The Effect of a 13-Hour Curriculum To Improve Residents' Teaching Skills

A Randomized Trial

17 August 2004 | Volume 141 Issue 4 | Pages 257-263

Background: Although resident physicians often teach, few trials have tested interventions to improve residents' teaching skills. A pilot trial in 2001–2002 found that 13 trained resident teachers taught better than did untrained control residents.

Objective: To determine whether a longitudinal residents-as-teachers curriculum improves residents' teaching skills.

Design: Randomized, controlled trial from May 2001 to February 2002 (lot trial) and March 2002 to April 2003.

Setting: 4 generalist residencies affiliated with an urban academic medical center.

Participants: 62 second-year residents: 23 in the 2001–2002 pilot trial and 39 more in 2002–2003; 27 of the 39 participants were medicine residents required to learn teaching skills.

Intervention: A 13-hour curriculum in which residents practiced teaching and received feedback during 1-hour small-group sessions taught twice monthly for 6 months.

Measurements: A 3.5-hour, 8-station, objective structured teaching examination that was enacted and rated by 50 medical students before and after the intervention. Two trained, blinded raters independently assessed each station (inter-rater reliability, 0.75).

Results: In the combined results for 2001–2003, the intervention group (n = 33) and control group (n = 29) were similar in sex, specialty, and academic performance. On a 1 to 5 Likert scale, intervention residents outscored controls on overall improvement score (post-test–pretest difference, 0.74 vs. 0.07; difference between intervention and control groups, 0.68 [95% CI, 0.55 to 0.81]; P < 0.001) by a magnitude of 2.8 standard deviations and on all 8 individual stations. The intervention residents improved 28.5% overall, whereas the scores of control residents did not increase significantly (2.7%). In 2002–2003, 19 intervention residents similarly outscored 19 controls (post-test–pretest difference, 0.83 vs. 0.14; difference between intervention and control groups, 0.69 [CI, 0.53 to 0.84]; P < 0.001). Twenty-seven medicine residents required to learn teaching skills achieved scores similar to those of volunteers.

Limitations: The study was conducted at a single institution. No "real life" assessment with which to compare the results of the objective structured teaching examination was available.

Conclusions: Generalist residents randomly assigned to receive a 13-hour longitudinal residents-as-teachers curriculum consistently showed improved teaching skills, as judged by medical student raters. Residents required to participate improved as much as volunteers did.

Editors' Notes Context Although resident physicians often have responsibility for teaching other residents and medical students, few formal evaluations of curricula to improve their teaching skills exist. Contribution This randomized, controlled trial, which included 62 second-year residents, showed that those assigned to complete a 13-hour teaching skills curriculum received higher ratings from medical students than did those who did not complete the curriculum. Implications Formal curricula can improve residents' performance as teachers. –The Editors

 

Author and Article Information

From University of California, Irvine, Irvine, California, and University of Southern California, Los Angeles, California.

Acknowledgments: The authors thank Carole J. Bland, PhD (University of Minnesota, Minneapolis), for academic contributions; Dolores Medina-Sasina for data management; and all of the BEST students, residents, staff, and faculty.

Grant Support: By the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program, the Health Resources and Services Administration (Residency Training in Primary Care grant no. 22 HP00006-01), and The Tamkin Foundation.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Elizabeth H. Morrison, MD, MSEd, Department of Family Medicine, University of California, Irvine, College of Medicine, 101 City Drive South, Building 200, Suite 512, Route 81, Orange, CA 92868-3298; e-mail, ehmorris{at}uci.edu.

Current Author Addresses: Drs. Morrison and Prislin: Department of Family Medicine, University of California, Irvine, 101 City Drive South, Building 200, Suite 512, Route 81, Orange, CA 92868-3298.

Drs. Rucker and Hubbell: Department of Internal Medicine, University of California, Irvine, 101 City Drive South, Building 200, Suite 720, Route 81, Orange, CA 92868-3298.

Dr. Boker: Office of Educational Affairs, University of California, Irvine, College of Medicine, Medical Education Building 802, Irvine, CA 92697-4089.

Mr. Gabbert: 4 Gooseberry Court, Coto de Caza, CA 92679.

Dr. Hitchcock: Division of Medical Education, University of Southern California, Keck School of Medicine, 1975 Zonal Avenue, Keith Administration and Medical Forum Building 211, Los Angeles, CA 90089-9024.

Author Contributions: Conception and design: E.H. Morrison, L. Rucker, J.R. Boker, F.A. Hubbell, M.A. Hitchcock, M.D. Prislin.

Analysis and interpretation of the data: E.H. Morrison, L. Rucker, J.R. Boker, C.C. Gabbert, M.A. Hitchcock, M.D. Prislin.

Drafting of the article: E.H. Morrison, L. Rucker, J.R. Boker.

Critical revision of the article for important intellectual content: E.H. Morrison, L. Rucker, J.R. Boker, C.C. Gabbert, F.A. Hubbell, M.A. Hitchcock, M.D. Prislin.

Final approval of the article: E.H. Morrison, L. Rucker, J.R. Boker, C.C. Gabbert, F.A. Hubbell, M.A. Hitchcock, M.D. Prislin.

Provision of study materials or patients: L. Rucker.

Statistical expertise: J.R. Boker, C.C. Gabbert.

Obtaining of funding: E.H. Morrison.

Administrative, technical, or logistic support: E.H. Morrison, C.C. Gabbert.

Collection and assembly of data: E.H. Morrison, C.C. Gabbert.