A systematic review of resident-as-teacher programmes


Andrew G Hill, Department of Surgery, South Auckland Clinical School, University of Auckland, Middlemore Hospital, PO Box 93311 Otahuhu, Auckland, New Zealand. Tel: 00 64 9 276 0076; Fax: 00 64 9 267 9482; E-mail: ahill@middlemore.co.nz


Context  Residents in all disciplines serve as clinical teachers for medical students. Since the 1970s, there has been increasing evidence to demonstrate that residents wish to teach and that they respond positively to formal teacher training. Effective resident-as-teacher (RaT) programmes have resulted in improved resident teaching skills. Current evidence, however, is not clear about the specific features of an effective RaT programme.

Objectives  This study was performed in order to investigate the effectiveness of RaT programmes on resident teaching abilities and to identify the features that ensure success. Methods of assessment used to ascertain the effectiveness of RaT programmes are also explored.

Methods  The literature search covered the period between 1971 and 2008. Articles focusing on improving resident teaching skills were included. Each study was reviewed by two reviewers and data were collected using a standard abstraction summary sheet. Study outcomes were graded according to a modified Kirkpatrick's model of educational outcomes.

Results  Twenty-nine studies met review inclusion criteria. Interventions included workshops, seminars, lectures and teaching retreats. Twenty-six studies used a pre- and post-intervention outcome comparison method. Subjective outcome measures included resident self-evaluation of teaching skills or evaluation by medical students, peers and faculty members. Objective outcome measures included written tests, evaluation of teaching performance by independent raters and utilisation of objective structured teaching examinations. One study objectively measured learning outcomes at the level of medical students, utilising the results of an objective structured clinical examination. Overall resident satisfaction with RaT programmes was high. Participants reported positive changes in attitudes towards teaching. Participant knowledge of educational principles improved. Study methodologies allowed for significant risks of bias.

Conclusions  More rigorous study designs and the use of objective outcome measures are needed to ascertain the true effectiveness of RaT programmes. Future research should focus on determining the impact of RaT programmes on learning achievement at the level of medical students.