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Radiology Residents as Teachers:
Current Status of Teaching Skills Training in United States Residency
Programs
Andrea Donovan, MD
Ac
FrCMThRa‘‘DImape-
ªdo
92
Rationale and Objectives: Radiology residents often teach medical students and other residents. Workshops developed with the goal of
improving resident teaching skills are becoming increasingly common in various fields of medicine. The purpose of this study was to deter-mine the prevalence and structure of resident-teacher training opportunities within radiology programs in the United States.
Method and Materials: Program directors with membership in the Association of Program Directors in Radiology (APDR) were surveyed
to determine views on a panel of topics related to resident-teacher training programs.
Results: A total of 114 (56%) of 205 APDR members completed an online survey. Approximately one-third (32%) stated that their program
provided instruction to residents on teaching skills. The majority of these programs (72%) were established within the last 5 years. Resi-
dents provided teaching to medical students (94%) and radiology residents (90%). The vast majority of program directors agreed that it isimportant for residents to teach (98%) and that these teaching experiences helped residents become better radiologists (85%). Ninety-four
percent of program directors felt that the teaching skills of their residents could be improved, and 85% felt that residents would benefit from
instruction on teaching methods. Only one-third of program directors felt their program adequately recognized teaching provided by
residents.
Conclusion: Program directors identified residents as being active contributors to teaching in most programs. Although teaching was
viewed as an important skill to develop, few programs had instituted a resident-teacher curriculum. Program directors felt that residents
would benefit from structured training to enhance teaching skills. Future studies are needed to determine how best to provide teachingskills training for radiology trainees.
Key Words: Radiology; teaching; curriculum; residency training; faculty development.
ªAUR, 2010
Residents contribute to the teaching of medical
students and residents, and spend up to one-quarter
of their work hours teaching, evaluating or super-
vising trainees (1). Although many residents enjoy teaching
and consider it to be an important component of their training
(2), many feel inadequately prepared to teach (3). Formal
instruction in effective teaching methods is desired by resident
trainees (4).
Postgraduate accrediting bodies, including the Accredita-
tion Council for Graduate Medical Education, consider
teaching skills to be among a group of core competencies
that residents must achieve during their training (5,6).
Subsequently, the last decade has witnessed an increase in
ad Radiol 2010; 17:928–933
om the Department of Medical Imaging, Sunnybrook Health Sciencesentre, Room AG 278, 2075 Bayview Avenue, University of Toronto, Canada4N 3M5 (A.D.). Received November 20, 2009; accepted March 9, 2010.is study was supported by the grant from the RSNA/AUR/APDR/SCARDdiology Education Research Development Grant. Project Title:eveloping Radiology Residents as Teachers: Program Director Views andplementation of a National Resident Teacher Development Course’’;plicant’s role: Principal Investigator. Address correspondence to: A.D.mail: [email protected]
AUR, 2010i:10.1016/j.acra.2010.03.008
8
resident-focused workshops geared toward helping residents
improve their teaching skills (7–9). In 2001, approximately
one-half of Accreditation Council for Graduate Medical
Education–accredited residency programs in family medicine,
internal medicine, pediatrics, psychiatry, general surgery, and
obstetrics-gynecology had established programs for residents
to improve their teaching skills (8).
In radiology, the prevalence and diversity of teacher training
activities for radiology residents has not been studied. It is
unknown whether such programs are flourishing to the
same extent as witnessed in other residency programs.
Certainly, resident-teacher training would likely be beneficial
in radiology because learner-teacher interactions are common
in daily practice (10,11). Instruction on teaching skills may
assist radiology residents not only to become more effective
teachers, but also to increase their overall satisfaction with
teaching and potentially increase their retention in academic
teaching centers (8,9,12).
Radiology program directors, together with their residency
training committee, influence the structure of residency
training programs and opportunities for residents to develop
their teaching skills. The goals of the present study were to
determine the prevalence of resident-teacher training
programs in radiology residencies, evaluate factors associated
with establishment of resident-teacher training programs,
TABLE 1. Radiology Program Director and ResidencyProgram Demographics
Academic Radiology, Vol 17, No 7, July 2010 RESIDENT-TEACHER TRAINING IN RADIOLOGY
and assess radiology program directors’ attitudes toward
resident-led teaching activities.
