Flipping Tickborne Illnesses with Infographics

This interactive module is designed for implementation within an Emergency Medicine Residency program. The target audience is post-year-graduate one to post-year-graduate four residents, medical students, physician assistant postgraduate trainees, physician assistant students, and physician assistants.

A knowledge of tickborne illness represents a critical component of infectious disease education for Emergency Medicine residents. Ticks that harbor these organisms are highly endemic to the continental United States and zoonotic infections are a critical differential diagnosis in the evaluation of patients in the Emergency Department.1 There is significant morbidity and mortality associated with tickborne diseases, and many of the signs and symptoms can mimic other common presentations. While these illnesses can present a diagnostic challenge and coinfection does occur, treatment is generally straightforward and readily available.2 An understanding of vectors and rates of transmission in a geographic area can foster a high clinical suspicion and ensure that effective treatment is administered.3.

After participation in this module, learners will be able to 1) list the causative agents for Lyme Disease, Babesiosis, Tularemia, Ehrlichiosis, Anaplasmosis, Tick Paralysis, Rocky Mountain Spotted Fever, and Powassan Virus, 2) identify different clinical features to distinguish the different presentations of tickborne illnesses, and 3) provide the appropriate treatments for each illness.

This module utilized the flipped classroom model of education for independent learning, along with small group discussion as the in-class active learning strategy. Learners independently completed pre-assigned readings and questions based on the readings. In didactics sessions, learners created an infographic of each of the tickborne illnesses. Each infographic was shared with the entire group in the final 30 minutes of the didactic session.

Each learner completed a pre-test prior to receiving the educational preparatory materials. At the end of the session, participants completed a post-test, a Likert scale survey to evaluate the program, and a free text box to provide qualitative feedback on the session. Efficacy of the education content was determined by post-test scores.

Unfortunately, the pre-test file was corrupted by a virus and inaccessible, resulting in no comparison data. A post-course test of 4 questions and a Likert scale evaluation was completed by 22 participants. 72.7% of the participants felt the session increased his/her knowledge on the topic, and 59% enjoyed the format of the session. Fifty-percent of the participants missed zero post-course test questions, 27% missed one question, and 22% missed two or more questions. Comments for improvement suggested a better explanation on the use of software to create the infographics.

The post-course test and evaluation suggest the session achieved positive Kirkpatrick levels I and II of evaluation, was effective, and the objectives were met. Based on comments for improvement, information on the infographic software should be provided ahead of the session. This session has become a regular part of our 18-month residency didactic curriculum.

Infectious disease, tickborne illness, zoonosis, flipped classroom, infographic, cognitivism.