One-year impact of an ambulatory pulmonary curriculum for fellows leveraging adult learning theory.

Abstract

Background: In pulmonary and critical care medicine (PCCM) fellowship, inpatient training is often prioritized over outpatient learning, resulting in fellows' dissatisfaction with their ambulatory education. Additional challenges limit the use of best practices for teaching and learning in graduate medical education.

Objective: To develop a 3-year ambulatory pulmonary curriculum leveraging principles of adult learning theory such as flipped classroom elements and interprofessional teaching, and to evaluate the first year of this curriculum.

Methods: We developed an ambulatory pulmonary curriculum at a large academic PCCM fellowship program including 24 topics over 3 years. Sessions emphasized case- and discussion-based learning in a small group setting, often incorporating flipped classroom elements. Most sessions also included interprofessional teaching for hands-on practical skill development. Assessment of the first year of the curriculum was performed using a mixed-methods approach, with pre- and postintervention surveys followed by fellow focus groups. Beginning with the third session, paired pre- and posttests for knowledge and trainee self-assessed comfort with the topic were evaluated. In-training exam (ITE) scores were compared to preintervention years.

Results: Comparison of paired pre- and posttests demonstrated improved comfort in all 6 sessions, and improved knowledge in 5 of the 6 sessions assessed. ITE scores of all fellows following the first year of the curriculum were significantly increased compared to one of the 2 prior years, and ITE scores for the first-year fellows were significantly higher than both preceding academic years. Fellow and faculty surveys reflected that the curricular content, use of interprofessional teachers, small group setting, and use of presession reading all enhanced education. Fellow focus groups emphasized that content selection and teaching methodologies were strengths of the curriculum.

Conclusions: In its first year, the implementation of an ambulatory pulmonary curriculum grounded in adult learning theory and highlighting interprofessional teachers positively impacted fellow knowledge and comfort. Our curriculum is a first of its kind to demonstrate improvement in PCCM fellow knowledge and to expand the use of interprofessional teaching and flipped classroom elements to graduate ambulatory pulmonary education.