Background: Although residency programs strive to train residents in effective teaching, few tools to provide direct observation and feedback exist. In our prior work, we developed and validated observed structured teaching exercises (OSTEs) for pediatric and internal medicine residents. Exercises include providing feedback on a presentation, teaching on rounds, teaching at the bedside, and giving a chalk talk. Despite their utility, little work has been done to embed OSTEs into the residency curriculum. A natural home for the OSTEs is in the transition from intern to supervisory resident when residents take on increasing responsibilities leading teams and teaching students.
Purpose: We aimed to implement the OSTEs into the residency curriculum during the transition from intern to second-year resident. We sought to increase direct observation of resident teaching, provide residents with useful feedback, and improve resident teaching of students and interns.
Description: At our hospital, junior residents have one three-hour longitudinal curriculum (LC) session weekly. The OSTEs were implemented into a July LC session. Twelve residents participated, and each junior resident spent half of one morning serving as a simulated student and the other half as the teacher. As the simulated student, residents observed their co-residents teaching and worked with a faculty member to provide feedback on one OSTE. Residents then switched roles and taught their co-residents, receiving feedback on three different OSTEs. Residents and faculty completed surveys on their experience. The Partners IRB exempted the study.
Twelve residents participated as both teachers and simulated students. Nine completed the residency program’s standard LC survey that asks how the session compared to all other LC sessions. Residents ranked the OSTEs 6.22 on a Likert scale of 1 (worst) to 7 (best), in the top 20% of all LC sessions they had participated in. Eleven residents completed an OSTE-specific survey. All responding residents (11/11) agreed or strongly agreed that they felt more prepared to teach on the wards from their experiences as the teacher. The majority of responding residents (10/11) agreed or strongly agreed that they learned new teaching skills as a simulated student. Six faculty members participated in the OSTEs (including the first author, MIM), and five provided feedback (MIM was excluded). All faculty members (5/5) agreed or strongly agreed that the case was reflective of a real teaching encounter.
Conclusions: We successfully implemented OSTEs into a longitudinal curriculum for junior residents. Residents felt that both teaching and acting as a student were useful to prepare them for teaching on the wards. Faculty felt the OSTEs were realistic to allow them to provide feedback to residents. Future work will include repeating OSTEs during future LC sessions, analyzing resident progression through OSTE cases, and comparing teaching skills of residents who participated in OSTEs to those who did not.