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Background:
Residents are at the forefront of student education in the hospital, yet valid tools to assess their performance as teachers are lacking.
Aims:
To develop a valid evaluation tool for assessing resident performance as educators for clerkship students.
Method:
A mixed-methods design was used. Focus groups of residents and medical stu...
Context in source publication
Context 1
... resident focus group was asked to reflect on their experiences interacting with medical students during the in-patient pediatric clerkship or their experiences with resi- dents when they themselves were medical students (focus group #4). Table 1 provides an outline of the questions that guided the focus group interviews. We purposefully sampled group participants from the three strata of medical education of interest: third and fourth year medical students, and residents to maximize diversity within each group. ...
Citations
... This is in line with published literature, with evidence supporting that medical students perceive interns as important role models in their education. 86,87 The students of this study also perceived being a good performer as an enabler for being inclusive in the medical community. The traditional hierarchical structures pervade almost all systems in Sri Lanka, including healthcare (discussed above) and education due to students feeling condescension. ...
Phenomenon: Developing foundational clinical procedural skills is essential to becoming a competent physician. Prior work has shown that medical students and interns lack confidence and competence in these skills. Thus, understanding the student's perspective on why these skills are more difficult to acquire is vital for developing and reforming medical curricula. Approach: This study explored procedural skills learning experiences of medical students with qualitative methods. Through purposive sampling, 52 medical students from the third, fourth, and final years were selected for inclusion. Data were collected using six audio-recorded, semi-structured focus group discussions. Transcripts were manually coded and analyzed using inductive content analysis. Findings: Students provided rich and insightful perspectives regarding their experiences in learning procedural skills that fell into three broad categories: 1) barriers to procedural learning, 2) reasons for learning, and 3) suggestions for better learning outcomes. Students described a range of barriers that stemmed from both patient and clinician interactions. Students were reluctant to make demands for their own benefit during clerkships. The most commonly expressed reason for wanting to learn procedural skills was the desire to be a competent and independent intern. The motivators suggested that students felt empathetic toward interns and visualized a successful internship as a learning goal. Participants suggested peer learning, improved teaching of procedural skills, assessments, and feedback to improve their learning. Insights: This study generated valuable information to promote critical reflection on the existing curriculum and pedagogical approaches to procedural skills development. Medical educators need to sensitize the clinical teachers to student perspectives and what students are really learning to make impactful changes to teaching and learning procedural skills. Students' self-advocacy skills and self-directed learning skills need to be developed for them to seek out learning opportunities and to promote life-long learning. Lessons from this study may also apply to curriculum design in general, especially in teaching clinical skills. Empowering the learner and embracing a learner-centered approach to teaching and learning procedural skills will benefit future clinicians and their patients.
... Supervisors should display excellent clinical knowledge and skills, professionalism 21,22 and teamwork, and encourage students to reflect on their practice and balance their time and professional and personal lives. 12,23,24,25 Supervisors should know what constitutes a good supervisor-trainee relationship, that is, showing evidence of a bond, trust, agreement of supervisory goals and openness. 26 Supervision requires supervisors to have current knowledge and continually improve their clinical reasoning in the context of challenging heavy clinical workloads. ...
... According to registrars and FPs, FP supervisors had good clinical trainer and supervisor attributes or acted as good role models with excellent communication and organisational skills, openness, honesty, willingness to teach and teamwork, as found in previous studies. 12,24,25,58 In some districts, FP supervisors worked as a team when challenged because of their multiple roles or level of experience in training by sharing their responsibilities. Teamwork is essential for professional satisfaction, as described in the UK medical education system. ...
Background: Specialist training in family medicine (FM) is growing rapidly in sub-Saharan Africa. The strong emphasis on workplace-based learning for speciality training makes it vital to gain in-depth insights into registrar supervision. Previous studies have explored aspects of supervision at decentralised sites in high-income countries, however, little is known about the benefits and constraints of decentralised postgraduate supervision in low- to middle-income countries, especially in Africa.
Aim: This study aimed to explore family physicians’ and registrars’ perceptions of the strengths and challenges of clinical and educational supervision across decentralised training sites.
Setting: The study was conducted across two provinces at five decentralised training sites affiliated with the University of the Witwatersrand, Johannesburg.
Methods: This qualitative study involved semi-structured interviews with a purposive sample of 11 FPs and 11 registrars. The data were thematically analysed.
Results: Two of the four themes identified, ‘supervision is context-specific and supervisor-dependent’, and ‘the nature of engagement matters’, involved strengths and challenges. The other two, ‘supervision is not ideal’ and ‘the training environment is challenging’, focussed on challenges.
