Competitive Small Grant Awards Program
The CLIME competitive small grant awards program supports innovative medical education research and curricular projects, locally and across the WWAMI region. $20,000 is distributed each year to support projects at the University of Washington. Principal Investigators (PIs) of funded projects are required to present at a work-in-progress session to foster ongoing project development and disseminate knowledge. PIs of unfunded projects are invited to consult with CLIME leadership to help improve their projects for future CLIME and other grant submissions.
2017 CLIME FUNDED PROPOSALS
» Extracorporeal Life Support Education for Critical Care Fellows: A Novel Multimodality Curriculum
» TeamBITS Online - Expanding Access to Teamwork Training for Medical Students
» Effect of Curriculum and Contextual Factors on Dental School Graduates’ Treatment of Adult Patients with Developmental Disabilities
» UWSOM Faculty Interview Project: Living with curriculum change
» A Qualitative Programmatic Evaluation of Clinical Faculty Development Needs
“EXTRACORPOREAL LIFE SUPPORT EDUCATION FOR CRITICAL CARE FELLOWS: A NOVEL MULTIMODALITY CURRICULUM”
Jenelle Badulak, MD; Fellow, Pulmonary, Critical Care & Sleep Medicine
- Basak Coruh, MD, Pulmonary, Critical Care & Sleep Medicine, University of Washington
- Andy Luks, MD, Pulmonary, Critical Care & Sleep Medicine, University of Washington
- Pablo Sanchez, MD, PhD, Cardiothoracic Surgery, University of Washington
Grant Amount: $4,163
Abstract: Extracorporeal life support (ECLS) is an advanced endovascular tool used to bypass the heart and lungs in cases of severe cardiopulmonary failure. Due to the rapidly expanding use of ECLS in adult intensive care units there is a need for ECLS education
during critical care fellowship. Currently, educational materials and available time for didactic education for adult critical care fellows are limited. We will create a pilot ECLS curriculum for University of Washington (UW) critical care fellows using multiple educational modalities including in-person lecture, a web-based tool containing modules and case scenarios, and in-person simulation. Effectiveness of this curriculum will be measured using: 1) pre- and post-curriculum knowledge and attitudinal assessment; 2) skills checklist during in-person simulation; 3) post-curriculum qualitative evaluation. Additionally, we will compare the performance of learners receiving the web-based curriculum only to those also receiving traditional in-person lectures using a quasi-experimental method. After evidencebased revisions, the web-based educational tool will be made internationally available through the
Extracorporeal Life Support Organization (ELSO)
“TEAMBITS ONLINE - EXPANDING ACCESS TO TEAMWORK TRAINING FOR MEDICAL STUDENTS”
Rebekah Burns, MD; Assistant Professor, Pediatric Emergency Medicine
- Sara Kim, PhD; Associate Dean for Quality Improvement, University of Washington
- Genevieve Pagalilauan, MD; Internal Medicine, University of Washington
- Taylor Sawyer, DO, M.Ed.; Pediatrics, University of Washington
- Rachel Umoren; Pediatrics, University of Washington
Grant Amount: $4,163
Abstract: Effective communication and teamwork skills are essential for graduating medical students. The Capstone course: Transition to Residency Series provides graduating medical students an opportunity to participate in interprofessional clinical simulations based on the the TeamSTEPPS program, an evidence-based approach to teamwork training. The in-person simulations, also known as Team BITS, have been well-received by learners but are time intensive with many students unable to participate due to scheduling and geographic limitations. This proposal will increase the access of students to the curriculum by implementing and evaluating a curricular innovation: TeamBITS Online - an online module consisting of didactic content and a computer-based simulation based on the same learning objectives and scenario as the in-person class. The module will be easily accessible to students across the WWAMI region through the UW Canvas LMS. The curriculum will be evaluated by comparing TeamSTEPPS knowledge, attitudes, teamwork behaviors and participant satisfaction between in-person call and online groups. A comparative cost analysis will also be performed on faculty time, software development, and simulation center costs to provide an estimated cost per student.
