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A Curriculum for Residents on the Move

Date: January 1, 2013

Stephen Sisson’s idea for tapping the Internet to improve ambulatory training at Johns Hopkins now reaches more than 10,000 residents around the country.
Stephen Sisson’s idea for tapping the Internet to improve ambulatory training at Johns Hopkins now reaches more than 10,000 residents around the country.


In the late 1990s, internist Stephen Sisson and others set out to improve ambulatory care education at Johns Hopkins. At the time there was no set curriculum, and devising a live lecture series was tough, since housestaff saw patients at all different times. With the Internet booming, Sisson, internist Mark Hughes and two fellows decided they wanted a computer-based, interactive learning tool.

Thus was born the Johns Hopkins Medicine Internet Learning Center.

“We hypothesized that a curriculum in ambulatory care delivered via the Internet could be incorporated into a range of residency training programs,” says Sisson, director of the center since 1998. “We also thought program directors would view it as a valuable educational resource, and that it would meet requirements from the Accreditation Council for Graduate Medical Education to document and evaluate trainees’ educational experiences.”

Sisson and colleagues developed a curriculum that residents could access at their convenience over the course of a year. They designed 17 modules, covering areas like hypertension and depression. Each presented a clinical scenario focusing on understanding concepts, with links to related journal articles or abstracts, images and videos. Residents were quizzed at the outset and end of each module.

In 2001, Sisson and others marketed their curriculum to other residency program directors for a $1,500 annual fee. Twenty-four signed on, and all money raised was poured back into refining the website and residents’ performance evaluation.

Sisson now has 180 residency program subscribers (serving more than 10,000 residents) and 43 modules, plus a mobile site. Content is developed by an editorial board of general internal medicine faculty. Modules are revised annually to include important updates. 

Authors try to inject some fun. In the asthma module, for example, all mock patients’ names were taken from the former Baltimore-based television drama The Wire. Other cases use the names of Baltimore Ravens football players.

Incorporating resident feedback over time, Sisson says they have learned more about what residents want. As a result, pre- and post-module test scores and learner satisfaction have increased. Sisson and his team have published what they've learned from residents about website design and a guide for educators who plan to develop online learning courses. 

The Internet Learning Center also has evolved from a mainly teaching website to a teaching and evaluation site, compiling huge amounts of data on group perfromance and how to rate individual performance. 

To better capture both the educational and evaluation aspects of the site, the name will soon be changing to the Physician Education and Assessment Center (PEAC).

Sisson’s group is now looking at how each resident’s rank score on the modules relates to board exam performance. They’ve surveyed program directors and input score data for clues.

“We’re hoping to show that our scores predict board performance, which would make it a much more useful tool,” says Sisson, noting that a director could intervene before a struggling resident sits for the board exam.

The learning center overall, he says, is “beyond what I could have hoped for.”