INTRODUCTIONResidents as Teachers Module 1

OBJECTIVES

Review role of residents as teachers Discuss and define characteristics and

behaviours of good teachers Introduction of Residents as Teachers

Curriculum Review why it is important Review evidence to support implementation

RESIDENT AS TEACHER

How much of your time is spent teaching?-almost none- <10%- 10-25%- ~25%- >25%

RESIDENT AS TEACHER

How much of your time is spent teaching?-almost none- <10%- 10-25%- ~25%- >25%

Residents spend up to 25% of their time doing some form of teaching (Sheets et al, 1991)

RESIDENT AS TEACHER

Residents are critical to learning of others:

Resident colleagues

Medical students

Staff

Patients and families

RESIDENT AS TEACHER

Junior learners often find the teaching provided by their resident colleagues is some of the most valuable Medical students have reported that up to one

third of their clinical learning comes from residents (Bing-you et al, 1992)

Residents have the greatest effect on student cognitive growth during clerkship (Roop, 2001)

Role models influence learners professionalization, and career paths (Wright, 1997)

RESIDENT AS TEACHER

Teaching is a key element of the CanMEDS Scholar role

Scholar Role Residents are expected to “facilitate the learning

of patients, families, students, residents, other health professionals, the public and others, as appropriate”

Importance of role is highlighted by including it in evaluation of residents during each rotation and for accreditation

RESIDENT AS TEACHER

Other benefits beyond fulfilling residency requirements Teaching identifies

gaps in knowledge Provides

opportunities for organizing and synthesizing knowledge

If we teach and do at the same time we maximize learning

RESIDENT AS TEACHER

Other benefits beyond fulfilling residency requirements Improve professional

growth and development

Enhanced teaching skills for the future ….this won’t end

when/if you leave an academic centre!

RESIDENT AS TEACHER

Yet residents haveLimited instruction on how to

teach!!Limited time to learn how to

teach!!

WHAT MAKES A GOOD TEACHER

What do we know from the research? There are

characteristics associated with clinical teaching excellence (Irby, 1978, 1981, 1991)

Good teachers make a positive difference to student learning (Griffith,1998; Stern, 2008)

*With thanks to Allyn Walsh

WHAT MAKES A GOOD TEACHER

In medicine the following have been identified as characteristics which make an excellent teacher:

Knowledge Analytic ability Organization Clarity of presentation Group interaction skills Enthusiasm and stimulation of interest Clinical supervision skills Clinical competence Professionalism

(Irby , 1978)

WHAT MAKES A GOOD TEACHER The Cleveland Clinic’s Teaching

Effectiveness Instrument

Another tool to evaluate teaching effectiveness

Outlines 15 characteristics which are highly valued

As you read them consider: Which ones you do well?

Which ones you could improve?

THE CLEVELAND CLINIC’S TEACHING EFFECTIVENESS INSTRUMENT

Establishes a good learning environment

Stimulates me to learn independently

Allows me autonomy appropriate to my level

Organizes time to allow for both teaching and care giving

Offers regular feedback

Clearly specifies what I am expected to know and do

Adjusts teaching to my needs

Asks questions that promote learning

Gives clear explanations Adjusts teaching to diverse

settings Coaches me on my

clinical/technical skills Incorporates research data and

practice guidelines into teaching

Teaches diagnostic skills Teaches effective

communication skills Teaches principles of cost-

appropriate care

(Modified from Copeland, 2000)

RESIDENTS AS TEACHERS CURRICULUM

Do you feel that your ability to teach has improved or declined throughout your training thus far?

