NewIdeas Teaching Psychiatrie Residents to Teach DavidJ. Katzelnick, M.D.,JuniusJ. Gonzales, M.D. Mary C. Conley, M.D.,John L Shuster, M.D. Jonathan F. Borns, M.D. Teaching other residents andmedicalstudents is one oftheprimary activities of psychiatrie residents, yet most receive minimal ornoformal training orsupervision on how to teach. This report describes a Teaching Day Workshop, designed andimplemented by residents at theM1lssachusetts General Hospital with thesupport of their faculty andan educational consultant, asone model to introduce theconcepts andtechniques 0/ teaching to psychiatrie residents. The participating residents were unanimous in their positive appraisal oftheworkshop, andtheyrecommended that additional seminars on teaching be integrated intotheresidency'5 core curriculum. Ways thattheTeaching DayWorkshop can be adapted for use by other residency training programs are discussed. The authors believe that teaching residents to be better teachers can have an impact on recruitment of medical students intopsychiatry andpsychiatrie residents intocareers in academic psychiatry.

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any studies of medical education have demonstrated that resident physicians are important teachers and role models for medical students and less experienced residents. A 19705 cross-sectional survey of internal medicine residents estimated that they received, on average, 45% of their education from fellow residents (1). A 1980 survey found that psychiatrie residents spend on average 1-2 hours a day teaching and feIt they should do more (2). In addition, a significant percentage of medical student teaching in psychiatry is done by residents. This is especially important because psychiatry has had difficulty recruiting the best medical students, perhaps in part due to the way that psychiatry is taught to medical students (3). Despite this major teaching commitment, most psychiatrie residency programs lack formal programs to improve the teaching skills of their residents. A recent survey by Painter et al. (3) of psychiatrie

residency programs found that only 13% of psychiatrie residents receive any training to improve their teaching. Educational research on how to best teach psychiatrie residents to become hetter From the Massachusetts General Hospital Departrnent of Psychiatry, where DIs. Katzelnick, Gonzales, Conley, and Shuster were residents and Dr. Borus was director of residency training. Dr. Katzelnick is now assistant professor of psychiatry at the University of Wisconsin, Madison. Dr. Gonzales is now ADMHA Fellow at the National Institute ofMental Health, Rockville, MD. Dr. Conley is now staff psychiatrist at the Brigharn and Wornen's Hospital and instnJctor in psychiatry at Harvard Medical School, Boston. Dr. Shuster is now assistant professor of psychiatry at the University of Alabama, Birmingham. Dr. Borus is now director of psychiatryat the Brigharn and Wornen's Hospital and associate professor of psychiatry at Harvard Medical School, Boston. Address reprint requests to Dr. Katzelnick. Center for Affective Disorders. University of Wisconsin Department of Psychiatry, Room 86/276, 600 Highland Avenue, Madison WI 53792. Copyright Cl1991 Academic Psychiatry.

teachers is limited . Courses about teaching have been developed for residents in internal medicine (4,5), obstetrics-gynecology (5), neurology (6), and pediatrics (7) . Preliminary research in other specialties has shown that resident teaching can be improved by formal teaching skills workshops (5,7). Although teaching psychiatry to medical students presents unique challenges not encountered in other specialties, especially in the areas of supervision and evaluation, only two reports have been published on teaching programs designed for psychiatrie residents (8, 9). The importance of improving resident teaching skills was emphasized in the 1984 General Professional Education of the Physician report (0), and the need to teach psychiatry residents to be good teachers has been the focus of two recent articles 01, 12) and an excellent pamphlet prepared by the American Psychiatrie Association Committee on Medical Student Education (3). In addition, today's residents are tomorrow's faculty. The Painter et a1. (3) survey found that only 24% of the nation's psychiatry departments offer any education skills development programs for their full-time faculty. Thus it is clear that improving residents' teaching skills now can have an important long-term effect on the quality of faculty teaching in the future. This article will first describe a Teaching Day Workshop, designed and implemented at the Massachusetts General Hospital (MGH)by psychiatry residents with the support of their faculty and an educational consultant, as one model to introduce the eoneepts and techniques of teaching to psychiatrie residents. It will review Teaching Day Workshop activities, including the teaehing format, objectives, and materials utilized for each activity. Both formal and informal course evaluations are discussed in relation to why we believe the workshop was a suceess, what variables need to be studied in designing psychiatry resident teaching programs, and what the im-

