Residents as Teachers in postgraduate medical education: a structured review of global evidence and emerging gaps

Abstract

Background

Residents serve as frontline educators in contemporary healthcare systems, yet formal preparation for this role remains uncommon globally. The persistent gap between teaching responsibility and structured institutional support represents a significant concern for educational quality, resident professional development, and patient safety.

Objectives

To synthesize the current evidence on residents’ involvement in teaching, their perceptions of the educator role, factors influencing teaching effectiveness, and the outcomes of formal Residents as Teachers (RaT) programs.

Methods

A structured narrative review was conducted using PubMed, Embase, and ERIC from 2010 to 2025, guided by a PCO (Population, Concept, Outcome) framework. Studies involving medical or surgical residents in postgraduate years 1–6 examining teaching roles, perceptions, or RaT program outcomes were included. Systematic reviews and studies focused on faculty or undergraduate populations were excluded. The screening and reporting process was informed by PRISMA principles; narrative synthesis with thematic organization was applied.

Results

Thirty-two studies met inclusion criteria, yielding four interconnected themes: (1) residents universally recognize teaching as central to their professional identity yet carry substantial informal teaching loads without formal preparation; (2) institutional culture, prior experience, and motivational profiles significantly shape teaching effectiveness; (3) residents across specialties and regions consistently request structured training with explicit objectives; and (4) longitudinal, integrated programs produce more durable skill gains than brief stand-alone workshops.

Conclusions

Despite substantial informal teaching activity, residents remain underprepared for their educator role. Structured, longitudinal RaT programs are needed, particularly in under-researched healthcare systems, where unique cultural, institutional, and workforce characteristics call for locally developed approaches.

Introduction

Modern healthcare systems depend not only on clinical competence but on how effectively knowledge, skills, and professional values are transmitted to future physicians. As medical training has grown more complex and the number of learners continues to increase, the physician’s role as an educator has shifted from an informal expectation to a core professional responsibility [1]. This shift has raised important questions about whether healthcare systems are adequately prepared to sustain a sufficient pipeline of well-trained clinical educators.

Physicians are routinely expected to teach medical students, interns, residents, and other healthcare professionals in addition to their clinical duties. Yet healthcare systems worldwide face persistent shortages of qualified clinical educators [2]. Evidence from multiple regions identifies ongoing challenges in faculty recruitment and retention, gaps in academic-service collaboration, and insufficient infrastructure to support health professions education [3–5]. As training programs expand, these pressures intensify, placing an ever-greater informal teaching burden on those least formally prepared to carry it: residents.

Residents occupy a dual role as both active learners navigating their own professional development and as educators who contribute substantially to the clinical training of students, junior trainees, and allied health professionals. Studies estimate that residents deliver up to one-third of undergraduate clinical teaching in many academic health systems [6], often without receiving any systematic preparation for that responsibility. This gap between teaching load and formal readiness carries consequences not only for educational quality but for patient safety: underprepared resident teachers provide less effective feedback and are more likely to overlook teachable moments related to near-miss events [6, 40].

In response, Residents as Teachers programs have emerged as a structured solution curriculum designed to equip residents with the pedagogical knowledge, skills, and confidence needed to fulfill their teaching responsibilities effectively. Despite their recognized value, fewer than one-quarter of residency programs globally offer any formal RaT curriculum, and those that do are often brief and stand-alone, with minimal longitudinal reinforcement [7].

In the Middle East region, similar concerns have been documented: gaps in academic-service collaboration, inconsistency in supervision quality, and underdeveloped curricula for clinical instruction [8–10]. Yet RaT programs in this region are entirely absent from the published literature, and residents’ perceptions of teaching and learning needs have not been formally examined.

This structured review synthesizes current evidence on residents’ teaching roles, the factors shaping their teaching effectiveness, the case for formal RaT programs, and the outcomes of structured training interventions. A key aim is to document the geographic distribution of RaT research and identify gaps in the wider Middle East region.

Methods

Review design

A structured narrative review was conducted, given the heterogeneity in study designs, populations, geographic settings, and publication periods represented in the RaT literature [11]. A narrative synthesis with thematic organization was used to integrate findings from the included studies.

