Although physicians serve as teachers in hospitals, clinics, and medical schools across the United States and Canada, they typically receive little formal training in effective teaching.1 The Liaison Committee on Medical Education (LCME) and Accreditation Council for Graduate Medical Education both highlight teaching as an essential skill and duty of all physicians.2,3 In fact, the LCME requires all medical schools to collaborate with residency programs on “Residents as Teachers” curricula. Additionally, on the centennial of the Flexner Report, the Carnegie Foundation for the Advancement of Teaching issued a report championing a medical education system that provides learners with opportunities to assume the many roles and commitments associated with being a physician, including educator, advocate, innovator, investigator, and administrator.4 The rationale for the development of medical students’ teaching skills is outlined in a literature review by Dandavino and colleagues1:
(1) medical students are future residents and faculty members who will have teaching roles; (2) as teaching is an essential aspect of physician-patient interaction, medical students may become more effective communicators as a result of such training; and (3) medical students with a better understanding of teaching and learning principles may become better learners.
Despite widespread support for teaching doctors-in-training how to be better educators, such teaching-skills training is lacking across the medical education continuum. According to a recent survey of accredited U.S. MD-granting medical schools, while all 99 of the responding institutions offered opportunities for their students to teach (e.g., by acting as a peer tutor, peer mentor, small-group facilitator, teaching assistant in various courses, or contributor to curriculum design), only 43 schools (44%) provided a formal, comprehensive program designed to train their students to teach effectively.5 As medical schools implement such teacher training programs, they should also find ways, in parallel, to encourage student interest in teaching. For that reason—to inspire enthusiasm for teaching—we organized a medical student teaching competition (MSTC). Here, we describe the development, implementation, and initial results of the MSTC at Emory University School of Medicine (EUSOM).
EUSOM in Atlanta, Georgia, matriculates approximately 140 students per year. Medical students have the opportunity to fill various educational roles (e.g., peer mentor/tutor, presenter, small-group facilitator, patient educator) during their time at EUSOM; however, EUSOM offers no formal training for teaching, nor did the school offer, prior to the MSTC, any large-scale demonstrations of exemplary medical student teaching before an audience of peers and faculty members.
Development of the MSTC
In January 2014, with the support of EUSOM faculty advisors and leaders, a group of six third- and fourth-year EUSOM medical students, including four of us (A.K.D, J.P.H., C.L.S., E.R.), initiated development of the MSTC. For guidance and support we identified a faculty advisor (K.D.M.) from the Department of Medicine who is also a member of the department’s Academy of Medical Educators (a group whose mission is to “advance and support teaching across the Department of Medicine”6). We modeled the MSTC after a similar teaching competition that involves medicine fellows—that is, the J. Willis Hurst Demonstration of Teaching Excellence—which was developed and directed by our faculty advisor (K.D.M.) in partnership with the Department of Medicine. We chose to adapt this competitive event both because of its success at EUSOM and because of the expected accessibility and benefit of such an event to both preclinical and clinical medical students.
Beginning six months before the competition, we met monthly to develop and implement the MSTC. We held the first event on July 31, 2014. Similarly in 2015, six third- and fourth-year medical students (A.K.D., J.P.H., C.L.S., V.L., Y.D., E.R.) created a medical education interest group and organized the second MSTC (held on August 5, 2015). The third MSTC was held on August 1, 2016. For all three years, we had one main objective for this event, which was a component of a comprehensive effort at EUSOM: to encourage student interest in teaching during medical school by demonstrating examples, identifying exemplars, and rewarding excellence.
Given that the MSTC complements EUSOM’s formal initiatives to improve the teaching skills of doctors-in-training, including medical students, we believe the MSTC is relevant to other medical schools with similar goals and can be implemented elsewhere.
Structure and implementation of the MSTC
Preliminary selection round.
