Resident attendance at weekly conferences after implementation of an optional asynchronous learning curriculum.

Asynchronous learning (ASL) is a student-centered method of teaching utilizing online learning resources to overcome time and space constraints to facilitate information sharing and interaction amongst learners.1 Studies show it to be a valued and effective method of learning.2 As the availability of online educational resources for physicians has increased in recent years,3 Free Open Access Medical Education (FOAM) has become a familiar term to many. Some have suggested that ASL via FOAM can be a more flexible and cost-effective teaching method compared to conventional methods.4 In fact, FOAM may be preferred by the current generation of ‘millennial’ learners.5,6 Despite its increasing prevalence and utilization, FOAM is not a panacea. Educators who support a constructivist epistemology for education argue that the inherent isolation of ASL (studying alone at a private computer workstation) is a detriment. In addition, ASL can decrease learner satisfaction by diminishing a student’s sense of connection to peer learners.7 As such, blended learning, a hybrid combining classroom and online learning, creates a stronger sense of community amongst learners than either traditional or online courses alone.8 The Emergency Medicine (EM) Residency Review Committee (RRC) encourages programs to supplement the weekly educational conference curriculum with ASL in the form of “Individualized Interactive Instruction (III)”.9 In response, our EM residency program devised and implemented an optional, Web-based, asynchronous learning curriculum (ASYNC) to supplement our traditional planned weekly residency educational conferences, in essence creating an optional ”blended curriculum”. Consistent with RRC recommendations, we permitted residents to utilize ASYNC to obtain up to 20% of required residency educational conference attendance as extra credit (the equivalent of one hour out of the five offered each week within the extant didactic curriculum). The American College of Graduate Medical Education (ACGME)-mandated 70% conference attendance rate served as an inherent incentive to participate in ASYNC.9 There is no existing evidence to inform whether introducing an asynchronous learning curriculum will have unintended consequences such as lowering attendance to planned educational activities. Considering the current generation of ‘millennial’ learners’ preference for FOAM,5 it is conceivable that implementation of ASYNC would be associated with a reduction in attendance rates within the EM didactic curriculum. Such experiences may give educators and program directors pause before implementing an analogous curriculum. ASYNC Design and Implementation We implemented ASYNC in February 2015 at an urban, academic medical center which hosts a postgraduate year (PGY) 1-4 EM training program of 48 residents. ASYNC consists of two components, devised and supervised by residency program directors. The first portion incorporates Academic Life in Emergency Medicine’s (ALiEM) Approved Instructional Resources (AIR) series.10 Since most of the curated FOAM content from AIR comprises of high-yield evidence-based summaries of medical literature, we developed the second part of ASYNC to encourage the primary appraisal of the literature to promote self-directed assessment seeking and reflection. This second component of ASYNC consists of two monthly high-impact journal articles, selected by faculty. Learners are expected to read the articles and contribute to an online discussion board designed to encourage interaction amongst residents and faculty regarding if and how the literature can be translated into clinical practice.