“EFFECT OF CURRICULUM AND CONTEXTUAL FACTORS ON DENTAL SCHOOL GRADUATES’ TREATMENT OF ADULT PATIENTS WITH DEVELOPMENTAL DISABILITIES”
Kimberly Espinoza, DDS, MPH; Clinical Assistant Professor - Dental Pathway, Oral Medicine
- Ashland Doomes, DMD; Oral Medicine, University of Washington
Grant Amount: $4,163
Abstract: Adults with developmental disabilities have high rates of untreated dental disease, compounded by difficulty accessing dental care. Dental school students and graduates often feel unprepared to treat patients with special needs and the care of patients with special needs is often not a high priority in the dental school curriculum. A unique program, the Dental Education in the Care of Disabilities (DECOD) Program at the UW School of Dentistry aim to improve access to care for adults with developmental disabilities through didactic and clinical training in the delivery of oral health care to this population. While some research shows that increased exposure to patients with special needs increases student comfort and willingness to treat, there is paucity of research related to whether or not providers actually treat adults with their disabilities in their practices and to what extent. This project examines, qualitatively, how dental school graduates' interest in treating adult patients with developmental disabilities is influenced by dental school curriculum as well as contextual factors within the first year out of practice.
“UWSOM Faculty Interview Project: Living with curriculum change”
David M. Hudson, PhD; Research Assistant Professor, Orthopaedics and Sports Medicine
- Lynne Robins, PhD; Biomedical Informatics and Medical Education, University of Washington
Grant Amount: $3,350
Abstract: In fall 2015, the UWSOM implemented the first of three integrated learning phases of its new curriculum: the scientific foundations phase. This 18-month phase is comprised of 7 interdisciplinary blocks, an immersion experience, and intergrated themes and threads. It is designed to bring together basic, clinical and social sciences and incorporate evidence-based active learning methods. Block, thread, and theme planning is conducted collaboratively by teams of faculty representing all WWAMI sites; this is a significant departure from prior more Seattle-centric approaches to curriculum development and dissemination. The purpose of the proposed project is to explore the experiences of involved faculty members and give voice to their unique insights using qualitative interviews. Verbatim transcripts of recorded interviews will be analyzed thematically using an iterative constructivist approach informed by phenomenology. Our goals are to describe, interpret and illuminate faculty members' experiences and perceptions of curriculum change and to use findings to inform continuous curriculum improvement.
“A Qualitative Programmatic Evaluation of Clinical Faculty Development Needs”
Corrie McDaniel, DO; Assistant Professor, Pediatrics
- Sahar Rooholamini MD, MPH; Pediatrics, University of Washington
- Arti Desai MD, MSPH; Pediatrics, University of Washington
- Susan Marshall MD; Pediatrics, University of Washington
Grant Amount: $4,163
Abstract: Nationally full-time clinical and clinician-educator faculty under-utilize mentorship. Given the importance of mentorship in early career faculty development, we established a Junior Faculty Mentorship Program (JFMP) at the University of Washington Department of Pediatrics. The JFMP meets quarterly and is structured in 2 components: a traditional featured speaker followed by 45 to 60 minutes of junior faculty small group work targeted to the overall topic of the meeting. Leveraging the benefits of small group mentorship, we developed this novel concept of a rotating, small-group mentorship model. In this model, we emphasize short, topic-specific sessions promoting group discussion, collaboration, and team-based learning concepts while minimizing the potential challenges of small group work such as coordinating schedules and competing faculty interests. Using realist evaluation methodology as a conceptual framework, the aim of this study is to gain an understanding of the lived experience of junior academic clinical faculty who participate in the JFMP through a qualitative programmatic evaluation. Ultimately, our findings will lead to programmatic and curricular refinements within the JFMP.
2015-2016 CLIME FUNDED PROPOSALS
» Craniofacial Case-Based Learning Modules: Cleft Lip & Palate Pilot Study
» ABO Leaders: A Community of Practice for Transfusion Medicine Education
» Podcasting Pedagogy: Developing Theory to Understand an Emergency Medicine Educational Phenomenon
» Teaching Students in Clinic and the Effect on Preceptor Productivity
» The Layered Teaching Model: A Novel Psychiatric Curriculum Integrating "Just-in-Time" Teaching Into Clinical Experience from a Practical and Adult Learning Theoretical Foundation
» Pregnancy and Parental Leave in Medical Education: Where are we now?
