Teaching behaviors that define highest rated attending physicians: a study of the resident perspective

What do medical students think are characteristics of a good ultrasound tutor? A qualitative study

PURPOSE

This study was designed to elicit medical students' opinions on the characteristics of a good ultrasound tutor. The results should help educators to create an optimal teaching environment and inform tutor training.

MATERIALS AND METHODS

The qualitative study recruited 15 participants from a larger mixed-methods study of 64 medical students who underwent a basic course on abdominal ultrasound taught by faculty and near-peer tutors. During semi-structured interviews, they were asked which characteristics make a good ultrasound tutor. We used inductive thematic analysis to identify the most important categories.

RESULTS

Medical students identified teaching themes and subthemes relating to teaching skills (e.g., course structure, repetition, vocabulary, feedback, guidance of participants), tutors' attitudes (e.g., atmosphere creation, empathy) and knowledge as the crucial components of being a good ultrasound tutor.

CONCLUSIONS

While some of the themes that students identified are generic to medical education, others are specific to ultrasound teaching. Tutors can use our results to assess their own teaching. They should aim to address learning needs, optimise understanding, give adequate feedback, and create a non-threatening atmosphere with empathic interactions. Accounting for the ultrasound-specific setting they should possess the necessary knowledge, provide verbal guidance to their students, and distribute examination time wisely.

Breathing, Obstruction, Restriction, and Gas Exchange: A Pulmonary Function Testing Interpretation Framework for Novice Learners

Pulmonary function testing (PFT) is a common method of assessing patients with respiratory symptoms, yet exposure to PFT is variable throughout medical training. Therefore, incorporating a dedicated approach to teaching PFT into the formal medical education curriculum can ensure that trainees become familiar with both the relevant physiologic principles involved in interpreting PFT results and the indications for performing PFT in clinical practice. In this "How I Teach" article, we present breathing, obstruction, restriction, and gas exchange (BORG), a novel, small-group workshop designed to teach novice learners a sequential framework for PFT interpretation. The BORG workshop comprises two segments: a whiteboard minilecture that illustrates the BORG framework and a case-based worksheet whereby learners apply this approach to sets of PFTs with increasing difficulty. Our workshop is grounded in two cognitive psychology frameworks: the cognitive theory of multimedia learning and the dual-process theory. We provide three figures and four supplementary videos to illustrate our workshop's design and delivery, as well as both learner and instructor versions of our BORG worksheet. Last, we address three PFT concepts that have challenged us as instructors and provide evidence-based teaching scripts. The BORG workshop can be used by medical educators working with medical students and residents as a means of helping learners progress along the continuum from a basic understanding of spirometry to independent analysis and interpretation of PFTs to application of PFT results to medical decision making.

A Pediatric Resident Curriculum for the Use of Health Literacy Communication Tools

BACKGROUND

Despite evidence that use of evidence-based communication tools (EBCT) with a universal precautions approach improves health outcomes, medical trainees report inadequate skills training.

OBJECTIVE

We developed, implemented, and evaluated a novel, interactive curriculum featuring a 30-minute, single-session didactic with video content, facilitated case-based discussions and preceptor modeling to improve use of EBCT among pediatric residents. A direct observation (DO) skills checklist was developed for preceptors to evaluate resident use of EBCT.

METHODS

Shortly after implementation of the curriculum, residents completed a survey assessing self-reported frequency of EBCT use both pre- and post-intervention. DOs were conducted 2 to 3 weeks after the didactic was completed and scores were compared among residents who participated in the curriculum and those who did not. A longitudinal 6-month follow-up survey was also distributed to assess changes over time.

KEY RESULTS

Forty-seven of 78 (60%) of residents completed the survey and 45 of 60 (75%) of the eligible residents participated in the DO. There was significant change in self-reported use of all but one EBCT after participation in the curriculum. Residents reported sustained increased frequency of use of all communication tools except for Teach Back, Show Back, and explanation of return precautions in the 6 months following the curriculum. Notably, there was no significant difference in resident scores in the DO among residents who participated in the didactic session and those who did not.

CONCLUSIONS

This novel interactive curriculum addresses ACGME (Accreditation Council for Graduate Medical Education) core competencies and fulfills a needed gap in resident curricula for health literacy-related skills training. Findings suggest a small, positive affect on frequency of self-reported use of health literacy EBCT. However, our findings demonstrate a lack of parallel improvement in resident performance during DO. Future curricula may require certain modifications, as well as reinforcement at regular intervals. [HLRP: Health Literacy Research and Practice. 2022;6(2):e121-e127.] Plain Language Summary: Use of evidence-based communication tools, such as presenting information in small chunks and avoiding complex medical terms among pediatric trainees, is limited. This study describes a new and interactive health literacy curriculum, with emphasis on preceptor modeling and DO to improve use of evidence-based communication tools among residents. After participation in the curriculum, residents report greater use of evidence-based communication tools. However, results from DO of residents did not demonstrate similar improvements.

Impact of Bedside Rounding on Attending Teaching Evaluations

OBJECTIVE

To examine associations between bedside rounding (BSR) and other rounding strategies (ORS) with resident evaluations of teaching attendings and self-reported attending characteristics.

