Challenges in Medical Education
We know that case-based active learning is one of the most effective teaching methods, especially for the modern learner. It is essential to help learners acquire cognitive strategies for clinical problem solving and how to apply principles of pathophysiology at the bedside. Equally important is teaching learners to perform under cognitive load conditions that reflect their real-world clinical environment.
​
The problem we are facing is that current approaches to active learning rely heavily on small-group case discussions and simulation, which depend on a high ratio of experienced faculty to learners thereby limiting scalability. Simulation, in particular, is highly resource-intensive, making it difficult for learners to gain sufficient reps with complex cases that are low-frequency but high-consequence. In addition, opportunities to participate in small-group cases and sim are largely confined to formal training programs, leaving practicing clinicians with fewer options to engage in active, case-based learning after graduation.
Rapid Sequence was created to help address some of these challenges. It is a gamified clinical case simulation tool where individual learners asynchronously work through cases in a non-multiple choice format. Learners input orders into a simulated EMR, and case events are responsive to learner actions. They are also required to cope with cognitive load features including management of multiple patients simultaneously, time pressure, distractor ‘pop-ups’ (eg: evaluating a triage EKG for ischemia), and a soundtrack of background ED noise.
Learners receive immediate feedback on their performance with a score of 1 to 5 stars. They then have the opportunity to either replay the case or watch the teaching videos. The teaching videos discuss each case in detail and incorporate a set of core mental models of pathophysiology and clinical problem solving. These mental models recur throughout the different case discussions, and learners are then required to apply these concepts in subsequent cases
Development of Rapid Sequence was based on educational principles of inductive learning, active retrieval, immediate feedback, and spaced repetition. It is an asynchronous teaching tool that is easily scalable, and also provides an environment that supports psychological safety with learners working through cases and receiving feedback individually rather than in front of instructors and peers, providing a protected space to fail.
​
We are also currently experimenting with various ways that Rapid Sequence can be integrated into existing residency curriculum. Stay tuned!
Contact us for group subscriptions for training programs and medical groups: rapidsequence@coffeewalkeducation.com
Research forum abstract (link):
The case simulator was integrated into a structured 4-hour workshop consisting of two rounds, each with a game block followed by a teaching block. Learners navigated the clinical cases during the game block, and the cases were then discussed during the teaching block. The second game block then required learners to apply identical principles in new clinical contexts. The cases in the second game block were designed to be more challenging than in the first game block. Case performance was scored on a pre-defined 1- to 5-star scale based on critical actions.
There were 34 participants in the workshop, the majority emergency physicians at a junior resident level of training or higher. Participants were given 55 minutes to complete the first game block and 40 minutes to complete the second game block. All four patient cases were completed by 76% of participants in the first game block, and by 80% of participants in the second game block. Average case performance improved significantly on the cases in the second game block.