Junior doctors
Interactive format is favoured in case conference Alexander Sheng1, John Eicken2, Cheryl Lynn Horton2, Eric Nadel2 and James Takayesu1 1
Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Emergency Medicine, Brigham and Women’s Hospital, Boston, Masachusetts, USA
2
SUMMARY Background: Follow-up case presentation (FCP), a staple of emergency medicine residency conference curricula nationwide, has traditionally been delivered using POWERPOINTTM (PP). The sole use of the PP lecture format may limit audience participation. In light of existing literature supporting chalkboard and morning report formats, we changed FCP to an interactive chalkboard format with limited PP slides. We hypothesised that this change will enhance the perceived educational impact of FCP on learners. Methods: To examine learners’ perceptions regarding the PP-based and ‘chalkboard talk’ discussion formats, we conducted a time-series investigation with
pre- and post-intervention questionnaires using the fivepoint Likert scale. After obtaining Institutional Review Board exemption, 60 emergency medicine residents (post graduate years 1–4) were recruited through e–mail to complete the preintervention questionnaire. The post-intervention questionnaire was administered following a run–in period of nine postintervention FCPs. The questionnaires were compared using Mantel–Haenszel chi-square tests. Results: The pre- and postintervention questionnaire completion rates were 83.3 per cent (50/60) and 65 per cent (39/60), respectively. The chalkboard format was perceived by learners to be significantly more effective than
PP-based FCPs at educating the learner regarding the topics covered (3.5 versus 4.0, preversus post-, respectively, p = 0.003), teaching practical knowledge (3.4 versus 3.8, p = 0.014), stimulating selfknowledge assessment (3.4 versus 3.8, p = 0.023), encouraging the generation of broad differential diagnoses (3.4 versus 3.9, p = 0.008), and promoting an interactive learning environment (3.1 versus 4.1, p < 0.0001). Conclusions: The implementation of chalkboard format with interactive discussion is perceived by learners to be the superior didactic educational medium, compared with the exclusive use of PP slides for FCPs.
The chalkboard format was perceived by learners to be significantly more effective
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 241–245 241
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6/29/2015 10:24:13 AM
After the initial presentation, the discussion is driven by audience participation
INTRODUCTION
T
he pervasive use of PowerPointTM (PP) in medical education has led to a comprehensive transformation in the way many oral presentations are given. Instead of ‘chalk talks’, 35–mm slides and overhead projectors, there are now over 30 million PP presentations created daily.1 Failure to adhere to multimedia design principles may lead to the elevation of format over content, however, resulting in a barrage of neverending bullets, lists, and animations that can distract and confuse the learner.2–4
Our emergency medicine residency conference curriculum currently incorporates monthly 15–minute follow-up case presentations (FCPs) by interns and second-year residents (PGY–2s). Topics are chosen by the presenter based on a case seen in the emergency department that possesses important clinical diagnosis or management issues. They are traditionally presented using the PP format to illustrate the emergency department evaluation, course and clinical outcome, followed by an evidence-based overview of pathophysiology and management. When used without adherence to basic principles of multimedia design,2–4 the limitations of PP were readily apparent. In light of existing literature supporting the use of chalkboard discussion,5–7 we changed the initial case presentation to an interactive chalkboard format, allowing the presenter to use up to three PP slides for lab results, electrocardiograms, images and essential teaching points only. After the initial patient presentation, the discussion is driven by audience participation to discover key history and physical examination findings, generate and narrow the differential diagnosis, and propose diagnostic and treatment
plans (see Appendix S1). The changes to FCP are similar to and are modelled on the ‘morning report’, a commonly used format in many primary care and internal medicine residency programmes.8 The morning report format is often very high yield from an educational standpoint, and is regarded as the most important educational activity of the internal medicine residency training.9 The optimal medium to deliver FCPs to emergency medicine residents is unknown. Through the use of a time-series pre- and post-intervention questionnaire, we sought to assess resident learner and presenter attitudes towards learning from the PP lecture-based and interactive ‘chalkboard talk’ formats. We hypothesised that the changes to the FCP format would more easily engage and maintain learner attention, enhance their intrinsic interest in the subject matter, create a student-centred learning environment, and promote active discussion and enthusiasm for future sessions. Our secondary hypothesis was that presenters would attain a higher selfperceived level of expertise in the topic when preparing for FCP in the new format.
