Department of Surgery, University of Auckland, New Zealand.
Med Educ. 2009 Dec;43(12):1129-40. doi: 10.1111/j.1365-2923.2009.03523.x.
Residents in all disciplines serve as clinical teachers for medical students. Since the 1970s, there has been increasing evidence to demonstrate that residents wish to teach and that they respond positively to formal teacher training. Effective resident-as-teacher (RaT) programmes have resulted in improved resident teaching skills. Current evidence, however, is not clear about the specific features of an effective RaT programme.
This study was performed in order to investigate the effectiveness of RaT programmes on resident teaching abilities and to identify the features that ensure success. Methods of assessment used to ascertain the effectiveness of RaT programmes are also explored.
The literature search covered the period between 1971 and 2008. Articles focusing on improving resident teaching skills were included. Each study was reviewed by two reviewers and data were collected using a standard abstraction summary sheet. Study outcomes were graded according to a modified Kirkpatrick's model of educational outcomes.
Twenty-nine studies met review inclusion criteria. Interventions included workshops, seminars, lectures and teaching retreats. Twenty-six studies used a pre- and post-intervention outcome comparison method. Subjective outcome measures included resident self-evaluation of teaching skills or evaluation by medical students, peers and faculty members. Objective outcome measures included written tests, evaluation of teaching performance by independent raters and utilisation of objective structured teaching examinations. One study objectively measured learning outcomes at the level of medical students, utilising the results of an objective structured clinical examination. Overall resident satisfaction with RaT programmes was high. Participants reported positive changes in attitudes towards teaching. Participant knowledge of educational principles improved. Study methodologies allowed for significant risks of bias.
More rigorous study designs and the use of objective outcome measures are needed to ascertain the true effectiveness of RaT programmes. Future research should focus on determining the impact of RaT programmes on learning achievement at the level of medical students.
所有学科的住院医师都担任医学生的临床教师。自 20 世纪 70 年代以来，越来越多的证据表明住院医师愿意教学，并且对正规教师培训反应积极。有效的住院医师作为教师（RaT）计划导致住院医师教学技能的提高。然而，目前的证据尚不清楚有效 RaT 计划的具体特征。
本研究旨在调查 RaT 计划对住院医师教学能力的有效性，并确定确保成功的特征。还探讨了用于确定 RaT 计划有效性的评估方法。
文献检索涵盖了 1971 年至 2008 年期间。纳入了专注于提高住院医师教学技能的文章。由两位审稿人对每项研究进行审查，并使用标准摘要汇总表收集数据。根据教育成果的改良 Kirkpatrick 模型对研究结果进行分级。
有 29 项研究符合综述纳入标准。干预措施包括讲习班、研讨会、讲座和教学静修。26 项研究采用了干预前后结果比较的方法。主观结果测量包括住院医师对教学技能的自我评价或医学生、同行和教师的评价。客观结果测量包括书面测试、独立评估者对教学表现的评估以及客观结构化教学考试的使用。一项研究在医学生层面上客观地测量了学习结果，使用了客观结构化临床考试的结果。住院医师对 RaT 计划的总体满意度很高。参与者报告说对教学的态度发生了积极变化。参与者对教育原则的了解有所提高。研究方法存在重大偏倚风险。
需要更严格的研究设计和使用客观结果测量来确定 RaT 计划的真正有效性。未来的研究应侧重于确定 RaT 计划对医学生学习成绩的影响。
