Thomas Frank, MD
OB/GYN, MHMC
email Dr. Frank
phone: 778-7856

ABSTRACT

As outlined in the mission statement for the Scholars Collaboration in Teaching and Learning, medical school faculty "are finding it increasingly difficult to dedicate time, effort, and creativity to medical education". Residents, who already provide the majority of student education in some clinical settings, will likely play an increasingly important role as teachers in the face of such faculty pressures. The level of instruction given to residents in the development of teaching skills is disproportionately low compared to the importance of this role within the medical school. A cohort of dedicated medical educators, in collaboration with medical students as invested ÒconsumersÓ, provides the ideal group to direct the development and evaluation of a teaching skills development program for residents.

DEFINITION OF NEED
For some time, residents have played a critical role in the education of medical students. A 1993 survey of residency program directors estimated that over 60% of medical student teaching in clinical rotations was done by housestaff [ Bing-You RG. Med Educ 1993; 27:259-265]. This teaching includes formal instruction of clinical skills as well as the "informal curriculum" of professional values [Stern DT. Acad Med 1998; 73(suppl) s28-s30]. As faculty cope with the pressures of increasing clinical burdens and scarcity of funding, the importance, as well as the proportion, of teaching by residents will likely increase. Some of the increased clinical demands have been met by the use of "physician extenders": medical personnel who, under the guidance and supervision of experienced clinicians, may be trained to provide effective and efficient patient care. One of the stated purposes of the Scholars Collaboration in Teaching and Learning is the identification and development of a cohort of dedicated and talented educators. Once developed, the impact of this group's efforts may be magnified by training residents, already established in their position as teachers, as "teaching scholar extenders".

PROJECT OUTLINE
A group which promotes collaboration between students and faculty dedicated to medical education would seem ideally suited to direct the design and implementation of a teaching skills development program for residents. Such a project would include:

NEEDS ASSESSMENT: may include focus on specific topics (e.g. professionalism, training in procedural skills) and/or teaching skills (e.g. bedside teaching, giving feedback). Such needs assessment might be derived from a combination of review of the current CWRU School of Medicine curriculum, exit interviews with graduating CWRU medical students, and review of AAMC competencies for medical students.

TEACHING INTERVENTION: the intervention might take place in the form of a teaching workshop(s), dedicated blocks of time as teaching electives, or targeted training within specific clinical contexts (e.g. bedside teaching on the inpatient wards, the "one-minute preceptor" in the ambulatory setting). The literature on adult education in general and faculty development in particular will supplement the experience of faculty members in guiding these interventions.

EVALUATION: Evidence exists to support that teacher training for residents improves resident teaching skills. Replicating such results would certainly be a primary outcome goal. Less is known, however, about the impact of resident teacher training on student clinical performance; documentation of such an effect would be an important contribution to the literature on medical education.

PROPOSED BENEFIT
Though thoughtful evaluation of outcomes will be an important part of this project, several positive influences may be hypothesized:

Improved clinical performance by students as a direct result of improved instruction

Heightened standards for teaching - Several residency programs with teacher training for their residents report anecdotally that their residents become more demanding "consumers" and pressure their faculty to meet heightened standards for teaching excellence

Facilitate faculty development - The same programs which are developed for training residents as teachers may be easily adapted for faculty development. Furthermore, evidence exists to support the notion that teachers often learn as much or more than their students. To the extent that faculty outside of the Scholars Collaboration are involved in the implementation of resident training, some degree of faculty development is necessarily incorporated into this project.

"Create a supportive environment for teachers of medicine" - In several studies, residents have identified teaching as an important responsibility. Many of the same studies, however, report a sense of underappreciation amongst residents for their role as teachers and the sense that this responsibility is in conflict with the successful completion of other resident responsibilities. Residents represent the teachers with whom students have the most sustained direct contact. To recognize teaching efforts and promote enthusiasm within this group is critical to developing a positive learning environment in the clinical arena.

Development of future medical education scholars - Unlike the "physician extenders" in the patient care setting, the residents as "teaching extenders" are the teachers of tomorrow. As they become tomorrow's faculty members, we may be hopeful that we have increased the skill and dedication that they bring to the education of their students.