 Good morning, everyone. Welcome to Grand Rounds. It's an honor to have you all. This will be a new year and in this new year we're starting up with a bang for Grand Rounds. This can be considered our education subspecialty Grand Rounds for the year. We have a special guest, Dr. Steve Flynn, who I'll introduce in just one moment. He will actually be followed by a potpourri of the passionate educators here. The educators, not only our faculty at Moran, as you know, this will be led by Catherine Hu, Ariana Levin, amongst others. And then we'll be wrapped up in the end by Marissa La Rochelle, who will be speaking about some of our new initiatives on feedback. So just again, a little bit of bookkeeping. Omicron is among us and we are continuing to have residents, fellows, etc, who are testing positive. Again, please, please recognize that we are always aware when they do test positive we certainly rely on you all to arrange schedules. Please let us know what type of resources you need. The, of course, priorities are covering consoles and VA. And so there may be some trading and we do ask for your flexibility and thank you for that ahead of time. So without further ado, it's an honor to introduce a fellow ophthalmic educator. He's even be Flynn MV PhD. He completed his medical school at LSU Shreveport did, and also his PhD at the University of Cincinnati. He has a full time appointment with LSU Shreveport ophthalmology department, he staffed satellite clinic at an affiliated hospital. He also sees and supervises senior resident clinic and residents in the operating room. In terms of didactics he's responsible for teaching optics refractive surgery UV it is at his program. In a previous life he taught psychology at the collegiate level, his PhD is in cognitive psychology. And the thing that I really have been most impressed with in my time in interactions. Steve is a forward thinker very progressive in his thought process about how we educate how we can do it more comprehensively and in a more innovative way so without further ado. Dr Flynn welcome to Salt Lake City. We are all ears and excited to hear you present. Thank you Dr petty everybody hear me okay. Audio is great. All right, well it is one of the people with y'all this morning I am Steve Flynn, and let me see if I can figure out how to advance the slides here. Okay, all right, so, as Dr Betty mentioned, I am on the faculty at LSU Shreveport. I live at Lake Clinic out 100 miles east down I 20. So I thought a map would help. And I am as he said comprehensive by training. So, it gives me great pleasure to say that the reason I am speaking to you this morning is that I am a candidate for a faculty position here at Moran. Some of you may be thinking, well, what makes this guy a candidate. Well, I mean I'm a pretty strong comprehensive ophthalmologist but there are a lot of strong comprehensive ophthalmologist between here and Monroe so I don't think that's why. Rather, I think it's because Dr petty and Dr Olson see in me, someone who may be able to contribute to the pivot in your curriculum that you began about a year and a half ago, when you started moving from the sort of attending centered traditional lecture model of resident didactics to a resident centered interactive reverse classroom approach. And specifically, the way I might be able to contribute to that is that I'm the author of a fairly comprehensive set of ophthalmology didactics material that is currently hosted online by the Academy. And this slide is my cue to go to Google. I invite everyone to go with me if you'd like open the tab. And if you'll type in OCAP review into your search bar. And then my slides come up. First, followed by the Moran core. And here we are looking on that. And here we are at the website. Yes, we accept. Okay, so scrolling down a little bit we see a bunch of tabs these tabs are organized roughly look the board books. So, first we have basic optics and they're open that up. Each of these are individual slide sets. And there are about 290 slides sets in total about 30,000 slides give or take a few. I'm the sole author. All the slides that were reviewed by the Academy before they went live. There's no barriers to access you don't have to be a member of the Academy. There's no fees involved. You don't have to register to pop up as anybody from across the country and around the world can access them. Continuing to open these up here. So financial interest in the slides the Academy didn't pay me anything for them, and they don't pay me anything for my ongoing activities I'm constantly revising slide sets, adding new ones on occasion, continuing to click through, we're down to Rhett and vitrious we're in alphabetical order here by the way. And while we're here in Rhett and vitrious. Let me call your attention. Let's let a set, excuse me concerning arm porn and CMB the reason for this foreshadowing will be apparent in a couple of minutes. And last but definitely not least we have you be it is. And again while we're here. May I point out that there's a toxo slide set. There's a similar slide set. Here's TV. So I'm going to go back to my slides now. If you'd rather stay and sort of peruse the website and just sort of half listen to me that that's fine by me. Okay, so the slides went live. The site that is about a year and a half ago a little longer early 2020. And it just gives me great pleasure to say that the response from residents has been overwhelming. As you can see here, these are from unsolicited emails from residents, and these are pretty typical of the sort of the response I've got this just been really really gratified gratified to see how well residents have responded apparently these slides work really, really well as far as the residents are concerned. So, why is that what is it about the slides that sort of allows them to be so effective well again if we look into the comments the feedback I've received. Once again, these are unsolicited comments. It's the format, and the format is what I call for lack of a better term conversational q amp a and I call it that to separate it to distinguish it from traditional q amp a is there's a, there's a stem all the following are true about keratitis, except, and then there are, you know say four or five choices, you won't find that kind of question and answer in the slide says, instead, the slides are for the most part, organized like a conversation will relaxed conversation between and attending and a resident so there's the topic at hand whatever it may be. And the attending is asking the