PCO framework

The PCO (Population, Concept, Outcome) framework guided the search strategy (Table 1). This approach supported the systematic generation of search terms and identification of relevant synonyms across three major databases.

Table 1.

PCO Framework for Literature Review Search Strategy

Component	Primary Terms	Alternate Terms	Additional Terms
Population	Medical residents	Postgraduate trainees	Surgical residents, Resident physicians
Concept	Residents as teachers	Teaching role, Peer teaching	Clinical teaching, Medical education
Outcome	Perceptions	Attitudes, Perspectives	Learning needs, Teaching effectiveness, Competency

PCO Population, Concept, Outcome

Search strategy

An initial scoping search using Google Scholar was conducted to familiarize the researcher with the specific terminology and research landscape. A systematic search was then conducted in PubMed, Embase, and ERIC from February to May 2025, covering literature published between 2010 and 2025. Boolean operators were applied both within and between PCO concepts during the development of the search strategy. After pilot testing, the following final search strings were applied:

• PubMed: ((medical residents) OR (surgery residents)) AND (as teacher).

• Embase: ('medical residents' OR (medical AND residents) OR (surgery AND residents)) AND as AND teachers.

• ERIC: ((medical residents) OR (surgery residents)) AND (as teacher).

All retrieved references were imported into EndNote software, deduplicated, and screened against inclusion criteria. Manual citation tracking was performed on all included full-text studies to identify additional eligible references not captured in the database search.

Inclusion and exclusion criteria

Studies were included if they involved medical or surgical residents in postgraduate years 1–6, examined teaching roles, perceptions, attitudes, or RaT program interventions, and were conducted in clinical learning environments. Only peer-reviewed publications in English from 2010 to 2025 were included. No geographic restrictions were applied to ensure representation from diverse healthcare systems.

Studies were excluded if they focused primarily on faculty or attending physicians, addressed undergraduate populations, consisted of systematic reviews or meta-analyses, or lacked an explicit focus on residents as teachers.

Screening process

Screening was conducted by the primary researcher in line with PRISMA principles. Records identified through the database search numbered 1,453 in total: PubMed (n = 202), ERIC (n = 32), and Embase (n = 1,219). Following the removal of 428 duplicates, 1,025 unique references were subjected to title screening. Nine hundred and nine records were excluded: 697 were clinical studies with no educational focus, 130 addressed undergraduate education, and 82 were faculty-focused. The remaining 116 articles were assessed at the abstract level, with 71 further excluded. Forty-five full-text articles were retrieved, of which 14 were excluded (7 not resident-focused; 7 were review studies). One article was identified through reference screening. A total of 32 studies were included in the final synthesis, as illustrated in Fig. 1.

Fig. 1.

PRISMA Flow Diagram illustrating the literature search and study selection process

Screening decisions at both title/abstract and full-text stages were subsequently reviewed by a second co-author (N.G.), who independently verified inclusion and exclusion judgments against the pre-specified PCO framework and eligibility criteria. Discrepancies were resolved through discussion between the two authors until consensus was reached. The thematic structure derived from the narrative synthesis was similarly reviewed and confirmed by N.G. prior to finalization, providing an additional layer of interpretive checking across both the selection and analytical phases of the review.

Data synthesis

Narrative synthesis with thematic organization was employed to integrate findings from the included studies [11]. Given the methodological heterogeneity of the included literature, spanning quantitative surveys, pre-post intervention studies, qualitative designs, and randomized controlled trials, a narrative synthesis approach was selected as most appropriate for integrating evidence across diverse study types.

Study findings were organized using the structured data extraction framework presented in Table 2, which included citation, research aim, methodology, population, key findings, and primary conclusions. Following extraction, the key findings of all 32 included studies were read iteratively and in full. Recurring conceptual patterns were identified inductively across studies, without the imposition of a pre-determined theoretical framework.

Table 2.

