Implementation at Your Site
Identify Leadership Roles
One of the first things to do after your site decides to adopt the Foundations curriculum is to assign leadership roles.
- Foundations Site Director should take charge of the implementation, year-long planning, and maintenance of Foundations courses. Ideally this person will be available to act as the Lead Instructor for most Foundations Meetings (F1 or F2). Site Directors are the primary contact for correspondence with our executive team and will be responsible for completing the annual survey on behalf of their respective program.
- Associate Site Directors should help with planning and act as Lead Instructors when the Site Director is unavailable. May assist with implementation/management of other FoEM courses.
- Lead Instructors should be assigned to each unit of the Foundations curriculum (use the Instructor Schedule Template to help plan this). They will be in charge of organizing teaching materials for a given Foundations Meeting, recruiting and providing resources to Small Group Instructors (SGIs), and managing assignments for Foundations Learners. If you implement Foundations I, II and/or III you may consider having a single Lead Instructor per unit to cover all courses OR assign different Lead Instructors per course.
Making Use of Provided Leadership Resources
Foundations Course Schedule Templates
The link above offers an overview of standard course schedules that may be used to copy and paste into your own site-specific documents to aid year-long curricular planning. These can also be found on the website under Quicklinks for Leadership. Included are the following:
- Foundations I (F1), Foundations II (F2) and combined F1+F2 course schedule templates
- Foundations III (F3) course schedule template
- F1, F2 and F3 combined course schedule template
- EKG course schedule template (including EKG I and EKG II content)
- Imaging I course schedule template
- F1 Instructor Schedule Template- can be used to recruit and organize Lead and Small Group Instructors
- F1 + F2 Instructor Schedule Template- same as above for sites adopting both courses
- F1 + F2 + F3 Instructor Schedule Template- same as above for sites adopting all three courses
Guidelines and References
The following resources will be immensely valuable to ensure a smooth implementation process and answer any detailed questions you may have. The most up to date versions of these documents can be found under Quicklinks for Leadership.
- Site Director Foundations Guide (this document) covers all the nuts and bolts of year-long planning and implementation at your site
- Lead Instructor Foundations Guide covers all the nuts and bolts of weekly planning and running Foundations Meetings
- F1, F2 and F3 Small Group Instructor Guides review expectations and best practices
- Small Group Organizers help plan for small groups and assign learner roles
- Schedule Templates to plan courses and organize course instructors
- Tracking Google Form Example and Instructions to track resident compliance and attendance
- Instructor Flag Google Form Example and Instructions tool for instructors to notify leadership of learners in need
- Learner Guidelines for Foundations Cases reviews expectations and best practices for learners
- F1 and F2 Example Foundations Cases can be used for reference to learn oral boards style review within the Foundations setting
- Learner Note Sheets, 3 case (F1) or 2 case (F2) to be used as a reference during Foundations cases
Foundations I and II are flipped classroom courses, requiring learners to review asynchronous core content prior to each Foundations meeting. Foundations III, on the other hand, includes paired asynchronous content which learners may reference at their discretion.
Using the Foundations website, F1 and F2 learners will have the ability to choose from different Learning Pathways (LPs) for required asynchronous assignments; this allows learner choice for independent study based on learning style. All LPs cover the same core content and are intended to take 1-2hr to complete. Detailed asynchronous assignments can be reviewed for each system from the Foundations main page
Foundations I Learners may choose from 3 different Learning Pathways: Traditional Textbook, High-Yield Text or Multimedia.
- Traditional Textbook
Reading selections from Rosen’s (9th Ed) OR Tintinalli’s (9th Ed- NEW 2020)
- High-Yield Text
River’s Written Board Review book (8th/9th Ed- SAME) OR Tintinalli Manual (8th Ed)
Hippo Videos AND FOAM resources
Foundations II Learners may choose from 2 different Learning Pathways: Text-based or Multimedia
Mixed readings from “Critical Care Medicine” (Parrillo, 5th Ed- NEW), Harwood-Nuss (6th Ed) and citations for primary literature
FOAM resources with optional supplement of Hippo Videos
Foundations III Learners are asked to reference suggested asynchronous content prior to F3 meetings. These are primarily composed of FOAM resources and primary literature. There are also “paired resources” which learners can reference for deeper dive information on select topics. Since the topics in this course are more nuanced, the approach to asynchronous content is more variable than for F1 and F2. Your site may decide to make these assignments mandatory or optional. Content may also be used for resident self-study if the course is not officially implemented by your site.
Access to Learning Pathway Resources
You must consider the best way for learners to access these resources based on what is available at your institution. Your institutional online library is likely to include access to some of the text-based and primary literature resources- your learners will need guidance as to what is available and specifically how to gain access. Regarding other resources, your program may choose to sponsor EMRA memberships, Hippo or Rosh subscriptions for resident learners. The recommended approach would be to offer a sort of education or CME fund that allows residents to choose which resources they prefer. Be sure and explain options for access during your Orientation Meeting or in your Course Introduction email.
