“An academical system without the personal influence of teachers upon pupils is an Arctic winter.” Attributed to Sir William Osler
This report describes a novel part of the Teaching Residents to Teach program that we have developed at Temple University School of Medicine: the appointment of a Chief Resident for Education or “Academic Chief.” The inception of this position grew out of the interest of a uniquely talented resident who was interested in an academic career, resident and student education, and modern theories of teaching and learning. It has since become an established and sought after senior resident position, and one that has now been duplicated at other schools (1). To put this special appointment in its educational context, we will describe some of the resident-as-teacher history and literature. We have described our course curriculum that focuses on the concepts and application of modern, adult learning theories elsewhere (2). Though the mechanism has not been determined, it has been found that residents’ teaching skills improve when they acquire knowledge of learning theory and teaching techniques and that these enhance their sense of clinical skill and mastery (3). In addition, it is thought that grasping these basic learning tenets helps residents become more cognizant of their own learning styles and to strive to become independent, self-motivated learners and teachers. Thus, we have made adult learning theory a focal point for our academic chief position and overall program.
Medical education and accrediting bodies have articulated the need to provide specific instruction in teaching techniques. The Liaison Committee on Medical Education requires that there be “…links… [of] medical student education to graduate medical education programs” and that all staff teaching medical students be adequately trained in teaching techniques (4). The Accreditation Committee for Graduate Medical Education requires that “Clinical training should provide sufficient experiences in: teaching psychiatry to medical students, residents, and others in the health professions,” and that “Residents must be instructed in appropriate methods of teaching, and have ample opportunity to teach students in health professions” (5). Medical students report a high level of learning from their clinical house staff. As early as 1966 they reported that one-third of their clinical learning was supervised by residents (6). This has increased to about one-half of their clinical education, as reported on recent American Association of Medical Colleges Graduation Questionnaires (7). In 1970, residents across all specialties reported spending 20% to 25% of their time teaching and evaluating medical students (8). However, formal residency training in teaching lagged for many years, with only 20% of internal medicine residencies having formal programs to improve teaching skills in 1993 (9). Since then, however, the resident-as-educator literature has become rich with innovative programs. Some of these include Morrison’s (10) intensive “13-hour curriculum” in internal medicine, Loyola’s psychiatry program utilizing student feedback to inspire resident attention to teaching medical students, and Wright State’s emphasis on direct faculty observation and feedback, and team-based learning in psychiatry (11) As noted, psychiatry at Wright State has now utilized the academic chief position to enhance their teaching programs (1).
Historically, chief residents in psychiatry have academic as well as administrative responsibilities. At Temple, we designated the additional Chief Resident for Education, specifically, to spearhead our resident-as-educator program and to work on and enhance medical student education, some aspects of residency training, and to pursue his or her own educational scholarship endeavors. Our appointment of a Chief Resident for Education addresses the increasing national focus on teaching competence, and serves several functions for the resident, the program, and for medical students. Just as the role of the subintern bridges the path from clerk to resident, so does the academic chief resident position transition the senior resident to junior faculty (12). The formalization of this role adds a layer of mentorship between academic faculty and residents. It promotes the career of a senior resident interested in an academic appointment and ideally allows them protected time to engage in scholarly activities such as educational research, presentation at national meetings, enhancing teaching skills, and developing educational curricula for both graduate and undergraduate medical education. Medical students benefit directly as recipients of the academic chief’s teaching, and indirectly, in their observation of the resident’s career development. They see, also, the value we place on education at the undergraduate and graduate level. This chief serves as an academic role model to the students and junior residents. The Academic Chief partners with the Administrative Chief to preserve and promote the integrity of our educational mission for both students and residents.
Since we began this position 5 years ago, our Academic Chiefs have had varied interests and have served different leadership roles within our department. All of their activities have been supervised by both the Residency Training Director and the Director of Medical Student Education in Psychiatry. The first Academic Chief, now a member of our faculty, assisted in the curriculum development and implementation of our Teaching Residents to Teach course, which has been described elsewhere (2). She worked on novel aspects of this course implementation including an extensive module on the application of adult learning theory. With the Administrative Chief, she designed a survey mechanism to deliver timely medical student feedback to residents about their teaching skills. This has given all residents the beginning of a teaching portfolio by the time they leave the residency. In addition, she revised major portions of the residency curriculum, provided individual case supervision to the psychiatry subinterns, precepted second-year medical students in the doctoring course, and organized peer teaching didactics and a journal club. She did research, presented at two national meetings, and served on departmental educational committees. Subsequent chiefs have had different focuses depending on their particular interests. All have presented at national meetings, supervised subinterns, lectured to third-year clerks, and have studied adult learning theory and its application to medical education. One completed her doctoral thesis in public health and another pursued subspecialty training. Our current Academic Chief is spearheading the next iteration of our teaching program. This is a group supervision venue designed for residents who are particularly interested in teaching medical students. This was modeled after our group for junior faculty using a case-based, nonhierarchical consensus style of supervision (13). The success of this model, based on participant satisfaction, was attractive to our residents who wished to duplicate the ongoing format to discuss student specific problems.
All of our academic chief residents report that they have derived enhanced teaching skills, self-confidence in those activities, and career development benefits from the implementation of the position. Their growing teaching portfolios and scholarly presentations and manuscripts have placed them in an excellent position to negotiate and transition to their first academic appointments and even promotions. Students are grateful for our attention to their education, knowing the special role of the chief, the curriculum for all residents, and the added “layer” of mentorship.
Although there are mandated requirements for training of residents as teachers of medical students, it is unproven that it results in objective measurable improvements in learning and performance. There may actually be inherent problems in having residents be highly responsible for the education of medical students. Their own lack of experience, relative unsophisticated content and clinical knowledge, closeness in development and identification, and desire to be liked may make them less effective teachers of medicine. This would be an important longitudinal research question to answer: to establish a formal method to measure educational benefit and effectiveness of our or any program and actual improvement in teaching and learning. Student recruitment is always a priority for academic psychiatry departments. What is the outcome of the role modeling of our best resident teacher? This, too, is a legitimate research question that needs to be addressed.
In summary, educational techniques and tools are central to the practice of clinical medicine and medical education. The literature suggests that knowledge of these theoretical constructs enhances adult teaching and learning as well as clinical self-efficacy. Our special appointment of a Chief Resident for Education is a potential model for other programs to help transition exceptional trainees into clinician educators: a stepping-stone to an academic career.
At the time of submission, the authors disclosed no competing interests.