Impact of a Teaching Rotation on Residents' Attitudes Toward Teaching: A 5-Year Study

The Liaison Committee on Medical Education has stated that residents should be trained in teaching skills.1 According to a 2001 survey by Morrison et al,2 55% of residency programs provide formal teaching instruction. Approaches vary from required teaching programs, teaching electives,3,4 protected blocks of time for teaching opportunities,5,6 designating “teaching residents” on clinical rotations,7 and organizing teaching skills retreats. Overall, lectures and workshops are the most commonly used formats, and large group discussions or role playing are often used.2 

Studies evaluating the attitudinal effects of those programs have mostly been narrative or qualitative in nature.3,4,11 Our 5-year study quantitatively evaluated the impact of a teaching rotation on residents' attitudes toward teaching.

In July 2004, the pediatric residency program at the University of California, Irvine, instituted a required 1-month teaching rotation for second-year residents named “Residents as Teachers.” Didactic sessions for the residents included instruction on the following: effective lecturing, teaching in various clinical settings, understanding learning styles and emotional intelligence, and providing constructive feedback. The research study was reviewed and approved by the Institutional Review Board of the University of California, Irvine.

Residents implemented teaching skills via scheduled teaching activities. They practiced didactic teaching skills by (1) leading discussions regarding common pediatric topics at medical student conferences and (2) teaching key pediatric topics at resident noon conferences. They practiced case-based teaching by (1) presenting and working through a case at morning report and (2) working through cases with medical students in small groups. Residents also participated in teaching clinical skills, and taught interns and medical students history and physical exam skills in the outpatient and inpatient settings. They worked one-on-one and in small groups with interns and medical students, and provided performance feedback.

Before and after the rotation, residents were given a maximum of 5 minutes to anonymously fill out questionnaires focused on their attitudes toward teaching. Participation was voluntary. The questionnaire consisted of providing responses to 5 questions derived from Part II of the American Academy of Pediatrics' Residents as Teachers Handbook pretest.12 A Likert scale was used to quantify responses (table 1).

Residents (n  =  73) completed prerotation questionnaires from July 2004 through September 2009, and 70 residents completed postrotation questionnaires.

The data from the questionnaires were analyzed using the Mann-Whitney U test. The mean values increased for all of the categories examined when comparing the prerotation and postrotation questionnaires (table 2). Four categories showed a significant increase: feeling prepared to teach (P < .0001), having confidence in teaching ability (P < .0001), being aware of expectations as a teacher (P < .0001), and having a healthy anxiety level (P  =  .0037). There was an increase in the level of enthusiasm, but the P value did not reach a statistically significant range (P  =  .12).

Using the Kruskal-Wallis method of analysis, the level of enthusiasm was found to be significantly higher on the prerotation questionnaire than all other attitudinal factors, including the level of preparedness, confidence, awareness of expectations, and level of anxiety (P < .0001 compared to all other factors).

Analysis of the prerotation and postrotation questionnaires from July 2004 through September 2009 demonstrated that following a teaching rotation, residents felt more prepared to teach, developed greater confidence in their teaching skills, possessed a greater awareness of their expectations as teachers, and had less anxiety about teaching.

The level of enthusiasm rose following the teaching rotation, but the increase did not reach a statistically significant range. However, the level of enthusiasm was significantly higher prior to the rotation than the other factors, thus demonstrating that residents were already enthusiastic about teaching, and their level of enthusiasm remained high following a teaching rotation.

This study's primary contribution is its quantitative design, which provides objective data to support prior narrative and qualitative reports on the positive attitudinal effects of a teaching rotation on resident trainees.8,9,11 Validity is augmented by the 5-year length of the study and the large number of residents involved in the study (n  =  73). Previously, the largest number of residents studied for attitudinal effects was 21, and the greatest length of study was 1 year.11 

Our study has a few limitations. First, all of the study participants are categorical pediatric residents from the same residency program. Thus, our results may not be generalizable to residents from other specialties. Second, our program is at a large university teaching institution, which may preselect for residents with a strong interest in teaching.

We plan to expand upon the findings in this study. The long-term success of our program may be evaluated by ascertaining after graduation whether the residents' positive attitudes toward teaching have been sustained, and how many of these residents are still teaching.

Further areas of research may include evaluation of residents' teaching skills by structured examination of their lectures and bedside teaching. Previous studies using structured examination have shown mixed improvement in residents' teaching abilities following completion of a formal training program.5,6,13 However, the training programs consisted of a miniretreat and/or a series of noon conference lectures rather than a 1-month rotation with dedicated teaching time.

Residents are enthusiastic about teaching, and their level of enthusiasm remains high following a teaching rotation. Residents feel more prepared to teach, more confident in their teaching ability, more aware of their expectations as a teacher, and less anxious about teaching following a formal teaching rotation. Our quantitative study, involving a relatively large number of residents over 5 years, provides objective data to support prior narrative and qualitative reports on the positive attitudinal effects of a teaching rotation on residents.