Learning to teach and teaching to learn

BMC Medical Education 2006, 6:20

While an educational intervention for senior internal medicine residents leading morning report improved the educational experience of the audience, the teaching residents reported reduced confidence in their medical knowledge.

Background
Resident-led morning report is an integral part of most residency programs and is ranked among the most valuable of educational experiences. The objectives of this study were to evaluate the effect of a resident-as-teacher educational intervention on the educational and teaching experience of morning report.
Methods
All senior internal medicine residents were invited to participate in this study as teaching participants. All internal medicine residents and clerks were invited to participate as audience participants. The educational intervention included reading material, a small group session and feedback after teaching sessions. The educational and teaching experiences were rated prior to and three months after the intervention using questionnaires.
Results
Forty-six audience participants and 18 teaching participants completed the questionnaires. The degree to which morning report met the educational needs of the audience was higher after the educational intervention (effect size, d = 0.26, p = 0.01). The perceptions of the audience were that delivery had improved and that the sessions were less intimidating and more interactive. The perception of the teaching participants was that delivery was less stressful, but this group now reported greater difficulty in engaging the audience and less confidence in their medical knowledge.
Conclusion
Following the educational intervention the audience's perception was that the educational experience had improved although there were mixed results for the teaching experience. When evaluating such interventions it is important to evaluate the impact on both the educational and teaching experiences as results may differ.

Are Neurology residents in the United States being taught defensive medicine?

From Clinical Neurology and Neurosurgery Volume 108, Issue 4 , June 2006, Pages 374-377

Objective
To study whether and how fear of litigation and defensive medicine are communicated during residency training and to assess whether this affects residents’ attitudes.

Methods
Neurology residents in the US (n = 25) and, as a control group, Neurology residents training in Germany (n = 42) were asked to rate multiple items regarding litigation, defensive strategies and how often these issues are raised by teaching physicians. Statistic analysis was performed using nonparametric tests.

Results
Residents in both countries indicated that litigation is an “important problem”, although US residents stated this significantly more often (p < 0.001). Initiation of tests motivated mainly by fear of litigation (p = 0.004) and explicit teaching of defensive strategies by teaching physicians (p < 0.02) were reported more often by US residents.

Conclusion
Neurology residents in both the US and Germany perceive a litigational threat, but significantly less so in Germany. This difference may result at least in part from teaching of defensive strategies reported more often in US programs.