Internet-based Approaches to Enhance Education of Allergy and Immunology Fellows: Practical Examples

The real-life examples listed below were collected in response to a discussion with a Residency Review Committee for Allergy and Immunology of the Accreditation Council for Graduate Medical Education (ACGME).

Remembering the ACGME 6 Core Competencies by a SIMPLE mnemonic

The Accreditation Council for Graduate Medical Education (ACGME) is responsible for the accreditation of post-MD medical training programs within the United States. The ACGME developed the so-called 6 "core competencies" that all residents should achieve during their training. When I was a chief resident, the concept was still new and not easy to remember so I made up a SIMPLE mnemonic for the 6 competencies:

SIMPLE

Systems-Based Practice
Interpersonal Skills and Communication
Medical Knowledge
Patient Care
Learning - Practice-Based and Improvement
Etiquette ~ professionalism

Let's look at each competency in detail and see how we can use Internet-based tools and service to increase the proficiency and didactic value.

PRACTICE-BASED LEARNING AND IMPROVEMENT

Examples of Learning Activities: didactic lecture, assigned reading, seminar, self-directed learning module, conference, small group discussion, workshop, online module, journal club, project, case discussion, one-on-one mentoring, or other examples of learning activities.

1. Describe one learning activity in which residents engage to identify strengths, deficiencies, and limits in their knowledge and expertise (self-reflection and self-assessment); set learning and improvement goals; identify and perform appropriate learning activities to achieve self-identified goals (life-long learning).

The residents created an online case-based curriculum of allergy and immunology (http://allergycases.org/) used to post case discussions under the guidance of faculty members. The residents were assigned articles to review for the reference section of each clinical case. The cases were used as self-directed learning modules with questions guiding the discussion through each module. An online form with question-and-answer type headlines was used to publish the clinical cases (https://spreadsheets.google.com/viewform?key=p6MskqOaqmuAtKcMX0lv7cg). The cases were discussed in small groups with direct input from a faculty member, and also on individual bases with one-on-one mentoring.

The residents were encouraged to identify strengths and deficiencies in their online presentation with each clinical case. Faculty members set learning and improvement goals by providing reference materials for further reading related to each case.

For example, a resident had questions regarding the use of immunotherapy in pregnancy. A faculty member encouraged the resident to identify the deficiencies and limits in his knowledge and expertise through guided self-reflection and self-assessment. The resident was provided verbal feedback and reference materials and encouraged to post the answers to the following questions at the learning website. The following questions were addressed: "Can immunotherapy be started if a patient is pregnant or planning to become pregnant?, Can immunotherapy be continued if the patient is on it and becomes pregnant?, What happens when the immunotherapy extract expires during pregnancy and a new vial has to be used?" (Subcutaneous Immunotherapy and Pregnancy, http://allergynotes.blogspot.com/2008/09/subcutaneous-immunotherapy-and.html).

The residents were encouraged to achieve some of the goals of life-long learning by subscribing to a specific news feed updated daily with the latest developments in the field of allergy and immunology (http://allergynotes.blogspot.com/).

In 2008, AllergyCases.org became the most popular case-based curriculum of Allergy and Immunology online ranked number one among 8.9 million pages by Google.com. The website is endorsed by both the American Academy of Allergy Asthma and Immunology (AAAAI) and the American College of Allergy, Asthma and Immunology (ACAAI). AllergyCases.org is supported by faculty members and fellows at Creighton University and Louisiana State University Health Sciences Center (Shreveport). It has received more than half a million page views since 2008 and has 620 daily subscribers (around 1,000 page views daily from the U.S. and around the world). The educational value of the cases is enhanced by succinct clinical notes, innovative mind maps and mnemonics. The case reports do not follow real cases and are modified in compliance with HIPAA to protect patient confidentiality. The AllergyCases.org project was presented at the 2008 and 2009 Annual Meeting of the American College of Allergy, Asthma and Immunology (ACAAI).

A poster was presented during the 2009 ACAAI meeting and published in the corresponding journal:

Dimov, V.; Randhawa, S.; Auron, M.; Casale, T. An Online Case-based Curriculum for Allergy and Immunology Education: Organization and Results. American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Meeting. Annals of Allergy, Asthma & Immunology.

The residents used a novel communication tool available from Twitter.com to share what they learned during journal club with their peers at another allergy and immunology fellowship training program under the supervision of faculty members. This experience with a self-directed learning module was summarized in an online article (Allergy and Immunology Journal Club on Twitter, http://allergynotes.blogspot.com/2008/12/allergy-and-immunology-journal-club-on.html).

