The Surgery Resident's Role in Teaching Medical Students

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The Surgery Resident's Rolein Teaching Medical
Students

• Larry Tan, MD
• Director, Surgery Undergraduate
• Department of Surgery
• University of Manitoba
• March 2010

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Objectives

• Medical school accreditation process
• Description of Education Directive 24
• How ED-24 applies to residents who act as
  teachers
• How ED-24 is implemented in the Department of
  Surgery
• Resident's role in teaching medical students in
  the clerkship rotation and in formal teaching
  sessions
• Feedback on resident teaching from the medical
  students
• Note blue text are hyperlinks

ED-24
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• Medical School Accreditation

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Medical School Accreditation

• Liaison Committee on Medical Education is the
  accrediting body for all North American medical
  schools
• LCME determines whether medical schools meet
  established standards for structure, resources
  and education delivery
• Educational Objectives are outlined in ED-01 to
  ED-47
• ED-24 is an objective found to be poorly
  implemented in accreditation of other North
  American medical schools

ED-24
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LCME Accreditation Actions

• Possible outcomes of accreditation are
• Grant accreditation status (full, preliminary or
  provisional) or deny accreditation for new
  schools
• Continue accreditation status, with or without
  specifying terms
• Continue accreditation, with warning of probation
• Continue accreditation, with probation
• Withdraw accreditation

ED-24
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University of Manitoba Accreditation Schedule

• Previous accreditation 2004 full approval,
  with areas of partial non-compliance, including
  ED-24
• Upcoming accreditation
• LCME secretariat visit March 1-2, 2010
• Mock accreditation (voluntary) November 2010
• Database submission to LCME January 2011
• LCME accreditation visit April 2011
• Accreditation report June 2011

ED-24
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Accreditation Probation

• Probation for
• One or more areas of noncompliance that must be
  corrected in 12-24 months
• Previously identified areas of noncompliance that
  have not been corrected
• Medical schools placed on probation must inform
  the public within 24 hours, e.g. Dalhousie
  University 2009
• Failure of probation can lead to withdrawal of
  accreditation
• University of Manitoba was in partial
  non-compliance with ED-24 in 2004

ED-24
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What Is ED-24?

• An Educational Directive that governs oversight
  of teaching interactions between residents and
  medical students.
• Residents must know the objectives for the
  medical students they are teaching.
• Residents must be given training in how to teach.
  In cases where performance is weak, residents
  must be given remedial training.
• Students should provide feedback on residents who
  teach them.
• Residents should receive feedback on their
  teaching performance from faculty and students.

ED-24
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ED-24

• Minimal expectation 1
• Residents and other instructors who do not hold
  faculty ranks (such as graduate students and
  postdoctoral fellows) should receive a written
  copy of the course/clerkship objectives and clear
  guidance from the course/clerkship director about
  their roles in teaching and evaluating medical
  students.
• From www.lcme.org

ED-24
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ED-24

• Minimal Expectation 2
• The institution and/or relevant departments
  provide resources such as workshops/written
  materials to enhance the teaching and evaluation
  skills of residents and other non-faculty
  instructors.
• From www.lcme.org

ED-24
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ED-24

• Other Expectations
• There should be central monitoring of the level
  of resident/other instructor participation in
  activities to enhance their teaching/evaluation
  skills.
• The LCME encourages formal assessment of the
  teaching and evaluation skills of residents and
  other non-faculty instructors, with opportunities
  provided for remediation if their performance is
  inadequate.
• From www.lcme.org

ED-24
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Implementation of ED-24

• ED-24 implementation is a shared responsibility
  of
• Faculty Undergraduate Medical Education office
• Faculty Postgraduate Medical Education office
• Department of Surgery Undergraduate program
• The surgical residency and fellowship programs
• The Surgery residents and fellows

ED-24
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ED-24 - Implementation

• In the Department of Surgery, ED-24 must be
  implemented across
• 24 clerkship rotations at seven sites
• six Royal College primary residency programs
• two Royal College fellowship programs and
• 10 other fellowship programs

ED-24
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• The Surgery Resident's Role in Teaching Medical
  Students

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CanMEDS Scholar Role

• Physicians...facilitate the learning of
  ...students...
• Describe principles of learning relevant to
  medical education
• Collaboratively identify the learning needs and
  desired learning outcomes of others
• Select effective teaching strategies and content
  to facilitate others' training
• Demonstrate an effective lecture or presentation
• Assess and reflect on a teaching encounter
• Provide effective feedback
• Describe the principles of ethics with respect to
  teaching

From http//rcpsc.medical.org
ED-24
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Three Types of Teaching Responsibilities

• Service- or rotation-based teaching
• Ex. supervising a clerk rotating on your service
• Formal teaching sessions assigned by service or
  residency program
• Ex. presenting at service rounds or grand rounds
  to an audience that includes medical students
• Formal teaching sessions assigned by Department
  of Surgery Education Office
• Ex. teaching knot-tying or the breast
  examination to medical students

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Service- or Rotation-Based Teaching

• Patient-centered, ward-based, often informal
• Daily opportunity for teaching
• Clerkship objectives are available for each
  rotation residents must read these objectives
• Residents must know their own objectives in the
  CanMEDS Scholar domain

ED-24
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Written Copy of the Course/Clerkship Objectives

• Latest versions of the clerkship rotation
  descriptions are found on the undergraduate
  webpage for the Department of Surgery
• Residents must read the clerkship objectives and
  rotation information for the general surgery and
  selective rotations in which they supervise
  medical students
• Feedback and corrections are welcome please
  email surgundergrad_at_hsc.mb.ca

ED-24
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Teaching Assigned by Service or Residency Program

• Formal, scheduled sessions
• Occur weekly or monthly
• Residents should provide objectives for academic
  presentations e.g. objective page on a
  Powerpoint presentation
• Objectives can be developed in conjunction with
  the residents' preceptors
• Please keep the students' educational goals in
  mind

ED-24
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Teaching Assigned by Department of Surgery
Education Office

• At present, very few teaching sessions assigned
  to residents, pending development of
  comprehensive objectives and teaching scripts for
  each session
• In the future, the objectives and the teaching
  material for all teaching sessions will be
  available through OPAL, allowing more resident
  participation

ED-24
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Evaluation of Medical Students

• MITERs are discussed at mid-point of rotation
  formative feedback
• FITERs are completed by the attending staff at
  the end of the rotation summative feedback
• Residents provide feedback on student performance
• FITERs are divided into cognitive domains similar
  to CanMeds
• Resident feedback is incorporated into the FITER
• Copy of Surgery Clerkship FITER and MITER
  available on Department of Surgery Undergraduate
  Education webpage

ED-24
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Educational Resources

• New resident orientation
• TIPS program
• Surgical Foundations Seminar Series
• One-minute preceptor
• Giving effective feedback
• Faculty development workshops
• Public-speaking workshop for PGY3s
• OPAL (Online Portal for Advanced Learning)
  training and workshops

ED-24
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Feedback on Resident Teaching Performance

• Comprehensive online mechanism under development
  by Faculty of Medicine, implemented via OPAL
• Most residency and fellowship programs have a
  mechanism for providing feedback on resident
  teaching performance (e.g. paper-based forms,
  T-Res, WebEval, One45).
• The students on service should also provide
  feedback.
• Feedback should be collected and reported every
  6-12 months to allow anonymity for the student
  responders.

ED-24
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Summary

• Implementation of ED-24 will require cooperation
  and coordination among the students, residents,
  program directors, teaching staff, the Department
  of Surgery and the Faculty of Medicine
• Please review the clerkship objectives and
  evaluation forms for your rotation, available
  through the Surgery clerkship webpage
• www.umanitoba.ca/faculties/medicine/units/surgery/
  education/undergrad/rotation/index.html
• Feedback and comments - surgundergrad_at_hsc.mb.ca

ED-24