aliem-cord-logoThis ALiEM MEdIC series is part of a very special event! In a few days in Nashville, TN the ALiEM Design Fellows (Dr. Catherine Patocka & Dr. Jeremy Voros) and I will be joining forces with CORD’s Dr. Rob Cooney to organize a special Design Thinking Hackathon. This workshop will take place at CORD’s 2016 Academic Assembly, which is only a few days away.  We are very excited that our Design fellows team will be helping to introduce people to the world of Design Thinking!

During our session we will be challenging a group Emergency Medicine educators from all across the nation to rethink their local residency conference (#EMConf). But we need YOUR help! And we’re asking it via the ALiEM MEdIC series through the Case of the Catastrophic Classroom.

We’re hoping that you can help us uncover facets of a problem facing all of us each week:

How can we make our classroom/academic time truly count for our residents?

Take a look at the following case, and let us know what problems you think that you see in our case, but also share the problems you have encountered with the residency academic programs you remember (or are currently experiencing).


The Case of the Catastrophic Classroom

By Drs. Catherine Patocka (@PatockaEM), Jeremy Voros (@VorosMD), Robert Cooney (@EMEducation)

Jill, an emergency physician, is a recently-hired junior faculty member at the St. Elsewhere Emergency Medicine (EM) residency program. She completed her own training 5 years ago at a well-respected residency, where she was chief resident, and then stayed on as a faculty member. She had a strong interest in resident education and was active on the CORD listserv. But there was a well-established leadership team at her home program and limited opportunity for advancement.

Jill took a position at St. Elsewhere, a less-established residency, that offered her a leadership role. Her first challenge in this new role was a revamp of their weekly half-day educational conference.

This is how the St. Elsewhere residency program’s informational web page described about their conference:

“Our residents are relieved from regular hospital duties (i.e. they receive protected time) to attend conference. The sessions are held in a Campbell-Morrison memorial lecture hall at St. Elsewhere every Wednesday from 7:30 am to 12:30 pm for their educational conference. The day begins with a Morbidity and Mortality conference, followed by various lectures delivered by senior residents or faculty members. Lecture topics are on a repeating curriculum on a 1.5-year cycle, thereby ensuring that the residents see every topic as both a junior and senior resident. Our curriculum is based on the EM Model and uses guided readings from prominent EM textbooks.”

When Jill emailed the current program director (PD) about who the last curriculum lead was within the faculty, and how s/he designed the curriculum. The PD quickly wrote back stating that he couldn’t remember, and that he thinks it was always that way. He wrote: “I think this is the way things are done because this is the way things have always been done.


Jill’s First St. Elsewhere’s EM Conference Experience

Jill arrived early and sat in the back of the hall taking notes throughout the first conference. She was joined in the back of the lecture hall by a rotating cast of 3-4 faculty members who came and went throughout the conference. Only one other faculty member attended the whole conference but he worked on his laptop the whole time.

The Morbidity & Mortality (M&M) conference was a series of typical case presentations lead by a senior resident. The resident involved in the management of the case stood before the group as well, answering questions about his thought process and management choice. Several residents took questions clearly placing blame on their choices, and one of the residents became quite tearful and had to leave the podium mid-presentation.

A 4-question multiple choice quiz followed M&M, about the week’s assigned reading. Residents perfunctorily completed the quiz. Correct answers were provided by the residency coordinator afterward. No discussion followed.

M&M was followed by several PowerPoint-driven, didactic lectures. One was given by a senior resident, and included a detailed review of the Kreb’s Cycle. Another was given by a faculty member on renal emergencies but the slide deck was clearly prepared by someone else, as evidenced by the fact that the other person’s name was still listed on the title slide.

Throughout the conference most residents were slumped in their chairs staring at their smartphones. One resident slept in the front row.

There was confusion over which faculty member was supposed to deliver the final lecture and the assigned person was not present or reachable by phone. As such, the conference ended 45 minutes early.


Jill Meets with the Stakeholders

Jill met with one of the chief residents, Rob, to discuss conference. Rob is well-respected among the residents and besides being clinically excellent is a reliable advocate with the administration. He expressed frustration about conference. The format is largely unchanged from when he was an intern. He feels too much of the teaching is done by senior residents – which though beneficial for junior residents, leaves senior residents’ needs unfulfilled. Early on he had hoped to stay at the program when he graduated but now he is actively looking for an academic position elsewhere.

Jill heard more complaints from faculty after their last staff meeting. Several staff members complained that there was no CME credit for them if they attended. One faculty member, who had previously been a regular presenter at conference, complained about the lack of financial incentive (i.e. “There is no buy-down! It’s essentially volunteer work!”) or even recognition throughout the residency for active involvement in the educational conference (“I don’t even get a thank-you letter!”). Others complained that the early start time made coordinating childcare difficult. Some expressed surprise to learn of any concern over the quality of conference.

Jill also met with the program director, Ravi. He has been in the position for 5 years. Two of those years were complicated by conditional accreditation by the ACGME. When asked about conference he became exasperated. His primary goal is to stick to the ACGME requirements, especially those concerning total conference time and faculty supervision. He acknowledges his focus has been on duty hour compliance and implementing resident assessment based on the new milestones, rather than educational innovation.


Jill Seeks Advice

Jill reached out to her colleagues on the various listservs for suggestions to reinvigorate St. Elsewhere’s educational conference. Many users suggested a “flipped classroom” approach but each had different conceptions of the final product. Some recommended FOAM resources on the internet, but others expressed concern about ACGME compliance. Other popular suggestions included small group sessions, off-site learning, and self-directed study.


Key Questions

  1. What problems have you encountered in your EM Conference / Academic Day proceedings?
  2. What are problems that you can identify in the above case? Are there any specific problems that resonate with you?
  3. What are some solutions you have encountered or seen with regards to rejuvenating academic proceedings for residency programs?


Weekly Wrap-Up

This month, we will actually be opening up our weekly wrap-up to our hack-a-thon participants. We hope to post some of the solutions that the #CORDAA16 Hack-a-thon will generate for this case. This means that there will be a short delay in the wrap-up this month, and we will aim to post these insights within a few weeks of our initial discussion.

Additionally, Robert Cooney and Teresa Chan will author a blog post that summarizes the process we used to generate these cases.

On March 18, we will plan to post the Expert Responses and Curated Community Commentary for this case. After that date, you may continue to comment below, but your commentary will no longer be integrated into the curated commentary, which was released on that date. That said, we’d love to hear from you, so please comment below!


All characters in this case are fictitious. Any resemblance to real persons, living or dead, is purely coincidental. Also, as always, we will generate a curated community commentary based on your participation below and on Twitter. We will try to attribute names, but if you choose to comment anonymously, you will be referred to as your pseudonym in our writing.