Design and Implementation
Prior to implementing this curriculum, the Department of Internal Medicine (IM) offered a “Teaching Resident Rotation” to third-year residents in which teaching experiences were concentrated into one month and only accommodated one-third of the cohort. In July 2015 the residency program adopted a 4+1 (X+Y) schedule which allowed implementation of a longitudinal 3-year teaching skills curriculum for all residents (Figure 1).[12]
The curriculum was designed and implemented using a six-step approach to curriculum development.[13] In the planning phase the Resident Teaching Skills Committee comprised of educators from the Department of IM and medical education experts from the Office of Consultation and Research in Medical Education (OCRME) conducted a review of RAT literature.[7, 9, 10, 14] The committee created a list of teaching topics relevant to residents’ teaching responsibilities and opportunities. Each member independently ranked topics in order of importance (Supplemental table 1). The most highly ranked topics were discussed, and fifteen teaching skills were chosen to be delivered over three years. Teaching skills sessions with associated learning objectives are listed in Table 1. Every 10 weeks residents participated in a topic-specific experiential skills-based workshop which utilized various educational strategies including video-taped scenarios, small-group discussions, role-play, and reflection. IM/OCRME faculty and chief residents facilitated the workshops. Each workshop followed the same pedagogy (Figure 2) starting with debriefing/ reflection on residents’ deliberate practice of the previously taught skill and introduction of a new skill followed by practice with feedback from clinician educators and peers. To promote deliberate practice, before leaving the workshop every resident committed to personal action plan aimed at furthering skill development related to that session topic. Pocket cards summarizing key take-home points were distributed at the end of each session (Supplemental table 2A-H). Residents were expected to attempt to implement their personal action plan and these experiences were debriefed allowing for individual/group reflection to deepen learning and efficacy in using these skills. Pocket cards with workshop learning objectives were distributed electronically to all departmental faculty allowing them to reinforce and provide workplace-based feedback on the teaching skill residents were practicing. (Supplemental table 3).
Data Collection
Several measures were used to assess characteristics of participants and perceived impact of the curriculum on learners’ confidence and skills. Information on baseline experience and teaching interest (Supplemental table 4) was collected from all residents at the beginning of Year One. At the end of each year (for three years), participants completed: 1) assessment of overall confidence in using each teaching skill (Supplemental table 5); and 2) retrospective pre-post self-assessment comparing their perceived competence with each teaching skill at the end of each year. (Supplemental table 6).
Overall data was collected for three years; PGY1, PGY2 and PGY3 cohort data was collected for three, two and one year, respectively. Participants completed a curricular satisfaction at the end of three years (Supplemental table 7).
Response to the Association of American Medical Colleges (AAMC) Graduation Questionnaire (GQ) survey asking medical students to evaluate IM resident teaching effectiveness during their clerkships was reviewed prior to and after implementation of the teaching skills curriculum to further assess impact of the curriculum.
Data Analysis
Confidence and self-assessed competence in performing each teaching skill was assessed using a 5-point Likert scale (“4” or “5” considered confident and self-assessed competence). Wilcoxon signed-rank test was used to test change in response at each post-assessment compared to baseline and compared to prior year post-assessment. Jonckheere-Terpstra test for ordered differences was used to assess the differences in confidence scores among program years. Statistical analyses were performed using SAS version 9.4.
This project was deemed non-human-subjects research by the Institutional Review Board of the University of Iowa.