RESIDENTS AS TEACHERS CURRICULUM

We know from the literature that:

Residents without formal training have not been shown to improve

Teaching skills decline over time without specific reinforcement

(Edwards et al, 1998)

RESIDENTS AS TEACHERS CURRICULUM

While residents are expected to participate in teaching and evaluation they lack formal training

RESIDENTS AS TEACHERS CURRICULUM

Residents: Often feel unprepared for their role as teachers

Express conflict balancing their clinical and educational duties

Most residents would like to receive training to develop and improve their teaching skills

(Yedidia et al, 1995; Moon, 1992)

RESIDENTS AS TEACHERS CURRICULUM

What does the evidence say? Is a teaching curriculum helpful?

Multiple studies have been conducted to evaluate courses designed to teach residents across all areas of clinical practice

In general formal instruction in how to teach improved residents teaching skill and confidence in their role as educators

RESIDENTS AS TEACHERS CURRICULUM

We should all strive to improve our teaching skills:

How to do it?

When to fit it in?

RESIDENTS AS TEACHERS CURRICULUM

Our plan: Online curriculum

E-learning has been shown to be at least as effective as more traditional teaching methods (Cook et al, 2008)

May help overcome some of the logistical constraints

Can be done on your own schedule and easily be referred to when teaching issues arise

RESIDENTS AS TEACHERS CURRICULUM

Our plan:Supplementation with academic half day

sessionsOpportunity for further curriculum

development as needs are identified

RESOURCES

Barth RJ, Rowland-Morin PA, Mott LA, Burchard KW. Communication effectiveness training improves surgical resident teaching ability. Journal of American College of Surgeons. 1997;74:938-942.

Bing-You RG, Sproul MS. Medical students’ perceptions of themselves and residents as teachers. Medical Teacher. 1992;14:133-138.

Busari JO, Scherpbier JA, Van Der Vleuten CPM, Essed GGM. A two-day teacher-training programme for medical residents: investigating the impact on teaching ability. Advances in Health Sciences Education. 2006;11:133-144. 

Copeland HL, Hewson MG. Developing and testing an instrument to measure the effectiveness of clinical teaching in an academic medical center. Acad Med. 2000; 75(2):161-166

Edwards JC, Kissling GE, Brannan JR, Plauche WC, Marier RL. Study of teaching residents how to teach. Journal of Medical Education. 1988; 63:603-610.

Gaba ND, Blatt B, Macri Cj, Greenberg, L. Improving teaching skills in obstetrics and gynecology residents: evaluation of a residents-as-teachers program. American Journal of Obstetrics and Gynecology. 2007;196:87.e1-87.e7.

Hammoud MM, Haefner HK, Schigelone, Gruppen, L. Teaching residents how to teach improves quality of clerkship. American Journal of Obstetrics and Gynecology. 2004;191:1741-1745.

RESOURCES Lawson BK, Harville LM. The Evaluation of a training program for improving

residents teaching skills. J Med Ed. 1980;55:1000-1005. Litzelman DK, Stratos Ga, Goldberg RM. The effect of a clinical teaching retreat

on residents’ teaching skills. Academic Medicine. 1994;69:361-366. Mitchell S, Cook J, Densen P. A teaching rotation of residents. Academic

Medicine. 1994; 69:434. Morrison EH, Lewis EM, Gabbert CC, Boker JR, Kumar B, Harthill, M. Evaluating a

“service elective” in clinical teaching for medical students. Medical Teacher. 2003;25:662-663.

Spickard A, Corbett EC, Schorling JB. Improving residents’ teaching skills and attitudes towards teaching. Journal of General Internal Medicine. 1996;11:475-480.

Walsh, A. Anatomy of a Great Teacher Presentation. Teaching Residents to Teach Workshop. 2009. Hamilton, ON

White CB, Bassali RW, Heery LB. Teaching residents to teach: an instructional program for training pediatric residents to precept third-year medical students in the ambulatory clinic. Archive of Pediatrics and Adolescent Medicine. 1997;151:730-735.

Wipf JE, Orlander JD, Anderson JJ. The effect of a teaching skills course on interns’ and students’ evaluations of their resident-teachers. Academic Medicine. 1999;74:938-942.