resident questions probing her knowledge of the topic course the resident answers, almost all the questions correctly. Occasionally, the tables are turned and the resident is asking the attending to clarify some topic or another on rare occasions the the interlocutors will break through the glass and ask me, or Dr Flynn, a question, and I will on occasion, ask them a question, but for the most part, it's like two people talking and the structure this format goes on and allows me throughout the course of a time set assuming a slide set to to construct to frame out the topic at hand, and then to to fill it in with the with the facts that the resident needs to know to understand that topic and, and apparently it works really well. Okay, pardon me one second. All right, so I claimed earlier that I could contribute to Moran pivot from the traditional model to the reverse classroom and the reason I say that is I think the slide sets are an ideal resource for the sort of curriculum that you are implementing here at Moran. I imagine that one sort of impediment or roadblock or at least speed bump you've run into in implementing your reverse classroom approach is a dearth of appropriate resources. And that's not surprising, because I imagine again that most of your faculty, all of whom are excellent educators have spent their entire lives developing didactics along the traditional models so they created didactics that they the educator would be standing in front of a residence, and they would be presenting about the topic. But that's not what you're doing now. So what are those educators supposed to do when they have all this didactic material that's created for this one model and now you've adopted a different model they can't simply hand you their lecture notes and say, Okay, here it is learning on your own it's just not very effective. You need something that was developed with independent self directed learning in mind, and that's exactly what my slides were created for. Okay, let me show you an example of how this might work. So here is a screen grab from the moran website that you all recognize. It is the posterior infectious UBI this lesson plan that Dr. Rochelle created and was gracious to put online. Before I go into further Dr. Rochelle are you with us today. You may not be able to unmute yet I'll call them. Yes, I'm here. Nice to meet you and thanks again for creating your lesson plan and sharing it with everyone I hope I hope we get a chance to talk to me later on. Okay, so he, again, Dr. Rochelle has selected posterior infectious UBI this as her, her lesson plan. I think we can all agree on two things about posterior infectious UBI this one is it's extremely important topic. And to it is a challenging one. It's one that when residents encounter it, especially junior residents. They find it daunting to say the least. And at the beginning of her lesson plan we can see why here is where she lays out sort of the topics involved in infectious posterior UBI. And, and by my count, she has identified about 18 entities that she felt were important enough to point out by name. And that's a lot, but I'd like you now and here was a point or that foreshadowing earlier. Take a look at the, the topic she's identified she's identified and think back to the website. If you cross reference the two, you find that I have material and my material, pretty extensive material covering all of her topics except one with apologies, Dr. Rochelle I have nothing for you regarding the West Nile virus. You can see that should she choose to Dr. Rochelle could take the slides and assign them to the residents as pre work, and the residents could then use those slides on their own on their own time and in their own manner to to drill down on whichever ones of these one or always topics that Dr. Rochelle felt needed doing so. All right. In addition, if you look at the, the classroom portion of her lesson plan you see that she's going to start with a short quiz to assess the residents knowledge of the pre work. Conveniently, all my slides that's our question and answer format. So, whether or not Dr. Rochelle decided to use them. Prior to the classroom, she could always use them as a resource as a text, a test bank if you will, to draw out questions and answers that she could use in her in her quiz. So let's take a look at some slides and again we're going to draw our inspiration from, from her, her lesson plan, and I noted that in the assigned pre work. Despite the fact that there were 18 entities identified by name in the topic section, she singled out one Bartonella for, you know, this is the one you have to review so I'm going to take that to mean that she felt Bartonella was especially important. So let's take a look at some slides on Bartonella. Now, our question and answer format so the plan had been for all of you to be here with me today and I would throw out the questions and maybe y'all would shout out the answers. That is not really practical unless Megan and Ethan are y'all, y'all feeling good about Bartonella maybe no, no, okay, all right so we won't do that then. I'm going to play both roles I'm going to ask a question and I'm going to get the answer. I'll pause like I have a beat to give you a chance to think of an answer of course you're going to read the question much fan, much faster than I ask it. And that's an important point these are intended, the intended consumption method is a resident reading them to him or herself. So when we go through them would be much slower than it would actually be for a resident. So what is the cause of the organism in Bartonellosis that is Bartonella Hensley a, and what sort of organism isn't microbiologically speaking, well it's a bacterium. And specifically here the resident is prompted to come up with rod versus Cox's eye, and it is a rod, and is it Graham positive or negative. It is brand negative. Here's a picture of it. How are humans infected or infected be the bite, lick or scratch from a cat, especially a kitten. And what is the common name for Bartonellosis, well we call it cat scratch disease. And now I'm going to skip ahead I guess this slide we continue some demographics who's at risk, etc, etc. So skipping ahead. How does cat scratch disease present. First, there's a focal something and the point of a question like this is for the resident to come up with that one keyword that may show up say on the OCAP, or the written qualifying exam, that keyword that will queue in the resident. Aha, what we're talking about here is Bartonellosis and that