Abstract
Objective
Podcasts are increasingly utilized as educational tools within emergency medicine (EM). As EM residency programs seek to incorporate asynchronous educational material, it is important to ensure we are covering the full breadth of EM core content. This study sought to describe the distribution of EM core content among three popular EM podcasts.
Methods
We performed a retrospective study of the distribution of podcast topics among three popular EM podcasts from July 2011 to June 2021. We evaluated the podcast episode content and alignment with the EM core content, as defined by the Model of the Clinical Practice of Emergency Medicine (MCPEM) and American Board of Emergency Medicine (ABEM) examination distribution. Data are presented descriptively.
Results
We identified 2759 podcast episodes, consisting of 7413 total topics and 2498.7 hours of content. The most frequently covered topics were “signs, symptoms, and presentations” (20.1% of total hours vs. 7.9% of MCPEM and 10.0% of ABEM exam) and “procedures and skills integral to the practice of emergency medicine” (14.8% of total hours vs. 8.1% of MCPEM and 8.0% of ABEM exam). The least frequently covered topics was were “immune system disorders”(0.5% of total hours vs. 2.0% of MCPEM and 2.0% of ABEM exam),“environmental disorders”(0.8% of total hours vs. 2.4% of MCPEM and 2.0% of ABEM exam), “obstetrics and gynecology” (1.0% of total hours vs. 5.4% of MCPEM and 3.0% of ABEM exam), and “cutaneous disorders” (0.9% of total hours vs. 4.3% of MCPEM and 3.0% of ABEM exam).
Conclusions
Our findings suggest an imbalance of MCPEM core content in three popular EM podcasts.
Keywords: emergency medicine, FOAM, medical education, podcast
INTRODUCTION
The use of podcasts as an educational tool has increased significantly over the past two decades, with emergency medicine (EM) on the forefront. 1 , 2 Podcasts are used as an educational tool by a range of learners, including medical students, residents, fellows, advanced practice practitioners, and attending physicians. 3 They are a popular form of asynchronous education used by EM residents, with the majority of EM residents listening to podcasts at least once a month and nearly 50% listening once per week. 4 Residents find podcasts to be accessible and engaging; they believe that podcasts offer them broad exposure to EM core content and personalized learning. 5 Podcasts have been shown to be an effective educational tool for learners, with data demonstrating that participants using podcasts perform similar on knowledge assessment compared to participants using other modalities. 1 Informed by the theoretical concept of constructivism, podcasts may function to scaffold knowledge through an asynchronous pathway that can then be supplemented and applied in conference or at the bedside. 6 , 7 With increased podcast utilization, learners may not be considering the breadth of EM core content when selecting podcast topics, possibly leading to an imbalance of educational focus.
In 2008, the Council of Residency Directors in Emergency Medicine (CORD) Academic Assembly Conference Alternatives Workgroup formally recommended the use of asynchronous material, including podcasts, as part of EM residency curricula. 8 As learners and EM residency programs continue to incorporate podcasts as educational material into their training, it is important that educators critically review podcast content utilized to ensure balanced curricular coverage of the full breadth of EM core content.
Prior research has demonstrated an imbalance in blog content when compared to Model of the Clinical Practice of Emergency Medicine (MCPEM) and American Board of Emergency Medicine (ABEM) exam, but to our knowledge to date, no studies have evaluated podcasts. 9 , 10 , 11 Given the expanding use of online resources and podcasts in particular, it is important to determine the extent to which content builders are covering the breadth of EM topics and assess these trends over time.
The primary objective of this study was to describe the distribution of podcast content among three popular and commonly used EM podcasts. As secondary objectives, we sought to compare these with the MCPEM and ABEM examination distribution as well as to describe the distribution of podcast topics over time. Given the impact of COVID‐19, we also planned an a priori subgroup analysis of the distribution of content devoted to COVID‐19.
METHODS
Study design
We performed a retrospective study of the distribution of podcast topics over a 10‐year period. We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE; www.strobe‐statement.org) guidelines. This study was granted an exemption by the institutional review board at the University of Florida College of Medicine‐Jacksonville.
