Elsevier

Journal of Surgical Education

Volume 72, Issue 5, September–October 2015, Pages 949-956
Journal of Surgical Education

Original Reports
Residents as Educators: A Modern Model

https://doi.org/10.1016/j.jsurg.2015.04.004Get rights and content

Education during surgical residency has changed significantly. As part of the shifting landscape, the importance of an organized and structured curriculum has increased. However, establishing this is often difficult secondary to clinical demands and pressure both on faculty and residents. We present a peer-assisted learning model for academic institutions without professional non-clinical educations. The “resident as educator” (RAE) model empowers residents to be the organizers of the education curriculum. RAE is built on a culture of commitment to education, skill development and team building, allowing the upper level residents to develop and execute the curriculum. Several modules designed to address junior level residents and medical students’ educational needs have been implemented, including (1) intern boot camp, (2) summer school, (3) technical skill sessions, (4) trauma orientation, (5) weekly teaching conferences, and (4) a fourth year medical student surgical preparation course. Promoting residents as educators leads to an overall benefit for the program by being cost-effective and time-efficient, while simultaneously promoting professional development of residents and a culture of education.

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.

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