Conclusion: Supervisors and registrars described the postgraduate FM supervision as context-specific and supervisor-dependent. Supervisors displayed good clinical-teacher characteristics and supervisory relationships. However, several challenges, including registrars’ workload, resource shortages and a lack of standardisation across training sites, need to be addressed. Regular faculty development is essential for supervisors to be aware of relevant aspects of, and current trends in, postgraduate training.
... However, they receive little to no training to do so. Few universities include in the residency curriculum courses to equip them with the educational bases for these interactions (Lavjay Butani et al., 2013). It is important that residents receive training and that their roles as teachers are formalized (Méndez-López et al., 2013). ...
COVID-19 pandemic forced many changes, including how clinical rotations take place. Reducing face-to-face contact transformed a considerable amount of the activities to distance settings. The residents on the pathology program have a crucial role in the undergraduate medical students’ learning process. To recreate the regular face-toface contact where members of this learning community would interact, an online oneweek rotation on oncologic pathology was designed. The purpose of this study was to explore the perception of undergraduate students of the role of residents as educators on the pathology rotation taught by residents. A quantitative approach considered a crosssectional and descriptive design to study the phenomenon. The sample consisted of 55 6thyear medical students from a private school in Mexico where the online rotation was taught by residents from July to December 2020. The instrument consisted of a 27-item survey distributed online. Although participants stated they were satisfied with the teaching competence of the residents (mean 4.54), there seems to be a disagreement that the practical part of the sessions, where microscopy techniques are used, should be taught by them (mean 3.84). Students highlighted that they felt more comfortable and relaxed, as well as more confident in asking questions with residents than they did with medical specialists. The resident-student interaction is an enriching learning opportunity for both. Near peer contact found in the residents’ role as educators still needs to be formalized in the curriculum but an initial adaptation done during the pandemic might show its contribution. Keywords: higher education, educational innovation, teaching, medical education, residents, educators’ role, pathology
... Based on the title and abstract review, we fully reviewed 14 additional articles on RaT of which 13 were relevant (Butani et al., 2013;Donato and Harris, 2013;Donovan, 2011;Keller et al., 2012;Lachman, Christensen, and Pawlina, 2013;Lakshmanan et al., 2014;Patocka, Meyers, and Delaney, 2011;Peyre et al., 2011;Ricciotti et al., 2012;Smith and Kohlwes, 2011;Snydman et al., 2013;Wachtel, Greenberg et al., 2013;Yuan et al., 2014). Current trends in the literature are that 1) RaT programs vary in content and design, with mostly discipline-specific, one-off deliveries; 2) program evaluations are not conducted aside from some assessments of resident teaching; and 3) a learner-centered approach should be incorporated into program development and implementation (Jarvis-Selinger et al., 2011). ...
This article was migrated. The article was not marked as recommended. PurposeUsing a systems-based approach for developing and implementing a residents as teachers (RaT) initiative follows the trend of systems thinking in health care and medical education, and assures positive outcomes and sustainability. This paper outlines the steps for a systematic, program-wide RaT initiative, using the University of British Columbia (UBC) as a case example. Project period was 2013-2015.Study DesignThe initiative team surveyed 65 of UBC's then 72 residency programs on their level of involvement and comprehensiveness in teaching residents to teach, which they used to create a 0-4 classification system. A six-topic RaT core curriculum was developed and train-the-trainer sessions were offered to build capacity within programs to customize and deliver the topics. An online scheduling system was used to schedule RaT sessions, track resident attendance, and disseminate evaluation surveys.ResultsA portion of the programs (n=21, 34%) were classified at Level 0, indicating few to no teaching competencies were taught. After the implementation of RaT in four programs, the majority of residents (n=61, 88%) indicated the overall quality of the educational experience was good or excellent. Most responses (n=2-93, 89-100%) agreed or strongly agreed that learning objectives were met for each RaT topic. Conclusions
Implementing a systems-based approach for RaT allows for centralized curriculum, administration, and evaluation, but also allows individual programs to have ownership and responsibility over curriculum adaptation, delivery methods, and faculty and resident engagement. Furthermore, the classification system provides a way to identify program needs and track improvements across all postgraduate residency training.
... (Merriam-Webster Dictionary, 2017) Examples of stakeholder informed selections scholarship include educator role-modelling (Butani, Paterniti, Tancredi, & Li, 2013), cultural competency training (Kamaka, 2010 ) and social accountability (Preston, Larkins, Taylor, & Judd, 2016). More recently Kelly et al. (2018) published a systematic review of stakeholder views of medical selection methods. ...
