574JGIMBlackwell Publishing, Ltd.REVIEWWamsley et al., “Resident-as-Teacher” CurriculaA Literature Review of “Resident-as-Teacher” CurriculaDo Teaching Courses Make a Difference?Maria A. Wamsley, MD, Katherine A. Julian, MD, Joyce E. Wipf, MDOBJECTIVES: To examine the evaluation methods of residentteaching courses and to estimate the effectiveness of theseteaching courses.DESIGN: We searched the literature from 1975 to May 2003using the PubMed MESH terms internship and residencyand teaching; 1,436 articles were identified and 77 containedinformation regarding teaching courses. Fourteen articlescontained information regarding outcomes of resident teachingcourses and were selected for intensive review.MAIN RESULTS: Five uncontrolled pre-post studies used resi-dent self-reported teaching skills/behaviors as outcomemeasures; all reported some improvement in self-reported skills.Three uncontrolled pre-post studies examined live or video-taped resident teaching encounters and all revealed improve-ment in some teaching skills. One uncontrolled trial and threenonrandomized controlled trials used learner evaluations ofresident teaching behaviors as outcomes and all revealed animprovement in ratings of residents after course participation.Four randomized controlled trials of resident teaching cur-ricula are included in this review. One study did not showany quantitative benefit of a resident teaching course onperformance on an objective structured teaching evaluation.Two studies assessing resident teaching evaluations before andafter course participation showed conflicting results. One studynoted improvements in resident teaching skills assessedthrough videotape analysis.CONCLUSIONS: Resident teaching courses improve residentself-assessed teaching behaviors and teaching confidence.Teaching courses are linked to improved student evaluations.Further studies must be completed to elucidate the best for-mat, length, timing, and content of resident teaching coursesand to determine whether they have an effect on learnerperformance.KEY WORDS: teaching; curriculum; education-residents; intern-ship; residency.J GEN INTERN MED 2004;19:574–581.Studies estimate that residents spend up to 20% of theirtime on teaching activities—regardless of their futurecareer plans.1 Residents recognize they have responsibilityfor teaching medical students, interns, and fellow resi-dents. Surveys demonstrate that residents enjoy teachingand consider it vital to their own education.2 Studies alsoshow that residents conduct more teaching at the bedsidecompared to attendings.3 Additionally, one survey foundthat medical students estimated one third of their knowl-edge could be directly attributed to house staff teaching.4Another study found that residents assigned teachingactivities increased their knowledge acquisition of assignedteaching subjects.5Despite their significant teaching responsibilities, manyresidents receive no formal instruction on how to teacheffectively. In a 2001 survey, 55% of residency directorsindicated their programs offered residents formal instruc-tion in teaching skills.6 Although “resident as-teacher” cur-ricula are becoming more common in residency programs,surveyed program directors still express the need for moreresident instruction in teaching.6Although there are many published studies describingresident teaching courses, most have not been effectivelyevaluated. To synthesize the current knowledge regardingresident teaching courses, we reviewed literature publishedfrom 1975 through May 2003. We sought to answer thefollowing questions:• What methods have been used in evaluating the effec-tiveness of resident teaching courses?• What is the estimate of the effectiveness of residentteaching courses?METHODSWe searched the literature using the PubMed MESHterms internship and residency and teaching. The searchwas restricted to English language studies publishedbetween 1975 and May 2003. We identified 1,436 articles.We limited our search to studies published after 1975—when resident teaching courses first appeared.7Two of the authors (MAW and KAJ) evaluated eachcitation for its relevance to resident teaching courses. Oneor both of these authors selected 77 articles for furtherreview. Both authors reviewed abstracts of these 77 articlesfor information about outcomes of resident-as-teacherReceived from the Department of Medicine (MAW, KAJ), Univer-sity of California, San Francisco, Calif; and Department ofMedicine (JEW), Veterans Administration Puget Sound HealthCare, University of Washington, Seattle, Wash.Address correspondence and requests for reprints to Dr.Wamsley: 400 Parnassus, Box 0320, San Francisco, CA 94143(e-mail: [email protected]).JGIM Volume 19, May 2004, Part 2 575programs. Studies employing resident self-report of teachingskills or objective criteria (learner evaluations of residents,objective structured teaching evaluations, or videotapereview) as outcome measures were included. Articles thatwere descriptive in nature, reported only resident satisfac-tion, or involved fellows/faculty were excluded. One orboth of the authors (MAW and KAJ) identified 30 articlesand read them in their entirety for data on outcomes asdescribed above. The bibliographies of these 30 articleswere cross-referenced; 3 additional articles were identifiedfor further review. Fourteen articles met the inclusioncriteria described above and are presented in this paperfor further analysis. These articles were selected throughconsensus between both authors (MAW and KAJ) whoindependently reviewed and abstracted data from eacharticle. Subsequently, the authors compared assessments andcame to a consensus regarding the interpretation of the data.RESULTSThe 14 articles selected for detailed analysis are sum-marized in Tables 1–3. The studies involved residents fromdifferent disciplines and postgraduate years. The teachingprograms studied ranged from a 1-hour lecture to a 13-hour teaching course. Eleven studies described the teach-ing methodology utilized in their curriculum, includinglarge and small group discussion,7–15 lecture,7–9,11,14,16 roleplay,7–9,11,12,14–17 reflection on videotaped vignettes,7,10,11,13–15standardized students,17 and review of videotaped teachingin a small group setting or with a consultant.8,10,11,16 Par-ticipants in the studies ranged from 6 to 446. Evaluationdesigns consisted of pre-post cohort studies, post-postcohort studies, nonrandomized control