Designing and facilitating academic half day activity for Internal medicine residency program through applying FIRST-ADLX Framework – Dr. Alaa El-Nazzal

The academic half-day (AHD) is a weekly academic activity (4 hours) required by Saudi Commission for health specialties for any accredited post-graduate training programs provided by different consultants in the same specialty to cover important and common topics in the curriculum in lecture format.

One of the topics presented on the AHD for the internal medicine residency program at the International Medical Center, Jeddah (IMC) was about the disease of asthma.

It was designed and facilitated by applying the FIRST ADLX framework for 20 trainees (Residents).

It was about diagnosing and treating asthma by addressing the causes, triggers, classifications, and investigations, assessing its severity then managing its critical or chronic presentation according to the latest guidelines.

The learning journey was designed and facilitated to meet each trainee’s learning needs and training level, by this the (Individualization) principle was applied.

The senior learner who is at an advanced training level felt recognized and engaged by sharing his/her knowledge and skills with his/ her colleagues which reflects the principle of (Trust the learner) by giving the learner the full opportunity by design to share his/her previous expertise and build on it through interactive discussion.

This domain was applied in the design through grouping techniques based on the learners’ level in the training so the senior resident will assist the junior resident in the learning process during the activities.

The Interactive discussion between the learners about the diagnosis and next step in disease management activates the second domain which is (Interacting within positive group dynamics) by ensuring everyone’s participation in the activities and the distribution of roles in each move according to each level of training. This motivates everyone to engage and collaborate without fear of mistakes.

For example, when one of the learners takes the medical history during the role play performed by one of the senior trainees, the learners in the same group document the information gathered by applying documentation skills.

Then they share their constructive feedback with their colleague who gathered the history and each one of the group members will be gathering at one point during the day.

Among the principles that have been applied is the principle of (Probing and Assessing) in the design by including activities that asses the learning progress and this was done through solving multiple-choice questions (MCQs) related to the topic individually through an audience response system than as a group to ensure application of the concept and achieving the learning outcomes, then, through facilitation by being present with the groups during the discussions about the diagnosis and the next steps of management to ensure that the learning outcomes are achieved.

As for the domain of (Reviewing Activities within RAR Model), it was activated in each learning activity through the principle of increasing the readiness for the activity by preparing all the instructions and tools needed to facilitate the activity. This was done, for example, before starting to take the medical history by giving clear instructions and preparing the learners to take progress notes as documentation, then by facilitating the activity and moving between Its stages, and then in reviewing actively through questions that direct the learner to reach the diagnosis and think about the next steps in the management of each case, which promote clinical reasoning skills and deepening the learning to achieve desired learning outcomes.

The design and facilitation of applying the domain (Sequencing within Session Flow) through the principle of Structuring & Sequencing in designing activities according to the content logical sequence of learning and then ensuring Repetition without boredom during the learning journey, and that was by starting with experiencing the cases in the role play then discussing them, trying to reach a diagnosis to manage them properly. Then by recalling the content that was read before the trip and linking it to cases. Special activities were also designed that activate the principle of linking and summarizing, such as summarizing the content in the form of mental maps after discussing it with the group.

As for the domain of (Transforming Learning into performance), I needed the learning to be Reflected into Reality, the activities were designed according to the principles that promote the reflection on the medical practice and Practicing & eXperiencing to diagnose and manage the disease, then ensuing Continuity & Follow up through application tools in the practice. This was applied in facilitation by the emphasis on the reflection of cases in the practice and providing some tools like cards that summarize the basic classifications that make it easier for the learner to apply them in daily medical practice.

Designing and facilitating the academic day by applying FIRST-ADLX Framework has positively reflected on residents’ engagement and their desire to continue without boredom and their feedback is attached in the screenshot.

Designing and facilitating learner experience journeys in medical education can be achieved despite the great effort needed at the beginning, but it guarantees a deeper impact of learning that is reflected in reality.

FIRST-ADLX Framework provided me with everything I need to design and facilitate learning journeys in medical education that ensure learner-centricity and bridge the gap between learning and practice. It made me confident and proud to practice my role as a medical educator with a huge responsibility to educate future generations of competent physicians who heal humans holistically minds, bodies, and souls.



Dr. Alaa El Nazzal

  • Consultant Internal Medicine & Functional medicine
  • Executive Director, Learner Experience Division
  • Deputy Executive Director, Research Center
  • Director, Wellness Office
  • Program Director, Internal Medicine Residency training
  • International Medical Center, Jeddah
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