Summary of Reviewed Literature

Author(s) & Year	Research Question/Aim	Design & Population	Key Findings
Qualitative & Needs-Assessment Studies (Perceptions and Learning Needs)
Bartle & Thistlethwaite (2014) [14]	To explore motivations and influences on junior doctors becoming educators	Qualitative semi-structured interviews; 12 junior doctors, Australia	Motivation shaped by past teaching experiences and role models; most viewed themselves as clinicians first; barriers included unclear recognition of educator role
Nishikura et al. (2021) [26]	To investigate the impact and challenges of RaT in rural community-based education	Qualitative; general medicine residents, Japan (thematic analysis of interviews)	Initial unfamiliarity with RaT concept; structured programming facilitated bidirectional learning; challenges included limited senior mentorship and institutional misalignment
Saucier et al. (2021) [13]	To explore family medicine residents’ experiences as teachers of medical students	Qualitative phenomenology (focus groups); 18 family medicine residents, United States	Six themes: learning environment, stimulating learning, role modeling, collaborating, supervising, and transferring knowledge; emphasized multifaceted nature of teaching roles
Nguyen et al. (2022) [38]	To design and describe a RaT curriculum tailored for neurosurgical training	Needs assessment and curriculum development (Kern’s Model); neurosurgical residents and faculty, United States (needs-assessment survey and curriculum mapping)	Curriculum modules: bedside teaching, feedback, assessment, adult learning; residents reported increased confidence; faculty observed improved teaching behaviors
Cross-Sectional Survey Studies (Attitudes, Involvement, and Prevalence)
Sánchez-Mendiola et al. (2010) [19]	To explore residents’ opinions on their educational role and identify learning needs for a RaT program	Cross-sectional; medical and surgical residents, Mexico (needs-assessment survey)	High teaching load without formal preparation; strong educator role identity; preferred clinical content via small-group facilitation; ~50% peer learning from residents; need for context-specific RaT programs
Ng et al. (2013) [15]	To examine family medicine residents’ perspectives on teaching opportunities and mentorship	Cross-sectional; family medicine residents, Canada (survey)	77.7% expressed interest in teaching as part of future careers; residents in integrated programs had greater academic involvement; minimal prior formal preparation was reported
Dotters-Katz et al. (2016) [24]	To assess residents’ attitudes toward teaching and motivation to teach in clinical settings	Cross-sectional Q methodology; residents and fellows across GME programs, United States	Three motivational profiles: enthusiastic, reluctant, and rewarded; even motivated residents cited time constraints and limited training as primary barriers
Zundel et al. (2017) [28]	To evaluate how pediatric surgery residents learn and teach	Cross-sectional; pediatric surgery residents, Germany/Switzerland/Austria (survey)	53% never received formal educational training; 93% unaware of RaT programs; high motivation to teach despite limited preparation; predominantly learned from peers
Nassar et al. (2021) [17]	To assess radiology residents’ perceptions of their teaching role and involvement in teaching activities	Cross-sectional multicentric; radiology residents, Lebanon (survey)	42% considered themselves better suited than faculty to teach; 83% expressed strong demand for formal training; 72% did not receive adequate feedback on teaching performance
Ni et al. (2021) [27]	To identify learning needs of radiation oncology residents for developing teaching skills	Quantitative web-based; radiation oncology residents, United States (web-based survey)	70.8% reported no formal teaching training; residents with training significantly more confident; most commonly taught other residents and medical students
Biesalski et al. (2022) [18]	To evaluate neurological residents’ involvement in clinical teaching	Prospective cross-sectional; neurological residents, Germany (survey)	Majority dedicated up to one-quarter of working time to teaching; nearly all viewed it as rewarding; 78% rarely received feedback; barriers included time and insufficient training
Jarvis-Selinger et al. (2023) [20]	To examine residents’ perceptions of learning to teach over a 7-year span	Quantitative Likert survey; orthopedic surgery residents, Canada	Residents learned informally through modeling and trial-and-error; consistently reported lack of formal preparation; perceptions and challenges unchanged over 7 years
Rowe et al. (2024) [22]	To examine residents’ prior teaching experience, attitudes, and factors for sustained engagement	Cross-sectional; 92 residents across 11 specialties, United States (survey)	Prior teaching experience associated with higher preparedness; significant barriers: time constraints, unclear content, and perceived student disinterest; differences not explained by PGY or program capacity
Villanueva & Rydberg (2025) [16]	To examine experiences and perspectives of PM&R residents on teaching medical students	Descriptive cross-sectional; PM&R residents, United States (survey)	94.2% involved in teaching; median 6 h/week; only 28% felt adequately prepared; 71.8% would benefit from formal training; main barriers: time and limited institutional support
Short-Term Intervention Studies (Confidence and Knowledge Outcomes)
Ostapchuk et al. (2010) [33]	To evaluate the effectiveness of a RaT course in improving residents’ teaching skills	Pre-post; multispecialty residents, United States (pre/post teaching OSCE and confidence survey)	17% improvement in teaching OSCE scores; increased confidence across all teaching domains; learner ratings remained unchanged despite confidence gains
Wachtel et al. (2013) [23]	To determine how residents describe their training, proficiency, and comfort level in teaching before and after instruction	Pre-post; emergency medicine residents following a -hour session, United States (pre/post self-rated proficiency survey)	Over half rated teaching proficiency as novice pre-intervention; all felt more prepared and confident post-intervention; majority had no prior formal training