keyword is the Ciclopustular. It's a Ciclopustular rash that appears in the inoculation site. Here's a picture, followed by, so here we have some amount of time later and we want the resident able to pull this up we're talking hours days weeks months. And then there's going to be another key finding and again it's something that's so important, we want the resident to be able to pull that word up specifically. So, a couple of weeks later, regional lymph adenopathy develops and followed by or accompanied by a flu-like syndrome. So what percent of patients will go on to develop ophthalmic involvement. It's not that many but it's still a it's still enough for us to be quite concerned about five to 10%. So what is the most common ophthalmic enivestation? Now this is where the lecture may go a little sideways for some residents, because of course the answer is neuroretinitis, but no, it's not neuroretinitis. The answer is paranoid oculoglandular syndrome. Now what are the two hallmarks of paranoid oculoglandular? It's a unilateral something conjunctivitis. We're looking for a histology here. And the answer is granulomatous. Here's a picture of a granulomatous conjunctivitis secondary to POS. Now granulomatous conjunctivitis is a distinctly uncommon entity and what two histologic forms are vastly more common. That would be papillary and follicular. The point here is to get the resident to situate to contextualize the conjunctivitis associated with oculoglandular with what they already know about conjunctivitis. And also to reinforce the fact that, you know, we always talk about papillary and follicular conjunctivitis, but there is this other form granulomatous that needs to be a warm in mind. And then we extend that a little bit. Okay, so when you hear granulomatous conjunctivitis, two entities should come to mind. The first is POS. What is the other? And if I forced you to guess on a granulomatous condition affecting the eye, you would probably get this right. It is sarcoid. Sarcoid can not always but can cause a granulomatous conjunctivitis. All right, and now we're pivoting back to where we were. The other hallmark of paranoid oculoglandular is ipsilateral something lumvedinopathy. And what we're looking for here as you can see is location, specifically two locations. So and is ipsilateral, pre-uricular and or submandibular lumvedinopathy. Here we have a picture of a child with a fairly massive submandibular lumvedinopathy associated with their, with their parents. Okay, so wait a minute. What about the other science and symptoms, the impaired up gaze, lid retraction, the stagmus and light near dissociation. No, no, those are the signs and symptoms of paranoid syndrome, not paranoid oculoglandular system, a CQB syndrome. And this is a question that I think is really important, especially for the junior residents, interns, medical students, because quite often we are referring to more senior residents and we use the word paranoid as a shorthand. I have a patient with a paranoid syndrome, right? I just have a patient with paranoid. And we know in context which of these we're referring to. But for someone who is listening, they may get the impression that paranoid just means this one thing. So I want to extend the word paranoid show that it has these different meanings so they can be forewarned about that. And while we're on the subject, just a question or two, where is the lesion in paranoid syndrome? That's the dorsal midbrain, we'd also accept pre-tectile nucleus as an answer here. And do paranoid syndrome and paranoid oculoglandular syndrome have anything to do with each other? And the answer to that question is, other than being described by the same position, Henri, no, it'll have anything to do with each other. All right, now I'm skipping over. I had a further discussion of paranoid oculoglandular in terms of other organisms that can cause it, etc. I invite you to look at the slides on the website if you're interested. So skipping now to what is the other common abominable manifestation, that's neuro-retinitis. But before we discuss Bartonella neuro-retinitis, neuro-retinitis specifically, pardon me, I'm getting ahead of myself, let's review posterior ubiotis more generally. Okay, first backing up another step. What are the four basic anatomic locations in which ubiotis can originate? Well, that would be anterior, intermediate, posterior, and pan-ubiotis. The location is most likely to manifest ubiotis from Bartonella, and that is the posterior segment. Drilling down now on posterior ubiotis, what are the four posterior inflammation locations? Well, it can be primarily in the coroid, primarily in the retina, in the coroid and retina, or the optic nerve and retina. Primarily in the coroid, we call that a coroiditis. If it's primarily in the retina, it's a retinitis. If it's in both, it's a coriorretinitis or a retinocoriditis. And if it's the optic nerve and retina, we call that a neuro-retinitis. But before we go on, some of you are thinking, wait a minute, this is too basic. Well, for most of the people on this zoom, it is too basic. But for a medical student, for an intern, this could be revelatory. It could be for them, well, aha, now I get it. So, having, it's challenging to create a review material that's aimed at both senior residents and, say, interns. It's like trying to teach a meaningful math lesson to first graders, eighth graders, and high schools. You just can't do it where every aspect of the lesson is a nugget, a pearl for every person watching. So in my experience, what the senior residents do when they get to a part like this is they fast forward. They go, huh, yeah, yeah, yeah, yeah, got it, got it, got it, got it. So this format makes fast forwarding very simple. They go right through, skip the slides, they see the slides are skipping until they get to the slides, they feel they need to review. So the, yes, this material is basic, but it doesn't provide an impediment to senior residents in terms of their utilizing the slides. Okay, of these four forms, with which is Bartonella classically associated, it is neuro-retinitis. And some of the other causes of neuro-retinitis, and I think this is an important topic to at least touch upon because all of us, I think, or most of us who are non-UBI specialists, we hear neuro-retinitis, we think Bartonella and not much else. But in fact, the differential for neuro-retinitis is fairly extensive. And so we want the resident to bear in mind that there are a number of other causes of this condition. And one of these, of