Medical Teacher, Vol. 14, No. 2/3, 1992
133
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Medical students’ perceptions of themselves and residents as teachers
ROBERT G. BING-YOU & MARGA S. SPROUL, Maine Medical Center, Portland, Maine and University of Vermont College of Medicine, Burlington, Vermont
Eighty-three medical students from one class at the University of Vermont College of Medicine were surveyed as to their perceptions of both themselves and residents as teachers. Sixty seven percent of the students felt that residents played a signijicant role as teachers during the first clinical year. Students estimated that one-third of their knowledge could be attributed to housestafl teaching. A large majority of students wanted to teach students during medical school (80%) and residency (93%). Ninety percent of students surveyed would participate in a workshop to improve teaching skills prim to beginning residency; of this group, forty nine students ranked the importance of components of a teaching skills workshop. The findings suggest that medical students are interested both in learning teaching skills and teaching during medical school and during residency. SUMMARY
Residents have an important role as teachers of medical students and fellow residents (Edwards & Marier, 1988; Bing-You & Harvey, 1991). Recent authors (Escovitz, 1990; Harris & Miller, 1990; Kaplan et al., 1990; Schaffer et al., 1990) have also described programs utilizing medical students to teach fellow students. Since Barrow’s study (1966) 25 years ago of students’ favorable perceptions of residents as teachers, little information has been gathered to see if students’ perceptions toward resident teaching have changed (Byrne & Cohen, 1973; Lowry, 1976). Furthermore, medical students’ perceptions of themselves as teachers has received little attention. Although a small number of programs to teach medical students teaching skills have been described in the literature (Greenberg & Jewett, 1987; Greenberg et al., 1988; Steward & Myers, 1989; Paiva et al., 1982), the willingness of students to participate in such programs has not been determined. We surveyed one class of medical students to investigate students’ current perceptions of themselves and residents as teachers and
134
Robert G.Bing-You & Marga S. Sproul
relationships between these perceptions and interest in teaching skills improvement programs.
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Method The entire class of 1992 ( n = 9 7 ) from the University of Vermont (UVM) College of Medicine was administered a questionnaire during a mandatory class meeting the month after their first clinical year (January 1991). Eighty three students completed the questionnaire, for a response rate of 85.6%. Students were informed that the authors were interested in their ‘learning experiences’ during the first year as a clinical clerk. Confidentiality was emphasized. Students typically complete the major clerkships (pediatrics, medicine, surgery, obstetrics-gynecology (OB-GYN), and psychiatry) at either the UVM Medical Center, or Maine Medical Center, an affiliated community teaching hospital. A small number of students may also complete the medicine and OB-GYN clerkships at Champlain Valley and Physician’s Hospital, Plattsburgh, New York, another affiliated community hospital. Demographic information on the questionnaire included sex, age, college major, and other advanced degrees beyond college. Students were then asked how much they agreed or disagreed with the three statements shown on Table I using a Likert-type scale of one to five. TABLE I. Proportions of students’ responses (tt=83) to statements regarding themselves and residents as teachers 1
I would like to have definite teaching responsibilities as a house officer. During each of the 5 rotations, house officers played a significant role as medicine teachers: su*gety
pedim‘cs OB-GYN psychiatry I would like to have the opportunity to teach other medical students while I am in medical school.
2
0%
0%
1% 2% 6%
4% 11% 13% 11% 12%
9%
6%
0%
3
4
5
*
7% 42% 51%
11% 15% 18% 22% 24%
29% 31% 34% 36% 31%
55% 41% 29% 22% 27%
0% 20% 47%
33%
*Liken-type scale: 1 =strongly disagree, 2 =disagree, 3 =do not agree or disagree, 4 =agree, 5 =strongly agree.
