Teaching psychiatric residents to teach

Psychiatry Residents as Medical Student Educators: a Review of the Literature

OBJECTIVE

Professional organizations and medical schools need trainees as medical student educators. There are limited data describing the training of residents and fellows as educators. There are also limited data describing the impact of trainee educators on medical student performance and clerkship experience.

METHODS

A narrative literature search was done in PubMed, Embase, and PsychINFO from inception to January 1, 2021, to explore the approaches, methods, and outcomes (e.g., potential benefits) of psychiatric trainees as medical student educators. A total of 630 papers were screened using title and abstract, of which 20 met inclusion criteria. Studies were categorized into four quality tiers based on methodology.

RESULTS

Studies described how training programs utilized trainees as student educators, and various methods of teaching instruction. Residents and fellows valued being educators and reported these experiences increased teaching abilities. Medical students rated trainee educators well. Resident-led teaching initiatives were associated with increased exam scores in one study. Data were limited by low survey response rates, qualitative (i.e., subjective) inquiry, and heterogeneity in teaching and training modalities.

CONCLUSIONS

Due to a lack of high-quality studies, definitive conclusions cannot be drawn about the effectiveness of psychiatry trainees as medical educators nor about how to best train them as educators. Nevertheless, literature suggests that incorporating trainees as educators both augments resident and fellow training and enhances medical student experience and performance. Future research should assess needs and standardize methods, curricula, and outcome measures more systematically.

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 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.

Characteristics of medical students and residents who select psychiatry : implications for recruitment

Effective recruitment of psychiatric residents begins with understanding medical students' motivations for entering psychiatry. The author reviews the recent literature on the personalities of medical students interested in psychiatry compared with those interested in other specialties, the positive and negative factors that medical students cite when deciding whether to enter psychiatry, and the variables that are important to medical students and residents when selecting psychiatry residency programs. The implications of these studies for enhancing recruitment into psychiatry are discussed.

Teaching and learning psychiatry

This article reviews the teaching-learning process in psychiatry. It describes eight attributes of a successful teacher, suggests ways that psychiatrists may improve their teaching skills, and delineates four stages (exposure, incorporation, integration, and mastery) of the learning process that have implications for how and what we teach. Methods to evaluate teaching rigorously so that it can be academically rewarded are described. At a time when the place of the psychiatric teacher in the academic medical center is precarious and often discouraging, the author discusses sources of support from students, fellow faculty, and national colleagues that can help sustain teaching in, and teachers of, psychiatry.