No. %
Program director gender
Male 80 70.2
Female 34 29.8
Years in practice
<5 years 11 9.7
5–10 years 26 22.8
11–20 years 42 36.8
>20 years 35 30.7
Years as program director
<2 years 38 33.3
2–5 years 34 29.8
>5 years 42 36.9
Number of radiology residents
<10 12 10.5
10–20 26 22.8
>20 76 66.7
Residency program setting
Academic 95 83.3
Private practice 19 16.7
MATERIALS AND METHODS
Institutional review board approval was granted for this
retrospective Health Insurance Portability and Accountability
Act–compliant study. After extensive review of the medical
education literature, a questionnaire was designed and then
piloted to ensure clarity. The survey was used to determine
program directors’ views on the role of residents as teachers
and the prevalence of resident-teacher training programs in
residency programs across the United States. A link to an
anonymous and voluntary survey was e-mailed to 205 radi-
ology program directors with membership in the Association
of Program Directors in Radiology (APDR). The survey was
completed using online survey software (www.surveymonkey.
com). Program directors were e-mailed a reminder to
complete the survey 1 month after the initial e-mail.
In this study, a ‘‘resident-teacher training program’’ was
defined as a workshop or course within the radiology
residency program that provided opportunities for residents to
enhance their teaching skills. The survey collected basic demo-
graphic information of program directors, including gender,
age, years of practice, years as program director, and practice
setting (academic or private practice). Specific information
pertaining to the residency program was also collected,
including number of residents in the program, resident teaching
responsibilities, and the presence, duration, and format of any
resident-teacher training program in existence at the program
director’s institution. In addition, the survey evaluated potential
barriers to implementing a resident-teacher skills curriculum.
In the final part of the survey, program directors ranked 13
statements pertaining to resident-led teaching using a 5-point
Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4
= agree, 5 = strongly agree). These statements helped to assess
program directors’ opinions on the importance of resident-led
teaching, the need for more structured resident-teacher
training programs, and whether the teaching efforts of both
faculty and residents were adequately recognized at their insti-
tutions. The scores from all program directors were averaged
to produce a mean score for each of the 13 statements. Specific
details of the survey questions are provided in the tables in the
results section.
Statistical analysis was performed using SAS software,
version 8.2 (SAS Institute, Cary, NC). Chi-square and Fisher
exact tests were used for analysis of categorical data. P < .05
was considered statistically significant for all analyses.
RESULTS
Program Director and Residency ProgramDemographics
One hundred fourteen of 205 radiology program directors
with membership in the APDR completed the online
survey for a response rate of 55.6%. Respondent demo-
graphics are presented in Table 1. Eighty of 114 (70.2%)
program directors were male and 34 (29.8%) were female.
Respondents had practiced radiology for varying lengths
of time, with the largest proportion (42 of 114, 36.8%) prac-
ticing for 11–20 years. Most respondents (72 of 114, 63.2%)
served as program director for 5 years or less. Residency
programs varied in size, with most programs (76 of 114,
66.7%) having more than 20 residents per program
(Table 1). Academic, rather than private practice, was the
most common residency training setting (95 of 114,
83.3%) (Table 1).
Radiology Resident Teaching Responsibilities
The vast majority of respondents indicated that their residents
taught medical students (107 of 114, 93.9%), other radiology
residents (102 of 114, 89.5%), as well as non-radiology trainees
(76 of 114, 66.7%) (Table 2). One hundred three of 114
(90.4%) respondents indicated that their residents delivered
case conferences, and 31 of 114 (27.2%) stated that their
residents were required to present at grand rounds (Table 2).
Teaching Skills Training for Residents
A minority of surveyed programs provided teaching skills
training for faculty and residents. Thirty-six of 114 (31.5%)
stated that residents received instruction on teaching skills
(Table 3). The majority (26 of 36, 72.2%) of resident-
teacher training programs were established within the past 5
years. Nearly two-thirds (23 of 36, 63.9%) of these teacher-
training programs had mandatory attendance requirements
929
TABLE 2. Radiology Resident Teaching Responsibilities*
Resident Teaching Activity No. %
Teach medical students 107 93.9
Teach other radiology residents in the program 102 89.5
Deliver case conferences 103 90.4
Present at multidisciplinary conferences 76 66.7
Present at grand rounds 31 27.2
*More than one response was possible making the total number of
responses greater than the number of respondents (n = 114).
