TEACHING RESIDENTS TO TEACH

1. TEACHING RESIDENTS TO TEACH  Cheryl Murphy, MD; Mark Bosma, MD; Adriana Wilson, MD; Michael Stubbs MDand Malgorzata Rajda, MD PURPOSE OF THE PROJECT • To address the need to teach residents how to teach • To teach residents specific skills in developing objectives, teaching methods, evaluation and delivery of feedback • To engage learners using adult learning principles CONCLUSIONS • Postgraduate psychiatry residents in all years of the Dalhousie Psychiatry program appear keen and receptive to learning both new and effective ways to teach in a wide variety of settings. • The option to participate in a workshop, involving both didactic teaching and interactive opportunities to practice skills in a standardized case setting was favored nearly universally by attendees. • After completing the day-long workshop, the resident feedback was overwhelmingly positive in terms of both the ongoing need for similar learning opportunities and the relevance of the workshop format. • Particular highlights of the session included use of the “triad” teaching method involving colleagues, and suggestions on how to effectively develop objectives and give feedback. • Teaching methods used in the workshop addressed learning needs identified by the residents. • The design of this workshop incorporated and modeled skills identified by residents. • Unfortunately, not all residents were able to attend the workshop (19/35), due to prior scheduling conflicts, clinical or on-call duties, timing clashes with electives, leaves of absence, examinations, and some uncertainty around content as this was a pilot project. We anticipate that as this teaching workshop is formally integrated into the curriculum, many of these obstacles to attendance will be addressed. RESULTS Workshop Engagement To engage residents at the start of the workshop, they were asked three questions (results below): What are your teaching roles? • Bedside teaching • Didactic medical student teaching • Inter-professional teaching • Formal university rounds/journal clubs What are the challenges of teaching in your role as resident? • Time restraints • Environmental constraints • Identifying learner needs • Lack of support from supervisors • Difficulty in balancing the roles of learner and teacher • Challenges of delivering feedback What do you want to gain from this workshop? • How to engage the learner • How to choose effective teaching methods • How to facilitate an interactive session • How to give feedback Resident Attendance 19 out of 34 residents (58%) attended the workshop (refer to pie chart for distribution by year of training) ABSTRACT The Royal College of Physicians and Surgeons of Canada identifies specific core competencies (CanMEDS) that are to be achieved during residency training. The requirement to teach is one of the key competencies of the Scholar role, yet it has traditionally been neglected in many residency curricula. To address this concern in the Dalhousie psychiatry residency program, a needs assessment was conducted through a resident focus group and online survey. The results overwhelmingly supported the need for a curriculum addressing teaching skills, with a preference for an interactive format. A collaborative group of medical education professionals, psychiatry faculty and residents was assembled to develop and deliver the curriculum. Residents from all five years of training were invited to a one day workshop, facilitated by the planning group. A combination of didactic and interactive sessions, including role playing, was used to introduce the core topics of effective teaching. These included development of objectives, identification and evaluation of appropriate teaching methods, assessment of learners and feedback delivery skills. The workshop format and content was evaluated by residents via a debriefing session and formal written evaluation. 19 residents attended (58% of residents) and 15 completed evaluations (79%). 100% of participants who completed evaluations reported the workshop was relevant, appropriate for level of training and would improve their teaching skills. The success of this pilot project has confirmed the relevance of teaching residents to teach. The collaborative planning group intends to further develop this curriculum, which could serve asa model for other residency training programs. METHODS • A resident focus group was assembled and an online survey was circulated to all Psychiatry residents at Dalhousie University. This formed the foundation of our needs assessment, which was used to guide the design of the Resident As Teacher curriculum. • The program design and implementation, including the writing of the cases used in the workshop, occurred through an inter-professional collaboration between the Division of Medical Education at Dalhousie University, and Psychiatry faculty and resident representatives. • The workshop curriculum was based on adult learning principles and an experiential approach to learning, with a heavy emphasis on modeling of the expected skills. • Residents were informed ahead of time that attendance was mandatory, and they would be excused from clinical duty. • The workshop ran from 10 am to 4 pm, with 45 minutes allocated for lunch. • Both the morning and afternoon sessions included brief didactic introductions to basic theory about the topics to be covered, followed by case-based small group exercises or role-plays. • The residents were divided into mixed junior-senior groups. The groups were assigned a teaching scenario that was used as a foundation for their work in the