The Resident-as-Teacher: It's More Than Just About Student Learning

Docere, the Latin root of the word doctor, means to teach, and teaching is an intrinsic part of being a physician. Most physicians routinely teach their students, residents, colleagues, and patients. Residents regularly contribute to the education of medical students and their fellow residents and may spend up to one-fourth of their time supervising, instructing, and evaluating students and junior colleagues.¹ Teaching by residents is different from, and likely complementary to, that of their attending staff and faculty. Residents tend to teach (1) different things (bedside skills and patient management rather than factual knowledge),² (2) in a different way (as near-peer teachers); and (3) at different times (teaching while on-call). The impact of effective resident teaching goes beyond medical students and includes effects on patients but has particular benefits for the residents themselves and the systems in which they work and learn.

Benefits for Students

Medical students benefit greatly from having residents as teachers: it has been estimated that nearly one-third of their learning in the clinical setting comes from residents.¹ As near-peer teachers, residents are close enough to the students they teach to understand the optimal approach for them to learn.³ Residents also are “consciously competent,” that is, they still can deconstruct performance on a clinical task and articulate the detailed steps to facilitate learning by novices and advanced beginners. Beyond that, residents are important role models for their junior colleagues,^4,5 and students likely acquire professional values and behaviors from their resident supervisors.

Resident teaching has other positive effects on students. Highly rated resident-teachers increase student satisfaction. The study by Huynh and colleagues⁶ in this issue shows that positive experiences with resident-teachers and a perceived high quality of resident education is associated with high overall satisfaction with a clerkship rotation. Medical students' career choice has also been linked with good resident teaching in surgery.⁷

Benefit for the Residents and the System

There are also effects on the residents themselves: Those who teach have increased enthusiasm for teaching and greater job satisfaction.⁵ In addition, residents who are more successful or higher-rated teachers tend to have better knowledge acquisition.^1,8 There may thus be some truth to Joseph Joubert's adage “to teach is to learn twice.”⁹

Residents with effective teaching skills may also have a positive effect on patient care. Resident involvement in teaching activities has been shown to have a positive effect on the resident's communication skills,³ and good patient communication skills have been associated with better clinical outcomes.^8.10

Improving Resident Teaching

Given these benefits of teaching by residents, a concern raised by the Huynh and colleagues⁶ study is that the residents did not address all the learning objectives of the medical students. It is not clear whether that is a generalizable finding or related to reduced teaching on particular topics in the program studied. The authors' recommendation is for programs to ensure residents are prepared to teach in all the common content areas and key competencies needed by the students.

From a systems perspective, teaching is one of the skill domains in competency frameworks, such as that of the Royal College of Physicians and Surgeons of Canada or the Accreditation Council for Graduate Medical Education, which form the basis of residency education and accreditation requirements.^11,12 Recognizing the critical role of resident teaching skills, the North American undergraduate medical education accreditation body requires programs and resources “to enhance the teaching and assessment skills of residents.”^13(p14)

The findings of Huynh and colleagues⁶ underscore that residents need formal instruction, support, and mentoring to enhance their teaching skills. Guidance on how to build an effective resident-as-teacher program has been published.⁴ Excellent programs exist and have been shown to improve residents' teaching skills¹⁴ and clinical knowledge.^1,8 Resident-as-teacher programs appear to do more than this and have positive effects on medical student perceptions of their clerkships. We can only encourage that these programs continue to be studied and become available to all trainees.