Original ReportsResidents as Educators: A Modern Model
Introduction
The landscape of surgical resident education at most institutions has changed substantially over the last few decades, owing to a myriad of factors including work-hour restrictions, attending responsibilities, patient expectations, curriculum oversight, and accreditation guidelines. Ward teaching, apprenticeship modeling, and grand rounds have historically been the building blocks of the surgical curriculum. The Accreditation Council for Graduate Medical Education now mandates that programs have a “comprehensive, effective and well-organized educational curriculum; ensure that conferences be scheduled to permit resident attendance on a regular basis, and resident time must be protected from interruption by routine clinical duties.”1 Constraints on faculty time, including requirements for relative value units, increased documentation, and in the case of academic faculty, research productivity, have severely limited the amount of faculty time that can be devoted to resident education. These evolving pressures have put a strain on the educational environment of modern surgical residency programs, necessitating change. Many institutions have addressed these demands by relying on ancillary staff and nonclinical educators who receive salary support to provide resident education. We present a model for academic institutions without salaried professional nonclinical educators.
The “resident as educator” model (RAE) was introduced at Vanderbilt University in 2008, empowering residents to serve as the organizers and, often, the teachers of the educational curriculum. Peer-assisted learning is defined as individuals of similar training levels who are not professional teachers who help each other learn and as a result learn by teaching.2, 3, 4, 5 The model that follows was presented in 2012 as a workshop at the annual meeting for the Association for Program Directors in Surgery (APDS).6 As surgery residencies at academic centers are often seven years in length, considerably longer than other specialties, many of these years in training are at the equivalent of attending status in some specialties. Prior work has shown that both faculty and students have indicated that residents are highly valuable for clinical and surgical education.7, 8 Also, many residents come to training with significant teaching exposure or experience, having served as teaching assistants for anatomy or other courses while in medical school, some having even participated in formal students-as-teachers training programs.9, 10 There have been limited formal studies investigating the use of peer learning in resident education.11, 12 However, these studies confirmed that peer teaching, as in the RAE model, can be effective in the resident population.4, 11, 12 Residents provide a unique and beneficial perspective on effective education given their shared proximity to the learners training level. Therefore, surgical residents at academic institutions are a strong, sustainable, and often already well-trained option to bridge the gap in faculty availability.
From an administrative perspective, promoting residents as educators leads to an overall total benefit for the program and department, increases efficiency in curriculum, and is both cost effective and time efficient. We outline these aspects later in the article as they pertain to intern and junior resident education.
Section snippets
Background
Resident education has historically been based on a large lecture-teaching model or clinical teaching. Accordingly, resident education at Vanderbilt before a curriculum revision in 2007-2008 was largely centered on weekly Grand Rounds conferences. Other educational opportunities included a faculty-led teaching session following grand rounds and educational discussions centered on cases presented at weekly morbidity and mortality conferences (J.L.T., personal communication). No organized
Operational Details
The education curriculum is run, organized, developed, and executed by residents. The Resident Education Committee is the group that holds ownership for allocating responsibility and promoting the culture of sustainability and includes all residents in research. Residents responsible for different modules are expected to attend, as this committee reviews each module and explores avenues for improvements each year (Fig. 2). The ownership is divided among the nonclinical residents in research
Advantages and Disadvantages
An important byproduct of the RAE model is promoting a culture of education within the residency. Resident teaching demands that the instructor master the topic covered, and the adage that one learns best when he or she teaches is at the centerpiece of the philosophy behind the RAE model. Upper-level surgical residents are often at the same training level as attending physicians in other specialties with shorter training requirements; therefore, early teaching should be part of any surgery
Conclusion
We present a potential education model for an academic surgery program to improve junior-level curriculum, as well as promote midlevel residents in their professional development. In addition, RAE is aimed to improve the efficient use of faculty time. Even in academic surgery programs that have robust nonclinician educator support, allowing residents to be responsible for curriculum design and change (especially with oversight) may lead to a more applicable and adaptable educational program.
