Residents' perceptions of their teachers: facilitative behaviour and the learning value of rotations

Summary. Despite changes in modern medicine the role of the clinical teacher remains central to medical residents' education and rotations continue to be their dominant educational context. Residents have strong positive feelings for clinical teachers who are perceived as interested in teaching and for those rotations that provide a balance of educational opportunities and patient care responsibilities. Research in residency education has focused on teacher behaviours used to teach medical residents clinical information or patient care skills but has neglected teacher behaviours used to facilitate effective learning relationships with residents. To explore the impact of clinical teachers' use of facilitative behaviours on residents' educational experience, we use concepts stemming from the psychologist Carl Rogers' work previously shown to be associated with positive learning outcomes — empathy, unconditional positive regard, and congruence. These constructs are measured by the use of the four scales of the Barrett-Lennard Relationship Inventory (BLRI) — level of regard, unconditionality of regard, congruence and empathy. Our study measures the correlation between residents' perceptions of clinical teachers' use of facilitative behaviours and residents' evaluation of the learning value of rotations. Thirty-three residents completed the BLRI on a different clinical teacher for each of six monthly rotations. A total of 158 surveys were returned. There were strong positive correlations between three of the BLRI variables and residents' perception of the learning value of rotations. Potential uses of these findings are discussed.     

The perceptions of attending doctors of the role of residents as teachers of undergraduate clinical students

INTRODUCTION: Much of undergraduate clinical teaching is provided by residents. An earlier study showed the attitude of residents towards teaching to be generally positive. Little is known, however, about attending doctors' views on their own and residents' roles as teachers of medical students. OBJECTIVES: To examine attending doctors' perceptions of the (dis)advantages of resident teaching, their own teaching abilities and the need for a teacher training programme for residents. METHOD: A questionnaire survey of 76 attending doctors was carried out in the Departments of Obstetrics & Gynaecology and Paediatrics at the teaching hospitals of the Universities of Maastricht and Amsterdam, the Netherlands. RESULTS: Attending doctors perceive teaching by residents to be beneficial for students and residents alike. Although they consider themselves to be better suited than residents to teach medical students, they see teaching as an integral part of residency training and feel it should be recognised as such by departments and medical schools. Attending doctors are in favour of a teacher training programme for residents, which should include communication, clinical and teaching skills as well as skills such as time management and (self-) assessment. DISCUSSION: Despite the uneven distribution of participants between the departments, no significant differences were found between departments. It is interesting that attending doctors perceive teacher training as beneficial to residents' teaching skills, but provide more feedback on residents' attitudes than on their teaching. The results show that, in general, attending doctors share residents' views that teaching is an important component of residency and that a teacher training programme for residents is to be recommended.     

Teaching and assessing clinical skills: a competency-based programme in China

The objective of this study was to develop a compentency-based clinical skills teaching and assessment programme in China utilizing modern teaching techniques. Medical teachers from three schools agreed on items for inclusion in the complete physical examination of an asymptomatic adult, an outline for an adult and paediatric history, and important interviewing skills. Lesson plans, performance checklists, and written and videotape training materials were developed. Standardized patients were trained at one school to assist with the teaching at that school and with the assessment at all three schools. A national, a provincial, and a local medical school in China were used. Before beginning the new curriculum for students in their first year of clinical training, baseline data were collected on skills of students at various levels of training in the previous curriculum at all three schools. Although in the previous curriculum there was some improvement in clinical skills among advanced compared to more junior students, performance was lower than expected by staff. One year after implementation of the new curriculum, students were evaluated. These students significantly outperformed their counterparts as well as the more senior level students tested the previous year. This project has established a competency-based teaching and assessment programme in China that allows for rapid improvement in the clinical skills of students. Within a short time, a sophisticated group of medical educators has been formed, who now function as consultants to other educators in their own country. Many aspects of this programme are being adapted throughout China and are applicable to medical schools throughout the world.     

