Introduction: The ways in which Emergency Medicine (EM) physicians interact with the medical literature has been transformed with the rise of Free Open Access Medical Education (FOAM). Although nearly all residents use FOAM resources, some criticize the lack of universal quality assurance. This problem is a particular risk for trainees who have many time constraints and incompletely developed critical appraisal skills. One potential safeguard is journal club, which is used by virtually all EM residency programs in North America to review new literature. However, EM resident perspectives have not been studied. Our research objective was to describe how residents perceive journal club to influence how they translate the medical literature into their clinical practice. Our research question was whether FOAM has influenced residents’ goals and perceived value of journal club. Methods: We developed a semi-structured interview script in conjunction with a methods expert and refined it via pilot testing. Following constructivist grounded theory, and using both purposive and theoretical sampling, we conducted a focus group (n = 7) and 18 individual interviews with EM residents at the 4 training sites of the University of British Columbia. In total, we analyzed 920 minutes of recorded audio. Two authors independently coded each transcript, with discrepancies reconciled by discussion and consensus. Constant comparative analysis was performed. We conducted return of findings through public presentations. Results: We found evidence that journal club works as a community of practice with a progression of roles from junior to senior residents. Participants described journal club as a safe venue to compare practice patterns and to gain insight into the practical wisdom of their peers and mentors. The social and academic activities present at journal club interacted positively to foster this environment. In asking residents about ways that journal club accelerates knowledge translation, we actually found that residents cite journal club as a quality check to prevent premature adoption of new research findings. Residents are hesitant to adopt new literature into their practice without positive validation, which can occur during journal club. Conclusion: Journal club functions as a community of practice that is valued by residents. Journal club is a primary way that new evidence can be validated before being put into practice, and may act as quality assurance in the era of FOAM.

Innovation Concept: Canadian medical students completing their Emergency Medicine (EM) clerkship rotations must develop approaches to undifferentiated patients. Increasingly used in postgraduate EM education, Open Educational Resources (OERs) are a convenient and flexible solution to meeting medical student educational needs on their EM rotation. We hoped to supplement Canadian medical student EM education through the development of ‘ClerkCast’, a novel OER and podcast-based curriculum on CanadiEM.org. Methods: We utilized the Kern Six Step approach to curriculum development for ‘ClerkCast’. A general needs assessment involved a review of available OERs and identified a lack of effective EM OERs specific for medical students. A specific online needs assessment was used to determine which EM topics required further education for medical students. The survey was shared directly with key Canadian medical student and undergraduate medical educator stakeholder groups, and distributed globally through the CanadiEM social media networks. Results of the needs assessment highlighted shared perceptions of educational needs for medical students, with an emphasis on increased need for education on critical care and common EM presentations. We used the topics determined to be highest priority for the development of our first ten episodes of ‘ClerkCast’. Curriculum, Tool or Material: Podcast episodes are released from CanadiEM biweekly. Episodes are 30 to 45 min in length, and focus on cognitive approaches to a common EM presentation for medical students. Content is anchored on medical student interactions with a staff or resident EM co-host. Podcasts are supplemented by infographics and blog posts highlighting the key points from each episode. Learners are also encouraged to interact with the content through review quizzes on a provided question bank. Quality assurance of the content is provided by physician co-hosts who review episode scripts both prior to recording. Post-production feedback is elicited via comments on the curriculum's host website, CanadiEM.org, and through direct email correspondence to the ClerkCast address. Conclusion: With an ever increasing number of OERs in EM and critical care, the systematic development of new resources is important to avoid redundancies in content and medium while also addressing unmet learner needs. We describe the successful use of the Kern Six Steps for curriculum development for the creation of our novel EM OER for Canadian medical students, ‘ClerkCast’.

Introduction: CanadiEM.org is a multi-author open access medical education website which aims to improve emergency care in Canada by building an online community of practice for healthcare practitioners and providing them with high quality, freely available educational resources. It is used by physicians, allied health professionals, and trainees globally. Junior (medical student and/or resident) Editors are key members of the community who are mentored to advance their academic skills and knowledge for their careers and the healthcare field. The program also aims to increase the sustainability of the CanadiEM project by supporting the creation and publishing of online content. We aimed to assess the impact and efficacy of this program while discovering ways to improve it. Methods: The experience of all current and previous Junior Editors were assessed through a survey developed by the authorship team for this purpose. The survey consisted of 48 questions, including 15 multiple choice questions rated using a Likert Scale, 10 open-ended questions, and 23 demographic or binary yes/no questions. The participants' perceptions of their experience, desire for future involvement, and opinions regarding implementation of the program at other medical education websites were assessed using open-ended qualitative questions. These responses were thematically analyzed. Results: A total of 28 Junior Editors responded (71.7% of those surveyed). They listed their responsibilities as uploading/copyediting posts, authorship of posts, infographic creation, social media promotion, authorship of podcast summaries, editing of podcasts, and logo design. Results revealed a positive experience across all domains, with participants citing a better experience when compared to previous similar roles. 85.7% (24/28) stated they achieved their expectations from the program, and 82.1% (23/28) would incorporate this program into another medical education website if given the opportunity. Conclusion: Junior Editors reported positive experiences across all responsibilities, with particular value placed on digital and authorship skills development, inspiration for future FOAMed, research engagement, and mentorship/networking. Through collaboration with current team members, we will implement improvement initiatives. Based upon these results, we believe that the Junior Editor model may also be viable within other medical education communities.

