Introduction

We have changed our learning model, and instead of having traditional noon conferences, we now have an “Academic Half Day” one day a week. The noon conference format usually involves a lecture by an expert on a specific topic, often delivered as a Powerpoint presentation, with a strong focus on acquiring medical knowledge.

While medical knowledge is just one ACGME competency, it is significantly over represented in the traditional educational model. We want our residents to be successful when they complete their training, and so we believe that residents need to learn not only appropriate medical knowledge but also to develop their practice based learning, systems based practice, professionalism, interpersonal skills, and effective patient care.

We chose a case-based format for our AHD -- why?

There is a divide between the classroom and the clinical environment that we practice in, and case-based learning bridges this gap. Medicine is best learnt with patients, and experiential learning is easier to teach in a case-based format. We believe that a case-based learning format improves recall since the context is closer to real life, and learning has “higher fidelity” when transfer of knowledge is driven by reality.

We want to help our residents transition to adult learning. We want our graduates to be self directed in their learning and committed to life-long learning. We know that many adults do not become adult learners, and that many adult learners can regress. Case based learning teaches the tools that allow our trainees to subsequently engage in life-long learning after they graduate from the program.

What does the AHD look like for our residents?

Every Wednesday (after completing essential ward work when applicable), residents attend the morning AHD, where they have three hours of protected time, and participate in a unique, innovative learning environment. After their AHD session, residents attend the weekly Medical Grand Rounds from 12:15 to 1:15 pm, and then perform their usual duties.

What will the AHD look like for interns?

Interns perform their usual duties on Wednesday mornings. In addition, they may cover residents that morning to allow their seniors protected time to attend the Resident AHD. They attend Grand Rounds at noon, and afterwards meet in the AHD conference room for the Intern AHD, with three hours of protected time, and an opportunity to participate in the same innovative learning environment as the residents. One unique consequence of implementing the AHD has been the ability for interns to rotate exclusively with their ward attendings on Wednesdays, which leads to an intimate one-on-one educational experience with the potential for unparalleled interactions between the intern and attending.

Is protected time really protected during the AHD?

Yes! On Wednesday mornings, residents hand over their pagers to interns and meet at the AHD conference room for their Resident AHD. During Grand Rounds, they take back their pagers, and pick up their intern’s pagers to allow interns to participate in the Intern AHD in the afternoon.

How has the AHD changed ward attending rounds?

On all weekdays except Wednesdays, since there are no more noon conferences, there is no need to break ward rounds at noon (which is usually about the time when discussions get interesting!). The ward team has much more flexibility about how they structure and implement their ward rounding schedule.

On Wednesday mornings, ward attendings will round with the interns alone. We hope that this will allow a better working relationship between interns and their attendings.

Do residents on electives and ambulatory block rotations attend the AHD?

Yes they do.

What is the single most unique feature of our AHD?

Our residents have found the ability to engage in an interactive learning experience in an immersive, protected environment to be educational, clinically focused, but above all, a fun and enjoyable experience.