Education Research: What Medical Students Value in Neurology Residents: A Qualitative Study to Inform Resident as Teacher Curricula.

Abstract

Residents are responsible for much of the formal and informal teaching of neurology clerkship medical students. High-quality resident teachers can enhance clerkship satisfaction, decrease neurophobia, and increase specialty interest. To train such residents, some institutions have developed resident as teacher (RAT) curricula. Existing RAT curricula are highly variable, partly because of our limited understanding of medical student attitudes and expectations regarding the qualities and skills of effective resident teachers. We sought to identify important themes in resident teaching, based on qualitative analysis of written evaluations by students, to better inform future RAT curricula in neurology. Clerkship student evaluations of residents from 2012 to 2023 at a single institution were collected and anonymized. The narrative comments were thematically coded using conventional content analysis in an iterative process of reconciliation and recoding. Randomly selected evaluations were analyzed in batches of 50 at a time until thematic saturation was achieved. A total of 200 evaluations yielded 6 themes with 27 subthemes: (1) Work-based learning, teaching and assessment: "sets expectations," "student involvement in care," "student autonomy over care," "helps students prepare/practice," "gives feedback," "mentorship and coaching," and "challenges students"; (2) Attitudes as teacher: "likes to teach," "made time to teach," "inspirational/fun," "patience," "approachability," and "learner-centric"; (3) Learning environment: "safety" and "clear communication"; (4) Role modeling: "knowledge," "skills," "attitudes," and "leadership"; (5) Content of teaching: "clinical skills," "medical knowledge," "nonmedical topics," and "directed to further learning"; and (6) Context of teaching: "bedside/in exam room," "attending rounds," "in workflow," and "break for teaching." The most prevalent subthemes were "student involvement in care," "gives feedback," "safety," "made time to teach," and "approachability." In their written evaluations of neurology residents, medical students identified many attributes, skills, and methods that led to a positive learning experience. Many of these themes highlighted the importance of residents facilitating work-based learning, cultivating the learning environment, and serving as role models rather than formal teaching activities alone. We provide recommendations for further RAT curricular development informed by these results. Using these findings, we further illustrate how residents influence the tripartite interaction between the learner, their subject, and their environment seen in existing learning theories.