METHODS To assess resident learner and presenter attitudes towards each FCP format, we created a timeseries pre- and post-intervention
questionnaire using five-point Likert scaled responses. We piloted the initial 11–item questionnaire on 12 individuals – 10 residents and two faculty members – to assess item content validity. The final version of the distributed questionnaire is shown in Appendix S2. The questions focused on the learners’ reaction to and satisfaction with FCP, and asked the presenters the number of hours spent preparing the presentation and the perceived level of topic expertise attained as a result. After obtaining IRB exemption, all 60 residents in our 4–year residency programme were recruited by an e–mail containing a link to a voluntary anonymous online survey pre-intervention. A post-intervention survey was distributed to the same group of residents after a run-in period of nine FCPs using the new format. The five-point Likert scale responses were compared using Mantel–Haenszel chi-square tests and the number of hours spent in preparation of the presentation was compared using a Wilcoxon rank sum test in SAS 9.3 (SAS Institute, Inc., Cary, NC, USA).
RESULTS Fifty (83.3%) of 60 residents completed the pre-intervention questionnaire. Thirty-nine (65%) of 60 residents completed the post-intervention questionnaire. There were no partially completed
242 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 241–245
tct_12301.indd 242
6/29/2015 10:24:14 AM
surveys. The questionnaire completion rate per post graduate year is shown in Figure 1. According to pre- and postintervention questionnaires (using a scale of 1 = very ineffective, 3 = undecided and 5 = very effective), respondents perceived the new format of FCP to be significantly more effective at educating the learner (3.5 versus 4.0, pre- versus post-intervention, respectively, p = 0.003), teaching practical knowledge that can be applied in upcoming shifts (3.4 versus 3.8, p = 0.014), 100 90 80 70
stimulating self-assessment of knowledge (3.4 versus 3.8, p = 0.023), encouraging the generation of broad differential diagnoses for the patient’s presentation (3.4 versus 3.9, p = 0.008), and promoting an interactive learning environment that fosters group discussion (3.1 versus 4.1, p < 0.0001). Respondents did not perceive the new format of FCP to be significantly more effective at motivating further self-directed learning (2.9 versus 3.2, p = 0.12) and altering patient management more frequently (2.6 versus 2.7,
Pre Post Total
60 50 40 30 20 10 0
PGY-1
PGY-2
PGY-3
PGY-4
All
Figure 1. Number of pre- and post-intervention questionnaires by post graduate year (PGY)
p = 0.68). The change in format did not appear to affect enthusiasm for attending future sessions (1.3 versus 1.2, p = 0.054) or perceived expertise attained by the presenter from preparing for FCP (4.1 versus 4.1, p = 0.7). The number of hours spent preparing for the FCP was reported to be significantly less (8.0 hours versus 5.0 hours, p = 0.05) postintervention. A detailed comparison of pre- and post-intervention responses is presented in Table 1.
Respondents perceived the new format of FCP to be significantly more effective at educating the learner
DISCUSSION Follow-up case presentations (FCPs) are used as part of the curriculum for numerous emergency medicine training programmes across the nation. Whereas our previous FCP format facilitates active learning by the presenter, the suboptimal use of the PP lecture format can limit active audience participation, and induces learner fatigue, boredom and information overload. We acknowledge that the problem lies not in PP itself, but in the way in which it is implemented.10 Although more laborious and intricate to produce, a wellprepared PP-based lecture that adheres to multimedia design
Table 1. Comparison of pre- and post-intervention responses Questions
Pre
Post
p
How effective do you perceive the follow-up case conference to be at… …educating you regarding the topics covered?
Mean
3.5
4.0
0.003
…teaching you practical knowledge that you can apply on your upcoming shift?
Mean
3.4
3.8
0.014
…stimulating you to assess your own knowledge about the topic being covered?
Mean
3.4
3.8
0.023
…motivating you to read more on the topic being covered?
Mean
2.9
3.2
0.12
…encouraging you to actively generate a broad differential diagnosis for the patient’s presentation?
Mean
3.4
3.9
0.008
…promoting an interactive learning environment that fosters group discussion?
