I have been involved at all levels of medical education throughout my medical career. However, residency training has always held a special place in my heart. It was a particularly challenging time for me, especially as an international medical graduate. One of my co-residents and I always joked that residency was the only time in our lives that we were not “good students,” and the first time we did not feel up to par.
Perhaps there was a reason for that. During undergraduate medical education, the learning was structured, organized, and it was the priority. In fellowship, I had the undivided attention of three wonderful faculty members and an individualized learning plan, resulting in my most impactful training experience Conversely, my residency was the constant juggling of multiple clinical responsibilities, managing different and at times conflicting expectations, limited time for education, and a poor work-life balance This is not much different from the current residents’ experience. The balance between service and education is difficult to achieve and a one size fits all approach prevails in didactics. More than once, residents told me that they received the same lecture every year for each year they were in the program.
In 2020, the Council of Emergency Medicine Residency Directors published an evidence-based guide to best practices in clinical teaching. Based on a critical review of the literature, the paper focused on instructor teaching strategies, clinical teaching models, and adequate use of technology. In this blog post, I will focus on their suggestions for the instructor.
First, be prepared! Not only for lectures but also for bedside and outpatient teaching: review the cases, prepare teaching points in advance, and set expectations for the learners, other team members, and even the patients. I work in a highly specialized clinic, so every week, I send an email to the resident who is rotating with me with the names of the patients they are expected to see the next day, particularly for those that are coming to clinic for the first time. We review the overall expectations of the encounter, how the clinic works, and the cases they will be seeing beforehand. I guide them on the basics of history and neurological examination in behavioral and cognitive neurology, possible red flags, and some specifics for the case in question, based on the information available. This preparation also helps me in reviewing the pertinent literature in more challenging cases or defining the learning points in advance for the appointment.
Second, set the example! Create and foster an environment that is conducive to learning. Take advantage of opportunities to go beyond clinical competence, to educate in communication skills, compassion, and professionalism. A “good clinical teacher” demonstrates not only strong clinical and technical knowledge, but also creates a positive and learning environment, has great communication and teaching skills and is enthusiastic about medicine, education, and people in general.
Third, guide the learners into knowledge integration! Instead of focusing on presenting the full content, choose a few relevant topics for the level of the learner. Whenever possible, alternate between semi-related topics (interleaving) to strengthen learning. This is an important approach during residency, when a similar clinical presentation may be observed across subspecialties within the same specialty. For instance, right-sided weakness may be observed in a patient with a stroke, a brain tumor, or multiple sclerosis. Provide the resident time to think through the case, to answer your questions, and whenever possible, review teaching points, and repeat information presented earlier.
Finally, encourage teamwork and interprofessional learning! Residents must learn to be effective team members regardless of their roles, as promoting teamwork and communication skills improves care.
As I drafted this blog post, I asked a few residents in my program what their main suggestions were. The answers were varied, but a few topics stood out. In the plethora of information and available resources, residents may feel lost in how to prioritize the literature, teaching videos, and tools. So, consider providing a list of resources, tailored by year of training, in order of relevance and priority for your residents. My residents also mentioned how helpful it is when faculty ensure they know and understand the basics, before going “over their head” with more complex material. Most prefer case-based and interactive activities to lectures, which encourage recapping previous learned content in subsequent activities.
It is humbling and invigorating to realize that despite my many years of teaching experience and positive reviews from trainees, there is always room for improvement in my own teaching. Over the past few weeks, intentionally and even unintentionally at times, I incorporated a number of the tips and suggestions above, and I will continue to enhance my work by listening and learning from my residents.
Did you know that the Harvard Macy Institute Community Blog has had more than 370 posts? Previous blog posts have explored topics including blending case- and problem- based learning, leveraging Twitter for residency applications, and coaching in graduate medical education.