Sampling and population
We compiled a list of podcasts released by Emergency Medicine Reviews and Perspectives (EMRAP), EMCrit, and Emergency Medicine Cases from July 2011 to June 2021. We are not aware of any clearly established podcast rankings in EM; therefore, we selected these three podcasts by group consensus due to their similar focus, large audience (EM:RAP 20,000 subscribers per month, EMCases 15 million downloads since 2010), extensive track record (>10 years), and use of rotating monthly topics.
Study protocol
We developed a data extraction tool to identify and categorize the podcast episodes (Appendix 1). All investigators were trained on the use of the data extraction tool. The investigators piloted the tool with a random sample of 10% of the podcasts and modified it in accordance with the data from the pilot. Five investigators obtained the following data using publicly accessible information: month and year of podcast, segment title, and segment duration (in seconds). Then, two investigators each evaluated all of the podcast episode content and alignment with the EM core content based on podcast title and show notes, as defined by the ABEM exam (https://www.abem.org/public/become‐certified/qualifying‐exam/exam‐content) and MCPEM. 9 All reviewers were familiarized with the EM core content and study protocol before collecting data. In keeping with prior literature, each podcast episode could cover more than one topic (e.g., both “signs and symptoms” and “cardiovascular”) with the total time being allocated to both topics. 10 Any discrepancies with regard to podcast episode topics were decided by consensus between the two topic reviewers and the two lead authors.
Data analysis
The analyses were descriptive in nature, conducted in Microsoft Excel 365. We calculated the total count and total duration (in seconds) of episodes for each EM core content topic. Data were presented in a summative manner as well as by specific podcast and by academic year. To establish inter‐rater reliability, we calculated a 10‐year kappa score. The distribution of content related to COVID‐19 was restricted to the time period from December 2019 through June 2021.
RESULTS
A total of 2760 podcasts episodes were identified from July 2011 to June 2021. One podcast episode was being excluded due to no longer being available. The 2759 podcast episodes consisted of 7413 total topics and 2498.7 hours of content. The kappa for topic identification was excellent at 0.852. Table 1 provides a summary of episode topic distribution by episode count and duration, in comparison to MCPEM and ABEM exam percentage for each EM core content topic, with a threshold of 5% difference. Table S1 provides a summary of the distribution of topics across the three individual podcasts. Table S2 provides a summary of the distribution of EM core content topics per academic year from 2011 to 2021.
TABLE 1.
Distribution of podcast episodes covering EM core content by count and duration, in comparison to MCPEM and the ABEM board examination
| Total count (n = 7413) | Total hours (n = 2498.7) | Percent of MCPEM | Percent of ABEM exam | Difference in total hours and MCPEM | Difference in total hours and ABEM | |
|---|---|---|---|---|---|---|
| Signs, symptoms, and presentations | 1516 (20.5%) | 502.0 (20.1%) | 7.9% | 10.0% | 12.2%* | 10.1%* |
| Abdominal and gastrointestinal disorders | 130 (1.8%) | 49.2 (2.0%) | 8.0% | 7.0% | −6.0%* | −5.0%* |