“CRANIOFACIAL CASE-BASED LEARNING MODULES: CLEFT LIP & PALATE PILOT STUDY”
Anne V. Hing, MD, Professor, Pediatrics
- Michael Cunningham, MD, PhD; Carrie Helke, MD, MS; Kelly Evans, MD; Emily Gallagher, MD, MPH; Tara Wenger, MD, PhD; Pediatrics, University of Washington
- Yvonne Gutierrez, MD; Pediatrics, Children's Hospital of Los Angeles
- Katrina Dipple, MD, PhD; Pediatrics, UCLA
- Ophlr Klein, MD, PhD; Orofacial Sciences and Pediatrics, UCSF
- Howard Saal, MD; Pediatrics, Cincinnati Children's Hospital
Grant Amount: $4,850
Abstract: Approximately one in 400 children is born with a craniofacial anomaly. Children with craniofacial anomalies may have impairment of breathing, feeding, speech, vision or hearing, and typically undergo multiple surgeries throughout their life. Multidisciplinary team care is recommended and team pediatric care is necessary to assure that the health needs of the child with craniofacial anomalies are fully addressed at presentation and throughout childhood. Yet, many teams rely on community providers who may have limited experience in the management of children with craniofacial conditions. And, access to pediatric faculty with expertise in the care of children with craniofacial anomalies is limited. Online core curricula for medical management of craniofacial conditions is needed for learners who do not have access to expert faculty and by current faculty to improve teaching options and monitor learner update of concepts. The long-term goal of this proposal is the creation of an online series of case-based learning modules for craniofacial conditions that chronicle the longitudinal management of a child's care from infancy to adulthood and are adaptable for individual and small group learning environments. For this pilot project, we will develop content for a cleft lip/palate module, and trial the use of this learning module over a six-month period.
“ABO LEADERS: A COMMUNITY OF PRACTICE FOR TRANSFUSION MEDICINE EDUCATION”
Ryan A. Metcalf, MD; Assistant Medical Director for Transfusion Services Laboratories; Assistant Professor, Laboratory Medicine
- Monica Pagano, MD; Laboratory Medicine, University of Washington
- Jennifer Andrews, MD, MSc; Pathology and Pediatrics, Stanford University
- Sara Bakhtary, MD; Morvarid Moayeri, MD, PhD; Laboratory Medicine, UCSF
- Sarah Barnhard, MD; Pathology and Laboratory Medicine, UC-Davis
- Andrea McGonigle, MD; Pathology, UCLA
Grant Amount: $4,500
Abstract: Transfusion medicine education materials for residents are limited. The Advancing Blood KnOlwedge (ABO) Leaders project encompasses a novel approach to this problem wherein education materials are created collectively through a community of practice. As a pilot project, seven co-investigators from five west coast institutions will each have two months to create a 30-minute PowerPoint presentation, after which two other members will have two months to review and edit the presentation. Therefore, each member will create one and review two presentations (three steps total). During each step, members will also write two multiple-choice questions for those particular topics. In the end, each topic will have six questions to assess learning. At completion, seven evidence-based, peer-reviewed presentations will be available for all members to use for teaching. The presentations will also be available on our planned ABO Leaders website for all learners to access for free. We will use three methods to measure the effectiveness of these materials: 1) Post lecture quizzes using the six questions made for each topic to assess learning; 2) Administering a 20-minute validated examination at the end of each year to compare pre- and post-intervention resident competency; 3) In-service examination trends specific to transfusion medicine.
“PODCASTING PEDAGOGY: DEVELOPING THEORY TO UNDERSTAND AN EMERGENCY MEDICINE EDUCATIONAL PHENOMENON”
Jeff Riddell, MD; Senior Fellow, Emergency Medicine
- Jonathan Ilgen, MD, MCR; Alisha Brown, MD; Emergency Medicine, University of Washington
- Lynne Robins, PhD; Biomedical Informatics and Medical Education, University of Washington
- Michelle Lin, MD; Emergency Medicine, UCSF
- Jonathan Sherbino, MD, MEd; Emergency Medicine, McMaster University
Grant Amount: $2,620
Rationale: Emergency medicine (EM) educational podcasts have become increasingly popular platforms for resident learning, yet little is known about how or why residents are embracing this educational phenomenon.
Specific Aims: This qualitative study seeks to describe and understand the processes of podcast consumption among residents in ways that will inform a conceptual framework to guide future research.
Methods: We propose a grounded theory approach to understanding the value of podcasting as an educational medium based on the perceptions of the residents who consume podcasts.