Ryg et al. (2016) [31]	To evaluate the efficacy of residents as teachers in an ophthalmology module	Prospective intervention; third-year medical students with resident instructors, United States (pre/post knowledge assessment)	Significant improvement in ophthalmology knowledge; students perceived residents as effective educators; RaT model feasible in undergraduate education
Anderson et al. (2020) [43]	To evaluate the impact of a RaT workshop on surgical residents’ knowledge, confidence, and feedback skills	Pre-post; general surgery residents (PGY1–5), United States (pre/post knowledge test and confidence survey)	Significant improvement in knowledge scores; confidence in teaching and feedback increased substantially; participants found workshop content useful and applicable
Ofshteyn et al. (2021) [34]	To determine whether a RaT workshop improved medical students’ perceptions of resident teaching	Pre-post; surgical residency program, United States (pre/post student-evaluation survey)	Students rated residents significantly higher post-workshop in communication, feedback, and organization; improvements consistent across multiple evaluation items
Kobritz et al. (2022) [32]	To evaluate impact of resident-led RaT workshops and adaptability to virtual delivery	Pre-post with 8-month follow-up; surgical residents, United States (pre/post survey with 8-month follow-up)	30–40% confidence gains in bedside instruction and feedback; sustained at 8-month follow-up; 93.9% agreed workshop facilitated transition to educator role
Tipton et al. (2022) [41]	To evaluate impact of RaT workshop on residents’ teaching skills at 1-year follow-up	Prospective with 1-year follow-up; general surgery residents, United States (pre/post survey with 1-year follow-up)	Immediate confidence gains sustained at one year; knowledge scores declined but remained above baseline; perceptions of institutional support declined over time
Müller et al. (2025) [40]	To implement and evaluate a 4-week RaT course on pediatric residents’ self-perceived teaching competencies	Mixed-methods pre-post; pediatric residents, Germany (pre/post survey with qualitative interviews)	Improved competencies in didactics, student-centered learning, communication, professionalism, and reflective practice; increased confidence sustained post-program
Zeeni et al. (2025) [39]	To evaluate the effectiveness of an educational workshop on resident teaching quality and student outcomes	Pre-post mixed-methods; anesthesiology residents, Lebanon (pre/post survey with OSCE and psychological-safety measures)	Students reported better knowledge, skills, and rotation satisfaction; residents’ teaching concepts improved; improvement in learner psychological safety and OSCE scores
Longitudinal/Multi-Year Program Studies (Sustained Teaching Outcomes)
Zackoff et al. (2019) [35]	To evaluate the impact of a longitudinal RaT curriculum on PGY-1 resident teaching competency	Controlled prospective; PGY-1 pediatric residents, United States (faculty-rated teaching-competency assessment)	Significant improvement in didactic teaching, feedback, and precepting; curriculum recipients outperformed control group; clinical experience alone insufficient for teaching skill development
Frey-Vogel (2020) [30]	To design and evaluate a RaT curriculum for senior residents leading morning report	Educational intervention; senior pediatric residents with faculty mentors, United States (longitudinal curriculum evaluation with confidence/effectiveness ratings)	Residents valued faculty mentorship and structured facilitation guide; over six years, curriculum consistently improved confidence and effectiveness
Geary et al. (2021) [36]	To evaluate the efficacy of a RaT program across three years of implementation	Pre-post; general surgery residents, United States (pre/post confidence survey across 3 program years)	Significant increases in confidence for giving feedback, leading discussions, and teaching technical skills; improvements sustained across multiple years
Ratan et al. (2021) [37]	To evaluate long-term sustainability and impact of a resident-led RaT program	Longitudinal program evaluation; OB-GYN residents and medical students, United States (longitudinal teaching-domain ratings)	Gains in 11 of 13 teaching domains; student ratings improved over three academic cycles; ten residents earned distinguished educator designation
Rowat et al. (2021) [42]	To describe implementation and evaluate effectiveness of a longitudinal teaching curriculum	Pre-post; internal medicine and psychiatry residents, United States (pre/post confidence survey and faculty observation)	Significant increases in confidence across teaching domains; faculty observed performance improvements; residents appreciated interactive and longitudinal structure
Babenko et al. (2023) [29]	To examine longitudinal trends in residents’ teaching self-efficacy post-program	Longitudinal repeated measures; family medicine residents (N = 56), Canada (repeated-measures self-efficacy survey)	Confidence and skill increased post-program but declined in first practice years; at 3 years, most scores remained higher than pre-program; 74% reported ongoing teaching involvement
Liang et al. (2023) [25]	To compare effectiveness of a 3-year stepwise RaT program versus traditional format	Randomized controlled; first-year residents, Taiwan (randomized controlled trial with teaching-performance ratings)	Longitudinal group scored significantly higher in teaching performance in years 2 and 3; structured multi-year program promoted progressive skill development and higher learner satisfaction
Tieken et al. (2025) [21]	To understand residents’ perspectives on excellent surgical educators and identify curriculum gaps	Longitudinal curriculum with semi-structured interviews; 7 general surgery residents, United States	Curriculum enhanced skills; residents felt uncomfortable teaching procedural tasks and giving constructive criticism; facilitators and barriers identified across educator, learner, and systemic domains

