APPD Annual Meeting – Miami, FLApril 2, 2011

UNIVERSITY OF WISCONSIN

Program DirectorJohn Frohna, MD

Associate Program Director

Melissa Cercone, MDChief Residents

Lindsay Geier, MDJeff Yaeger, MD

UNIVERSITY OF NEW MEXICO

Program DirectorBenjamin Hoffman MD

Associate Program Directors

Amy Staples MDWalter Dehority MD

Chief ResidentRebecca Rotello MD

Regularly scheduled didactic sessions

Departmental conferences, including regular morbidity and mortality conferences, seminars, teaching rounds, and other structured educational experiences must be conducted on a regular basis and with sufficient frequency to fulfill educational goals.

Reasonable requirements for resident attendance should be established for the various conferences; their attendance should be documented, and there must be appropriate faculty participation.

Press and release the "GO" button.While the light is flashing red and green, enter the 2 digit channel code: 41After the second digit is entered, Press and release the "GO" button. The light should flash green to confirm.Press and release the "1/A" button.  The light should flash amber to confirm.

1 2 3 4 5 6

46%

16%

4%

8%

26%

0%

1. Program Director2. Associate Program 

Director3. Coordinator4. Chief Resident5. Resident6. Other

1 2 3

23% 21%

57%1. 1‐102. 11‐203. 21+

1 2

2%

98%1. Yes2. No

1 2 3 4 5

4%

13%

0%

25%

58%1. <25%2. 25%3. 50%4. 75%5. 100%

1 2 3

81%

2%

17%

1. Frequently (daily)2. Infrequently3. Never

1 2 3 4

60%

2%4%

35%

1. Strongly agree2. Agree3. Disagree4. Strongly disagree

1 2

67%

33%

1. Yes2. No

Identify limitations inherent in a traditional noon conference structureDiscuss benefits of block curriculum designDescribe the process of block curriculum developmentDescribe evaluation opportunities for looking at block conferences. 

To change or not to changeThe process of becoming a blockheadNow what do I do?Plan for evaluation

Limitations to your current lecture formatBenefits of a block curricular designBarriers to change

Content based on presenting signs/ symptomsBlock conferences every 2 weeksFriday afternoonsAll available residents attendProtected timeAttending/fellow coverage

Weekly meetingThursday afternoons1‐5 pmFollows noon Grand Rounds

4‐5 separate topics▪ Increased interaction as afternoon progresses▪ Integrates current schedule▪ Ensures no one misses single topics

All residents attend when not post‐call or awayProtected timeAttending coverage

Identify key stakeholders who need to be involvedIdentify content goals and initial motivationIdentify content sourcesEstablish overall designStructureTimingCoverageHandling absencesExpectations for residents and faculty

UW

RevolutionaryInvolvement of residents/facultyClinical presentation approachContent based on PREP topics

UNM

EvolutionaryMix of didactic, small group and interactive workABP content specs, PREP, reliable speakers

ParticipantsEinstein problemsTime Space

Individual session formatPreparation for presentersLearning objectivesFacilitating attendance

Design50 problem‐based sessions over 2 years

ParticipantsPL1‐3s

Scheduleq2 weeks on Fri afternoons, 1‐3:30pm

AbsencePost‐test +/‐ remediation

Pediatric Education and Active Resident Learning

Pre‐readingPre‐quiz (Turning Point)Didactic IntroductionMultidisciplinary & Active Learning▪ Resident Scholar▪ Cases, video, role play, 

simulationPost‐quizResident feedback

Design18 month recurring curriculum2 months core content per year

ParticipantsPL 1‐3s

ScheduleThursday PM after grand rounds 1‐5 PM

Clinical coverageFaculty

AttendanceMonitored

Didactics carry over from Noon Conference

Need reliable speakersIncreasingly interactive

2‐3 hours lectureInteractive Sessions▪ Journal Club▪ QI curriculum▪ Simulation lab▪ Boards review▪ Housestaff meetings

Individual sessionsEfficacyQuality

Broader impactSatisfactionAttendanceDuty hoursClinical care

Session EvaluationResident pre/post knowledgeResident pre/post self‐efficacyResident and PD assessment of quality

General ImpactAttendanceResident and faculty perceptionsDuty hoursClinical care

Pre‐conversion surveyOld Noon Conference

6 month follow‐upResident school

Annual evaluations2006‐2010

ChallengesSmall numbersFaculty differentially involved

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

UNM Actual Attendance

UNM Potential Attendance

UW Actual Attendance

UW Potential Attendance

Noon Conf Block Conf

% Residen

t  Class

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Inpatient Outpatient Inpatient Outpatient

UW Noon

UW Block

UNM Noon

UNM Block

Faculty Residents

% Respo

nden

ts Perce

iving Interferen

ce

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Inpatient Outpatient Inpatient Outpatient

UW Noon

UW Block

UNM Noon

UNM Block

Faculty Residents

% Respo

nden

ts Perce

iving Interferen

ce

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Happy with NoonConference

Unhappy withNoon Conferences

Happy withPEARLs

% Wanting toRevert to Noon

Conf.

Residents

Faculty

% Respo

nden

ts

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% Happy withDaily Noon Conf.

% Unhappy withDaily Noon Conf.

Happy withResident School

% Wanting toRevert to DailyNoon Conf

Residents

Faculty

% Respo

nden

ts

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

PL‐1, 2 PL‐3

4.37 4.31

2006

2007

2008

2009

2010

Avg=3.38

Avg=3.45

QuestionPre‐Resident School (%)

Post‐Resident School (%)

Difference  (95 % CI) p‐value

Satisfactionwith Resident Attendance

21.6 43.7 ‐22.1 (‐42.4 to ‐1.8) 0.0165

Difficult to Complywith Duty HourRequirements?

36.1 13.0 23.1 (4.9 to 41.3) 0.0068

Overall Happiness with Resident School

29.0 50.1 ‐21.1 (‐42.0 to ‐0.1) 0.0246

Question Noon (%) PEARL (%) p‐value

Satisfactionwith Resident Attendance

35.0 95.8 <0.0001

Difficult to Complywith Duty HourRequirements?

28.6 12.0 0.2012

Overall Happiness with 

PEARL26.0 61.4 0.0096

QuestionPre‐Resident School (%)

Post‐Resident School (%)

Difference  (95 % CI) p‐value

Satisfactionwith Quality of Presentations

65.3 88.3 ‐23.0 (‐43.9 to ‐1.8) 0.0168

Difficult to Complywith Duty HourRequirements?

41.7 2.9 38.8 (20.1 to 57.3) 0.0001

Overall Happiness with Resident School

84.6 100.0 ‐15.4 (‐28.0 to ‐2.7) 0.0088

Question Noon (%) PEARL (%) p‐value

Satisfactionwith Quality of Presentations

60.1 100.0 0.0012

Difficult to Complywith Duty HourRequirements?

21.4 0.0 0.0339

Overall Happiness with 

PEARL64.3 100.0 0.0028

Careful planningStructureClinical coverageCurriculum

ImplementationEvaluation

It Can Be Doneand people will rejoice!