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Medical Education in Pulmonary, Critical Care, and Sleep Medicine pp 43–59Cite as

Teaching Residents

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Part of the book series: Respiratory Medicine ((RM))

Abstract

Effective strategies for teaching residents pulmonary and critical care medicine (PCCM) are grounded in adult learning theory. Residents have growing independence in clinical responsibilities, and their learning primarily derives from work-related clinical functions. As they progress through training, motivation to learn shifts increasingly inward, as there are fewer external pressures imposing learning requirements, and enhancement of knowledge and skills has more direct transference to professional development and personal achievement. Residents prefer active learning techniques that are problem-focused and collaborative, rather than passive learning that is content-focused and further separated from the clinical environment. Residents also bring an abundance of knowledge to the learning environment, allowing teachers to focus on clinical reasoning and application of existing knowledge. The intensive care unit (ICU), Pulmonary Consultation service, and Pulmonary Clinic are all settings with numerous educational opportunities for both cognitive and technical skill development. There are many potential barriers to effective teaching of residents, however, including time constraints and competing service demands, as well as high clinical acuity in settings like the ICU. There are several strategies to overcome these potential logistical impediments to learning, including approaches to teaching when time is limited. This chapter provides a learning theory-based framework that emphasizes important contextual considerations when teaching residents, in addition to practical approaches and diverse strategies for effective teaching in multiple settings where residents are encountered in PCCM.

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References

  1. West CP, Dupras DM. General medicine vs subspecialty career plans among internal medicine residents. JAMA. 2012;308:2241.

    Article  CAS  Google Scholar 

  2. Lorin S, Heffner J, Carson S. Attitudes and perceptions of internal medicine residents regarding pulmonary and critical care subspecialty training. Chest. 2005;127:630–6.

    Article  Google Scholar 

  3. Santhosh L, Babik J, Looney MR, Hollander H. Whither the pulmonary ward attending? Preserving subspecialty exposure in United States internal medicine residency training. Ann Am Thorac Soc. 2017;14:565–8.

    Article  Google Scholar 

  4. Bannon S, Ford K, Meltzer L. Understanding millennials in the workplace. CPA J. 2011;81:61–5.

    Google Scholar 

  5. Almoosa KF, Goldenhar LM, Puchalski J, Ying J, Panos RJ. Critical care education during internal medicine residency: a national survey. J Grad Med Educ. 2010;2:555–61.

    Article  Google Scholar 

  6. Trowbridge RL, Almeder L, Jacquet M, Fairfield KM. The effect of overnight in-house attending coverage on perceptions of care and education on a general medical service. J Grad Med Educ. 2010;2:53–6.

    Article  Google Scholar 

  7. Barrett H, Bion JF. An international survey of training in adult intensive care medicine. Intensive Care Med. 2005;31:553–61.

    Article  CAS  Google Scholar 

  8. Dorman T, Angood PB, Angus DC, et al. Guidelines for critical care medicine training and continuing medical education. Crit Care Med. 2004;32:263–72.

    Article  Google Scholar 

  9. Peets AD, McLaughlin K, Lockyer J, Donnon T. So much to teach, so little time: a prospective cohort study evaluating a tool to select content for a critical care curriculum. Crit Care. 2008;12:R127.

    Article  Google Scholar 

  10. Bentley JD, Knapp RM, Petersdorf RG. Education in ambulatory care—financing is one piece of the puzzle. N Engl J Med. 1989;320:1531–4.

    Article  CAS  Google Scholar 

  11. Dent JA. AMEE Guide No 26: clinical teaching in ambulatory care settings: making the most of learning opportunities with outpatients. Med Teach. 2005;27:302–15.

    Article  Google Scholar 

  12. Irby DM. Teaching and learning in ambulatory care settings: a thematic review of the literature. Acad Med. 1995;70:898–931.

    Article  CAS  Google Scholar 

  13. Hale A, Glassman R, Fessler D, Mukamal KJ, Stead W. Meeting the needs of the resident trainee during an elective subspecialty rotation. Int J Med Educ. 2016;7:115–8.

    Article  Google Scholar 

  14. Ramani S, Leinster S. AMEE Guide no. 34: teaching in the clinical environment. Med Teach. 2008;30:347–64.

    Article  Google Scholar 

  15. Miloslavsky EM, Boyer D, Winn AS, Stafford DEJ, McSparron JI. Fellows as teachers: raising the educational bar. Ann Am Thorac Soc. 2016;13:465–8. AnnalsATS.201601-026PS.

    PubMed  Google Scholar 

  16. Miloslavsky EM, McSparron JI, Richards JB, Puig A, Sullivan AM. Teaching during consultation: factors affecting the resident-fellow teaching interaction. Med Educ. 2015;49:717–30.

    Article  Google Scholar 

  17. Ha D, Faulx M, Isada C, Kattan M, Yu C, Olender J, Nielsen C, Brateanu A. Transitioning from a noon conference to an academic half-day curriculum model: effect on medical knowledge acquisition and learning satisfaction. J Grad Med Educ. 2014;6:93–9.

