Those who teach, can: Characterizing the link between teaching and professional competency
Awardees: Charles Christopher Smith (HMS), Lori R. Newman (HMS), Grace Huang (HMS), Richard Schwartzstein (HMS), Eileen Reynolds (HMS)
Summary: Characterizing the link between teaching and professional competency. Awardees plan to study whether teaching and clinical skills correlate, and whether teaching training improves clinical performance.
Doctor, from the Latin docēre ‘to teach’
Awardees planned to characterize the relationship between teaching and doctoring by examining the impact of an intensive teaching skill enhancement program for doctors in training. “We’ve always had the idea that being a good teacher and educator helps you to be a good clinician,” said Christopher Smith, Associate Professor of Medicine at Harvard Medical School and Director of the Internal Medicine Residency Program at Beth Israel Deaconess Medical Center (BIDMC). He pointed to the fact that he and his medical educator colleagues, all with some background in education, frequently draw parallels between clinical teaching and patient care.
The BIDMC Internal Medicine Program created the Clinician Educator Track, the first of its kind for internal medicine residents, providing the knowledge and skills to succeed as teachers and educators in the medical field (read more about the program in their Academic Medicine, Journal of the Association of American Medical Colleges Innovation Report). CET residents complete a 2.5-year program in which they review foundations of medical education, design and assess new curricula, and evaluate learners and programs. To date, they have graduated three classes (17 residents total).
What does it mean to be a good doctor? The Accreditation Council for Graduate Medical Education has attempted to answer this question with a detailed series of milestones to help define competence for clinical residents. Smith and his team developed a series of comprehensive multi-source evaluations based on these milestones; these evaluations are regularly completed by faculty, peers, nurses, and other members of the healthcare team. “With multiple evaluations in different rotations,” Smith explained, “you can get a picture of competency."
The researchers acknowledge, however, that their sample pool of residents at BIDMC is already a very high performing group in the top percentile of their field, and that assessing so few CET residents makes it difficult to assess change. They compared CET residents with control residents on metrics of competency scores, class rank, and the six dimensions of the ACGME competency definition – their total data spanned four years, 10,000 evaluations, and the class ranks of 191 residents. The underlying premise is that as the CET residents’ teaching skills improve, so do their clinical skills. In support of this theory, the results showed increases in clinical skill over the course of training at a faster rate among CET residents compared to their peers, as well as concomitant increases in class rank. While these primary findings were not quite statistically significant, subsequent analyses have shown that specific areas of clinical skills are more greatly enhanced by training to be educators.
In addition, the team conducted qualitative analyses of comments associated with the resident evaluations and focus group analyses of the CET residents. They posed a question to these residents: “What are the attributes and skills of good teachers that enhance clinical skills?” They found that four themes of attributes/skills emerged in these conversations: Relationships (e.g., openness, consideration, advocacy), Communication (e.g., compassion, enthusiasm, effective questioning, active listening), Relation to Self (e.g., receptivity to feedback, confidence, flexibility), and Relationship with Knowledge (e.g. organization, application, curiosity).
Ultimately, the team found a strong association between teaching skills and clinical skills, but is working with a small sample size and acknowledges that this correlation does not establish causation. They found the qualitative analysis very powerful, and see potential implications for other pre-professional tracks, such as business.
They are enthusiastic about the external response that the implementation of the CET track has garnered, and expect to see similar programming emerge at other medical schools.