For each of the five specialties, students were asked to estimate what percentage of their knowledge came from their own initiative, interns, residents, or attendings (totaling 100% for each specialty). Prior teaching experience and instruction was determined as well as students’ willingness to participate in a workshop to improve teaching skills prior to beginning residency. Lastly, those students willing to participate in a teaching workshop were asked to rank components of a teaching workshop in order of importance (1 =most important). Proportions or mean values were calculated for each question. Spearman correlation analysis was used to examine associations between, students’ desire to teach as house officers, students’ desire to teach other students, age and an average score of each
Medical students as teachers
135
TABLE 11. Mean percentage response (SD) of students’ perceptions of the origin of their knowledge during each of the five rotations in the first clinical year (n=83) Own Initiative
Intern
Resident ~
Medicine Surgery Pediatrics OB-GYN Psychiatry
42.7 47.2 44.6 51.8 52.2
(18.6) (21.4) (20.8) (21.3) (20.2)
17.4 11.9 13.8 11.5 4.6
(11.2) (11.4) (10.5) (10.3) (9.4)
24.5 23.5 19.1 18.4 21.7
Attending ~~~
(12.1) (14.0) (10.8) (12.9) (17.2)
15.4 17.4 22.5 18.3 21.5
(10.1) (13.8) (12.7) (11.6) (14.7)
~
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Mean of five rotations
47.5
12.3
21.2
19.0
student’s perception of residents as having a significant role as teachers (i.e. for each student’s response to question 2 in Table I, an average score was calculated for all five specialties). Chi-square analysis examined differences in frequencies of students’ responses. TABLE 111. Students’ mean ratings of components of a teaching skills improvement workshop (n=49)
Giving feedback Teaching problem-solving Leading discussions Managing a ward team Lecturing skills Improving teaching in work rounds Bedside teaching Questioning skills Improving teaching in attending rounds Public speaking skills Teaching behavior Planning instruction Self-assessment of skills Theories on learning Observing teaching activities Audio-visual techniques Being videotaped teaching Teaching psychomotor skills
Mean*
SD
Range
5.11 5.19 5.28 5.38 5.38 5.60 6.02 6.91 7.15 7.33 8.00 8.00 9.52 11.61 11.68 12.63 13.46 14.79
3.64 3.76 3.24 3.61 3.92 4.22 3.87 3.51 4.11 4.83 4.15 4.17 3.80 4.96 4.36 4.22 4.96 3.34
1-15 1-15 1-12 1-15 1-13 1-17 1-16 1-16 1-15 1-16 1-17 1-16 3-16 1-18 2-18 3-18 1-18 5-18
*Students were asked to rank items in the list, with 1=most important.
Results The mean age of the 83 respondents was 27.2k3.4 years. Fifty one percent (n=42) were women. A majority of students (78%) were science- majors in college (i.e. biochemistry, psychology). Only nine students (1 1%) had advanced degrees beyond college. Table I describes students’ desires to teach fellow medical students and future students as a house officer. Ninety three percent of students would like to have
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Robert G. Bing-You & Marga S. Sproul
teaching responsibilities later as a resident (i.e. agree or strongly agree). A majority of the students (80%) would also like to teach other medical students during medical school. Table I also describes how students perceive residents’ roles as teachers. The percentage of students feeling that residents played a significant role as teachers during the first clinical year (i.e. agree or strongly agree) ranged from 58% for both the OBGYN and psychiatry rotations to 84% for the medicine clerkship. A student’s desire to teach as a resident was significantly correlated with a desire to teach fellow students (r=0.36, ptO.O1). Students’ average scores of their perceptions of residents as teachers was also significantly correlated with a desire to teach other students (r=0.24, ~(0.05). None of the students’ responses in Table I were significantly related to age, sex, college major, or having an advanced degree. Considering all five clerkships together, students felt that most (47.5%) of their knowledge during the first clinical year came from their own initiative (range 42.7%-52.2%, Table 11). Interns and residents contributed to approximately one-third (33.5%) of students’ knowledge. The low percentage for psychiatry interns reflects the usual absence of interns rotating through psychiatry at these institutions. Fifty-one percent (n=42) of the responding students stated that they had teaching experience in the past. Of these students, the vast majority (n-22) were tutors or teaching assistants in college. Five students had taught high school students and another five had been coaches or instructors in a sport (e.g. swimming). Only 12 students (14%) had formal instruction in teaching skills. A significantly higher proportion of students with advanced degrees had prior formal instruction in teaching (44%) than students without advanced degrees (1 1%) (chi-square= 7.34, pt0.01). Ninety percent (n=75) of responding students were willing to participate in a workshop to improve teaching skills prior to beginning residency. A significant proportion of students interested in attending a teaching skills improvement workshop also wanted to have teaching responsibilities as a resident (chi-square =4.15,p
133
Med Teach Downloaded from informahealthcare.com by TIB/UB Hannover on 01/08/15 For personal use only.
