Teaching residents to teach will improve medical education

Medical residents take on a variety of responsibilities. Some are clear, upfront, and obvious: the responsibilities they have been training for since entering medical school. Coming up with a treatment plan and carrying it out is first and foremost their raison d’etre, and they put an enormous amount of effort into it. However, they also acquire a host of other duties. They run interference for attendings. They coordinate with nursing. Hand-offs take a chunk of time at the beginning and end of every shift.

Teaching medical students is a job they have had limited, if any, training for. For many residents, it is also an everyday part of their lives.

In grad school, I taught labs on psychometrics. It was a requirement for funding, but it was also one of the most pleasant, rewarding aspects of my academic life. Teaching is always challenging: Finding the level the student is at, using language that works for them, and helping them make as much progress as they can in understanding difficult topics. Not coincidentally, teaching is also a key part of working with patients; patients are students of their own bodies. Healthcare providers need to be able to explain a patient’s medical situation clearly and at the patient’s level of comfort.

The lack of training residents get in working with medical students can manifest in a variety of ways. Some immediately rise to the challenge. Many are too soft on medical students, not pushing us to develop the skills we’ll badly need. They have vivid, recent memories of their own humiliations at the hands of cruel attendings who pimped relentlessly and for the sake of their own ego rather than teaching. Others reenact that ego-plumping pimping, demanding trivial and obscure answers and being dismissive and hostile if students don’t provide them. Neither approach helps medical students learn.

Residents also struggle with feeling inadequate. Impostor syndrome is classic, so thoroughly written about with respect to medical education that it’s a running joke among medical students. We all have impostor syndrome; none of us feel strong enough, smart enough, good enough — if you do, you probably shouldn’t be practicing medicine! We laugh about it, but we feel it keenly. If the brightest among us (the classmate with a PhD in immunology, the friend who consistently scores in the high 90s on exams) feel like they aren’t enough, what do the rest of us think we’re doing, being mediocre in medical school?

Unfortunately, those feelings of inadequacy make teaching medical students difficult for many residents. They may pepper their speech with disclaimers: “I don’t know if.” “This might be wrong but.” These kinds of comments undermine the faith of their medical students, often unnecessarily. Being self-deprecating to the point where a medical student is uncomfortable cuts off the student from asking questions the resident might well know the answers to. And it is always an option for a resident to say, “I don’t know. Why don’t you take a look at the literature and let me know what you find?” It’s not cruel to give us homework. Homework helps us, and it can help the resident, too.

The best residents — the ones students rave about to each other — are those who find the balance between pushing us to do our best, to go beyond what we thought we could do, and pushing us too hard. Residents don’t have the years of experience with teaching that attendings do, but they have different strengths, and they can play to those strengths.

Residents are close to their exams, often still studying. They’re closer to new, exciting research than most attendings, who drift away from what’s happening in research by the simple passage of time, surrounded by clinical and administrative duties. If residents talk to med students about what they’re interested in and passionate about, they don’t need to fear looking undereducated. Acknowledge areas of strength and areas of weakness. In medicine, everyone cares about something. It’s how we got here.

It also helps when residents recognize what they’re feeling. If they’re pressed for time and overburdened, that’s not a moment for teaching. It might be a moment for a brief clinical pearl, but not an extended overview. Don’t try to teach when you’re crunched, exhausted, angry — and that may feel like it describes a large chunk of residency, depending on the field and program, but medical students are more than capable of picking up on the way you feel. If you’re trying to teach when you’re angry, those feelings bleed over into it, and medical students will be too busy worrying about whether this will negatively affect your impression of them (and their grade) to learn. Give yourself permission to take a step back from this duty. Medical students will learn whether or not you personally teach them right this instant. You are critical in many ways, but that doesn’t mean you are single-handedly responsible for everything all of the time, whatever it may feel like.

Residents have so much to offer medical students. Without training, residents take on the strenuous job of teaching in addition to their other responsibilities, and they deserve credit for that. Focusing on residents’ strengths as educators, rather than their weaknesses, can improve medical education.

Kristin Puhl is a medical student and can be reached on Twitter @kristinpuhl.

Image credit: Shutterstock.com

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