Defining Student-as-Teacher Curricula in the Absence of National Guidelines: An Innovative Model.

Teaching is a critical skill in the medical profession, yet has only recently gained recognition as a core skill for medical students and trainees. Student-as-teacher (SAT) programs provide medical students formal teaching instruction with opportunities for practice. While efforts to determine how SAT courses should be taught are ongoing, the authors' review of SAT programs in medical schools' curricula shows they are diverse and often developed by faculty and trainees who advocate for formal teacher training at their institutions, rather than by medical school leadership. Consequently, there is significant heterogeneity among known SAT programs with regard to content, format, and evaluation methods. As efforts are underway to create guidelines and competency frameworks for SAT programs, medical educators must engage in open and critical discussion about the optimal content and organization for SAT educational experiences, emphasizing outcomes-based value and curricular and experiential consistency across programs. The authors describe an innovative SAT elective at Harvard Medical School (HMS), discuss research supporting curricular content and decisions, and emphasize potential implications for the conception and implementation of SAT programs at other institutions. The HMS SAT course is a year-long, elective, longitudinal curriculum built on a community of practice model and comprising 5 key components: Fundamentals of Medical Education seminar series, teaching field experiences, teaching observations, final educational product, and self-reflection. This 5-component theoretically justified model covers essential topics of SAT programming, providing students a comprehensive educational skills training curriculum. Medical educators developing SAT courses must identify common core competencies and curricular activities to implement SAT programs informed by the perspective of local stakeholders and institutional needs. Further growth of SAT programs in medical education offers opportunities for collaboration and coordination among medical educators, institutions, and licensing and accreditation bodies, to further develop consistent guidelines for teaching medical education skills to future medical educators.

Student engagement in the online classroom: comparing preclinical medical student question-asking behaviors in a videoconference versus in-person learning environment.

The COVID-19 pandemic forced medical schools to rapidly transform their curricula using online learning approaches. At our institution, the preclinical Practice of Medicine (POM) course was transitioned to large-group, synchronous, video-conference sessions. The aim of this study is to assess whether there were differences in learner engagement, as evidenced by student question-asking behaviors between in-person and videoconferenced sessions in one preclinical medical student course. In Spring, 2020, large-group didactic sessions in POM were converted to video-conference sessions. During these sessions, student microphones were muted, and video capabilities were turned off. Students submitted typed questions via a Q&A box, which was monitored by a senior student teaching assistant. We compared student question asking behavior in recorded video-conference course sessions from POM in Spring, 2020 to matched, recorded, in-person sessions from the same course in Spring, 2019. We found that, on average, the instructors answered a greater number of student questions and spent a greater percentage of time on Q&A in the online sessions compared with the in-person sessions. We also found that students asked a greater number of higher complexity questions in the online version of the course compared with the in-person course. The video-conference learning environment can promote higher student engagement when compared with the in-person learning environment, as measured by student question-asking behavior. Developing an understanding of the specific elements of the online learning environment that foster student engagement has important implications for instructional design in both the online and in-person setting.

A flipped classroom in graduate medical education.

BACKGROUND: The role of the flipped classroom model in graduate medical education (GME) is not yet defined. We set out to evaluate the feasibility, acceptability and outcomes of a flipped classroom instructional model in an internal medicine curriculum. METHODS: This pilot study was carried out in an academic medical centre in the USA with 43 second-year internal medicine postgraduate trainees. Trainees watched videos on the pharmacological treatment of type 2 diabetes outside of the classroom, followed by an in-class session in which they engaged in case-based discussions. The intervention was evaluated using surveys and a knowledge test before, immediately after and 6 months after the intervention. RESULTS: The mean number of correct answers for a 10-question knowledge test was 5.25 before the intervention, 8.00 in the immediate post-intervention test, and 7.10 in the 6-month follow-up test (p < 0.001). Six months after the intervention, 57.1% of participants reported prescribing an antidiabetic medication discussed at the session. In a focus group, trainees reported their preference for interactive, case-based learning, concern about the time required for preparation and interest in incorporating real patient cases. DISCUSSION: Trainees preferred the flipped classroom, which also resulted in increased knowledge and self-reported prescribing changes; however, the required preparatory time may limit its feasibility in GME.

Getting up to Speed: A Resident-Led Inpatient Curriculum for New Internal Medicine Interns.

Introduction: The transition from medical school to internship is an important milestone in medical training and often is a challenge for trainees. This resident-designed and -led inpatient curriculum for internal medicine interns was created to address common clinical scenarios and how best to manage them. Methods: During the Intern Summer Curriculum, interns participated in weekly small-group sessions facilitated by senior residents. Each case-based session was structured around a clinical topic. Working in pairs with an expert faculty member as a reviewer, volunteer junior and senior residents reviewed and edited each session. During the 2 years we conducted surveys of learners and instructors in the curriculum, there were 200 intern learners and 68 resident instructors. Results: The Intern Summer Curriculum was evaluated highly by all participants. Of the intern and resident survey responses, 92% (N = 77) of interns felt that the curriculum should be continued for future interns, and 100% (N = 50) of residents felt that residents should continue to teach in this program. Interns felt that the curricular content helped them better understand topics they commonly encountered and improved their ability to perform day-to-day tasks. Resident instructors felt that teaching in this program was a valuable learning experience and helped strengthen teaching skills. Discussion: This resident-run inpatient curriculum for internal medicine interns can serve as a valuable learning experience for the intern learners, as well as for the resident instructors, and aid in bringing all interns up to speed at the beginning of intern year.

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.