regional needs assessment survey was conducted for an RT curriculum for GSRs. The survey was developed by a group of trauma stakeholders and revised after being piloted on a small, representative group of GSRs. We surveyed GSRs in the Northeast region regarding their experience and confidence with RT; interest in an RT curriculum; and content, format, and scope for an RT curriculum.

RESULTS

The survey response rate was 43%, reflecting the viewpoints of GSRs at 8 major training centers across the Northeast. Only 13% of respondents were interested in pursuing a career in Trauma and Critical Care despite 97% of them training at a Level I Trauma Center. Twenty-nine percent and 33% of GSRs had ever assisted with or performed RT, respectively. Twenty-one percent of GSRs reported feeling confident performing RT. Most respondents (98%) agreed or strongly agreed that an RT curriculum would add value to their general surgery education. The most positively rated content topics were resuscitative maneuvers (100% positive responses [PR]), when to cease resuscitative efforts (100% PR), and morbidity and mortality associated with RT (98% PR). The most highly rated learning methods were individual RT simulation time (97% PR) and a tour of the trauma bay equipment (97% PR).

CONCLUSIONS

This needs assessment demonstrates a lack of experience and confidence with RT, a strong learner interest in an RT curriculum, and a desire for experiential learning methods. Learning objectives are defined herein, and the next steps involve developing educational materials for an RT curriculum for GSRs.

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.

Generational 'othering': The myth of the Millennial learner

CONTEXT

The health professions education (HPE) literature is replete with recommendations for how educators should adapt practices to the needs of generations of learners using generation theory to bridge perceived differences between learners and educators. Yet the evidence supporting the application of generation theory in HPE has not been critically examined. If unsubstantiated, these applications may perpetuate biases towards learners they are intended to support.

METHODS

This paper critically reviews generation theory in the HPE literature, with particular focus on recent recommendations regarding "Millennial" learners. We used Google Scholar, MEDLINE, EBSCO, JSTOR and PsycINFO to search for articles pertaining to the origins and uses of generation theory within and outside HPE. This synthesis is presented as a preliminary understanding of how ideas of generation theory arose and permeated the HPE literature, and explores the effects of generation theory on education practices.

RESULTS

In the HPE literature, the translation of generation theory into practice recommendations generally follows a pattern consistent with translations advanced in other literatures: broad generalisations drawn from limited data are used as evidence to support instructional approaches specifically designed for generational cohorts. Outside HPE, this application of generation theory has been criticised as a form of stereotyping that ignores the internal differences and diversity inherent in any large group of people. Accordingly, problematising the needs of generations such as "Millennial" learners in the HPE literature may perpetuate narrow or privileged assumptions by educators.

CONCLUSIONS

Generational archetypes such as that of the "Millennial learner" are myths that perpetuate unfounded generalisations about cohorts, reinforce power differentials between age groups, and minimise the unique needs of individuals. To individualise and strengthen teaching practices in HPE, we recommend adopting "generational humility" as a means to more purposefully address the dynamic social, cultural and historical influences that shape individuals within each generation of learners.

Enhancing intern emergency medicine education using a combined didactic and web-based learning curriculum: The EDGE programme

OBJECTIVE

To assess the effectiveness of an education programme that integrates web-based learning into classroom sessions.

METHODS

This prospective study involved a convenience sample of ED interns rotating at two study site hospitals between April 2015 and January 2017. Interns undertook weekly ED classroom-based education and were given access to a web-based learning resource with completion being voluntary. To assess change in medical knowledge multiple choice examinations were administered during week 1 and week 10 of the term. The study's primary end-point was the effect of the web-based resource on participants' knowledge. The median % of online modules completed by participants (75%) was used as a cut-off to create two groups. The % improvement between the test scores at week 1 and week 10 of each group were then compared. Intern satisfaction with the programme was also assessed using a satisfaction survey.

RESULTS

The average examination score for all participants was significantly higher at week 10 than week 1 (80% vs 68%; P < 0.001). The primary end-point, % improvement between the week 1 and week 10 scores of those that completed ≤75% of web-based modules (mean 16%; 95% CI 12-20%) and those that completed >75% of web-based modules (mean 27%; 95% CI 20-34%), showed a statistically significant difference (P = 0.03). Interns surveyed were also highly satisfied with programme.

CONCLUSIONS

This blended curriculum that integrates a web-based resource into classroom learning shows promise in enhancing intern emergency medicine education.

Several Ways Generation Z May Shape the Medical School Landscape

Just as medical colleges have adapted to the Millennial generation of students, a new generation is poised to enter as matriculants. Learner attributes of this generation, Generation Z, are in stark contrast to previous ones, but more than that, they provide new challenges that undergraduate universities are already facing. This article aims to highlight some of these challenges, including those relating to student counseling services, volunteering activities, learning environments, and learner perspectives. These challenges are framed and discussed within the context of medical education.

Fake news, influencers and health-related professional participation on the Web: A pilot study on a social-network of people with Multiple Sclerosis

BACKGROUND

Over the last few decades, patients have increasingly been searching for health information on the Internet. This aspect of information seeking is important, especially for people affected by chronic pathologies and require lifelong treatment and management. These people are usually very well informed about the disease but are nonetheless vulnerable to hopes of being cured or saved, often amplified by misinformation, myths, legends, and therapies that are not always scientifically proven. Many studies suggest that some individuals prefer to rely on the Internet as their main source of information, often hindering the patient-doctor relationship. A professional approach is imperative to maintain confidentiality, honesty, and trust in the medical profession.

