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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 2  |  Issue : 3  |  Page : 164-170

Emergency Medicine Residents as Teachers: A Survey Pertaining to the Perceptions toward Teaching by Such Residents


1 Department of Emergency Medicine, Clinical Skills and Simulation Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
2 College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
3 Research Unit, Clinical Skills and Simulation Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
4 Department of Emergency Medicine, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia

Date of Web Publication1-Jul-2019

Correspondence Address:
Hesham Hazem Alghofili
College of Medicine, King Saud University Medical City, King Saud University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JNSM.JNSM_71_18

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  Abstract 


Background and Aim: There is a current trend for emergency medicine (EM) residents to adopt the role of educators within their given institution. Incidentally, such educational roles have become a part of residency training programs in many training hospitals worldwide. The current study was conducted in order to determine the perceptions of EM residents regarding their role as a teacher. Methods: A validated survey questionnaire was distributed online via Google Forms to all EM residents in six major governmental hospitals in Riyadh, Saudi Arabia. Results: A total of 76 EM residents responded to the survey. Almost 89.5% of these residents (n = 68) did not possess any previous formal training in teaching. Incidentally, 36 (47.4%) residents claimed that their institution required them to undertake a teaching role. Interestingly, a significant portion of residents (76.3%) loved to share their clinical experiences with their students. Conversely, although the majority of the residents (76.3%) felt rewarded on account of their teaching, 28.9% reported feeling stressed when they taught undergraduate medical students. Conclusion: EM residents seemed to embrace their role as teachers and deemed teaching to be a noble part of their job. It would seem, however, that, although residents gain certain benefits from teaching both academically and psychologically, there is a clear need for more in-depth formal training in teaching modalities. The amount of clinical and teaching workload should be balanced to minimize further stress among resident tutors.

Keywords: Academic impact, emergency medicine, experience, perception, psychological impact, resident, teaching


How to cite this article:
Alaska YA, Alghofili MH, Al-Shehri MD, Alghofili HH, Isnani A, Arafat MS. Emergency Medicine Residents as Teachers: A Survey Pertaining to the Perceptions toward Teaching by Such Residents. J Nat Sci Med 2019;2:164-70

How to cite this URL:
Alaska YA, Alghofili MH, Al-Shehri MD, Alghofili HH, Isnani A, Arafat MS. Emergency Medicine Residents as Teachers: A Survey Pertaining to the Perceptions toward Teaching by Such Residents. J Nat Sci Med [serial online] 2019 [cited 2019 Jul 16];2:164-70. Available from: http://www.jnsmonline.org/text.asp?2019/2/3/164/254484




  Introduction Top


Providing a reliable educational service has become a part of residency training programs in many training hospitals worldwide. Teaching hospitals regularly ask their residents to educate junior residents, interns, and medical students as part of their clinical duties. Indeed, many studies have shown that teaching greatly impacts learning,[1],[2],[3] increases an individual's self-confidence, and expands the knowledge base of both medical students and residents.[4],[5] Recent reports indicate that up to 50% of students' clinical skills and expertise emanated from the residents who taught them, and that 33% of their knowledge could actually be attributed to the guidance and teaching of such residents.[3],[6] The significant majority of students (67.0%) believed that emergency medicine (EM) residents had a great impact on their learning during their first clinical year.[7] Resident tutors may also positively influence the future choice of specialty of the students they teach.[8]

Residents spend approximately a quarter of their time (25.0%) on teaching. Moreover, the time spent by residents in teaching undergraduate medical students was found to vary from one institution to the other.[1] Residents believed that teaching undergraduate medical students was as important as their role within the clinic.[9] They perceived teaching as something that is enjoyable, and they valued their role as educators.[4] On the other hand, some residents felt that, if they were not fully equipped to teach, they would lose self-confidence. Many residency program directors believe that residents need to undergo further training with regard to teaching and the acquisition of teaching skills.[10],[11],[12],[13],[14] Despite the inherent ability of some residents, their perceived teaching skills were still at a suboptimal level. Moreover, their teaching focuses mainly on the clinical and practical aspects of the skills. It seems that, frequently, theoretical explanations are missed out.[15]

Students' feedback of residents (as their teachers) plays an important role, particularly in improving the teaching skills of residents.[16] Research has shown that undergraduate medical students were not fully satisfied with the teaching abilities of resident tutors, and the feedback that residents provided to the student in each shift did not fill their knowledge gaps.[15] To the best of our knowledge, the thoughts and opinions of residents in relation to being a “resident tutor” have not been fully discussed in Saudi Arabia. This study was, therefore, conducted in order to determine the viewpoint of residents on their role as teachers. Residents from the EM were chosen due to the high acuity of certain inpatients and the less structured but unique setting that EM residents tend to operate in. As a result of this high-pressure environment, their educational goals and roles (as both learners and teachers) become more challenging.


