1. A Multicenter Look at Inpatient EBM Teaching and PBLI-1 Milestone Mastery Thomas Hahn, MD & Jennifer Edgoose, MD, University of Wisconsin-Madison Caitlin D’Agata, MD & Sarah Hilding, MD, Tufts University Mattie White, MD & Jay Brieler, MD, Saint Louis University 2015 STFM Annual Spring Conference April 2015

2. Objectives Explore an inpatient curricular tool called TEACH Cards Examine how the tool has been used at multiple institutions to improve inpatient teaching and enhance EBM curriculum Apply the tool to show advancement in the ACGME Practice-Based Learning and Improvement-1 milestone

3. Background-Inpatient Teaching Current research – Beside rounds – Simulation experiences What is high quality teaching? – Mini teaching sessions (Torre et al., 2005)

4. Evidence-Based Medicine Curriculum Formal two day workshop (Allan et al, 2008) Thirty hours of didactic and hands-on teaching (Shaughnessy et al., 2012) A two week rotational block (Thom et al, 2004). PBLI curriculum often is lacking in clerkships (Willis et al, 2014)

5. ACGME Residency Milestones

6. Merge Our Curricular Agendas Inpatient Teaching EBM

7. TEACH Cards T eaching E vidence-Based Medicine A nd C linical topics in the H ospital

10. TEACH Cards Pilot Study December 2013-February 2014 UW Family Medicine-Madison Residency St. Mary’s Inpatient Rotation Pre and post-survey prospective cohort study 28 participants

11. “I believe I am learning all the core topics required to care for critically ill adults.” Mean: 4.00 3.42 p = 0.037 1 (Strongly Agree) 7 (Strongly Disagree)

12. “I can write a PICO question.” Mean: 3.04 2.42 p = 0.022 1 (Strongly Agree) 7 (Strongly Disagree)

13. Limitations of Pilot Study Small sample size One institution Measuring perception

14. Kirkpatrick Evaluation Model Learning Reaction Behavior Results

15. Hypotheses Use of TEACH Cards will: – Increase frequency of inpatient teaching – Improve the user’s ability to write and answer a PICO question – Improve efficiency in answering clinical questions

16. Methods What: Mulitcenter prospective cohort study with pre and post surveys When: December 2014-August 2015 Who: Students, residents, faculty Where: Inpatient family medicine service at each participating residency

17. Multicenter Study Institutional differences – IRBs – Use of cards – EBM curricula

18. Preliminary Results 7 completed pre and post surveys so far (mostly from UW) Trend toward positive findings regarding frequency of inpatient teaching and efficiency with clinical inquiries

19. TEACH Cards Website www.fammed.wisc.edu/teachcards Instructions on how to use the cards Links to all the cards, which fit on mobile devices PDF that can be printed to make paper copies Hope to have mobile app link in the future

20. Activity Try the website from your mobile device (www.fammed.wisc.edu/teachcards) Practice using a card Discuss with those around you how the cards might work at your institution Large group discussion and questions

21. Acknowledgements Craig Gjerde, PhD – University of Wisconsin-Madison John Frey, MD – University of Wisconsin-Madison Jim Witkins – University of Wisconsin-Madison Larissa Zakletskaia, MS – University of Wisconsin-Madison

22. References Allan, G., Korownyk, C., Tan, A., Hindle, H., Kung, L., & Manca, D. (2008). Developing an integrated evidence-based medicine curriculum for family medicine residency at the University of Alberta. Academic Medicine, 83(6), 581-587. Allen, S. et al (2013). The family medicine milestone project: A joint initiative of the Accreditation Council for Graduate Medical Education and the American Board of Family Medicine. 1-22. American Academy of Family Physicians (2011). Recommended curriculum guidelines for family practice residents: Care of the critically ill adult. AAFP Reprint no. 291. Kirkpatrick, D. L., & Kirkpatrick, J. D. (2006). Evaluating training programs: The four levels. Third edition. Berrett-Koehler Publishers, Inc. Shaughnessey, A., Gupta, P., Erlich, D., & Slawson, S. (2012). Ability of an information mastery curriculum to improve residents’ skills and attitudes. Family Medicine, 44(4), 259-264. Thom, D., Haugen, J., Sommers, P., & Lovett, P. (2004). Description and evaluation of an EBM curriculum using a block rotation. BMC Medical Education, 4, 19. Torre, D. M., Simpson, D., Sebastian, J. L., & Elnicki, D. M. (2003). Learning/feedback activities and high quality teaching: Perceptions of third-year medical students during and inpatient rotation. Academic Medicine, 80, 950-954. Willis, D. R., Bennett, I., Jones, B. G., Renshaw, S. E., Holley M, & Dankoski, M. E. (2014). Practice-based learning and improvement in family medicine student clerkships: A CERA study. Family Medicine, 46(6), 423-428.