OBJECTIVE

we aimed to examine, in a medically supervised Italian web community (SMsocialnetwotk.com) dedicated to people with Multiple Sclerosis (pwMS), the posts shared by users and to verify the reliability of contents of posts shared by users pinpointed as Influencers through an online questionnaire.

METHODS

we grouped the posts published on SMsocialnetwork from April to June 2015 into those with medical content (scientifically correct or fake news), and those related to social interactions. Later, we gave a questionnaire to the community asking to identify the three users/Influencers providing the most reliable advice for everyday life with MS and the three users/Influencers providing the most useful information about MS treatments.

RESULTS

308 posts reported scientific and relevant medical information, whereas 72 posts included pieces of fake news. 1420 posts were of general interest. Four out of the 6 Influencers had written only posts with correct medical information (3 were pwMS, 1 was a Neurologist) and never any fake news. The remaining 2 appointed Influencers (2 pwMS) had written only posts about general interests.

CONCLUSION

the identification of fake news and their authors has shown that the latter are never appointed as Influencers. SMsocialnetwork.com acted as a "web safe environment" where the Influencers contributed by sharing only correct medical information and never fake news. We speculate that the presence of neurologists and psychologists supervising the information flow might have contributed to reduce the risk of fake news spreading and to avoid their acquisition of authoritative meaning.

A Randomized Comparative Trial of the Knowledge Retention and Usage Conditions in Undergraduate Medical Students Using Podcasts and Blog Posts

Introduction

Podcasts and blog posts have gained popularity in Free Open Access Medical education (FOAM). Previous work suggests that podcasts may be useful for knowledge acquisition in undergraduate medical education. However, there remains a paucity of research comparing the two mediums. This study aims to investigate if there are differences in knowledge acquisition and usage conditions by medical students using podcasts and blog posts.

Methods

Medical students were randomized to either the podcast or blog post group. They completed an initial online assessment of their baseline knowledge on the subject matter. Participants then received access to learning materials and were given four weeks to complete the follow-up assessment on their own time. Independent t-test, paired samples t-test, and a mixed ANOVA (analysis of variance) were conducted to assess knowledge acquisition. An intention-to-teach analysis was used to impute missing data from students lost to follow-up. Simple descriptive statistical data was used to describe media usage conditions.

Results

Completion of at least one follow-up assessment was comparable (68% podcasts (n = 21/31), 73% blog posts (n = 22/30)). Both groups showed significant improvements in their test scores, with an average 22% improvement for the podcast group and 29% for the blog post group. There was no significant statistical difference in knowledge acquisition between educational modalities overall. Students in the blog post group that completed both post-intervention quizzes showed a larger improvement than the podcast group in the toxicology topic, with similar improvements in the asthma topic. The podcast group tended to engage in multiple activities while using the learning materials (e.g. at least two to three of the following: driving, eating, chores, taking notes, exercising/walking), while the blog readers tended to do fewer activities (e.g. only one of the following: note taking, eating).

Conclusion

This study suggests that podcasts and blog posts are useful for extracurricular knowledge acquisition by undergraduate medical students with no significant difference between the two modalities. The usage conditions for each type of media differ.

A Needs Assessment for a Longitudinal Emergency Medicine Intern Curriculum

Introduction

A key task of emergency medicine (EM) training programs is to develop a consistent knowledge of core content in recruits with heterogeneous training backgrounds. The traditional model for delivering core content is lecture-based weekly conference; however, a growing body of literature finds this format less effective and less appealing than alternatives. We sought to address this challenge by conducting a needs assessment for a longitudinal intern curriculum for millennial learners.

Methods

We surveyed all residents from the six EM programs in the greater Chicago area regarding the concept, format, and scope of a longitudinal intern curriculum.

Results

We received 153 responses from the 300 residents surveyed (51% response rate). The majority of respondents (80%; 82% of interns) agreed or strongly agreed that a dedicated intern curriculum would add value to residency education. The most positively rated teaching method was simulation sessions (91% positive responses), followed by dedicated weekly conference time (75% positive responses) and dedicated asynchronous resources (71% positive responses). Less than half of respondents (47%; 26% of interns) supported use of textbook readings in the curriculum.

Conclusion

There is strong learner interest in a longitudinal intern curriculum. This needs assessment can serve to inform the development of a universal intern curriculum targeting the millennial generation.

Mobile computing for radiology

The rapid advances in mobile computing technology have the potential to change the way radiology and medicine as a whole are practiced. Several mobile computing advances have not yet found application to the practice of radiology, while others have already been applied to radiology but are not in widespread clinical use. This review addresses several areas where radiology and medicine in general may benefit from adoption of the latest mobile computing technologies and speculates on potential future applications.

Producing a successful PeRLs video

Academic Emergency Medicine publishes selected peer-reviewed videos that present state-of-the-art research, practice, and evidence in the field of emergency medicine. These videos are referred to as peer-reviewed lectures (PeRLs). This commentary reviews considerations for creating, filming, and producing high-quality PeRLs videos.

Faculty development in medical education research

This 2012 Academic Emergency Medicine consensus conference breakout session was devoted to the task of identifying the history and current state of faculty development in education research in emergency medicine (EM). The participants set a future agenda for successful faculty development in education research. A number of education research and content experts collaborated during the session. This article summarizes existing academic and medical literature, expert opinions, and audience consensus to report our agreement and findings related to the promotion of faculty development.