Introduction

1. Introduction Residents as Teachers Module 1

2. 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

3. Resident as Teacher • How much of your time is spent teaching? -almost none - <10% - 10-25% - ~25% - >25%

4. 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)

5. Resident As Teacher • Residents are critical to learning of others: • Resident colleagues • Medical students • Staff • Patients and families

6. 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)

7. 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

8. 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

9. 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!

10. Resident As Teacher • Yet residents have • Limited instruction on how to teach!! • Limited time to learn how to teach!!

11. 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

12. 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)

13. 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?

14. The Cleveland Clinic’s Teaching Effectiveness Instrument • Establishes a good learning environment • Stimulatesme 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)

15. Residents as Teachers Curriculum • Do you feel that your ability to teach has improved or declined throughout your training thus far?

16. 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)

17. Residents As Teachers Curriculum • While residents are expected to participate in teaching and evaluation they lack formal training

18. 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)

19. 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

20. Residents as Teachers Curriculum • We should all strive to improve our teaching skills: • How to do it? • When to fit it in?

21. 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

22. Residents As Teachers Curriculum • Our plan: • Supplementation with academic half day sessions • Opportunity for further curriculum development as needs are identified

23. 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. • BusariJO, 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, MacriCj, 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.

24. Resources • Lawson BK, Harville LM. The Evaluation of a training program for improving residents teaching skills. J Med Ed. 1980;55:1000-1005. • LitzelmanDK, 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. • SpickardA, 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.