Teaching residents to teach: A pilot study for an innovative online curriculum.

Introduction: Resident-as-teacher (RAT) curricula have improved teaching behavior, ability, and confidence among resident participants. However, there are limited data on the appropriate format, length, and content. With teaching being a core residency competency and residents delivering one-third of student teaching in the clinical setting, properly training residents in clinical teaching is essential. We created a formal, scalable, asynchronous RAT curriculum. We report the pilot implementation of this curriculum along with feasibility, user acceptability, and preliminary knowledge outcomes. Methods: In this pilot pre-post interventional study, senior emergency medicine residents completed a formalized online education curriculum during their "teach month." The curriculum consisted of three online modules completed weekly over a 4-week rotation. Topics included adult learning, assessment and feedback, and group teaching. Several surveys were sent to residents before and after curriculum implementation. The surveys rated satisfaction and asked several education-specific knowledge questions to assess learning. Ratings were analyzed using means and confidence intervals (95%). Knowledge questions were graded and then analyzed by ANOVA and Fisher's LSD test. Results: After the online modules were completed, the intervention group residents' mean score on knowledge questions was significantly higher than that prior to the curriculum and significantly higher than that the control group (previous graduated residents; 6.00 vs. 2.70, p = 0.0001; and 6.00 vs. 3.00, p = 0.0003, respectively). This score was maintained 3 months after completing the online modules. Intervention group residents were more satisfied with the online education resources than the control group (p = 0.048). Conclusions: Residents participating in a formalized online curriculum during their teach month demonstrate a high comprehension of education concepts and increased satisfaction with the provided educational resources and report high satisfaction with the teach month. Our pilot study suggests that a short online education-focused curriculum is an effective method of providing RAT training and may be applicable to clinical teachers across specialties and experience levels.

Faculty Development and the Emergency Medicine Educator: A National Needs Assessment.

BACKGROUND: Faculty development (FD) encompasses structured programming that aims to enhance educator knowledge, skill, and behavior. No uniform framework for faculty development exists, and academic institutions vary in their faculty development programming, ability to overcome barriers, resource utilization, and achievement of consistent outcomes. OBJECTIVE: The authors aimed to assess current FD needs among emergency medicine educators from six geographically and clinically distinct academic institutions to inform overall faculty development advancement in emergency medicine (EM). METHODS: This cross-sectional study assessed FD needs among EM educators. A survey was developed, piloted, and distributed to faculty via each academic institution's internal e-mail listserv. Respondents were asked to rate their comfort level with and interest in several domains of FD. Respondents were also asked to identify their previous experience, satisfaction with the FD they have received, and barriers to receiving FD. RESULTS: Across six sites, 136/471 faculty completed the survey in late 2020 (response rate of 29%): 69.1% of respondents reported being satisfied overall with the FD they have participated in, and 50.7% reported being satisfied with education FD specifically. Faculty report higher comfort levels and interest in several domains when satisfied with the education-specific FD they have received compared with those who report not being satisfied. CONCLUSIONS: EM faculty report generally high satisfaction with the overall faculty development they have received, although only half express satisfaction with their education-related faculty development. Faculty developers in EM may incorporate these results to inform future faculty development programs and frameworks.

Gamification of Hospital Utilization: Incorporating Cost-consciousness in Daily Practices.

Healthcare costs in the United States have skyrocketed over the past decade, contributing to an estimated $750 billion in wasteful spending annually. Despite the demand to improve residency education on value-based, cost-conscious healthcare, there is no consensus on how to best teach this practice. Traditional lectures have failed to demonstrate enduring change in clinical practice patterns, provider attitudes, and reductions in hospital expenditures. We sought to evaluate whether gamification is an effective pedagogical tool to teach cost-consciousness to emergency medicine (EM) residents by creating a 60-minute interactive session based on the popular gameshow, the Price is Right. Costs and associated charges for common laboratory tests, radiographic studies, medications, and common physical resources typically found in the emergency department (ED) were first obtained through direct communication with the ED clinical director and hospital leadership. The session itself consisted of three phases with several Price-is-Right-themed games, which included realistic visual stimuli reminiscent of the gameshow that were created by the authors using the PowerPoint. Formal quantitative and qualitative feedback was solicited at the end of the session. Quantitative evaluation of the educational intervention was obtained through a 22-item questionnaire using a five-point Likert-type scale from 19 of the 22 enrolled residents (86% response rate). Responses were generally very positive with an overall course rating score of 4.16 (SD +/- 0.90). Qualitative feedback identified learners' predilection for gamified delivery of nonclinical content during conference. The majority of residents (89%) recommend the activity to be used in subsequent offerings to other learners. With healthcare costs on the rise, our feasibility study demonstrated that gamification is an effective way to teach mindful, cost-conscious care to EM residents. Gamification offers a fun and engaging alternative that should be further utilized in EM educational formats. Future studies are needed to longitudinally assess the learner retention and cost-containment practices.

Evaluation of the branched-chain DNA assay for measurement of RNA in formalin-fixed tissues.

We evaluated the branched-chain DNA (bDNA) assay QuantiGene Reagent System to measure RNA in formalin-fixed, paraffin-embedded (FFPE) tissues. The QuantiGene Reagent System does not require RNA isolation, avoids enzymatic preamplification, and has a simple workflow. Five selected genes were measured by bDNA assay; quantitative polymerase chain reaction (qPCR) was used as a reference method. Mixed-effect statistical models were used to partition the overall variance into components attributable to xenograft, sample, and assay. For FFPE tissues, the coefficients of reliability were significantly higher for the bDNA assay (93-100%) than for qPCR (82.4-95%). Correlations between qPCR(FROZEN), the gold standard, and bDNA(FFPE) ranged from 0.60 to 0.94, similar to those from qPCR(FROZEN) and qPCR(FFPE). Additionally, the sensitivity of the bDNA assay in tissue homogenates was 10-fold higher than in purified RNA. In 9- to 13-year-old blocks with poor RNA quality, the bDNA assay allowed the correct identification of the overexpression of known cancer genes. In conclusion, the QuantiGene Reagent System is considerably more reliable, reproducible, and sensitive than qPCR, providing an alternative method for the measurement of gene expression in FFPE tissues. It also appears to be well suited for the clinical analysis of FFPE tissues with diagnostic or prognostic gene expression biomarker panels for use in patient treatment and management.