Implementation of Learner Centered Teaching in an Emergency Medicine Residency
Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD
Baystate Medical Center, Tufts School of Medicine
Background
Results
● Active learning formats such as Flipped Classroom or
Team Based Learning are increasingly popular in medical
education as they are more engaging and preferred by
learners.
● Previous studies have shown increased learner
engagement and satisfaction with active learning formats,
though some decrease in test scores has been observed.
● Lectures are a passive learning technique with limited
knowledge transference and retention.
● The effect of implementing an active learning curriculum
in an Emergency Medicine (EM) residency on objective
measures of knowledge is unknown.
● 23 residents were enrolled
● Mean change in Percentile Rank:
○ -1.2 (95%CI -9.5-7.2, p=0.77) for all subjects
○ +7.4 (95%CI 3.5-18.2, p=0.13) for residents Below Target in
2014
● Mean change in Distance from their Target Score:
○ 0.7 (95%CI -1.1-2.5, p=0.44) for all subjects
○ 2.2 (95%CI -0.5-4.9, p=0.09) for residents Below Target in
2014
Conclusions
● Implementation of an LCT curriculum did not show a
statistically significant improvement or worsening of ITE
performance.
● There was a trend toward greater improvement in both
Percentile Rank and Distance from Target score for residents
who were below target in 2014.
● Areas for future study include:
○ Evaluation of the individual components of the LCT
○ Change in clinical performance
○ Impact on ITE scores for those Below Target
Objective
● We hypothesize that implementing an active learning
curriculum within an EM Residency will increase In Training
Exam (ITE) Scores.
Methods
● Single center, single group, pre-post study of the effect of
changing to a Learner Centered Teaching (LCT) curriculum in
an EM residency training program.
● All residents with both 2014 (pre-) and 2015 (post-) ITE scores
were eligible for inclusion.
○ Starting in July 2014 the LCT curriculum was implemented
with approximately half of the core content lectures
replaced with small group discussions that included prediscussion homework submitted in advance.
● Performance on the ITE was evaluated for all residents
completing both 2014 and 2015 exams.
○ The mean change in Percentile Rank on the ITE and the
mean Distance from Target score, how far the subject was
from their year specific goal, were evaluated with a paired t
test.
○ A secondary outcome evaluated was change in Percentile
Rank and Distance from Target for the residents Below
Target in 2014 (PG1 = 65, PG2 = 70, PG3 = 75).
Limitations
● Interventions in
a single center study may not be
generalizable to a broader population.
● This study was not adequately powered to show a significant
difference in ITE performance among the sub-set of residents
below their target score in 2014.
● Other unrecognized confounders may have impacted ITE
scores.
References
Click headings to further view content
Implementation of Learner Centered Teaching in an Emergency Medicine Residency
Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD
Baystate Medical Center, Tufts School of Medicine
Background
● Active learning formats such as Flipped Classroom or Team
Based Learning are increasingly popular in medical education
as they are more engaging and preferred by learners.
● Previous studies have shown increased learner engagement
and satisfaction with active learning formats, though some
decrease in test scores has been observed.
● Lectures are a passive learning technique with limited
knowledge transference and retention.
● The effect of implementing an active learning curriculum in
an Emergency Medicine (EM) residency on objective
measures of knowledge is unknown.
Implementation of Learner Centered Teaching in an Emergency Medicine Residency
Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD
Baystate Medical Center, Tufts School of Medicine
Objective
●We hypothesize that implementing an active
learning curriculum within an EM Residency will
increase In Training Exam (ITE) Scores.
Implementation of Learner Centered Teaching in an Emergency Medicine Residency
Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD
Baystate Medical Center, Tufts School of Medicine
Methods
●Single center, single group, pre-post study of the effect of changing to a
Learner Centered Teaching (LCT) curriculum in an EM residency training
program.
●All residents with both 2014 (pre-) and 2015 (post-) ITE scores were eligible
for inclusion.
○Starting in July 2014 the LCT curriculum was implemented with
approximately half of the core content lectures replaced with small group
discussions that included pre-discussion homework submitted in advance.
●Performance on the ITE was evaluated for all residents completing both
2014 and 2015 exams.
○The mean change in Percentile Rank on the ITE and the mean Distance
from Target score, how far the subject was from their year specific goal,
were evaluated with a paired t test.
○A secondary outcome evaluated was change in Percentile Rank and
Distance from Target for the residents Below Target in 2014 (PG1 = 65,
PG2 = 70, PG3 = 75).
Implementation of Learner Centered Teaching in an Emergency Medicine Residency
Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD
Baystate Medical Center, Tufts School of Medicine
Graphs
Implementation of Learner Centered Teaching in an Emergency Medicine Residency
Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD
Baystate Medical Center, Tufts School of Medicine
Results
●23 residents were enrolled
●Mean change in Percentile Rank:
○-1.2 (95%CI -9.5-7.2, p=0.77) for all subjects
○+7.4 (95%CI 3.5-18.2, p=0.13) for residents Below
Target in 2014
●Mean change in Distance from their Target Score:
○0.7 (95%CI -1.1-2.5, p=0.44) for all subjects
○2.2 (95%CI -0.5-4.9, p=0.09) for residents Below
Target in 2014
Implementation of Learner Centered Teaching in an Emergency Medicine Residency
Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD
Baystate Medical Center, Tufts School of Medicine
Conclusions
●Implementation of an LCT curriculum did not
show a statistically significant improvement or
worsening of ITE performance.
●There was a trend toward greater improvement in
both Percentile Rank and Distance from Target
score for residents who were below target in 2014.