    Article  Google Scholar 

  18. Chen LYC, Hubinette MM. Exploring the role of classroom-based learning in professional identity formation of family practice residents using the experiences, trajectories, and reifications framework. Med Teach. 2017;39:876–82.

    Article  Google Scholar 

  19. Raman M, Mclaughlin K, Violato C, Rostom A, Allard J, Coderre S. Teaching in small portions dispersed over time enhances long-term knowledge retention. Med Teach. 2010;32:250–5.

    Article  Google Scholar 

  20. Cottrell S, Linger B, Shumway J, Spickard A, Hall W, McCann R. Using information contained in the curriculum management information tool (CurrMIT) to capture opportunities for student learning and development. Med Teach. 2004;26:423–7.

    Article  Google Scholar 

  21. Chen LYC, McDonald JA, Pratt DD, Wisener KM, Jarvis-Selinger S. Residents’ views of the role of classroom-based learning in graduate medical education through the lens of academic half days. Acad Med. 2015;90:532–8.

    Article  Google Scholar 

  22. Lim KG, Dunn WF, Klarich KW, Afessa B. Internal medicine resident education in the medical intensive care unit: the impact on education and patient care of a scheduling change for didactic sessions*. Crit Care Med. 2005;33:1534–7.

    Article  Google Scholar 

  23. Mehta NB, Hull AL, Young JB, Stoller JK. Just imagine: new paradigms for medical education. Acad Med. 2013;88:1418–23.

    Article  Google Scholar 

  24. Tainter CR, Wong NL, Cudemus-Deseda GA, Bittner EA. The “Flipped Classroom” model for teaching in the intensive care unit. J Intensive Care Med. 2017;32:187–96.

    Article  Google Scholar 

  25. Bergmann J, Sams A. Flip your classroom: reach every student in every class every day. Eugene: International Society for Technology in Education; 2012.

    Google Scholar 

  26. Jones MD, Rosenberg AA, Gilhooly JT, Carraccio CL. Perspective: competencies, outcomes, and controversy—linking professional activities to competencies to improve resident education and practice. Acad Med. 2011;86:161–5.

    Article  Google Scholar 

  27. Teunissen PW, Scheele F, Scherpbier AJJA, van der Vleuten CPM, Boor K, van Luijk SJ, van Diemen-Steenvoorde JAAM. How residents learn: qualitative evidence for the pivotal role of clinical activities. Med Educ. 2007;41:763–70.

    Article  CAS  Google Scholar 

  28. Teunissen PW, Boor K, Scherpbier AJJA, van der Vleuten CPM, van Diemen-Steenvoorde JAAM, van Luijk SJ, Scheele F. Attending doctors’ perspectives on how residents learn. Med Educ. 2007;41:1050–8.

    Article  CAS  Google Scholar 

  29. Tainter CR, Wong NL, Bittner EA. Innovative strategies in critical care education. J Crit Care. 2015;30:550–6.

    Article  Google Scholar 

  30. Croley WC, Rothenberg DM. Education of trainees in the intensive care unit. Crit Care Med. 2007;35:S117–21.

    Article  Google Scholar 

  31. Eckleberry-Hunt J, Tucciarone J. The challenges and opportunities of teaching “Generation Y”. J Grad Med Educ. 2011;3:458–61.

    Article  Google Scholar 

  32. Alsop R. The trophy kids grow up: how the millennial generation is shaking up the workplace. San Francisco: Jossey-Bass; 2008.

    Google Scholar 

  33. Landry M-A, Lafrenaye S, Roy M-C, Cyr C. A randomized, controlled trial of bedside versus conference-room case presentation in a pediatric intensive care unit. Pediatrics. 2007;120:275–80.

    Article  Google Scholar 

  34. Peters M, Ten Cate O. Bedside teaching in medical education: a literature review. Perspect Med Educ. 2014;3:76–88.

    Article  Google Scholar 

  35. Mangione S, Neiman L. Pulmonary auscultatory skills during training in internal medicine and family practice. Am J Respir Crit Care Med. 1999;159:1119–24.

    Article  CAS  Google Scholar 

  36. Gonzalo JD, Heist BS, Duffy BL, et al. The art of bedside rounds: a multi-center qualitative study of strategies used by experienced bedside teachers. J Gen Intern Med. 2013;28:412–20.

    Article  Google Scholar 

  37. Irby DM. How attending physicians make instructional decisions when conducting teaching rounds. Acad Med. 1992;67:630–8.

    Article  CAS  Google Scholar 

  38. Irby DM, Wilkerson L. Teaching when time is limited. BMJ. 2008;336:384–7.

    Article  Google Scholar 

  39. Wilkerson L, Sarkin RT. Arrows in the Quiver: evaluation of a workshop on ambulatory teaching. Acad Med. 1998;73:S67–9.

