Thursday, November 17, 2011

Is having residents do most of medical student teaching bad?

It's surprising when a statistic comes out that at face value looks a bit shocking, but if you reflect a little, it's absolutely obvious.  Dr. Vinny Aurora just posted a tweet from a conference she is at about the percentage of teaching medical students on inpatient wards receive from residents.  This was then retweeted numerous times within a few minutes of when she posted it, meaning people felt this was useful and important information.  She followed up with several other tweets about how this makes it imperative that we teach residents how to teach.  I completely agree with this.  What I find a bit odd is that people still are excited to know that the bulk of clinical teaching for our students in the third and fourth year comes from residents, and not faculty.

I would venture that there are probably more junior faculty who populate the ward posts where students are learning than senior faculty.  I have no data to prove that, but if I look at my own department's attending schedule I would hazard to say that over half of the ward attendings are junior faculty.  This is the reality of academic medicine.  Most of the teaching on inpatient wards comes from the junior third of the clinicians in the facility.

I would then argue that it really is not bad.  There seems to be this unstated implication that education provided by residents is somehow less useful, and almost dangerous.  I know the LCME emphasizes having faculty be actively involved in teaching students, and I completely agree that having a completely absent faculty member on an inpatient service is not only a poor learning environment, it can lead to disastrous clinical care consequences.  What I would argue against is the notion that residents have nothing to offer in the realm of education.  Some of the best teachers I worked with as I went through third and fourth year were residents (and even the fourth year sub-intern when I was a third year student on my internal medicine rotation).  I realize that just like faculty, there are some are more engaged in teaching, and some are more knowledgable than others.  On the whole, I think we underestimate the power of resident teaching.  Most students will never go into neurology.  Thus, they really don't need me as a Parkinson's subspecialist to pontificate about the idiosyncracies of what anatomical target to choose for DBS.  They need someone who can show them what a resting tremor looks like, and how to distinguish that from an essential tremor.  Our neurology residents can all do that.

That being said, I again totally agree that our residents are on the whole under-prepared for the teaching role they assume on July 1 of their intern year, and we need to invest much more in teaching them how to teach.  But along the way, we need to appreciate them for what they are.  They truly are the front lines of clinical year teaching for medical students.

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