all those listed, which is the most common cause of neuro-retinitis, that is Bartonella biosubstantial. And what percent of cat scratch disease patients will develop neuro-retinitis, it's not very many, it's only just a few, one or two percent. And how will they present, what will they complain of, these patients with a big complaint of acute unilateral decreased vision. And we will, dilated exam reveal, as you know, it reveals dyskidema and macular edema with exudate distributed in a fashion that we call a macular star. And we have a nice picture of a macular star. Which layer of the retina contains the exudates, and thus is responsible for the macular star pattern. And this is one where there are sort of two answers. So we use the blank out technique here. It's the blank blank layer specifically, and then an eponym before we're looking for the second part. So that is the outer plexiform civically Henry's layer. And we have a picture of that just for those interested or the residents may need to review the basic anatomy here. In addition to neuro-retinitis, how else can catch infection disease manifest in the posterior pole, the liquid actually cause a focal or multi focal retinal chlorideitis. And we'll sit and have exam reveal other signs of inflammation. And typically, yes, there could be some anterior segment and vitreous cell as well. Okay, so the set goes on from there to address Bartonellosis diagnosis and management, but we're going to, we're going to bow out of it at this point. Okay, so if I joined the Moran community, what could you expect? Well, you could expect that the slides would migrate from their current home on the Academy's website over to Moran's core. You could expect that I would be available to assist Moran's faculty, those who wish to incorporate slide sets into their lesson plans. And by assist, I mean, of course, helping them find appropriate slide sets. But not only that, I'm happy to customize them. So maybe Dr. LaRochelle says, oh, Dr. Flynn, time out at Bartonella, love all that stuff. But as you know, I got 18 entities I've got to cover. I don't have time for the residents to read all that stuff about ocular glandular. Can you cut it down for me and just give me some Bartonella slides that focus on neuro-retinitis? Absolutely. Or she might say, you know, you really, the West Nile virus is an important pathogen with regard to infectious posterior edus. You would really be doing a service to our residents in particular, and the Obamac community residents in general, if you were to create a slide set concerning West Nile virus. Okay, I'm happy to do that as well. I can't do that quite as quickly as I can customize a slide set, but give me a little time and I can get that West Nile slide set created. You can also expect me to work with your curriculum committee as you continue your pivot, as you continue your reorganization around the reverse classroom method. And you can expect me to be involved in resident and medical student teaching. I have taught the medical student, you know, the intro to the eye exam lecture, et cetera, but many times I enjoy it. One thing I do at my institution is when the first years go through the orbital dissection in gross anatomy, I, when my schedule permits, I will attend and sort of walk around the room and interact with the students while they dissect the orbit and answer clinical questions and answer the anatomy questions I can answer, which is not all of them. In terms of teaching residents, I'm very experienced in that as well. My clinic is composed of me and one senior resident, and he or she and I see all the patients we have no other subspecialty help with us. I tell them it's on an island over there. And so by doing that for the past 15 years, I've become pretty well versed in resident education. I would also mention that I elected to provide to Dr. Olson for my, my three letters of recommendation are all from former residents who have gone on to do fellowship, they've all completed their fellowship for all now out in practice. So, if any stakeholder wants to know what residents say about me vis-a-vis being a teacher, I would suggest that you approach Dr. Olson of course those letters are addressed to him there is letters to do with as you will, but there is information available to those of you who are interested in drilling down on well, in this guy actually teach. And with that, I'll open it up to questions. Good goodness, Dr. Flynn I'm, I'm speechless that is an extraordinary amount of material dedication, you know one thing I'll just say if I was to try and describe, you know what has made you know Moran what it is over the years it's been empowering passionate people to do extraordinary things and you know the fact that this is a passion you've had that you not only have had an idea but then delivered and delivered and delivered over and over to create this. It's certainly I mean it's exactly who we are what we do and I have other thoughts I'm going to actually just mute myself here let a few others chime in. So we'll take the conversation for the next five minutes just to make sure we have time for other presenters, and then we can have you at the end as well with any additional questions. Dr. Olson I see you're unmuted. Steve, I think that's spectacular what you really created is an educational data set. And we're used to instead didactic lectures, you could find the same material but it's very laborious and in in often trying to die through that is consistent so trying to go through. Take all the different literature and the rest meld it down into a data set that people can logically go through I think is a spectacular addition and I was also very impressed. If anyone would like to be unmuted you can raise your hand we have several Catherine and others who were co hosts already that can unmute. I'll just make a comment. There's a book called make it stick it sort of become the Bible for educators and higher education secretly in medicine. And there they really outline how to create durable learning. I mean cramming for a test versus what they argue really compellingly creates a durable long term learning is is actually self testing self reflection doing that at different intervals. In addition to that learning in a variety of ways, hearing it doing a test and then the really, you know, exceptional thing here is, this is unlike anything I personally have seen. It does allow residents to really anyone to commit to an answer. And even if they're wrong, durable learning occurs actually equally as