Medical students’ perceptions of themselves and residents as teachers
ROBERT G. BING-YOU & MARGA S. SPROUL, Maine Medical Center, Portland, Maine and University of Vermont College of Medicine, Burlington, Vermont
Eighty-three medical students from one class at the University of Vermont College of Medicine were surveyed as to their perceptions of both themselves and residents as teachers. Sixty seven percent of the students felt that residents played a signijicant role as teachers during the first clinical year. Students estimated that one-third of their knowledge could be attributed to housestafl teaching. A large majority of students wanted to teach students during medical school (80%) and residency (93%). Ninety percent of students surveyed would participate in a workshop to improve teaching skills prim to beginning residency; of this group, forty nine students ranked the importance of components of a teaching skills workshop. The findings suggest that medical students are interested both in learning teaching skills and teaching during medical school and during residency. SUMMARY
Residents have an important role as teachers of medical students and fellow residents (Edwards & Marier, 1988; Bing-You & Harvey, 1991). Recent authors (Escovitz, 1990; Harris & Miller, 1990; Kaplan et al., 1990; Schaffer et al., 1990) have also described programs utilizing medical students to teach fellow students. Since Barrow’s study (1966) 25 years ago of students’ favorable perceptions of residents as teachers, little information has been gathered to see if students’ perceptions toward resident teaching have changed (Byrne & Cohen, 1973; Lowry, 1976). Furthermore, medical students’ perceptions of themselves as teachers has received little attention. Although a small number of programs to teach medical students teaching skills have been described in the literature (Greenberg & Jewett, 1987; Greenberg et al., 1988; Steward & Myers, 1989; Paiva et al., 1982), the willingness of students to participate in such programs has not been determined. We surveyed one class of medical students to investigate students’ current perceptions of themselves and residents as teachers and
134
Robert G.Bing-You & Marga S. Sproul
relationships between these perceptions and interest in teaching skills improvement programs.
Med Teach Downloaded from informahealthcare.com by TIB/UB Hannover on 01/08/15 For personal use only.
Method The entire class of 1992 ( n = 9 7 ) from the University of Vermont (UVM) College of Medicine was administered a questionnaire during a mandatory class meeting the month after their first clinical year (January 1991). Eighty three students completed the questionnaire, for a response rate of 85.6%. Students were informed that the authors were interested in their ‘learning experiences’ during the first year as a clinical clerk. Confidentiality was emphasized. Students typically complete the major clerkships (pediatrics, medicine, surgery, obstetrics-gynecology (OB-GYN), and psychiatry) at either the UVM Medical Center, or Maine Medical Center, an affiliated community teaching hospital. A small number of students may also complete the medicine and OB-GYN clerkships at Champlain Valley and Physician’s Hospital, Plattsburgh, New York, another affiliated community hospital. Demographic information on the questionnaire included sex, age, college major, and other advanced degrees beyond college. Students were then asked how much they agreed or disagreed with the three statements shown on Table I using a Likert-type scale of one to five. TABLE I. Proportions of students’ responses (tt=83) to statements regarding themselves and residents as teachers 1
I would like to have definite teaching responsibilities as a house officer. During each of the 5 rotations, house officers played a significant role as medicine teachers: su*gety
pedim‘cs OB-GYN psychiatry I would like to have the opportunity to teach other medical students while I am in medical school.
2
0%
0%
1% 2% 6%
4% 11% 13% 11% 12%
9%
6%
0%
3
4
5
*
7% 42% 51%
11% 15% 18% 22% 24%
29% 31% 34% 36% 31%
55% 41% 29% 22% 27%
0% 20% 47%
33%
*Liken-type scale: 1 =strongly disagree, 2 =disagree, 3 =do not agree or disagree, 4 =agree, 5 =strongly agree.
