Quantitative Study of the Characteristics of Effective Internal Medicine Noon Conference Presentations

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.

A Critical Appraisal and Targeted Intervention of the Oncology Experience in an Internal Medicine Residency

Most oncology education is provided to residents on an inpatient oncology service, with limited outpatient exposure. There exists considerable need to develop effective education strategies to teach resident physicians basic concepts in oncology. We created a 2-hour small-group interactive workshop, using interactive cases, followed by a number of questions regarding curability, survival, and possible treatment options. All residents were asked to fill out optional questionnaires before and after this workshop. A total of 64 residents participated in this study with an average of 16 residents per session. Significant deficits in knowledge were identified, and prognosis was estimated correctly by 40% of residents when presented with a variety of clinical scenarios. We demonstrated an increase in comfort level in basic oncology concerns, comfort level at estimating prognosis, and managing toxicity based on pre- and post-level testing. Our results confirm that the oncology inpatient rotation may not be adequate in educating residents. The format of our workshop demonstrates that it is possible to create and implement a focused intervention with fairly limited resources. This can serve as a platform for evaluation of oncology medical education of internal medicine residents at other institutions.

"MS4 Report": a Student-Led and Remote Model for Case-Based Learning in Preparation for Residency

Case-based conference preparation is a valuable skill rarely covered in medical school training. We implemented an innovative program to teach fourth-year medical students to prepare and facilitate a virtual case presentation conference with faculty mentorship. Feedback survey results indicated improved confidence in case presentation and in establishing a broad differential.

The micro revolution: effect of Bite-Sized Teaching (BST) on learner engagement and learning in postgraduate medical education

CONTEXT

Bite-sized learning is an instructional method that utilizes brief, focused learning units. This approach may be beneficial in medical education given demands on learner time and cognitive load. This study aims to assess the impact of this approach on knowledge acquisition and learner attitudes in postgraduate medical education.

METHODS

An instructional method, termed Bite-Sized Teaching (BST), was implemented within the curriculum at a US Internal Medicine postgraduate training program. In BST, content is distilled into manageable units focused on relevant schemas and delivered via brief peer teaching. A two-fold assessment of BST was performed that included cross sectional survey to assess learner attitudes and experiences and a controlled study to assess knowledge acquisition with BST and case-based teaching control.

RESULTS

One hundred and six of 171 residents (62% response rate) completed the survey. Most residents (79.8%) reported BST was among the best conference types in the curriculum. Important components of BST cited by residents include the distilled content, multiple short talk format and peer teaching. Residents report incorporating what they learned via BST into their teaching (76.1%) and clinical practice (74.1%). Resident who had participated as speaker were significantly more likely to report incorporating learning from BST into their teaching (87.2% vs 63.0%, p < 0.01, Cramer's V effect size = 0.37) and clinical practice (89.7% vs 65.3%, p = 0.02, Cramer's V effect size 0.28). Fifty-one residents participated in the knowledge assessment. Residents taught via BST scored significantly higher on immediate post-test compared to case-based teaching (score [SE] 62.5% [1.9] vs 55.2% [2.4], p = 0.03, Hedges g effect size 0.66). While both groups improved over pretest, there was no significant difference in scores between BST and case-based teaching at two (score [SE] 57.1 [2.1] vs 54.8 [2.5], p = 0.54) and six weeks (score [SD] 55.9 [2.1] vs 53.0 [2.9], p = 0.43).

CONCLUSIONS

Teaching via brief, focused learning units delivered by peers is well received by learners and appears to have a significantly greater impact on immediate knowledge recall than case-based teaching. Further study on long term knowledge retention and behaviors is needed. Bite-Sized Teaching may be a promising instructional approach in medical education.

Qualitative Research Methods in Medical Education

Qualitative research was originally developed within the social sciences. Medical education is a field that comprises multiple disciplines, including the social sciences, and utilizes qualitative research to gain a broader understanding of key phenomena within the field. Many clinician educators are unfamiliar with qualitative research. This article provides a primer for clinician educators who want to appraise or conduct qualitative research in medical education. This article discusses a definition and the philosophical underpinnings for qualitative research. Using the Standards for Reporting Qualitative Research as a guide, this article provides a step-wise approach for conducting and evaluating qualitative research in medical education. This review will enable the reader to understand when to utilize qualitative research in medical education and how to interpret reports using qualitative approaches.

