In 2000, 80% of pediatric programs in the United States had a RAT curriculum.4
Our 2009 survey showed that number still is not 100%, despite accreditation requirements. Of those curricula that do exist, their effectiveness, their outcomes, and how they are perceived have not been well documented. Our group specifically did not assess programs outside of the United States to narrow the scope of the needs assessment.
Leadership and support are keys to the success of any curricular program. Most responding programs have designated faculty members responsible for the curriculum, but we did not assess whether that additional responsibility placed an undue burden on faculty. Most curricula are led by physicians with some workshop training but not necessarily advanced educational training/degrees. Even fewer programs have medical education specialists (nonphysician) involved in the RAT leadership. This lack of access to educational training or specialists can disadvantage programs with fewer resources. Our study demonstrates a lack of funding in most programs. Despite this, most programs are moderately/extremely satisfied with the support they receive. Although this suggests the RAT leadership can be satisfied with nonfinancial support, it cannot be interpreted to mean funding is not important.
The process of creating and delivering RAT curricula is highly variable. Most programs have developed their curricula based on site-specific issues, such as resident needs, faculty opinions, and considerations of medical educators. Although some programs reported using models from the literature, most programs did not incorporate experiences of others. Not applying principles from programs that work is counter to what Glassick8
advocates as critical to evaluating scholarship. There are well-described models that can provide a foundation for a RAT curriculum and that warrant consideration by those planning such programs.,9,10
Although programs might not be interested in publishing results, evidence of curricular efficacy can demonstrate a positive return on investment to participants, leadership, and other programs.
The data suggest that there is a core set of topics that form the foundation of most curricula. There are also additional topics that are rarely/not reported, which might be highly beneficial to programs (eg, simulations, goals and objectives, time management, self-assessment, and leadership and change). Not including such valuable topics could indicate a lack of faculty comfort and experience in the topic areas, time constraints, or lower prioritization. Based on the variability among programs, residents in different programs might not experience training in a number of important educational topics, perhaps pointing to the need for national resources that would include value-added topics.
Most programs rely on lectures for curriculum delivery. We did not assess the features or methods used during lectures. If faculty deliver lectures in a way in which learners are passive, that would not be ideal for maximum learning. In fact, using only didactic techniques to instruct on effective instructional techniques does not provide a role model for ideal methods. Respondents also reported that workshops are frequently used, but there was no assessment to determine how effective those were in residents' learning. Methods such as online information and training or networks and discussion groups are rarely cited in carrying out these curricula, excluding many potentially active and valuable methods for instruction.
Our results indicate limited curricular evaluation, demonstrating a lack of the scholarship rigor that Glassick8
promoted. Resident satisfaction with RAT curriculum and increased confidence in teaching postintervention represent important aspects of evaluation but only within the context of measuring the teaching performance and learner satisfaction. This confirms findings that most RAT curriculum evaluations met the first and second levels of Kirkpatrick's educational outcomes framework and do not extend to an assessment of behavior (level 3) or outcomes (level 4).,11,12
The call for outcomes-based evaluations and measures by the ACGME underscores the importance of improving and increasing the evaluation of curricular outcomes in addition to including longitudinal and multicentered evaluations of teaching skills and effectiveness.
Some programs still do not have a RAT curriculum, which is concerning, given the mandate to residents to become effective teachers. It is possible that the development of a national RAT curricular resource would be of benefit to these programs.
Finally, nearly all respondents expressed interest in development of, and access to, a national RAT curricular resource as long as it was not mandated and was easy to access. Programs are also interested in introducing/improving their RAT curricula contingent on it not resulting in the addition of another layer of work or requirements on an overburdened faculty. One could envision a train-the-trainer program online in areas of feedback, problem learner, orienting a learner, and skills teaching.