An evaluation of flipped e-learning experiences.

AIM: The "flipped" classroom is an educational strategy gaining popularity for its growing evidence base that suggests it may successfully improve learning outcomes. Also known as reverse instruction, this approach has been typically implemented and studied in in-person post-secondary settings. The utilization of a flipped approach in the healthcare education literature has been examined in a wide range of contexts, but little has been written regarding continuing professional development (CPD). Therefore, with success in other contexts there is potential for the flipped classroom approach to enhance student satisfaction, learner engagement, and learning outcomes in the context of online education for CPD. METHODS: In this paper, we describe the structure and format of such a course using a qualitative case study framework. RESULTS: This study contributes to a more comprehensive understanding of effective ways of overcoming distributed learning challenges in online CPD using a flipped approach.

Comprehensive assessment of critical care needs in a community hospital*.

OBJECTIVE: To design and implement a needs assessment process that identifies gaps in caring for critically ill patients in a community hospital. DESIGN, SETTING, SUBJECTS: This mixed-method study was conducted between June 2011 and February 2012. A conceptual framework, centered on the critically ill patient, guided the design and selection of the data collection instruments. Different perspectives sampled included regional leaders, healthcare professionals at the community hospital and its referral hospital, as well as family members of patients who had received care at the community ICU. Data sources included interviews (n = 22), walk-throughs (n = 5), focus groups (n = 31), database searches, context questionnaires (n = 8), family surveys (n = 16), and simulations (n = 13). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Nine needs were identified. At the community hospital, needs identified included lack of access to human resources, gaps in expertise, poor patient flow and ICU bed use, communication, lack of educational opportunities, and gaps in end-of-life care and interprofessional teamwork. Needs were also identified in the interhospital interaction between the community and referral hospitals, which included an inadequate hospital network and gaps in transfer and repatriation of patients. The methodology uncovered the causes and widespread impact of each need and how they interacted with one another. Proposed solutions by the participants are presented including both organizational and educational/clinical solutions. CONCLUSIONS: This study captured needs in a complex, interprofessional, interhospital context, which can be targeted with tailored interventions to improve patient outcomes in a community hospital. Furthermore, this study provides a preliminary framework and rigorous methodology to performing a needs assessment in this setting.

Curriculum inventory: Modeling, sharing and comparing medical education programs.

Abstract descriptions of how curricula are structured and run. The American National Standards Institute (ANSI) MedBiquitous Curriculum Inventory Standard provides a technical syntax through which a wide range of different curricula can be expressed and subsequently compared and analyzed. This standard has the potential to shift curriculum mapping and reporting from a somewhat disjointed and institution-specific undertaking to something that is shared among multiple medical schools and across whole medical education systems. Given the current explosion of different models of curricula (time-free, competency-based, socially accountable, distributed, accelerated, etc.), the ability to consider this diversity using a common model has particular value in medical education management and scholarship. This article describes the development and structure of the Curriculum Inventory Standard as a way of standardizing the modeling of different curricula for audit, evaluation and research purposes. It also considers the strengths and limitations of the current standard and the implications for a medical education world in which this level of commonality, precision, and accountability for curricular practice is the norm rather than the exception.

Current status of curriculum mapping in Canada and the UK.

CONTEXT: As part of curriculum evaluation, management and quality assurance strategies, many undergraduate medical schools are in the process of constructing computer-based curriculum maps. METHODS: A survey was distributed to Canadian and UK medical schools to determine the current status, characteristics, and challenging and successful aspects of their efforts in curriculum mapping. Quantitative and qualitative analyses were performed. RESULTS: The majority of schools are in the process of building maps and about 20% of schools have completed maps but continue to upgrade them. The software used to construct the maps and the educational elements included in them vary among schools. A variety of educational outcome frameworks are employed for curriculum evaluation. Current major challenges include human resource demands, the use of medical ontologies, faculty development and interface design. CONCLUSIONS: Given that these problems are common and their solutions are resource-intensive, there is a place for collaboration and a need for further research.

It's about TIME: a general-purpose taxonomy of subjects in medical education.

CONTEXT: Modern computer technology permits the creation of detailed, dynamic electronic curriculum maps to facilitate curriculum searching, organisation and quality assurance. However, when attempting to map curricular content, a common question to arise is: 'To what should we map our curriculum?' With respect to content (i.e. the subject being taught, learned or examined), mapping to terminal outcomes or competencies may be too broad, whereas mapping to learning objectives is too specific. METHODS: To address this problem, the authors created TIME-ITEM (topics for indexing medical education; en Français: index des thèmes pour l'éducation médicale), a hierarchical taxonomy of topics relevant to medical education. It is a general-purpose, intermediate-granularity, standardised index that covers the entire range of subject matter in medical education. The content and structure of topics within TIME was developed in consultation with medical educators and librarians at several Canadian medical schools. As far as possible, the language used is standardised to the Unified Medical Language System. RESULTS: TIME is available as a web application that allows users from various schools to enter their school-specific outcomes, competencies and learning objectives, and then link these to the standardised topics in a way that is meaningful to the school. The entire TIME content and structure can then be exported, via xml, to external applications and used as an index for curriculum mapping, meta-tagging learning objects, or categorising examination questions. TIME can be viewed at http://www.time-item.org (username: 'guest'; password: 'guest').

TIME as a generic index for outcome-based medical education.

TIME (Topics for Indexing Medical Education) is a general-purpose, intermediate-granularity taxonomy of topics that describe the content of undergraduate medical education. Within outcome-based education systems, curriculum planning focuses on the desired product rather than process, and the contributions of curricular elements to achievement of the outcomes must be made visible. In this paper, we discuss how TIME may be used as a content index in curriculum maps to link curricular elements to multiple outcome frameworks. This assists with curriculum development and evaluation, quality assurance, curriculum searching, detection of gaps and redundancies, and sharing of educational objects. TIME is available at http://www.time-item.org (username "guest"; password "guest").

An evaluation of the Acute Critical Events Simulation (ACES) course for family medicine residents.

INTRODUCTION: A 2-year residency must prepare family physicians to provide a broad range of services. In many settings, especially rural and remote practices, family physicians provide emergency and inpatient care and thus encounter critically ill patients. Evidence of the importance of early recognition and aggressive intervention in critical illness is growing. However, opportunities to safely practise critical care skills during residencies are limited. METHODS: The 2-day Acute Critical Events Simulation (ACES) course was offered to all family medicine residents at the University of Ottawa in 2009. The course included lectures, case discussions, hands-on task training and a half-day of high-fidelity simulation. Its aims were to enhance the abilities of residents in family medicine to recognize signs of critical illness, to teach competencies in the early resuscitation and care of such patients, and to increase residents' confidence to include inpatient and emergency care in their practices, or to practise in a rural or remote setting. A postcourse questionnaire, which included Likert-scale and open-ended questions, was distributed to all participants. RESULTS: Thirty-seven participants completed the survey. The ACES course was exceptionally well-received by participants, who reported increases in confidence and perceived competence, as well as intentions to change practice. The course appeared to increase participants' confidence to work in rural or remote areas and include inpatient or emergency medicine services in their practices. CONCLUSION: The ACES course achieved its aims, and participants reported positive outcomes. This highly interactive, simulation-based program may help prepare residents for work in rural or remote communities with critically ill patients.