Three months before the MSTC, we recruited applicants by e-mailing all EUSOM students, including dual-degree students. We placed no restrictions on what student contestants could teach. All contestants enjoyed complete independence to design their teaching session as they wished and to seek guidance from mentors.
Seven weeks before the final competition, each contestant delivered a three-minute preview of his or her planned eight-minute teaching session to the medical students who had organized the MSTC in a given year. We judged the applicants in the preliminary selection round against a standardized judging scoring sheet (List 1) adapted from one used by the J. Willis Hurst Demonstration of Teaching Excellence. The eight students with the highest overall scores advanced to the next and final round of the MSTC.
Academic physicians as teaching coaches.
We involved academic physicians in all stages of the event (as advisors to us, teaching coaches, judges, and audience members) in order to surround all medical students, particularly those participating in the contest, with faculty members who share an interest in teaching excellence.
The eight finalists were given one month to prepare for the MSTC. We paired each finalist with a physician who, serving as a teaching coach, provided feedback and helped the student improve his or her presentation. The selected teaching coaches had previously won awards for their dedication to medical student teaching, and many had also served as clerkship course directors and/or residency and fellowship program directors. These teaching coaches were ineligible to serve as competition judges.
We publicized the event widely to medical students and faculty members alike through various channels: our Web site,7 e-mail, social media, a short promotional video of the eight finalists, and a digital flier delivered to the medical school community.
Each year, we held the competition one evening in a large lecture hall in the medical school that seats roughly 160 people. The timing (6:00–8:00 PM) enabled clinicians and medical students to attend after completing their clinical duties. Attendance at the event was voluntary. A pizza dinner and refreshments were available before and during the event for all in attendance. We also broadcasted the 2015 and 2016 events online using the live video streaming application Periscope (Twitter, San Francisco, California). Each presentation lasted eight minutes. The subjects of the teaching sessions were creative and diverse, clinical and nonclinical (Table 1). Questions were not allowed from either the judges or the audience because of time limitations. One of us (J.P.H.) monitored the time, displaying two-minute and one-minute warnings, then a stop sign, to each finalist.
We selected five faculty members of various specialties who had been awarded for their dedication to medical student teaching to judge the final presentations. We also selected two resident physician judges. We provided each judge with a suggested scoring sheet (List 1) to use as a guide in evaluating and ranking the finalists. Although not validated, the scoring sheet included qualitative metrics deemed to be beneficial in effective presentations for the J. Willis Hurst Demonstration of Teaching Excellence. After the conclusion of the last presentation, the judges were allotted time to make any final adjustments to their rank order list. Judges were not allowed to deliberate together because we wanted to reduce the possibility of common pitfalls associated with group decision making (e.g., popularity bias, individual influence).8 The finalist with the best composite score was named the winner, awarded a cash prize of $100, and commemorated by having his or her name inscribed on an MSTC winners’ plaque displayed in the EUSOM building. We did not announce the ranking of the other seven finalists because we considered all eight finalists to be excellent student teachers; we felt rank ordering them was unnecessary. The finalists did not receive formal feedback from the judges after the event because of time limitations, but they knew they could follow up with their teaching coaches for feedback and further mentorship.
The MSTC required minimal financial resources. Our annual budget was $890, which covered the costs of dinner, winners’ plaque, prize money, and printing of programs and judging scoring sheets.
As we began planning the MSTC in 2015, we hoped to evaluate the success of the MSTC through an anonymous survey of medical students in the audience (Table 2). After receiving an exempt review from the Emory University institutional review board, we created a questionnaire using Google Forms (Google, Mountain View, California). At the conclusion of the presentations, we requested that students follow the projected URL and complete the one-time survey via their phones, tablets, or laptops before the winner was announced. The questionnaire asked students to rate agreement or disagreement with various statements using a five-point Likert scale.
