References Methods Background Results Conclusions Click headings to further view content Implementation of Learner Centered Teaching in an Emergency Medicine Residency ●Active learning formats such as Flipped Classroom or Team Based Learning are increasingly popular in medical education as they are more engaging and preferred by learners. ●Previous studies have shown increased learner engagement and satisfaction with active learning formats, though some decrease in test scores has been observed. ●Lectures are a passive learning technique with limited knowledge transference and retention. ●The effect of implementing an active learning curriculum in an Emergency Medicine (EM) residency on objective measures of knowledge is unknown. ●23 residents were enrolled ●Mean change in Percentile Rank: ○-1.2 (95%CI , p=0.77) for all subjects ○+7.4 (95%CI , p=0.13) for residents Below Target in 2014 ●Mean change in Distance from their Target Score: ○0.7 (95%CI , p=0.44) for all subjects ○2.2 (95%CI , p=0.09) for residents Below Target in 2014 ●Single center, single group, pre-post study of the effect of changing to a Learner Centered Teaching (LCT) curriculum in an EM residency training program. ●All residents with both 2014 (pre-) and 2015 (post-) ITE scores were eligible for inclusion. ○Starting in July 2014 the LCT curriculum was implemented with approximately half of the core content lectures replaced with small group discussions that included pre- discussion homework submitted in advance. ●Performance on the ITE was evaluated for all residents completing both 2014 and 2015 exams. ○The mean change in Percentile Rank on the ITE and the mean Distance from Target score, how far the subject was from their year specific goal, were evaluated with a paired t test. ○A secondary outcome evaluated was change in Percentile Rank and Distance from Target for the residents Below Target in 2014 (PG1 = 65, PG2 = 70, PG3 = 75). ●Implementation of an LCT curriculum did not show a statistically significant improvement or worsening of ITE performance. ●There was a trend toward greater improvement in both Percentile Rank and Distance from Target score for residents who were below target in ●Areas for future study include: ○Evaluation of the individual components of the LCT ○Change in clinical performance ○Impact on ITE scores for those Below Target ●Interventions in a single center study may not be generalizable to a broader population. ●This study was not adequately powered to show a significant difference in ITE performance among the sub-set of residents below their target score in ●Other unrecognized confounders may have impacted ITE scores. Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD Baystate Medical Center, Tufts School of Medicine Objective ●We hypothesize that implementing an active learning curriculum within an EM Residency will increase In Training Exam (ITE) Scores. Limitations

Background Implementation of Learner Centered Teaching in an Emergency Medicine Residency Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD Baystate Medical Center, Tufts School of Medicine ●Active learning formats such as Flipped Classroom or Team Based Learning are increasingly popular in medical education as they are more engaging and preferred by learners. ●Previous studies have shown increased learner engagement and satisfaction with active learning formats, though some decrease in test scores has been observed. ●Lectures are a passive learning technique with limited knowledge transference and retention. ●The effect of implementing an active learning curriculum in an Emergency Medicine (EM) residency on objective measures of knowledge is unknown.

Objective Implementation of Learner Centered Teaching in an Emergency Medicine Residency Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD Baystate Medical Center, Tufts School of Medicine ●We hypothesize that implementing an active learning curriculum within an EM Residency will increase In Training Exam (ITE) Scores.

Methods Implementation of Learner Centered Teaching in an Emergency Medicine Residency Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD Baystate Medical Center, Tufts School of Medicine ●Single center, single group, pre-post study of the effect of changing to a Learner Centered Teaching (LCT) curriculum in an EM residency training program. ●All residents with both 2014 (pre-) and 2015 (post-) ITE scores were eligible for inclusion. ○Starting in July 2014 the LCT curriculum was implemented with approximately half of the core content lectures replaced with small group discussions that included pre-discussion homework submitted in advance. ●Performance on the ITE was evaluated for all residents completing both 2014 and 2015 exams. ○The mean change in Percentile Rank on the ITE and the mean Distance from Target score, how far the subject was from their year specific goal, were evaluated with a paired t test. ○A secondary outcome evaluated was change in Percentile Rank and Distance from Target for the residents Below Target in 2014 (PG1 = 65, PG2 = 70, PG3 = 75).

Graphs Implementation of Learner Centered Teaching in an Emergency Medicine Residency Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD Baystate Medical Center, Tufts School of Medicine

Results Implementation of Learner Centered Teaching in an Emergency Medicine Residency Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD Baystate Medical Center, Tufts School of Medicine ●23 residents were enrolled ●Mean change in Percentile Rank: ○-1.2 (95%CI , p=0.77) for all subjects ○+7.4 (95%CI , p=0.13) for residents Below Target in 2014 ●Mean change in Distance from their Target Score: ○0.7 (95%CI , p=0.44) for all subjects ○2.2 (95%CI , p=0.09) for residents Below Target in 2014

Conclusions Implementation of Learner Centered Teaching in an Emergency Medicine Residency Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD Baystate Medical Center, Tufts School of Medicine ●Implementation of an LCT curriculum did not show a statistically significant improvement or worsening of ITE performance. ●There was a trend toward greater improvement in both Percentile Rank and Distance from Target score for residents who were below target in ●Areas for future study include: ○Evaluation of the individual components of the LCT ○Change in clinical performance ○Impact on ITE scores for those Below Target

Limitations Implementation of Learner Centered Teaching in an Emergency Medicine Residency Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD Baystate Medical Center, Tufts School of Medicine ●Interventions in a single center study may not be generalizable to a broader population. ●This study was not adequately powered to show a significant difference in ITE performance among the sub-set of residents below their target score in ●Other unrecognized confounders may have impacted ITE scores.

