Novel Emergency Medicine Curriculum Utilizing Self-Directed Learning and the Flipped Classroom Method: Neurologic Emergencies Small Group Module
This is a group discussion, case-based curriculum to cover emergency medicine neurology core content. It was created and implemented at The Ohio State University Emergency Medicine Residency program and was designed to educate our emergency medicine (EM) residents, PGY-1 to PGY-3, as well as medical students and attending physicians.
Length of Curriculum:
The neurologic emergencies module consists of eight 45-60-minute small group sessions for a total of six to eight hours of content. This curriculum block is part of an overall 18-month emergency medicine residency curriculum.
In 2015, approximately 7 million emergency department visits were related to diseases of the nervous system. Headache alone represented 2.8% of all emergency department visits, making it the fifth most common chief complaint.1 Residents must be proficient in the differential diagnosis and management of the wide variety of neurological emergencies. To address this specific curricular need, we developed a flipped classroom case-based small group discussion series for emergency medicine learners that emphasizes self-directed learning activities, followed by facilitated small group discussions pertaining to the topic reviewed. The active learning fostered by this curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4The application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for emergency medicine residents.4-6
We aim to teach the presentation and management of neurologic emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group discussions in place of traditional lectures. In doing so, a goal of the curriculum is to encourage self-directed learning, improve understanding and knowledge retention, and improve the educational experience of our residents.
The educational strategies used in this curriculum include: small group modules authored by education faculty and content experts based on the core emergency medicine content as outlined in the ABEM model curriculum.7 This program also includes resident-submitted questions that were developed during review of the content. The use of free open access medical education (FOAM) resources allows learners to work at their own pace and maximize autonomy.
The modules and associated learning resources are posted on a digital learning management system for faculty and residents to review at least one week before the session. On the day of the sessions, learners divide into small groups of 10-15 participants with a mix of junior and senior residents. Each group is led by both a faculty leader and an optional designated senior resident who has spent extra time preparing to lead the discussion.
Learners evaluated the content using end-of-session feedback forms. Learners were also surveyed after the curriculum implementation and asked to evaluate the effectiveness of the small group curriculum. Faculty small-group facilitators assessed learner participation.
Overall the neurology small group curriculum was well received by residents and faculty educators. A majority of residents (63%) reported that the small group discussions were good or excellent, compared to only 24% of residents that felt that grand rounds lectures during the same time were good or excellent. Residents evaluated the neurology block teaching methods as effective, with an average rating of each small group session receiving more than 4.3 out of 5 (4 being agree, 5 being strongly agree).
Learners and educators were enthusiastic about the conference structure and expressed a preference for it rather than the previous, lecture-based didactics. This implementation showed that case-based, flipped classroom small group modules are a preferred format for teaching core content in emergency neurology. Significant faculty time was required to create and update the small modules, which may limit widespread adoption of this format for resident education. Future developments could help guide learners with different baseline knowledge.
Emergency medicine, flipped classroom, medical education, neurologic emergencies, pedagogy, teaching.