A poster was presented during the 2009 ACAAI meeting and published in the corresponding journal:

Dimov, V.; Randhawa, S.; Auron, M.; Casale, T. The Utility of a Real-time Microblogging Service for Journal Club in Allergy and Immunology. American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Meeting. Annals of Allergy, Asthma & Immunology.

2. Describe one example of a learning activity in which residents engage to develop the skills needed to use information technology to locate, appraise, and assimilate evidence from scientific studies and apply it to their patients’ health problems. The description should include:

a) locating information
b) using information technology
c) appraising information
d) assimilating evidence information (from scientific studies)
e) applying information to patient care

Residents created an online news bulletin forum called Allergy Notes (http://allergynotes.blogspot.com/). They were encouraged to use information technology to locate and appraise evidence from scientific studies and apply it to their patients’ health problems.

For example, a resident was assigned to find the answer to the question "How prevalent is sesame allergy?" Using information technology, the resident located the related information in online databases such as Pubmed and Google Scholar which led him to specific journal articles. Under the guidance and with the direct input of a faculty member, the resident appraised and assimilated the evidence information from scientific studies. The summary was posted online to be shared with other residents and to create a permanent record for later reference (Sesame Food Allergy: Questions and Answers, http://allergynotes.blogspot.com/2008/12/sesame-food-allergy-questions-and.html). The collected information was directly applied to patient care by answering questions such as "How prevalent is sesame allergy?, What is the prevalence of sesame allergy in food allergic patients?, What is the prognosis of sesame food allergy (SFA)?, How do you diagnose sesame food allergy (SFA)?"

A poster was presented during the 2009 ACAAI meeting and published in the corresponding journal: Dimov, V.; Randhawa, S.; Auron, M.; Casale, T. The Utility of a Weblog to Stay Current with the New Developments in Allergy and Immunology. American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Meeting. Annals of Allergy, Asthma & Immunology.

3. Give one example and the outcome of a planned quality improvement activity or project in which at least one resident participated in the past year that required the resident to demonstrate an ability to analyze, improve and change practice or patient care. Describe planning, implementation, evaluation and provisions of faculty support and supervision that guided this process.

The residents participate in an annual "weed walk" aimed at improving the recognition of common pollen-producing plants (weeds and trees) in their area. This planned quality improvement project included the attendance of all staff members (residents, faculty, nurses, research personnel).

The residents were guided through recognizing and analyzing different pollen-producing plants in the field through an one hour walk in the field. They were encouraged to take pictures of pollen-producing plants with a digital camera. The pictures were later uploaded to a photo sharing website by Google, Inc. (Picasa Web Albums, Pollen-producing plants (weeds and trees) in Omaha, Nebraska, http://picasaweb.google.com/seeomaha/PollenProducingPlantsWeedsAndTreesInOmahaNebraska#) and the residents labeled each plant under the guidance of faculty members. This pollen-recognition project was used to improve and change practice or patient care with faculty support and supervision that guided this process.

A poster was presented during the 2009 ACAAI meeting and published in the corresponding journal:

Dimov, V.; Randhawa, S.; Auron, M.; Casale, T. Digital Image Sharing Web Service for Recognition of Pollen-producing Plants in a Specific Geographic Region. American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Meeting. Annals of Allergy, Asthma & Immunology.

4. Describe how residents:

a) develop teaching skills necessary to educate patients, families, students, and other residents;
b) teach patients, families, and others; and
c) receive and incorporate formative evaluation feedback into daily practice. (If a specific tool is used to evaluate these skills have it available for review by the site visitor).

The residents are actively encouraged to develop teaching skills necessary to educate patients, families, students, and other residents. All residents worked together to identify useful links for
Patient Information on Topics in Allergy and Immunology and they were published online as a combined list for later referral (Patient Information on Topics in Allergy and Immunology, http://allergynotes.blogspot.com/2008/03/patient-information-on-topics-in.html). The purpose of the exercise was to develop a selection of high-quality links that can be used later to print patient information when requested by patients or health workers.

For example, a patient with hereditary angioedema (HAE) had a question about a newly-approved medication to treat her condition. Under the guidance of a faculty member, the resident was able to identify the FDA source of the approval information published just a few weeks ago and to print a patient information sheet. In addition, a diagram developed several month prior to the patient encounter was identified from the learning repository (http://allergynotes.blogspot.com/), printed and used to explain the place of the new therapy in the current management concept. The whole experience was summarized in an online article for later reference (C1 Inhibitor Cinryze Approved by FDA for Prophylaxis Against Hereditary Angioedema Attacks, http://allergynotes.blogspot.com/2008/12/c1-inhibitor-cinryze-approved-by-fda.html). The educational process was associated with evaluation feedback by the faculty.

