Brief Report

Growing Teachers:Using Electives to Teach Senior Residents

How to Teach

Alexandra R. Martins, M.D., Melissa R. Arbuckle, M.D., Ph.D.Alicia A. Rojas, M.D., Deborah L. Cabaniss, M.D.

Objective: Many physicians teach but few are taught how toteach, particularly through pedagogical interventions. The au-thors describe a method for teaching curriculum developmentand classroom skills to psychiatric residents using an elective inthe fourth postgraduate year.

Methods: An elective in pedagogy provided a framework for theplanning, teaching, and evaluation phases of developing a newcourse.

Results: The elective resulted in four new, well-received coursesand encouraged two participants to pursue careers in academicpsychiatry.

Conclusion: The elective helped residents achieve essentialteaching skills, foster mentoring relationships with senior teach-ing faculty, and develop as future junior faculty members.

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Although the Accreditation Council of Graduate Med-ical Education (ACGME) recognizes teaching as a

core competency for residents (1, 2) and the benefits oflearning and practicing teaching skills in residency havebeen well documented (2–4), a 2001 survey found thatonly 62% of psychiatric programs offer formal instructionin how to teach (5). We searched PubMed for the periodbetween 1950 to May 2009 using the keywords residentteacher, residents as teachers, and resident teaching elec-tive for original articles in English and literature reviews.Most published reports described limited interventionsranging from single 1-hour sessions to half or full-dayweekend retreats (2, 6). The 2001 survey (5) showed amean of 11.5 hours of training in teaching skills across allresidency programs offering such curricula. In addition,curricula on pedagogy have mainly focused on how to givefeedback, supervise medical students, improve teaching atbedside and morning report, give mini-lectures on assignedtopics, and lead small group discussions (2, 3, 6–8). None toour knowledge described a specific pedagogical interventiondesigned to instruct residents in how to design and teach newcourses. Nevertheless, many junior faculty members areasked to do just that. Thus, there is a pressing need to teachthis skill.

Methods

We designed a course called Growing Teachers, anindividualized elective in the fourth postgraduate trainingyear during which residents have weekly, 45-minute meet-ings with a mentor to guide them through the planning,teaching, and evaluation phases of creating a new course.

Planning PhaseUnder the guidance of an experienced medical educator,

residents identify a course topic. In consultation with other

Received May 24, 2009; revised July 24, 2009; accepted August 10,2009. Dr. Martins is affiliated with the Department of Psychiatry at NewYork State Psychiatric Institute and New York Presbyterian Hospital atColumbia; Dr. Arbuckle is the Associate Director for Residency Trainingat New York State Psychiatric Institute and New York PresbyterianHospital at Columbia; Dr. Rojas is affiliated with the Department ofPsychiatry at New York Presbyterian Hospital at Columbia and theCenter for Psychoanalytic Training and Research at Columbia Univer-sity; Dr. Cabaniss is the Director of Psychotherapy Training at New YorkState Psychiatric Institute and New York Presbyterian Hospital at Co-lumbia. Address correspondence to Alexandra Martins, M.D., NY StatePsychiatric Institute, Washington Heights Community Service, 513 West166th St., 4th Floor, New York, NY 10032; am2637@columbia.edu(e-mail).

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faculty experts in the topic, the resident-mentor pair de-termines the target audience (e.g., other residents, medicalstudents, and/or other staff), the length of the teachingmodule, the duration of each session, and the appropriatesetting (e.g., inpatient unit versus classroom). Once thetopic and frame are chosen, residents survey the literature,reflect on their clinical experiences, and propose the struc-ture and content of the module. In subsequent weeklymeetings, the resident-mentor pair establishes the learningobjectives, maps out the content of each class, develops asyllabus, and identifies pertinent class readings. An impor-tant activity of the mentor in these meetings is helping theresident design teaching activities (e.g., patient vignettesand/or audiovisual material) that will effectively help stu-dents achieve the learning objectives.

