Medical Students' Professional Development as Educators Revealed Through Reflections on Their Teaching Following a Students-as-Teachers Course.

Phenomenon: Teaching is an important part of the tri-partite mission of every medical center. Although teaching often is given lower priority and recognition as opposed to patient care and/or research, this activity for many physicians in academic medicine ranks second to their patient care responsibilities. Medical teacher training has traditionally been aimed at faculty and residents through faculty development initiatives, continuing education for physicians at professional conferences, formalized degree or certificate programs in education, and residents as teachers programs. More recently medical schools have developed medical-students-as-teachers programs, often offered as 4th-year electives, to introduce learners to the theory of teaching and learning with appropriate application in the clinical setting. Data on learner outcomes and students' perceptions and experiences in these programs consist mostly of their satisfaction after completing such a program. In this article we explore 4th-year medical student trainees' experiences and emerging self-concepts as educators during a teaching elective. APPROACH: The purpose of this project was to explore students' reflections on their experiences in a 4th-year medical students-as-teachers course in their own words through their written self-assessment narratives. We used qualitative content analysis to examine 96 trainees' self-reported, written reflective narratives of how they translated their students-as-teachers course experience into application by applying newly learned educational theories, instructional strategies, and feedback skills while teaching novice peers physical diagnosis skills. FINDINGS: Narratives revealed candid self-assessments and detailed descriptions of their experiences and what they valued most from the course. Content analysis revealed nine key themes: using teaching strategies for adult learning, preparing for class, modeling professionalism, incorporating clinical correlations, exceeding course requirements, giving and receiving feedback, providing mentoring, creating a positive learning climate, and growing as educators. Insights: This study's results reveal how learners perceive and translate their experiences in a teaching course, in terms of incorporating particular knowledge or skills, valuing or displaying certain professional behaviors, and gaining self-awareness and satisfaction from teaching experiences. The findings of this study, specifically major themes from self-assessment narratives, provide us with a better understanding of medical students' developing identities and emerging professional self-concept as educators, specifically as experienced through a combination of formal teaching, and applying education theories and strategies. Findings may be informative from a program evaluation lens but also for faculty development initiatives related to training medical teachers and the larger landscape of the emerging field of Health Professions Education.

A "Resident-as-Teacher" Curriculum Using a Flipped Classroom Approach: Can a Model Designed for Efficiency Also Be Effective?

PROBLEM: The Accreditation Council for Graduate Medical Education requires training that enhances resident teaching skills. Despite this requirement, many residency training programs struggle to implement effective resident-as-teacher (RAT) curricula, particularly within the context of the 80-hour resident workweek. APPROACH: In 2013, the authors developed and evaluated an intensive one-day RAT curriculum using a flipped classroom approach. Twenty-nine second-year residents participated in daylong RAT sessions. The curriculum included four 1-hour workshops focusing on adult learning principles, giving feedback, teaching a skill, and orienting a learner. Each workshop, preceded by independent reading, featured peer co-teaching, application, and feedback. The authors evaluated the curriculum using pre- and postworkshop objective structured teaching examinations (OSTEs) and attitudinal and self-efficacy teaching questionnaires. OUTCOMES: Residents demonstrated statistically significant improvements in performance between pre- and postworkshop OSTEs on each of three core skills: giving feedback (P = .005), orienting a learner (P < .001), and teaching a skill (P < .001). Residents expressed positive attitudes surrounding teaching on the retrospective pre-post attitudinal instrument (P < .001) and rated themselves as more effective teachers (P < .001) after the training. NEXT STEPS: The authors have demonstrated that the flipped classroom approach is an efficient and effective method for training residents to improve teaching skills, especially in an era of work hour restrictions. They have committed to the continuation of this curriculum and are planning to include assessment of its long-term effects on resident behavior change and educational outcomes.

A learner-centered diabetes management curriculum: reducing resident errors on an inpatient diabetes pathway.

OBJECTIVE: Diabetes errors, particularly insulin administration errors, can lead to complications and death in the pediatric inpatient setting. Despite a lecture-format curriculum on diabetes management at our children's hospital, resident diabetes-related errors persisted. We hypothesized that a multifaceted, learner-centered diabetes curriculum would help reduce pathway errors. RESEARCH DESIGN AND METHODS: The 8-week curricular intervention consisted of 1) an online tutorial addressing residents' baseline diabetes management knowledge, 2) an interactive diabetes pathway discussion, 3) a learner-initiated diabetes question and answer session, and 4) a case presentation featuring embedded pathway errors for residents to recognize, resolve, and prevent. Errors in the 9 months before the intervention, as identified through an incident reporting system, were compared with those in the 10 months afterward, with errors classified as relating to insulin, communication, intravenous fluids, nutrition, and discharge delay. RESULTS: Before the curricular intervention, resident errors occurred in 28 patients (19.4% of 144 diabetes admissions) over 9 months. After the intervention, resident errors occurred in 11 patients (6.6% of 166 diabetes admissions) over 10 months, representing a statistically significant (P = 0.0007) decrease in patients with errors from before intervention to after intervention. Throughout the study, the errors were distributed into the categories as follows: insulin, 43.8%; communication, 39.6%; intravenous fluids, 14.6%; nutrition, 0%; and discharge delay, 2.1%. CONCLUSIONS: An interactive learner-centered diabetes curriculum for pediatric residents can be effective in reducing inpatient diabetes errors in a tertiary children's hospital. This educational model promoting proactive learning has implications for decreasing errors across other medical disciplines.

