PHILOSOPHY & Curriculum Design

Curriculum Design – Mount Sinai Emergency Medicine Conference


Resources:

Model of Clinical Practice of EM (exhaustive list of topics)

ACGME Program Requirements (didactic rules start on page 31)

Mission Statement

The mission of the Mount Sinai Emergency Medicine conference is to complement the excellent clinical education that residents receive with a comprehensive conference curriculum that is designed to train the future leaders of emergency medicine. The curriculum will enhance their fund of core medical knowledge, expose them to the breadth of emergency medicine practice and careers, instill a sense of social consciousness and understanding of larger societal forces that affect our patients, and foster a sense of community within residency and faculty of the Mount Sinai Emergency department. The curriculum will accomplish these four pillars through effective multimodal educational strategies.


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Curriculum Outline (Duncan, Last update: October 2022)


Problem Identification, Needs Assessment (General)

Problem


Across the country, emergency medicine conference education has been rocked by COVID. The greater education landscape has had to pivot against in-person restrictions, learn novel approaches to simulation, and navigate the online teaching arena (Zoom, almost ubiquitously).


Throughout these changes the ACGME requirements for emergency medicine (EM) didactics remain steadfast as always, stating, “…residents must be provided with protected time to participate in core didactic activities.” (The term “didactic” is used interchangeably in the document, sometimes encompassing or synonymous with “conference.” It, importantly, does not specifically refer solely to didactic lectures, but rather formal instructional training.)

The ACGME does, in fact, make some stipulations about didactic sessions:

· “Didactic experiences must include administrative seminars, journal review, presentations based on the defined curriculum, morbidity and mortality conferences, and research seminars."

· “[These] should include joint conferences co-sponsored with other specialties.”

· “[They] should include problem-based learning, evidence-based learning, and computer based instruction.”

· “There must be an average of at least five hours per week of planned didactic experiences developed by the program’s faculty members.”

· “Individualized interactive instruction must not exceed 20 percent of the planned didactic experiences.”

· “Each core physician faculty member must attend, on average per year, at least 20 percent of planned didactic experiences.”

· “Residents must actively participate, on average, in at least 70 percent of the planned didactic experiences offered.”

· “All planned didactic experiences must have an evaluative component to measure resident participation and educational effectiveness.”

While the tentacles of education span far and wide across many different initiatives throughout the institution, weekly resident conference remains a necessary opportunity to fulfill the requirements above. These exist, of course, to prepare residents for independent practice after their training has concluded.


Impact


Board Scores


A review from Wood et al in WESTJEM (2020) summarizes a number of impacts of weekly resident conferences. Interestingly, they note there is no strong data showing a significant impact of conference on board scores, though one study they cited associated faculty presence at conference with increased boards scores. (1)


Wellness


There is a paucity of data on the impact of resident conference on wellness, though one qualitative study in September of 2021 by Li-Sauerwine et al revealed that conference can exist as a mechanism for a large number of wellness influences. (Pre/post-conference tasks, protected time, reflective exercises, food, etc.) (2)


Knowledge Acquisition


An important barrier to knowledge translation for our targeted audience (Sinai residents) is the size and length of residency. Learners ideally have lessons catered to their level of knowledge and training, though there is no clear data on effectiveness of this. (1) Classically understood, adult learning is best achieved through active learning modalities, though EM conferences often are passive in delivery of content.

Targeted Needs Assessment

The Sinai EM residency is a large program with a total of one hundred residents spanning four years of training. They are English-speaking MDs who trained in the United States. There are a number of pieces to address and consider in this targeted needs assessment, and we will address them one by one:

Learner Performance

There is no perfect way to gauge the effectiveness of conference. As of now, ITE scores may be considered a surrogate for the effectiveness of the educational programming at the residency, which includes conference (but is certainly not limited to it). ITE scores are highly variable in the residency.

How consequential this is remains to be seen as the post-graduate boards passing rates are adequate among Sinai grads. It does suggest, however, that education can be bolstered during residency. This should not rest solely on the shoulders of conference, but this is a potential avenue for improvement.

Learner Preference

Post-conference surveys (required at every conference session) provide high-volume data on learner preferences. It will be worth delving into this when the time comes for programming for individual sessions, understanding of course that learner preference does not always correlate with effective education.

ACGME Stipulations

The conference curriculum at Sinai fulfills the requirements of the ACGME with a number of initiatives. (Five hours weekly, joint conference with trauma, etc.) However, delineating the performance of core faculty remains a hurdle as this designation is being addressed actively.

Faculty Performance

*In flux.*


Goals and Objectives


The conference curriculum is unique in that there are longitudinal goals as well as objectives that should be established for each individual conference session. Here we will address longitudinal conference goals and objectives which are broad.


The goals of conference (broad, immeasurable) are:

  • …for learners to learn core emergency medicine content.

  • …for learners to gain exposure to career subspecialties and niches.

  • …to foster the sense of community among all members of the Sinai EM residency.


The objectives for specific conferences are far too vast to cover in this assessment. Luckily, CORD has created a comprehensive list of block-specfic objectives that can serve as an excellent framework from block-to-block. They can be found here.


When addressing the curriculum as a whole, the objectives for learners include the following.


By the end of the conference curriculum, Sinai EM residents will successfully:

  • …recall the basic facts and concepts of core emergency medicine content.

  • …explain fundamental emergency medicine evaluation and care to patients and colleagues.

  • …interpret appropriate imaging, lab values, and exam findings pertinent to the specialty.

  • …manage ED patients in mock-scenarios.

  • …critique patient-care treatment plans.

  • …appraise literature relevant to the treatment of patients in the ED

  • …value their role in the healthcare landscape.

  • …value their colleagues from other specialties.

  • …value time with their colleagues.

(Adapted in part from Tozer et al., 2018) (3)


Program Objectives


In accordance with the ACGME guidelines, the aforementioned bullet points listed in Needs Assessment will serve as program objectives. (Attendance and division of time spent for conference.)



Assessment


The above curriculum is new to the 2022-2023 academic calendar and will be reassessed by a robust survey in December, 2022.


References

  1. Wood DB, et al. Conference Didactic Planning and Structure: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors [published correction appears in West J Emerg Med. 2020 Aug 10;21(5):1287]. West J Emerg Med. 2020;21(4):999-1007. Published 2020 Jul 3. doi:10.5811/westjem.2020.5.46762

  2. Li-Sauerwine, Simiao, et al. “Moving beyond Personal Factors: A National Study of Wellness Interventions in Emergency Medicine Residency Programs.” AEM Education and Training, vol. 5, no. 4, 2021, https://doi.org/10.1002/aet2.10690.

  3. Tozer, Jordan et al. “Strategic Questioning in Emergency Medicine Training.” AEM education and training vol. 2,4 336-338. 3 Oct. 2018, doi:10.1002/aet2.10126