Promoting effective teaching and learning: hospital consultants identify their needs

OBJECTIVES: The aim of this study was to help hospital consultants identify their needs in relation to teaching skills, leading to the development of a teacher training programme. DESIGN: The study was directed at all 869 consultants in the region and initially involved a postal questionnaire which had a 60.5% response rate. SETTING: Hospitals throughout Northern Ireland. SUBJECTS: Hospital consultants. RESULTS: Results from this questionnaire indicated that while the majority of respondents were interested teachers, only 34% had received any teacher training. The questionnaire was followed by a focus group study involving three groups of consultants drawn randomly from those who had responded to the questionnaire. Participants in these groups identified the following key areas of hospital education: qualities of hospital teachers; selection procedures; problems of teaching in hospitals; the need for teacher training and how it should be provided. CONCLUSION: The study highlighted that hospital teachers need to acquire and update their teaching skills through attending courses that should include basic teaching and assessment/appraisal skills. These courses should last 1 or 2 days and be provided at a regional or subregional level. As a result of this study, teacher training courses have been developed in this region.     

A systematic review of resident‐as‐teacher programmes

Context Residents in all disciplines serve as clinical teachers for medical students. Since the 1970s, there has been increasing evidence to demonstrate that residents wish to teach and that they respond positively to formal teacher training. Effective resident‐as‐teacher (RaT) programmes have resulted in improved resident teaching skills. Current evidence, however, is not clear about the specific features of an effective RaT programme. Objectives This study was performed in order to investigate the effectiveness of RaT programmes on resident teaching abilities and to identify the features that ensure success. Methods of assessment used to ascertain the effectiveness of RaT programmes are also explored. Methods The literature search covered the period between 1971 and 2008. Articles focusing on improving resident teaching skills were included. Each study was reviewed by two reviewers and data were collected using a standard abstraction summary sheet. Study outcomes were graded according to a modified Kirkpatrick's model of educational outcomes. Results Twenty‐nine studies met review inclusion criteria. Interventions included workshops, seminars, lectures and teaching retreats. Twenty‐six studies used a pre‐ and post‐intervention outcome comparison method. Subjective outcome measures included resident self‐evaluation of teaching skills or evaluation by medical students, peers and faculty members. Objective outcome measures included written tests, evaluation of teaching performance by independent raters and utilisation of objective structured teaching examinations. One study objectively measured learning outcomes at the level of medical students, utilising the results of an objective structured clinical examination. Overall resident satisfaction with RaT programmes was high. Participants reported positive changes in attitudes towards teaching. Participant knowledge of educational principles improved. Study methodologies allowed for significant risks of bias. Conclusions More rigorous study designs and the use of objective outcome measures are needed to ascertain the true effectiveness of RaT programmes. Future research should focus on determining the impact of RaT programmes on learning achievement at the level of medical students.     

An appraisal of methods of evaluating training in psychiatry

A survey of American chief residents ^¶ in psychiatric training centres was carried out to assess how these training programmes gathered feedback on teacher effectiveness and programme content. The chief resident in each programme was asked to report how his or her department elicited information from their residents about course and teacher quality. Responses from 184 training centres in the United States were obtained and accounted for 75% of the existing centres. Fifty questionnaires were returned with the survey results and were analysed. The seven factors of clinical teacher effectiveness previously described in the literature were used to evaluate these questionnaires. The majority lacked consistent coverage of the teaching factors with the percentages of questionnaires covering a specific behaviour as follows: teacher organization, 58%; instructor knowledge, 42%; group interactional skills, 42%; instructor enthusiasm, 30%; clinical supervision skills, 25%; display of professional characteristics, 19%; and clinical competence, 17%.     

Role modelling: how does it influence teaching in Family Medicine?

OBJECTIVE: To undertake a qualitative study to explore the influence of role modelling on teaching by comparing faculty members recollections of their teachers' behaviours with residents perceptions of the same behaviours in a family medicine residency programme in Saudi Arabia. METHOD: Using semi-structured interviews of faculty and a questionnaire based on the issues arising from the interviews, faculty members' recollections of their medical teachers' behaviours were compared with residents' current perceptions of the same teaching behaviours. SETTING: Department of Family Medicine, King Fahad National Guard Hospital, Riyadh, Saudi Arabia. SUBJECTS: Faculty and residents. RESULTS: The four best-remembered teacher behaviours were: positive behaviour towards patients, negative behaviour towards junior colleagues, effective presentation of subject content and encouragement to participate in patient care. The residents perceived positive behaviour towards patients, positive behaviour towards junior colleagues, suboptimal skills of subject content presentation, and insufficient encouragement for trainees to actively participate in patient management. Although faculty retained many unhappy memories of teacher behaviour, it was encouraging that there was no evidence of perpetuation of the negatively perceived behaviours which provoked them. CONCLUSIONS: Discernment of the value of technical teaching skills was not a predictor of later proficiency.     