Note. Studies grouped by design/methodology category as recommended in peer review; publication year shown for each study

RaT Residents as Teachers, GME Graduate medical education, PGY Postgraduate year, PM&R Physical medicine and rehabilitation, OSCE Objective structured clinical examination, OB-GYN Obstetrics and gynecology

Identified patterns were grouped by conceptual similarity into descriptive categories. These categories were then examined through cross-study comparison and refined into four higher-order interconnected themes, as illustrated in Fig. 2. The process was informed by narrative synthesis principles as described by Lucas et al. and is consistent with published approaches to thematic organization in health professions education reviews [11, 12]. The resulting thematic structure was reviewed and confirmed by all co-authors prior to finalization.

Fig. 2.

Interconnected themes from the Residents as Teachers literature synthesis

A comprehensive summary of all included studies is presented in Table 2 (see landscape pages below).

Results

Descriptive overview of included studies

Thirty-two studies met the inclusion criteria. Most (n = 24, 75%) were published from 2020 onwards, reflecting growing scholarly interest in the residents’ educator role. Geographically, 21 studies (66%) originated in the United States, with the remainder distributed across Europe (n = 3), Canada (n = 2), Lebanon (n = 2), Taiwan (n = 1), Japan (n = 1), Australia (n = 1), and Mexico (n = 1). Intervention studies were the most common design (n = 15), comprising fourteen pre-post designs and one randomized controlled trial. The remaining studies included nine cross-sectional surveys, five qualitative investigations, and three mixed-methods designs. The majority (74%) focused on a single specialty, most commonly surgery and family medicine. A comprehensive study-by-study summary is provided in Table 2, and the search and selection process is illustrated in Fig. 1.

Four interconnected themes emerged, as illustrated in Fig. 2: (1) Residents’ Teaching Load and Self-Perceived Roles (2), Factors Influencing Residents’ Teaching Roles (3), The Need for Formal RaT Programs, and (4) The Impact of Structured Teaching Skills Training.

