I NTRODUCTION Residents as Teachers Module 1

O BJECTIVES 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

R ESIDENT AS T EACHER How much of your time is spent teaching? -almost none - <10% % - ~25% - >25%

R ESIDENT AS T EACHER How much of your time is spent teaching? -almost none - <10% % - ~25% - >25% Residents spend up to 25% of their time doing some form of teaching (Sheets et al, 1991)

R ESIDENT A S T EACHER Residents are critical to learning of others: Resident colleagues Medical students Staff Patients and families

R ESIDENT A S T EACHER 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)

R ESIDENT A S T EACHER 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

R ESIDENT AS T EACHER 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

R ESIDENT AS T EACHER 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!

R ESIDENT A S T EACHER Yet residents have Limited instruction on how to teach!! Limited time to learn how to teach!!

W HAT MAKES A G OOD T EACHER 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

W HAT 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)

W HAT 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?

T HE C LEVELAND C LINIC ’ S T EACHING E FFECTIVENESS I NSTRUMENT 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 r esearch data and practice guidelines into teaching Teaches diagnostic skills Teaches effective communication skills Teaches principles of cost- appropriate care (Modified from Copeland, 2000)

R ESIDENTS AS T EACHERS C URRICULUM Do you feel that your ability to teach has improved or declined throughout your training thus far?

R ESIDENTS A S T EACHERS C URRICULUM 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)

R ESIDENTS A S T EACHERS C URRICULUM While residents are expected to participate in teaching and evaluation they lack formal training

R ESIDENTS AS T EACHERS C URRICULUM 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)

R ESIDENTS AS T EACHERS C URRICULUM 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

R ESIDENTS AS T EACHERS C URRICULUM We should all strive to improve our teaching skills: How to do it? When to fit it in?

R ESIDENTS A S T EACHERS C URRICULUM 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

R ESIDENTS A S T EACHERS C URRICULUM Our plan: Supplementation with academic half day sessions Opportunity for further curriculum development as needs are identified

R ESOURCES 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: Bing-You RG, Sproul MS. Medical students’ perceptions of themselves and residents as teachers. Medical Teacher. 1992;14: 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: 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): Edwards JC, Kissling GE, Brannan JR, Plauche WC, Marier RL. Study of teaching residents how to teach. Journal of Medical Education. 1988; 63: 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:

R ESOURCES Lawson BK, Harville LM. The Evaluation of a training program for improving residents teaching skills. J Med Ed. 1980;55: Litzelman DK, Stratos Ga, Goldberg RM. The effect of a clinical teaching retreat on residents’ teaching skills. Academic Medicine. 1994;69: 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: Spickard A, Corbett EC, Schorling JB. Improving residents’ teaching skills and attitudes towards teaching. Journal of General Internal Medicine. 1996;11: Walsh, A. Anatomy of a Great Teacher Presentation. Teaching Residents to Teach Workshop 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: 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: