A program to develop residents as teachers

Child Adversity and Trauma-Informed Care Teaching Interventions: A Systematic Review

OBJECTIVES

Health professionals need training to provide trauma-informed care (TIC) for children with adverse childhood experiences (ACEs), which can affect short- and long-term health. We summarize and evaluate published curricula for health professionals on ACEs and TIC.

METHODS

We searched PubMed, Embase, Web of Science, CINAHL, Cochrane Central Register of Controlled Trials, PsychInfo, and MedEdPORTAL through January 2021. Studies meeting the following criteria were included: Described teaching interventions on ACEs, TIC, and child abuse and maltreatment; included health care providers or trainees as learners; were written in English; included an abstract; and described a curriculum and evaluation. We reviewed 2264 abstracts, abstracted data from 79 studies, and selected 51 studies for qualitative synthesis.

RESULTS

Studies focused on ACEs/TIC (27), child abuse (14), domestic/intimate partner violence (6), and child maltreatment/parental physical punishment (4). Among these 51 studies, 43 were published since 2010. Learners included a mix of health professionals (34) and students (17). Duration, content, and quality of the 51 curricula were highly variable. An analysis of 10 exemplar curricula on ACEs and/or TIC revealed high and very high quality for methods and moderate to very high quality for curriculum evaluation, suggesting that they may be good models for other educational programs. Four of the 10 exemplars used randomized controlled trials to evaluate efficacy. Studies were limited to English language and subject to publication bias.

CONCLUSIONS

ACEs and TIC are increasingly relevant to teaching health professionals, especially pediatricians, and related teaching curricula offer good examples for other programs.

The development and evaluation of "Training the trainer" curriculum for surgical residents: Feasibility study

BACKGROUND

Over the last decades, there has been greater emphasis on enhancing teaching skills and concepts of Train-The-Trainer (TTT) have been widely adopted across surgical training programs. Current TTT curricula, however, mostly address teaching generic principles without specific guidance on how to teach technical skills among residents. The aim of this proof-of-concept study was to design a bespoke TTT curriculum for surgical technical skills and evaluate its impact.

MATERIAL AND METHODS

A bespoke TTT curriculum was developed to address key teaching surgical skills including a training framework, and performance enhancing feedback. The curriculum was delivered to 41 junior surgical residents in this feasibility study and focused on promoting a training framework including three domains; "set" involving pre-operative preparation, "dialogue" referring to teaching techniques and "closure" covering structured feedback. It was evaluated using Kirkpatrick's model: (i) course feedback; (ii) training quality assessment on a suturing simulated scenario using (a) Competency Assessment Tool (CAT) and a (b) Structured Training Trainer Assessment Report (STTAR) tool; (iii-iv) follow-up survey after one year.

RESULTS

The TTT curriculum was well-perceived, with a median score of 4/5 ("agree") across all components of evaluation forms. The simulated training scenario demonstrated a significant reduction in suturing errors following delivery of training (pre-TTT [4.25; IQR:4.42]; post-TTT [2.34; IQR:2.38], p-value = 0.014). Improvement in teaching was also noted and reflected in 'Set' (pre-TTT [3.50; IQR: 3.00] and post-TTT [5.00; IQR: 0.00], p-value = 0.019) and 'Closure' (pre-TTT [4.75; IQR: 1.88] and post-TTT [5.00; IQR: 0.00], p value = 0.007). 25% of participants contributed to the long-term survey highlighting that most practiced skills within 6 months of the curriculum with positive feedback from their learners.

CONCLUSION

This proof-of-concept study confirms the feasibility and acceptability of delivering a bespoke Train-The-Trainer curriculum to surgical residents. It provides a structured training framework that can enhance teaching technical skills.

A Systematic Scoping Review on Portfolios of Medical Educators

BACKGROUND

Heralded as a teaching, assessment and reflective tool, and increasingly as a longitudinal and holistic perspective of the educator's development, medical educator's portfolios (MEP)s are increasingly employed to evaluate progress, assess for promotions and career switches, used as a reflective tool and as a means of curating educational activities. However, despite its blossoming role, there is significant dissonance in the content and structure of MEPs. As such, a systematic scoping review (SSR) is proposed to identify what is known of MEPs and its contents.

METHODS

Krishna's Systematic Evidenced Based Approach (SEBA) was adopted to structure this SSR in SEBA of MEPs. SEBA's constructivist approach and relativist lens allow data from a variety of sources to be considered to paint a holistic picture of available information on MEPs.

RESULTS

From the 12 360 abstracts reviewed, 768 full text articles were evaluated, and 79 articles were included. Concurrent thematic and content analysis revealed similar themes and categories including: (1) Definition and Functions of MEPs, (2) Implementing and Assessing MEPs, (3) Strengths and limitations of MEPs and (4) electronic MEPs.

DISCUSSION

This SSR in SEBA proffers a novel 5-staged evidence-based approach to constructing MEPs which allows for consistent application and assessment of MEPs. This 5-stage approach pivots on assessing and verifying the achievement of developmental milestones or 'micro-competencies' that facilitate micro-credentialling and effective evaluation of a medical educator's development and entrust-ability. This allows MEPs to be used as a reflective and collaborative tool and a basis for career planning.

Deliberate teaching tools for clinical teaching encounters: A critical scoping review and thematic analysis to establish definitional clarity

PURPOSE AND METHOD

We conducted a scoping review of tools designed to add structure to clinical teaching, with a thematic analysis to establish definitional clarity.

RESULTS

Six thousand and forty nine citations were screened, 434 reviewed for eligibility, and 230 identified as meeting study inclusion criteria. Eighty-nine names and 51 definitions were identified. Based on a post facto thematic analysis, we propose that these tools be named "deliberate teaching tools" (DTTs) and defined as "frameworks that enable clinicians to have a purposeful and considered approach to teaching encounters by incorporating elements identified with good teaching practice." We identified 46 DTTs in the literature, with 38 (82.6%) originally described for the medical setting. Forty justification articles consisted of 16 feedback surveys, 13 controlled trials, seven pre-post intervention studies with no control group, and four observation studies. Current evidence of efficacy is not entirely conclusive, and many studies contain methodology flaws. Forty-nine clarification articles comprised 12 systematic reviews and 37 narrative reviews. The most number of DTTs described by any review was four. A common design theme was identified in approximately three-quarters of DTTs.

CONCLUSIONS

Applicability of DTTs to specific alternate settings should be considered in context, and appropriately designed justification studies are warranted to demonstrate efficacy.

Literature review of teaching skills programs for junior medical officers

OBJECTIVE

The aim of this review was to assess the current evidence regarding the efficacy of teaching skills programs for junior medical officers. We aimed to compare and contrast these results with findings from previous literature reviews, the last of which were published in 2009.

METHODS

In order to capture studies since the last published literature reviews, five databases and grey literature were searched for publications from January 2008 to January 2015. A search for literature reviews without using the timeframe limitation was also performed.

RESULTS

The search from January 2008 to January 2015 resulted in the inclusion of 12 studies. Five systematic reviews of the topic were found which included 39 individual studies that were also analysed. Nearly all studies reported positive effects. Twenty nine studies reported change in attitudes, 28 reported modification in knowledge, 28 reported change in behaviour, 6 reported change in the organisation and two reported change in program participant's students. There were substantial threats of bias present.

CONCLUSIONS

The literature reviewed demonstrated many positive effects of teaching skills programs, which supports their utilization. However, high level outcomes need to be evaluated over longer periods of time to establish their true impact. An organisation specific approach to these programs needs to occur using sound course design principles, and they need to be reported in evaluation trials that are designed with robust methodology.

Residents-as-Teachers Publications: What Can Programs Learn From the Literature When Starting a New or Refining an Established Curriculum?

BACKGROUND

Teaching residents how to teach is a critical part of resident education because residents are often the major teachers of medical students. The importance of formal residents-as-teachers (RAT) curricula has been emphasized throughout the literature, yet not all residency programs have such a curriculum in place.

OBJECTIVE

The purpose of our study was to (1) review the medical education literature for established RAT curricula, (2) assess published curricula's reproducibility, (3) evaluate the type of outcomes achieved using the Kirkpatrick model of evaluation, and (4) identify curricula that training programs could feasibly adopt.

METHODS

We performed a literature review using PubMed, Medline, Scopus, PsycINFO, ERIC, and Embase. Key search words included residents, residents as teachers, teaching, internship and residency, and curriculum. In addition, a search of MedEdPORTAL was performed using the same key terms. Articles were evaluated based on the reproducibility of curricula and the assessment tools. Evaluation of educational outcomes was performed using the Kirkpatrick model.

RESULTS

Thirty-nine articles were deemed appropriate for review. Interventions and evaluation techniques varied greatly. Only 1 article from the literature was deemed to have both curricula and assessments that would be fully reproducible by other programs.

CONCLUSIONS

A literature review on RAT curricula found few articles that would be easily reproduced for residency programs that want to start or improve their own RAT curricula. It also demonstrated the difficulty and lack of rigorous outcome measurements for most curricula.

A novel resident-as-teacher training program to improve and evaluate obstetrics and gynecology resident teaching skills

BACKGROUND

Residents play a significant role in teaching, but formal training, feedback, and evaluation are needed.

AIMS

Our aims were to assess resident teaching skills in the resident-as-teacher program, quantify correlations of faculty evaluations with resident self-evaluations, compare resident-as-teacher evaluations with clinical evaluations, and evaluate the resident-as-teacher program.

METHOD

The resident-as-teacher training program is a simulated, videotaped teaching encounter with a trained medical student and standardized teaching evaluation tool. Evaluations from the resident-as-teacher training program were compared to evaluations of resident teaching done by faculty, residents, and medical students from the clinical setting.

RESULTS

Faculty evaluation of resident teaching skills in the resident-as-teacher program showed a mean total score of 4.5 ± 0.5 with statistically significant correlations between faculty assessment and resident self-evaluations (r = 0.47; p < 0.001). However, resident self-evaluation of teaching skill was lower than faculty evaluation (mean difference: 0.4; 95% CI 0.3-0.6). When compared to the clinical setting, resident-as-teacher evaluations were significantly correlated with faculty and resident evaluations, but not medical student evaluations. Evaluations from both the resident-as-teacher program and the clinical setting improved with duration of residency.

CONCLUSIONS

The resident-as-teacher program provides a method to train, give feedback, and evaluate resident teaching.

A Pilot Study of a "Resident Educator And Life-long Learner" Program: Using a Faculty Train-the-Trainer Program

PURPOSE

We sought to create a resident educator program using a Train-the-Trainer (TTT) approach with adaptable curricula at a large tertiary health care center with a medical school and 60 accredited residency programs.

METHODS

The Resident Educator And Life-long Learner (REALL) Program was designed as a 3-phase model. Phase 1 included centralized planning and development that led to the design of 7 teaching modules and evaluation tools for TTT and resident sessions. Phase 2 entailed the dissemination of the TTT modules (Learning Styles, Observational Skills, Giving Feedback, Communication Skills: The Angry Patient, Case-Based Teaching, Clinical Reasoning, Effective Presentations) to faculty trainers. In phase 3, specific modules were chosen and customized by the faculty trainers, and implemented for their residents. Evaluations from residents and faculty were collected throughout this process.

RESULTS

A total of 45 faculty trainers representing 27 residency programs participated in the TTT program, and 97% of trainers were confident in their ability to implement sessions for their residents. A total of 20 trainers from 11 residency programs implemented 33 modules to train 479 residents, and 97% of residents believed they would be able to apply the skills learned. Residents' comments revealed appreciation of discussion of their roles as teachers.

CONCLUSION

Use of an internal TTT program can be a strategy for dissemination of resident educator and life-long learner curricula in a large academic tertiary care center. The TTT model may be useful to other large academic centers.

Guidelines for evaluating the educational performance of medical school faculty: priming a national conversation

BACKGROUND

The academic community needs a sound framework for the promotion and advancement of educators. The Group on Educational Affairs of the Association of American Medical Colleges organized a consensus conference that affirmed the use of five domains for documenting the quantity and quality of scholarly engagement in educational activities: teaching, curriculum, advising/mentoring, educational leadership/administration, and learner assessment.

SUMMARY

In this article, we offer detailed guidelines to evaluate these five domains of educator performance and the essential elements of scholarly activity. The guidelines are adapted from our developmental educator portfolio template and educator portfolio analysis tool, previously published in MedEdPORTAL. A short tool for educator performance evaluation that summarizes items in the guidelines is proposed for discussion.

CONCLUSIONS

Our goal in this article is to itemize criteria for systematic faculty evaluation that can be applied in any institutional setting to assist promotion decision makers in their task of evaluating medical school faculty.

Rewarding the resident teacher

Residents routinely make significant contributions to the education of medical students. However, little attention has been paid to rewarding these individuals for their involvement in these academic activities. This report describes a program that rewards resident teachers with an academic appointment as a Clinical Instructor. The residents participate in the laboratory portion of the anatomy program at the Cleveland Clinic Lerner College of Medicine. They prepare weekly cadaver dissections and present these dissections to the first year medical students. Guidelines developed by the anatomy faculty and approved by the appropriate committees at both the Cleveland Clinic and Case Western Reserve University establish requirements that a resident must meet to qualify for an academic appointment. Evaluation of this program indicates that it has been very successful based on medical student feedback, resident interest in gaining teaching experience, and residency directors appreciation of the opportunity for residents to gain valuable teaching experience in an academic setting.

A systematic review of resident-as-teacher programmes

CONTEXT

Residents in all disciplines serve as clinical teachers for medical students. Since the 1970s, there has been increasing evidence to demonstrate that residents wish to teach and that they respond positively to formal teacher training. Effective resident-as-teacher (RaT) programmes have resulted in improved resident teaching skills. Current evidence, however, is not clear about the specific features of an effective RaT programme.

OBJECTIVES

This study was performed in order to investigate the effectiveness of RaT programmes on resident teaching abilities and to identify the features that ensure success. Methods of assessment used to ascertain the effectiveness of RaT programmes are also explored.

METHODS

The literature search covered the period between 1971 and 2008. Articles focusing on improving resident teaching skills were included. Each study was reviewed by two reviewers and data were collected using a standard abstraction summary sheet. Study outcomes were graded according to a modified Kirkpatrick's model of educational outcomes.

RESULTS

Twenty-nine studies met review inclusion criteria. Interventions included workshops, seminars, lectures and teaching retreats. Twenty-six studies used a pre- and post-intervention outcome comparison method. Subjective outcome measures included resident self-evaluation of teaching skills or evaluation by medical students, peers and faculty members. Objective outcome measures included written tests, evaluation of teaching performance by independent raters and utilisation of objective structured teaching examinations. One study objectively measured learning outcomes at the level of medical students, utilising the results of an objective structured clinical examination. Overall resident satisfaction with RaT programmes was high. Participants reported positive changes in attitudes towards teaching. Participant knowledge of educational principles improved. Study methodologies allowed for significant risks of bias.

CONCLUSIONS

More rigorous study designs and the use of objective outcome measures are needed to ascertain the true effectiveness of RaT programmes. Future research should focus on determining the impact of RaT programmes on learning achievement at the level of medical students.

Residents as teachers in Canadian paediatric training programs: A survey of program director and resident perspectives

BACKGROUND

The importance of the teaching role of residents in medical education is increasingly being recognized. There are little data about how this role is perceived within training programs or how residents develop their teaching skills. The aims of the present study were to explore the perspectives of Canadian paediatric program directors and residents on the teaching role of residents, to determine how teaching skills are developed within these programs, and to identify specific areas that could be targeted to improve resident teaching skills and satisfaction.

METHODS

Program directors and residents in Canadian paediatric residency programs were surveyed about the scope of teaching performed by residents, resident teaching ability and resources available for skill development.

RESULTS

Responses were received from 11 of 13 program directors contacted. Nine programs agreed to have their residents surveyed, and 41% of residents in these programs responded. Directors and residents agreed that residents taught the most on general paediatric wards, and that medical students and residents were the most frequent recipients of resident teaching. While 72% of directors reported that instruction in teaching was provided, only 35% of residents indicated that they had received such training. Directors believed that residents needed improvement in providing feedback, while residents wanted help with teaching at the bedside, during rounds and in small groups. Teaching performance was included in rotational evaluations in most programs, but residents were often uncertain of expectations and assessment methods.

CONCLUSION

There is a general consensus that residents play an important teaching role, especially on the inpatient wards. Residents' ability to fill this role could be enhanced by clearer communication of expectations, timely and constructive feedback, and targeted training activities with the opportunity to practice learned skills.

Short-term outcomes and long-term impact of a programme in medical education for medical students

OBJECTIVES

There is growing appreciation of the value of early preparation of future medical educators. Staff development programmes, conferences and workshops pertaining to the training of educators may be crucial to the pursuit of a school's larger educational mission to educate students, doctors and scholars and to provide comprehensive knowledge, research, patient care and service. This study examined the efficacy of a 1-week educational intervention aimed at preparing medical students to become effective doctor educators by building skills early in their careers. The study asked whether participation in a 5-day teacher training programme led to increased knowledge of instructional methods, more favourable attitudes towards teaching, and the integration of structured instructional design methods in a student-developed teaching project.

METHODS

A mixed methods research design was employed with quantitative data captured through pre- and post-test inventories, qualitative components captured through written comments, and a 2-year post-intervention survey. Quantitative analyses included pre-/post-intervention repeated measures with calculated effect sizes. Qualitative analysis was conducted using constant comparative methods.

RESULTS

Subjects demonstrated improved content knowledge and more positive attitudes towards motivation, teaching confidence, teacher roles, varied pedagogy, and use of assessment, instructional planning, and evaluation. Subjects were able to incorporate the programme's teaching theory and methods into their teaching projects and assessment of peers' and others' teaching in their own institutions 2 years post-training.

CONCLUSIONS

This study demonstrates that a well-designed programme for teacher preparation can be pedagogically effective for training medical students to become better educators and that this learning can be incorporated into long-term practice.

Residents-as-teachers curricula: a critical review

PURPOSE

Residents serve as medical students' primary teachers for practical clinical skills. The purpose of this study is to provide an updated systematic review of the literature on residents-as-teachers curricula to determine the most evidence-based curricula and evaluation strategy.

METHOD

In 2008, the authors performed a systematic review of the literature with PubMed using the MESH terms "internship and residency" and "teaching," as well as a key word search of the term "residents as teachers." The search was limited to publications in English from 1975 to 2008.

RESULTS

A total of 24 studies met inclusion criteria. Eleven (45.8%) were uncontrolled studies, seven (29.2%) were randomized control trials, and six (25%) were nonrandomized controlled trials. The mean sample size of all studies was 39.6. Evaluation was performed by a variety of means including objective structured teaching exams (5; 20.8%), videotape evaluations (6; 25.0%), learner evaluations (11; 45.8%), and self-questionnaires (7; 29.2%). The mean intervention length was 7.6 hours, and the most common intervention was based on the One-Minute Preceptor.

CONCLUSIONS

Research on residents-as-teachers curricula is limited by both the number of studies and their methodology. Despite this, the results demonstrated that residents-as-teachers curricula can significantly improve residents' teaching skills. In addition, the studies' methodologies have improved over time. Using these data, the authors recommend an evidence-based intervention and evaluation, which would include a three-hours-or-longer intervention (and, if possible, periodic reinforcement) based on the One-Minute Preceptor. The evaluation should be a randomized controlled trial using an objective structured teaching examination.

Improving the teaching skills of residents as tutors/facilitators and addressing the shortage of faculty facilitators for PBL modules

BACKGROUND

Residents play an important role in teaching of medical undergraduate students. Despite their importance in teaching undergraduates they are not involved in any formal training in teaching and leadership skills. We aimed to compare the teaching skills of residents with faculty in facilitating small group Problem Based Learning (PBL) sessions.

METHODS

This quasi experimental descriptive comparative research involved 5 postgraduate year 4 residents and five senior faculty members. The study was conducted with all phase III (Final year) students rotating in Gastroenterology. The residents and faculty members received brief training of one month in facilitation and core principles of adult education. Different aspects of teaching skills of residents and faculty were evaluated by students on a questionnaire (graded on Likert Scale from 1 to 10) assessing i) Knowledge Base-content Learning (KBL), ii) PBL, iii) Student Centered Learning (SCL) and iv) Group Skills (GS).

