#KEYLIMEPODCAST 339: Back to the Future – The One Room Schoolhouse

In this week’s episode, the co-hosts discuss innovation scholarship and the criteria for rigor and the utility for teachers and educators. The article providing background for their conversation outlines the challenge of developing academic half day curricula where the cohort of learners is small, yet the range of experience is large. Will they find an innovative method to foster efficient and effective teaching for such a complex audience?

Listen here to find out.


KeyLIME Session 339

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Harms, S et al. One Room Schoolhouse: A Novel Intervention for Inspired Academic Half-Day Learning in Distributed Campus Settings. J Med Educ Curric Dev. 2021 July


Jon Sherbino (@sherbino)


I worry sometimes that our podcasts skews too far towards the ivory tower. By this I mean the podcast emphasizes theory and explanatory research. However, I suspect for a large percentage of the KeyLIME podcast audience the answers demanded from the literature are less abstract and more pragmatic in nature. In my opinion, we discuss innovations and  solutions to the practical problems faced by clinician educators too infrequently. I do not mean to suggest that there is a hierarchy between research and innovation. In fact van Melle et al., on behalf the Canadian Association of Medical Educators produced this encompassing and evidence-informed definition of education scholarship “an umbrella term which can encompass both research and innovation in health professions education. Quality in education scholarship is attained through work that is peer reviewed, publicly disseminated and provides a platform that others can build on.”  Of course, this definition rests on the work of Lee Schulman, Ernest Boyer and others.

Today we tackle innovation scholarship and the criteria for rigor and the utility for teachers and educators. The context for this discussion is the challenge of developing academic half day curricula (academic conference in the US) curricula where the cohort of learners is small and the distribution is across a range of experience. What innovation fosters efficient and effective teaching for such a complex audience?


The authors state: “[the] One Room Schoolhouse (ORS), a unique, evidence-informed, community-based curriculum … clinically reflective of the community in which residents practiced and where residents were given the autonomy to implement novel pedagogical elements would result in better test scores and improved learner satisfaction among ORS learners.”

Key Points on the Methods

 An innovative academic half day curriculum was developed for a distributed campus of 9 residents (PGY 2 to 5)in a psychiatry residency program.

The curriculum was developed by the residents in collaboration with community faculty. Complex clinical scenarios encountered by learners in the community were developed into a case based approach. A module consised of two to three weekly academic sessions relevant to the complex case. Learning objectives were established personal or group needs. Between sessions residents would independently research answers to the learning objectives to meet personal needs. Additional learning opportunities included site visits to relevant community agencies or to engage with special populations. required curriculum elements (e.g. OSCE, EBM etc.) were tied to the modules as appropriate.

Evaluation of the innovation included 1: analysis of resident assessment, and 2: analysis of semi-structured focus groups using interpretive description.

Analysis of resident assessment included knowledge scores on annual standardized national exams, two annual OSCE  exams and in-training assessment reports (ITERS) over a three year. Analysis of variance was conducted with postgraduate year and curriculum types (ORS vs main campus) as independent measures.

A researcher, external to the residency training program, conducted a single focus group of residents, voluntarily recruited by email. Two researchers independently coded the transcript using an inductive approach.

Key Outcomes

There were 24 residents across the three years of study in the ORS curriculum compared with 78 residence in the traditional curriculum.

The analysis of variance did not demonstrate a difference in knowledge scores, even when controlling for variation  in test difficulty across academic years. analysis of variance did not show difference in performance on in training assessment nor on the April OSCE. There was a statistically significant difference on November OSCE results showing that ORS curriculum students performed better then traditional curriculum students, an average of approximately five percentage points.

Five residents participated in the focus group. Six themes emerged.

  1. The previous model for the curriculum at thedistributed site was unsatisfactory, primarily relying on videoconferencing from the main campus.
  2. The one room schoolhouse was a positive development because of the learning integration that was key to the design, including experiential learning
  3. Learning is social engagement thin and beyond the classroom. Specifically residents were aware of the social accountability of their interactions within the community and sought reater cohesiveness among residents of various stages of training.
  4. There was greater tolerance of uncertainty, particularly in the lack of an expert presenting material. Participating in the one room school house  required courage as they often missed out on curricular offerings from the main campus.
  5. Residents described increased agency as related to their learning; they described improved self confidence as a clinician., who would be engaged in lifelong learning.
  6. There were a few criticisms about the innovation or suggestions for improvement.

Key Conclusions

The authors conclude…

“Creating opportunities to enhance personal agency when acquiring knowledge, inspiring engagement about patient-related problems, and incorporating interdisciplinary learning through community engagement were critical pedagogical elements that were attributed to the success of the ORS.”

Spare Keys – Other take home points for Clinician Educators

One challenge in publishing an innovation is that it requires a scholar to provide a unique definition. Too often innovations can often closely resemble one another, despite the claims and reputations of the authors. Making difference is explicit and illuminating points of commonality is key to connect the domain of related innovations.  In the absence of explicit definitions, boundaries can blur and the ordering of the literature can suffer.

Innovation scholarship must be informed by Glassick’s criteria.

  1. Clear goals
  2. Adequate preparation
  3. Appropriate methods
  4. Significant results or outcomes
  5. Effective presentation
  6. Reflective critique

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