A Novel Iterative-Learner Simulation Model: Fellows as Teachers

Abstract

Background Simulation is an effective method for teaching clinical skills but has not been widely adopted to educate trainees about how to teach. Objective We evaluated a curriculum for pediatrics fellows by using high-fidelity simulation (mannequin with vital signs) to improve pedagogical skills. Intervention The intervention included a lecture on adult learning and active-learning techniques, development of a case from the fellows' subspecialties, and teaching the case to residents and medical students. Teaching was observed by an educator using a standardized checklist. Learners evaluated fellows' teaching by using a structured evaluation tool; learner evaluations and the observer checklist formed the basis for written feedback. Changes in fellows' pedagogic knowledge, attitudes, and self-reported skills were analyzed by using Friedman and Wilcoxon rank-sum test at baseline, immediate postintervention, and 6-month follow-up. Results Forty fellows participated. Fellows' self-ratings significantly improved from baseline to 6-month follow-up for development of learning objectives, effectively reinforcing performance, using teaching techniques to promote critical thinking, providing constructive feedback, and using case studies to teach general rules. Fellows significantly increased agreement with the statement “providing background and context is important” (4.12 to 4.44, P = .02). Conclusions Simulation was an effective means of educating fellows about teaching, with fellows' attitudes and self-rated confidence improving after participation but returning to baseline at the 6-month assessment. The simulation identified common weaknesses of fellows as teachers, including failure to provide objectives to learners, failure to provide a summary of key learning points, and lack of inclusion of all learners.

Teaching during consultation: factors affecting the resident-fellow teaching interaction

“…Based on focus group participant suggestions and our inferences from these data, our study suggests that a number of potential interventions can enhance the resident-fellow interaction ( changes at systems-based factors rather than personal behaviours. 20 Therefore, interventions that affect systems-based factorssuch as by altering hospital processes to minimise pushback and to increase face-to-face communication with consultants, improving fellow teaching skills in the setting of consultation, [27][28][29][30] and promoting the importance of teaching within subspecialty divisionsall hold promise for improving teaching within consultative medicine in academic medical centres.…”

“…Contributors: EMM contributed to the conception and design of the work, and the acquisition, analysis and inter- Perceptions and expectations Develop and implement specific expectations of both resident and fellow responsibilities as they pertain to the consultation process Disseminate the fact that fellows are interested in teaching residents, and residents are interested in learning from fellows, within both residency and fellowship programmes Pushback Implement a mechanism for residents to evaluate fellows and subspecialty consult service Fellows' teaching skills Develop programmes aimed at improving fellows' teaching skills, particularly in the setting of consultation [28][29][30] pretation of data, and drafted the manuscript. JIM and JBR contributed to the acquisition, analysis and interpretation of data.…”

A simulation‐based resident‐as‐teacher program: The impact on teachers and learners

“…However, in contrast to true ward‐based teaching, simulation can provide predictable scenarios in a controlled environment, which eliminates the distractions and unpredictability that exist on the wards, without compromising patient safety. Recently, Tofil et al described the first use of simulation in a trainee‐as‐teacher program . The investigators utilized a 1‐time simulation‐based teaching session, during which pediatric fellows completed a teacher‐training workshop, developed and served as facilitators in a simulated case, and received feedback.…”

“…Recently, Tofil et al described the first use of simulation in a trainee-asteacher program. 17 The investigators utilized a 1-time simulation-based teaching session, during which pediatric fellows completed a teacher-training workshop, developed and served as facilitators in a simulated case, and received feedback. The use of simulation allowed fellows an opportunity to apply newly acquired skills in a controlled environment and receive feedback, which has been shown to improve teaching skills.…”

Education in consultation: A comparative survey-based assessment of perceived educational effectiveness within a university and community-based internal medicine residency

“…Though curricula for faculty and resident clinician educators have been successfully developed, programs for fellows are limited (Heflin, Pinheiro, Kaminetzky, & McNeill, 2009;Hill, Yu, Barrow, & Hattie, 2009;E. M. Miloslavsky, Boyer, et al, 2016;Richards, McCallister, & Lenz, 2016;Rosenbaum et al, 2011;Smith, McCormick, & Huang, 2014;Tofil et al, 2014). Curricula specific to teaching in consultation are necessary for fellowships given their unique challenges.…”