Data Analysis: Grounded theory will be used to analyze the interview transcripts and develop conceptual linkages to existing theories of communication, cognition, and learning. Transcripts will be analyzed in stages. A substantive-level theory will emerge out of the stages of the coding process in ways that will ultimately culminate in a novel conceptual framework.
“TEACHING STUDENTS IN CLINIC AND THE EFFECT ON PRECEPTOR PRODUCTIVITY”
Tomoko Sairenji, MD, MS; Acting Assistant Professor, Family Medicine
- Tim Evans, MD, PhD, FACP; Internal Medicine, University of Washington
Grant Amount: $5,000
Abstract: High quality outpatient learning is indispensable for medical student education. However, recruitment and retention of clinical training sites has been increasingly difficult, as primary care providers are pressured to increase clinical revenue. Though the idea that teaching medical students decreases productivity is unproven, it is a common barrier for providers to pursue clinical teaching. We seek to conduct a pilot study to investigate whether medical student teaching affects clinical productivity with a mixed methods study. Productivity will be measured by patient volume and billing data at 10-15 Family Medicine required clerkship sites, and compared with data when students are absent. Educator perception of productivity and methods for improved teaching will be collected with telephone interviews to each of these sites. Best practices of teaching methods from successful preceptors will be compiled for dissemination. This study will allow us to further our intent to explore preceptor productivity on a larger scale of family medicine educators in different settings and institutions.
“THE LAYERED TEACHING MODEL: A NOVEL PSYCHIATRIC CURRICULUM INTEGRATING "JUST-IN-TIME" TEACHING INTO CLINICAL EXPERIENCE FROM A PRACTICAL AND ADULT LEARNING THEORETICAL FOUNDATION”
Thomas Soeprono, MD; Acting Assistant Professor, Psychiatry
Grant Amount: $4,500
Abstract: Providing consistent education on a busy clinical service is challenging due to varying provider schedules and frequent, unpredictable interruptions. Despite valiant attempts to incorporate teaching into clinical practice, education is often separated in space and time from relevant clinical cases. We would like to address these challenges in clinical education by proposing an alternate educational model for incorporating teaching into clinical practice, the Layered Teaching Model (LTM).
The LTM integrates education into clinical practice using brief video lectures, maps that demonstrate clinical thinking (connecting theory and practice), and questions to help learners assess their knowledge and to facilitate larger medical team discussions, and quizzes for self evaluation. These components are “layered” into the clinical experience in a “just-in-time” format so as to diminish
the natural barriers to education in the clinical setting and enable seamless care to our patients by well-informed
physicians and students. This model is integrated into an independent learning platform that requires no introduction or administrator. The model was designed specifically for busy clinical services with unpredictable schedules like consultation services and the emergency room.
“PREGNANCY AND PARENTAL LEAVE IN MEDICAL EDUCATION: WHERE ARE WE NOW?”
Shobha Stack, MD, PhD; Acting Instructor, Medicine
- Jennifer Best, MD; General Internal Medicine, University of Washington
- Christy McKinney, PhD, MPH; Oral Health Sciences, University of Washington
Grant Amount: $5,000
Abstract: In 1983, a national survey found that 50% of children born to women physicians were born during residency training. In the subsequent years, the issue of parental leave in medical training was frequently editorialized but rarely characterized across specialties until at 1993 survey which showed that maternity leave averaged less than eight weeks. There was no concurrent assessment of the consequences to the residency program or resident. We will conduct the first study in over 20 years on this topic by surveying University of Washington trainees and their program directors on parental leave. Through this survey, we will characterize parental leave practices across specialties and the factors that determine its length, assess the presence and content of parental leave policies across specialties and its effect on training and maternal well-being, and finally, determine how program characteristics influence trainee perceptions of the ideal time to have children. The results of this survey will enable us to identify potential solutions to the complex issues of staffing and education during parental leave, while maintaining resident wellness. Findings from this study will be shared with the Department of Graduate Medical Education to inform policy and disseminated by peer-reviewed publication.