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plications are for psychiatry of formally teaching residents how to teach. STIMULUS FOR DEVELOPING THE WORKSHOP Six months prior to the workshop, we surveyed 11 of the 12 PGY-2 MGH psychiatry residents to assess their interest in improving their teaching skills and to determine the specific areas that they feIt needed improvement. We found that although 10 of 11 had taught medical students during their intemship, none had had any formal courses or seminars on how to teach. None of the 11 responded that they feIt adequately prepared to teach medical students now, and all but one were interested in participating in a seminar focused on improving their clinical teaching skills. The areas they were most interested in leaming about were fair evaluation of students, educational theory, and teaehing the art of psychiatrie interviewing. The results of this survey are consistent with a survey of pediatric residents that found that only 18% feIt confident in their roles as teachers (7). We then reviewed the medical edueation literature searching for materials from prior resident teaching skills programs that could be adapted for our Teaching Day Workshop (4-9, 1~16) . THE TEACHING DAY WORKSHOP The workshop took place at an off-eampus site on a Saturday and was led by the four PGY-2 and PGY-3 psychiatric residents from the planning group. Sixteenof the program's 32 residents, representing aIl three (PGY-24)residency classes, voluntarily attended the workshop. Several residents who had stated adesire to participate in Teaching Day did not attend due to vacations, illness, or religious prohibitions to participation on a Saturday. Staff eoverage was provided so that the residents on call could participate. Twelve faculty members also participated as small-group leaders, lecturers, and panel ,

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discussants. The chief of psychiatry, director and associate director of residency training, and director of medical student education as weIl as the director of faculty development at the medical school all had active teaching roles in the workshop and provided support at all phases of the project. The schedule for the day is shown in Table 1. Attention was given to designing the day so that four different teaching formats (lectures, small-group discussions, tutorials, and supervision) were all appropriately modeled in at least one activity. The workshop began with a welcome and introduction to Teaching Day by the resident organizers. The director of medical student education then gave brief reflections

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on the importance of residents as teachers in both clinical and didactic areas. The next activity was a lecture by the director of residency training on basic concepts of learning and the roles of teaching in psychiatry. This lecture employed a logical structure and was supplemented by slides and cartoons to not only convey content but also demonstrate the teaching skills utilized in organizing and presenting an effective lecture. This lecture was followed by a panel discussion featuring four teachers from the department. Each 100off with a brief statement of his/her personal approach to teaching, described past experiences as a student or teacher that indelibly marked his/her teaching style, and shared teaching "pearls"

TADLE 1. Teaching Day Workshop 1. Introduction (8:30-9:30, coffee and donuts) a. "Reflections on the resident's role as a teacher in the Massachusetts General Hospital Department of Psychiatry: Past, present, and future" Gerald Adler, M.D., director, medical student education b. Lecture: "Teaching and Leaming in Psychiatry" Jonathan Borus, M.D., director of residency training 2. A Closer Look at Leaming and Teaching: Panel Discussion (9:30-10:15) Distinguished MGH faculty give personal cornmentary on teaching, followed by question and answer period, then open discussion. Ned Cassem, M.D., chairman, Department of Psychiatry Anne Fishel. Ph.D., family therapy teacher Steve Hyrnan, M.D., neuroscience teacher Nicholas Kouretas, M.D., psychotherapy teacher Dreak-Coffee and donuts (10:15-10:30) 3. Experlences with Leaming and Teaching: Task Groups (10'.30-11:30) To assess effective and ineffective leaming and teaching through small-group participation. i, List powerful (both positive and negative) experiences we have had in leaming and teaching. ii. List five characteristics of powerfulleaming and teaching. iii, Reconvene and share lists in group discussion .

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Teaching psychiatric residents to teach.

Teaching other residents and medical students is one of the primary activities of psychiatric residents, yet most receive minimal or no formal trainin...
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