Mean
3.1
4.1
Interactive format is favoured in case conference Alexander Sheng1, John Eicken2, Cheryl Lynn Horton2, Eric Nadel2 and James Takayesu1 1
Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA Emergency Medicine, Brigham and Women’s Hospital, Boston, Masachusetts, USA
2
SUMMARY Background: Follow-up case presentation (FCP), a staple of emergency medicine residency conference curricula nationwide, has traditionally been delivered using POWERPOINTTM (PP). The sole use of the PP lecture format may limit audience participation. In light of existing literature supporting chalkboard and morning report formats, we changed FCP to an interactive chalkboard format with limited PP slides. We hypothesised that this change will enhance the perceived educational impact of FCP on learners. Methods: To examine learners’ perceptions regarding the PP-based and ‘chalkboard talk’ discussion formats, we conducted a time-series investigation with
pre- and post-intervention questionnaires using the fivepoint Likert scale. After obtaining Institutional Review Board exemption, 60 emergency medicine residents (post graduate years 1–4) were recruited through e–mail to complete the preintervention questionnaire. The post-intervention questionnaire was administered following a run–in period of nine postintervention FCPs. The questionnaires were compared using Mantel–Haenszel chi-square tests. Results: The pre- and postintervention questionnaire completion rates were 83.3 per cent (50/60) and 65 per cent (39/60), respectively. The chalkboard format was perceived by learners to be significantly more effective than
PP-based FCPs at educating the learner regarding the topics covered (3.5 versus 4.0, preversus post-, respectively, p = 0.003), teaching practical knowledge (3.4 versus 3.8, p = 0.014), stimulating selfknowledge assessment (3.4 versus 3.8, p = 0.023), encouraging the generation of broad differential diagnoses (3.4 versus 3.9, p = 0.008), and promoting an interactive learning environment (3.1 versus 4.1, p < 0.0001). Conclusions: The implementation of chalkboard format with interactive discussion is perceived by learners to be the superior didactic educational medium, compared with the exclusive use of PP slides for FCPs.
The chalkboard format was perceived by learners to be significantly more effective
© 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 241–245 241
tct_12301.indd 241
6/29/2015 10:24:13 AM
After the initial presentation, the discussion is driven by audience participation
INTRODUCTION
T
he pervasive use of PowerPointTM (PP) in medical education has led to a comprehensive transformation in the way many oral presentations are given. Instead of ‘chalk talks’, 35–mm slides and overhead projectors, there are now over 30 million PP presentations created daily.1 Failure to adhere to multimedia design principles may lead to the elevation of format over content, however, resulting in a barrage of neverending bullets, lists, and animations that can distract and confuse the learner.2–4
Our emergency medicine residency conference curriculum currently incorporates monthly 15–minute follow-up case presentations (FCPs) by interns and second-year residents (PGY–2s). Topics are chosen by the presenter based on a case seen in the emergency department that possesses important clinical diagnosis or management issues. They are traditionally presented using the PP format to illustrate the emergency department evaluation, course and clinical outcome, followed by an evidence-based overview of pathophysiology and management. When used without adherence to basic principles of multimedia design,2–4 the limitations of PP were readily apparent. In light of existing literature supporting the use of chalkboard discussion,5–7 we changed the initial case presentation to an interactive chalkboard format, allowing the presenter to use up to three PP slides for lab results, electrocardiograms, images and essential teaching points only. After the initial patient presentation, the discussion is driven by audience participation to discover key history and physical examination findings, generate and narrow the differential diagnosis, and propose diagnostic and treatment
plans (see Appendix S1). The changes to FCP are similar to and are modelled on the ‘morning report’, a commonly used format in many primary care and internal medicine residency programmes.8 The morning report format is often very high yield from an educational standpoint, and is regarded as the most important educational activity of the internal medicine residency training.9 The optimal medium to deliver FCPs to emergency medicine residents is unknown. Through the use of a time-series pre- and post-intervention questionnaire, we sought to assess resident learner and presenter attitudes towards learning from the PP lecture-based and interactive ‘chalkboard talk’ formats. We hypothesised that the changes to the FCP format would more easily engage and maintain learner attention, enhance their intrinsic interest in the subject matter, create a student-centred learning environment, and promote active discussion and enthusiasm for future sessions. Our secondary hypothesis was that presenters would attain a higher selfperceived level of expertise in the topic when preparing for FCP in the new format.
