The Effect of a 13-Hour Curriculum To Improve Residents' Teaching Skills

The Effect of a 13-Hour Curriculum To Improve Residents' Teaching Skills

A Randomized Trial

From University of California, Irvine, Irvine, California, and University of Southern California, Los Angeles, California.

Abstract

Background: Although resident physicians often teach, few trials have tested interventions to improve residents' teaching skills. A pilot trial in 2001–2002 found that 13 trained resident teachers taught better than did untrained control residents.

Objective: To determine whether a longitudinal residents-as-teachers curriculum improves residents' teaching skills.

Design: Randomized, controlled trial from May 2001 to February 2002 (πlot trial) and March 2002 to April 2003.

Setting: 4 generalist residencies affiliated with an urban academic medical center.

Participants: 62 second-year residents: 23 in the 2001–2002 pilot trial and 39 more in 2002–2003; 27 of the 39 participants were medicine residents required to learn teaching skills.

Intervention: A 13-hour curriculum in which residents practiced teaching and received feedback during 1-hour small-group sessions taught twice monthly for 6 months.

Measurements: A 3.5-hour, 8-station, objective structured teaching examination that was enacted and rated by 50 medical students before and after the intervention. Two trained, blinded raters independently assessed each station (inter-rater reliability, 0.75).

Results: In the combined results for 2001–2003, the intervention group (n = 33) and control group (n = 29) were similar in sex, specialty, and academic performance. On a 1 to 5 Likert scale, intervention residents outscored controls on overall improvement score (post-test–pretest difference, 0.74 vs. 0.07; difference between intervention and control groups, 0.68 [95% CI, 0.55 to 0.81]; P < 0.001) by a magnitude of 2.8 standard deviations and on all 8 individual stations. The intervention residents improved 28.5% overall, whereas the scores of control residents did not increase significantly (2.7%). In 2002–2003, 19 intervention residents similarly outscored 19 controls (post-test–pretest difference, 0.83 vs. 0.14; difference between intervention and control groups, 0.69 [CI, 0.53 to 0.84]; P < 0.001). Twenty-seven medicine residents required to learn teaching skills achieved scores similar to those of volunteers.

Limitations: The study was conducted at a single institution. No “real life” assessment with which to compare the results of the objective structured teaching examination was available.

Conclusions: Generalist residents randomly assigned to receive a 13-hour longitudinal residents-as-teachers curriculum consistently showed improved teaching skills, as judged by medical student raters. Residents required to participate improved as much as volunteers did.

Article and Author Information

Acknowledgments: The authors thank Carole J. Bland, PhD (University of Minnesota, Minneapolis), for academic contributions; Dolores Medina-Sasina for data management; and all of the BEST students, residents, staff, and faculty.
Grant Support: By the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program, the Health Resources and Services Administration (Residency Training in Primary Care grant no. 22 HP00006-01), and The Tamkin Foundation.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Elizabeth H. Morrison, MD, MSEd, Department of Family Medicine, University of California, Irvine, College of Medicine, 101 City Drive South, Building 200, Suite 512, Route 81, Orange, CA 92868-3298; e-mail, ehmorris{at}uci.edu.
Current Author Addresses: Drs. Morrison and Prislin: Department of Family Medicine, University of California, Irvine, 101 City Drive South, Building 200, Suite 512, Route 81, Orange, CA 92868-3298.
Drs. Rucker and Hubbell: Department of Internal Medicine, University of California, Irvine, 101 City Drive South, Building 200, Suite 720, Route 81, Orange, CA 92868-3298.
Dr. Boker: Office of Educational Affairs, University of California, Irvine, College of Medicine, Medical Education Building 802, Irvine, CA 92697-4089.
Mr. Gabbert: 4 Gooseberry Court, Coto de Caza, CA 92679.
Dr. Hitchcock: Division of Medical Education, University of Southern California, Keck School of Medicine, 1975 Zonal Avenue, Keith Administration and Medical Forum Building 211, Los Angeles, CA 90089-9024.
Author Contributions: Conception and design: E.H. Morrison, L. Rucker, J.R. Boker, F.A. Hubbell, M.A. Hitchcock, M.D. Prislin.
Analysis and interpretation of the data: E.H. Morrison, L. Rucker, J.R. Boker, C.C. Gabbert, M.A. Hitchcock, M.D. Prislin.
Drafting of the article: E.H. Morrison, L. Rucker, J.R. Boker.
Critical revision of the article for important intellectual content: E.H. Morrison, L. Rucker, J.R. Boker, C.C. Gabbert, F.A. Hubbell, M.A. Hitchcock, M.D. Prislin.
Final approval of the article: E.H. Morrison, L. Rucker, J.R. Boker, C.C. Gabbert, F.A. Hubbell, M.A. Hitchcock, M.D. Prislin.
Provision of study materials or patients: L. Rucker.
Statistical expertise: J.R. Boker, C.C. Gabbert.
Obtaining of funding: E.H. Morrison.
Administrative, technical, or logistic support: E.H. Morrison, C.C. Gabbert.
Collection and assembly of data: E.H. Morrison, C.C. Gabbert.