2014-2015 CLIME Funded Proposals
» Suffering where thou art? Exploring Medical Student Perception of Medication Education Regarding Suffering
» An Interactive Learning Module to Improve Communication in Crucial Conversations
» Microsurgical Technical Skills Simulation Curriculum
» Medical Student Perceptions of Giving Feedback to Faculty During Third Year Clerkships
» Peer Observation and Feedback of Bedside Teaching
» Examining Pedagogy in a Clinical Conditions Course: Strengthening Curricular Alignment and Interprofessional Education (IPE)
» Impact of a Structured Just-in-Time Intervention on Trainee Laceration Repair Performance
“SUFFERING WHERE THOU ART? EXPLORING MEDICAL STUDENT PERCEPTION OF MEDICATION EDUCATION REGARDING SUFFERING”
Thomas R. Egnew, EdD, LICSW, Clinical Professor, Family Medicine
- William R. Phillips, MD, MPH
- Theodore J. Phillips Endowed Professor, Family Medicine
- Peter R. Lewis, MD, Professor; Kimberly Myers, Pennsylvania State UCOM
Grant Amount: $2,130
Abstract: An ancient goal of medicine is the relief of suffering, yet little is known about how medical students are prepared to accomplish this. The UWSOM is currently undergoing a curriculum renewal process which incorporates the enduring values that "patient welfare comes first" and that students are protected "from harm and negative experiences" while being provided "meaningful and positive learning experiences." Inadequate preparation to therapeutically engage suffering risks compromising patient welfare while at the same time engendering harmful and negative student experiences which mitigate meaningful and positive learning. This qualitative study involving student focus groups builds on an earlier pilot study surveying UWSOM students' perceptions of their medical education about suffering. By further exploring student perceptions of their experience of their education about suffering, we propose to gather information that supports the fulfillment of the values espoused in the UWSOM's curriculum renewal efforts.
“AN INTERACTIVE LEARNING MODULE TO IMPROVE COMMUNICATION IN CRUCIAL CONVERSATIONS”
Caroline Jeanette Hurd, MD, Clinical Assistant Professor, Department of Medicine
Anthony Back, MD, Professor, Department of Medicine
Grant Amount: $4,900
Abstract: Communication with patients and families facing serious illness is one of the most important skills physicians learn in training. Until recently, these skills were primarily taught by traditional paradigms in medical education such as lectures and observation. As our understanding improves about how learners learn best, this paradigm is evolving to incorporate more active participation and self-assessment that use innovative technology platforms. With a grant from the Cambia Health Foundation, I have salary support for two years to design and implement an innovative curriculum for crucial communications into the Internal Medicine and Pediatric residencies with a focus on delivering serious news and conducting family conferences. The curriculum will include self-directed modules, simulated patient practice sessions and multi-media just-in-time learning tools. As the Cambia grant only provides salary support, the CLIME grant would help fund the development of an interactive online module, as part of this curriculum, for emotional cue identification. This is a central skill for excellent patient-centered care and the module will provide practice for residents using a validated tool and then apply these new skills to a patient encounter and see how they impact patient-provider relationships.
“MICROSURGICAL TECHNICAL SKILLS SIMULATION CURRICULUM”
Kari Keys, MD, Assistant Professor, Plastic Surgery
Jeffrey Friedrich, Plastic Surgery
Isaac Bohannon, Assistant Professor, Otolaryngology
Jason Ko, Plastic Surgery
Grant Amount: $3,000
Abstract: Background: Microsurgical skills are currently taught largely in the arena of the operating theater. These skills are highly technical and require the acquisition of new fine motor movements and the adaptation to a two-dimensional field of view. Technical skills such as this are particularly suited for iterative learning in a lab environment rather than the intermittent and sporadic environment of the operating room.
Methods: A novel simulation curriculum will be developed and implemented for trainees who will be performing microsurgery. The curriculum will involve didactic modules, expert video, structured and graduated hands-on practice, and assessment.
Outcomes: The curriculum will be evaluated through trainee self-assessment and expert assessment using the Global Rating Scale for the discrete multistep task of microsurgical vessel anastomosis.
“MEDICAL STUDENT PERCEPTIONS OF GIVING FEEDBACK TO FACULTY DURING THIRD YEAR CLERKSHIPS.”
Amanda Kost, MD, Assistant Professor, Family Medicine
- Heidi Combs, Associate Professor, MD, Psychiatry
- Eileen Klein, MD, Professor, Pediatrics
- Lynne Robins, PhD, Professor, Medical Education
- Patricia Kritek, MD, EDM, Associate Professor, Medicine
Grant Amount: $4,000
Abstract: Although feedback from teacher to student is a critical component of medical education, very little is known about the experience of students giving feedback to teachers. Limited existing literature and UWSOM focus groups done with fourth year students suggests it is a negative experience. We seek to understand medical student perceptions of giving feedback to teachers through a qualitative analysis of structured interviews. This research is meant to be a companion study to a project previously funded by CLIME that is investigating the perceptions of third year clerkship faculty on receiving feedback from students. Results from both studies will help guide the creation of surveys to better understand the student and teacher experience of student generated feedback. Results can also suggest faculty development activities aimed at improving this experience for both students and teachers.