METHODS

Faculty from three academic medical centers who attended resident teaching services for ≥4 weeks during the 2018-2019 academic year were invited to complete a survey about personal and rounding characteristics. The survey instrument was iteratively developed to assess rounding strategy as well as factors that could affect choosing one rounding strategy over another. Survey results and teaching evaluation scores were linked, then deidentified and analyzed in aggregate. Included evaluation items assessed resident perceptions of autonomy, time management, professionalism, and teaching effectiveness, as well as a composite score (the numeric average of each attending's scores for all of the items at his or her institution). BSR was defined as spending >50% of rounding time in patients' rooms with the team. Hallway rounding and conference room rounding were combined into the ORS category and defined as >50% of rounding time in these settings. All of the scores were normalized to a 10-point scale to allow aggregation across sites.

RESULTS

A total of 105 attendings were invited to participate, and 65 (62%) completed the survey. None of the resident evaluation scores significantly differed based on rounding strategy. Composite scores were similar for BSR and ORS (difference of <0.1 on a 10-point scale). Spearman correlation coefficients identified no statistically significant correlation between rounding strategy and evaluation scores. An exploratory analysis of variance model identified no single factor that was significantly associated with composite teaching scores (P > 0.45 for all) or the domains of teaching efficacy, professionalism, or autonomy (P > 0.13 for all). Having a formal educational role was significantly associated with better evaluation scores for time management, and the number of lectures delivered per year approached statistical significance for the same domain.

CONCLUSIONS

Conducting BSR did not significantly affect resident evaluations of teaching attendings. Resident perception of teaching effectiveness based on rounding strategy should be neither a motivator nor a barrier to widespread institution of BSR.

The Nephrology Clinician Educator: Pathway and Future

In the medical profession, teaching has always been a routine expectation for practicing physicians. While this remains true today, in recent years, we have seen the emergence of a well-defined career pathway for those practicing physicians who want to focus on education: the clinician educator. This is a physician who is highly active in the practice of teaching, science of learning, service as a role model for young physicians, and leading educational programs. In nephrology, one can have a fruitful and fulfilling career as a lifelong clinician educator. As career interest in our specialty wanes, the clinician educator is the professional well suited to reverse this trend. In this article, we will further define the clinician educator and map out a pathway of skills needed to thrive in this rewarding career. We also provide recommendations to both educators and leaders to ensure the clinician educator pathway continues to grow.

Who did the case? Perceptions on resident operative participation

BACKGROUND

The ACGME case log is one of the primary metrics used to determine resident competency; it is unclear if this is an accurate reflection of the residents' role and participation.

METHODS

Residents and faculty were independently administered 16-question surveys following each case over a three-week period. The main outcome was agreement between resident and faculty on resident role and percent of the case performed by the resident.

RESULTS

Matched responses were collected for 87 cases. Agreement on percent performed occurred in 61% of cases, on role in 63%, and on both in 47%. Disagreement was more often due to resident perception they performed more of the case. Faculty with <10 years experience were more likely to have disagreement compared to faculty with ≥10 years (p = 0.009).

CONCLUSIONS

There was a high degree of disagreement between faculty and residents regarding percent of the case performed and role. Accurate understanding of participation and competency is vital for accrediting institutions and for resident self-assessment meriting further study of the causes for this disagreement to improve training and evaluation.

It depends on your perspective: Resident satisfaction with operative experience

INTRODUCTION

Resident satisfaction is a key performance metric for surgery programs; we studied factors influencing resident satisfaction in operative cases, and the concordance of faculty and resident perceptions on these factors.

METHODS

Resident and faculty were separately queried on satisfaction immediately following operative cases. Statistical significance of the associations between resident and faculty satisfaction and case-related factors were tested by Chi-square or Fisher's exact test.

RESULTS

Residents and faculty were very satisfied in 56/87 (64%) and 36/87 (41%) of cases respectively. Resident satisfaction was associated with their perceived role as surgeon (p < 0.04), performing >50% of the case (p < 0.01), autonomy (p < 0.03), and PGY year 4-5(p < 0.02). Faculty taking over the case was associated with both resident and faculty dissatisfaction. Faculty satisfaction was associated with resident preparation (p < 0.01), faculty perception of resident autonomy (p < 0.01), and faculty familiarity with resident's skills (p < 0.01).

CONCLUSIONS

Resident and faculty satisfaction are associated with the resident's competent performance of the case, suggesting interventions to optimize resident preparation for a case or faculty's ability to facilitate resident autonomy will improve satisfaction with OR experience.

Student Evaluation of Faculty Physicians: Gender Differences in Teaching Evaluations

PURPOSE

To investigate whether there is a difference in medical student teaching evaluations for male and female clinical physician faculty.

METHODS

The authors examined all teaching evaluations completed by clinical students at one North American medical school in the surgery, obstetrics and gynecology, pediatrics, and internal medicine clinical rotations from 2008 to 2012. The authors focused on how students rated physician faculty on their "overall quality of teaching" using a 5-point response scale (1 = Poor to 5 = Excellent). Linear mixed-effects models provided estimated mean differences in evaluation outcomes by faculty gender.

RESULTS

There were 14,107 teaching evaluations of 965 physician faculty. Of these evaluations, 7688 (54%) were for male physician faculty and 6419 (46%) were for female physician faculty. Female physicians received significantly lower mean evaluation scores in all four rotations. The discrepancy was largest in the surgery rotation (males = 4.23, females = 4.01, p = 0.003). Pediatrics showed the next greatest difference (males = 4.44, females = 4.29, p = 0.009), followed by obstetrics and gynecology (males = 4.38, females = 4.26, p = 0.026), and internal medicine (males = 4.35, females = 4.27, p = 0.043).

CONCLUSIONS

Female physicians received lower teaching evaluations in all four core clinical rotations. This comprehensive examination adds to the medical literature by illuminating subtle differences in evaluations based on physician gender, and provides further evidence of disparities for women in academic medicine.