A randomized trial of an intervention to improve resident-fellow teaching interactions on the wards

Abstract

BackgroundSubspecialty fellows can serve as a tremendous educational resource to residents; however, there are multiple barriers to an effective resident-fellow teaching interaction in the setting of inpatient consultation. We designed and evaluated a resident-directed intervention to enhance communication and teaching during consultation on the general medicine wards.MethodsFive medical teams were randomized to receive the intervention over a 3 month period (3 control, 2 intervention teams). The intervention was evaluated with pre and post-intervention surveys.ResultsFifty-nine of 112 interns completed the pre-intervention survey, and 58 completed the post-intervention survey (53 % response rate). At baseline, 83 % of the interns noted that they had in-person interactions with fellows less than 50 % of the time. 81 % responded that they received teaching from fellows in less than 50 % of consultations. Following the intervention, the percentage of interns who had an in-person interaction with fellows greater than 50 % of the time increased in the intervention group (9 % control versus 30 % intervention, p = 0.05). Additionally, interns in the intervention group reported receiving teaching in more than 50 % of their interactions more frequently (19 % control versus 42 % intervention, p = 0.05). There were no differences in other measures of teaching and communication.ConclusionsWe demonstrate that a time-efficient intervention increased perceptions of in-person communication and the number of teaching interactions between interns and fellows. Further studies are warranted to determine whether such an approach can impact resident learning and improve patient care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0796-9) contains supplementary material, which is available to authorized users.

Education in consultation: A comparative survey-based assessment of perceived educational effectiveness within a university and community-based internal medicine residency

“…One initial study demonstrated the effectiveness of a "Fellow As Clinical Teacher" curriculum in improving participant skills in structured teaching exercises as well as fellow interest in teaching (E. M. Miloslavsky, Criscione-Schreiber, et al, 2016). This group also recently showed that outreach to residents on primary teams, aimed at improving the quality of consult questions and encouraging residents to ask fellows for in-person teaching, successfully increased in-person teaching interactions during consultation (Gupta, Alladina, Heaton, & Miloslavsky, 2016). These educational innovations and emphasis may help address our study's findings that one-on-one interactive education is desired but underutilized.…”

Enhancing the Inpatient Consultation Learning Environment to Optimize Teaching and Learning

“…Despite the fact that teaching during consultation has many potential benefits and is desired by both residents and fellows, our previous work suggests that fellows are an underused teaching resource. 14,15 This may be because the primary team-consultant interaction is an example of situated learning 16 taking place in the academic medical center environment, which presents many potential barriers to effective consultation and an optimal learning environment. These factors can be broadly divided into interpersonal and systems issues (Box 1).…”

Making the Consult Interaction More Than a Transaction: Helping Fellows Be Better Teachers and Residents Be Better Learners

“…4 We therefore, encourage resident-driven strategies to increase the teaching that residents receive, such as setting up an in-person time for follow-up communication and empowering the residents to ask for teaching during the interaction. 16 One internal medicine intervention focused on resident-driven strategies to actively engage in the teaching interaction, resulted in increased perceptions of in-person communication and number of in-person teaching interactions. 16 Residents also are discouraged from making the assumption that fellows are too busy to teach, as this perception may be inaccurate.…”

“…16 One internal medicine intervention focused on resident-driven strategies to actively engage in the teaching interaction, resulted in increased perceptions of in-person communication and number of in-person teaching interactions. 16 Residents also are discouraged from making the assumption that fellows are too busy to teach, as this perception may be inaccurate. 4…”