Audience: This curriculum, created and implemented at The Ohio State University Wexner Medical Center, was primarily designed to educate our emergency medicine (EM) residents (PGY1-3) and emergency medicine/internal medicine (EM/IM) residents (PGY1-5) on core obstetrics and gynecology topics in EM. Additional audience members include medical students and faculty physicians. Introduction: In 2013, there were over 1 million emergency department visits in the United States which resulted in primary obstetric or gynecologic diagnoses.1 EM Residents must be proficient in the differential diagnosis and management of the wide variety of obstetric and gynecologic emergencies. To do this, we developed a flipped classroom curricular model, which consists of self-directed learning activities completed by learners, followed by small group discussions pertaining to the topic reviewed. The active learning fostered by this type of curriculum increases faculty and learner engagement and interaction time typically absent in traditional lecture-based formats.2-4 Studies have revealed that the application of knowledge through case studies, personal interaction with content experts, and integrated questions are effective learning strategies for EM residents.4-6 The Ohio State University Wexner Medical Center EM residency didactic curriculum recently transitioned to a “flipped classroom” approach.7-10 Our didactic curriculum is delivered over the course of 18 months; however, it could easily be adapted to other academic calendar cycles. The flipped classroom curriculum maximizes didactic time and resident engagement, fosters intellectual curiosity and active learning, and meets the needs of today’s learners. 3,6,11 Objectives: We aim to teach the presentation and management of obstetric and gynecologic emergencies through the creation of a flipped classroom design. This unique, innovative curriculum utilizes resources chosen by education faculty and resident learners, study questions, real-life experiences, and small group discussions in place of traditional lectures. In doing so, a goal of the curriculum is to encourage self-directed learning, improve understanding and knowledge retention, and improve the educational experience of our residents. Methods: The educational strategies used in this curriculum include small group modules authored by education faculty and content experts based on the core EM content. This program also incorporates submission of questions from residents that were developed during their review of the content prior to the session. The Socratic Method, used during small group sessions, encourages active participation; small groups also focus on the synthesis and application of knowledge through the discussion of real life experiences. The use of free open access medical education (FOAM) resources allows learners to work at their own pace and maximize autonomy.

Author(s): Thompson, Laura; Lipps, Jonathan; Leung, Cynthia; Green, Brad; Schaffernocker, Troy; Ledford, Cynthia; Davis, John; Kman, Nicholas

BACKGROUND2][3][4] This trend is attributable to recommendations handed down from several key organizations.In 2011, the Alliance for Clinical Education (ACE) endorsed the use of the Accreditation Council of Graduate Medical Education (ACGME) Core Competencies and the Association of American Medical Colleges (AAMC) Entrustable Professional Activities (EPA) to guide medical educators in redesigning the fourth-year curriculum.Additionally, ACE published four specific guidelines.First, they recommended that all students demonstrate progress towards mastery of the six ACGME Core Competencies.Second, they stated that all students should complete a capstone course specifically designed to prepare them for residency.Third, they said that medical school curricula should provide specialty-specific objectives to prepare students for residency in their intended specialty.Finally, they endorsed a system for helping students identify and correct gaps in their knowledge and skills during the fourth year. 1 The authors began their efforts to respond to the call for fourth-year curriculum revision with a review of the literature, specifically looking for what medical graduates entering emergency medicine (EM) were lacking upon entry into residency.A study by Lyss-Lerman found that program directors believed that interns' primary shortcomings were in the areas of medical knowledge, professionalism, organizational skills, and self-reflection. 4More recently, the development of Level 1 ACGME Milestones has helped to more clearly articulate expectations of graduating medical

Introduction This simulation case was designed to evaluate the ability of third- and fourth-year emergency medicine clerkship students and acting interns to perform the tasks outlined in the Association of American Medical College's Core Entrustable Professional Activity 10, to “recognize a patient requiring urgent or emergent care and initiate evaluation and management.” The overarching goal is to assess medical students’ ability to recognize and take steps to stabilize a sick patient. Methods In this case, students encounter a physician, simulated with a high-fidelity manikin, who has suddenly become confused. Students are expected to recognize that he is acutely ill, call for help, and begin the initial steps of resuscitation. Bedside testing reveals hypoglycemia, which students are expected to treat. Further examination, history gathering, and diagnostic tests reveal that the patient is suffering from gram-negative sepsis. Students are evaluated on their ability to recognize signs of serious illness, call for appropriate help, perform critical assessment and treatment tasks, communicate their findings to an attending physician, and determine the appropriate patient disposition. Outcomes are measured using critical action checklists. Results Initial trials of this case demonstrated its feasibility. All 13 students who have participated in this session have identified all five critical actions. Discussion In later iterations, the number of roles was streamlined in order to reduce how many personnel were required. As a result of the very high critical-actions success rates of the first two groups of students tested, our case-specific checklist was revised with the goal of improving its discriminatory power.

