ncreasingly, undergraduate medical education is moving from unstructured didactic large group and minimally supervised clinical lessons to small, closely supervised as well as structured clinical sessions1. Part of this transition was to promote deep learning amongst the students, by encouraging them to have more discussions and interactions with their seniors or supervisors to understand the context in which certain clinical approaches are taken. However, this is hindered by many clinicians and senior clinical teachers' extremely busy schedule. They have to treat a large number of patients, participate in higher level management and translational research.

At the same time, it has been reported that teaching activities could take up as much as 20% of the residents' time, and this contributes to one-third of the knowledge acquired by the medical students2. It is thus crucial that we ensure that they are well-versed in teaching. However, besides providing their service to hospitals, these residents also have to receive their regular and sometimes intensive training in areas like domain-specific skills and knowledge, which poses a challenge.

Context

At the Yong Loo Lin School of Medicine (NUS Medicine), National University of Singapore (NUS), there was an imperative need for us to design a program that has a practical approach to equip the residents to teach their juniors with the foundational understanding of the medical and health professions education framework. This was due to varying factors listed below.

1. As part of our quality improvement efforts and 2020 goals to enhance the student learning environment to give undergraduates a WOW learning experience.

2. Development of residents' teaching skills in order to achieve competency in Practice-Based Learning and Improvement as part of the Accreditation Council for Graduate Medical Education-International's standards.

3. Residents are more involved in teaching, assessing and providing feedback to learners since they often have more direct contact time with students than senior faculty in an academic medical center with learners of various seniorities embedded in nearly all clinical teams.

4. To integrate a residents-as-teachers (RaTs) workshop into the curriculum of all residency programs offered at our institution.

Innovation

We developed an eight-hour, interactive and practical training program incorporated into the main learning context for all residents and specialists at the National University Health System (NUHS) academic centre. The first workshop was conducted in 2012 and four more sessions had been run up to 2014.

Content

Experiential learning theory was used to impart best-practices and hone skills in: (a) effective bedside teaching; (b) formative work-based assessment; and (c) providing feedback to enhance student learning, (d) contemporary clinical-assessment practices and (e) managing time effectively. Forma

Format

The program was built around discussion on actual cases in clinical education, with the facilitators highlighting the principles and theories behind some of the best practices and theories and discussing challenges residents encountered during the session.

The format included interactive small group discussion with problem-based scenarios, role-play, direct observation and videoed micro-teaching exercises incorporating techniques such as the RIME model, 1-minute preceptor and modified Pendleton feedback model. We selected these practical techniques to promote timely, concise teaching output relevant to a busy resident and to address the challenges of effectively engaging learners at multiple levels.

Multimedia, especially videos were used to complement the content delivered. Participants were also given a short handout from which certain elements were highlighted during the workshop and they were encouraged to read it afterwards.

During the hands-on microteaching sessions, trained standardized participants acting as patients or students were involved. Participants were encouraged to reflect on their experience before and during the workshop. The resource person also highlighted the key points as tips towards the end of the session.

Assignment

From the second workshop onwards, we introduced a postworkshop assignment consisting of video recording and analysis (with workshop faculty feedback) of a resident-delivered, bedside teaching session that is required for certification of the resident as teacher. This is for them to apply what they have learnt to their daily practice.

Implications

The workshop has been offered five times since, with a total attendance of 87 residents to date. Seventy-eight residents (92%) completed feedback on their RaTs workshop experience with 99% of them rating it as good, very good or excellent. Many found the role-play and microteaching activities very engaging. Participants also found the content simulating, which prompted them to think about teaching in new ways.

Additionally, they rated the workshop especially highly in terms of helping them to plan and implement teaching activities in their daily practice more effectively. When asked what immediate changes they would implement, most comments focused on integrating the specific, practical techniques shared in the workshop into their routine student contact, particularly on giving feedback using techniques like the sandwich model.

Despite the relatively positive feedback, we encountered difficulties with the post-workshop assignment that was designed to complete the learning cycle. Only 21 participants completed since it was introduced. Anticipated next steps include peer observation and feedback of resident teaching for the ongoing development of our residents as faculty.

Conclusion

In conclusion, the practical and hands-on nature of the workshop was well received with participants feeling empowered and requesting even more practical exposure.

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