Teaching PhaseThe teaching phase begins in the classroom. The resi-

dent and mentor review the climate and content of eachweek’s class and plan for the next class. This helps theresident develop flexibility in response to the classroomenvironment. During this phase, the mentor observes oneclass and offers feedback during a subsequent meeting tofurther help the resident adjust the content and his or herteaching style as the course progresses.

Evaluation PhaseIn the final phase, the mentor helps the resident develop an

anonymous, written feedback form to solicit learner recom-mendations for improvement and to measure whether thelearning objectives were met. The resident and mentor reviewthis feedback together and revise the course accordingly.

Once the first round of teaching and evaluation ends, theresident is encouraged to teach the course again (e.g., toeach cohort of students or residents rotating through aunit). Periodic refreshers with the mentor are also encour-aged to discuss any difficulties that emerge and to fosterthe mentorship.

Results

The Growing Teachers elective has been offered for 3years and was completed by two senior residents; an ad-ditional resident was enrolled at the time of writing. Thefirst participant (AR) developed a 12-week course in sup-portive psychotherapy, which she first taught to medicalstudents and junior residents rotating through an outpatientprogram and has continued to teach as a junior facultymember. The second resident (AM) developed two cours-

es: a 4-week module on conducting psychotherapy withinpatients who have severe and persistent mental illness,which she taught to three cohorts of medical students andjunior residents rotating through an inpatient unit duringher senior year and has continued to teach as a junior facultymember, and an 8-week module on psychodynamic psycho-therapy taught so far to two groups of residents from aneighboring residency program. The third participant is cur-rently in the teaching phase of a course designed to teachjunior residents how to write an initial psychiatric evaluationand is scheduled to repeat this course throughout the 2009–2010 academic year. Thus, participants have created coursesthat could be taught multiple times and are an ongoing part ofthe didactic curriculum.

All participants in this elective were mentored by a seniorclinician (DC) who is a member of the institution’s teachingacademy and well versed as an educator. Participants alsoconsulted with a separate faculty member of their choice withexpertise in the courses’ content. The planning phase hasranged from about four to eight mentoring sessions, theteaching phase varied depending on the length of the module,and the evaluation phase lasted one session. In its entirety, theelective has typically lasted from 6 months to 1 year.

The residents who completed this elective have receivedexcellent feedback, comprised of both written evaluationsfrom the students obtained on the last day of the courseand verbal feedback from the mentor, which was collec-tively reviewed in a 45-minute session between the mentorand resident. Learner feedback indicated that studentswere enthusiastic about the topics, format, clinical rele-vance, and quality of teaching. The residents used theconstructive criticism to enhance their teaching of subse-quent groups of learners. The following represent feed-back on the elective from the three participants:

I knew that I liked to teach, but you cannot really know until youdo it. It has been eye-opening to see what good teaching actually is,the work that goes into it, and the amount of energy and creativityneeded to be effective. The experiences I’ve had in this elective andwith my mentor have contributed significantly to my career choiceupon graduation.

Developing and teaching my course as a senior resident helped megain confidence and excitement about assuming the role and re-sponsibilities of a teacher and an attending. My knowledge basewas consolidated in researching and writing the syllabus, and teach-ing the course several times over the past year allowed me to makefine tuned adjustments to enhance the learner’s (and my own)experience.

The process of developing this course has quickly turned me fromformer student to prepared teacher. I have examined the craft ofhistory-writing, reflected on the challenges I have faced, and boiled

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down some key points that I can communicate readily. My thoughtprocess has become sharper, and I feel increasingly attuned to theneeds of trainees at different levels.

Discussion

The Growing Teachers elective offers residents the op-portunity to learn pedagogical skills that are essential fortheir development as educators. It does more than simplyoffer residents the chance to teach or to take a short courseon how to work with medical students; it systematicallyteaches residents to plan, execute, and evaluate their ownteaching module. It also demonstrates the advantage ofbasing all educational experiences on well-delineated,measurable learning objectives (9) and provides an invalu-able rubric for developing any type of educational expe-rience, such as courses, case conferences, and supervision.

