Development and implementation of just-in-time curricula for on-shift teaching during times of boarding

Overcrowded emergency departments (EDs) due to boarding of inpatients can lead to fewer patients seen by residents and may negatively impact their education. The existing literature recommends providing educational resource banks to augment teaching during overcrowding. We aimed to develop and evaluate the use of an educational curriculum during times of boarding.

Using Kern's model of curriculum development, we conducted local and national needs assessments to identify existing curricula. The final curriculum consisted of electrocardiogram (ECG) cases, procedural resources, journal articles, and oral boards style cases. The derived curriculum was implemented at the study site, where content was released weekly via email or Slack and via our departmental educational blog. Residents were asked to fill out a survey assessing their satisfaction with the resource, their current patient load, and current National Emergency Department Overcrowding Study score (NEDOCS). We compared clinician educator satisfaction with teaching before implementation and at 3 months after implementation using Wilcoxon rank-sum test.

The national needs assessment was sent to the Council of Residency Directors (CORD) listserv. There were 36 unique program responses with only one program with resources for teaching during overcrowding. The derived curriculum was used seven times during the study period. The mean (±SD) NEDOCS at the time of resource use was 238.7 (±23.6). The median (range) number of active patients while using the resource was 4 (0-7). ECG cases were the most used resource. Mean (±SD) satisfaction with teaching before implementation was 2.8 (±0.9; Likert-type item scale 1 to 6 from not at all to a great deal satisfied). Satisfaction with teaching improved after implementation of the curriculum, with the mean (±SD) increasing to 3.5 (±1.0; p = 0.01).

We report the development and implementation of a local educational curriculum for use during times of boarding. The curriculum was lightly used during the study period, but the availability of a curriculum may have increased satisfaction with teaching during boarding.