The Problem
Many residents regularly consume FOAM (Free Open Access Medical Education) and online educational materials independently, without faculty guidance or input. At the same time, residency programs are looking for ways to provide high-quality asynchronous learning opportunities to their residents while remaining compliant with the Emergency Medicine Residency Review Committee (RRC-EM) Accreditation Council for Graduate Medical Education (ACGME) guidelines.
The Innovation: The Asynchrony Course
Using Brown University’s online learning management system (“Canvas”), we designed a fully asynchronous, faculty-directed digital course in emergency medicine (EM). This course provides faculty insight and perspective for residents using FOAM and other online resources, while allowing residents to earn ACGME-compliant Individualized Interactive Instruction (III) credits.
This is the start of the third year of the course at Brown EM, which is titled Asynchrony. It is a stand-alone asynchronous course, not a flipped classroom model. Although the weekly modules follow our didactics curriculum calendar, residents can follow along week-by-week, or do any of the year’s modules at any time.
Target Learners
The course is designed for all post-graduate level learners in emergency medicine. However, a given module may have some basic or more advanced content. The faculty member states in the assignment page if a particular topic is meant more for PGY-1s and PGY-2s versus PGY-3s and PGY-4s. All faculty members are also enrolled in the course, invited to the discussion boards, and can use the modules for topic review as well.
Materials Needed: Learning Management System
Access to a learning management system (LMS) may be provided by an affiliated university or hospital system. Alternatively, there are numerous open source learning management systems available online. Ideally, a faculty champion for the program with an interest in digital education and FOAM serves as a director.
The ACGME/RRC-EM Requirements for III
For an asynchronous educational activity to qualify as III, it must meet 4 criteria:
The program director must monitor resident participation.
There must be an evaluation component.
There must be faculty oversight.
The activity must be monitored for effectiveness.
Asynchrony fulfills these requirements in a format that can be tracked and archived for reporting purposes.
Course Description
Each week, a faculty member creates a topic-centered module that includes an assignment page, a mandatory discussion page, and a 10-question quiz.
The Assignment Page
The page covers one specific topic and follows the residency curricular calendar blocks.
Faculty create an engaging, informal narrative and weave in hyperlinks to curated digital sources.
Faculty comment on, or add to, the source materials in their narrative.
Multimedia formats are encouraged, including podcasts, videos, blog posts, full text online articles, and recorded lectures.
Theme songs can be included (just for fun).
“Optional Extras” can be included, such as: lay press articles, human interest stories, tangentially related fun things, and links to additional educational resources for the super-motivated.
The Discussion Page
This page is mandatory: a resident must post to gain access to the quiz.
The page includes multiple open-ended prompt questions that facilitate discussion.
Residents are encouraged to ask any questions they have for faculty experts.
The LMS notifies discussants when a new comment/answer is added.
The Quiz
The quiz includes 10 multiple choice questions.
Residents have three tries to pass; 8/10 earns credit.
Credits are logged automatically by Canvas.
Canvas also tracks residents’ performance on individual questions, and pooled information for all respondents to any given question, for targeted troubleshooting.
See it in action below!
Outcomes Measured and Lessons Learned
Survey data from the first year, with 33 of our 48 residents responding, evaluated the program as follows, using a 5-point Likert scale with 5 being ‘outstanding’:
Ease of use (mean score = 4.15)
Quality of content (mean 4.58)
Variety of content (mean 4.58)
Resources utilized (4.36)
Appropriateness of time spent doing the activity (mean 4.03)
Several residents complained that the completion of the modules often took longer than the hour for which they received credit. However, some residents also stated they were much more engaged with the material when completing a module online than they are at their traditional weekly conference.
The program is optional, but interestingly, the survey data demonstrated that several of the residents asked that it be made mandatory. We currently have five hours of weekly live conference, with Asynchrony as an additional option to use for up to 20% of the conference hours requirement.
As one might expect due to the optional nature of the course, there are some residents who engage every week, others who “binge” on several modules every month or two (or heavily before their semi-annual review), and others who do not engage at all. Likewise, there are faculty who participate frequently on the discussion boards or demonstrate interest in creating modules, and others who eschew the electronic format completely.
When queried on why they do or do not participate in the optional modules every week, lack of time was the most common reason.
Closing Thoughts
The CORD III Task Force recently released a blog post on “Best Practices in III.”1
Faculty participation in the direction of asynchronous learning is key, not just in adhering to Best Practices guidelines on III, but in giving residents real-world perspective on online and FOAM materials. Learners trying to navigate the FOAM world on their own have exposure to many small pieces of high quality information, but may not yet know how to assemble those pieces into a larger, cohesive picture.
Asynchrony aspires to be an entertaining online resource for our residents to utilize in the study of emergency medicine, using a variety of faculty-curated resources that fill in possible FOAM gaps while adhering to current suggested Best Practices in III.2 Possible future changes may include releasing slightly longer modules bi-weekly for two hours of credit, making the course open access so that other programs may participate, or other incentives to promote resident and faculty participation on a regular basis as long as the program remains optional.
1.
CORD Individualized Interactive Instruction Task Force Update: Best Practices in III. CORD EM Blog. https://cordemblog.wordpress.com/2016/06/09/cord-individualized-interactive-instruction-task-force-update-best-practices-in-iii/. Published June 9, 2016. Accessed June 14, 2016.
2.
Stuntz R, Clontz R. An Evaluation of Emergency Medicine Core Content Covered by Free Open Access Medical Education Resources. Ann Emerg Med. 2016;67(5):649-653.e2. [PubMed]
Read more about the IDEA Series.
Photo credits: Lightbulb (c) Can Stock Photo
Author information
Gita Pensa, MD
Clinical Assistant Professor
Department of Emergency Medicine
Warren Alpert School of Medicine
Brown University
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