Reiter et al 1 just published a review on Individual Interactive Instruction also known as asynchronous learning in the Annals of Emergency Medicine.

They chronicled the events in 2008 that led CORD (Council of Emergency Medicine Residency Directors) to recommend integration of individual interactive instruction into the residency curriculum. The summary recommendations by Sadosty et al 2 discuss components, strengths, and weakness of both asynchronous and synchronous learning paradigms along with background about Malcolm Knowles and andragogy.

Ultimately, they concluded:

  • With the explosion of web-based learning tools (such as this blog!), it is easier to educate residents in a self-directed and self-initiated manner.
  • There is and always will be a role for synchronous curriculum
  • Residencies should incorporate both curricular styles in order to provide the best education possible.

Great, so we all agree that asynchronous learning is awesome, but there is just one small hitch towards the integration of asynchronous learning… CORD didn’t define it nor recommended delivery methods in the 2008 workgroup.

So… what counts as asynchronous learning?

“Individual interactive instruction is defined as individualized learning away from groups of similar-level learners, which allows learners to consume material at their own pace on their own time table.” – Reiter et al.

But what is the material?

I have talked to a few people who say that it is exactly this ambiguity that prevents them from launching a vibrant asynchronous curriculum for their resident education. Their concerns include potentially negative feedback from the RRC, which could have devastating consequences.

But there are some that have been developing curricula that they feel meet the CORD recommendations. Reiter et al mention that residents are offered a listed catalog of resources such as podcasts, articles, textbooks, and online lectures that are PGY level specific. Credit is given by taking a short online quiz specific to the material read.

They also corresponded with Dr. Cynthia Benson, currently an Administrative Fellow at Staten Island University Hospital and my former chief resident at SUNY Downstate, Brooklyn. She provided examples of asynchronous learning, which paired in conjunction with recommended online articles such as:

  • Simulation sessions
  • Board review sessions
  • Journal clubs
  • Slit lamp procedure labs

These activities were directly supervised by a faculty member who is either physically present during the event (i.e. moderating board review session), or who has read the material being used.  We would use this reference list to ensure residents completed the required number of materials in each category.

Balancing Act

I wonder, however, does it really meet the definition of asynchronous learning if residents have to choose a preselected article or review session?  Doesn’t asynchronous mean that residents get the freedom of choosing any article, podcast, blog, or review session of their choice on their own schedule? Unfortunately, I think the reality is that there must be some oversight to ensure quality and consistency in residency training and education. We need to find that balance somehow.

  • Do you use asynchronous learning in your training program?
  • If so, what is considered asynchronous learning?
  • How is credit given?
  • What is the faculty oversight process like?
  • How is knowledge gained or retained assessed?

I am currently in the process of reviewing the literature to try to find definitions of asynchronous learning that residency programs are using.  I would love to hear your thoughts and please share your experiences!

Reiter D, Lakoff D, Trueger N, Shah K. Individual interactive instruction: an innovative enhancement to resident education. Ann Emerg Med. 2013;61(1):110-113. [PubMed]
Sadosty A, Goyal D, Gene H, Kilian B, Beeson M. Alternatives to the conference status quo: summary recommendations from the 2008 CORD Academic Assembly Conference Alternatives workgroup. Acad Emerg Med. 2009;16 Suppl 2:S25-31. [PubMed]
Nikita Joshi, MD

Nikita Joshi, MD

ALiEM Chief People Officer and Associate Editor
Clinical Instructor
Department of Emergency Medicine
Stanford University
Nikita Joshi, MD


Emergency Medicine Doctor Associate Editor of ALiEM Gun Sense Advocate #FOAMed #Docs4GunSense #MomsDemandAction Tweets represent my own views and opinions