ABSTRACT
Study Objectives: COVID-19, due to the cancellation of many clinical rotations, has introduced new challenges as graduating students prepare to start residency with less direct patient care experience compared to prior years. In many schools, clinically relevant ECG interpretation is typically learned in a longitudinal fashion at the bedside and this lack of clinical experience may affect acquisition of this key skill. To bridge this gap in knowledge within the requirements of social distancing the investigators developed a novel, virtual ECG curriculum designed for MS-4 students entering residency. Our objectives include increased self-confidence with ECG interpretation, recognition of key ECG patterns and arrhythmias, and understanding pathologies related to ECG findings. Methods: Learners were MS-4 students self-selected from a single osteopathic medical school. Using Kern’s Six Steps of Curriculum Design, the investigators adapted an existing ECG curriculum that was originally developed for emergency medicine PGY-1s. The curriculum consisted of biweekly Zoom lectures over 4 weeks for a total of 8 sessions and 12 hours. Each session included additional readings, homework, weekly summaries, and an end-of-course project. Outcomes were measured according to the Kirkpatrick model. Learner reaction was assessed using a Too-Much-Too-Little (TMTL) scale from 1-5, with 3 indicating a perfect score. Knowledge acquisition was assessed using a pre- and post-course test. Although we have collected preliminary feedback for behavioral changes, we plan to formally assess for level 3 outcomes in a follow-up survey after July 1, 2021. Anonymous surveys were used for data collection, and statistical analysis was conducted using a percentages independent sample t-test. Results: The total sample size was 27 self-selected MS-4 students who met inclusion criteria. Learner reactions were overwhelmingly positive, with 100% (27) indicating they would take the course again or recommend it to a friend. Using a TMTL scale, 77% (21) of participants gave a 3 for lecture length, 58% (16) gave a 3 for time commitment (with 42% stating time commitment was too low and 0% too high), and 77% (21) gave a 3 for level of detail the course provided. The average score between the pre- (M = 56%, SD = 14) and post-tests (M = 73%, SD = 12) showed a statistically significant improvement (p<0.0001). Student’s confidence with interpreting ECGs, understanding ECG rhythms, and ability to call a “Code STEMI” all improved (2.59 to 3.59, 2.67 to 3.74, 2.56 to 3.67 respectively;p<0.0001 for all comparisons). Preliminary behavioral feedback from students following the course included the ability to identify and interpret pathology such as Wellen’s waves, hypothermia, and Wolf-Parkinson-White Syndrome during clinical rotations. Conclusion: This study demonstrated that virtual teaching is a satisfactory method for medical students to learn ECG interpretation and provides an additional mode that medical educators can use in the future. Learners drastically improved their self-confidence and knowledge with ECG interpretation following participation in a novel, virtual learning curriculum.
ABSTRACT
Learning Objectives: After participating in this educational intervention, junior EM residents were able to discuss the basics of ventilator management and critical care pharmacology, as well as identify an approach to the deteriorating ventilated patient. : Background: The rapid rise of COVID-19 cases posed a unique staffing challenge to residency programs. The addition of ICU assignments, particularly for junior residents who may not have had prior critical care exposure, led to the development of a just-in-time curriculum to address this training gap. Seniors residents, with ample and recent critical care experience, were in a unique position to provide education and guidance to junior learners. Educational Objectives: After participating in this educational intervention, junior EM residents were able to discuss the basics of ventilator management and critical care pharmacology, as well as identify an approach to the deteriorating ventilated patient. Curricular Design: Following Kern's six step approach (1) There was clear need due to the sheer volume of critically ill patients at our institution. (2) We developed areas of content focus through a needs-assessment directed at residents who had already begun managing critical COVID patients. (3) Objectives described above. (4) The curriculum included three lectures and three corresponding study guides for reference. The lectures were led by senior residents focused on creating a relaxed discussion-based learning environment. A critical care pharmacist collaborated on the module on sedative, paralytic, and vasopressor selection. (5) The curriculum was launched on April 10th and concluded April 23rd 2020. A virtual meeting platform was selected given the necessity of socially distant learning, and for ease of recording and re-distribution. (6) We will judge effectiveness with a knowledge based survey to measure understanding and retention. Impact: 100% of interns attended at least one lecture. 13 of 16 interns provided feedback, giving an average rating of 4.77 (on a 5-point Likert scale) for how well the curriculum prepared them for the COVID ICU. We plan to administer a knowledge based survey 6-8 months post intervention, with completed results by CORD 2021.