  Methods Top


After receiving approval from the Institutional Review Board at King Saud University, Riyadh, Kingdom of Saudi Arabia, an online survey was implemented for all EM residents in six major government hospitals including King Abdul-Aziz Medical City, King Faisal Specialist Hospital and Research Center, King Khalid University Hospital, King Saud Medical City, Prince Mohammad bin Abdul-Aziz Hospital, and Prince Sultan Medical Military City in Riyadh, Saudi Arabia.

The survey questionnaire was developed after an extensive review of all previous studies that had explored the role of residents as teachers.[2],[3],[14] From these studies, we customized our questionnaire to suit our objectives. The survey instrument was validated by testing it via a pilot study on ten residents (who were excluded from the actual sample) in King Saud University Medical City, Riyadh, Saudi Arabia. Accordingly, it was deemed that no changes were required. A Cronbach's alpha of 0.85 was obtained. Following this, the survey questionnaire was uploaded and saved to Google Forms, and the corresponding hyperlink was sent via E-mail to all potential survey respondents (EM residents).

The survey questionnaire consisted of three questions on the demographics of the respondents (i.e., their gender, their level of residency, and the details of their specific institution), as well as a further 23 questions on their experience and perception of teaching undergraduate medical students that aimed to determine the psychological, emotional, and academic perceptions of the respondents. Of the 23 questions, 5 were multiple-choice questions and 18 were Likert-type questions. The Likert-type questions were designed with responses ranging from 1 to 5 (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = strongly agree).

Statistical analysis

Data were analyzed using the Statistical Package for the Social Sciences (SPSS®), version 23 (SPSS Inc., Armonk, New York, USA). The results were presented as numbers and percentages. Any significant differences between groups were calculated using the Chi-square test. P < 0.05 was considered statistically significant.


  Results Top


A total of 76 EM residents (47 males [61.8%]; 29 females [(38.2%]) responded to the survey. Twenty-two respondents (28.9%) were residency year 1, 26 (34.2%) were residency year 2, 15 (19.7%) were residency year 3, and 13 (17.1%) were residency year 4 residents. A total of 62 respondents (81.6%) taught undergraduate medical students and interns of whom 71% (n = 44) used <25% of their shift time in teaching, whereas 14 (22.5%) of the respondents spent around 50% of their shift time in teaching, and 4 (6.4%) spent >50%. Approximately 89.5% of residents did not have any previous formal training in teaching. Incidentally, 36 (47.4%) residents claimed that their institution required them to teach undergraduate students. Of these, 25 (69.4%) residents were required to teach <25% of their shift's time, 9 (25%) were required to teach around 50% of their shift time, and 2 (5.6%) were required to >50% of their shift time [Table 1].
Table 1: Demographic characteristics of the participants

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The perceptions of emergency medicine residents toward teaching

Only 28 (36.8%) residents claimed to have enough knowledge of teaching, whereas 14 (18.4%) residents believed that they possessed insufficient knowledge to engage in such an activity, and 34 (44.7%) residents remained neutral. More than half of the residents (61.8%) agreed that being a physician was akin to be a teacher, and 76.3% of residents revealed that they loved to share their clinical experiences with their students. Fifty-eight residents (76.3%) claimed that teaching students was a responsibility. On the other hand, 40 residents (52.6%) claimed that a certain level of experience was needed in order to be an effective teacher, and 27 (35.5%) residents requested training sessions/seminars/and workshops before they were assigned a teaching role. Approximately 19 residents (25.0%) felt that teaching should be minimized during their shift because of time constraints [Table 2].
Table 2: Emergency medicine residents' perceptions toward teaching

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The academic and psychological impact of teaching undergraduate medical students and interns on emergency medicine residents