River’s Written Board Review
If your program or any of your learners are considering purchasing the River’s text (9th edition), visit Ohio ACEPs website for a 25% discount offered to Foundations Learners. Of note, we must have your registration and an accurate list of your site’s Foundations Learners (accomplished by completing the Site Roster) in order to verify their participation to qualify for the discount.
HippoEM Educational Videos
Please contact Hippo Education directly for access for PGY1 residents. Hippo offers group discount rates and individual residents can get discounted subscriptions ($189/yr) through EMRA. Additionally, program directors can track resident progress using the Hippo PD Dashboard. For details and lowest available prices contact Dan@hippoed.com.
EM Coach (www.emcoach.org) is a paid resource that may be used for both asynchronous learning and assessment purposes. They offer coordinated content with Foundations I and II courses including assignments for asynchronous study (lectures, readings) that may take the place of Learning Pathway content. EM Coach is a CORD member benefit available to programs for $500 per program per year and can be purchased through CORD here.
If your institution has a Rosh Review subscription (https://www.roshreview.com), you will have access to mini-tests that coordinate with each unit (#30 each) of Foundations I and Foundations II content, in addition to more global assessments of resident knowledge. There are also 4 (total) mini-tests that coordinate with combined sessions for Foundations III. Questions regarding pricing and use of these assessments should be directed to the website above.
In order for your off-service, vacation, and post-overnight residents to keep on track with learning goals for the year, you should determine the best way to share in-class learning materials (Foundations Case Teaching Points, Challenge EKG answers) with Foundations learners. We recommend using Slack, your institutional digital dropbox, or email.
Note that under the “Course Schedule for Leaders” we will provide a PDF of Case Teaching Points for each F1 and F2 unit. These should be shared with learners after each meeting so they can independently review learning points, particularly those that may not have been covered in class due to time limitations. You should NOT send whole cases to learners after meetings- this will help maintain the integrity of Foundations Cases for other sites and future use. Full access to F3 unit content is available through both the Leadership and Learner menus on the Foundations website.
General Meeting Structure
The standard Foundations I meeting format involves 3 Small Group Instructors for each Foundations meeting. Ideally small groups should have 2-6 learners. The easiest setup logistically is to have three small groups and three small group instructors (who administer a single oral boards case to each group). However, if you expect less than 6 or more than 18 F1 learners for most weeks you should consider adjusting small group planning accordingly. The Lead Instructor Guide has additional details and resources if you chose to break from the standard format.
The standard Foundations II meeting format involves 2 different advanced cases which should be given to 2 or 4 small groups with an equal number of Small Group Instructors. Ideally small groups should have 3-4 learners, but should have no less than 2 and no more than 6 on a routine basis. The Lead Instructor Guide has additional details and resources to help divide groups and manage rotations.
The standard Foundations III meeting format involves a single group discussion led by a faculty instructor.
Access to Meeting Resources
Using the Leadership Course Schedules for Foundations I and II, you can access links to specific cases for each unit of F1 and F2. All course content for F1 and F2 will be available at the beginning of the academic year, so you may move around course units to best suit your site’s curriculum schedule. Note that these course schedules also provide links to “Teaching Points Handouts”. These should be shared with learners after each meeting to they can independently review learning points, particularly those that may not have been covered in class due to time limitations. You should NOT send whole cases to learners after meetings- this will help maintain the integrity of Foundations Cases for other sites and future use.
The Leadership Foundations III course page includes Teaching Guides for each unit of F3. Please note F3 content will be released in stages and estimated release dates are listed on the F3 course page. Unlike F1 and F2, we are intentionally allowing learners to access teaching resources for F3. We want as many learners as possible to access this important content, even if their site isn’t implementing F3. Also, the key benefit of moderated meetings for F3 is the discussion, shared experiences, etc and it matters less if they know what content will be covered in advance. The F3 course does not include Teaching Points documents. The Teaching Guide is intended to serve this same purpose as the Teaching Points documents used in the F1 and F2 courses.
Tracking Resident Attendance and Assigning Asynchronous Credit
In order to monitor resident progress and performance over the course of the year, you may want to keep track of information related to Foundations meetings including resident attendance, completion of asynchronous work and performance on associated assessments.
Specific data that may be tracked for each Foundations Learner:
- Attendance for each Foundations meeting (FM)
- Self-reported independent study time prior to each FM
- Learning Pathway resources used to study prior to each FM
- Rosh Review mini-tests completed by each learner and performance on those tests (found on Rosh PD Dash)
- EM Coach asynchronous work and assessment completion (found through EM Coach account)
Recommended approach for tracking data:
- Track using Google Forms -> our team has created a model Google Form (found on the website under “Quicklinks for Leadership”) that can be replicated with info specific to your site (resident names, specific Foundations sessions, etc).