For each of the five specialties, students were asked to estimate what percentage of their knowledge came from their own initiative, interns, residents, or attendings (totaling 100% for each specialty). Prior teaching experience and instruction was determined as well as students’ willingness to participate in a workshop to improve teaching skills prior to beginning residency. Lastly, those students willing to participate in a teaching workshop were asked to rank components of a teaching workshop in order of importance (1 =most important). Proportions or mean values were calculated for each question. Spearman correlation analysis was used to examine associations between, students’ desire to teach as house officers, students’ desire to teach other students, age and an average score of each
Medical students as teachers
135
TABLE 11. Mean percentage response (SD) of students’ perceptions of the origin of their knowledge during each of the five rotations in the first clinical year (n=83) Own Initiative
Intern
Resident ~
Medicine Surgery Pediatrics OB-GYN Psychiatry
42.7 47.2 44.6 51.8 52.2
(18.6) (21.4) (20.8) (21.3) (20.2)
17.4 11.9 13.8 11.5 4.6
(11.2) (11.4) (10.5) (10.3) (9.4)
24.5 23.5 19.1 18.4 21.7
Attending ~~~
(12.1) (14.0) (10.8) (12.9) (17.2)
15.4 17.4 22.5 18.3 21.5
(10.1) (13.8) (12.7) (11.6) (14.7)
~
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Mean of five rotations
47.5
12.3
21.2
19.0
student’s perception of residents as having a significant role as teachers (i.e. for each student’s response to question 2 in Table I, an average score was calculated for all five specialties). Chi-square analysis examined differences in frequencies of students’ responses. TABLE 111. Students’ mean ratings of components of a teaching skills improvement workshop (n=49)
Giving feedback Teaching problem-solving Leading discussions Managing a ward team Lecturing skills Improving teaching in work rounds Bedside teaching Questioning skills Improving teaching in attending rounds Public speaking skills Teaching behavior Planning instruction Self-assessment of skills Theories on learning Observing teaching activities Audio-visual techniques Being videotaped teaching Teaching psychomotor skills
Mean*
SD
Range
5.11 5.19 5.28 5.38 5.38 5.60 6.02 6.91 7.15 7.33 8.00 8.00 9.52 11.61 11.68 12.63 13.46 14.79
3.64 3.76 3.24 3.61 3.92 4.22 3.87 3.51 4.11 4.83 4.15 4.17 3.80 4.96 4.36 4.22 4.96 3.34
1-15 1-15 1-12 1-15 1-13 1-17 1-16 1-16 1-15 1-16 1-17 1-16 3-16 1-18 2-18 3-18 1-18 5-18
*Students were asked to rank items in the list, with 1=most important.
Results The mean age of the 83 respondents was 27.2k3.4 years. Fifty one percent (n=42) were women. A majority of students (78%) were science- majors in college (i.e. biochemistry, psychology). Only nine students (1 1%) had advanced degrees beyond college. Table I describes students’ desires to teach fellow medical students and future students as a house officer. Ninety three percent of students would like to have
Med Teach Downloaded from informahealthcare.com by TIB/UB Hannover on 01/08/15 For personal use only.
136
Robert G. Bing-You & Marga S. Sproul
teaching responsibilities later as a resident (i.e. agree or strongly agree). A majority of the students (80%) would also like to teach other medical students during medical school. Table I also describes how students perceive residents’ roles as teachers. The percentage of students feeling that residents played a significant role as teachers during the first clinical year (i.e. agree or strongly agree) ranged from 58% for both the OBGYN and psychiatry rotations to 84% for the medicine clerkship. A student’s desire to teach as a resident was significantly correlated with a desire to teach fellow students (r=0.36, ptO.O1). Students’ average scores of their perceptions of residents as teachers was also significantly correlated with a desire to teach other students (r=0.24, ~(0.05). None of the students’ responses in Table I were significantly related to age, sex, college major, or having an advanced degree. Considering all five clerkships together, students felt that most (47.5%) of their knowledge during the first clinical year came from their own initiative (range 42.7%-52.2%, Table 11). Interns and residents contributed to approximately one-third (33.5%) of students’ knowledge. The low percentage for psychiatry interns reflects the usual absence of interns rotating through psychiatry at these institutions. Fifty-one percent (n=42) of the responding students stated that they had teaching experience in the past. Of these students, the vast majority (n-22) were tutors or teaching assistants in college. Five students had taught high school students and another five had been coaches or instructors in a sport (e.g. swimming). Only 12 students (14%) had formal instruction in teaching skills. A significantly higher proportion of students with advanced degrees had prior formal instruction in teaching (44%) than students without advanced degrees (1 1%) (chi-square= 7.34, pt0.01). Ninety percent (n=75) of responding students were willing to participate in a workshop to improve teaching skills prior to beginning residency. A significant proportion of students interested in attending a teaching skills improvement workshop also wanted to have teaching responsibilities as a resident (chi-square =4.15,p
