University of Cincinnati
Pulmonary / Critical Care Fellowship Program
Cincinnati, OH
Mitchell Rashkin, MD and Peter Lenz, MD
Rationale: Multiple barriers exist for fellows to receive optimal and comprehensive preparation for board exams. Asynchronous clinical experiences create a wide variability in the learning experience for fellows and large didactic conferences are not conducive to high level retention of complex material. We aimed to improve the pulmonary and critical care fellowship conference learning experience, board exam preparation, and performance on the pulmonary and critical care in-training exam (ITE) by developing a more robust board review program and curriculum that incorporated state of the art adult learning principles. Over the past year, we implemented a 4-phase, multifaceted board review program to address the multiple learning issues listed above.
Description of Program: Phase 1: We created an interactive hour long session each month for the presentation of 15-20 carefully targeted, board-style questions using an audience response system (ARS). Real-time deficits in knowledge could be identified and addressed. The question error rate provided an index of the effort needed to remediate any deficiencies. During this phase the questions were created by our faculty. The ARS allowed for an engaging, non-threatening adult learning environment to be realized. Phase 2: We accumulated data from the initial board review sessions to determine the content areas we needed to work on in the upcoming conferences. Phase 3: We began requiring that all presenters from all disciplines submit at least 2 board style questions on the content they presented to our fellows at lunchtime conferences. Evaluating fellow performance on these questions during subsequent board review conferences allowed us to formally evaluate our curriculum and to improve subsequent conference quality. Phase 4: Formal instruction was given to the fellows on how to write board-style questions and the questions the fellows create are now presented and validated by faculty and fellows present during the discussion portion of our sessions. Fellows now get an idea of the literature review and research effort that goes into creating high caliber board style questions.
Summary: The implementation of our board review program has improved our fellows’ ITE scores. in fact, our current 3rd year fellows improved from their 1st year under-national average mean score of 70.2% (87.7/125) to an above-national average score during their 2nd year of 76.5% (95.6/125) after our intervention had been in place for one year. Implementing a board review program and holding the fellows and faculty mutually responsible for its content can improve ITE scores and improve the fellow learning experience multifold. Making the faculty accountable for board style content from their lectures allows our program to more meaningfully evaluate the effectiveness of our didactic conferences and to objectively refine the content of teaching sessions. Requiring the fellows to vigorously research board style topics they encounter in clinical practice provides a new dimension to their education and allows for asynchronous learning experiences to now be shared. The validation process that occurs when fellows’ questions are challenged has provided healthy discussions on various pulmonary and critical care topics amongst our faculty and fellows. Our board review program was awarded the 2012 Darlene Buczak Award for innovations in Medical education earlier this year by the Association of Pulmonary and Critical Care Program Directors (APCCMPD).