METHODS To assess resident learner and presenter attitudes towards each FCP format, we created a timeseries pre- and post-intervention
questionnaire using five-point Likert scaled responses. We piloted the initial 11–item questionnaire on 12 individuals – 10 residents and two faculty members – to assess item content validity. The final version of the distributed questionnaire is shown in Appendix S2. The questions focused on the learners’ reaction to and satisfaction with FCP, and asked the presenters the number of hours spent preparing the presentation and the perceived level of topic expertise attained as a result. After obtaining IRB exemption, all 60 residents in our 4–year residency programme were recruited by an e–mail containing a link to a voluntary anonymous online survey pre-intervention. A post-intervention survey was distributed to the same group of residents after a run-in period of nine FCPs using the new format. The five-point Likert scale responses were compared using Mantel–Haenszel chi-square tests and the number of hours spent in preparation of the presentation was compared using a Wilcoxon rank sum test in SAS 9.3 (SAS Institute, Inc., Cary, NC, USA).
RESULTS Fifty (83.3%) of 60 residents completed the pre-intervention questionnaire. Thirty-nine (65%) of 60 residents completed the post-intervention questionnaire. There were no partially completed
242 © 2015 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2015; 12: 241–245
tct_12301.indd 242
6/29/2015 10:24:14 AM
surveys. The questionnaire completion rate per post graduate year is shown in Figure 1. According to pre- and postintervention questionnaires (using a scale of 1 = very ineffective, 3 = undecided and 5 = very effective), respondents perceived the new format of FCP to be significantly more effective at educating the learner (3.5 versus 4.0, pre- versus post-intervention, respectively, p = 0.003), teaching practical knowledge that can be applied in upcoming shifts (3.4 versus 3.8, p = 0.014), 100 90 80 70
stimulating self-assessment of knowledge (3.4 versus 3.8, p = 0.023), encouraging the generation of broad differential diagnoses for the patient’s presentation (3.4 versus 3.9, p = 0.008), and promoting an interactive learning environment that fosters group discussion (3.1 versus 4.1, p < 0.0001). Respondents did not perceive the new format of FCP to be significantly more effective at motivating further self-directed learning (2.9 versus 3.2, p = 0.12) and altering patient management more frequently (2.6 versus 2.7,
Pre Post Total
60 50 40 30 20 10 0
PGY-1
PGY-2
PGY-3
PGY-4
All
Figure 1. Number of pre- and post-intervention questionnaires by post graduate year (PGY)
p = 0.68). The change in format did not appear to affect enthusiasm for attending future sessions (1.3 versus 1.2, p = 0.054) or perceived expertise attained by the presenter from preparing for FCP (4.1 versus 4.1, p = 0.7). The number of hours spent preparing for the FCP was reported to be significantly less (8.0 hours versus 5.0 hours, p = 0.05) postintervention. A detailed comparison of pre- and post-intervention responses is presented in Table 1.
Respondents perceived the new format of FCP to be significantly more effective at educating the learner
DISCUSSION Follow-up case presentations (FCPs) are used as part of the curriculum for numerous emergency medicine training programmes across the nation. Whereas our previous FCP format facilitates active learning by the presenter, the suboptimal use of the PP lecture format can limit active audience participation, and induces learner fatigue, boredom and information overload. We acknowledge that the problem lies not in PP itself, but in the way in which it is implemented.10 Although more laborious and intricate to produce, a wellprepared PP-based lecture that adheres to multimedia design
Table 1. Comparison of pre- and post-intervention responses Questions
Pre
Post
p
How effective do you perceive the follow-up case conference to be at… …educating you regarding the topics covered?
Mean
3.5
4.0
0.003
…teaching you practical knowledge that you can apply on your upcoming shift?
Mean
3.4
3.8
0.014
…stimulating you to assess your own knowledge about the topic being covered?
Mean
3.4
3.8
0.023
…motivating you to read more on the topic being covered?
Mean
2.9
3.2
0.12
…encouraging you to actively generate a broad differential diagnosis for the patient’s presentation?
Mean
3.4
3.9
0.008
…promoting an interactive learning environment that fosters group discussion?
Mean
3.1
4.1
