One-year impact of an ambulatory pulmonary curriculum for fellows leveraging adult learning theory

Abstract Background In pulmonary and critical care medicine (PCCM) fellowship, inpatient training is often prioritized over outpatient learning, resulting in fellow dissatisfaction with their ambulatory education. Additional challenges limit the use of best practices for teaching and learning in graduate medical education. Objective To develop a three-year ambulatory pulmonary curriculum leveraging principles of adult learning theory such as flipped classroom elements and interprofessional teaching, and to evaluate the first year of this curriculum. Methods We developed an ambulatory pulmonary curriculum at a large academic PCCM fellowship program including 24 topics over three years. Sessions emphasized case- and discussion-based learning in a small group setting, often incorporating flipped classroom elements. Most sessions also included interprofessional teaching for hands-on practical skill development. Assessment of the first year of the curriculum was performed using a mixed-methods approach, with pre- and post-intervention surveys followed by fellow focus groups. Beginning with the third session, paired pre- and post-tests for knowledge and trainee self-assessed comfort with the topic were evaluated. In-training exam (ITE) scores were compared to pre-intervention years. Results Comparison of paired pre- and post-tests demonstrated improved comfort in all 6 sessions, and improved knowledge in 5 of the 6 sessions assessed. ITE scores of all fellows following the first year of the curriculum were significantly increased compared to one of the two prior years, and ITE scores for the first-year fellows were significantly higher than both preceding academic years. Fellow and faculty surveys reflected that the curricular content, use of interprofessional teachers, small group setting, and use of pre-session reading all enhanced education. Fellow focus groups emphasized that content selection and teaching methodologies were strengths of the curriculum. Conclusion In its first year, the implementation of an ambulatory pulmonary curriculum grounded in adult learning theory and highlighting interprofessional teachers positively impacted fellow knowledge and comfort. Our curriculum is a first-of-its kind to demonstrate improvement in PCCM fellow knowledge, and to expand the use of interprofessional teaching and flipped classroom elements to graduate ambulatory pulmonary education.