Twenty-seven students in 2014, 20 students in 2015, and 35 students in 2016 submitted applications to be considered as contestants in the MSTC. Approximately 150 medical students and faculty members attended the MSTC in 2014, 2015, and 2016. Additionally, 35 people streamed the MSTC online in 2015. Of the 130 students in attendance at the MSTC in 2015, 60 (46%) submitted the survey. Among the survey participants, 3 (5%) were first-year medical students, 25 (42%) were second-year medical students, 13 (22%) were third-year medical students, and 19 (32%) were fourth-year medical students. We believe we were able to attract a large audience because our diverse marketing strategies allowed us to build excitement over the weeks leading up to the MSTC.
Students’ reactions to the MSTC were favorable (Table 2). After attending the event, students reported being more interested in seeking out opportunities both to teach (mean = 4.3) and to learn how to teach effectively (mean = 4.3). Students also noted that they were better able to identify characteristics of effective teaching (mean = 4.3) after attending the event. Our survey data also suggested that the MSTC increased student interest in learning about careers in academic medicine (mean = 3.8).
We believe that several factors contributed to the success of the MSTC, including both student leadership in all aspects of the event from development to implementation and synergy with EUSOM’s formal initiatives to improve teaching skills of doctors-in-training. Additionally, the support of various deans at EUSOM and physicians from the Department of Medicine, including our faculty advisor (K.D.M.), was crucial to the event’s success.
However, we note several limitations related to how we measured the success of our event. The response rate to our audience survey was less than 50%, so the data may not be representative of all students in the audience. Some attendees may not have had an electronic device easily accessible or not enough time and motivation to complete the survey. Finally, students who attended the MSTC may have been more interested in teaching than the average medical student.
As measured both by the number of medical students and faculty members who attended the MSTC and by the results from the survey, we believe the MSTC was associated with a positive change in students’ attitudes towards teaching and careers in academic medicine. Although our current study demonstrated that the MSTC encouraged student interest in teaching at a single institution, this event has not yet been implemented at other institutions. Further analysis will be required once this event has been implemented in other settings and institutions.
If the MSTC and its positive effects prove reproducible at other institutions, the competition and even the medical student teaching coach partnership model could be implemented at medical schools that seek to encourage interest among medical students in developing and honing teaching skills. Also, the MSTC could easily complement other formal, comprehensive programs designed to train students to teach effectively. For further study, the MSTC and exit polling should be reproduced at other academic institutions. Additional surveying would be necessary to study the event’s effect both on students’ perceptions of medical education and on faculty members’ perceptions of their roles as mentors and judges. A future study should include both pre- and post-event surveys of contestants and attendees. The ideal study would be longitudinal, following the finalists, to assess their perceptions of and engagement in medical education activities across the medical education continuum, and to determine if they are more likely to pursue careers in academic medicine.
The MSTC is part of a larger movement at EUSOM to emphasize the importance of excellent teaching by medical students, residents, fellows, and faculty members and to provide doctors-in-training with opportunities to improve their teaching skills. Future goals for our group include coordinating instruction for all medical students about the basic principles of education, adult learning theory, and effective teaching; providing opportunities for more students to practice teaching with a teaching coach; and integrating opportunities for students to teach short lectures to their peers on topics aligned with the preclinical and clinical medical school curricula.
Acknowledgments: The authors express sincere thanks to Dr. J. William Eley, Dr. Ira K. Schwartz, Dr. Gordon Churchward, Dr. Hugh A. Stoddard, and Dr. William T. Branch Jr for supporting this work. They would also like to thank the many physicians and residents who served as judges and teaching coaches. They would like to acknowledge Dr. James C. Lockwood and Dr. Michael J. LaRiviere for help with the Medical Student Teaching Contest (MSTC) in 2014; Dr. Tammy Kim for help with the MSTC in 2015; and Shruti Chandramouli, Ariella Dagi, Varun Kannan, Albert Liao, Priya Marathe, and Julie Siegel for help with the MSTC in 2016. Finally, they gratefully acknowledge the student applicants and finalists who competed in the MSTC.