Residents as Teachers: Strategies for Improving Peer Based Education in a Community Based Residency Program Bernard Birnbaum, MD Kim Marvel, PhD Kristen Bene, MS Fort Collins Family Medicine Residency Program Fort Collins, CO STFM Annual Meeting 2008

Seminar Goals and Objective –Identify the limited research on peer based education in medicine –Describe strategies used to improve resident peer teaching –List challenges inherent in peer based education and curricular ways of addressing these challenges

Seminar Structure Introductions Rationale Brief review of the literature on peer based education Brief summary of the FCFMRP Curriculum Small Group role play and discussion Large Group discussion about peer based education Summary

Introductions Bernard Birnbaum Kim Marvel Kristen Bene And YOU???

Why are we doing this seminar? A large percentage of resident learning is peer based and nearly 50% of family medicine programs have curricula Most literature on residents as teachers is based in university programs or IM/Peds settings – how are community programs different? We developed a residents as teachers curriculum and noted a lack of research addressing the challenges of peer-peer education or near-peer education

Literature Review What research has been done? Pearls from the literature Near-peer teaching

Literature Review Cate and Durning (2007) review of 2006 articles and conference abstracts on peer teaching. Found 7 articles and 21 conference abstracts. Talked about but not published. Most comes out of IM, Surgery, Peds. Little in FM literature. International authors

Literature Review: Pearls Rationale for doing peer teaching (Cate and Durning, 2007) –Alleviate faculty pressures –Offer educational at own cognitive level –Social role modeling –Alternative to studying –Increased intrinsic motivation –Prepare for role as educator Is it successful? –2004 literature review found insufficient evidence to support increased clinical competence from peer teaching, but most studies indicated perception of competence increased. (Busari and Sherpbeir, 2004)

Literature Review: Pearls Psychology of peer teaching –Cognitive Congruence –Social role Congruence (near-peers) (Cate and Durning, 2007) Medical resident Physician Teacher Learner Medical resident Physician Teacher Learner Medical resident Physician TeacherLearner Physician Teacher Medical resident Physician Medical resident Learner Physician Medical resident TeacherLearner Physician Medical resident

Overview of our curriculum Three part curriculum Yearly seminar for upper level residents Yearly discussion session with departing residents and upcoming second year residents Individual meeting with medicine service upper level resident

Yearly Seminar: Logistics 3-hour session Late in academic year (May or June) R-1 and R-2 classes Faculty facilitators available for small- group activities

Yearly Seminar: Overview of Content Review adult learning theory Observational learning/Social learning theory Learner assessment Feedback vs evaluation Features of effective clinical teaching Teaching styles Clinical teaching in 5 steps Teaching on our inpatient services Practice and roll play the skills

Yearly Seminar: Overview of Content (cont.) Review teaching opportunities Define resident role as teacher and peer educator Specific role of leader/manager of the inpatient service

Yearly Seminar: Specific Topics Review the four roles of a clinical teacher –Physician, supervisor, teacher, person Review adult learning theory –Focus on self-directed learning and adult learner needs –learner assessment Discuss setting expectations Review the difference between feedback and evaluation Give strategies for providing effective feedback

Yearly Seminar: Specific Topics Teaching Strategies: Four steps of clinical teaching –Needs assessment –Teaching to the learner –Feedback –Reinforcement Four Teaching Styles –Assertive –Suggestive –Collaborative –Facilitative

Yearly Seminar: Specific Topics Strategies for Successful Teaching: Clinical Teaching in 5 steps model Mini-lectures Mindful Modeling Ongoing feedback Patient education = student/resident education

Yearly Seminar: Specific Topics Role Plays: Seminar includes one role play on feedback in the middle Ends with three scenarios in which groups of three role play learners, preceptors, and observers Ends with group discussion on the challenges that came up in the role plays –Facilitator reinforces points that were covered in the seminar

Yearly Discussion Session One-hour session All three years attend (especially helpful to include departing residents and upcoming second year residents) Held late in academic year (June) Ideas about effective teaching solicited from residents Summary of ideas are distributed to all residents and faculty

Individual Meetings with Upper- Level Residents minute meeting between faculty physician and upper-level resident The goal of this meeting is to check in with the upper-level on medicine and see how things are going. The objective is to provide the upper-level the opportunity to: –Identify personal strengths and weaknesses related to teaching on service –Improve their use of the 5-minute preceptor model –Review strategies for giving feedback

One-on-One Meeting Evaluation 7 of 11 upper-levels rated the session on residents as teachers. 5 point scale 1 = Strongly Disagree to 5 = Strongly Agree Average ratings –Satisfied with content = 4.0 –Improved my teaching skills = 3.85 –Used information as upper-level in hospital = 4.33 –Mtgs have improved peer teaching at program = 4.0

Seminar Evaluation 4 of 11 upper-levels rated the session on residents as teachers. 5 point scale 1 = Strongly Disagree to 5 = Strongly Agree Average ratings –Satisfied with content = 4.0 –Useful role plays = 3.75 –Improved my teaching skills = 3.75 –Used information as upper-level in hospital = 3.75

Review of the one minute preceptor model Get a commitment Probe for supporting evidence Encourage discussion Reinforce what was right Correct mistakes and agree on a learning plan

Role Plays and Discussion 3 groups Do role play Discuss issues generated by the role play Return to large group and present discussion points