Acknowledgment
Dr. Clark Kensinger received salary support from the Renal Biology and Disease Training Program Grant: NIH/NIDDK 5T32DK007569. We would like to thank Dr. John Tarpley (J.L.T.) and Mrs. Margaret Tarpley for providing information that contributed to the manuscript. In addition, we would like to thank Dr. Julia Shelton and Dr. Felicitas Koller for their contributions to the initial presentation of this material at the APDS annual conference in 2012.
References (41)
- et al.
Does intentional support of degree programs in general surgery residency affect research productivity or pursuit of academic surgery?
J Surg Educ
(2014) - et al.
Resident awareness of documentation requirements and reimbursement: a multi-institutional survey
Ann Thorac Surg
(2014) - et al.
Surgical research abroad
Surgery
(2013) - et al.
Commentary: the role of global surgery electives during residency training: relevance, realities, and regulations
Surgery
(2013) - et al.
Recruiting women to vascular surgery and other surgical specialties
J Vasc Surg
(2013) - et al.
Impact of implementation of a pediatric surgery fellowship on general surgery resident operative volume
J Surg Educ
(2012) - et al.
Teaching in the operating room: results of a national survey
J Surg Educ
(2012) - et al.
Women in academic surgery: the pipeline is busted
J Surg Educ
(2012) - et al.
Veterans affairs general surgery service: the last bastion of integrated specialty care
Am J Surg
(2011) - et al.
The use of a multidisciplinary morbidity and mortality conference to incorporate ACGME general competencies
J Surg Educ
(2011)
Guidelines for maintaining a professional compass in the era of social networking
J Surg Educ
International medical graduates in general surgery: increasing needs, decreasing numbers
J Am Coll Surg
Moral distress in the third year of medical school; a descriptive review of student case reflections
Am J Surg
Work hours restrictions as an ethical dilemma for residents: a descriptive survey of violation types and frequency
Curr Surg
Work-hour restrictions as an ethical dilemma for residents
Am J Surg
Missed opportunities: a descriptive assessment of teaching and attitudes regarding communication skills in a surgical residency
Curr Surg
The impact of aviation-based teamwork training on the attitudes of health-care professionals
J Am Coll Surg
The effectiveness of peer tutoring in further and higher education: a typology and review of the literature
Higher Educ
Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school
Adv Med Educ Pract
Cited by (18)
Comparing Faculty and Trainee Evaluators of First-Year Resident Skills
2024, Journal of Surgical EducationImplementation and Assessment of Mentoring and Professionalism in Training (MAP-IT): A Humanistic Curriculum as a Tool to Address Burnout in Surgical Residents
2023, Journal of Surgical EducationCitation Excerpt :Furthermore, resident-led curricula have shown to be effective for learners. Integration of RAT leads to overall benefits in general surgery training programs, including promoting a culture of education and career development and cultivating leadership skills.13,32 With continued evaluation of this longitudinal curriculum, further assessment of the impact of RAT is warranted.
Evaluating General Surgical Residency Education Structure and Incorporation of the Resident as Educator Model
2022, Journal of Surgical EducationCitation Excerpt :To avoid these problems, an expert in their field ought to be providing oversight for resident educators preparing didactics. Programs implementing an RAE model have recognized similar limitations with peer learning and still include recurring faculty-led education sessions in their weekly curriculum.12 That being said, senior residents have gained a wealth of knowledge that can be effectively utilized in an RAE model.
“Residents as Teachers” Workshops Designed by Surgery Residents for Surgery Residents
2022, Journal of Surgical ResearchCitation Excerpt :Additionally, our approach is supported by literature which demonstrates numerous benefits associated with near-peer teaching in medical education, including alleviating teaching pressures for faculty, providing leadership and coaching skills training, enhancing confidence, and practicing feedback and assessment.13 Promoting RAT has also led to overall benefits in general surgery training programs, including promoting a culture of education and career development, cultivating leadership skills, efficiently using faculty time, and filling a need for educators in programs with few nonclinical educators.16 Our process of identifying a need within our own surgical training program, and creating an effective solution based on current surgical education literature and previous experiences as surgeon educators highlights the andragogical learning process necessary to surgical education, and to lifelong learning as a surgeon.12
Teaching on Rounds and in Small Groups
2021, Surgical Clinics of North America