INTRODUCTION:Entrustable professional activities (EPAs) are units of professional practice defined as tasks or responsibilities that trainees are entrusted to perform unsupervised. AAMC Core EPA 10 is defined as the ability to "recognize a patient who requires emergent care and initiate evaluation and management." We designed a simulation scenario to elicit EPA 10-related behaviors for learner assessment to guide entrustment decisions.METHODS:This case presents a 61-year-old male with a complaint of feeling ill. The students need to diagnose an ST segment elevation myocardial infarction that leads to a pulseless ventricular tachycardia arrest. A simulation manikin is used, and students are assessed using a checklist. The tool is a set of critical actions that were proposed by a group of content experts, based on the following EPA 10 functions: recognizing unstable vital signs, asking for help, and determining appropriate disposition. In addition to case-specific behavioral items, an overall entrustment item was added to inform the entrustment decision.RESULTS:This case was implemented in a mandatory fourth-year clerkship for 7 years prior to its adaptation for entrustment on EPA 10. In recent experience from one institution, about 14% of students failed to meet entrustment. Students rated the experience as valuable (average 5.0, on a 5-point Likert scale) and thought that it would change their performance in a clinical setting (average 4.95, on a 5-point Likert scale).DISCUSSION:Faculty raters noted challenges regarding entrustment based on a single simulation and the implications that team role (supporting role vs. leader role) has on entrustment.

Author(s): King, Andrew; Greenberger, Sarah; Thompson, Laura; Panchal, Ashish; McGrath, Jillian; Khandelwal, Sorabh

BackgroundProcedural skills training is a critical component of medical education, but is often lacking in standard clinical curricula. We describe a unique immersive procedural skills curriculum for medical students, designed and taught primarily by emergency medicine faculty at The Ohio State University College of Medicine.ObjectivesThe primary educational objective of this program was to formally introduce medical students to clinical procedures thought to be important for success in residency. The immersion strategy (teaching numerous procedures over a 7-day period) was intended to complement the student's education on third-year core clinical clerkships.Program designThe course introduced 27 skills over 7 days. Teaching and learning methods included lecture, prereading, videos, task trainers, peer teaching, and procedures practice on cadavers. In year 4 of the program, a peer-team teaching model was adopted. We analyzed program evaluation data over time.ImpactStudents valued the selection of procedures covered by the course and felt that it helped prepare them for residency (97%). The highest rated activities were the cadaver lab and the advanced cardiac life support (97 and 93% positive endorsement, respectively). Lectures were less well received (73% positive endorsement), but improved over time. The transition to peer-team teaching resulted in improved student ratings of course activities (p<0.001).ConclusionA dedicated procedural skills curriculum successfully supplemented the training medical students received in the clinical setting. Students appreciated hands-on activities and practice. The peer-teaching model improved course evaluations by students, which implies that this was an effective teaching method for adult learners. This course was recently expanded and restructured to place the learning closer to the clinical settings in which skills are applied.

Abstract This standardized patient case and workshop was developed as part of a small-group curriculum for preclinical medical students. The session is intended to be used with preclinical or early clinical learners to give students practice obtaining a chronic disease history while simultaneously recognizing and treating depression after a myocardial infarction. Depression is an under-recognized medical condition after a patient experiences a myocardial infarction. Practitioners often mistakenly overlook depression as a “normal response” after myocardial infarction. Evidence suggests that patients who are depressed after having a myocardial infarction suffer worse outcomes. Specifically, depressed patients postmyocardial infarction experience more social problems over the first year, are slower to return to work, and report more stress than their non-depressed counterparts. Additionally, depressed patients after myocardial infarction are at increased risk for subsequent cardiac events, including reinfarction and rehospitalization, compared with those without depression. This standardized patient case and workshop provide an active learning environment using a standardized patient to teach about depression in the setting of chronic cardiovascular disease. Students practice a patient-centered approach to taking a history with a focus on hospital follow-up and the impact of a chronic disease on psychological functioning. Although our evaluation data is limited to student and facilitator feedback, students are expected to demonstrate the patient care and communication skills utilized in this workshop during an observed structured clinical encounter.

Abstract Introduction This standardized patient case introduces the unique needs of lesbian, gay, bisexual, and transgendered (LGBT) youth during an outpatient visit. This workshop was developed by clinician educators as part of a small-group curriculum for preclinical medical students. This case was developed by an internal medicine physician and vetted through pediatricians and clinicians with an interest in LGBT health. The session is intended to be used with preclinical or early clinical learners to give students practice in obtaining a complete history while simultaneously recognizing the added psychosocial stressors on LGBT youth, and how these stressors may manifest as physical complaints. Methods The session was run in a small-group setting, with a faculty facilitator. Students interviewed standardized patients in their weekly small-group session (12 students and one facilitator per group). The case pertained to a 15− to 25-year-old patient with chief complaint of headache. In delving deeper into social history, the students encountered the scenario of a patient with conflicted views on his/her sexual orientation and family pressures. Results The case and session have been used to train about 560 medical students. A subset (n = 95) of students was randomly selected to evaluate the small-group session. Eighty-seven percent of students rated the session as excellent or good, 12% as fair, and 2% as poor. During the 2013-14 and 2014-15 academic years, 88% of facilitators (n = 17) agreed or strongly agreed that the “content of the session was at the appropriate level for the students' level of learning.” Additional comments were generally positive, including “content was excellent and ‘real’” and “students did a great job discussion LGBT content.” Areas for improvement included suggestions that “more time” be allowed for discussion and reflections stating that “addressing both adolescent and LBGT in one session was challenging.” Discussion This standardized patient case introduces the unique needs of an LGBT youth during an outpatient visit, and has been used to train medical students to recognize the unique needs for a patient-centered, compassionate environment when treating adolescents who self-identify as LGBT.