Exploring Family Medicine Residents’ Experiences Teaching Medical Students

Resident teachers contribute a substantial amount to the educational experience for medical students. Multiple stakeholders, including residency programs,^1-3 the Liaison Committee on Medical Education,⁴ and the Accreditation Counsel for Graduate Medical Education,³ have increasingly emphasized the preparation of residents to teach.^1,2,5 Although there are core pedagogical concepts that should be incorporated into curricula to prepare residents teachers,³ these programs may require different foci than programs designed for faculty.⁶

Qualitative studies on student perspectives of quality resident teachers indicate creating a safe learning environment, team inclusivity, coaching, and feedback are qualities valued by medical students in resident teachers.⁷ Residents recognize their role as teachers and need for preparation to teach,^8-11 however there is little in the literature about residents’ perspectives on their experiences teaching students.

As near-peer learners, the interactions between medical students and residents differ from those between medical students and faculty. Near-peer teaching offers multiple benefits,^5,12,13 including cognitive congruence, and the ability to foster a safe learning environment, because teachers better understand learner challenges, and learners feel comfortable with sharing knowledge deficits.¹²

Understanding residents’ current perspectives about teaching medical students can provide insight into the near-peer relationship between residents and students and allow stakeholders to tailor training programs by emphasizing concepts that add value to this relationship. This study presents the results from an inquiry focusing on exploring a cohort of family medicine residents’ experiences with medical students in their role as teachers.

The Augusta University Institutional Review Board approved the study. We developed this phenomenology study¹⁷ using focus groups in consultation with faculty appointed to Augusta University’s Educational Innovation Institute with expertise in qualitative research. We utilized focus groups to allow the use open-ended questions to individual and shared perspectives on resident experiences.

The predetermined set of questions with associated themes relevant to the objective of this study are included in Table 1. A practice focus group session ensured question clarity.

We invited all residents (N=31) from a family medicine residency program affiliated with a Southeastern US medical school to participate. The principle investigator (PI) introduced the study to the residents face to face during protected educational time. This convenience sampling of invited participants attended one of three focus group sessions offered during nonclinical time in the regular workday and voluntarily consented to participate. The fourth author (D.S.) was the focus group facilitator, and although known to the participants, she had no role in resident evaluation in her role as the departmental medical student program manager.

The audio recorded focus group sessions were held privately at the residency site with only the participants and facilitator over approximately 1 hour. The PI transcribed the audio, which was cross checked by the facilitator. We destroyed audio files to protect confidentiality.

Six study team members individually coded the deidentified transcripts from all three sessions for themes. Prior to group coding through an iterative process, the study team agreed on criteria to determine final themes: (1) multiple reviewers must agree, (2) theme could not be better accounted for by another theme, and (3) theme had supporting quotes from more than one resident. We held team meetings if at least three members of group were present. Second-cycle coding was done by PI to summarize study team’s derived themes. The study team reviewed and voted, all in the affirmative, on the second-cycle coding of final themes, definitions, (Table 2) and supporting quotes identified by resident postgraduate (PG) level.

We shared derived themes with resident participants. Although response rate low, they agreed on content. We invited two additional faculty who did not participate in the initial coding process to peer review finalized themes, definitions, and supporting quotes, and they agreed on the relationship between themes and supporting quotes.

Eighteen residents (six PGY1, nine PGY2, and three PGY3) participated in the study. Emerging themes of residents’ experience with students in their role as teachers centered on teaching methods. These themes and their definitions (Table 2) fell into six categories: (1) the learning environment, (2) stimulating learning, (3) role modeling, (4) collaborating, (5) supervising, and (6) transferring knowledge (Table 2). Table 3 presents supporting quotes for themes.

Residents identified their role as teachers in the setting of their interactions and employed teaching approaches as opposed to internal motivations, or their contribution to undergraduate medical education. Residents perceived that experiences teaching medical students focus on the medical students’ transition into and ability to function within a clinical environment. Teaching medical knowledge was a minor part of their teaching methods.

Emerging themes that support residents’ perceived experiences about medical student transition into the clinical environment are giving students a safe place to reason away from the attending physician, providing expectations of what to do so students can participate in clinical care, and including students as part of the health care team. Emerging themes that support residents’ perceived experiences regarding medical students functioning in the clinical environment include modeling patient care and assisting students in their development of clinical reasoning and application. They supervise students, but give students autonomy to practice patient care skills.

These emerging themes add to the limited literature on residents’ perception of their experiences with students in their role as teachers. The similarities between the emerging themes and some of the behaviors students value in resident teachers⁷ further support existing studies on resident teaching behaviors valued by medical students. A potential broad application of these findings is to inform relevant stakeholders about concepts to emphasize in preparing residents to teach students so residents are given tools to effectively leverage existing interactions with students in the clinical environment.

The limitations of this study are that findings reflect the perspectives of a resident cohort at a single institution, and they were primarily PGY-1 and PGY-2 residents.

Future directions include a follow-up study on resident perspectives on their internal motivation for teaching, barriers and challenges to teaching, and how resident and student interactions differ based on level of training and trend over time in individual residents as they progress.