The “Future” of Didactics

Kathryn Andolsek MD, MPHDuke University HospitalGraduate Medical Education

Imagine the best didactic experience you ever had?

Goal

• Anticipate expectations for “didactics”• Develop creative, feasible, cost- effective

options

Didactics

• Definition• Impact on Learning• What ACGME really

requires• Possible “options” • New content• Competency

Didactics– Defined: (ACGME 9/29/2010 glossary)

• Didactic: A kind of systematic instruction by means of planned learning experiences such as conferences or grand rounds

• GME: period of didactic and clinical education in a specialty….

Evidence Based Educational approach

• Limited evidence of impact of Traditional lectures

• On- line learning “as good” • Refocus from “strategy” to outcome

Adult Learning Theory(with thanks to Malcolm Knowles)

• Active Learning– Problem/case based

– interaction associated = better achievement & retention of information

– Best ways of learning =• Doing• Teaching others

• “Just in time” learning– Virtual and or simulation environments

• Capacity of learner to access and integrate multiple sources of information (this generation may be the best at multi-tasking)

Bligh, 2000

Institutional Requirements

CPR (new)• PD must…oversee and ensure the quality of didactic

& clinical education in all sites II.A.4.a (IM)

• … curriculum must contain the following educational components: regularly scheduled didactic sessions IV.A.3……..

• learning objectives …must: be accomplished through appropriate blend of supervised patient care responsibilities, clinical teaching and didactic educational events VI.A.4.a)

IM- Didactics

• Regularly Scheduled Didactic sessions IV.A.3• Must include a didactic program. based upon core knowledge content IV.A.3.a.

– May include lectures, web-based content, pod casts IV.A.3.a.1• Program must afford each resident an opportunity to review all of the core

curriculum topics IV.A.3.a.1• Residents must have opportunity to participate in

– morning report, – grand rounds, – journal club, and – M and M (or quality improvement) – all of which must involve faculty IV.A.3.a.2

• Program must provide opportunities for residents to interact with other residents and faculty in educational session at a frequency sufficient for peer-peer and peer-faculty interaction VI.A.3.a.3

• Didactic and clinical education must have priority in the allotment of residents’ time and energy VI.A.3

Surgery - didactic sessions:

• The education of surgeons. encompasses both didactic instruction in the basic and clinical sciences + procedural skills and operative techniques Int.A.

• Regularly Scheduled Didactic sessions IV.A.3• Increases in resident complement: documentation of

adequate clinical material and complex operative cases and quality didactic education III.B.2.b)

• Regularly scheduled didactic sessions IV.A.3• Didactic and clinical education must have priority in the

allotment of residents’ time and energy VI.A.3

Didactics

• opportunity to review • opportunity to participate in– morning report, – grand rounds, – journal club, and – M and M (or quality improvement) – all of which must involve faculty

• opportunities for residents to interact with other residents and faculty

• Core content of anything specified by RRC

Generation Y (1982-1998)

Capturing Lectures

• Audacity• Camtasia• Lectopia• Panopta• And more….

Duke iTunesUwww.itunes.duke.edu

Duke itunesU

Public MaterialLogin for Classes• Net ID protected• Invitation only

GME iTunesU

Wiki

• Website allowing numerous people access for edits

• Restriction options for viewing, editing, etc.• Examples:– Meeting agenda and minutes– Program Information managed by residents (ex.

Pathology)– Project Committee Organization– Group work– Lecture series (ex. Health Policy)

Health Policy Lecture Series Example

Links from Wiki• Roster• Lecture Schedule• Presenter Bio• Presenter Photo• Readings• iTunesU• Evaluation• Post-test

New Content

• Professionalism• Personal Responsibility• Patient Safety• Transitions of Care• Alertness Management/Fatigue Mitigation• Supervision• Teamwork

Other On-line Resources

• LIFE Curriculum– www.LIFEcurriculum.com– Trigger Scenarios

• MedEdPortal– www.aamc.org/mededportal

• AMA Electronic Ethics Journal (virtual mentor)– http://virtualmentor.ama-assn.org/

Didactics

• Definition• Impact on Learning• What ACGME really

requires• Possible “options” • New content• Competency

FAQs, Possible pertinence to Didactics

• Duty hours are defined as all clinical and academic activities related to the program; i.e., patient care (both inpatient and outpatient), administrative duties relative to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled activities, such as conferences. Duty hours do not include reading and preparation time spent away from the duty site. VI.G.1. Max Hours work per week

• Duty hours do not include reading, studying, and academic preparation time, such as time spent away from the patient care unit preparing for presentations or journal club .

• Any tasks related to performance of duties, even if performed at home, count toward the 80 hours.

• Residents who have satisfactorily completed the transition of care may, at their discretion, attend an educational conference that occurs during the four hours VI.G.4.b) Max Duty Period Length

• The goal of the added hours at the end of the on-call period is to promote didactic learning and continuity of care

• If attendance (at a conference) is “strongly encouraged,” the hours should be included because duty hours apply to all required hours in the program, and it is difficult to distinguish between “strongly encouraged” and required. Another way to look at it is that such a journal club, if held weekly, would add two hours to the residents’ weekly time. A program in which two added hours result in a problem with compliance with the duty hour standards likely has a duty hour problem Duty Hours limits and Research and Other Non-Patient Care Activities

References

• Andolsek KM, Murphy G, Pinheiro S, Petrusa E, Tuck T, Weinerth J. Efficacy and Efficiency of Webcast Orientations Versus Live Resident Orientations: Results of a 2-Year Survey. Journal of Graduate Medical Education: March 2010; 2(1): 136-140.

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• Cook DA Levinson AJ Garside S Time and learning efficiency in Internet-based learning: a systematic review and meta-analysis Adv Health Sci Educ Theor Pract 2010 Dec, 15(5):755-70 Epub 2010 May 13

• Cook DA Levinson AJ Garside S Dupras DM Erwin PJ Montori VM Internet-based learning in the health professions: a meta-analysis JAMA 2008 Sept 10, 200(10:1181-96

• Cook DA Gelula MH Dupras DM Schwartz A Instructional methods and cognitive and learning styles in web based learning: repot of two randomized trials Med Educ 2007 Sep 4(9):897-905

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• Griner PF, Danoff D. Sustaining change in medical education. JAMA, 2000;283(18)2429-2431

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