morning session and was expanded upon in the afternoon session. • Participants were given a workbook which included the course materials and some additional resources for future reference. The morning session was comprised of “Effective Teaching”, a module about: • Objectives • What they are, why we use them and how to write them • Teaching methods • An exploration of different teaching approaches and the need to tailor the approach to the learner and the context (i.e. bedside teaching versus small group) • Evaluation and assessment • This area focused on the need for constructive alignment, explicitly connecting the objectives, the teaching method and evaluation & assessment The afternoon session was dedicated to “Giving Feedback to Learners”: • This module focused on exploration of the purpose and types of feedback, as well as challenges and strategies to address difficult situations when they arise There was a debriefing session at the conclusion of the workshop: • There was an informal discussion with participants • Residents completed a formal written evaluation of the workshop’s content, implementation and value • The feedback was collated and will be used to inform future sessions FUTURE DIRECTIONS • This pilot project lends itself to a wide variety of possible future directions, aimed at enriching content and enhancing the accessibility to a more extensive audience. Considerations have been made to: • Continue the workshop as a regular part of the annual curriculum, possibly with alternating content every second year. • Incorporating teaching logbooks, portfolios or OSTEs as part of a graduated teaching responsibility. • Offer the workshop to both psychiatry residents and staff alike. • Develop feedback mechanisms or scales in order to help qualify behavioral or attitudinal change amongst residents across several years. • Ongoing encouragement of attitude and cultural change within the Dalhousie Psychiatry Department in order to help facilitate acceptance and support for a positive teaching atmosphere. BACKGROUND • The CanMEDS competencies framework was established by the Royal College of Physicians and Surgeons of Canada (RCPSC) to reflect the variety of roles desired in a practicing physician. • A similar concept was developed by the Accreditation Council for Graduate Medical Education, with the following competencies: • Patient Care • Medical Knowledge • Practice Based Learning and Improvement • Interpersonal and Communication Skills • Professionalism • Systems Based Practice • The RCPSC defines the role of Scholar as follows: “Physicians demonstrate a lifelong commitment to reflective learning as well as the creation, dissemination, application, and translation of medical knowledge”. • A key competency of the Scholar role is contribution to and facilitation of the learning of others, including patients and their families, students, residents, other health professionals and the general public. • Despite the universal acceptance of this competency by medical schools, it remains a relatively neglected aspect of residency curriculum.1 The many reasons may include a very full curriculum which puts emphasis on the medical expert role, and lack of confidence on the part of staff who have little formal training on how to teach and thus are uncomfortable doing it. • It has been suggested that residents benefit from both teaching and training in teaching skills.2,3 There is consensus that residents’ teaching skills can, and should be, improved.4 • In our experience, there are several barriers to residents acting as teachers, including: • Perception that they are learners, not teachers • Belief that teaching occurs in the classroom only • Hesitation to evaluate and provide feedback to others • Lack of time • Dalhousie Psychiatry is a moderately sized 5 year training program with an average of 35 residents. Residents are expected to contribute to the learning of others, but historically there has been little formal instruction on how to teach. • Our University is fortunate to have a Division of Medical Education, which could be used as a collaborative resource to provide such instruction. Evaluation Form Results 15 out of 19 residents (79%) completed evaluation forms. Of evaluations completed: • 100% of residents (n=15) rated the workshop as relevant • 100% of residents (n=15) rated the materials as being appropriate for level of training • 100% of residents (n=15) felt the workshop would improve their teaching skills • 87% of residents (n=13) felt the workshop should be repeated • Rating scores for components of workshop design and content were uniformly positive (See Tables 1 and 2) Most common learning points identified by residents: • Importance of developing clear, effective objectives • Importance of and strategies for providing constructive feedback Most common suggested changes for future “Resident as teacher” sessions: • Provide additional information on different teaching techniques • Discuss how to assess learner needs to optimize relevance of teaching • Involve senior residents in the delivery of the workshop Strengths of the workshop that should be retained: • Interactive approach, including role playing • Continued focus on the concept of providing feedback ACKNOWLEDGEMENTS The authors wish to thank Drs. Joan Evans, Joan Sargeant and Blye Frank from Dalhousie Division of Medical Education for their advice, help and contributions. For additional information please contact: Dr. M. Bosma Department of Psychiatry Dalhousie University bosmam@cdha.nshealth.ca *Response range 1 through 9 *Response range 1 through 9