Morrison Elizabeth H, Rucker Lloyd, Boker John R, Gabbert Charles C, Hubbell F Allan, Hitchcock Maurice A, Prislin Michael D
Department of Family Medicine, College of Medicine, University of California, Irvine, Irvine, California 92868-3298, USA.
Ann Intern Med. 2004 Aug 17;141(4):257-63. doi: 10.7326/0003-4819-141-4-200408170-00005.
Although resident physicians often teach, few trials have tested interventions to improve residents' teaching skills. A pilot trial in 2001-2002 found that 13 trained resident teachers taught better than did untrained control residents.
To determine whether a longitudinal residents-as-teachers curriculum improves residents' teaching skills.
Randomized, controlled trial from May 2001 to February 2002 (pilot trial) and March 2002 to April 2003.
4 generalist residencies affiliated with an urban academic medical center.
62 second-year residents: 23 in the 2001-2002 pilot trial and 39 more in 2002-2003; 27 of the 39 participants were medicine residents required to learn teaching skills.
A 13-hour curriculum in which residents practiced teaching and received feedback during 1-hour small-group sessions taught twice monthly for 6 months.
A 3.5-hour, 8-station, objective structured teaching examination that was enacted and rated by 50 medical students before and after the intervention. Two trained, blinded raters independently assessed each station (inter-rater reliability, 0.75).
In the combined results for 2001-2003, the intervention group (n = 33) and control group (n = 29) were similar in sex, specialty, and academic performance. On a 1 to 5 Likert scale, intervention residents outscored controls on overall improvement score (post-test-pretest difference, 0.74 vs. 0.07; difference between intervention and control groups, 0.68 [95% CI, 0.55 to 0.81]; P < 0.001) by a magnitude of 2.8 standard deviations and on all 8 individual stations. The intervention residents improved 28.5% overall, whereas the scores of control residents did not increase significantly (2.7%). In 2002-2003, 19 intervention residents similarly outscored 19 controls (post-test-pretest difference, 0.83 vs. 0.14; difference between intervention and control groups, 0.69 [CI, 0.53 to 0.84]; P < 0.001). Twenty-seven medicine residents required to learn teaching skills achieved scores similar to those of volunteers.
The study was conducted at a single institution. No "real life" assessment with which to compare the results of the objective structured teaching examination was available.
Generalist residents randomly assigned to receive a 13-hour longitudinal residents-as-teachers curriculum consistently showed improved teaching skills, as judged by medical student raters. Residents required to participate improved as much as volunteers did.
尽管住院医师经常参与教学，但很少有试验对提高住院医师教学技能的干预措施进行测试。2001 - 2002年的一项试点试验发现，13名经过培训的住院医师教师比未经培训的对照住院医师教学效果更好。
确定一项纵向的住院医师作为教师的课程是否能提高住院医师的教学技能。
2001年5月至2002年2月（试点试验）以及2002年3月至2003年4月的随机对照试验。
与一家城市学术医疗中心相关联的4个全科住院医师项目。
62名二年级住院医师：2001 - 2002年试点试验中有23名，2002 - 2003年又有39名；39名参与者中有27名是需要学习教学技能的内科住院医师。
一项为期13小时的课程，住院医师在为期6个月、每月两次的1小时小组会议中进行教学实践并获得反馈。
一项3.5小时、8个站点的客观结构化教学考试，在干预前后由50名医学生进行实施和评分。两名经过培训的、不知情的评分者独立评估每个站点（评分者间信度为0.75）。
在2001 - 2003年的综合结果中，干预组（n = 33）和对照组（n = 29）在性别、专业和学业成绩方面相似。在1至5的李克特量表上，干预组住院医师在总体改善得分上高于对照组（后测 - 前测差异，0.74对0.07；干预组与对照组差异，0.68 [95%可信区间，0.55至0.81]；P < 0.001），高出幅度达2.8个标准差，且在所有8个单独站点上均如此。干预组住院医师总体提高了28.5%，而对照组住院医师的分数没有显著增加（2.7%）。在2002 - 2003年，19名干预组住院医师同样高于19名对照组住院医师（后测 - 前测差异，0.83对0.14；干预组与对照组差异，0.69 [可信区间，0.53至0.84]；P < 0.001）。27名需要学习教学技能的内科住院医师取得了与志愿者相似的分数。
该研究在单一机构进行。没有可用于比较客观结构化教学考试结果的“实际生活”评估。
由医学生评分者判断，随机分配接受为期13小时纵向住院医师作为教师课程的全科住院医师教学技能持续得到提高。被要求参与的住院医师与志愿者提高程度相同。
