To teach is to learn twice, revisited: A qualitative study of how residents learn through teaching in clinical environments

Abstract

Background As the saying goes, ‘to teach is to learn twice’; the teaching role contributes to one’s own learning as a professional. Near-peer teaching in clinical practice has been shown to contribute to the development of not only teaching skills but also necessary competencies for doctors. Research on how near-peer teachers learn through their teaching roles has mainly focused on classroom learning. Understanding how the phenomenon of ‘teaching is learning twice’ occurs in clinical settings and its influencing factors is important for the development of a quality workplace learning environment. We, therefore, investigated how residents learn through teaching in clinical practice and the factors influencing this process. Methods The study was conducted using a methodology based on grounded theory and from a social constructivist perspective. Several teaching hospitals in Japan were included, and the study participants were post-graduate year 2 residents (PGY2s) from these hospitals. The interviews were recorded, transcribed into text, and analysed by the first author. Results From January 2016 to July 2022, we conducted 13 interviews with 11 PGY2s from nine educational hospitals. PGY2s played diverse educational roles in clinical settings and learned competencies in almost all areas as physicians through such roles. Knowledge transfer and serving as role models stimulated their intrinsic motivation, encouraged reflection on their own experiences, and promoted self-regulated learning. Educating on procedural skills and clinical reasoning prompted reflection on their own procedural skills and thought processes, and supporting post-graduate year 1 residents’ reflections led to the refinement of their own knowledge and thought processes through the verbal expression of their learning experiences. Such processes required the formation of a community of practice. Education promoted learning through reflection and made the image of the expert that PGY2s aspired to be clearer. Conclusions We found that residents acquire various physician competencies through multiple processes by teaching as near-peer teachers in clinical settings, that a community of practice must be formed for near-peer teaching to occur in a clinical setting, and that teaching brings learning to those who teach by promoting reflection and helping them envision the professionals they seek to be.