A Web-based curriculum to improve residents' education in outpatient medicine.

Objective: Internal medicine residents’ training is shifting from the patient to the outpatient setting. Although learning from experience in caring for patients remains the mainstay of outpatient educational efforts, supplemental teaching conferences are frequently used. However, delivering outpatient medicine conferences continues to be a challenge for many residency programs, especially when residents are spread across dispersed sites. Our program is no exception. Weekly discussion topics have often varied between clinic sites despite attempts to achieve a uniform curriculum. The educational materials prepared by the faculty were difficult to distribute and varied in quality, format, and length. The faculty observed that the residents were usually unaware of the discussion topic in advance and had rarely prepared for the conference. A survey of the residents confirmed these observations. In the 1999–2000 academic year, we implemented a Web-based curriculum in order to improve accessibility of the learning materials, residents’ preparation for conferences, consistency in the format and quality of the materials, and the residents’ engagement in their learning. Description: As access to the Web is available from all training sites, we placed curricular resources for the three-year– cycling curriculum on our residency’s Web site. In order to streamline Web publication and achieve a consistent, concise format, we developed templates for the teaching modules. Each module covers the conference’s objectives, a listing of one to three required readings hyperlinked to online versions when available, with additional hyperlinks to online guidelines and other pertinent resources, and two to six clinical cases with discussion questions. An editorial board reviews these teaching modules prior to Web publication. E-mail reminders containing a hyperlink to the upcoming module are sent to the participants weekly, and the residents and faculty review the materials before each conference. Faculty facilitate the discussion rather than lecturing from the materials, thereby encouraging learner-centered, case-based educational experiences. Discussion: The residents and faculty report a significantly improved educational experience with this new system. A survey conducted before and after implementation indicates that the residents were more often aware of the topics being covered (20% before, 60% after), were more often prepared for each session (5% before, 35% after), and perceived improved learning. The residents now ascribe a higher value to outpatient medicine education in their training, and the faculty report that the residents participate more in conference discussions. The residents also report using these modules for self-study when they are unable to attend clinic conferences. Initially, a significant number of the selected readings were not available online, requiring the participants to use the traditional versions. Given the increasing availability of online resources such as the full text of journal articles, textbooks, and other references, we now choose only readings available electronically, making this a fully paperless system. We hope that this improved accessibility to readings will further improve preparation and the educational experience. Future plans include moving toward a more interactive testing interface that will allow residents to assess their knowledge of outpatient medicine and the residency program to further evaluate the effectiveness of this approach. Inquiries: Peter J. Embi, MD, Chief Resident and Medical Informatics Fellow, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, OP30, Portland, OR 97201; e-mail: ^embip@ohsu.edu&.