Residents play key roles not only in patient care but also in teaching medical students
Two articles in a recent edition of The Journal of Graduate Medical Education focus on enhancing residents’ ability to teach. The first one, by Hill et al., entitled ‘Impact of a Resident-as-Teacher Workshop on Teaching Behavior of Interns and Learning Outcomes of Medical Students’
(J Grad Med Ed 2012; 4(1):34-41) looks at the teaching behavior and effectiveness of interns (PGY-1) in New Zealand after a training workshop.
In this study, 34 interns, with no previous teaching experience participated in a 1.5-day resident-as-teacher (RAT) training workshop which focused on general clinical teaching principles, bedside teaching, giving effective feedback, discussion leading, and lecturing. Subsequently, these interns were evaluated anonymously by fourth-year medical students using a teaching effectiveness instrument adapted from a previously validated tool. The students’ performance in the clerkship was evaluated by an OSCE. Two other hospitals with the same clerkship curriculum served as controls.
The interns who participated in the training were ranked significantly higher by medical students’ ratings of teaching behavior versus the interns at the control hospitals. No difference was seen between student surgical OSCE performance at the end of the clerkship between the hospitals.
The second study by Keller, et al., “Using a Commercially available Web-based Evaluation System to Enhance Resident’s Teaching” (J Grad Med Ed 2012; 4(1):64-67) addresses methods to reinforce and prevent the deterioration of teaching skills over time. The study relied on a Web-based system (E*Value) to help prevent degradation of teaching skills (after 6-session RAT workshop).
Ten ob-gyn residents in Washington, DC participated in a reinforcement process where they documented self-assessments after teaching sessions with students (and also received student evaluations) through their web-based evaluation system. Eight months after the RAT workshop, 9/10 residents completed an Objective Structured Teaching Examination (OSTE) centered around the skills learned in the workshop, and were compared to 13 controls who completed the exam 3 weeks after the RAT workshop. There was no statistical difference between the groups, but the, residents who underwent the reinforcement process scored significantly higher for teaching in the presence of a patient (p <009) and their overall mean for teaching was significantly higher (p= .05).
The sample size in both studies is small. In the first, the student OSCE is not a good measure of the intervention chosen and multiple confounders were not accounted for. In the second, non-historical controls would have been ideal. However, these articles highlight the known and important role of residents as teachers.
In preparing our young physicians for careers in academic medicine, do we provide them with sufficient tools to become successful medical educators? How can we do better? How can we best assess the impact of teaching education on medical student learning?
For further reading on these topics, consider:
1. Srinivasan M, Meyers FJ, Pratt DD, Collins JB, Braddock C, Skeff K, West DC, Henderson M, Hales RE, Hilty DM. "Teaching as a Competency": Competencies for Medical Educators. Acad Med. 2011;86:1211-1220. http://www.ncbi.nlm.nih.gov/pubmed/21869655
2. Post RE, Quattlebaum RG, Benich, JJ. Residents-as-Teacher Curricula: A Critical Review. Acad Med. 2009;84:374-380. http://www.ncbi.nlm.nih.gov/pubmed/19240450
3. The One Minute Preceptor: Microskills of Clinical Teaching
4. SNAPPS
Reviewed in July 2012 by:
Dora Judit Stadler, MD
Assistant Dean for Graduate Medical Education
Assistant Professor of Medicine
WCMC-Q