Residents Must Be Taught to Teach, Training Directors Say

While residents may be well trained in clinical skills, they lack training in how to teach others, said respondents to a medical-education survey conducted by researchers at the University of California at Irvine (UCI).

Seventy-five percent of residency training directors in six medical specialties surveyed by the research team said they believed that medical residents need more teacher training.

Researchers at UCI surveyed directors of all residency programs accredited by the Accreditation Council on Graduate Medical Education (ACGME) in psychiatry, family medicine, internal medicine, pediatrics, general surgery, and obstetrics/gynecology. They identified participants through the 2000-01 American Medical Association’s Graduate Medical Education Directory.

In addition, researchers queried graduate medical education (GME) leaders, including deans or directors of GME offices. In total, 1,346 residency training directors and GME leaders responded to the survey.

Overall, psychiatry residency programs fared a bit better than average in terms of offering formal teacher training to residents, according to survey responses. Of all the medical specialties surveyed, 55 percent offered residents formal training in teaching skills, while 62 percent of psychiatry programs indicated that they offered this type of training. Only 31 percent of surgery program respondents said that there was teacher training for residents in this specialty.

Of the surveyed specialties, 86 percent of respondents whose programs offer formal teacher training to residents said that this type of training is mandatory for residents at some point during residency education. In psychiatry, 92 percent of respondents whose programs offer formal teacher training to residents indicated that teacher education was mandatory.

The psychiatry data are not surprising in light of the American Board of Psychiatry and Neurology’s program requirements as defined by the Residency Review Committee (RRC) in Psychiatry. The RRC sets guidelines for the training of psychiatry residents. In the guidelines, the RRC specifies that clinical training should provide all PGY-2 through PGY-4 residents with “sufficient experiences” in teaching psychiatry to medical students, residents, and others in the health professions.

Findings from the survey are clear on one point: The more teacher training, the better. Seventy-five percent of the residency training directors surveyed said that residents would benefit from teacher training. Donald Fidler, M.D., who is director of the Health Sciences Teaching Scholars Program, a multidisciplinary program that instills teaching skills in medical faculty, and director of medical student education at West Virginia University, agreed. “It is important for residents to be taught to teach because they are on the front lines in the emergency rooms and clinics,” Fidler told Psychiatric News.

Fidler, who said that there is probably not enough formal training for psychiatry residents in how to be good teachers, believes that medical students tend to trust and listen to residents more than more senior faculty because the residents are closer to them in age and experience.

“I believe that teaching others forces residents to critically examine what they know and to acquire greater competence in their subject matter,” Nyapati Rao, M.D., told Psychiatric News. Rao is chair of APA’s Council on Medical Education and Career Development and director of psychiatric residency training at the State University of New York-Downstate in Brooklyn.

Rao also said that teaching helps residents improve their communication and public-speaking skills.

“In our program at SUNY-Downstate,” said Rao, “there are substantial opportunities for our residents to teach medical students, their junior colleagues, and residents from other disciplines.”

Rao added that his students take part in classroom teaching and clinical supervision of medical students. “I think that by teaching medical students,” continued Rao, “our residents are acting as role models and attracting future practitioners of psychiatry to the field.”

In addition to their schooling, however, residents can turn to professional associations for help with teacher training. The Association of Academic Psychiatry’s (AAP) Bristol Myers-Squibb Fellowship Program is one way residents can acquire specialized teacher training. (This fellowship is different from one of a similar name at APA.) The two-year fellowship is awarded to residents who show promise as educators and provides them with an opportunity to learn how to excel as academic psychiatrists. The residents attend two annual AAP meetings, where they participate in academic-oriented workshops and receive mentoring in academic activities such as teaching.

APA’s own Committee on Medical Student Education published a brochure in 1988 titled “Psychiatric Residents as Teachers,” which is currently being updated. The brochure discusses the advantages of learning how to teach in residency, teaching techniques, and student attitudes toward psychiatry, among other topics.

In addition, the spring 2001 issue of APA’s Psychiatric Residents’ Newsletter dealt solely with the issue of residents as teachers. In a front-page article, resident Geoff Gabriel, M.D., M.S., wrote, “Few of us are given formal instructions in the process of teaching and evaluating others, and we often feel that we have no ownership in the endeavor.”

Gabriel addressed one erroneous assumption made about doctors, “. . .that if any individual has been engaged in the lifetime process of learning, as we physicians are, he or she will be able to effectively teach others.” That is not automatically true, he suggested.

The Psychiatric Residents’ Newsletter is published quarterly by APA’s Committee of Residents and Fellows.

More information about the AAP/Bristol Myers-Squibb Fellowship Program can be found on the Web at www.academicpsychiatry.org under the “awards” link. ▪