well when they're wrong as when they're right in an answer and in short, I, as I think about my, you know, coming up on renewing the ABO certification. This is going to definitely be a tool that I use Catherine I see that you both you and Rachel Patel, or live when you go ahead. We're happy to wait for other questions we were just getting ready for our segment. And thanks so much for being here with us Dr plan. Just a very quick comment, which is just that this resource is incredibly helpful, and we'll talk about this a little bit more but to make preview that the pre work assignments for our lectures are something that we're talking about, how can we keep this fresh as long as it's new and having a resource that's built in that offers the same degree of interactive learning is something incredibly valuable that we don't really have as much to this degree and to be an amazing supplement to my score. It looks like a doctor degree has, I think she's been unmuted. Yes, this Kathleen degree, wonderful resource. Thank you Dr Flynn for all your hard work. I was just having a question about your, the licensing and copyright or do you own your copyright. Do you have a creative commons statement. I just wanted to know kind of what, what type of agreement. Do you have for this wonderful work because this is a lifetime of work and a life's work. I can truly see all your energy in this it's really remarkable and thank you so much for presenting us today. Thank you very much. In terms of copyright. I don't have a formal agreement with anyone. When the Academy and I were talking about whether they would host this. I asked the contact person, would I continue to own the slides and they said yes slides are still yours you're not, you're not going to be taking them over to us. We the Academy will not own them. I, but in terms of sort of holding on to them if you will and trying to control them. I decided early on, not to do that. The websites are all downloadable. I have, there's a short introduction on the website where I tell users, feel free to download users you'd like. All I ask of you user is if you modify a slide set. Keep it to yourself. Don't, don't distribute it just let my originals be out there, and you can use your modified slide set sort of in house if you will but no other than that there's no, I have no agreements no, there's nothing formal. I should I'm open to listening from, so like you know more about the sort of thing that I do. I think to Brandon Kennedy, you're in muted I saw your hand go up. So Steve will talk about that. Kathleen's the expert on this, and we'll talk about it. Hi everyone this is Brandon I'm one of the junior residents. Thanks Dr Flynn for all your contribution so I just had a quick question. I know myself and a couple other of us residents actually user slides already. My question is, is I primarily use them right now is like supplementation or augmentation of the knowledge once I kind of acquire it from the DCSC. In your experience with residents would you recommend using this as a primary source of learning as in learning for the first time once you're seeing this material, or kind of plowing through these slides once you have a better grass. Quickly, almost like, like he's like a Q&A format. That is a really good question, and it is one that I have wrestled with myself. My initial recommendation has been and it's on the website again in that introduction, my recommendation is pick a topic or analysis, read about it in the board series, and then come to my slide sense. The feedback I'm getting for residents who write me is that a number of them have said, I have given up on reading the board books, I just use pardon me I just use your slides, I don't necessarily recommend that, but I also don't feel like I'm in a position to tell a resident no you can't learn that way you have to learn this other way. So, I'm a bit torn. One of the downsides of the slides I will point out is, you have to have at least some fund of knowledge before you can use them in other words if someone is truly a neophyte, new to the field. Well their answer to every question is, I don't know, and it's not very useful for them. So if I could take just a minute Dr. Petty to show one other portion of the website. Do you mind. Please do. While you pull that up we'll just do the introduction to our next group. Dr Catherine who she'll be a cornea fellow with us next year. She'll be running the next portion Rachel Patel her UVitis fellow, other passionate educator and again, they'll be bookended by Marissa Laura shell. While you do pull that up I'll just share one wonderful thing about Catherine and a very thoughtful email early on match day for fellow she sent her co resident Marshall, a link from the SF match that told him where he was going to match even before it was released and it linked to a wonderful Rick Astley video of never going to let you down. So, Catherine, you just need that acknowledgement Dr Flynn carry on looks like you found it. I did you Rick rolled him. Excellent. said, excuse. Okay, two. I want to make two comments if I could real quick one. All the topics are standalone so if you want to read about Bart Nelosis, we have the Bart Nelosis slide said you don't need to read anything else to prepare you for the Bart Nelosis slide said, except the optics, the optics are a tutorial. They're intended to take a naive individual knows nothing about optics, step by step. In fact, they're called chapters we're not. They're called chapters so they're chapter 123 etc. So, by the time you finished the optics, you the reader the user will have a good basic fundamental grasp of clinical optics. Are you ready to go out and refract people know refraction still takes practice but you are ready to answer most of the sorts of questions you're going to encounter on the okay. Okay, so I'd like to draw your attention to this section, new ophthalmologist overviews and basics. This consists of slide sets created with the intent of addressing the neophyte issue. In other words people who truly know nothing about ophthalmology and when they encounter them. This one thinking MS threes who decided they want to go into ophthalmology or MS spores early in their career. So if we click on on that. See, there are currently seven topics. These sets are not in question and answer format. These are narrative versions of the same slide sets that are in the main portion of the website so in other words, when you read through these you're not asked questions, it's just, you know, we can take a look