●Areas for future study include:
○Evaluation of the individual components of the
LCT
○Change in clinical performance
○Impact on ITE scores for those Below Target
Implementation of Learner Centered Teaching in an Emergency Medicine Residency
Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD
Baystate Medical Center, Tufts School of Medicine
Limitations
●Interventions in a single center study may not be
generalizable to a broader population.
●This study was not adequately powered to show a
significant difference in ITE performance among
the sub-set of residents below their target score in
2014.
●Other unrecognized confounders may have
impacted ITE scores.
Implementation of Learner Centered Teaching in an Emergency Medicine Residency
Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD
Baystate Medical Center, Tufts School of Medicine
References
1.
Silverberg, J. (1995). Lectures, interactive learning, and knowledge retention in continuing medical education. … Continuing Education …, 15, 231–234. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/chp.4750150407/abstract
2. Subramanian, A., Timberlake, M., Mittakanti, H., Lara, M., & Brandt, M. L. (2012). Novel educational approach for medical students: improved retention rates using interactive medical software compared with traditional lecture-based format. Journal of Surgical
Education, 69(4), 449–52. doi:10.1016/j.jsurg.2012.05.013
3. Bloom, B. S. (2005). Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews. International Journal of Technology Assessment in Health Care, 21(3), 380–5. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/16110718
4.
Bligh, D. (1985). What’s the use of lectures? Journal of Geography in Higher Education.
5.
Mehta, N., Hull, A., Young, J., & Stoller, J. (2013). Just imagine: new paradigms for medical education. Academic Medicine, 88(10), 1418–1423. doi:10.1097/ACM.0b013e3182a36a07
6.
Thomas, P. a, & Bowen, C. W. (2011). A controlled trial of team-based learning in an ambulatory medicine clerkship for medical students. Teaching and Learning in Medicine, 23(1), 31–6. doi:10.1080/10401334.2011.536888
7.
Albanese, M., & Mitchell, S. (1993). Problem-based learning: A review of literature on its outcomes and implementation issues. Academic Medicine, 68(1), 52–81. Retrieved from http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:c.pdf#6
8. Haidet, P., O’Malley, K. J., & Richards, B. (2002). An initial experience with “team learning” in medical education. Academic Medicine : Journal of the Association of American Medical Colleges, 77(1), 40–4. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/11788321
9. Kelly, P. A., Haidet, P., Schneider, V., Searle, N., Seidel, C. L., Boyd, F., & Richards, B. F. (2005). Teaching and Learning in Medicine : An International A Comparison of In-Class Learner Engagement Across Lecture , Problem-Based Learning , and Team Learning
Using the STROBE Classroom Observation Tool Classroom Observation Tool. Teaching and Learning in Medicine: An International Journal, 17(2), 112–118. doi:10.1207/s15328015tlm1702
10. Burnette, K., Ramundo, M., Stevenson, M., & Beeson, M. S. (2009). Evaluation of a web-based asynchronous pediatric emergency medicine learning tool for residents and medical students. Academic Emergency Medicine : Official Journal of the Society for
Academic Emergency Medicine, 16 Suppl 2, S46–50. doi:10.1111/j.1553-2712.2009.00598.x
11. Mallin, M., Schlein, S., Doctor, S., Stroud, S., Dawson, M., & Fix, M. (2014). A survey of the current utilization of asynchronous education among emergency medicine residents in the United States. Academic Medicine : Journal of the Association of American
Medical Colleges, 89, 598–601. doi:10.1097/ACM.0000000000000170
12. Pluta, W. J., Richards, B. F., & Mutnick, A. (2013). PBL and beyond: trends in collaborative learning. Teaching and Learning in Medicine, 25 Suppl 1(September 2014), S9–16. doi:10.1080/10401334.2013.842917
13. Prober, C. G., & Khan, S. (2013). Medical education reimagined: a call to action. Academic Medicine : Journal of the Association of American Medical Colleges, 88(10), 1407–10. doi:10.1097/ACM.0b013e3182a368bd
14. Sadosty, A. T., Goyal, D. G., Gene Hern, H., Kilian, B. J., & Beeson, M. S. (2009). Alternatives to the conference status quo: summary recommendations from the 2008 CORD Academic Assembly Conference Alternatives workgroup. Academic Emergency Medicine :
Official Journal of the Society for Academic Emergency Medicine, 16 Suppl 2, S25–31. doi:10.1111/j.1553-2712.2009.00588.x
15. Prober, C., & Heath, C. (2012). Lecture Halls without Lectures- A proposal for Medical Education. N Engl J Med, 366(18), 1657–1659. Retrieved from http://www.hadassah.ru/media/1904201/LectureHallsWithoutLecturesAProposalforMedicalEduc.pdf
16. Doucet, M. D., Purdy, R. a, Kaufman, D. M., & Langille, D. B. (1998). Comparison of problem-based learning and lecture format in continuing medical education on headache diagnosis and management. Medical Education, 32(6), 590–6. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/10211248
17. Tune, J. D., Sturek, M., & Basile, D. P. (2013). Flipped classroom model improves graduate student performance in cardiovascular, respiratory, and renal physiology. Advances in Physiology Education, 37(4), 316–20. doi:10.1152/advan.00091.2013
18. Muzyk, A., White, C., Kinghorn, W., & Thrall, G. (2013). A Psychopharmacology Course for Psychiatry Residents Utilizing Active-Learning and Residents-As-Teachers to Develop Life-Long Learning Skills. Academic Psychiatry, 37(5), 332–5.
doi:10.1176/appi.ap.12060124
19. Wagner, M., & Thomas, H. (2002). Application of the medical knowledge general competency to emergency medicine. Academic Emergency Medicine, 9(11), 1236–41. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12414477
20. Cheng, D. (2008). Board review course effect on resident in-training exam. International Journal of Emergency Medicine, 1(4), 327-9. pubmedID: 19384650.