March 2024


Happy almost-spring.  And happy Daylight Savings Time, for those who observe it.   106 years ago today Daylight Savings Time was introduced in the United States, leading to a century or so of confusion for those of us who try to schedule meetings across time zones.

Enjoy another edition of the Journal Club.    See you in a few weeks!

Amit, Jon and Karen

Screen time

Growdon AS, Oñate A, Staffa SJ, Berger S, Callas C, Chitkara MB, Crook TW, Daniel DA, Huth K, Lehmann S, Len KA, Murray AM, Neeley M, Devon EP, Pingree E, Rose S, Weinstein A, Wolbrink TA. The Effect of Providing Protected Time for Utilization of Video-Based Learning in the Pediatric Clerkship: A Randomized Trial. Acad Pediatr. 2024 Jan-Feb;24(1):139-146.

Reviewed by Marguerite Costitch

What was the study question?

Does providing protected time for completion of a video-based curriculum and/or making the completion of the curriculum mandatory improve lesson completion and knowledge acquisition?  How do students perceive provision of protected time for completion of a video-based curriculum?’

How was this study done?

The authors conducted a multicenter, randomized controlled trial assessing completion of and knowledge gain following review of a 6-video curriculum highlighting high yield topic areas. Students were randomized into four different study groups: protected time with mandatory completion, protected time with optional completion; no protected time with mandatory completion; no protected time with optional completion. Students randomized to receive protected time were given two hours (specific, assigned time blocks) to complete the curriculum; these time-blocks were compared with timestamps for pre-and post-test completion to determine whether students were accessing the curriculum during protected time. To assess knowledge acquisition, students were asked to complete multiple-choice question tests both before and after completion of the curriculum. Student perceptions were assessed via a post-clerkship survey, specifically analyzing free-text responses. 

What were the results?

326 students across 7 medical schools participated in the study; 160 (49%) completed both pre-and post-tests and were included in the analysis. Students assigned to receive protected time completed more lessons than those students who did not receive protected time (p <0.001). There were no statistically significant differences in lesson completion between students assigned to mandatory completion versus optional completion. There was no significant difference in knowledge acquisition among all four study groups, regardless of whether assigned mandatory completion or given protected time. When looking at specific videos, only three topic videos (developmental milestones, Kawasaki Disease, croup) demonstrated significant knowledge acquisition after completion of the video lesson (p <0.001, p<0.001, p 0.019, respectively). Students generally appreciated the protected time, but qualitative themes that emerged were lack of need, competition with opportunities to engage in clinical care, and poor integration into daily workflow. Only 0.8% of pre-test attempts were made during designated protected time.

How can I apply this to my work in education?

There has been increasing demand from both learners and medical educators to integrate more asynchronous online or video-based curricula into clerkship curricula to supplement clinical experiences and support in-person learning opportunities, but little research has been done on how to best incorporate these curricula into current clerkship models. These study authors provide some insight into how protected time is used by students and how it may help support self-directed learning using an adult learning theory approach.

Editor’s Note:  In a side note buried in this richly layered study, the authors observed that a third of measured access to the curriculum occurred between midnight and 6 am, raising concerns about work assigned ‘after hours’ during clerkships and its potential impact on sleep. (JG)

The coach and the coachee  

Park, A, Gillespie, C et al. Scaffolding the Transition to Residency: A Qualitative Study of Coach and Resident PerspectivesAcademic Medicine 2024; 99(1):91-7.

Reviewed by: Melanie Rudnick and Megan Kabara

What was the study question? 

What are the perspectives of residents and faculty coaches who participated in a coaching program aimed at helping learners transition from medical school to residency? 

How was the study done? 