Background
Attempts to utilise the experiences of stakeholders to better inform selection into medicine are rare in the literature. Published scholarship to date reflects a myriad of competing goals for selecting and graduating 'good doctors' amidst increasingly complex health care environments. This includes debates around what is the 'good doctor', selection methods, health care decision-making, the doctor-patient relationship, patient-centredness, professionalism and stakeholder experiences with doctors. Within the complexity manifested by these multiple dimensions, decisions about the characteristics and capabilities on which selection should be based may have privileged some stakeholder groups over others, with patient experiences particularly de-emphasised. The aims of this pilot study were to focus on front-line medical educators as stakeholders whose experiences might be valuable for informing selection into medicine and to inform a larger-scale study of the topic from the perspectives of a more diverse group of stakeholders, including patients.
Method
Fourteen (14) medical educator participants were recruited for a semi-structured group interview at an international conference for health professional educators. The audio-recording was transcribed verbatim and the raw data were de-identified and organised with the aid of computer assisted data analysis software. Coding was initiated and Smith's interpretative phenomenological analytical (IPA) method employed (Smith, Flowers, & Larkin, 2009).
Results
Initial analysis yielded four broad phenomenological themes: perceptions of 'good doctors', selection processes, selection-related challenges and possible solutions. The more deeply experiential data were captured in an analytical commentary of first-person accounts that may be useful for informing future selection strategies. Participant experiences mirrored the major debates in medical selection but their accounts revealed a negativity and cynicism about the topic that was concerning and warrants further investigation.
Conclusion
This study contributes to medical student selection research through offering an account of the 'lived experiences' of front-line medical educator stakeholders.
... Sherbino J, et al. [31] 5.1 (1.6) 57.1% 14.3% Ilgen JS, et al. [32] 5.0 (1.9) 57.1% 0% Butani L, et al. [33] 4.9 (1.5) 57.1% 0% Hill AG, et al. [10] 4.4 (2.2) 28.6% 14.3% EM, et al. [34] 4.0 (1.4) 28.6% 0% Smith CC, et al. [35] 4.0 (1.4) 0% 0% Hosein Nejad H, et al. [36] 3.7 (1.4) 0% 0% Jibson MD, et al. [37] 3.5 (2.1) 0% 14.3% Lacasse M, Ratnapalan S [38] 3.4 (1.4) 0% 0% Kensinger CD, et al. [39] 3.1 (2.0) 0% 0% ...
The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to prepare residents to teach and assess medical students and other learners. In order to achieve this, many programs develop formal residents as teachers (RAT) curricula. Medical educators may seek the guidance of previously published literature during the development of RAT programs at their institutions.
The authors sought to identify key articles published on the subject of RAT programs over the last 10 years. The authors utilized a formal literature search with the help of a medical librarian and identified additional articles from virtual discussions among the author group and an open call for articles on Twitter using the hashtag #MedEd. Virtual discussions occurred within an online community of practice, the Academic Life in Emergency Medicine (ALiEM) Faculty Incubator. The lead author conducted a four-round modified Delphi process among the author group in order to narrow the broad article list to five key articles on RAT programs. The authors summarize each article and provide considerations for junior faculty as well as faculty developers.
Curriculum development and program evaluation should utilize established frameworks and evidence-based approaches. The papers identified by this Delphi process will help faculty use best practices when creating or revising new RAT curriculum. In addition, faculty tasked with guiding junior faculty in this process or creating faculty development programs around curriculum development will find these articles to be a great resource for building content.
... 21 During the video panel discussion, an invited expert panelist felt that the devaluing of feedback further underlined the importance of effectively training residents in the delivery of feedback. 22 She cautioned that many resident teacher curricula are modeled on faculty teaching programs; however, this assumes that residents and faculty share the same learning needs. Therefore, more scholarship on effective resident teacher curricula is required. ...
Background :
Physician well-being is garnering increasing attention. In 2016, theJournal of Graduate Medical Education(JGME) published a review by Kristin Raj, MD, entitled "Well-Being in Residency: A Systematic Review." There is benefit in contextualizing the literature on resident well-being through an academic journal club.
Objective :
We summarized an asynchronous, online journal club discussion about this systematic review and highlighted themes that were identified in the review.
Methods :
In January 2017,JGMEand the Academic Life in Emergency Medicine (ALiEM) blog facilitated an open-access, online, weeklong journal club on the featuredJGMEarticle. Online discussions and interactions were facilitated via blog posts and comments, a video discussion on Google Hangouts on Air, and Twitter. We performed a thematic analysis of the discussion and captured web analytics.
Results :
Over the first 14 days, the blog post was viewed 1070 unique times across 52 different countries. A total of 130 unique participants on Twitter posted 480 tweets using the hashtag #JGMEscholar. Thematic analysis revealed 5 major domains: the multidimensional nature of well-being, measurement of well-being, description of wellness programs and interventions, creation of a culture of wellness, and critique of the methodology of the review.
Conclusions :
Our online journal club highlighted several gaps in the current understanding of resident well-being, including the need for consensus on the operational definition, the need for effective instruments to evaluate wellness programs and identify residents in distress, and a national research collaboration to assess wellness programs and their impact on resident well-being.