RESULTS

There were 33 PBL teaching sessions in which 120 evaluation forms were filled; out of these 53% forms were filled for residents and 47% for faculty group. The faculty showed a statistically greater rating in "KBL" (faculty 8.37 Vs resident 7.94; p-value 0.02), "GS" (faculty 8.06 vs. residents 7.68; p-value 0.04). Differences in faculty and resident scores in "the PBL" and "SCL" were not significant. The overall score of faculty facilitators, however, was statistically significant for resident facilitators. (p = .05).

CONCLUSION

1) Residents are an effective supplement to faculty members for PBL; 2) Additional facilitators for PBL sessions can be identified in an institution by involvement of residents in teacher training workshops.

A literature review of "resident-as-teacher" curricula: do teaching courses make a difference?

OBJECTIVES

To examine the evaluation methods of resident teaching courses and to estimate the effectiveness of these teaching courses.

DESIGN

We searched the literature from 1975 to May 2003 using the PubMed MESH terms internship and residency and teaching; 1,436 articles were identified and 77 contained information regarding teaching courses. Fourteen articles contained information regarding outcomes of resident teaching courses and were selected for intensive review.

MAIN RESULTS

Five uncontrolled pre-post studies used resident self-reported teaching skills/behaviors as outcome measures; all reported some improvement in self-reported skills. Three uncontrolled pre-post studies examined live or videotaped resident teaching encounters and all revealed improvement in some teaching skills. One uncontrolled trial and three nonrandomized controlled trials used learner evaluations of resident teaching behaviors as outcomes and all revealed an improvement in ratings of residents after course participation. Four randomized controlled trials of resident teaching curricula are included in this review. One study did not show any quantitative benefit of a resident teaching course on performance on an objective structured teaching evaluation. Two studies assessing resident teaching evaluations before and after course participation showed conflicting results. One study noted improvements in resident teaching skills assessed through videotape analysis.

CONCLUSIONS

Resident teaching courses improve resident self-assessed teaching behaviors and teaching confidence. Teaching courses are linked to improved student evaluations. Further studies must be completed to elucidate the best format, length, timing, and content of resident teaching courses and to determine whether they have an effect on learner performance.

Direct observation as a tool for needs assessment of resident teaching skills in the ambulatory setting

OBJECTIVE

This study was undertaken to develop and test a tool for direct observation of resident clinical teaching skills as a needs assessment before designing programs to improve teaching.

STUDY DESIGN

An 18-item checklist for a needs assessment of teaching skills was developed. Residents were observed teaching medical students while providing care in outpatient clinics. Teaching skills were documented by using the checklist, with each item assessed for performance only. Observations were compared across levels of resident education.

RESULTS

Fifty-four encounters were observed and scored. There was no difference in frequency of skill performance with advancing level of training. Items relating to orientation and feedback were observed less frequently than other skills.

CONCLUSION

The combination of the needs assessment tool and direct observations was used to evaluate teaching skill deficiencies. This study confirmed the findings of the AAMC Medical Student Graduation Questionnaire (MSGQ) of the nationwide need to improve specific resident teaching skills.

Implementation and evaluation of a training program to improve resident teaching skills

OBJECTIVE

This study was undertaken to develop, implement, and evaluate a program designed to improve residents' teaching skills.

STUDY DESIGN

A training program to improve the teaching skills of obstetrics and gynecology residents was developed and implemented. All residents completed a survey of their teaching skills, participated in the program, and then completed a follow-up survey. The surveys were compared using the Wilcoxon signed rank test. Medical students also completed surveys about participating residents' teaching skills either before or after the intervention.

RESULTS

The training program was well received by the residents. Resident self-rating scores significantly improved (P<.05) in a number of areas, such as ability to teach physical examination skills, and explaining topics in a clear and concise manner. Interestingly, student ratings of resident teaching skills did not improve.

CONCLUSION

Although the training program improved resident self-ratings of teaching skills, this was not reflected in student ratings of resident teaching skills. Possible explanations for this difference will be explored.