Formalizing Teaching Responsibilities for Junior Surgical Housestaff Encourages Educator Development

Abstract

Resident-led teaching on surgical services is typically disorganized, and the primary responsibility is often unassigned. Creation of a specified role of "teaching resident" (TR) is hypothesized to encourage residents to teach more, develop leadership skills, and enhance medical student clerkship experiences. All residents in general surgery training at the University of California, San Francisco, were surveyed to determine perceptions of teaching responsibility. Independently, second-year residents were solicited for voluntary participation in a TR program that gave them primary responsibility for teaching medical students assigned to their services during a 1-month rotation. After completion of the TR rotation, these residents evaluated the TR experience with their prior rotation at the same hospital (which had the same service structure but no TR duties). Medical student clerkship evaluations were reviewed to compare experiences between the 2 periods as well. Overall response rate for the general survey administered to all residents was 93% (67/72). All 6 second-year residents rotating through the designated services over a 6-month period volunteered to participate, but 2 did not have assigned medical students. Evaluations of the TR program were thus completed by 100% (4/4) residents. Time spent teaching medical students increased significantly, from 0.625 hours/week pre-TR to 2.75 hours/week during TR (p = 0.0026). All felt that teaching skills and motivation to teach increased, and 75% also reported improvement in leadership skills. Medical student scores on a 5-point scale revealed an increase in clinical instruction from 2.17 pre-TR to 3.25 (p = 0.0054). Satisfaction of clerkship objectives also increased from 3.17 pre-TR to 3.75 (p = 0.038). Junior surgical residents have interest in teaching, and their time spent doing so is significantly increased by the specific assignment of responsibility in a mid-level leadership role. Both residents and students benefit from this clinical service structure. Further formal development and program evaluation are in progress.