Teacher-training for hospital residents improves medical students' education, UCI study shows

08/17/04

Irvine, Calif., Aug. 17, 2003 - Resident physicians make better instructors for medical students and interns when they receive formal teaching training, a UCI College of Medicine study has found.

The study is among the first to quantify how specialized training for resident physicians improves their teaching and mentoring skills. Traditionally, medical students and interns at a hospital receive significant mentoring and supervision from resident physicians, who are themselves still undergoing medical training. Study results appear in the Aug. 17 issue of Annals of Internal Medicine.

"This study objectively evaluated the impact of teaching instruction on improving residents' performance as mentors and instructors," said Dr. Elizabeth H. Morrison, associate professor and director of predoctoral education in UCI's Department of Family Medicine. "Improving the teaching skills of residents is critical. Residents teach their trainees how to diagnose and treat patients. They model communication skills and many other professional attributes, so they have a huge impact on America's future doctors."

For the study, the researchers recruited 62 second-year residents from UCI Medical Center. Of these residents, 33 were randomly assigned to complete a "residents-as-teachers" program. Over six months, these residents completed 13 hours of special practice and training designed to improve their teaching and communication skills with students.

Before and after the training, all of the residents were given a teaching examination to evaluate their performance. When rated on teaching effectiveness, residents who received the training scored 28.5 percent higher than residents who did not receive the training, a statistically significant difference.

The twice-monthly, small-group sessions were designed to incorporate the best published evidence on teaching skills development for faculty and residents. The sessions stressed "hands-on" practice, with individualized, structured feedback by peers and faculty. After a brief didactic presentation, residents took turns teaching their peers using a structured teaching case designed for each specific module such as giving feedback, lecturing, leading discussions, bedside teaching, inpatient teaching, instruction in medical charting, and teaching a clinical procedure.

Other medical schools offer teaching aid for residents, but Morrison's study is distinctive for describing detailed instructional methods that other medical schools can easily adopt, and for measuring improvement in teaching skills with a validated and reliable examination. A national survey in 2000 by Morrison and colleagues showed that approximately 50 percent of residency programs offered some type of formal teaching skills training to residents; however, one-time lecture and workshop formats predominated, and less than 5 percent used objective methods like Morrison's to measure efficacy of the training interventions with residents.

"Residencies as we know them now are constantly evolving, with the current major trend mandating the setting of clearer learning expectations for resident competency and providing objective evidence of their accomplishment," said Dr. John R. Boker, director of research in medical education in the UCI College of Medicine and study co-author. "Teaching ability is one such competency that is attaining more prominence as a requirement for residency program accreditation, and Dr. Morrison's intervention provides a model for addressing this requirement."

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