| Cardiovascular disorders | 536 (7.2%) | 181.6 (7.3%) | 3.3% | 10.0% | 4.0% | −2.7% |
| Cutaneous disorders | 78 (1.1%) | 23.6 (0.9%) | 4.3% | 3.0% | −3.4% | −2.1% |
| Endocrine, metabolic, and nutritional disorders | 100 (1.4%) | 31.9 (1.3%) | 3.3% | 5.0% | −2.0% | −3.7% |
| Environmental disorders | 52 (0.7%) | 20.9 (0.8%) | 2.4% | 2.0% | −1.6% | −1.2% |
| Head, ear, eye, nose, throat disorders | 91 (1.2%) | 35.1 (1.4%) | 6.2% | 4.0% | −4.8% | −2.6% |
| Hematologic and oncologic disorders | 186 (2.5%) | 68.9 (2.8%) | 2.3% | 3.0% | 0.5% | −0.2% |
| Immune system disorders | 41 (0.6%) | 12.1 (0.5%) | 2.0% | 2.0% | −1.5% | −1.5% |
| Systemic infectious disorders | 212 (2.9%) | 74.3 (3.0%) | 3.6% | 7.0% | −0.6% | −4.0% |
| Musculoskeletal disorders | 107 (1.4%) | 44.0 (1.8%) | 3.0% | 3.0% | −1.2% | −1.2% |
| Nervous system disorders | 248 (3.4%) | 79.1 (3.2%) | 4.4% | 6.0% | −1.2% | −2.8% |
| Obstetrics and gynecology | 72 (1.0%) | 24.8 (1.0%) | 5.4% | 3.0% | −4.4% | −2.0% |
| Psychobehavioral disorders | 178 (2.4%) | 51.7 (2.1%) | 3.8% | 2.0% | −1.7% | 0.1% |
| Renal and urogenital disorders | 122 (1.7%) | 39.6 (1.6%) | 2.8% | 3.0% | −1.2% | −1.4% |
| Thoracic‐respiratory disorders | 399 (5.4%) | 144.7 (5.8%) | 4.0% | 7.0% | 1.8% | −1.2% |
| Toxicologic disorders | 571 (7.7%) | 170.2 (6.8%) | 5.8% | 4.0% | 1.0% | 2.8% |
| Traumatic disorders | 376 (5.1%) | 141.2 (5.7%) | 10.3% | 9.0% | −4.6% | −3.3% |
| Procedures and skills integral to the practice of EM | 1184 (16.0%) | 370.7 (14.8%) | 8.1% | 8.0% | 6.7%* | 6.8%* |
| Other core competencies of the practice of EM | 561 (7.6%) | 153.1 (6.1%) | 8.3% | 2.0% | −2.2% | 4.1% |
| Other (not in MCPEM) | 653 (8.8%) | 252.5 (10.1%) | 0.0% | 0.0% | 10.1%* | 10.1%* |
Note: Podcast episodes could qualify for more than one category.
Abbreviations: ABEM, American Board of Emergency Medicine; MCPEM, Model of Clinical Practice in Emergency Medicine.
Items with ≥5% difference between total hours and MCPEM or ABEM.
The most frequently covered EM core content podcast topics were “signs, symptoms, and presentations” (20.5% total podcasts and 20.1% total hours vs. 7.9% of MCPEM and 10.0% of ABEM exam) and “procedures and skills integral to the practice of emergency medicine” (16.0% total podcasts and14.8% total hours vs. 8.1% of MCPEM and 8.0% of ABEM exam). The least frequently covered EM core content podcast topics were “immune system disorders” (0.6% total podcasts and 0.5% total hours vs. 2.0% of MCPEM and 2.0% of ABEM exam),“environmental disorders” (0.70% total podcasts and 0.83% total hours vs. 2.4% of MCPEM and 2.0% of ABEM exam), “obstetrics and gynecology”(OB/GYN) (0.97% total podcasts and 24.76 total hours vs. 5.4% of MCPEM and 3.0% of ABEM exam), and “cutaneous disorders” (1.05% total podcasts and 0.94% total hours vs. 4.3% of MCPEM and 3.0% of ABEM exam). When restricting the content to December 2019 through July 2021, COVID‐19 content represented 5.3% of episodes (67/1324) and 5.4% of total hours (27.5/504.3).
DISCUSSION
To our knowledge, this is the first study to assess the topic distribution of podcast episodes among three highly used podcast series in EM. We found that there was a mismatch in this distribution when compared to topic breakdown in MCPEM and the ABEM exam. Understanding these discrepancies is critical to ensuring appropriate utilization of these resources within medical education and can inform both learners and faculty alike when discussing approaches to asynchronous education.
