Elizabeth H . Morrison and Janet Palmer Hafler

Resident physicians spend numerous hours every week teaching medical students and fellow residents, and only rarely are they taught how to teach. They can, however, be taught to teach more effectively. Teaching skills improvement initiatives for residents are taking a more prominent place in the educational literature. Limited evidence now suggests that better resident teachers mean better academic performance by learners. A small but important body of research supports selected interventions designed to improve residents’ teaching skills, but not all studies have demonstrated significant educational benefits for learners. An increasing number of valid and reliable instruments are available to assess residents’ clinical teaching, including objective structured teaching examinations and rating scales. In all specialties, rigorous research in evidence-based teacher training for residents will help prepare academic medical centers to meet the diverse and changing learning needs of today’s physicians-in-training. Pediatrics 2000;105:238–241; resident physicians, medical students, fellow residents, teaching, graduate medical education. ABBREVIATION. OSTE, objective structured teaching examination. Resident physicians spend many hours every week teaching medical students and fellow residents.1 As early as 1970, Brown2 reported that at one medical school, two-thirds of residents surveyed stated that they received .40% of their teaching from fellow housestaff, and the trend continues today.3 Residents also teach junior learners an important “informal curriculum” primarily at night and on weekends when attending physicians are not present.4 Residents are important teachers for generalist physicians-in-training: interns from different family medicine residencies reported spending nearly 25% of their educational contact time with residents as teachers.5 Yet resident physicians are only rarely taught how to teach. In a 1993 national survey, only 20% of internal medicine residency programs featured teaching skills improvement programs, despite the fact that residents provided 62% of inpatient teaching for medical students according to the residency directors’ estimates.6 Data are lacking on how many residents-as-teachers programs exist in pediatrics residencies. Evidence suggests that many residents teach ineffectively. When Wilkerson, Lesky, and Medio7 observed 14 internal medicine residents during hospital work rounds, residents modeled patient care at the bedside, verified examination skills, and gave brief lectures, but they rarely cited literature, asked questions, or gave feedback to their learners—all teaching behaviors found to be highly effective in the faculty development literature.8 Another observational study9 found that inpatient work rounds run by senior residents are often insufficiently thorough. Residents generally do not teach problem-solving skills or psychosocial topics as often as do attending physicians.10 In other studies, physicians-in-training themselves have identified teaching as an important— but undervalued—part of their responsibilities and education.11–13 In a qualitative study at New York University,14 internal medicine residents expressed intense conflicts about their teaching roles. Educators began to record these phenomena as early as 3 decades ago when Barrow15 found that medical students reported they wanted to have definite teaching responsibilities as residents. Bing-You’s more recent review16 also found this to be true. TEACHING SKILLS IMPROVEMENT PROGRAMS FOR RESIDENTS Residents-as-teachers programs can be traced back to the early 1960s.17 Programs have since become both more specialized and more common, in areas that include pediatrics,18–21surgery,22,23 internal medicine,24 psychiatry,12 family medicine,25 and others.26,27 Some programs take the form of brief, one-time teaching workshops, but other novel approaches have also been reported: resident-managed programs,28 learning styles workshops,29 month-long elective rotations to develop teaching abilities,30 and targeted training in ambulatory teaching skills.31 Most studies have not assessed the validity or reliability of the evaluation instruments32 used to assess their programs. On the whole, resident development programs have yet to evolve to the current level of faculty development programs. It is not known how well faculty development concepts apply to residents’ From the *Department of Family Medicine, and the Office of Curricular Affairs, University of California, Irvine, Orange, California; and the ‡Department of Pediatrics and the Office of Educational Development, Harvard Medical School, Boston, Massachusetts. Received for publication Jul 19, 1999; accepted Oct 15, 1999. Reprint requests to (E.M.) at the Department of Family Medicine, University of California, Irvine, 101 City Drive South, Bldg 200, Suite 512, Rte 81, Orange, CA 92868-3298. E-mail: [email protected] PEDIATRICS (ISSN 0031 4005). Copyright © 2000 by the American Acad-