Most residents claimed that teaching increased their base knowledge (84.2%) and boosted their confidence (84.2%). In fact, the majority of the residents who were surveyed viewed teaching as a valuable component of their continuing education (78.9%) [Table 3]. More than 59.2% of the residents felt comfortable in a teaching role, although 43.4% felt that they were obliged to teach. A large percentage of residents (81.6%) said that they gained personal satisfaction as a result of teaching and 85.5% stated that they loved to see the achievement of desired teaching outcomes. Moreover, 76.3% reported that they felt rewarded on account of their teaching. On the other hand, some residents claimed to have found teaching stressful (28.9%) and had had a hard time working with their schedules (19.7%). Some residents (10.5%) even claimed that teaching had caused them to spend less time with their families [Table 4].
Table 3: The academic impact of teaching undergraduate medical students and interns on emergency medicine residents

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Table 4: The psychological impact of teaching undergraduate medical students and interns on emergency medicine residents

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There were no significant correlations in the EM residents' perceptions (P = 0.584) toward the academic impact of teaching across the different institutions (P = 0.056) involved in this study. However, a significant difference in the psychological impact of teaching on EM residents from different institutions (P = 0.016) was noted.


  Discussion Top


The current study evaluated the perception of EM residents toward teaching and its academic and psychological impact. Less than 40% of the EM residents believed that their knowledge was sufficient to teach students; this value was less than that found in a study conducted in America and Canada which reported that 49% of residents felt qualified enough to teach.[17] Moreover, 61.9% of the respondents in our study claimed that being a physician is akin to be a teacher. Incidentally, 92% of the residents surveyed in the (2010) study conducted by Sánchez-Mendiola et al. considered teaching undergraduate medical students as being important to their role as a clinician.[9] However, the difference in the result between our study and theirs could be due to the small sample size in our study.

Residents agreed that teaching is a part of their clinical role, but more than 50% pointed out that, in order to achieve the desired results, previous teaching experience was desirable. Similarly, 35% of residents stated that learning how to teach is necessary for them to be an effective teacher. Studies have indicated that approximately 89.5% of EM residents are in fact formally untrained to teach and that formal training in teaching is not included in most medical residency training programs.[18] Many residency program directors believe that residents need to undergo further training pertaining to teaching strategies and the learning/acquisition of teaching skills.[12],[13],[14] Formal training in teaching techniques will result in residents acquiring better teaching skills as well as their being better placed to deliver a higher quality of education to their undergraduate students.[18]

Various teaching modalities have been reported in the literature. Residents who received educational training sessions in clinical teaching, via a symposium, workshop, or seminar, demonstrated greatly improved teaching abilities.[18] Providing an optimal and mandatory workshop to educate residents about teaching skills was successfully materialized through several seminars relating to teaching skills and clinical medical education, respectively.[19] Since undergraduate medical students spend a significant amount of time with their resident teacher, their feedback greatly contributes to improvements in teaching. Most of the residents feel that student feedback influences them to make positive changes in both their teaching style and teaching content.[16]

The students, on the other hand, claimed that the resident usually teach them the general principles of medicine, thereby enabling them to reach a diagnosis and devise an appropriate management plan for the patient. An Iranian study has shown that students do not benefit from the feedback of resident tutors and that this feedback does not help them to sufficiently improve their knowledge and practice.[15] However, some EM residents perceived their students as being mere beginners.[18]

Teaching has been shown to increase the knowledge base and self-confidence of residents.[4],[5] In fact, many residents claimed that teaching widens their knowledge base and raises their confidence and perceived teaching as a continuous learning process. There is no doubt that teaching is valued by those residents who want to build high-quality knowledge according to Kirkpatrick's (1994) “Hierarchy of Learning” model.[20]

The lack of time available to effectively teach the course material was reported by some residents. Residents are supposed to spend approximately a fifth of their time (25.0%) on teaching; however, our study showed that a significant majority (57.9%) of residents spend <25% of their shift in teaching, though variations in both the type and number of hospital tasks could be a possible explanation for this. Interestingly, this study has shown that 25 residents surveyed claimed that they were required to teach <25% of their shift while other hospitals minimized the teaching hours of their senior residents.[1]

