Background: Residents identify formal didactic teaching (FDT) as a critical component of learning on the medical wards on annual residency surveys. Similarly, faculty express a desire to incorporate FDT into the daily inpatient rotation experience. However, both residents and faculty note multiple barriers to its consistent implementation. We aim to study the impact of various interventions on resident and faculty perceptions on the frequency and quality, as well as their overall satisfaction with FDT.

Methods: We designed an online survey that was then electronically distributed amongst the survey participants. All residents (PGY1-4) who rotate on inpatient medical wards as part of the Internal Medicine Residency at a large academic center were included in this study. Internal medicine faculty who attend on the teaching services at two sites were surveyed. Survey data studied the frequency, quality, satisfaction, and barriers to FDT from a resident and faculty perspective.

Results: Survey data was collected from 92 residents and 45 faculty members (62% and 61% response rate, respectively). FDT was reported by the residents as relevant to patient cases (90% agree), at the appropriate level of training (80% agree), and effective (74% agree). Similarly, 69% of faculty were satisfied with the quality of their own FDT but only 44% were comfortable teaching on a wide range of topics. Residents indicate FDT only occurs consistently (often or always) 27% of the time in their daily inpatient experience and is only efficiently presented 48% of the time. Likewise, faculty note FDT only occurs more than twice per week 28% of the time. Less than half of the residents and faculty (40% and 38%, respectively) report being satisfied/very satisfied with the current frequency of didactic teaching of wards. Based on qualitative data, both residents and faculty report lack of time as the largest barrier to FDT (74 and 31 responses, respectively) while faculty also report lack of time to prepare lectures. In addition, 70% of faculty indicated that having a library of prepared mini lectures would be a helpful resource for FDT on the wards.

Conclusions: FDT is a core method of education during residency training. When FDT occurs at our institution, residents and faculty are often satisfied with the quality and appropriateness of lectures but this practice lacks consistency and efficiency. For both groups, time is the biggest barrier to consistent teaching, including lack of preparation time for faculty, inconsistent dedicated time for FDT, length of teaching sessions, and conflicting clinical duties. Creating a library of high yield, clinically relevant, 10-15 minute long didactic lectures in PowerPoint format to utilize prior to daily teaching rounds is proposed as a solution to improve FDT.