Foundations of Emergency Medicine: Application of a Flipped-Classroom Curriculum for Advanced Practice Clinician...

Advanced practice clinician (APC) presence has increased in emergency departments (ED), leading to increased exposure to higher acuity patient conditions. Relatively few APCs have completed formalized postgraduate emergency medicine (EM)-specific training, creating uncertainty around how well prepared APCs are in identifying and treating life-threatening conditions. Foundations of Emergency Medicine (FoEM) offers free open-access curricula, including Foundations I (F1), a flipped-classroom course targeting fundamental knowledge for resident physicians. We sought to use F1 for APC learners to improve their knowledge in identifying and treating emergent conditions.

In our single-center study, 23 APC postgraduate learners (17 nurse practitioners and 6 physician assistants) completed the F1 course between 2020-2021. The F1 course consisted of 23 virtual meetings led by faculty and senior residents, each lasting one hour. The APCs were asked to review vetted asynchronous resources for a recommended two hours before participating in small group, case-based learning sessions involving real-time feedback, curated teaching points, and paired online assessments. Immediately before and following F1 course implementation, participants completed a 50-question multiple-choice test and attitudes survey to quantify knowledge acquisition and evaluate the course. We evaluated change in knowledge scores using a Friedman test. Changes in self-assessed knowledge were evaluated using mixed-effects ordinal logistic regression.

Knowledge assessments showed APCs universally improved from the pre-course test (median score 23, 46%, IQR 20-26) to the post-course test (median score 33, 66%, IQR 31-37; adjusted P < .001). The APC self-assessments revealed improved overall EM knowledge (adjusted P = .02), yet respondents also reported an increased likelihood of seeking attending physician help (adjusted P < .001). Overall, 96% were satisfied with the course, 100% agreed that the course difficulty was appropriate, and 79% believed the course improved their performance in a clinical setting.

Implementation of the Foundations of Emergency Medicine, Foundations 1, curriculum was associated with increased classroom knowledge and self-assessed overall knowledge in EM among advanced practice clinicians, with high learner satisfaction in the course. Along with knowledge improvement, APCs also reported increased likelihood to seek guidance from an attending physician. These data form the basis for the use of FoEM in the APC learner population.