Overall, teaching was shown to have a positive psychological impact on residents. The majority of the residents felt both satisfied and rewarded when they educated junior residents, interns, and students. In fact, this study has shown that 76.3% of residents claimed that they loved to share their medical knowledge via teaching, which is a higher percentage than that found in a previous study, which showed that only 59.0% of residents experienced satisfaction on account of teaching.[18] On the contrary, feeling exhausted yet being obliged to teach was an emotion that was expressed by 28.9% and 43.4% of residents, respectively, in this study. Moreover, some resident tutors reported experiencing pressure caused by heavy time constraints, such as crowded teaching schedules. This meant that they had less time to spend with their families as was previously mentioned. Previous studies have explained how these scenarios make teaching “a cause of stress” in residency training.[17],[18] The difficulties encountered with teaching are actually related to the different workloads set by different hospitals, in addition to the lack of appreciation and acknowledgment shown to them by their superiors in relation to their teaching efforts.[13]

Limitations

Our study had some limitations. First, the study included a small sample size and the sampling included only those residents who were undergoing training in Riyadh, Saudi Arabia. We tried our best to secure an E-mail list of EM residents undergoing training outside Riyadh to no avail. Therefore, the results would have been more extensive if we had included a larger sample size and other regions of the country as part of our study. However, we were able to draw some significant result and conclusion that deserve consideration for further study. Second, the information that was retrieved was limited to the survey questions only, which could leave some relevant areas unexplored. Third, the cross-sectional design of the study could be considered to be another limitation because we were unable to examine certain relevant educational interventions and assess the residents before and after the intervention in terms of teaching ability.


  Conclusion Top


EM residents embrace their role as teachers and deem teaching to be a noble part of their job. In addition to this, EM residents benefitted from their teaching role both academically and psychologically. However, there is a need for them to undergo formal training in teaching modalities. Compatibility and balance in the clinical workload and teaching play an important role in achieving the desired outcomes for residents as teachers. To the best of our knowledge, this is the first study in Saudi Arabia that has investigated the perception of EM residents in teaching and its academic and psychological impact upon such individuals. We hope that our study will encourage researchers and practitioners to conduct further related studies in Saudi Arabia. Nonetheless, it is unclear at this time exactly which types of teaching modalities will improve the teaching abilities of EM residents. Further research and population-based studies are needed in order to validate our research and to answer the questions that have been posed in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.


  Emergency medicine residents as teachers: A survey pertaining to the perceptions towards teaching by such residents Top


Dr. Yasser Alaska et al.


  Survey Questionnaire For Em Residents Top


Dear Doctor,

We would like you to participate in this study “Emergency medicine residents as teachers: A survey pertaining to the perceptions towards teaching by such residents “The purpose of this questionnaire is to determine what you think and perceive of EM residents as teachers. Your participation in this research is voluntary. You may not choose to participate.

The procedure involves filling out this questionnaire survey form and it will take approximately less than 5 minutes to finish. Your responses will be confidential and we will not collect any information such as your name, email address or IP address. The results of this survey will be used for scholarly purposes only. Filling up and answering the survey questionnaire signifies your consent to join the study.

Thank you very much for your participation

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

PLEASE TICK (✓) YOUR RESPONSE ON THE QUESTIONS. FOR QUESTIONS REQUIRING YOUR COMMENTS AND SUGGESTIONS, PLEASE FILL UP THE APPROPRIATE BLANK SPACE PROVIDED.

A. Demographic profile:

Age_________ Gender ________ Level of Residency: __________

Institution (Hospital) : ____________________________________________

Do you teach undergraduate medical students and interns? ____ YES ____ NO

If yes, how much time do you spend (per shift) teaching undergraduate medical students and interns?

____ less than 25% of my shift ____ around 50% of my shift ____ more than 75% of my shift

Do you have a formal training in teaching? ____ YES ____ NO

Does your institution require you to teach undergraduate students? ____ YES ____ NO

If yes, how much time do they require you (per shift) to teach undergraduate medical students?

____ less than 25% of my shift ____ around 50% of my shift ____ more than 75% of my shift

B. Perception of “EM residents as teachers”



C. Academic impact of EM residents doing “teaching”



D. Psychological impact of EM residents as your teachers



--- - - - - - - - - - - - - - - - - - - THANK YOU VERY MUCH - - - - - - - - - - - - - - - - - - - - - - - - - - - - -



 
  References Top

1.
Ahn J, Jones D, Yarris LM, Fromme HB. A national needs assessment of emergency medicine resident-as-teacher curricula. Intern Emerg Med 2017;12:75-80.  Back to cited text no. 1
    
2.
Morrison EH, Shapiro JF, Harthill M. Resident doctors' understanding of their roles as clinical teachers. Med Educ 2005;39:137-44.  Back to cited text no. 2
    
