Residents are first-line teachers of medical students during the basic psychiatry clerkship. Through their daily interactions, residents provide considerable instruction to medical students regarding the evaluation and management of patients. In addition, residents are called upon to provide feedback, both formative and summative, to students regarding their developing skills. Surveys of residents themselves indicate a desire for specific preparation relative to teaching (1), yet few have formal training in teaching before residency. Both the Accreditation Council for Graduate Medical Education (ACGME) and the Liaison Committee on Medical Education (LCME) mandate that residents be prepared for their teaching role but do not specify how this should be done (2, 3).

Published reports of residents-as-teachers programs vary from brief one-time workshops (4) to more extended curricula over a number of months (5). Most of these reports are in disciplines other than psychiatry. The content of these teaching programs have focused on the learning environment and feedback, evaluation, and teaching theory (6, 7). A number of studies indicate that teaching programs for residents can be effective in improving resident self-reported behavior and confidence to teach (6, 8, 9). However, short interventions often do not lead to lasting improvements in teaching ability, and decrements in teaching skills have been reported without periodic reinforcement (7, 8).

Currently, there are no national guidelines regarding the content or goals for residents-as-teachers programs. While some aspects of teaching medical students are similar for residents across disciplines, a “one size fits all” approach will naturally include content that is not relevant to the psychiatry clerkship while omitting specific instruction in areas of importance to psychiatry, such as psychiatric interviewing and performing the mental status exam. Therefore, an effective residents-as-teachers program for psychiatric residents will need to include content specific to the learning environment and skill objectives of the psychiatry clerkship (1, 10).

During the 4-week basic psychiatry clerkship at the Johns Hopkins University School of Medicine, PGY-2 residents play a vital role in the education of medical students: supervising student clinical work and interactions with patients, evaluating required case write-ups, and providing end-of-clerkship evaluations of student clinical performance. Past resident preparation for teaching clerkship students included two orientation sessions focused on the goals, objectives, and structure of the clerkship as well as an overview of basic principles in giving feedback to students and instruction in evaluating student work. During the 2008–2009 academic year, didactic instruction to PGY-2 residents on teaching medical students was expanded through the addition of a series of five 1-hour sessions over a 3-month period focused on teaching and evaluating specific skills significant to the psychiatry clerkship. It was hypothesized that this multipart, longitudinal seminar series would increase resident confidence about teaching and would be beneficial in maintaining a high level of resident enthusiasm for teaching.

This article describes the curriculum that was delivered during the five-part teaching series and presents results of the resident feedback survey regarding the program.

Setting

The basic psychiatry clerkship is a 4-week required clinical clerkship for all medical students at the Johns Hopkins University School of Medicine. Each student is assigned to an inpatient psychiatry team at the Johns Hopkins Hospital on one of four inpatient psychiatry floors consisting of one or two PGY-2 residents and an attending psychiatrist. The PGY-2 residents rotate monthly on each of the 12 inpatient clinical teams.

Teaching Curriculum

The five teaching seminars were each 1 hour in duration and took place over the noon hour with lunch. All five sessions were delivered by the psychiatry clerkship director. While specific content was presented at each session, residents were also encouraged to share concerns from their teaching experiences with medical students, allowing for mentored discussion of problems and questions which developed during the year.

Table 1 describes the curriculum content of each of the teaching sessions. Sessions 1 and 2 focused on how to teach psychiatric interviewing skills. Session 3 covered how to establish and maintain a mentoring relationship with students on the wards. Session 4 addressed how to give feedback to medical students. Session 5 focused on how to evaluate student case write-ups.

Resident Feedback

The seminar series was, in essence, a program enhancement; as part of this quality improvement initiative, residents were surveyed prior to the beginning and at the conclusion of the seminar series regarding their attitudes related to teaching clerkship students. All 13 PGY-2 residents completed the preseminar questionnaire and 11 residents completed the postseminar questionnaire. The preseminar survey asked about prior teaching experience, and both pre- and postseminar surveys asked residents to rate themselves on the following items using a 3-point Likert response scale (1=very confident, 2=moderately confident, 3=low confidence):

In addition, the postseminar survey asked residents to rate the helpfulness of each of the sessions on teaching interviewing skills, giving feedback, and evaluating student case write-ups using a 3-point response scale (1=very helpful, 2=moderately helpful, 3=minimally helpful).

Teaching Experience

Ten of the 13 PGY-2 residents (77%) reported having had some teaching experience before residency. Of these, six had done tutoring, seven were teaching assistants in college or medical school, and two were primary classroom teachers. Over one-half had more than one prior teaching experience.

Confidence for Specific Teaching Skills

There were large pre- to postseminar increases in the percentage of residents who endorsed being “very confident” in performing four of six specific teaching skills, namely, interviewing, mental status exam, case formulation, and student evaluation (Table 2). The greatest increases were seen in confidence to teach formulation and evaluation of students.

Interest Level for Teaching

Prior to the teaching seminars, 10 residents (77%) reported their interest level for teaching was “high” and 10 (77%) reported their level of satisfaction from teaching was “high.” After the seminars, nine residents (82%) reported their interest level for teaching was “high” and eight (73%) reported their level of satisfaction from teaching was “high.” No resident reported a “low” level of interest in or satisfaction from teaching, either before or after the teaching seminars.

Helpfulness of the Teaching Seminars

Four residents (36%) found the sessions “very helpful” in teaching interviewing skills, six (55%) found them “moderately helpful,” and one (9%) found them “minimally helpful.” Five residents (45.5%) found the sessions “very helpful” in giving feedback to students, five (45.5%) found the sessions “moderately helpful,” and one (9%) found them “minimally helpful.” Two residents (18%) found the sessions “very helpful” in evaluating student write-ups, and eight (73%) found them “moderately helpful.” One resident missed the session related to evaluating write-ups and did not respond to this item.

At the end of the teaching seminar series, a greater percentage of PGY-2 residents rated themselves as “very confident” in teaching medical students on all measures sampled except supervising students. The greatest changes in confidence to teach were seen for teaching psychiatric formulation and in evaluating students. Notably, these were the two areas where PGY-2 residents felt least confident prior to the seminar series, suggesting that the corresponding seminars were especially helpful.

The teaching-to-teach curriculum reported here is distinct from other reported curricula in that it focused on providing didactic instruction to psychiatric residents to prepare them to teach psychiatry-specific skills of interviewing, doing a mental status exam, and developing a psychiatric formulation. Although the majority of PGY-2 residents in this study had prior teaching experience before residency, nearly all reported the teaching seminar sessions to be moderately helpful or very helpful. This suggests that the teaching skills required for residents during the psychiatry clerkship are quite specific and are not developed in other teaching experiences. Thus a teaching-to-teach curriculum designed for psychiatric residents fills an important educational niche by focusing on the skills distinctly needed during the clerkship.

Resident self-reported levels of interest in teaching and satisfaction from teaching were high both before and after the seminar series. Edwards et al. (7) and Wamsley et al. (8) have argued for the importance of reinforcing teaching principles to prevent degradation of teaching skills over time. While it is not possible to know whether interest and satisfaction would have remained high without the seminar series, it is likely that the longitudinal curriculum may have contributed to sustaining enthusiasm for teaching by providing on-going mentored support and discussion.

Of note, a relatively low percentage of residents reported feeling “very confident” in providing feedback to medical students at the beginning and at the end of the seminar series (23% and 36%, respectively). This likely reflects the fact that giving face-to-face feedback is generally challenging to do. The fourth teaching session on giving feedback discussed how to approach and carry out a feedback session with a student, and it included presentation of a video of a hypothetical feedback session as role-played by School of Medicine faculty. However, role playing by the residents themselves was not included in the seminar series. In the future, consideration will be given to developing role-playing scenarios for residents to enable them to practice giving feedback, as such sessions may strengthen residents’ abilities and confidence in this difficult area. The lack of change in confidence in supervising students was surprising given that session 3 was dedicated to this content area. One possible explanation is that the survey terminology (“supervise students”) was different than the corresponding terminology in session 3, which was entitled “establishing a relationship with clerkship students.”

This study has other limitations. Due to the small sample size, statistical comparisons could not be performed. In addition, since the longitudinal curriculum extended over a 3-month period of time, it is possible that some of the reported increases in self-confidence to teach may have been due to maturation and to continued teaching experience. Finally, this study looked at PGY-2 self-reported assessment of confidence to teach but did not examine resident teaching performance or teaching effectiveness. This should be a future focus of study.

Still, this report adds to the literature on residents-as-teachers by describing a teaching-to-teach curriculum specifically tailored for PGY-2 residents and focused on the skills that psychiatric residents are called upon to teach during the basic psychiatry clerkship. The findings of this study suggest that these sessions can be effective in improving resident confidence to teach during the psychiatry clerkship.

At the time of submission, Dr. Lehmann reported no competing interests.