Insights on Residency Training

Dr. Temte is a Chief Resident in Internal Medicine at Providence Portland Medical Center in Portland, OR.

We currently find ourselves at the start of another academic year. By this time in August, many medical trainees are settling into new roles. Recently graduated medical students are getting used to hearing Dr. before their name. New senior residents who were interns a short time ago now find themselves leaders of their own teams. As for myself, I am starting a pulmonary and critical care fellowship at a new academic center. By August, all these training doctors are considering the question of how they will lead and teach in their new roles.

Throughout medical school, we have the privilege of being taught by excellent instructors. While all our instructors had various pros and cons, very few of them provided dedicated instruction on how to be leaders and educators. Most residents have observed that their fellow residents doing most of the teaching. Early on, we model our teaching tactics based on what we’ve observed during our own learning. However, I found very quickly as I advanced from medical student to senior resident that it is a bit more complex than teaching others in the way that I would like to be taught. Diagnosing the learner and effectively teaching the student in front of me requires intention and training.

Residents as Teachers

At my residency program, we were fortunate to be able to create a Residents as Teachers program during the height of the COVID-19 pandemic. During the first few months of 2020, some clinic and elective time was canceled, which created an unexpected opening in our schedules. While we were at home working on research and learning via Teams, a few of us came together with our best teaching attendings and started to create a curriculum.

Luckily, many successful Residents as Teachers programs have been instituted at other programs, and we modeled our intervention after them. Together, we created resident-led workshops, curriculum, syllabus, and an elective rotation. During the 2021-2022 year, we had our inaugural Residents as Teachers session. We focused primarily on instructing second- and third-year residents and were excited to have 9 of the 18 senior residents join our group. As a result of the program, we’ve participated in some excellent teaching workshops, had more resident-led noon conferences, and increased teaching on the hospital wards.

One prerequisite for a Residents as Teachers certification was to get involved in a medical education project. This requirement has led to an improved simulation lab, medical student curriculum, and further POCUS teaching. To this day, helping to create and lead the first year of our Residents as Teachers is one of my favorite projects.

Resident Educator Tips – What I’ve Learned So Far

Resident-led education is so important and can create a meaningful impact for both the teacher and learner. During this last part of the article, I’ll leave you with a few tips I’ve acquired from my mentors. These are not all-encompassing but are a great place to start during your early career as a medical educator.

• Get involved in teaching. This may be daunting at first, especially early in your career. However, we all have something we are interested in and can pass along to our fellow trainees. Practice makes progress when it comes to teaching.
• Create psychological safety. Everyone learns best in a safe environment that is free of ridicule and undue stress. Bloggers on our site have discussed psychological safety before — for those interested in learning more.
• Focus on illness scripts. Many new learners are still building their pattern recognition skills. Comparing and contrasting illness scripts for a presenting illness can solidify clinical reasoning around a particular disease or framework.
• Teach one or two things at a time. Once you find a teaching point or area of improvement, focus on providing instruction around a few key takeaways. Make sure to emphasize the key points you want your learner to remember at the end of the lesson.
• Set clear goals and expectations. Make sure everyone knows how, when, and who will be doing the teaching.
• Prepare a few talks on your favorite subjects. This is your chance to dive deeply into an interesting topic and be the go-to expert on this subject.
• Provide take-home materials. This can be something as simple as a paper to read afterward or a framework you’ve created.
• Seek out frequent feedback. Having a mentor or an educator you look up to provide feedback on your teaching can be an invaluable experience.
• Join your residency’s Residents as Teachers program. If you do not have a Residents as Teachers program, creating one can help expand the education culture of your residency and be very rewarding.

I believe we all have a duty to train the next generation and pay it forward. Improving your skills as an educator will not only help the field of medicine but also improve your skills as a physician. I hope everyone experiences the joy of helping someone along their professional journey.