Joan A. Friedland

Residents-as-teachers Training in U.s. Residency Programs and Offices of Graduate Medical Education

Resident physicians provide a substantial proportion of the teaching that medical students and junior residents receive, spending numerous hours every week teaching. As stated in the Graduate Medical Education Core Curriculum of the Association of American Medical Colleges (AAMC), residents’ teaching skills are vitally important, particularly for those residents who teach third-year medical students in the so-called ‘‘core clinical clerkships,’’ which traditionally include internal medicine, pediatrics, obstetrics–gynecology, surgery, psychiatry, and family medicine. Although the residency review committee of only one of these specialties (psychiatry) currently mandates residents’ training in teaching skills, the Liaison Committee on Medical Education (LCME) states that residents should ‘‘participate in teaching [clerkship] students’’ and ‘‘be prepared for their roles as teachers and evaluators.’’ Residency programs vary in their teaching-skills training for residents. Bing-You and Tooker found in a 1993 survey of internal medicine residencies that only 20% offered teaching-skills improvement programs for their residents. In most specialties, no published studies have ever documented how many such residents-as-teachers programs exist. To clarify the prevalence and characteristics of residents-as-teachers curricula in U.S. graduate medical education, a group of investigators collaborating with the AAMC’s Section for Graduate Medical Education surveyed directors of residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME), as well as deans and directors of offices of graduate medical education (GME) at LCME-accredited medical schools.

Barriers to effective teaching

Medical school faculty members are charged with the critical responsibility of preparing the future physician and medical scientist workforce. Recent reports suggest that medical school curricula have not kept pace with societal needs and that medical schools are graduating students who lack the knowledge and skills needed to practice effectively in the 21st century. The majority of faculty members want to be effective teachers and graduate well-prepared medical students, but multiple and complex factors-curricular, cultural, environmental, and financial-impede their efforts. Curricular impediments to effective teaching include unclear definitions of and disagreement on learning needs, misunderstood or unstated goals and objectives, and curriculum sequencing challenges. Student and faculty attitudes, too few faculty development opportunities, and the lack of an award system for teaching all are major culture-based barriers. Environmental barriers, such as time limitations, the setting, and the physical space in which medical education takes place, and financial barriers, such as limited education budgets, also pose serious challenges to even the most committed teachers. This article delineates the barriers to effective teaching as noted in the literature and recommends action items, some of which are incremental whereas others represent major change. Physicians-in-training, medical faculty, and society are depending on medical education leaders to address these barriers to effect the changes needed to enhance teaching and learning.

Characteristics of house staff work rounds on two academic general medicine services

In this study, the authors determined how residents in internal medicine allotted their time during patient management rounds (work rounds). Fourteen house staff teams were observed for four days each, and the time spent on all activities was recorded. Of the 56 days studied, work rounds were not conducted on nine days. On the 47 days during which work rounds occurred, only 502 (76.4 percent) of a possible 657 visits to patients were made. Daily time spent on work rounds by each team averaged 49.4 minutes (range: 23.9 to 73.1), or 4.6 minutes (range: 2.3 to 6.6) per patient evaluated. Some part of a physical examination was performed on only 44 percent of the patients. For those patients examined, the average time of an examination was approximately one minute per patient. Vital signs sheets and medication sheets were reviewed infrequently. This study suggests that medical educators should be concerned about the thoroughness of house staff work rounds.

A standards-based, peer-reviewed teaching award to enhance a medical school's teaching environment and inform the promotions process

The authors provide the rationale, design, and description of a unique teaching award that has enhanced Baylor College of Medicines teaching environment and become highly valued by the promotions and tenure (P&T) committee in determining a faculty members readiness for promotion. This award is self-nominating and standards based. The primary purpose for development of the award was to provide the Baylor community and the P&T committee a method to understand and value the scholarship of teaching to the same degree that they understand and value the scholarship of discovery.The authors also present results from an internal evaluation of the program that included a survey and interviews. Between the inception of the award in 2001 and the internal review conducted in 2010, the award could have had an influence on the promotion of 130 of the recipients. Of the 130, 88 (65.6%) received this award before gaining their current rank (χ (1) = 16.3, P < .001). Stakeholders, including department chairs and members of the P&T committee, agreed that this award is valuable to those seeking promotion. Individual recipients stated that the award is good for the institution by encouraging reflection on teaching; increasing the recognition, importance, and value of teaching; encouraging the improvement of teaching skills; and providing a better understanding to others about what medical teachers really do. Of the 214 open-ended responses to survey questions of award recipients, more than half the comments were about the value of the award and its positive effect on promotion.

Skills for internship.

No abstract available.