Creative solutions to psychiatry's increasing reliance on residents as teachers.

This special issue answers an urgent need in academic psychiatry to find creative new solutions to our field’s increasing reliance on residents as teachers. Two forces are driving this. One is an old problem that is now getting the recognition that it deserves. Medical schools and their affiliated hospitals have long neglected the preparation of residents to teach despite the fact that residents work more directly with medical students in clinical settings than do attendings, making residents the students’ main, real-time, “in the trenches” teachers, their most immediate interpreters of clinical material, and their most direct supervisors. It is undeniable that residents must be better prepared for this teaching role than they have been. The second is a new problem. Increasing pressures on faculty to spend more time in direct clinical care or externally funded research are making protected time for faculty teaching scarcer, which, by default, makes teaching by the residents that much more critical. This second pressure makes it imperative that education program directors and departmental administrators guard against simply inserting residents as inexpensive substitute teachers into curricula that were designed to be taught by faculty. We must be sure that, in fairness to our students, their residents are well prepared to teach, and that, in fulfilling our educational obligations to the residents, learning to teach and teaching itself advance their professional development. This issue therefore collects in one place 12 articles reporting 14 new projects and one review from the United States and Canada that demonstrate the great range and variation of current efforts to raise the quality of teaching by psychiatric residents. The collection sheds much new light on what types of techniques residents can use, what content areas they are good at teaching, and even what teaching interventions residents themselves have developed on the basis of their interests and perceptions of resident and medical student educational needs. The issue contains an excellent review on assessment tools to evaluate such curricula (1). Among the issue’s reports of specific projects is an exciting variability in all aspects of structure and content—from the level of resident involvement in the creation of the project to the teaching methods employed and the topics, methods, and duration of the courses. For example, the durations of the teaching programs described ranged from a 1.5-hour single session (2), to multiyear clinician-educator tracks (3). Another dimension of interest, the degree of resident input into the formation of these new courses, ranged from a program that used the results of a resident survey to guide how much time to devote to teaching to teach in the residency curriculum (4) to several projects that were initiated and/or developed and implemented by the residents themselves (5–7). There are also varied structures, from a half-day teaching workshop (4) to several forms of Education Chief Residents (8–10). Thus, this issue of Academic Psychiatry is sure to give its readers new models to fit their program’s unique needs and to match any level of availability of resident, faculty, and curricular time. The specific teaching techniques or combinations of skills that the resident teachers were taught to use in their teaching is truly dazzling. Some examples include: