Residents as Teachers: Strategies for Improving Peer Based Education in a Community Based Residency Program

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Residents as Teachers Strategies for Improving
Peer Based Education in a Community Based
Residency Program

• Bernard Birnbaum, MD
• Kim Marvel, PhD
• Kristen Bene, MS
• Fort Collins Family Medicine Residency Program
• Fort Collins, CO
• STFM Annual Meeting 2008

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Seminar Goals and Objective

• Identify the limited research on peer based
  education in medicine
• Describe strategies used to improve resident peer
  teaching
• List challenges inherent in peer based education
  and curricular ways of addressing these challenges

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Seminar Structure

• Introductions
• Rationale
• Brief review of the literature on peer based
  education
• Brief summary of the FCFMRP Curriculum
• Small Group role play and discussion
• Large Group discussion about peer based education
• Summary

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Introductions

• Bernard Birnbaum
• Kim Marvel
• Kristen Bene
• And YOU???

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Why are we doing this seminar?

• A large percentage of resident learning is peer
  based and nearly 50 of family medicine programs
  have curricula
• Most literature on residents as teachers is based
  in university programs or IM/Peds settings how
  are community programs different?
• We developed a residents as teachers curriculum
  and noted a lack of research addressing the
  challenges of peer-peer education or near-peer
  education

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Literature Review

• What research has been done?
• Pearls from the literature
• Near-peer teaching

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Literature Review

• Cate and Durning (2007) review of 2006 articles
  and conference abstracts on peer teaching. Found
  7 articles and 21 conference abstracts. Talked
  about but not published.
• Most comes out of IM, Surgery, Peds. Little in FM
  literature.
• International authors

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Literature Review Pearls

• Rationale for doing peer teaching (Cate and
  Durning, 2007)
• Alleviate faculty pressures
• Offer educational at own cognitive level
• Social role modeling
• Alternative to studying
• Increased intrinsic motivation
• Prepare for role as educator
• Is it successful?
• 2004 literature review found insufficient
  evidence to support increased clinical competence
  from peer teaching, but most studies indicated
  perception of competence increased. (Busari and
  Sherpbeir, 2004)

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Literature Review Pearls

• Psychology of peer teaching
• Cognitive Congruence
• Social role Congruence (near-peers)
• (Cate and Durning, 2007)

Physician
Physician
Physician
Physician
Physician
Medical resident
Medical resident
Medical resident
Medical resident
Medical resident
Teacher
Learner
Teacher
Learner
Teacher
Learner
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Overview of our curriculum

• Three part curriculum
• Yearly seminar for upper level residents
• Yearly discussion session with departing
  residents and upcoming second year residents
• Individual meeting with medicine service upper
  level resident

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Yearly Seminar Logistics

• 3-hour session
• Late in academic year (May or June)
• R-1 and R-2 classes
• Faculty facilitators available for small-group
  activities

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Yearly Seminar Overview of Content

• Review adult learning theory
• Observational learning/Social learning theory
• Learner assessment
• Feedback vs evaluation
• Features of effective clinical teaching
• Teaching styles
• Clinical teaching in 5 steps
• Teaching on our inpatient services
• Practice and roll play the skills

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Yearly SeminarOverview of Content (cont.)

• Review teaching opportunities
• Define resident role as teacher and peer educator
• Specific role of leader/manager of the inpatient
  service

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Yearly SeminarSpecific Topics

• Review the four roles of a clinical teacher
• Physician, supervisor, teacher, person
• Review adult learning theory
• Focus on self-directed learning and adult learner
  needs
• learner assessment
• Discuss setting expectations
• Review the difference between feedback and
  evaluation
• Give strategies for providing effective feedback

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Yearly SeminarSpecific Topics

• Teaching Strategies
• Four steps of clinical teaching
• Needs assessment
• Teaching to the learner
• Feedback
• Reinforcement
• Four Teaching Styles
• Assertive
• Suggestive
• Collaborative
• Facilitative

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Yearly SeminarSpecific Topics

• Strategies for Successful Teaching
• Clinical Teaching in 5 steps model
• Mini-lectures
• Mindful Modeling
• Ongoing feedback
• Patient education student/resident education

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Yearly SeminarSpecific Topics

• Role Plays
• Seminar includes one role play on feedback in the
  middle
• Ends with three scenarios in which groups of
  three role play learners, preceptors, and
  observers
• Ends with group discussion on the challenges that
  came up in the role plays
• Facilitator reinforces points that were covered
  in the seminar

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Yearly Discussion Session

• One-hour session
• All three years attend (especially helpful to
  include departing residents and upcoming second
  year residents)
• Held late in academic year (June)
• Ideas about effective teaching solicited from
  residents
• Summary of ideas are distributed to all residents
  and faculty

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Individual Meetings with Upper-Level Residents

• 15-30 minute meeting between faculty physician
  and upper-level resident
• The goal of this meeting is to check in with the
  upper-level on medicine and see how things are
  going. The objective is to provide the
  upper-level the opportunity to
• Identify personal strengths and weaknesses
  related to teaching on service
• Improve their use of the 5-minute preceptor model
• Review strategies for giving feedback

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One-on-One Meeting Evaluation

• 7 of 11 upper-levels rated the session on
  residents as teachers.
• 5 point scale
• 1 Strongly Disagree to 5 Strongly Agree
• Average ratings
• Satisfied with content 4.0
• Improved my teaching skills 3.85
• Used information as upper-level in hospital
  4.33
• Mtgs have improved peer teaching at program
  4.0

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Seminar Evaluation

• 4 of 11 upper-levels rated the session on
  residents as teachers.
• 5 point scale
• 1 Strongly Disagree to 5 Strongly Agree
• Average ratings
• Satisfied with content 4.0
• Useful role plays 3.75
• Improved my teaching skills 3.75
• Used information as upper-level in hospital
  3.75

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Review of the one minute preceptor model

• Get a commitment
• Probe for supporting evidence
• Encourage discussion
• Reinforce what was right
• Correct mistakes and agree on a learning plan

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Role Plays and Discussion

• 3 groups
• Do role play
• Discuss issues generated by the role play
• Return to large group and present discussion
  points