his 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 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:
Interestingly, in this collection of articles residents showed a special appreciation for active-learning, game-show formats as a teaching method and for psychotherapy as a topic area. One of the programs that prominently featured a game format was developed by residents—a PRITE review course taught to fellow residents (5). The second format, team-based learning, was motivated by the authors’ idea that team-based learning would overcome barriers to teaching by residents in the clerkship (13), suggesting that faculty appreciate the residents’ affinity for such teaching modalities. Two other programs that were developed by residents resulted from the residents’ perception that they could fill a need in the teaching of psychotherapy to fellow residents (8) and to medical students (6). One other resident-driven project was unique because it was developed by PGY-2s, who are usually the busiest psychiatric residents with the most demanding clinical workloads. That they took the initiative and time to create a teaching manual for teaching medical students core clerkship topics (7) indicates that the need and potential for residents to develop as teachers is strongly felt by the residents themselves at all levels of training.
As important as what the residents taught to their students is how the residents were taught to teach and what they were taught.
The techniques that were used to teach the residents to teach were also quite varied. For example:
Most of the projects had medical students as the teaching audience and so most of the benefits of these projects accrue to the medical students. However, a number of the reports call attention to the important benefits for the residents of learning how to be teachers: preparation for the boards and for assuming the attending role (9); encouragement to embark on an academic career; and career development (3).
Three of the articles describe PGY-4 education or teaching chief residents. Variants of this position are chief resident for psychotherapy (8), a 2-month teaching resident rotation that supervises junior residents and medical students (9), and a chief resident for medical student education (10). Although it is not precisely an education chief or teaching chief resident position, one article (12) describes a novel elective for PGY-4s evocatively called "Growing Teachers" that mentors the senior resident through the design and teaching of a new course to a resident or medical student audience of his or her choice.
The most ambitious programs are three that place residents in clinician-educator tracks from the PGY-2 through PGY-4 years of their residencies (3). These three programs at the University of Michigan, Baylor, and the University of California at Davis emphasize the career development of their residents into educators by mentoring them through the production of curricula or scholarly projects and teaching supervisory, research, and writing skills.
The Assessment Toolbox (1) searched PubMed and PsycINFO for the terms , , , assessments, and and examined the instruments yielded by this search for their psychometric properties. The authors found 11 fully accessible tools that used self-report, learner evaluation, or one observed standardized teaching evaluation (OSTE). Most of the instruments satisfied tests of validity and reliability. The article’s table is very helpful in indicating whether specific domains of knowledge, attitudes, or skills are measured by each tool. This review should facilitate rigorous research on residents as teachers in the next crop of residents as teachers programs that we hope this issue will stimulate.
At the time of submission, Dr. Polan reported no competing interests. Disclosures of editors are published in each January issue.