References Implementation of Learner Centered Teaching in an Emergency Medicine Residency Shivani Mody, DO, Jade Malcho, MD, Adam Kellogg, MD Baystate Medical Center, Tufts School of Medicine 1. Silverberg, J. (1995). Lectures, interactive learning, and knowledge retention in continuing medical education. … Continuing Education …, 15, 231–234. Retrieved from 2. Subramanian, A., Timberlake, M., Mittakanti, H., Lara, M., & Brandt, M. L. (2012). Novel educational approach for medical students: improved retention rates using interactive medical software compared with traditional lecture-based format. Journal of Surgical Education, 69(4), 449–52. doi: /j.jsurg Bloom, B. S. (2005). Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews. International Journal of Technology Assessment in Health Care, 21(3), 380–5. Retrieved from 4. Bligh, D. (1985). What’s the use of lectures? Journal of Geography in Higher Education. 5. Mehta, N., Hull, A., Young, J., & Stoller, J. (2013). Just imagine: new paradigms for medical education. Academic Medicine, 88(10), 1418–1423. doi: /ACM.0b013e3182a36a07 6. Thomas, P. a, & Bowen, C. W. (2011). A controlled trial of team-based learning in an ambulatory medicine clerkship for medical students. Teaching and Learning in Medicine, 23(1), 31–6. doi: / Albanese, M., & Mitchell, S. (1993). Problem-based learning: A review of literature on its outcomes and implementation issues. Academic Medicine, 68(1), 52–81. Retrieved from 8. Haidet, P., O’Malley, K. J., & Richards, B. (2002). An initial experience with “team learning” in medical education. Academic Medicine : Journal of the Association of American Medical Colleges, 77(1), 40–4. Retrieved from 9. Kelly, P. A., Haidet, P., Schneider, V., Searle, N., Seidel, C. L., Boyd, F., & Richards, B. F. (2005). Teaching and Learning in Medicine : An International A Comparison of In-Class Learner Engagement Across Lecture, Problem-Based Learning, and Team Learning Using the STROBE Classroom Observation Tool Classroom Observation Tool. Teaching and Learning in Medicine: An International Journal, 17(2), 112–118. doi: /s tlm Burnette, K., Ramundo, M., Stevenson, M., & Beeson, M. S. (2009). Evaluation of a web-based asynchronous pediatric emergency medicine learning tool for residents and medical students. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 16 Suppl 2, S46–50. doi: /j x 11. Mallin, M., Schlein, S., Doctor, S., Stroud, S., Dawson, M., & Fix, M. (2014). A survey of the current utilization of asynchronous education among emergency medicine residents in the United States. Academic Medicine : Journal of the Association of American Medical Colleges, 89, 598–601. doi: /ACM Pluta, W. J., Richards, B. F., & Mutnick, A. (2013). PBL and beyond: trends in collaborative learning. Teaching and Learning in Medicine, 25 Suppl 1(September 2014), S9–16. doi: / Prober, C. G., & Khan, S. (2013). Medical education reimagined: a call to action. Academic Medicine : Journal of the Association of American Medical Colleges, 88(10), 1407–10. doi: /ACM.0b013e3182a368bd 14. Sadosty, A. T., Goyal, D. G., Gene Hern, H., Kilian, B. J., & Beeson, M. S. (2009). Alternatives to the conference status quo: summary recommendations from the 2008 CORD Academic Assembly Conference Alternatives workgroup. Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine, 16 Suppl 2, S25–31. doi: /j x 15. Prober, C., & Heath, C. (2012). Lecture Halls without Lectures- A proposal for Medical Education. N Engl J Med, 366(18), 1657–1659. Retrieved from Doucet, M. D., Purdy, R. a, Kaufman, D. M., & Langille, D. B. (1998). Comparison of problem-based learning and lecture format in continuing medical education on headache diagnosis and management. Medical Education, 32(6), 590–6. Retrieved from Tune, J. D., Sturek, M., & Basile, D. P. (2013). Flipped classroom model improves graduate student performance in cardiovascular, respiratory, and renal physiology. Advances in Physiology Education, 37(4), 316–20. doi: /advan Muzyk, A., White, C., Kinghorn, W., & Thrall, G. (2013). A Psychopharmacology Course for Psychiatry Residents Utilizing Active-Learning and Residents-As-Teachers to Develop Life-Long Learning Skills. Academic Psychiatry, 37(5), 332–5. doi: /appi.ap Wagner, M., & Thomas, H. (2002). Application of the medical knowledge general competency to emergency medicine. Academic Emergency Medicine, 9(11), 1236–41. Retrieved from Cheng, D. (2008). Board review course effect on resident in-training exam. International Journal of Emergency Medicine, 1(4), pubmedID: