1. Developing a Resident Driven Teaching Elective in a Residency Program
Tanner Nissly, DO, Kristen Helvig, MD, Joseph Brocato, PhD, Shailendra Prasad, MD, MPH, Department of Family Medicine and Community Health

2. Presentation Objectives
List reasons for developing a teaching elective
State types of “resident-teacher” models
Describe development of a resident driven teaching elective
Feedback on improving this

3. Graduate Medical Education at The University of Minnesota
67 accredited & 40 non-accredited training programs
850 residents and fellows

4. 73 fulltime faculty and 994 non salaried community faculty
Department of Family Medicine & Community Health University of Minnesota
Founded in 1971
over 1,500 residency alumni
73 fulltime faculty and 994 non salaried community faculty
8 Residencies
(five TC urban & suburban sites, two rural & small town sites)
175+ Residents
2 fellowships: Sports Medicine and Palliative Care

5. Broadway (North Memorial) Family Medicine Residency Program
Urban FM residency
large uninsured/underinsured population
Unopposed program
35+ years of teaching family medicine
High-volume, high-risk maternity care

6. ACGME/AOA General Competencies
Practice Based Learning and Improvement: “Residents are expected to participate in the education of patients, families, students, residents, and other health professionals”
Interpersonal Communications: “Work effectively as a member or leader of a healthcare team or other professional group”
Professionalism: “demonstrate accountability to the patients, society, and the profession.”

7. Why are “Residents as Teachers” Important?
Enhanced personal knowledge base of clinical knowledge & skills: increase in board scores (Seely,et. al)
Better resident preparation than self-study or lecture attendance (Weiss and Needlman, 1998)
Establishing future colleague networks
Resident research opportunities
Recruitment and retention of housestaff and teaching staff
Job satisfaction increase (Morrison, 2005)

8. What we know about Residents as Teachers
Residents have access & acceptability
(Pelletier & Belliveau, 1999
Independent reading (6.10)
Tutorials (6.10).
Resident Teaching (5.74).
Seminars (5.31)
Ward/service rounds (4.98)
Operating room (4.98)
Clinics (4.48)
Rounds & Didactics (4.33)
Attendings (3.80)
Nurses (2.60)

9. What we know about Residents as Teachers ?
Residents are a “crucial link”
Residents are medical students primary teachers for clinical skills
1/3 of a medical students knowledge attributable to residents
20% of resident’s time in teaching activities
a higher percentage than that of any other teaching faculty.
55% of residencies provide some teaching instruction,
average of 11 hours/resident during residency
(Post, et. al, 2009)

10. Residents as Teachers (EBM Recommendations)
Three hour or longer intervention + periodic reinforcement
One minute preceptor model (five microskills)
Most effective/least practical: OSTE, pre-post outcome measure of teaching improvement.
Second most effective/moderately practical: videotape evaluations and shorter interventions.
(Post, et. al, 2009)

11. Residents as Teachers (EBM Recommendations)
Third most effective/highest practicality: third party evaluation (intern and medical student)
Nothing mentioned about peer resident review…
Unknowns: ideal length of program and necessary skills to become effective clinical teacher.
(Post, et. al, 2009)

12. Barriers Toward Resident Teaching
Perceived Lack of Clinical Expertise/ Residents Own Self-Learning
Deferred Responsibility
Lack of Time
Deficient Pedagogical Expertise
No Organized Curriculum
Internal & External Motivation of the Teacher
Educational Philosophies of the Teacher
Competition?!
Others??

13. The “Learning Partners” Model (adapted from Crim & Hood)
Health care’s movement to more collaborative (and less competitive) models of education, means Residents must play multiple educational roles and have skills as…
Facilitators
Preceptors
Partners
in Learning
Mentors
Learners

14. Development of a teaching elective at Broadway Family Medicine
Identify need for developing teaching skills in a residency program
Describe methods/strategies
Overview of future direction

15. Identify Need at Broadway Family Medicine:
Residents are teachers:
Of students
Of each other
Of ourselves
Future of Family Medicine:
Teachers (good and bad) influence direction of students
Perception of program by potential future residents
Direct application to patient care:
We teach patients as well as one another

16. Methods/Strategies: Who is involved?
Group of residents who:
Have interest in teaching
Have identified a need to improve skills
Super enthusiastic about doing lots of extra work!!!!!

