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(MedEd)itorial: How to Become a Great Teacher During Residency

those-who-cant-teachers.pngOne of the things that frustrates me the most is when I hear a fellow resident talk about how they try to avoid teaching the medical students—either because they don’t enjoy it or don’t feel like they are good enough at teaching.

Personally, I believe that teaching medical students is an obligation for each resident and is a vital part of the job. We all want to sit around and complain about the orthopedic resident who doesn’t understand basic medical management, yet we simply defer opportunities to teach students this while we have them on our service. Moreover, we can all remember the rotations we loved the most and, almost assuredly, these rotations always featured a friendly resident who was eager to work with us and teach us how to become better students.

Still, teaching is hard.

Regardless of your specialty, every resident is pressed for time and is fighting to balance patient care, documentation, personal education, and that ever-allusive personal life. Unfortunately, teaching often feels like just another expendable obligation.

So how do you do it?

Let’s consider the following pieces of advice from my personal experiences as a student, resident, and tutor.

Budget time for teaching.

If you examine your daily schedule on each rotation, you’ll almost certainly find some down time each day that could be used for teaching your medical students. By budgeting teaching into your daily schedule, it makes it more likely that it will actually happen. Furthermore, it causes you to actually prepare topics. Even if you’re just doing 15-20 minutes worth of a didactic lecture, your students will certainly appreciate the effort.

Teach in the moment.

We are obviously all good at multi-tasking. We wouldn’t be able to survive as residents if we weren’t. With that in mind, try to teach your student as you are accomplishing patient care. For instance, any time I perform a paracentesis I make sure to talk with my student about the indications for the procedure, the technical aspects of the procedure itself, and, if I’m doing a large volume paracentesis, I will try to slip in a related lecture on the complications of liver failure. If you’re an OB resident looking at a fetal heart tracing, try to talk your student through what you are seeing. There are thousands of examples for this, none of which take much time out of your day.

Don’t be a bully.

During my third year surgery clerkship, I had an especially awful resident who enjoyed making students look bad in front of the attendings. He would aggressively ask incredibly difficult questions and then degrade us for not knowing the answer. Similarly, I’ve seen co-residents respond to missed questions with phrases such as, “How can you not know that, everyone else knows that, or how did you get through medical school up until now?” While the occasional student might be motivated by this “tough love”, almost everyone would agree that learning is much more fun in a supportive and stress-free environment.

Here are some tips to make that happen:

  1. Preface a difficult question with, “Has anyone taught you about _______?” This allows the student off the hook if they don’t know the answer and will help you realize what you can teach them.
  2. Have realistic expectations. Just last week I found myself rolling my eyes as an intern attempted to quiz a medical student on highly technical aspects of using an echo to determine the severity of aortic stenosis. How would they know that? Why is it even useful for them to know it at that moment? If you are going to ask questions, try to make it something that they could actually know.
  3. Don’t be aggressive and don’t single any one student out.
  4. Don’t try to embarrass your student. Did you like it when people did it to you? 

Teaching isn’t one size fits all.

We all know that there is not a one size fits all approach to learning. So, why do so many of us refuse to utilize multiple teaching strategies to reach our students? While some students may respond very well to challenging questions and enjoy the pressure of that, others would much rather learn through didactics or combination of the two. If I notice that a student is not responding to direct questions, I will always try to switch my teaching style up to fit their individual needs.

Make it relevant.

Although I am very interested in the role of coronary artery calcium screening in the risk stratification of coronary artery disease, I recognize that most of my students are not. If you are taking the time to teach, make sure that it is actually relevant to your students. Teaching should either be geared towards the patients currently on your service or topics that are likely to occur on the Shelf exam.

Minimize busy work.

Having your students look up a hundred journal articles or constantly give presentations on a topic is not the same as teaching. While it is very beneficial to have them read certain landmark articles (especially if it pertains to a certain patient they are caring for), you should still try to remember that they have other obligations and need to find time to study for their test. Personally, I limit myself to assigning no more than two journal articles per week and tend to target high yield topics, such as early goal-directed therapy for sepsis.

Give regular feedback.

As a student, we can all remember how frustrating it was to read a negative comment on an evaluation that was never brought to your attention during the actual rotation. Thus, I always try to be very conscious of this when dealing with my students. If I don’t like how they are presenting on rounds in the morning, I make sure to tell them what the problem is and offer them suggestions to fix it as the rotation goes along. At the end of the day, don’t be the asshole that gives a student a negative evaluation for something that you never told them they should fix.

While it is easier said than done, I try to provide weekly feedback along with a mid-rotation evaluation and end-of-rotation wrap up. I utilize weekly feedback to identify any issues that I have with the student’s performance or foundation of knowledge, and discuss how they’ve responded to previous feedback. At the midpoint evaluation, I try to complement students on the things they’ve done well, give them some insight into what their evaluation would be if the rotation ended today, and offer them some concrete suggestions on how to improve their performance. Finally, the end-rotation wrap-up is used for me to discuss what their evaluation will likely say and to offer some final suggestions that they can take with them to future rotations. Not all of my students are going to get great evaluations, but none of them are going to be able to complain that they didn’t know it was coming.

 

In conclusion, make teaching an important part of your role as a resident. It might not always be easy to do, but it makes a very big impact on your medical student and is a very rewarding part of this job. I always get so excited when I see a student or intern utilize something that I taught them.
 

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