residents as teachers: strategies for improving peer based education in a community based residency...

Residents as Teachers: Residents as Teachers: Strategies for Improving Strategies for Improving

Peer Based Education in a Peer Based Education in a Community Based Community Based

Residency Program Residency Program Bernard Birnbaum, MDBernard Birnbaum, MD

Kim Marvel, PhDKim Marvel, PhDKristen Bene, MSKristen Bene, MS

Fort Collins Family Medicine Residency ProgramFort Collins Family Medicine Residency ProgramFort Collins, COFort Collins, CO

STFM Annual Meeting 2008STFM Annual Meeting 2008

Seminar Goals and ObjectiveSeminar 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

Seminar StructureSeminar 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

IntroductionsIntroductions

• Bernard Birnbaum

• Kim Marvel

• Kristen Bene

• And YOU???

Why are we doing this seminar?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

Literature ReviewLiterature Review

• What research has been done?

• Pearls from the literature

• Near-peer teaching

Literature ReviewLiterature 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

Literature Review: PearlsLiterature 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)

Literature Review: PearlsLiterature Review: Pearls

• Psychology of peer teaching – Cognitive

Congruence – Social role

Congruence (near-peers)

(Cate and Durning, 2007)

Medical resident

Physician

TeacherLearner

Medical resident

Physician

TeacherLearner

Medical resident

Physician

TeacherLearner

Physician

Teacher

Medical resident

Physician

Medical resident

Learner

Physician

Medical resident

TeacherLearner

Physician

Medical resident

Overview of our curriculumOverview 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

Yearly Seminar: Yearly Seminar: LogisticsLogistics

• 3-hour session

• Late in academic year (May or June)

• R-1 and R-2 classes

• Faculty facilitators available for small-group activities

Yearly Seminar: Yearly Seminar: Overview of ContentOverview 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

Yearly Seminar:Yearly Seminar:Overview of Content (cont.)Overview of Content (cont.)

• Review teaching opportunities

• Define resident role as teacher and peer educator

• Specific role of leader/manager of the inpatient service

Yearly Seminar:Yearly Seminar:Specific TopicsSpecific 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

Yearly Seminar:Yearly Seminar:Specific TopicsSpecific Topics

Teaching Strategies:• Four steps of clinical teaching

– Needs assessment– Teaching to the learner– Feedback– Reinforcement

• Four Teaching Styles– Assertive – Suggestive – Collaborative – Facilitative

Yearly Seminar:Yearly Seminar:Specific TopicsSpecific Topics

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

Yearly Seminar:Yearly Seminar:Specific TopicsSpecific 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

Yearly Discussion SessionYearly 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

Individual Meetings with Upper-Individual Meetings with Upper-Level ResidentsLevel 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

One-on-One Meeting EvaluationOne-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

Seminar EvaluationSeminar 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

Review of the “one minute Review of the “one minute preceptor” modelpreceptor” model

• Get a commitment

• Probe for supporting evidence

• Encourage discussion

• Reinforce what was right

• Correct mistakes and agree on a learning plan

Role Plays and DiscussionRole Plays and Discussion

• 3 groups

• Do role play

• Discuss issues generated by the role play

• Return to large group and present discussion points