Summary of format, content, and effects of teaching-skills training programs involving family medicine residents
| TEACHING-SKILLS CURRICULUM | EVALUATION (ACCORDING TO KIRKPATRICK’S LEVELS OF EVALUATION 20)* | |||||||
|---|---|---|---|---|---|---|---|---|
| STUDY | PARTICIPANTS | FORMAT | CONTENT | MEASUREMENT TOOL | REACTIONS (APPRECIATION) | LEARNING | BEHAVIOUR (TEACHING BEHAVIOUR) | FM FINDINGS |
| Lawson and Harvill,12 1980 | FM and internal medicine residents | 13 1-hour weekly sessions | Objectives and planning; delivery methods; discussion and questioning; demonstration techniques (audiovisual and lecturing) | Videotaped teaching performances and written questionnaire | NA | NA | Significant (P < .001) gains in teaching performance (eg, delivery, organization, explanation, use of audiovisuals) and in attitude toward participating in a teaching-skills program | Not mentioned |
| Edwards et al,16 1988 | First-year residents in medicine, FM, obstetrics, and gynecology | 1 half-day course | Communicating objectives; motivating; directing attention; teaching procedures; feedback; evaluation | Randomized controlled trial; trained raters’ evaluation of videotapes, residents’ self- rating, and students’ ratings | NA | NA | Higher scores on evaluation of teaching skills in the experimental group compared with the control group | Before instruction, FM and medicine residents were rated significantly higher on formulating differential diagnoses; no other differences between specialties were statistically significant |
| Swanson et al,19 1992 | FM residents | Not specified | Presentation skills | Randomized controlled time series design; presentations were evaluated using a standardized format | NA | NA | Educational intervention can improve FM residents’ presentation skills; education coupled with repeated opportunities for presentation produces greater improvement than repeated presentations alone | Not mentioned |
| Morrison et al,13 2003 | Generalist residents (FM, internal medicine, pediatrics) | Longitudinal curriculum: 3-hour mini-retreat and 10 1-hour noon conference sessions in which interdisciplinary groups of 10 residents reviewed homework, brainstormed about teaching skills, and for 30 minutes actively practised the module’s skills in pairs or groups (with “standardized learners”) and mutually provided feedback | “Teachable moment” concept; “five-step microskills” model of clinical teaching Teaching skills: leadership and role modeling; orienting learners; giving feedback; bedside teaching; teaching procedures; group teaching, inpatient work rounds; teaching charting; giving mini- lectures | Randomized controlled trial; 3.5-hour, 8-station OSTE designed specifically to test clinical teaching skills of primary care residents; CTPI, a 28-item Q-sort instrument that measures comfort with clinical teaching | NA | NA | Intervention group improved their mean overall OSTE scores by 22.3% (more than 2 SD) from pretest to posttest | Not mentioned |
| Morrison et al,14 2004 | Generalist residents (FM, internal medicine, pediatrics) | Longitudinal curriculum: 3-hour mini-retreat and 10 1-hour noon conference sessions in which interdisciplinary groups of 10 residents reviewed homework, brainstormed about teaching skills, and for 30 minutes actively practised the module’s skills in pairs or groups (with “standardized learners”) and mutually provided feedback | “Teachable moment” concept; “five-step microskills” model of clinical teaching Teaching skills: leadership and role modeling; orienting learners; giving feedback; bedside teaching; teaching procedures; group teaching, inpatient work rounds; teaching charting; giving mini- lectures | Randomized, controlled trial; 3.5-hour, 8-station OSTE for generalist resident teachers; semistructured interviews 1 year after the curriculum for some participants | If the curriculum were shortened, participants recommended that the modules on teaching charting and bedside teaching be eliminated | 1 year after the program, residents in the intervention group had a richer, more elaborate understanding of teaching principles and skills | Mean overall posttest score for residents in the intervention group improved by 28.5%; control residents did not improve significantly on the overall posttest (2.7%) or on any station; 1 year after the program, intervention residents had greater enthusiasm for teaching during and after residency, had greater learner-centred approaches, and most planned to teach after residency (most control residents did not) | Not mentioned |
| Farrell et al,18 2006 | Program aimed at emergency medicine residents | 6 on-line modules | General principles of clinical teaching; effective feedback; teaching procedures; teaching with high-fidelity patient simulation; effective discussion-leading and lecturing | NA | NA | NA | NA | NA |
| Jain,15 2007 | Third-year FM residents | 10–12 1-hour weekly sessions: lectures, interactive discussions, video vignettes, role- playing sessions; residents referred to multiple resources (eg, websites); guidance from faculty supervisors | Qualities of adult learners; assessment of knowledge, attitude, and skills; tips for effective teaching; provision of effective and useful feedback | NA | NA | NA | NA | NA |
| Aiyer et al,17 2008 | First-year residents in various specialties (emergency medicine, FM, internal medicine, pediatrics, neurology, neurosurgery, obstetrics, gynecology, radiology, surgery) | 1-day mandatory intensive workshop, repeated 3 times a year so that all first-year residents could attend; concludes with an OSTE followed by a discussion | Orienting the learner, which included discussion of the individual clerkship goals and objectives; using clinical teaching microskills; giving feedback to learners; and evaluating student learners | Pre-post self- assessment surveys | Residents felt more prepared, enthusiastic, and confident about their ability to teach; increased understanding of what was expected of them as teachers; lower anxiety level regarding teaching; unchanged perception of teaching by positive example | Increased understanding of the difference between feedback and evaluation; no difference in understanding of the differences between giving someone feedback and a compliment or criticism | Residents more inclined to explain their role to team members, solicit learning goals from team members, and plan to meet each learner’s personal learning objectives; increased willingness to use the clinical teaching microskills and to make learners aware of the extent to which they give feedback, provide daily feedback, and provide feedback that is descriptive in nature; no increased willingness to admit “I don’t know,” to teach by positive example, or to wait at least 3 seconds for a response after asking a question | No specific analysis for FM residents; primary care residents noted a greater increase in their confidence in teaching ability and in assuming team control compared with non primary care residents; primary care residents’ self- ratings of their willingness to encourage bedside teaching and provide daily feedback to their learners showed a much greater increase compared with non primary care residents |
CTPI Clinical Teaching Perception Inventory, FM family medicine, NA not applicable or not assessed, OSTE objective structured teaching evaluation.
↵* None of the studies assessed results (patient or learner outcomes), Kirkpatrick’s fourth level of evaluation.