Introduction/Innovation Concept: Emergency departments (ED) across Canada have experienced increased patient volumes and greater demands on resources. Quality improvement (QI) projects have become common in the ED with the goal of providing better and more efficient care. These projects typically attempt to improve resource utilization or patient experience. Unfortunately, the opportunity to share and exchange information among physicians about QI projects is limited. The Free Open Access Medical Education (FOAMed) domain provides a good opportunity for physicians to share their successes and challenges when implementing QI projects. The Featured Leadership & Organizational Workplace (FLOW) Hacks is an ongoing dissemination project hosted on CanadiEM.org that aims to provide ED physicians with a forum for knowledge exchange and transfer. Methods: Emergency physician leaders from across Canada have been recruited to share their QI experiences. The FLOW Hacks are summarized as a standardized set of questions that aim to convey the most important aspects of the QI project. The physician responses are published on a monthly basis as a feature on the site. Our objective is to represent EDs from across Canada and of variable size. Curriculum, Tool, or Material: Our standardized questions collect information not only on the innovation and team members but also the methodology used for the QI initiative, the data collected, and the performance measures used to assess the outcome. There is a particular focus placed on the challenges that were encountered in implementing the initiative, how they were overcome, and how they would change their approach if they could redo the project. The goal of this format is to showcase the best QI initiatives in Canada so that others can replicate the work and learn from the challenges and success of the authors. Conclusion: The FLOW Hacks series is an innovative project to disseminate QI projects to emergency physicians and managers. In the next phase of this project we will conduct a qualitative analysis of the published FLOW Hacks to identify the common mistakes and best practices in implementation of QI initiatives.

Introduction: Developing structured online educational curricula that meet learner needs is challenging. Thrombosis and bleeding are areas of innovation and change in emergency medicine. We aimed to determine the learning needs of the Free Open Access Medical education (FOAM) community with the subsequent goal of developing structured curricula to meet them. Methods: A Massive Online Needs Assessment (MONA) was conducted to determine the perceived and unperceived educational needs in thrombosis and bleeding. The survey was designed by a multidisciplinary team of experts and was open from September 20 to December 10, 2016. The survey requested limited demographic information and contained questions to identify topics of interest. Respondents’ baseline knowledge and unperceived needs were assessed using 5 case scenarios containing 3 questions each. Knowledge gaps were defined a priori as topics where <50% of participants answered correctly. Results: We received 198 complete responses by staff physicians (n=109), residents (n=46), medical students (n=29) and allied health professionals (n=14) from 20 countries. 116/198 responses were from people working in emergency medicine. Topics of interest to participants included choice of anticoagulants, interruption of anticoagulation, management of bleeding and monitoring anticoagulation. Knowledge gaps were identified in 4 main areas including interruption of anticoagulation, management of bleeding (including reversal of anticoagulation and massive transfusion), inherited thrombophilia, and screening for malignancy in acute thrombosis. Conclusion: We have identified six priority topics to cover in our future online Thrombosis and Bleeding curriculum by surveying the online medical community. Although perceived and unperceived needs showed high congruence, two priority topics were only identified by assessing unperceived needs.

Introduction/Innovation Concept: The boom in online educational resources for medical education over the past decade has changed how physicians learn and keep up to date with new literature. While nearly all emergency medicine residents use online resources, few of these resources were designed to target knowledge gaps. Novel methods are required to identify learning needs to allow the targeted development of learner-centered curricula. Methods: A multidisciplinary team attempted to determine the feasibility of conducting a Massive Online Needs Assessment (MONA) to assess the perceived and unperceived educational needs in thrombosis and bleeding. An open, online survey was launched via Google Forms and disseminated using the online educational resource CanadiEM.org and social media platforms Twitter and Facebook with the goal of reaching participants of the Free Open Access Medical education (FOAM) community. Curriculum, Tool, or Material: The survey was designed to identify knowledge gaps and contained demographic, free text, and multiple choice questions. It took individuals approximately 30 minutes to complete and was incentivized with entry into a draw for one of four $250 Amazon Gift cards. Feasibility was defined a priori as 150 responses from at least 4 specialties in 4 or more countries. This sample was deemed the minimum number required to identify knowledge gaps (defined as <50% correct answers). The survey was open from September 20 to December 10, 2016. We received 198 complete responses from 20 countries. Respondents included staff physicians (n=109), residents (n=46), medical students (n=29), nurses (n=8), paramedics (n=4), a pharmacist (n=1) and a physician assistant (n=1). The survey entry page hosted on CanadiEM.org received page views from 866 unique IP addresses. As such, a conservative approximation of the completion rate per unique viewer was 22% (198/866). Conclusion: It is feasible to use a MONA to collect data on the perceived and unperceived needs of an online community. Such needs assessments could be used to make online resources more learner-centered.