Similar to prior studies on FOAM, there were several topics that had a substantial discordance between the MCPEM and ABEM examinations. In previous studies on FOAM, topics identified as poorly covered have included “psychobehavioral,” “OB/GYN,” “head, ear, eye, nose, throat disorders,” “cutaneous disorders,” “hematologic disorders” and “musculoskeletal disorders.” 10 , 11 Our data are consistent with these trends. We also found that among podcasts, “abdominal and gastrointestinal disorders” was significantly underrepresented. Topics previously identified as overrepresented in FOAM studies included cardiology, neurology, airway techniques, resuscitation, and ultrasonography. 10 , 11 Our study is consistent with these and found the greatest degree of overrepresentation in “signs, symptoms, and presentations” and “cardiovascular disorders.” These findings are important because individual podcasts may not cover the entirety of EM; therefore, educators and learners need to be aware of their limitations. Learning solely from podcasts may result in inadequate preparation for in‐training exams, board exams, and clinical practice for both trainees and attending physicians. Podcast content creators and learners alike should be aware of this limitation and may reconsider their topics of choice for thorough educational content.
Additionally, we found that COVID‐19 represented over 5% of all podcast time from December 2019 to June 2021. COVID‐19 is a topic that has become extremely relevant to our clinical practice and was rapidly integrated into the podcasts despite not being part of the MCPEM or ABEM board examination coverage. While this demonstrates a potential benefit for access to time‐sensitive and rapidly changing information, research has shown that this may be disproportionately covered in resident education. 12 While it remains unclear what would be disproportionate coverage in podcasts, future research should compare this with the MPCEM and ABEM examination as well as to evaluate the impact of this on coverage of other topics.
Future research should also assess how residency programs and individual learners incorporate podcast listening into their training and if the discordance in coverage impacts knowledge acquisition and translation. Additional research could assess the impact of podcast usage among practicing physicians and the potential impact on continued medical education and patient care. Finally, it would be valuable to determine how combinations of learning resources could be combined to balance coverage of topics.
LIMITATIONS
This study has several limitations. First, we evaluated only three podcasts in EM, including one pay‐for‐access podcast. It is unknown whether the findings reflect other podcasts in EM or in other fields. Our study also only evaluated English‐language podcasts, limiting our evaluation of non–English‐language podcasts. Additionally, we calculated podcast duration as the entire episode for each topic identified; however, it is possible that the total time devoted to each topic may not reflect the total episode run time. While we used MCPEM and the ABEM board examination as comparators, these may not fully represent the educational needs of all EM practitioners—particularly those outside of training. Finally, the majority of the podcast episodes reviewed came from a single podcast. While disproportionate, Table S1 demonstrates a similar proportion of topics were covered across the three podcasts.
CONCLUSIONS
Our findings suggest an imbalance of Model of the Clinical Practice of Emergency Medicine and American Board of Emergency Medicine examination emergency medicine core content in three popular emergency medicine podcasts. As podcasts become more integrated into resident education, it is important to understand these discordant distributions and build curriculum accordingly.
AUTHOR CONTRIBUTIONS
Alexandra Mannix and Michael Gottlieb conceived the study, designed the study, and supervised the data collection. Alexandra Mannix, Michael Gottlieb, Katarzyna Gore, Melissa Parsons, Maham Rehman, and Julia Saak undertook the acquisition of the data. Alexandra Mannix and Michael Gottlieb provided statistical advice on study design and analyzed the data. Alexandra Mannix, Melissa Parsons, Katarzyna Gore, and Michael Gottlieb drafted the manuscript, and all authors contributed substantially to its revision. Alexandra Mannix takes responsibility for the paper as a whole.
CONFLICT OF INTEREST
The authors declare no potential conflict of interest.
Supporting information
Data S1
Table S1
Table S2
ACKNOWLEDGMENTS
The authors thank the Diversity Inclusion Research and Education Collaboration Team (DIRECT).
Mannix A, Rehman M, Saak J, Gore K, Parsons M, Gottlieb M. Distribution of core content coverage among three popular emergency medicine podcasts: A 10‐year analysis. AEM Educ Train. 2022;6:e10798. doi: 10.1002/aet2.10798
Supervising Editor: Dr. Sally Santen
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data S1
Table S1
Table S2