INTERPERSONAL AND COMMUNICATION SKILLS

1. Describe one learning activity in which residents develop competence in communicating effectively with patients and families across a broad range of socioeconomic and cultural backgrounds, and with physicians, other health professionals, and health related agencies.

A patient and his family had a question about the price of the new HFA albuterol inhalers. Under the guidance of a faculty member, the residents were encouraged to discuss the management and financial concerns with the family in order to identify the best solution to their problems. The socioeconomic and cultural backgrounds were identified and discussed. The residents used a novel communication tool by Twitter.com to exchange information with other residents and faculty members across the country. A past ACAAI president provided a link to a newly-available $9 Albuterol Inhaler at WalMart which proved to be the most cost effective solution for this particular patient. This example of developing competence in communicating effectively with patients and families, and with physicians, other health professionals, and health related agencies was summarized in an online article (A/I Twitter Updates: $9 Albuterol Inhaler at WalMart and More, http://allergynotes.blogspot.com/2008/12/ai-twitter-updates-9-albuterol-inhaler.html).

2. Describe one learning activity in which residents develop their skills and habits to work effectively as a member or leader of a health care team or other professional group. In the example, identify the members of the team, responsibilities of the team members, and how team members communicate to accomplish responsibilities.

The residents were encouraged to develop their skills to work effectively as a member or leader of a health care team or a group by establishing and participating in an online learning group comprised of former and current allergy and immunology fellows and faculty member. The residents used the social network platform of Facebook.com to create an online group with a team leader, officers, and community liaisons (Creighton Allergy and Immunology Fellowship Faculty, Alumni, and Friends, http://www.facebook.com/group.php?gid=30823727886). The group was used to discuss clinical and research issues in strict compliance with HIPAA. A faculty moderator was also included in this initiative to guide members to communicate effectively, delegate and accomplish responsibilities.

The resident were also encouraged to join the official Facebook group of the American College of Allergy, Asthma & Immunology (ACAAI) and to apply for team and leadership roles in the professional network (American College of Allergy, Asthma & Immunology, http://www.facebook.com/groups.php?ref=sb#/group.php?gid=25896029508).

A poster was presented during the 2009 ACAAI meeting and published in the corresponding journal:

Dimov, V.; Parks, K.; Stokes, J.; Casale, T. The Utility of an Online Social Network Service for Professional Collaboration and Education in Allergy and Immunology. American College of Allergy, Asthma & Immunology (ACAAI) 2009 Annual Meeting. Annals of Allergy, Asthma & Immunology.

VI. SYSTEMS-BASED PRACTICE

1. Describe the learning activities through which residents will achieve competence in the elements of systems-based practice. Examples of such activities would include: work effectively in various health care delivery settings and systems, coordinate patient care within the health care system; incorporate considerations of cost-containment and risk-benefit analysis in patient care; advocate for quality patient care and optimal patient care systems; and work in interprofessional teams to enhance patient safety and care quality.

The residents attending the annual meeting of the American College of Allergy, Asthma & Immunology (ACAAI) in November 2008 focused specifically on incorporating considerations of cost-containment and risk-benefit analysis in the care of patients with severe asthma. Several management approaches to decrease the frequency of exacerbations and hospitalizations were discussed during a seminar workshop. The main teaching points were shared system-wide via a communication tool provided by Twitter.com. The learning experience was shared with the other members of the team via email and summarized in an online publication for later referral (Twitter Updates from the Severe Asthma Workshop at the 2008 Annual Meeting of American College of Allergy, Asthma & Immunology (ACAAI), http://casesblog.blogspot.com/2008/11/twitter-updates-from-severe-asthma.html).

The residents are planning to use Twitter.com to share updates from the upcoming ACAAI and AAAAI meetings to share new developments aimed at enhancing patient safety and care quality with interprofessional teams (Using Twitter to Microblog a CME Meeting, http://casesblog.blogspot.com/2008/10/using-twitter-to-microblog-cme-meeting.html).

Another initiative is to enhance the team communication in a system-based practice environment by using Qik.com and other "stream video from your phone" services to share updates and gather feedback from future scientific meetings focused on health care delivery systems and coordinating patient care within the health care system (Health workers usingQik or other "stream video from your phone" services for medical education, http://casesblog.blogspot.com/2009/01/any-health-workers-using-qik-or-other.html).

Updated: 04/04/2010

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