Fifteen faculty members with existing roles in UME and GME participated in a  coaching curriculum. Faculty coaches were each assigned about 10 residents, 94 residents in total. Coaching sessions occurred quarterly throughout the year and as needed. Coaches used structured templates for each meeting that focused on certain themes such as creating goals, identifying strategies for problem solving, and reflecting on values. At the end of the year, focus groups were held with participating residents, and individual interviews were held with the coaches. Data were coded and the research team developed analytical themes from concepts that appeared in both data sets. A conceptual model for coaching through residency transition was developed.

What were the results? 

Focus groups involving  39 residents (42% participation) and all 15 faculty coaches participated in interviews. Three analytic themes were generated: (1) coaching created an explicit curriculum for growth; (2) factors contributing to successful coaching; and (3) the way in which factors supporting coaching contrasted GME norms. The conceptual model describes how the transition from UME to GME has an inherent shift from academic performance to individualized goals along with working as part of a team that the coaching program can help make more explicit. 

How can I apply this work in education? 

Implementing a coaching program during the transition from medical school to residency can foster professional identity formation and aid in the development of a well-rounded adaptable physician. By implementing a coaching program, one hopes to see a smoother transition to residency and role in the health care team. Coaching makes the idea of practice-based learning and improvement more explicit, and can foster individualized support for self-directed learning, increased self-awareness, and help in building autonomy. Coaching can lead to skills such as confidence, humility, strong self-assessment, and goal setting which is not often emphasized in traditional GME training. 

Editor’s Comments: In this program, the faculty coaches were each given a 0.1 FTE support for coaching approximately 10 residents – demonstrating the commitment to providing coaching to residents at this critical transition point. Having dedicated time to foster the development of these relationships is likely a factor contributing to the success of both the coaching program and the residents involved in it. (KFo)

Flip before starting

Congdon M, Goldstein L, Maletsky KD, Craven M, Rose S, Devon EP. Pediatric Intersession: An Upfront Flipped-Classroom Curriculum to Promote Pediatric Clerkship Readiness. J Med Educ Curric Dev. 2024 Feb 7:11:23821205241229774. doi: 10.1177/23821205241229774. eCollection 2024 Jan-Dec.

Reviewed by Sanghamitra Misra

What was the study question? 

Can a strategically-developed flipped classroom pre-clerkship curriculum improve clerkship readiness?

How was the study done? 

The investigators developed an interactive flipped classroom “Pediatric Intersession (PI)” curriculum with case-based learning to improve pediatric clerkship readiness as measured by clinical knowledge. They started with a needs assessment and then crafted the curriculum with four daily 5-hour modules based on the 2019 COMSEP curriculum. All pediatrics clerkship students were required to participate in this 20-hour curriculum immediately before the start of the clerkship. Each day, there was a post-test. These modules replaced the existing weekly lecture-based clerkship didactics. 

What were the results?

From January to December 2021, 152 students participated in PI, and 66% of students completed the course evaluation. More than 90% of respondents indicated that PI enhanced their clinical learning. Pre-/post-testing demonstrated some knowledge gain following the small-group sessions, but there was no change on the NBME Pediatrics Subject Exam mean scores compared to prior cohorts of students. Although some students commented about too much required pre-reading, students felt well-prepared for the PI sessions. 

How can this be applied to my work in education?

We can all consider quality improvement in the way we provide our didactic sessions. Although hands-on clinical time is most important during a clerkship, students need dedicated time to bring their knowledge to a competent level to meaningfully care for patients. This knowledge can be gained in various ways such as independent items (videos, books, or online question banks) or within the clerkship through lectures or interactive case-based workshops. Timing of these sessions during or before the clerkship is also important. These investigators created a unique way of bringing student knowledge up before starting the clerkship using a flipped classroom model, and it was a success. Although not all of us have the time/faculty help to create something similar, we can create new methods of instruction to address our new age of learners. 

Editor’s Note: I love studies that compare educational strategies as our instruments to educate students evolve. In this study they show no difference between two strategies. In the new strategy though there is still faculty involvement required to perform small groups which would replace the lectures. (AKP)