Theme 1: residents’ teaching load and self-perceived roles

Across specialties and healthcare systems, studies consistently show that residents recognize teaching as integral to their professional identity while simultaneously operating with minimal formal preparation and limited institutional support. This gap between responsibility and readiness represents a systemic issue in postgraduate medical education rather than an isolated programmatic failing.

Multiple qualitative studies demonstrate that residents conceptualize teaching as inseparable from clinical care, encompassing the creation of a safe learning environment and the translation of theoretical knowledge into practical bedside reasoning [13]. This perspective spans geographical and specialty lines: Australian junior doctors similarly expressed a desire to teach better than their own role models, a motivation shaped by early experiences with both highly effective and markedly ineffective teachers [14].

Quantitative surveys reinforce the magnitude of informal teaching activity alongside the preparedness gap. Canadian family medicine residents regularly taught across multiple learner groups, including medical students, junior colleagues, and interprofessional team members, but described this teaching as informal and secondary to clinical duties [15]. U.S. physical medicine and rehabilitation residents estimated a median of six hours per week spent on teaching; yet only 28% felt adequately prepared, and two-thirds classified themselves as informal educators [16].

International evidence supports this pattern across diverse healthcare systems. Lebanese radiology residents recognized teaching as professionally integral, but reported receiving limited support and feedback [17]. German neurology residents reported high enjoyment of and frequent engagement in teaching, yet more than half lacked preparatory training, and 78% rarely received any feedback on their teaching [18]. Mexican residents similarly devoted substantial time to teaching and expressed a strong need for formal training [19].

Analysis of seven years of data from nearly 1,000 senior orthopedic residents revealed that although they provided approximately 90% of medical student teaching and were eager to improve, only one-third had received any formal instruction, and three-quarters believed their effectiveness could be meaningfully enhanced through structured educational training [20].

Theme 2: factors influencing residents’ teaching roles

Qualitative studies offer nuanced insight into how institutional and individual factors shape residents’ teaching effectiveness in practice. In Australian interviews, residents identified vague role descriptions, superficial orientation, and inconsistent supervisory involvement as signals that teaching was treated as optional. Conversely, flexible scheduling, visible role models, and structured mentoring helped validate the educator role [14]. Despite identifying enabling factors, residents continued to struggle to translate them into sustained practice, frequently citing inadequate preparation and competing clinical demands as persistent obstacles [21]. Two multi-institutional surveys demonstrate how prior teaching experience shapes both perceived barriers and the types of support residents seek. Surgical residents with considerable pre-residency experience expressed confidence but were frustrated by a lack of formative feedback; those with limited experience were constrained by underdeveloped teaching skills and time pressures. Neither postgraduate year nor program capacity explained these differences [22, 23]. Motivational heterogeneity further complicates the picture. One study identified three distinct resident attitude profiles: enthusiastic, reluctant, and rewarded, illustrating how residents assign different priorities to teaching based on intrinsic satisfaction, perceived burden, or external career incentives. Even highly motivated residents cited time constraints and limited pedagogical training as primary barriers [24].

Broader systemic factors also shape teaching effectiveness. In Taiwan, high clinical workload and irregular faculty availability led to significant dropout from a voluntary three-year RaT program, with completers attributing their persistence to a structured approach that incorporated stepwise workshops, mentor-observed bedside teaching, and regular formative feedback [25]. In Japan, a longitudinal community-based program facilitated bidirectional learning and relationship development, though persistent challenges included restricted senior mentorship and institutional misalignment [26].

Theme 3: the need for formal residents as teachers programs

The literature presents a convergent, cross-specialty, cross-regional case for structured formal training. Canadian family medicine residents reported minimal prior training and specifically requested guidance on feedback delivery, bedside teaching, small-group facilitation, and learner assessment, calling for formal curricula with explicit objectives [15]. Japanese residents described uncertainty about how to teach effectively despite high intrinsic motivation deficits, the authors argue, require a formal curriculum that clarifies teaching objectives, introduces structured instructional frameworks, and provides dedicated protected time [26].