- This form can be sent out by email or as a link to residents after each meeting. You may choose to require completion of this form in order to get credit for asynchronous work and meeting attendance.
- Data from your site’s Google Forms can get exported as an excel document and reorganized by your program coordinators to create summaries of resident participation and performance.
- Completion of Rosh Review or EM Coach assessments and scores can be obtained from their websites and can be added manually to the excel document mentioned above.
- Summary data can be reviewed and discussed with residents during mid-year and end of year evaluations and during CCC meetings.
Since learners are asked to complete 1-2hr of asynchronous work within the Learning Pathways for each unit of Foundations I and Foundations II, we suggest that you award asynchronous credit (III) to residents for this work. This will help motivate compliance with assignments. Assessment of knowledge and compliance with asynchronous work can be determined using self-reported independent study time, performance on classroom cases and performance on paired assessments linked to each Foundations unit. Of note, in keeping with the “interactive” requirement of III, learners should only be awarded III credit if they are present for the Foundations meeting associated with a given unit’s asynchronous work.
Frameworks, a supplementary curriculum for Foundations, focuses on teaching organized approaches to common clinical entities and primarily targets MS4 or PGY1/2 learners. The Frameworks curriculum aims to equip emergency medicine residents with cognitive scaffolding to efficiently work up and care for undifferentiated patients (e.g. “Approach to AMS”, “Approach to Stroke”, “Approach to Syncope”, etc). These may be used in the classroom setting and/or for on-shift teaching as a simple visual resource to provide resident learners with cognitive approaches to complex patient complaints.
In the classroom setting, Frameworks may be coordinated with Foundations I or II meetings or taught independently. Each Framework (30+ currently available) may be reviewed by a single instructor in a large group Q&A format. Details instructional guides are available for each Framework. Timing for each Framework will range from 15-30 minutes depending on the depth of review/discussion needed. All instructor content for Frameworks is hosted on the Foundations website under “Leadership Resources”.
Rosh Review Assessments
The Foundations I and II mini-tests target fundamental EM knowledge with broad, systems-based questions that directly coordinate with learning topics for each Foundations I and II unit. Mini-tests may be used to assess resident learning and reinforce knowledge from asynchronous and in-classroom content for each unit. If your program has access, we recommend that you assign (and require) these tests after each Foundations Meeting.
A global assessment of PGY1 resident knowledge is represented by the Foundations End of Year Assessment (#50 questions). This assessment may be assigned at the beginning and/or end of the F1 year to track progress.
The EKG I course is designed for intern-level learners. However, some programs are also using the curriculum for rotating medical students, PGY2 residents or NP/PA education. The EKG II course targets higher level learners and is most appropriate for PGY2-3 residents. The EKG I and EKG II course schedules are posted on the Foundations website and are also available in the Foundations Schedule Templates resource.
Both EKG courses may be implemented with a longitudinal OR a workshop-style approach.
- Longitudinal: 24 sessions each requiring 15-20 min of classroom time separate from other Foundations content and spaced over the course of the academic year.
- Workshops: (*preferred) require six 1-hour long meetings, each reviewing a different unit/theme with 4 representative challenge EKGs discussed in class.
Both courses follow a flipped classroom model with pre-meeting asynchronous resources accessed on the Foundations website followed by in-class challenge EKGs that may be reviewed in a large group setting by a single instructor. All instructor content for the EKG course will also be hosted on the Foundations Website under “Leadership Resources”.
Imaging I Course
The Imaging I course is designed for intern-level learners. However, any level learner may benefit from this course if they have not received formal imaging education. The Imaging I course schedule is posted on the Foundations website and available in the Foundations Schedule Templates resource.
This course includes 16 classroom meetings (50 min) led by a single instructor, including topic discussion and breakout activities. Suggested paired asynchronous content will be available on the Foundations website for reference, but is not required. All instructor content for the Imaging I course is hosted on the Foundations website under “Leadership Resources”.
Curriculum Feedback and Research
We encourage feedback regarding your use of our courses. Your leadership team should keep a running list of issues or suggestions for improvement. You should plan to host a brief discussion with your learners and instructors after the first few weeks of the course to check in and get their perspective. Don’t hesitate to reach out to our leadership team if you need help troubleshooting issues.
Our formal Foundations Survey of site leaders and learners will be administered in the spring of each year and will be crucial to continuing growth of the Foundations curriculum and meeting the needs of all parties. Immediate feedback may be submitted to our executive team using the “Submit Feedback” link on the Foundations main page. This is the ideal outlet for your suggestions for improvement, notification of content errors and ideas for future course development.
In addition to our formal annual survey, our team plans and conducts educational research throughout the year. We may reach out to your site to seek your participation in these projects. Be on the lookout for Foundations related presentations at major EM conferences.