Performance of residents serving as clinical teachers: a student-based assessment

Near-peer teaching in simulation

BACKGROUND

Development, implementation and evaluation of a simulation curriculum is time and resource intensive. Limited faculty time and training are cited as primary barriers to adopting simulation into medical education. Near-peer teaching is a potential solution to manage the increased teaching demands that occur with simulation use.

APPROACH

In 2022, we implemented a near-peer simulation curriculum for teaching junior physical medicine and rehabilitation (PM&R) residents high-acuity low-opportunity events commonly seen on the inpatient rehabilitation unit. The curriculum was taught by senior residents to supplement faculty lectures. Senior residents completed facilitator training on simulator logistics, debriefing and formative assessment.

EVALUATION

Residents completed an end-of-course questionnaire evaluating teaching effectiveness and perceived knowledge acquisition. All items were scored on a 5-point Likert-type scale. Learners rated their near-peers as having good clinical teaching effectiveness (mean [SD], 4.66[0.38]). Senior residents (n = 6) disclosed feeling knowledgeable about the topics they instructed (baseline 3.9[3.2-4.4]; after 4.6[4.1-4.9]; p = 0.19), and junior residents (n = 6) felt they gained knowledge and improved their ability to manage patients as a result of the near-peer curriculum (baseline 2.4[2.3-2.5]; after 3.9[3.5-4.2]; p = 0.005).

IMPLICATIONS

This educational programme is an example of how near-peer teaching can be used in simulation. Our simulation curriculum taught by near-peers was valued by learners as well taught and educational. Research is needed that directly compares the effectiveness of near-pear teaching to faculty instruction. We hope that by sharing our work, educators will feel inspired to use near-peer teachers for simulation instruction when faculty availability for teaching is scarce.

A comparison of teaching opportunities for rural and urban family medicine residents

CONTEXT

Medical schools of geographically large nations have expanded into rural areas to facilitate the development of a sustainable rural pipeline of physicians. Preceptor, or clinical teacher, recruitment at these sites has been an ongoing challenge. However, residents-as-teachers (RaT) curricula have not been modified to support the development of rural teachers. This study aimed to compare teaching opportunities between rural and urban family medicine residents and to identify mechanisms underlying potential differences.

METHODS

Year-1 and Year-2 family medicine residents at seven Canadian institutions participated in a mixed-methods study utilising a quantitative survey and a qualitative interview. Rural and urban residents rated the quantity and types of teaching opportunities available during their training, from which a chi-squared analysis was completed. Volunteer respondents participated in a structured interview, from which a thematic analysis was performed.

RESULTS

Rural family medicine residents had fewer opportunities to teach compared to their urban colleagues. This discrepancy was seen across multiple domains, including informal opportunities when on family medicine rotations, χ² (4, n = 242) = 45.26, P < .000, Bonferroni's adjusted P < .000. Thematic analysis centred around determining factors influencing teaching opportunities and identified that the academic context, personal factors and programme factors were key dimensions. Within these dimensions, the number of medical students, a desire to be an educator and administrative support were cited as influences on teaching opportunities.

CONCLUSIONS

The lack of teaching opportunities for rural trainees is attributable to a combination of practical and organisational factors revealed through thematic analysis. If rural graduates are not comfortable balancing the demands of service and teaching, this could compound the already prevalent issue of rural preceptor recruitment. It is essential to develop a rural-focused RaT curriculum to close this gap and produce competent educators who are ready to inspire generations of rural physicians.

Using the Modified Delphi Method to Develop a Tool to Assess Pediatric Residents Supervising on Inpatient Rounds

BACKGROUND

Consensus about behaviors that define effective supervision by residents of more junior trainees on pediatric inpatient rounds is lacking.

OBJECTIVE

Use modified Delphi method to develop a checklist of essential supervisory behaviors pediatric residents demonstrate while leading inpatient, non-ICU, nonspecialty teaching rounds and pilot the checklist.

DESIGN/METHODS

One hundred and forty-one initial candidate behaviors were identified through literature review and narrowed by local stakeholders. Forty-one behaviors were submitted to national experts identified through purposive sampling to be refined using the modified Delphi method. Participants indicated agreement with behaviors' inclusion in the checklist and whether any were nonobservable. Measures of central tendency and dispersion were used to identify consensus with a behavior's inclusion in the next cycle. A criterion was eliminated if >25% of experts felt it was not observable. Cycles continued until consensus was reached on ≤20 behaviors. The resulting checklist was piloted at 2 hospitals.

RESULTS

After 2 modified Delphi cycles, consensus was obtained on 18 behaviors for inclusion in the final checklist. These were spread across 3 subcategories: teaching, leadership, and patient safety. In the pilot, the checklist of behaviors discriminated between residents with differing levels of competency in supervising trainees on inpatient rounds. For residents who had the checklist completed by 2 faculties, there was 75% agreement in behaviors observed.

CONCLUSION(S)

Based on literature review, local stakeholder input, and consensus of national experts through the modified Delphi method, we created and piloted a checklist of observable behaviors characteristic of effective clinical supervision by pediatric residents leading trainee teams on inpatient, non-ICU, nonspecialty rounds.

Performance of Pediatrics' residents as clinical teachers: A student-based assessment

Objective

To assess the clinical teaching skills of Pediatrics' residents as rated by final year MBBS students by using augmented Stanford Faculty Development Program questionnaire (SFDPQ) in a teaching hospital, Lahore.

Methods

This cross- sectional survey was conducted in the Department of Pediatrics, King Edward Medical University, Lahore in six months in 2016.Total of 265 students of final year MBBS, attending the teaching sessions organized by residents during their four weeks rotation in Pediatrics were included by non-probability purposive sampling. The augmented SFDPQ was emailed to the study participants after the completion of the clinical rotation, following several encounters with the resident. The data was entered in SPSS 22 for statistical analysis. Scores for each domain (learning climate, control of session, communication of goals, promoting understanding and retention, evaluation, promoting self-directed learning, teacher's knowledge and teacher's attitude) were also presented as mean and standard deviation. One-sample Kolmogorov-Smirnov test was applied to observe the normality of data. Where normality of data was observed, independent sample t-test was applied and where normality of data was not observed, Mann-Whitney U test was applied to compare the score between genders. Score of four was considered as cut off score for satisfactory results.

Results

Out of 265 students, 250 responded with response rate of 94.3%. Out of 250 medical students, 105 (42.0%) were male and 145(58.0%) were female. The internal consistency (Cronbach's alpha) of this score was excellent (0.973). The mean score for all SFDPQ domains was also sub-optimal (2.90±0.611). The mean total score was sub-optimal for learning climate (3.39±0.69), control of session (3.25±0.77), communication of goals (3.26±0.86), promoting understanding and retention (3.26±0.77), evaluation (2.25±0.67), promoting self-directed learning (3.17±0.90), teacher's knowledge (3.14±0.93) and teacher's attitude (3.31±0.89), while it was good only for feedback (4.03±0.11). The mean total score for all SFDPQ domains in males and females was 3.05±0.54 and 2.79±0.64 respectively. Although sub-optimal in both the genders, the score was significantly higher in males with p-value 0.001.

Conclusion

We found suboptimal clinical teaching skills of Pediatrics' residents as rated by final year MBBS medical students.

Postgraduate Medical Education in Sub-Saharan Africa: A Scoping Review Spanning 26 Years and Lessons Learned

BACKGROUND

Investments in training physician specialists through postgraduate medical education (PGME) are critical for Sub-Saharan Africa, given the increasing burden of non-communicable diseases.

OBJECTIVES

The objectives of this scoping review were to (1) understand the breadth of publications on PGME from Sub-Saharan Africa, and (2) conduct a thematic analysis of lessons learned by specific training programs.

METHODS

We conducted a literature search of 7 databases for PGME literature published between January 1991 and December 2016. Two reviewers independently reviewed titles and abstracts for inclusion. Full-text articles were then reviewed, and bibliometric data were extracted to create a profile of PGME-related publications. Two authors coded the manuscripts to identify articles written about specific PGME programs. These were analyzed for lessons learned.

RESULTS

We identified 813 publications that reported on postgraduate medical education in Sub-Saharan Africa. Most articles were published between 2005 and 2016. Nations leading in publication were South Africa and Nigeria, followed by Ethiopia, Uganda, Kenya, Ghana, and Malawi. The largest number of articles related to general surgery training, followed by family medicine, emergency medicine, and anesthesiology. Thematic analysis revealed advantages of training programs for health facilities, challenges related to teaching, resourcing, and standardizing of training, and lessons learned related to international partnerships, faculty engagement, and research support for trainees.

CONCLUSIONS

PGME in Sub-Saharan Africa has evolved over the past 26 years. Future growth will require strategic support to scale programs, support new specialties, trainees, and teachers, and leverage best practice models to sustain PGME programs.

Teaching skills for medical residents: are these important? A narrative review of the literature

BACKGROUND

There is extensive evidence, mainly from the United States and Canada, that points towards the need to train medical residents in teaching skills. Much of the "informal curriculum", including professional values, is taught by residents when consultants are not around. Furthermore, data from the 1960s show the importance of acquiring these skills, not only for residents but also for all doctors. -Teaching moments can be identified in simple daily situations, like discussing a clinical situation with patients and their families, planning patients' care with the healthcare team or teaching peers and medical students. The aim here was to examine the significance of resident teaching courses and estimate the effectiveness of these courses and the state of the art in Brazil.

METHODS

We conducted a review of the literature, using the MEDLINE, PubMed, SciELO and LILACS databases to extract relevant articles describing residents-as-teachers (RaT) programs and the importance of teaching skills for medical residents. This review formed part of the development of a doctoral project on medical education.

RESULTS

Original articles, reviews and systematic reviews were used to produce this paper as part of a doctoral project.

CONCLUSIONS

RaT programs are important in clinical practice and as role models for junior learners. -Moreover, these educational programs improve residents' self-assessed teaching behaviors and teaching confidence. On the other hand, RaT program curricula are limited by both the number of studies and their methodologies. In Brazil, there is no such experience, according to the data gathered here, except for one master's thesis.

What Makes a Great Resident Teacher? A Multicenter Survey of Medical Students Attending an Internal Medicine Conference

BACKGROUND

Residents have a critical role in the education of medical students and have a unique teaching relationship because of their close proximity in professional development and opportunities for direct supervision. Although there is emerging literature on ways to prepare residents to be effective teachers, there is a paucity of data on what medical students believe are the attributes of successful resident teachers.

OBJECTIVE

We sought to define the qualities and teaching techniques that learners interested in internal medicine value in resident teachers.

METHODS

We created and administered a resident-as-teacher traits survey to senior medical students from 6 medical schools attending a resident-facilitated clinical conference at McMaster University. The survey collected data on student preferences of techniques employed by resident teachers and qualities of a successful resident teacher.

RESULTS

Of 90 student participants, 80 (89%) responded. Respondents found the use of clinical examples (78%, 62 of 80) and repetition of core concepts (71%, 58 of 80) highly useful. In contrast, most respondents did not perceive giving feedback to residents, or receiving feedback from residents, was useful to their learning. With respect to resident qualities, respondents felt that a strong knowledge base (80%, 64 of 80) and tailoring teaching to the learner's level (83%, 66 of 80) was highly important. In contrast, high expectations on the part of resident supervisors were not valued.

CONCLUSIONS

This multicenter survey provides insight into the perceptions of medical students interested in internal medicine on the techniques and qualities that characterize successful resident teachers. The findings may be useful in the future development of resident-as-teacher curricula.