New educational modules offer tough case studies around humanistic issues.

A new set of teaching modules taken from the Emmy Award-winning documentary about children with cancer, A LION IN THE HOUSE, raises tough questions around humanistic aspects of medical education and seeks to improve the quality of teaching and learning to enhance patient care.

Student perceptions of effectiveness of the eight step preceptor (ESP) model in the ambulatory setting.

BACKGROUND: Balancing consistently effective clinical teaching with quality patient care is a crucial challenge for ambulatory preceptors. Educators have developed frameworks of specific teaching behaviors to facilitate consistent, efficient precepting, but few have evaluated their effectiveness. We modified an existing precepting model by incorporating additional adult learning principles to create the Eight Step Preceptor (ESP) model. We then determined if students perceived faculty to be more effective teachers when they incorporated more ESP components into their precepting sessions. PURPOSES: The objective was to describe the association between faculty using the ESP behaviors during their precepting and medical students' satisfaction with their learning. METHODS: A trained observer timed the duration of precepting sessions in a children's hospital ambulatory clinic between August and November 2001. Students rated faculty "teaching effectiveness," and both students and observer rated whether faculty effectively incorporated ESP behaviors during each session. RESULTS: Sessions lasted on average 26 +/- 14 min. Faculty gave a teaching point and feedback in over 50% of the precepting sessions but did not consistently incorporate the other ESP behaviors. Faculty use of more ESP behaviors correlated significantly with greater teaching effectiveness (r = .62, p < .003) but not significantly with duration of precepting sessions. CONCLUSIONS: Students perceived faculty as more effective teachers when they incorporated more ESP behaviors while precepting. The ESP model was associated with more effective ambulatory precepting in our study.

A review of medical school programs that train medical students as teachers (MED-SATS).

BACKGROUND: Medical students represent medicine's future teachers. The objective of this literature review was to identify programs teaching medical students how to teach (MED-SATS). SUMMARY: Electronic searches were conducted and identified 39 programs (1966-2005). Students have assumed varied teaching roles: group facilitator, standardized patient, tutor, teaching assistant, standardized learner, course director, and peer teacher. Most participants were 4th-year students. The teaching techniques varied: group sessions, lectures, and individual teaching. To evaluate student teaching, programs used checklists, videotape review, group discussion, observation, examination scores, course grades, self-assessment exercises, and follow-up with residency training programs. CONCLUSIONS: Reports on how students are trained in medical schools to be teachers are limited. Of the programs identified, it is difficult to determine which programs are ongoing. Data on MED-SATS graduates teaching skills as resident and attending teachers are lacking. These issues present some challenges for future study.

Medical students' perceptions of feedback in a busy ambulatory setting: a descriptive study using a clinical encounter card.

BACKGROUND: Residents and medical students have expressed repeated concerns over the years about the inadequate amounts and quality of feedback in the clinical setting. Despite innovative ways to teach the skill of giving feedback, the problem has not been fixed. METHODS: In this study, the author introduced the clinical encounter card to the ambulatory setting for faculty to use as a cue to provide feedback to students. At the end of the 4-week rotation, students anonymously reported on the amount, frequency, and quality of feedback they received. RESULTS: Students reported that the learning climate for giving/receiving feedback was very good to excellent. They rated the quality and amount of feedback they received from faculty as high on the Likert scale and the frequency just above the mean. Most of the feedback was directed toward knowledge and skills, and there were few reports of demeaning behavior. Feedback was timely, and students reported using the feedback to improve their performance. The clinical encounter card improved feedback to students in a busy ambulatory setting. Whereas the author did not monitor how often the clinical encounter card was used, there were ample cards on each student to provide mid-rotation feedback and summative evaluations. The students rated the process as the best of any clerkship rotation. CONCLUSIONS: The clinical encounter card is an effective tool to enhance feedback in a busy pediatric ambulatory setting. It is not known if these results are generalizable, but readers are encouraged to repeat the study in other settings.