Emergency medicine residents recommended formal teaching-skills training as an essential residency component [23]. Radiation oncology residents identified specific learning needs around assessment and feedback delivery, which directly informed a specialty-specific curriculum [27]. In Central European pediatric surgery, residents were required to assume teaching responsibilities with minimal preparation, prompting explicit calls for formal, competency-based RaT training [28]. Physical medicine and rehabilitation residents reported that more than half specifically requested structured training [16].

A three-year longitudinal evaluation in general practice documented sustained gains in teaching confidence and skills among residents who received structured, guided workshops [29]. A program offering individualized feedback and supported practice opportunities highlighted the value of intentional mentorship and curricular design in preparing residents for their educational role [30].

Theme 4: impact of structured teaching skills training

Findings from RaT intervention studies suggest that formally trained residents can teach as effectively as faculty, reinforcing the value of structured preparation [31]. However, the magnitude and durability of improvements vary substantially with program design.

Short, intensive workshops consistently produce immediate confidence gains and high participant satisfaction [32, 33]. Confidence improvements do not automatically translate into improved teaching performance; however, learner ratings remained unchanged following brief interventions in several studies, suggesting that one-off sessions may be insufficient to achieve the behavioral changes necessary for better educational outcomes [23, 33, 34].

Longer, integrated programs demonstrate more durable results. A year-long clinically integrated curriculum combining workshops with direct practice significantly improved residents’ competency in didactic teaching, feedback, and precepting, with curriculum recipients outperforming a control group with comparable clinical exposure, confirming that clinical experience alone does not develop teaching skills [35]. A five-session general surgery curriculum delivered during protected conference time doubled the proportion of residents who formulated concrete plans to improve their teaching [36]. A three-year Academy of Resident Educators produced gains across 11 of 13 teaching domains, with medical student ratings improving over three academic cycles [37].

In neurosurgery, a three-year curriculum grounded in Kern’s model combined brief lectures with practice-based learning and direct-observation feedback, successfully balancing intensive operative schedules with progressive skill development [38]. Both an anaesthesiology resident-facilitator model and a pediatric resident-as-facilitator program reported sustained improvements in student satisfaction, OSCE scores, teaching self-efficacy, and learner psychological safety [39, 40].

Emerging evidence highlights the risk of gains diminishing without ongoing reinforcement. A four-hour workshop produced sustained improvements in confidence after one year, but participants’ knowledge scores and perceptions of institutional support declined over time, emphasizing the need for periodic booster sessions [41]. These findings collectively underscore that effective RaT programs require ongoing support structures, not only initial training [42, 43].

Research gaps and implications

Despite the growing body of literature on Residents as Teachers, the evidence base remains heavily concentrated in Western healthcare and educational systems. Of the 32 studies included in this review, 21 (66%) originated from the United States, while no studies were identified from the Gulf Cooperation Council (GCC) region and only two from the broader Middle East. To the best of the authors’ knowledge, no published studies during the review period explored RaT programs, residents’ teaching competencies, or perceptions of educator roles within GCC residency training contexts.

This geographic imbalance limits the generalizability and contextual transferability of existing RaT evidence. Residency training environments in the Middle East differ substantially from the predominantly Western settings represented in the literature, particularly in relation to healthcare workforce diversity, institutional hierarchy, cultural expectations surrounding teaching and feedback, and the operational demands of service-oriented training systems. In many GCC institutions, residents train within multicultural clinical teams and dual-accreditation structures that incorporate regional and international competency frameworks, including EmiratesMed and ACGME-International standards, which increasingly emphasize teaching and educational competencies. However, formalized and longitudinal RaT training remains limited across the region.

The absence of regionally generated evidence raises important concerns regarding the direct adoption of Western-designed RaT curricula without adequate contextual adaptation. Educational approaches shown to be effective in Western settings may not fully account for differences in motivational drivers, professional identity formation, interprofessional dynamics, and clinical workflow structures within GCC healthcare environments. Furthermore, the limited attention given to interprofessional teaching in existing RaT literature may inadequately reflect the realities of highly multicultural healthcare systems common in the region.