“PEER OBSERVATION AND FEEDBACK OF BEDSIDE TEACHING”
Somnath Mookherjee, MD, Assistant Professor, Medicine
- Daniel Cabrera, MD, MPH, Clinical Instructor, Medicine
- Christy McKinney, PhD, MPH, Clinical Assistant Professor, Medicine
Grant Amount: $4,000
Abstract: Teaching during bedside rounds is an important part of the education of students and house staff. There are many reasons to commend bedside rounding, foremost among them: patients prefer it and teachers and learners realize that it is a valuable means of learning clinical skills. However, it is challenging to teach effectively at the bedside, and there is little formal training in this skill. Our previous work has shown that peer observation and feedback of formal "conference-room” small-group teaching increases faculty confidence in several domains that are essential for optimizing teaching. In this pilot, we will evaluate a program of peer observation and feedback during bedside rounding, a setting which presents unique challenges in comparison to teaching in a structured environment away from patients. We will use a literature-based framework to train hospital medicine faculty in systematic observation and feedback of their peers' bedside teaching behaviors. We hypothesize that peer observation and feedback will increase faculty confidence in bedside teaching and increase faculty self-reported use of key bedside teaching skills. Findings from this program will be disseminated through peer-reviewed publication and workshops to faculty in other Departments who teach bedside learners.
“EXAMINING PEDAGOGY IN A CLINICAL CONDITIONS COURSE: STRENGTHENING CURRICULAR ALIGNMENT AND INTERPROFESSIONAL EDUCATION (IPE)”
Jennifer S. Pitonyak, PhD Assistant Professor, Rehabilitation Medicine
Grant Amount: $4,000
Abstract: Background: Lecture-based instruction is the primary pedagogical approach used in the interprofessional course REHAB 533: Disease and Diagnosis in Rehabilitation and student, faculty, and program feedback indicates a possible need to revise the current course methods. Course revision is strengthened when a structured process of program evaluation is used to examine how the delivered and experienced curriculum differs from the planned curriculum, and to assess course alignment with program curricular objectives.
Purpose: This project conducts a systematic evaluation of student, faculty, and program perceptions of current pedagogy used in REHAB 533, examines alignment of course content with program objectives, and identifies opportunities and innovations for IPE.
Methods: The project uses qualitative and quantitative program evaluation methods of interview, focus groups, survey, and curriculum mapping to synthesize findings. Implications: Course evaluation is necessary prior to revising instructional methods, as changes need to align with the curricula of all involved programs. This project addresses CLIME cores of instructional design, interprofessional collaboration & training, and educator development and informs innovative education research in these areas.
“IMPACT OF A STRUCTURED JUST-IN-TIME INTERVENTION ON TRAINEE LACERATION REPAIR PERFORMANCE”
Neil Uspal, MD, Assistant Professor, Department of Pediatrics
- Jennifer Reid, MD, Assistant Professor
- Anita Thomas, MD, Fellow, Department of Pediatrics
Grant Amount: $3,000
Abstract: Just-in-time (JIT) training is an educational modality in which procedural skills are taught to and reviewed with trainees immediately before the performance of a procedure. Seattle Children’s Hospital opened a new emergency department (ED) on April 23, 2013 containing a dedicated JIT training space. We plan to utilize this space to perform a research study to evaluate whether a structured, JIT intervention prior to a laceration repair procedure improves the technical performance of the procedure. In the standard teaching study phase, residents will receive usual training, ranging from no preparation to informal teaching in the JIT room, prior to a laceration repair. The supervising physician will then complete a mastery checklist after the procedure to determine how adherent the resident was to proper suturing technique. In the JIT training phase, residents rotating through the ED at this time will be provided a short, structured JIT training intervention by an ED supervising physician prior to suturing. The resident will then perform the laceration repair supervised by a second supervising physician. The supervising physician will once again complete a mastery checklist. We hypothesize that residents receiving the structured JIT intervention will be more adherent to correct suturing technique.