Evaluation of a teaching skills improvement programme for residents

Summary. This study addressed three evaluation questions about the effectiveness of a workshop to teach residents how to teach: (1) How do residents evaluate their own teaching skills? (2) How do students evaluate residents' teaching skills? (3) Do residents of various specialties differ in their teaching skills? One hundred and five residents rated their skills on the Inventory of Teaching Behavior significantly higher after attending the workshop than before it. Third-year students evaluated the teaching skills of both residents who had attended the workshop and those who had not. On four of the nine items of the Clinical Teaching Assessment Form, students rated residents who had attended significantly higher than the control residents. Some differences in teaching skills among the various specialties were found as were differences between resident self-rating and student rating. These data suggest that giving residents instruction can improve their teaching skills. By doing so, both the residents and the programme can benefit.     

Postgraduate education in medical ethics in Japan

The objective of this paper was to investigate what kind of postgraduate education in medical ethics medical residents in Japan receive and what they want for ethical education and guidelines. Sixteen teaching hospitals that provide a general internal medicine residency programme in Japan were used (145 medical residents working at the departments of general internal medicine). A total of 114 residents participated in our survey, yielding a response rate of 79%. Of these, 28% received education in medical ethics more than once a month; 24% were offered it only when ethical problems were involved in actual patient care; and 18% answered that opportunities were very rare and sporadic. A full 30% had received no education in medical ethics at all. Many residents (71%) learned medical ethics from individual supervising doctors. A majority of the residents had been taught about informed consent (79%) and doctor–patient relationships (54%); 46% had learned about the appropriateness of truth telling and of ethical decisions regarding withholding and withdrawing a life-sustaining treatment, respectively. A total of 85 residents (75%) wanted to have more comprehensive education in medical ethics, 13% could not decide, and 12% did not want it. Many (66%) thought that both doctors and ethical philosophers should jointly teach medical ethics in postgraduate residency programmes. The results suggest that many residents desire more comprehensive and interdisciplinary education in medical ethics and educators in Japan should aim to develop education programmes to meet these desires.     

Rewards for teaching excellence: practice in South African medical schools

Excellence in teaching through recruitment of good teachers, rewarding good teaching and the creation of staff development programmes are priorities in the mission statement of most universities. Often, reality belies intention. At many universities serious attempts to ensure maximum teacher effectiveness, overt recognition of teaching excellence, and specific development funding are lacking. This study examines the extrinsic (i.e. financial) reward systems which operate at the eight medical schools attached to South African universities and reports on the current situation. Replies indicated that a reward system of some type operates within the university at seven South African universities which have faculties of medicine and embraces all faculties. One university rewards medical school teachers specifically but, at another, no reward system exists at all. The monetary value of rewards varies greatly. Significant criticism of all systems was the inability to meet their design aims. There was criticism of the criteria, such as they are and where they exist, used to identify teaching excellence and to reward recipients. All replies indicated support for an impartial and equitable system of reward for effectiveness and excellence in teaching.     

Attending rounds on in-patient units: differences between medical and non-medical services

Summary. The objective of this cross-sectional observational study was to quantify communication patterns between teachers and trainees on in-patient attending ward rounds and assess trainees' perceptions of the effectiveness of teaching interactions. Sixty-nine in-patient ward rounds on medical and non-medical teaching services at a university hospital and its affiliated VA Medical Center were studied. Teaching rounds were observed and audiotaped, and trained raters coded verbal interchange for its location, speaker identity and topic of the exchange. One to three days following the teaching rounds, residents and students were interviewed and completed a questionnaire concerning recollections of the content of the session. Medical rounds lasted a mean of 90 minutes, while non-medical rounds averaged 38 minutes. Medical teams spent more time than non-medical teams on case presentations and discussions of diseases not directly related to patient care. Both groups averaged approximately 10 minutes directly interacting with patients, and equal times were spent speaking by the teacher and trainees. The role of postgraduate year 1 residents and medical students primarily was to recite details of patients' clinical condition. Twenty-nine per cent of trainees were unable to recall a specific teaching point from rounds when interviewed 1–3 days later. Duration and content of in-patient rounds differed on medical and non-medical services. For both, discourse tended to be hierarchical, with those at different training levels adhering to specific roles. Bedside patient interactions were limited. The content recalled by students and house staff suggests that new, more effective educational paradigms are needed.     

Influences on Turkish early childhood teachers’ science teaching practices and the science content covered in the early years

The first rationale of the study was not only to determine the topics taught in Turkish early childhood settings but also to define the frequency and time allocation for teaching science (n?=?382). In the second phase, through semi-structured interview questions, the aim was to gain detailed information about Turkish early childhood teachers’ (n?=?14) thoughts concerning the effectiveness of teacher education programmes, their level of confidence in teaching science, the obstacles they face, and the support from colleagues and school administrators. The findings revealed that Turkish early childhood teachers do not feel confident in teaching science and do not believe that they received adequate teacher training. In addition to these two reasons, the scarcity of resources and training opportunities can also be considered as contributory factors that may be helpful in explaining why the science content is too narrow and time allocation for science teaching is limited in Turkish early childhood settings.     

Short-term outcomes and long-term impact of a programme in medical education for medical students

Objectives  There is growing appreciation of the value of early preparation of future medical educators. Staff development programmes, conferences and workshops pertaining to the training of educators may be crucial to the pursuit of a school's larger educational mission to educate students, doctors and scholars and to provide comprehensive knowledge, research, patient care and service. This study examined the efficacy of a 1-week educational intervention aimed at preparing medical students to become effective doctor educators by building skills early in their careers. The study asked whether participation in a 5-day teacher training programme led to increased knowledge of instructional methods, more favourable attitudes towards teaching, and the integration of structured instructional design methods in a student-developed teaching project.
Methods  A mixed methods research design was employed with quantitative data captured through pre- and post-test inventories, qualitative components captured through written comments, and a 2-year post-intervention survey. Quantitative analyses included pre-/post-intervention repeated measures with calculated effect sizes. Qualitative analysis was conducted using constant comparative methods.
Results  Subjects demonstrated improved content knowledge and more positive attitudes towards motivation, teaching confidence, teacher roles, varied pedagogy, and use of assessment, instructional planning, and evaluation. Subjects were able to incorporate the programme's teaching theory and methods into their teaching projects and assessment of peers' and others' teaching in their own institutions 2 years post-training.
Conclusions  This study demonstrates that a well-designed programme for teacher preparation can be pedagogically effective for training medical students to become better educators and that this learning can be incorporated into long-term practice.     

Personal journal writing in a communication skills course for first-year medical students

Summary. Student journals are used at all levels of education to facilitate academic and personal learning. This paper describes the experience of journal writing from both a student and teacher perspective, in a communication skills course for first-year medical students at Queen's University, Kingston, Ontario, Canada. As one of the requirements of the course, students described their individual reactions to each weekly session in a journal. Teachers responded to each journal entry. Guidelines for journal usage in this course are described. The content of the journals includes topic-related information, comments concerning the student's individual experience of the course, and personal thoughts related to life experiences and becoming a doctor. A summary of evaluations of journal writing by teachers and students is presented. We have observed that journal writing facilitates a personal and reflective perspective to the first-year medical curriculum for both students and teachers. Journal writing appears to initiate and encourage self-awareness by providing a safe place for students to describe their experiences and relationships and to question their own values and beliefs. In the journal, through a mutual sharing of thoughts and feelings, barriers between students and teachers are diminished, leading to enhanced rapport and communication.     

A qualitative study of teacher's perceptions of an intervention to prevent conduct problems in Jamaican pre-schools

Background There is a growing evidence base showing the efficacy of school‐based interventions to prevent conduct problems but few evaluations have addressed teachers' perceptions of these programmes. Teachers' views on the acceptability, feasibility and usefulness of an intervention will influence implementation fidelity and programme sustainability and can help further our understanding of how the intervention works and how it may be improved. Methods A pilot study of the Incredible Years Teacher Training Programme supplemented by a curriculum unit on social and emotional skills was conducted in inner‐city pre‐schools in Kingston, Jamaica. Three pre‐schools comprising 15 classrooms participated in the intervention which involved seven monthly teacher workshops and 14 weekly child lessons in each class. At the end of the intervention in‐depth individual interviews were conducted with each intervention teacher. Results Teachers reported benefits to their own teaching skills and professional development, to their relationships with children and to the behaviour, social‐emotional competence and school readiness skills of the children in their class. Teachers also reported benefits to teacher–parent relationships and to children's behaviour at home. A hypothesis representing the teachers' perceptions of how the intervention achieved these benefits was developed. The hypothesis suggests that intervention effects were due to teachers' gains in skills and knowledge in three main areas: (1) a deeper understanding of young children's needs and abilities; (2) increased use of positive and proactive strategies; and (3) explicitly teaching social and emotional skills. These changes then led to the variety of benefits reported for teachers, children and parents. Teachers reported few difficulties in implementing the majority of strategies and strongly recommended wider dissemination of the intervention. Conclusions The intervention was valued by Jamaican pre‐school teachers and teachers felt they were able to successfully integrate the strategies learned into their regular practice.     

Humanizing medicine: a special study module

As medical schools begin to implement their new curricula under the guidance of Tomorrow's Doctors, the authors wish to raise some discussion on the form and content of the special study module (SSM) component. In order to do this they put forward in this paper proposals for an SSM in Medicine and Literature. This course has been designed jointly and will be run concurrently in three Scottish medical schools: Glasgow, Aberdeen and Dundee. Arguments for the course's acceptability to faculties of medicine and to students are discussed and its inclusion in the curriculum in terms of its educational impact, skills training, effect on personal development and broadening of the student's perspective are justified. The course structure, content and assessment procedures are described and a reading list proposed. The General Medical Council points out that SSMs should be seen as opportunities for innovation and this course demands a different educational approach from the standard objectives-led approach of most medical education. A process-led model is more appropriate as it stresses the way that students develop while taking the course rather than the end point reached at its finish.     

Day surgery: teaching the next generation

The advent of day surgery presents new opportunities and challenges for medical education. The opportunity to see patients pre-operatively and follow them through surgery to discharge on the same day is unique to day surgery. However, with rare exceptions, the development of educational programmes in ambulatory surgical settings is still largely at a rudimentary level. An undergraduate pilot programme was conducted at the University of Adelaide to explore the practicalities, acceptance and educational value of a day surgery programme for final-year medical students. The programme had three components: day surgery patient follow through, practical procedure tutorials and problem-based learning tutorials. It incorporated assessment of practical skills and theoretical knowledge with the use of log books and clinical and practical simulations as important elements in the assessment process. The pilot programme was accepted by all stakeholders and students' perceived significant gains in knowledge and skills. This programme may provide a teaching model that could be adapted for use in other medical schools.     

Bringing being into professional development: a qualitative investigation into teachers’ struggles moving beyond an epistemological framing of teaching and learning

The continued standardisation of publicly funded early education programmes has led to teacher educators and researchers focusing in on what works in preparing teachers and their students to succeed in these environments. Such a focus prioritises an epistemological understanding of teaching and learning and leads to investigations examining whether professional development programmes impact participants’ ways of knowing. Many within teacher education question this outcomes-based focus on teaching and learning and are seeking alternative forms of professional development. The programme examined in this article took up this call by implementing an ontological conception of professional development that re-centers the learning process through the experiences of teachers in their classrooms. Specifically, it assisted a collection of early educators in enacting new ways of professional being that attended to children’s worlds. Studying their experiences provides insight into the opportunities and challenges that exist for those who seek to transform the teacher education process.     

Personality,clinical performance and knowledge in paediatric residents

Summary. This study examines the relationship between personality, knowledge and teachers' evaluations of paediatric residents at a large, urban teaching hospital. All residents (n= 30 ) were graduates of foreign medical schools. Each resident completed the Myers-Briggs Type Indicator (MBTI) as a measure of personality and was rated (on a scale of 1-7) by teachers on each of 35 items representing 14 different aspects of clinical performance. These data were correlated with performance on the American Board of Pediatrics In-training Examination (ABPITE), and with demographic data. Ratings of knowledge were directly associated with scores on the ABPITE (r= 0.51 , P < 0.01 ) and with the MBTI continuous score for extraversion (r= 0.51 , P < 0.01 ), but inversely associated with age (r=?0.41, P < 0.01 ). ABPITE scores were also associated directly with MBTI Extraversion (r= 0.44 , P < 0.01 ) and inversely with age (r=?0.56, P < 0.001 ). Age and MBTI Extraversion were independently significant predictors of ABPITE (Multiple R= 0.64, P < 0.01 ) and ratings of knowledge (Multiple R= 0.59, P < 0.01 ). Results suggest that teachers' evaluations of knowledge have validity, and that age and introversion/extroversion play a significant role in both subjective and objective evaluations of paediatric knowledge. Demographic and personality variables may be predictive of knowledge acquisition, but are unrelated to many dimensions of clinical performance.