These findings highlight the need for contextually grounded research to better understand residents’ educational roles, perceived competencies, barriers to engagement in teaching, and learning needs within GCC residency programs. Future studies should prioritize the development and validation of culturally responsive assessment tools, exploration of interprofessional teaching practices, and evaluation of RaT interventions using longitudinal and outcomes-based methodologies. Additionally, integrating structured teaching opportunities within routine clinical workflows may enhance the feasibility and sustainability of RaT initiatives in high-service training environments.

Addressing these gaps may contribute not only to regional educational development but also to the diversification of the global RaT literature by incorporating perspectives from underrepresented healthcare systems and culturally diverse training environments.

Limitations

Several limitations of this review should be acknowledged. First, the search was restricted to three databases (PubMed, Embase, and ERIC) and to English-language publications. While these databases provide broad and complementary coverage of the medical and health professions education literature, studies published in other languages or indexed in regional databases may have been missed. Second, the included studies were methodologically heterogeneous, spanning quantitative surveys, pre-post intervention studies, qualitative investigations, and one randomized controlled trial. This heterogeneity precludes formal quantitative synthesis and limits direct comparability of findings across studies. Results should therefore be interpreted as indicative patterns rather than definitive conclusions.

Conclusions

This structured review synthesizes evidence across 32 studies spanning 15 years of RaT research. Across the included studies, residents consistently recognized and valued their educator role, reported substantial informal teaching loads, and were found to be systematically underprepared for the responsibilities they assumed. Motivation and enthusiasm, while widely present, were found to be insufficient in the absence of institutional support structures, protected teaching time, and formal pedagogical training.

Short workshops produced immediate gains in confidence but rarely led to lasting behavioral change. Longitudinal, integrated programs that combined structured instruction with direct practice, formative feedback, and ongoing coaching generally demonstrated more durable improvements in teaching skills than stand-alone workshops. The distinction between improvements in residents’ self-reported confidence and demonstrated gains in teaching performance or learner outcomes warrants particular attention, as objective assessments were less common and produced more variable results. Critically, the evidence base for RaT remains almost entirely Western, with minimal published research identified in the Middle East. This geographic gap calls for deliberate investment in regional needs assessments, contextually adapted program design, and rigorous evaluation of RaT interventions in under-studied healthcare systems. Scholars in the field have argued that preparing residents as educators is not solely a professional development priority but also carries implications for patient safety, given evidence linking underprepared resident teachers to reduced feedback quality and educational engagement in clinical settings [6, 44]. However, the causal pathway between resident teacher preparation and patient outcomes warrants direct investigation through future primary research. The present review underscores that institutional investment in structured, longitudinal RaT programs is both an educational imperative and a foundational requirement for sustaining high-quality clinical training amid growing demands on the healthcare workforce.

Abbreviations

ACGME

Accreditation Council for Graduate Medical Education

ERIC

Education Resources Information Center

GCC

Gulf Cooperation Council

GME

Graduate Medical Education

MBRU

Mohammed Bin Rashid University of Medicine and Health Sciences

OB-GYN

Obstetrics and Gynecology

OSCE

Objective Structured Clinical Examination

PCO

Population, Concept, Outcome

PGY

Postgraduate Year

PM&R

Physical Medicine and Rehabilitation

RaT

Residents as Teachers

UAE

United Arab Emirates

Authors’ contributions

L.M.A. contributed to the conception and design of the review, conducted the literature search, analyzed and synthesized the literature, and wrote the manuscript. N.G. independently reviewed screening decisions, confirmed the thematic structure and provided overall supervision. All authors read and approved the final manuscript.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was conducted in accordance with ethical research principles and the Declaration of Helsinki. It received approval from the Mohammed Bin Rashid University of Medicine and Health Sciences Institutional Review Board, Dubai Scientific Research Committee (MBRU IRB-2025-270, Ref: DSREC-SR-04/2025_07) on April 22, 2025. Human Ethics and Consent to Participate declarations: not applicable.

Consent for publication

Not applicable. This manuscript does not contain any individual person’s data in any form.

Competing interests

The authors declare no competing interests.