for example let me open up the ubi just we just did a topic. And you can see it starts talking about ubi this there's no question and goes on sorry. Okay, so goes on talk some more identifies key layers of the eye. The material is also simplified a little bit some of the complexity has been taken out to make it more appropriate for a junior learner. And I know you don't have time to read what I'm clicking on the point is I'm showing you there are no questions here. It's just narrative. So this is exceptional. This is, this is absolutely brilliant. I will let's let's do this let's take a little pause there's a lot of synergies that are coming right now with this next portion and we've left them kind of a perfect amount of time. Catherine why don't you take it away and then we'll come back to you at the wrap up in the end. Thank you so much. Thank you very much. Thank you very much. Thanks, Dr Flynn. Let me just share my screen here. And there's some visual aids here can everybody see my screen and hear me okay oops let me actually start from the side. All right, everybody see the screen okay. Yes, we're good. Thank you so much Dr Flynn this really kind of rolls in nicely to just we wanted to do a quick check in for mall or Moran ophthalmology learning experience and also of course get Dr Flynn's input as well. But really we're at 18 months into the roll out of this new curriculum. And we just wanted to kind of do a short check in discussion. And one of the kind of concerns or questions that we've had from faculty is really how to keep this material fresh every year. You know the first year it was really, really inspiring to see all the faculty revamp their entire curriculum, make interactive activities and come up with new ways to display and really communicate their, their lectures. And really how do we keep this material fresh and updated. And so we have some tips and some, some resources that we can distribute to faculty, and then also we'll pivot at the end to go to Dr La Rochelle on on rotation feedback. So to really start off I wanted to see if Dr Rachel Patel is still online just to go over some of the results from our faculty survey, we're doing kind of a research based approach with this as well. So take it away Dr Patel and we can kind of go over the summary of these results. Yeah, thanks Catherine. So this credit to all of this goes to everyone of you guys for the faculty and for the residents for filling out the copious amount of feedback that we requested over the last two years. And as you know we asked everyone to fill out a survey before back in 2019 before even broaching the topic of flipping classrooms to this more interactive learning. And then we pulled everyone again more formally last June so this is a one year, rather than a full 18 month feedback but I wanted to share with you guys what we found so far. So on the left, there's just a couple of the interesting interesting results that we found from the questionnaires and this includes how faculty felt that residents were participating during their didactic time and with more interactive during the next session, faculty felt that resident participation was up considerably. We also know that this is not necessarily a natural way to teach like people might be more comfortable with the traditional format and that's very understandable. But over after a year, the percent of faculty who said I'm definitely much more comfortable delivering lectures in the traditional format decreased with the year of experience so we do know that this can be an acquired level that people feel more comfortable with with time so that's one good thing about having this curriculum roll forward. And residents also felt dramatically that this flip classroom method was much more effective in their learning than the traditional method so on a scale of one to five days rated at 1.8 for the traditional lectures and 4.8 for the flip classroom yeah okay it's subjective but it is important people feel so strongly about that. What I wanted to focus on was what teaching methods people found effective because this is what Dr. Flynn was talking about like how can we make this something that what methods are working to improve learner retention and resident engagement. And you can see from both a faculty and resident perspective that some of the methods were overlapping so both felt that case based learning was super helpful and in fact of learning technique and quizzes as well. And team based learning which is a form of peer to peer teaching where residents learning teams and answer questions in teams. It are also something that both faculty and residents felt helpful. I wanted to draw your attention particularly to the world board style question response that the residents felt was effective. We didn't actually ask faculty I forgot about that so just to float this out there as an idea going forward for fresh ideas. Because this is something that might also be particularly suitable for zoom learning which is where we're at currently, where it is a form of case based learning where everyone can see a picture of slides. But then there's one resident who like has the platform for three minutes so there's not as much jumping about with zoom and answers questions in an all board style format. So just to let you know what faculty and residents think so far and of course we can add to the list of things that are working. Miran core and Dr. Flynn's lectures are built to try to share the knowledge of what's working with other people so that everyone can take that and roll with it in their didactics. Thank you so much Rachel. And then at this point I did want to kind of open it up to discussion but I think we'll just table this for the end of the this segment, but maybe just take a look at these questions. See if there's anybody who might want to raise their hand at the end of this discussion. But like I said kind of some updated some ideas for updating session material just speaking to faculty. And then some Moran core resources that we'll just take a look at in a bit. There's also possibility from moving from a 12 months to more of an 18 month curriculum for example I know oculoplastic on their rotation and lecture roadmap have this format where there's a standing kind of basic training and basics of trauma management that are given every year but then there's also rotation of other pathologies and management that are rotated every other year, just so that again the material is new for the rotating classes, and then keeping, keeping track of interesting