Resident-as-Teacher: Can It Be Done With an E-Learning Module?

The Liaison Committee on Medical Education requires that residents are adequately prepared for their teaching roles.¹  While in-person approaches have proven effective in imparting essential educational skills, guaranteeing universal exposure to this information is challenging, given the diverse schedules and clinical obligations residents face.²  The increasing use of e-learning has changed the ability to disseminate educational concepts to a wide audience.

E-modules have previously been successfully utilized to teach clinical and procedural knowledge in graduate medical education (GME), showing the potential of technology to foster the development of competent clinician educators.^3-10  Concurrent with the rise of e-learning, novel educational concepts such as growth mindset and coaching have emerged.^11-16  These concepts align with competency-based education, redirecting the focus from achieving perfection to fostering a culture of continuous learning.¹¹ 

Our goal was to design, implement, and evaluate acceptability of an interactive resident-as-teacher e-learning module focused on utilizing growth mindset and coaching techniques in teaching medical students. We hypothesized that by employing an e-learning platform and incorporating contemporary educational concepts, we could achieve a learning experience that was accessible and relevant to residents across specialties.

This study was performed at a large academic institution with 21 accredited residency programs, containing 277 postgraduate year (PGY) 1 residents across all specialties. E-learning module development, implementation, and evaluation were framed with a logic model (provided as online supplementary data).¹⁷ 

The module was created by the GME Resident-as-Teacher Subcommittee faculty chair (B.M.R.) and members of the Department of Education, Innovation, and Technology (S.J.L., G.C.B.), utilizing an existing resource within the institution, Articulate 360, a web-based e-learning course creation application.

From August to December 2022, the module was created using the 5E learning model of engage, explore, explain, elaborate, and evaluate for instructional design, incorporating content on psychological safety, growth mindset, and coaching.^11,15,18,19  It featured the R2C2 method, a reflective model for facilitating performance feedback that consists of 4 phases: relationship building, exploring reactions, exploring content, and coaching.²⁰ 

Residents who had been recognized as exceptional educators also recorded 30-second video vignettes to give institution-specific examples of best practices. Formative assessments were included throughout the module, and although residents were able to see immediate feedback, their answers were unable to be tracked for data collection.

In February 2023, the module was released via Blackboard Learn (Anthology Inc), a learning management system, with the requirement that all PGY-1 residents complete it within 1 month. Completion was tracked by the GME administrative team.

Completion data, resident specialty, and answers to a 3-question evaluation (provided as online supplementary data) were obtained through Blackboard, preserving anonymity of respondents. The evaluation consisted of rating the module’s relevance (5-point Likert scale) and 2 questions asking residents to identify an aspect of the module they liked and an aspect they would change.

Descriptive statistics were performed for response rate and overall module rating. One-way analysis of variance with Sîdák correction was used to compare Likert ratings of individual specialties with all specialties. Content analysis was used to review comments for patterns by 2 team members (B.M.R., A.E.R.).²¹  Both independently reviewed the comments, met to create categories, and then independently coded comments. In a final joint discussion, the reviewers achieved 90% concordance on aspects that residents liked and 82% concordance on aspects that residents would change, with coding then modified to resolve any differences.

Time for this project was supported by the Baylor College of Medicine Norton Rose Fulbright Educational Grant ($4,929). This study was approved by the Baylor College of Medicine Institutional Review Board.

A completion rate of 100% was achieved, with 271 of 277 (97.8%) completing within the designated 1-month period, and 6 additional residents (2.2%) completing during a remediation period. The Likert evaluation was completed by 276 of 277 (99.6%) residents, with an average rating of 4.06±0.90 on a 5-point Likert scale. Table 1 shows the distribution of residents’ ratings by specialties. The module was rated highest by family medicine (4.36±0.50) and pediatrics (4.36±0.62) and lowest by general surgery (3.28±1.06) and surgical subspecialties (3.63±1.05), with general surgery residents’ ratings significantly lower (P<.01, 95% CI 0.26-1.30) compared to all specialties.

A total of 256 of 277 (92.4%) residents provided comments for “What did you like about this module?” and 230 of 277 (83.0%) provided comments for “What would you change about this module?” Some comments had multiple patterns for a total of 354 coded comments for the first question and 256 coded comments for the second question. Content analysis and representative examples are displayed in Table 2. The most common areas residents liked were relevant teaching strategies (30.2%, 107 of 354), interactive design (21.5%, 76 of 354), and efficient delivery (20.1%, 71 of 354). The most requested change was addition of content such as teaching in challenging situations, more interactive scenarios, or a summary page (36.0%, 91 of 256).

Total time commitment for creation, implementation, and evaluation of the module was 45 hours for the GME faculty involved in this project, 30 hours for the members of the Department of Education, Innovation, and Technology, and 5 hours for residents.

By utilizing resident testimonials and engaging representatives from diverse specialties, we implemented a comprehensive approach to create an institution-wide curriculum. In total, this module was accessible and relevant to PGY-1 residents, although less so for general surgery residents.

Three important lessons learned were to have trainees as co-collaborators, involve specialists in technology early, and be inclusive of all specialties. The TPACK (technological, pedagogical, and content knowledge) model organized our approach to introducing novel technology into our resident-as-teacher curricula.²²  This framework emphasizes the 3 essential components of technological, pedagogical, and content knowledge for educational technology integration. While GME trainees and educators provided the content and pedagogical knowledge, collaboration with our internal Department of Education, Innovation, and Technology allowed creation of an interactive and engaging educational experience, with open-ended comments showing a desire for more content.

Although surgical subspecialty residents were included in module creation, general surgery residents were not. General surgery residents face unique challenges in instructing novice students on operating room protocols and basic surgical principles, ranging from suturing to trauma management.^23,24  In the future, modules will include content applicable to techniques used frequently in surgical specialties, such as teaching procedural skills, teaching under time constraints, and teaching in high-stakes environments.²⁵ 

By utilizing a learning management system, module compliance and reminders were easily performed by the GME office, and there was limited burden on program directors and coordinators. The PGY-1 module will continue, and PGY-2 and PGY-3 modules will be launched, with continued focus on coaching and growth mindset and additional procedural content to ensure applicability to all specialties. Other institutions could also use this template featuring their own resident videos to maintain a personal touch.

This project focused on exploring residents’ satisfaction with an e-module, ensuring it is user-centered and engaging. Our initial concern was that these modules would be met with cynicism; however, open-ended comments showed that the residents desired more information about these novel educational topics. A limitation is that we did not assess the module’s effectiveness. Future directions include adding assessments of knowledge gains and resident behavior changes.

This study demonstrates the successful development, implementation, and acceptability of an e-module for resident-as-teacher training. Delivery of relevant teaching strategies in an interactive manner was found to be effective for PGY-1 residents across specialties.

The online supplementary data contains a logic model for design and implementation of resident-as-teacher e-module and the survey used in the study.

This work was previously presented as an abstract at the Baylor College of Medicine Showcase of Educational Scholarship, Houston, Texas, USA, September 15, 2023.

Funding: Work on this project was supported by the Norton Rose Fulbright Educational Grant Fund from Baylor College of Medicine.

Conflict of interest: The authors declare they have no competing interests.