This review underscores the fact that the current literature regarding resident teaching courses is limited and constrained by studies with diverse experimental designs and outcome measures. The teaching methodology for the interventions varied widely. Many studies used resident self-assessment of teaching skills as an outcome measure. Although resident self-confidence is important, self-assessment may not represent actual skills obtained. As residents advance in their training, they gain teaching experience and may report increased comfort with teaching. Thus, uncontrolled studies that utilize self-assessed teaching skills will be confounded by additional resident teaching experience. Most of the studies had a small number of participants, making it difficult to obtain adequate power for effective analysis.
There is evidence that resident teaching courses improve learner evaluations of participants. The three nonrandomized controlled studies that measured student ratings demonstrated statistically significant improvement in resident evaluations after interventions varying from 3 to 6 hours. However, when impact is assessed by effect size, the percent change in evaluations after the intervention is small (2% to 11%), in part due to the concentration of evaluation scores in the upper half of the scale. Yet in the largest controlled study, these differences resulted in residents being perceived as “excellent” rather than “very good” teachers.15
The 4 randomized controlled studies varied in teaching intervention, content, and outcome measures; 3 showed improvement in at least 1 teaching outcome.8–10
In the negative study that showed similar OSTE performance between course participants and controls at 6 months, there was no OSTE obtained at baseline or immediately after the course.17
Thus, it is unclear whether skills were not acquired or if they were acquired and diminished over time. There are data from 4 small studies examining the lasting effects of resident teaching courses8,12,18,20
; 3 suggested a decline in teaching skills over time.8,12,20
This review is the first to systematically summarize the current literature regarding resident-as-teacher curricula. This review has several limitations. First, we recognize the potential effect of publication bias, in that positive studies are more likely to be published, and we reviewed only published studies. Additionally, only studies with “quantitative” results were selected for review. Although we attempted to comprehensively review the literature, our search included one large database in the English language and bibliography cross-reference; studies may have been missed. Despite potential limitations, our review does have its strengths. We synthesized data from a multitude of studies with a variety of outcomes. In doing so, we are able to identify the value of a resident teaching course and define important areas for future research.
Residents are vital to teaching in academic centers. There is evidence that teaching courses improve resident self-assessed teaching behaviors, self-confidence as a teacher, and result in higher learner evaluations of residents. Given these demonstrated positive effects, one might argue that all residency programs should require resident teaching instruction. However, many obstacles to course implementation exist. Teaching courses can be time intensive for residents and faculty, and it is challenging to provide residents with uninterrupted educational time. Many academic faculty are not given supported time to create and teach these courses. Competing curricular requirements for training may result in fewer time-intensive curricula. All of these barriers may contribute to the fact that nearly half of all residency programs do not provide formal instruction in teaching.6
Some questions remain regarding resident-as-teacher courses. First, it is not clear what parts of the teaching courses are the most effective; only 1 study evaluated differences between 2 teaching interventions.16
Additionally, an initial objective to compare course length, format, and timing could not be achieved due to the widely differing study designs and insufficient detail about course content. Future research should be completed to elucidate the best structure of resident teaching courses, as well as optimal level of trainee and teaching methods. Research also is needed to assess the lasting effect of resident teaching courses and the impact of brief follow-up sessions to reinforce skills. Randomized studies with immediate post assessment as well as 6-month to 1-year post assessments with reinforcement curricula would be helpful. Future studies should examine objective measures such as students’ acquisition of skills as a result of resident teaching. Although formal study may be challenging, we faculty who conduct resident-as-teacher courses have found intangible benefits such as enhanced intern and resident morale and increased program emphasis on teaching excellence.