... Graduate students, sometimes referred to as Graduate Teaching Assistants (GTAs), are typically involved in undergraduate training, especially in circumstances where there are limited human resources [1,2]. This educational involvement can provide opportunities for career development in medical education as well as enhance confidence and responsibilities as medical leaders especially in low and middle income countries [3,4]. ...
... Although this educational involvement is common, there are no available standard guidelines or best practices for GTAs providing undergraduate medical education in low and middle income settings [6]. Previous research has largely been conducted in high income and developed countries [2,[7][8][9][10][11][12][13] with no available literature on the experience of GTAs in developing countries. The relative dearth of literature in this regard may reflect a lack of prioritization of medical education research in developing countries. ...
Background
In most medical schools, graduate students, sometimes referred to as graduate teaching assistants, often participate in the training of undergraduate students. In developing countries like Uganda, are typically involved in undergraduate training. However, prior to this study there were no standard guidelines for this involvement. At the same time, the views and experiences of the graduate students in their role as educators had not been documented. Therefore, the aim of this study was to explore the views and experiences of graduate students about their involvement in undergraduate training in three Ugandan medical schools. The findings of this study will contribute to the development of policies for training in Ugandan medical schools. Methods
This was a qualitative study in which thirty in-depth-interviews were conducted among second and third year graduate students in three Ugandan medical schools in the MESAU consortium (Medical Education Services to all Ugandans) including Mbarara University of Science and Technology, Makerere College of Health Sciences and Kampala International University, Western Campus. ResultsAll graduate students from all the three medical schools viewed their involvement in undergraduate training as important. The study also revealed that graduate students increase available human resources and often compensate for the teaching missed when senior educators were absent. The graduate students expressed important views that need to be considered in the design of educational programs where they are to be involved. The respondents also reported a number of challenges in this undertaking that included lack of motivation, lack of orientation and having heavy workloads. The presence and commitment of senior educators to guide and support the graduate students in teaching activities was viewed as one significant intervention that would increase the effectiveness of their educational contributions. Conclusions
Graduate students enjoy their involvement in the training of undergraduate students despite the various challenges they face. In some departments, the involvement of postgraduate trainees is critical to the viability of undergraduate medical training.
... Exploratory sequential studies tended to begin with grounded theory to generate a model or framework that guides instrument development for the follow-up quantitative phase. For example, Butani, Paterniti, Tancredi, and Li (2013) used grounded theory to improve an existing faculty evaluation tool for medical residents. Their qualitative finding led to the development of new items related to the ''humanistic attitudes and behaviors'' (p. ...
Key scholars have lauded benefits of integrating mixed methods and grounded theory—or mixed methods–grounded theory (MM-GT)—yet there have been few attempts to ascertain in what ways researchers use MM-GT. Our aim was to systematically, but not exhaustively, examine applications of MM-GT and offer procedural guidelines. We identified 61 empirical MM-GT articles and developed a codebook for analysis. MM-GT was widely used across disciplines. Most published MM-GT provided little methodological detail regarding grounded theory, mixed methods, and their integration; theoretical development was noticeably absent; and the majority followed a convergent mixed methods design. This inquiry contributes to emerging discussions regarding the ways in which MM-GT can or should be used to more fully realize the potential of this approach.
http://journals.sagepub.com/doi/full/10.1177/1558689817710877
... [3] In addition, the ACGME and the Liaison Committee on Medical Education (LCME) mandate that residents be provided opportunities to effectively educate students and other healthcare professionals. [4,5] A recent review of the literature on residents as teachers of near-peers and as role models [6][7][8] indicates a need for rigorously evaluated, educational training interventions that are reproducible. ...
Background: Accrediting bodies require medical schools to teach patient safety and residents to develop teaching skills in patient safety. We created a patient safety course in the preclinical curriculum and used continuous quality improvement to make changes over time.
Objective: To assess the impact of resident teaching on student perceptions of a Patient Safety course.
Design: Using the Institute for Healthcare Improvement patient safety curriculum as a frame, the course included the seven IHI modules, large group lectures and small group facilitated discussions. Applying a social action methodology, we evaluated the course for four years (Y1–Y4).
Results: In Y1, Y2, Y3 and Y4, we distributed a course evaluation to each student (n = 184, 189, 191, and 184, respectively) and the response rate was 96, 97, 95 and 100%, respectively. Overall course quality, clarity of course goals and value of small group discussions increased in Y2 after the introduction of residents as small group facilitators. The value of residents and the overall value of the course increased in Y3 after we provided residents with small group facilitation training.
Conclusions: Preclinical students value the interaction with residents and may perceive the overall value of a course to be improved based on near-peer involvement. Residents gain valuable experience in small group facilitation and leadership.
