Introduction

Educational conferences have long served as a foundation for conveying didactic content in medical education, and significant energy is dedicated to organizing and preparing conferences for groups of learners. Conferences at the graduate medical education level often involve a variety of learning styles and employ previous experience as a teaching tool. Despite this, attendance at conferences in graduate training can vary greatly due to the multitude of demands on trainees' time and clinical responsibilities. The literature shows poor attendance at regularly scheduled conferences, with studies reporting average attendance rates ranging from 30% to 50%.^1–4

Previous research has attempted to determine factors associated with attendance at weekly conferences. These studies demonstrate that trainee attendance at conferences is affected by the date within the academic year, the year of training, and performance on United States Medical Licensing Examinations.² The presence of food at conferences has also been shown to improve resident and fellow attendance.^2,5 Regarding faculty attendance, the presence of food does not seem to have the same effect, although continuing medical education credit may improve overall attendance.^6,7

Sending reminder text pages to trainees prior to the start of conferences is a method that may be employed to enhance conference attendance. The goal of our study was to determine if routine text paging before regularly scheduled conferences improved attendance among fellows in 3 internal medicine fellowship programs. We hypothesized that reminder pages would improve conference attendance for all fellows.

Methods

We performed a prospective, randomized crossover study that included 3 fellowship programs at our institution: pulmonary and critical care, cardiovascular disease, and hematology-oncology. Each fellowship is 3 years in duration, with the majority of clinical rotations occurring during the first year of training. The study was performed between October 2014 and March 2015. Conference selection included the regularly scheduled key educational conferences, at which attendance is expected within each fellowship. The conferences included for all fellowships were chosen by the investigators based on educational emphasis, previously identified poor attendance, and location and time of each conference. Target conferences included 3 pulmonary, 4 cardiology, and 2 hematology conferences. All active fellows in each program, except study investigators, were included in the study. None of the fellowship programs studied have a mandatory conference attendance requirement for graduation, but conference attendance is tracked in all 3 programs. Deficiencies in attendance are noted in midyear trainee reviews and within the “professionalism” core competency performance for trainees.

Intervention and Control

Paging reminders, which included conference title, location, and time, were sent 30 minutes before every conference for those in the intervention arm. Those in the control arm did not receive these pages but received the usual weekly reminder e-mails regarding conferences for the following week. They also had access to their respective fellowship's conference calendar.

View Figure

• Download as Powerpoint
• Download Figure

Results

A total of 156 conferences were included for analysis: 75 during the first 3 months and 81 during the second 3 months. There were 84 cardiology conferences, 43 pulmonary conferences, and 29 hematology-oncology conferences. A total of 46 fellows were included in the study: 16 pulmonary, 16 cardiology, and 14 hematology-oncology (table 1). All fellows in each fellowship program (100%) participated in the study. Average attendance for all participants at the selected conferences during the study period was 45%. There were no differences in overall attendance between groups 1 and 2 during either block or the entire study period (table 2).

table 1 Demographics

View Fullscreen

table 2 Comparison of Mean Attendance Between Paging Groups

View Fullscreen

We found no differences when looking at the effect of paging reminders on overall individual attendance (43.7% versus 45.6%; P = .50; figure 2). On subgroup analysis, we found no difference of paging reminders for individuals based on year of training or fellowship (figures 2 and 3). No significant differences were identified between each fellowship or between the years of training in block 1 or block 2.

At the completion of the study, a survey was provided to all study participants with an overall response rate of 59% (27 of 46 fellows). The majority of fellows found paging reminders to be helpful prior to the conference (70%, 19 of 27; data provided as online supplement material), although almost 60% (16 of 27) of the participants felt that paging had no effect on their overall attendance, and 41% (11 of 27) reported being annoyed by reminder pages. The most common reason for absence from a conference was clinical responsibilities, followed by conference time and location.

View Figure

• Download as Powerpoint
• Download Figure

Discussion

In this randomized crossover study, we found that for 3 fellowship programs at our institution, paging reminders before a regularly scheduled conference had no effect on overall attendance. To our knowledge, this is the first study to determine the effect of routine paging reminders on conference attendance. The Accreditation Council for Graduate Medical Education previously recommended that residents in internal medicine programs attend an average of 60% of educational teaching conferences,² and published reports show average attendance rates ranging from 30% to 50%.^1–4 Prior studies have attempted to determine if conference attendance is predictive of performance on training examinations, with mixed results.^1–3

Reminders are popular tools utilized for adult learners. Previous studies have shown reminders to be beneficial for physicians with the implementation of clinical guidelines in preventative care.^9,10 Reminders in electronic health record systems have also been shown to be an effective tool, prompting internal medicine residents to perform routine screening in primary care clinics.¹¹ We extrapolated these data in formulating our hypothesis that similar reminders would have a beneficial effect on conference attendance. Our study, however, found no such benefit.

View Figure

• Download as Powerpoint
• Download Figure

A possible explanation for our findings is the burnout effect of receiving multiple pages, as 41% of our fellows reported being annoyed by routine paging reminders. Interestingly, 70% of fellows believed the paging reminders were helpful, but almost 60% believed pages did not improve their conference attendance. The most common reason given for conference absence was clinical responsibilities. It is possible that fellows recognized that attendance was expected but believed clinical responsibilities superseded that expectation. Within the pulmonary division, there was disagreement as to whether paging reminders would affect attendance, and some felt fellow-level learners should not be notified with a page before a conference to mimic “real world” obligations and responsibilities.

There are limitations to this study. It was conducted within a single specialty and a limited set of subspecialties at a single institution, which may limit the ability to generalize from the findings. Our sample included only current fellows and not residency-level trainees. Fellowship trainees at our institution have more protected research time compared with internal medicine residents. We attempted to address the potential bias of trainees attending a conference when their colleague received a reminder page, but only 19% (5 of 27) of survey responders reported this occurring.

While paging reminders had no effect on conference attendance, alternative measures should be investigated to improve attendance. Such alternative measures could include implementing teleconference technology, determining the most appropriate time and location for conferences, and providing appropriate support for adult learners with conflicting clinical responsibilities.

Conclusion

This study of internal medicine fellows found that paging reminders seem to have no effect on attendance, and alternative measures may need to be undertaken to improve overall attendance. The majority of fellows reported that clinical responsibilities were a major driver of poor attendance.