17. Methods/Strategies: Who is not involved?
Not for everyone
…yet

18. Methods/Strategies: Evolution
Presented here as a linear process… but this is more how it went -

19. 19

20. Methods/Strategies: Step 1: Create Initial Objectives
Personal reflection on:
My own past teaching experiences
Excellent teachers
Less than excellent teachers
Discussion with faculty well versed in teaching skills
***initial objectives were quite vague***

21. Methods/Strategies: Step 1: Create Initial Objectives
Results: from 1st teaching elective week ever at BFM
Improve my own teaching skills for the coming year
Learn how to teach in different settings
Create a teaching curriculum
Prepare a lecture to share findings with other residents and faculty

22. Methods/Strategies: Step 2: Read
Lit searches
Google-ing
References recommended by faculty mentors
Join STFM

23. Methods/Strategies: Step 2: Read
Results:
Discovery of existing models
MCW
UCI
Review of available resources (evaluations, curriculum, etc)
Clinical Teaching Perception Inventory
Guide to Planning and Implementing a Program
R.E.D course at Univ of MN
AAP curriculum guide
STFM!
Evidence
Reviewed by Dr. Brocato

24. Methods/Strategies: Step 2: Read
Programs have developed curriculum, required for residents
Compare/contrast to Resident-driven creation

25. Established curriculum
Pros
organized
required
good support structure
already has specific objectives
Cons
less opportunity for creativity
tailoring to specific needs

26. Resident-created Pros Cons:
Built from ground up which gives residents more investment/ownership
More easily tailorable
Cons:
Less organization
Less structure

27. Methods/Strategies: Step 3: Identify specific areas
Compiled from reading step

28. Methods/Strategies: Step 3: Identify specific areas
Large group presentation
Small group/team/inpatient
Outpatient/clinic
Microskills
Giving feedback
Role modeling
Orienting a learner
Bedside teaching
Teaching procedural skills
Mini lecture
Teaching charting
Teaching when time is limited
etc

29. Methods/Strategies: Step 4: Refine Objectives
Identify various venues for teaching at BFM and which skill sets can enhance those experiences
With better understanding of various areas, it is easier to identify particular areas of interest
Goals for skills within context of residency vs. career goals
Different residents identified a wide variety of specific interests/needs

30. Methods/Strategies: Step 5: Apply and Practice
Request more time in clinic with medical students
Intentionally identify specific areas to focus on with each teaching encounter (clinic, hospital, OB, etc)
Do more case presentations
Video review

31. Methods/Strategies: Step 6: Evaluate
From UCI:
Clinical Teaching Self Perception Inventory
From American Academy of Pediatrics:
Self evaluation pre/post test
Student evaluation of teachers
Reflective journaling

32. Future Direction: Refining the curriculum
Add to Moodle
Create Interest group
Video review/faculty oversight
Adjusted clinic time

33. Future Direction: Sustaining interest
Create ‘menu’ of objectives from residents who have taken elective to facilitate designing future electives
Expand availability to all residents

34. Future Direction: Evaluation Tools
Further develop/utilize
OSTE?

35. Future Direction: Moving on from basics
Teaching difficult students
Dealing with language/cultural barriers
Curriculum development
Logistics for program-wide instruction
Using our new skills to evaluate/improve those who teach us

36. So…where do we meet?

40. How is it going? Successes:
Excellent potential for tailoring elective to specific needs/interests
Involvement of residents with different areas of interests makes for great collaboration
Immediate ability to apply learning:
Medical students in clinic
Chief of service OB

41. How is it going? Frustrations: Lack of time Lack of resources
Disorganization
Based largely on experience of faculty, journal articles, etc. Little evidence.
No good standardized method of evaluating experience/achievement of objectives

42. References and Resources
(BEST): Residents’ Teaching Website
Post, Robert E. et. al. (2009). Residents as Teacher Curricula: a Critical Review. Academic Medicine, 84(3),
Schwenk, T. & Whitman, N (1993). Residents as Teachers: a Guide to Educational Practice.