3.
Seely AJ, Pelletier MP, Snell LS, Trudel JL. Do surgical residents rated as better teachers perform better on in-training examinations? Am J Surg 1999;177:33-7.  Back to cited text no. 3
    
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Sheets KJ, Hankin FM, Schwenk TL. Preparing surgery house officers for their teaching role. Am J Surg 1991;161:443-9.  Back to cited text no. 4
    
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Wamsley MA, Julian KA, Wipf JE. A literature review of “resident-as-teacher” curricula: Do teaching courses make a difference? J Gen Intern Med 2004;19:574-81.  Back to cited text no. 5
    
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Bernal Bello D, García de Tena J, Jaenes Barrios B, Martínez Lasheras B, de Arriba de la Fuente G, Rodríguez Zapata M, et al. The resident as teacher: Medical students' perception in a Spanish University. Rev Clin Esp 2014;214:371-6.  Back to cited text no. 6
    
7.
Bing-You RG, Sproul MS. Medical students' perceptions of themselves and residents as teachers. Med Teach 1992;14:133-8.  Back to cited text no. 7
    
8.
Alshahrani M, Dhafery B, Al Mulhim M, Alkhadra F, Al Bagshi D, Bukhamsin N, et al. Factors influencing Saudi medical students and interns' choice of future specialty: A self-administered questionnaire. Adv Med Educ Pract 2014;5:397-402.  Back to cited text no. 8
    
9.
Sánchez-Mendiola M, Graue-Wiechers EL, Ruiz-Pérez LC, García-Durán R, Durante-Montiel I. The resident-as-teacher educational challenge: A needs assessment survey at the national autonomous University of Mexico faculty of medicine. BMC Med Educ 2010;10:17.  Back to cited text no. 9
    
10.
Edwards JC, Kissling GE, Brannan JR, Plauche WC, Marier RL. Study of teaching residents how to teach. Acad Med 1988;63;603-10.  Back to cited text no. 10
    
11.
Farrell SE, Pacella C, Egan D, Hogan V, Wang E, Bhatia K, et al. Resident-as-teacher: A suggested curriculum for emergency medicine. Acad Emerg Med 2006;13:677-9.  Back to cited text no. 11
    
12.
Bing-You RG, Tooker J. Teaching skills improvement programmes in US internal medicine residencies. Med Educ 1993;27:259-65.  Back to cited text no. 12
    
13.
Busari JO, Scherpbier AJ, van der Vleuten CP, Essed GG. The perceptions of attending doctors of the role of residents as teachers of undergraduate clinical students. Med Educ 2003;37:241-7.  Back to cited text no. 13
    
14.
Busari JO, Prince KJ, Scherpbier AJ, Van Der Vleuten CP, Essed GG. How residents perceive their teaching role in the clinical setting: A qualitative study. Med Teach 2002;24:57-61.  Back to cited text no. 14
    
15.
Doluee MT, Kakhki BR, Salehi M, Talebi M, Emadzadeh M, Ziaee M, et al. Evaluation of the ability of emergency medicine residents in teaching and supervising emergency medicine interns. Electron Physician 2017;9:4541-5.  Back to cited text no. 15
    
16.
Katz-Sidlow RJ, Baer TG, Gershel JC. Providing rapid feedback to residents on their teaching skills: An educational strategy for contemporary trainees. Int J Med Educ 2016;7:83-6.  Back to cited text no. 16
    
17.
Isenberg-Grzeda E, Weiss A, Blackmore MA, Shen MJ, Abrams MS, Woesner ME, et al. Asurvey of American and Canadian psychiatry residents on their training, teaching practices, and attitudes toward teaching. Acad Psychiatry 2016;40:812-5.  Back to cited text no. 17
    
18.
Wachtel JK, Greenberg MR, Smith AB, Weaver KR, Kane BG. Residents as teachers: Residents' perceptions before and after receiving instruction in clinical teaching. J Am Osteopath Assoc 2013;113:23-33.  Back to cited text no. 18
    
19.
Patocka C, Meyers C, Delaney JS. Residents-as-teachers: A survey of Canadian specialty programs. CJEM 2011;13:319-24.  Back to cited text no. 19
    
20.
Praslova L. Adaptation of Kirkpatrick's four level model of training criteria to assessment of learning outcomes and program evaluation in higher education. Educ Assess Eval Account 2010;22:215-25.  Back to cited text no. 20
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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