Leveraging Peer Teaching for Global Health Elective Preparation: Implementation of a Resident-Led Global Health Simulation Curriculum

Introduction. As more trainees engage in global health electives, the call for best practices in predeparture preparation grows. However, many residency programs may not have the infrastructure or staffing in place to consistently meet these expectations. Objective. To assess the feasibility, benefits, and limitations of having residents trained to facilitate and implement a global health preparatory simulation curriculum. Approach. In 2016, we had 5 residents undergo online Simulation Use for Global Away Rotations (SUGAR) facilitator training. Since then, we have conducted 3 simulation sessions from 2016 to 2018. Feedback was obtained from 75% of our participants, which was found to be similar to feedback obtained from attending-led models. Lessons Learned. A resident-led global health preparatory curriculum provides a sustainable model for residency programs without placing additional burden on attending faculty.

Asking what do residents value most: a recent overview of internal medicine residents' learning preferences

BACKGROUND

Little is known about the preferred learning experiences of today's internal medicine residents. We conducted a survey of the educational experiences in an internal medicine residency to determine the learning opportunities internal medicine residents value most and why.

METHODS

An online, anonymous survey of 182 internal medicine residents was performed, with each resident receiving a survey each day over nine days. Participants were asked to state their most valuable learning experience over the past day, describe why it was valuable, and rank it on a 5-point Likert-type scale. Resident free-text responses were coded and grouped into themes. The location of and participants in the experience were also examined.

RESULTS

The 182 residents completed a total of 303 surveys. Of the 303 surveys, 92% (N=277) of the responses noted their chosen learning experience was useful. An attending was involved in 50% (N=152) of experiences; the patient was noted as a participant in 8% (N=25) of experiences. Free-text responses were coded into five thematic groups descriptive of why residents found their learning experiences to be valuable: Repetition in Learning, Effective Pedagogy, Clinical Problem Solving as an Individual or Collaboratively, Opportunity for Active Engagement, and Bedside Learning.

CONCLUSION

Our data provide a broader framework for designing and implementing future faculty development and resident curricula that emphasize interprofessional education and the patient as a key educational figure.

Resident versus faculty member simulation debriefing

BACKGROUND

Near-peer teaching is effective in graduate medical education, but it has not been compared with faculty member teaching in resident simulation. In this study, we sought to compare debriefing sessions of internal medicine (IM) intern simulation sessions led by academic faculty doctors with those led by senior IM residents in order to measure the effectiveness of near-peer teaching in this setting. Near-peer teaching is effective in graduate medical education, but has not been compared with faculty member teaching in resident simulation METHOD: Internal medicine interns participated in four simulation cases, two of which were debriefed by faculty members and two of which were debriefed by residents. Pre-simulation knowledge assessment was completed prior to the case. Following each debriefing, interns completed a Debriefing Assessment for Simulation in Healthcare (DASH) survey. Post-simulation knowledge assessments were completed 6 months after simulation. Debriefings were recorded and transcribed. Each statement made during debriefing was classified as either correct or erroneous by blinded reviewers.

RESULTS

Fifty interns participated in simulation, and the response rate on the DASH survey was 88%. There was no difference between DASH scores (p = 0.13), post-simulation knowledge assessments or error rates during debriefing (p = 0.31) for faculty member and resident instructors.

CONCLUSION

Our study suggests that residents and faculty members provide a similar quality of simulation instruction based on qualitative and quantitative evaluation.

Does Faculty Follow the Recommended Structure for a New Classroom-based, Daily Formal Teaching Session for Anesthesia Residents?

Background: A newly implemented 15-minute classroom-based, formal teaching session for anesthesia residents is given three times daily by the same faculty. The faculty member was provided a suggested template for the presentation. The template structure was developed by a group of residents and faculty to include best teaching practices. The goal of the current study was to measure how frequently the faculty teaching these sessions followed the template. Methods: From February 20, 2015 to February 6, 2016, a research assistant trained in education mapped a total of 48 teaching sessions to determine how frequently the teaching sessions included each of the elements in the recommended template structure. The assistant was chosen from outside the anesthesia department so as to minimize biases.

Results: It was found that 98% of the sessions used the teaching template's suggestion of using computer slides (e.g., a Powerpoint presentation). We observed that 75% of the sessions provided specific recommendations about patient care, 65% had reinforcement of learning points, 56% had a test or a quiz, 49% provided references and directions for further reading, 44% provided take-home messages, and 31% used a clinical case vignette presentation to introduce the keyword. The most common visuals were the use of a picture (38%) and a chart or a graph (35%). We also saw that 65% of the sessions had active involvement of residents. With respect to time and slide limitations mentioned in the template, we saw that 35% of the sessions finished within the recommended time limit of 15 mins and 21% had the recommended 10 or fewer slides. 

Conclusion: Compliance by the faculty to the recommended structure was variable. Despite this, the sessions have been well received and have become a permanent part of the residency curriculum more than two years after their implementation.