    Article  CAS  Google Scholar 

  40. Parrot S, Dobbie A, Chumley H, Tysinger JW. Evidence-based office teaching – the five-step microskills model of clinical teaching. Fam Med. 2006;38:164–7.

    PubMed  Google Scholar 

  41. Furney SL, Orsini AN, Orsetti KE, Stern DT, Gruppen LD, Irby DM. Teaching the one-minute preceptor. A randomized controlled trial. J Gen Intern Med. 2001;16:620–4.

    Article  CAS  Google Scholar 

  42. Aagaard E, Teherani A, Irby DM. Effectiveness of the one-minute preceptor model for diagnosing the patient and the learner: proof of concept. Acad Med. 2004;79:42–9.

    Article  Google Scholar 

  43. Cantillon P, Sargeant J. Giving feedback in clinical settings. BMJ. 2008;337:a1961.

    Article  Google Scholar 

  44. McGee SR, Irby DM. Teaching in the outpatient clinic. J Gen Intern Med. 1997;12:S34–40.

    Article  Google Scholar 

  45. Barsuk JH, Cohen ER, Feinglass J, McGaghie WC, Wayne DB. Residents’ procedural experience does not ensure competence: a research synthesis. J Grad Med Educ. 2017;9:201–8.

    Article  Google Scholar 

  46. Huang GC, Smith CC, Gordon CE, Feller-Kopman DJ, Davis RB, Phillips RS, Weingart SN. Beyond the comfort zone: residents assess their comfort performing inpatient medical procedures. Am J Med. 2006;119:71.e17–24.

    Article  Google Scholar 

  47. Huang GC, McSparron JI, Balk EM, Richards JB, Smith CC, Whelan JS, Newman LR, Smetana GW. Procedural instruction in invasive bedside procedures: a systematic review and meta-analysis of effective teaching approaches. BMJ Qual Saf. 2016;25:281–94.

    Article  Google Scholar 

  48. Back AL, Arnold RM, Tulsky JA, Baile WF, Edwards K. “Could I Add Something?”: Teaching communication by intervening in real time during a clinical encounter. Acad Med. 2010;85:1048–51.

    Article  Google Scholar 

  49. Patton K, Morris A, Çoruh B, Kross E, Carlbom D, Thronson R. Teaching to teach procedures: a simulation-based curriculum for senior residents or fellows. MedEdPORTAL Publ. 2015; https://doi.org/10.15766/mep_2374-8265.9997.

  50. Chudgar SM, Cox CE, Que LG, Andolsek K, Knudsen NW, Clay AS. Current teaching and evaluation methods in critical care medicine: has the Accreditation Council for Graduate Medical Education affected how we practice and teach in the intensive care unit?*. Crit Care Med. 2009;37:49–60.

    Article  Google Scholar 

  51. Singer BD, Corbridge TC, Schroedl CJ, Wilcox JE, Cohen ER, McGaghie WC, Wayne DB. First-year residents outperform third-year residents after simulation-based education in critical care medicine. Simul Healthc. 2013;8:67–71.

    Article  Google Scholar 

  52. Yee J, Fuenning C, George R, Hejal R, Haines N, Dunn D, Gothard MD, Ahmed RA. Mechanical ventilation boot camp: a simulation-based pilot study. Crit Care Res Pract. 2016;2016:1–7.

    Article  Google Scholar 

  53. Hayes CW, Rhee A, Detsky ME, Leblanc VR, Wax RS. Residents feel unprepared and unsupervised as leaders of cardiac arrest teams in teaching hospitals: a survey of internal medicine residents*. Crit Care Med. 2007;35:1668–72.

    Article  Google Scholar 

  54. Wayne DB, Butter J, Siddall VJ, Fudala MJ, Wade LD, Feinglass J, McGaghie WC. Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice. J Gen Intern Med. 2006;21:251–6.

    Article  Google Scholar 

  55. Barsuk JH, Cohen ER, Potts S, Demo H, Gupta S, Feinglass J, McGaghie WC, Wayne DB. Dissemination of a simulation-based mastery learning intervention reduces central line-associated bloodstream infections. BMJ Qual Saf. 2014;23:749–56.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA

    Jonathan M. Keller

  2. Pulmonary, Critical Care & Sleep Medicine, University of Washington, Seattle, WA, USA

    Başak Çoruh

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  1. Jonathan M. Keller
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  2. Başak Çoruh
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Correspondence to Başak Çoruh .

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Editors and Affiliations

  1. University of Washington, Seattle, WA, USA

    Patricia A. Kritek

  2. Harvard University, Boston, MA, USA

    Jeremy B. Richards

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Keller, J.M., Çoruh, B. (2019). Teaching Residents. In: Kritek, P., Richards, J. (eds) Medical Education in Pulmonary, Critical Care, and Sleep Medicine. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-10680-5_3

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  • DOI: https://doi.org/10.1007/978-3-030-10680-5_3

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  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-030-10679-9

  • Online ISBN: 978-3-030-10680-5

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