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How Medical Students Learn From Residents in the Workplace: A Qualitative Study

Karani, Reena MD, MHPE; Fromme, H. Barrett MD, MHPE; Cayea, Danelle MD, MS; Muller, David MD; Schwartz, Alan PhD; Harris, Ilene B. PhD

doi: 10.1097/ACM.0000000000000141
Research Reports

Purpose: To explore what third-year medical students learn from residents and which teaching strategies are used by excellent resident teachers in their interactions with students in the clinical workplace environment.

Method: In this multi-institutional qualitative study between January and March 2012, the authors conducted focus groups with medical students who were midway through their third year. Qualitative analysis was used to identify themes.

Results: Thirty-seven students participated. Students contributed 228 comments related to teaching methods used by residents. The authors categorized these into 20 themes within seven domains: role-modeling, focusing on teaching, creating a safe learning environment, providing experiential learning opportunities, giving feedback, setting expectations, and stimulating learning. Role-modeling, the most frequently classified method of teaching in this study, was not included in three popular “Resident-as-Teacher” (RAT) models. Strategies including offering opportunities for safe practice, involving students in the team, and providing experiential learning opportunities were not emphasized in these models either. Almost 200 comments representing the knowledge and skills students learned from residents were categorized into 33 themes within nine domains: patient care, communication, navigating the system, adaptability, functioning as a student/resident, lifelong learning, general comments, career/professional development, and medical content. Most of these areas are not emphasized in popular RAT models.

Conclusions: Residents serve as critically important teachers of students in the clinical workplace. Current RAT models are based largely on the teaching behaviors of faculty. The content and teaching strategies identified by students in this study should serve as the foundation for future RAT program development.

Dr. Karani is associate dean for undergraduate medical education and curricular affairs; director, Institute for Medical Education; and associate professor of geriatrics and palliative medicine, medicine and medical education, Icahn School of Medicine at Mount Sinai, New York, New York.

Dr. Fromme is associate program director, pediatric residency program; and associate professor of pediatrics, University of Chicago Pritzker School of Medicine, Chicago, Illinois.

Dr. Cayea is internal medicine clerkship director; and assistant professor, department of medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.

Dr. Muller is dean for medical education; and professor of medicine and medical education, Icahn School of Medicine at Mount Sinai, New York, New York.

Dr. Schwartz is professor and associate head, department of medical education, University of Illinois at Chicago, Chicago, Illinois.

Dr. Harris is professor, head and director of graduate studies, department of medical education, University of Illinois at Chicago, Chicago, Illinois.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Granted by institutional review boards at Icahn School of Medicine at Mount Sinai, University of Chicago Pritzker School of Medicine, Johns Hopkins University School of Medicine, and University of Illinois, Chicago, College of Medicine.

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A184.

Correspondence should be addressed to Dr. Karani, Icahn School of Medicine at Mount Sinai, One Gustave Levy Place, Box 1257, New York, NY 10029; telephone: (212) 241-1698; e-mail: reena.karani@mssm.edu.

© 2014 by the Association of American Medical Colleges