Although the Accreditation Council of Graduate Medical Education (ACGME) recognizes teaching as a core competency for residents (¹, ²) and the benefits of learning and practicing teaching skills in residency have been well documented (²—⁴), a 2001 survey found that only 62% of psychiatric programs offer formal instruction in how to teach (⁵). We searched PubMed for the period between 1950 to May 2009 using the keywords resident teacher, residents as teachers, and resident teaching elective for original articles in English and literature reviews. Most published reports described limited interventions ranging from single 1-hour sessions to half or full-day weekend retreats (², ⁶). The 2001 survey (⁵) showed a mean of 11.5 hours of training in teaching skills across all residency programs offering such curricula. In addition, curricula on pedagogy have mainly focused on how to give feedback, supervise medical students, improve teaching at bedside and morning report, give mini-lectures on assigned topics, and lead small group discussions (², ³, ⁶—⁸). None to our knowledge described a specific pedagogical intervention designed to instruct residents in how to design and teach new courses. Nevertheless, many junior faculty members are asked to do just that. Thus, there is a pressing need to teach this skill.

We designed a course called Growing Teachers, an individualized elective in the fourth postgraduate training year during which residents have weekly, 45-minute meetings with a mentor to guide them through the planning, teaching, and evaluation phases of creating a new course.

Under the guidance of an experienced medical educator, residents identify a course topic. In consultation with other faculty experts in the topic, the resident-mentor pair determines the target audience (e.g., other residents, medical students, and/or other staff), the length of the teaching module, the duration of each session, and the appropriate setting (e.g., inpatient unit versus classroom). Once the topic and frame are chosen, residents survey the literature, reflect on their clinical experiences, and propose the structure and content of the module. In subsequent weekly meetings, the resident-mentor pair establishes the learning objectives, maps out the content of each class, develops a syllabus, and identifies pertinent class readings. An important activity of the mentor in these meetings is helping the resident design teaching activities (e.g., patient vignettes and/or audiovisual material) that will effectively help students achieve the learning objectives.

The teaching phase begins in the classroom. The resident and mentor review the climate and content of each week’s class and plan for the next class. This helps the resident develop flexibility in response to the classroom environment. During this phase, the mentor observes one class and offers feedback during a subsequent meeting to further help the resident adjust the content and his or her teaching style as the course progresses.

In the final phase, the mentor helps the resident develop an anonymous, written feedback form to solicit learner recommendations for improvement and to measure whether the learning objectives were met. The resident and mentor review this feedback together and revise the course accordingly.

Once the first round of teaching and evaluation ends, the resident is encouraged to teach the course again (e.g., to each cohort of students or residents rotating through a unit). Periodic refreshers with the mentor are also encouraged to discuss any difficulties that emerge and to foster the mentorship.

The Growing Teachers elective has been offered for 3 years and was completed by two senior residents; an additional resident was enrolled at the time of writing. The first participant (AR) developed a 12-week course in supportive psychotherapy, which she first taught to medical students and junior residents rotating through an outpatient program and has continued to teach as a junior faculty member. The second resident (AM) developed two courses: a 4-week module on conducting psychotherapy with inpatients who have severe and persistent mental illness, which she taught to three cohorts of medical students and junior residents rotating through an inpatient unit during her senior year and has continued to teach as a junior faculty member, and an 8-week module on psychodynamic psychotherapy taught so far to two groups of residents from a neighboring residency program. The third participant is currently in the teaching phase of a course designed to teach junior residents how to write an initial psychiatric evaluation and is scheduled to repeat this course throughout the 2009—2010 academic year. Thus, participants have created courses that could be taught multiple times and are an ongoing part of the didactic curriculum.

All participants in this elective were mentored by a senior clinician (DC) who is a member of the institution’s teaching academy and well versed as an educator. Participants also consulted with a separate faculty member of their choice with expertise in the courses’ content. The planning phase has ranged from about four to eight mentoring sessions, the teaching phase varied depending on the length of the module, and the evaluation phase lasted one session. In its entirety, the elective has typically lasted from 6 months to 1 year.

The residents who completed this elective have received excellent feedback, comprised of both written evaluations from the students obtained on the last day of the course and verbal feedback from the mentor, which was collectively reviewed in a 45-minute session between the mentor and resident. Learner feedback indicated that students were enthusiastic about the topics, format, clinical relevance, and quality of teaching. The residents used the constructive criticism to enhance their teaching of subsequent groups of learners. The following represent feedback on the elective from the three participants:

The Growing Teachers elective offers residents the opportunity to learn pedagogical skills that are essential for their development as educators. It does more than simply offer residents the chance to teach or to take a short course on how to work with medical students; it systematically teaches residents to plan, execute, and evaluate their own teaching module. It also demonstrates the advantage of basing all educational experiences on well-delineated, measurable learning objectives (⁹) and provides an invaluable rubric for developing any type of educational experience, such as courses, case conferences, and supervision.

This elective has myriad benefits. The residents receive an opportunity to learn skills that are essential for good teaching but are rarely taught in medical education (¹⁰). Having the opportunity to teach the same module several times helps residents gain mastery and competency over the material and the experience of teaching. Teaching is also an effective way of consolidating their knowledge and skills (⁹).

Learning pedagogical skills and experiencing the gratification of interacting with students can interest residents in teaching careers. Identification with the mentor can also demonstrate to residents that teaching and developing educational experiences for students is a viable career option, on par with research or clinical work, and can thus expand their thinking about future career directions. For residents who pursue roles as educators, teaching responsibilities in residency can aid in the transition to junior faculty.

For the program and/or department, resident-teachers inject enthusiasm into the curriculum and add valuable teaching staff. The elective also enables teaching programs to "grow" their own educators and teach best practices, thus fostering excellence early in residents’ careers.

The fourth postgraduate training year presents an ideal time to offer this elective because senior residents have a broad knowledge base, extensive clinical experience, potential elective time, and interest in career planning. Although we require all fourth-year residents to teach small groups of medical students, we have kept the Growing Teachers elective optional because we think that the intensive nature of the project works best with willing and enthusiastic participants. In our experience, the residents’ choice not only to teach a course but also what to teach increases their zeal for the elective and fosters a sense of ownership over the material.

Intensive, individualized electives are clearly time-consuming for residents and faculty. However, the weekly time commitment for the faculty member in this elective is similar to that of a supervisor. Faculty members who are accomplished educators can be identified as "education mentors" and potentially relieved of other responsibilities while involved in pedagogical electives. For the resident, this can easily become one aspect of a senior rotation in an outpatient clinic, an inpatient unit, an emergency department, or a consultation-liaison service—activities already undertaken by many senior residents. Because the preparation, teaching, and mentorship involved in this elective are conducted at the discretion and pace of the resident, it does not interfere with other clinical responsibilities.

To our knowledge, this is the first resident elective that systematically instructs and mentors a resident through the stages of developing and implementing a new course. With this elective, residents not only learn effective teaching skills but also the steps involved in curriculum development—tools important for any academic psychiatrist.

At the time of submission, the authors reported no competing interests.