cases and epic this is something that I know Dr. Chacord does and then also other fellows do is they have a shared list and epic where they can add interesting patient cases. Good imaging and things like that that I think can be very very useful. And of course assigning residents pre work can also be a way to update session material, have the residents bring in interesting cases to discuss. And of course just a friendly reminder to be sure to send out that pre work with enough time in advance, but also for a lot of the cases that are oral or for a lot of the sessions that are world board style, just updating those cases every year. I know Dr Lynn even had a ocular surface disease management where she went through a case and next steps and management. I think rotating those cases are changing them every year can be very very fruitful. And then I did want to also, these are some of the examples that we can look at just while I'm pulling up the next, the next display but these are some things that other faculty have done, and really we've really gained a national attention at a p o and a lot of faculty and other program directors have reached out to myself, Dr petty and Dr Simpson. I'm really really interested in this curriculum as it's also a really, a leading question that applicants for residency also ask us, but I did want to just share a new screen here, everybody can see for our Moran core website. So on Moran core we have a section that is the Moran ophthalmology learning experience and we do have again instructional videos and support resources. We're planning on putting more resources in terms of writing up specific lecture formats just like you saw with Dr La Rochelle's lesson plan, so that other faculty can learn from other faculty and we are planning to update this site. We have also instructional videos and one that I actually wanted to actually show it's only three minutes long before we transition to Dr La Rochelle segment. But this is a just a technology ideas and resources, a video, and I'll just play a segment of it here, but it goes into specific ideas and resources that you can do specifically for, unfortunately for zoom lectures and if we're going to continue to have virtual sessions, so I'm just going to play that here. And let me see if I can optimize this for video, video settings. See here. Hopefully that is optimized for video. We hope roll out of the new curriculum everybody hear the sound okay. And the audio is gone now. Looks like it's showing your slide set again games and interactive platforms. And finally some lessons on this video is certainly not meant to be exhaustive, more of an intro to some ideas that we hope to find helpful. We'll post a summary of topics in this video on our website. So first up capturing screen images using a snipping tool on your computer may save you time instead of using a print screen function. I can't get through this one, but it is a fun and easy way to make sessions interactive. So we'll be posting some free PowerPoint templates on our website. We'll also have links to some audience response systems. One of the favorite ones that we've had is Kahoot, which is a free online interactive quiz and audience response system residents can log on using a unique code using their smartphone to create. You can see here during a neuro ophthalmology lecture led by Dr. C and Dr. Redfern that residents can earn points answering questions and kind of promote some friendly competition. You can create an account for free on Kahoot.it and creating a quiz is really easy just type in the question, and you can add any images or links or PowerPoint slides, and they have different formats of different types of questions that you may want to ask. And since Zoom will be in our lives for the foreseeable future when we can't have in person lectures, a good way to simulate small group discussions is using the breakout function on Zoom. You can use this for case based discussions and small group activities. Zoom has some pretty nice instructional videos that we will post on our website, but basically you as a host and organizer can actually break participants out into smaller virtual rooms and actually float between the rooms to see how the discussions are going. Another way to use Zoom is to pre-record lecture material that can supplement the pre-work you assigned residents before the interactive Friday session. This can be an efficient way to convey important but straightforward material or provide updates with new material to supplement older lectures that have been posted already on MoranCorp. Simply ask Ethan Peterson to send you a link to the University Zoom account for recording. We can then help edit the recording if needed and post it to MoranCorp with a shareable link like Dr. LaRochelle has in here. In summary, here are just a few ideas on how to incorporate technology into your flipped classroom sessions. We have assembled a list of helpful links and stuff I said descriptions covered in this video and more on our MoranCorp website under support resources. Alright, so yeah, just like that video had said, we have a pretty short digestible three minute videos on the site and then also a summary of pre-work assignment ideas and then also how to use these certain pull everywhere audience response systems. There's also another video on interactive partner small discussion activities as well and there's an example in that video that I'm not going to show, but where Dr. Vagunta, sorry I'm trying to move this bar from Zoom, but there's an example basically where Dr. Vagunta and Dr. Crom had us pair up in discussion on Zoom and then you would meet the main Zoom session and actually call your partner to kind of discuss the pieces. So there are a lot of kind of creative ideas that are out there that we've also posted on here as a reminder of the website. So now I'm going to reshare my PowerPoint here and we did want to pivot to Dr. LaRochelle and I know that not all faculty give lectures, but all faculty definitely interact with residents on rotation. So we did want to talk about some feedback forms that are that we are rolling out. So to make them more efficient and effective, making them timely, personal and also personalized and also specific. So I'm going to turn this over to her, but it's something that we wanted to integrate to the experience for both faculty and also residents as well. Thank you. Can you guys hear me and see me okay? Audio is great. Excellent. So thank you Dr. Flynn for showing us that really excellent resource. I mean I think as attendings, we're trying to prepare the lectures in this new format. It's a little daunting because not only do we have to come up with these great creative ways to impress the residents and occupy two hours of time face to face with this reverse classroom format, but we also have to prepare that the pre-work which I found to be even more daunting to come up with what do I want to tell the residents to read ahead of time and I think using your slides would be a really excellent way to cover that pre-work portion of it. So thank you. And this morning I have the distinct pleasure of discussing one of everybody's least favorite topics, which is feedback. I was thinking feedback is a little bit like syphilis. No one likes to give it or receive it and yet here we are with the incidence rising in every urban and academic center over the last decade. So with that, we are introducing a new, this is funny, the only face I can see right now is Jeff Petty on my screen and I'm just cracking up. So we're introducing a new resident feedback format supposed to be used as an on rotation, mid-rotation feedback. With the ultimate goal that in the same vein as our newly passed law, the No Surprises Act in medicine, that no resident will reach the end of their rotation and get a surprise feedback, like some horrendous flaw that they didn't know they were doing. And now it's the end of the rotation and they don't have time to remedy it. So the purpose of this is to have residents and faculty casually yet conscientiously engage in discussing areas of concern when they're still trying to address them. Let me just pull up the form here. And so we can, you know, imagine a resident awkwardly approaching and attending and the attending also awkwardly engaging in this in this discussion and we know that feedback is really uncomfortable on on both parties. I don't understand that I too cringe when I hear the word feedback, but we know it's important it has its purpose, and when done well in a timely manner and constructive feedback can be can be very helpful. It's a reminder that as attendings in academics, our purpose isn't to critique or blissfully ignore residents on their path of training but actually to create good ophthalmologists and that takes effort and willingness. Let me just pull this up. And while she's pulling that up one thing that's really important is this feedback just to stress. This is meant to be informal that doesn't go in a in any permanent record this really should allow for just some more safe space to discuss, recognizing that you know this is the conversation that is in their forming stage, not a final assessment or a formal feedback going to to to the education group. Can you guys see that screen. Yes. This is what we came up with. You'll notice the sort of normal areas that we cover professionalism clinical skills surgical skills and then consult and, importantly, we decided to have just two categories of below expected level, or at or above expected level. So this really isn't where you're grading the residents and saying that they're, you know, a nine out of 10 or eight out of 10 we're just trying to really target areas of concern when there's still time to address them on the rotation. And so this, like we said is not a permanent part of their record. I think it's helpful to at least write a few sentences or mark some categories but it doesn't have to be filled out in a very formal way. But it's just a way sort of using it as a springboard to to engage in that feedback during the rotation. And another helpful point of doing it at the mid rotation stage is that you can use this and simultaneously refer to the roadmap of what remind ourselves of the goals during the, the rotation that the resident should be learning and so if you're looking at your roadmap per se and UV itis and a resident supposed to accurately grade anterior chamber inflammation or perform an Ozard X injection, and we're at the halfway point of the rotation and you realize well I've never even asked this resident how much AC cell have you seen or I've never seen them perform an Ozard X. It can be a reminder to sort of reset where where the you perhaps are in engaging with the resident on their on rotation learning by referring to that roadmap. So, with that, I'd like to open it up to feedback. I was going to give you feedback. Let me give feedback. Somebody's been involved in education for a long time, and very involved in it for much of my career, less so lately. This is so much superior to what what typically happened and what was was we typically saw an involved in that. I just, I just think it's a spectacular and obviously it's a lot more work. I mean we had I think one of our best lectures when I was a resident was Tom Pettit would just come in with a series of glass slides we used to have those back then. And then he would just pass them around and then people will say well what do you think's going on and he talked about the case and that that was way better than the can lectures. It's so much superior to that it is more work, but but you're going to get out of what you put into it. And so that's where I see that this is going to be a much better learning experience. Just to add to that and we are at time. I just really came out of a lot of thought about how can we how can we, you know, foster communication and how can we get the right communication at the right time and you can see, you know this is not an onerous tool this is simply a guide I could very much see someone looking at this, just to guide a conversation as opposed to you know maybe even filling it out filling it out with with the resident along the way and please. I think one of the things we want to stress. This is, this is just a moment where you for you to have a conversation with your resident on service and help you help them grow. This time this is not meant to be something where we're we're tracking we're putting into the portfolio or going to the clinical competency committee. You know, I just want to again commend all of the mold committee you can see all their their names through all the educational resources Rachel Simpson for really heading this. It's been an extraordinary transformation and one that, if I didn't see it happening I wouldn't believe that all this could be done so thank you all. Thank you Dr Flynn was an honor a true honor to have you today with us and we, we are equally equally impressed with your passion your resources and commitment to education. Thank you everyone have a beautiful day.