This elective has myriad benefits. The residents receive anopportunity to learn skills that are essential for good teachingbut are rarely taught in medical education (10). Having theopportunity to teach the same module several times helpsresidents gain mastery and competency over the material andthe experience of teaching. Teaching is also an effective wayof consolidating their knowledge and skills (9).

Learning pedagogical skills and experiencing the grat-ification of interacting with students can interest residentsin teaching careers. Identification with the mentor can alsodemonstrate to residents that teaching and developing ed-ucational experiences for students is a viable career option,on par with research or clinical work, and can thus expandtheir thinking about future career directions. For residentswho pursue roles as educators, teaching responsibilities inresidency can aid in the transition to junior faculty.

For the program and/or department, resident-teachersinject enthusiasm into the curriculum and add valuableteaching staff. The elective also enables teaching programsto “grow” their own educators and teach best practices,thus fostering excellence early in residents’ careers.

The fourth postgraduate training year presents an idealtime to offer this elective because senior residents have abroad knowledge base, extensive clinical experience, po-tential elective time, and interest in career planning. Al-though we require all fourth-year residents to teach smallgroups of medical students, we have kept the GrowingTeachers elective optional because we think that the in-tensive nature of the project works best with willing andenthusiastic participants. In our experience, the residents’choice not only to teach a course but also what to teachincreases their zeal for the elective and fosters a sense ofownership over the material.

Intensive, individualized electives are clearly time-con-suming for residents and faculty. However, the weeklytime commitment for the faculty member in this elective issimilar to that of a supervisor. Faculty members who areaccomplished educators can be identified as “educationmentors” and potentially relieved of other responsibilitieswhile involved in pedagogical electives. For the resident,this can easily become one aspect of a senior rotation in anoutpatient clinic, an inpatient unit, an emergency depart-ment, or a consultation-liaison service—activities alreadyundertaken by many senior residents. Because the prepa-ration, teaching, and mentorship involved in this electiveare conducted at the discretion and pace of the resident, itdoes not interfere with other clinical responsibilities.

To our knowledge, this is the first resident elective thatsystematically instructs and mentors a resident through thestages of developing and implementing a new course.With this elective, residents not only learn effective teach-ing skills but also the steps involved in curriculum devel-opment—tools important for any academic psychiatrist.

At the time of submission, the authors reported no competinginterests.

References

1. Accreditation Council for Graduate Medical Education: Pro-gram Director Guide to the Common Program Requirements,2009. Available at http://www.acgme.org

2. Dewey CM, Coverdale JH, Ismail NJ, et al: Residents-as-teachers programs in psychiatry: a systematic review. CanJ Psych 2008; 53:75–76

3. Bensinger LD, Meah YS, Smith LG: Resident as teacher: theMount Sinai experience and a review of the literature. MtSinai J Med 2005; 72:307–311

4. Post RE, Quattlebaum RG, Benich JJ 3rd: Residents-as-teachers curricula: a critical review. Acad Med 2009; 84:374–380

5. Morrison EH, Friedland JA, Boker J, et al: Residents-as-teachers training in US residency programs and offices ofgraduate medical education. Acad Med 2001; 76:S1–S3

6. Mann KVC, Sutton E, Frank B: Twelve tips for preparingresidents as teachers. Med Teach 2007; 29:301–306

7. Garfield D, Atre-Vaidya N, Sierles F: Teaching the APAguidelines to psychiatry residents: a novel strategy. AcadPsychiatry 2002; 26:70–75

8. Troupin RH: The mini-fellowship in teaching: a senior res-ident elective. Invest Radiol 1990; 25:751–753

9. Tyler RW: Basic Principles of Curriculum and Instruction.Chicago, University of Chicago Press, 1949

10. Morrison EH, Hafler JP: Yesterday a learner, today a teachertoo: residents as teachers in 2000. Pediatrics 2000; 105:238–241

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