TABLE 3. Teaching Skills Training Opportunities
No. %
Residents provided with regular feedback on
teaching skills
57 50.0
Residents assigned a mentor for guidance with
teaching preparation
60 52.6
Department offers instruction to faculty on
teaching skills
32 28.1
Department offers instruction to residents on
teaching skills
36 31.6
A) Years resident teaching skills program has
been offered
<1 year 7 19.4
1–2 years 9 25.0
3–5 years 10 27.8
>5 years 10 27.8
B) Teaching skills program is mandatory for all
residents
23 63.9
C) Format of the resident teaching skills training
program
One time-workshop 26 72.2
Longitudinal lectures 9 25.0
Educational electives 1 2.8
TABLE 4. Barriers to Offering Teaching Skills Instruction*
Survey Statement No. %
Time constraints imposed by faculty clinical
and research duties
69 60.5
Lack of faculty trained in medical education 65 57.0
Teaching is viewed as faculty role rather than
resident role
23 20.2
Resident teaching skills are viewed as being
currently adequate
17 14.9
Program directors not familiar with concept of
teaching skills workshops
15 13.6
*More than one response was possible making the total number of
responses greater than the number of respondents (n = 114).
DONOVAN Academic Radiology, Vol 17, No 7, July 2010
for residents. The most common format was a one-time
workshop on teaching skills (26 of 36, 72.2%), followed by
a longitudinal course on teaching skills (9 of 36, 25.0%),
and educational electives (1 of 36, 2.7%) (Table 3). Thirty-
two of 114 respondents (28.0%) stated that their department
offered instruction to radiology faculty on teaching skills.
Fifty-seven of 114 (50.0%) respondents indicated that feed-
back on teaching skills was routinely provided to radiology
residents (Table 3). Sixty of 114 (52.6%) respondents indicated
that there was a method in place at their institution to assign
residents to a mentor who could provide guidance with
teaching activities, including preparation for grand rounds
(Table 3).
Barriers to Development of a Resident-teacher TrainingProgram
Program directors identified barriers that hindered develop-
ment of resident-teacher training programs (Table 4). The
majority (69 of 114, 60.5%) felt that the clinical and research
duties of faculty imposed time constraints that hindered
participation in resident-teacher workshops. Approximately
half of respondents (65 of 114, 57.0%) indicated that their
program did not have radiology faculty trained in medical
education who were able to provide instruction on teaching
skills. In addition, 23 of 114 (19.3%) respondents regarded
teaching as being a role of faculty rather than residents, and
15 of 114 (12.6%) respondents stated that they had not previ-
ously thought of the idea of implementing a program on
teaching skills to residents. Seventeen of 114 (14.3%) program
directors felt the teaching skills of their residents were
presently adequate (Table 4).
Program Director Views on Resident-led Teaching
A 5-point Likert scale was used to evaluate program directors’
opinions on resident-led teaching activities (Table 5). One
hundred thirteen respondents completed this portion of the
survey. The vast majority agreed or strongly agreed (111 of
113, 98.2%) that it was important for residents to participate
in a teaching role and that teaching experiences helped resi-
dents to become better radiologists (107 of 113, 94.7%).
Approximately three-quarters (88 of 113, 77.9%) felt that
teaching experiences increased residents’ satisfaction with
training.
930
Many program directors felt that teaching contributions of
residents were not adequately recognized. Only 39 of 113
(34.5%) felt that their program valued teaching provided by
residents and adequately recognized resident teaching efforts.
In contrast, more than two-thirds of respondents (76 of 113,
67.3%) felt that their program valued teaching provided by
faculty and adequately recognized faculty teaching efforts
(Table 5). Ninety-six of 113 (85.0%) felt that their department
should emphasize the importance of residents as teachers and
that teaching provided by residents complemented the
teaching provided by faculty (101 of 113, 89.4%) (Table 5).
The vast majority of respondents agreed or strongly agreed
(104 of 113, 93.8%) that the teaching skills of radiology resi-
dents could be improved. Furthermore, the majority (97 of
113, 85.8%) felt that residents would benefit from a teacher
development course, believed that there was a need for
TABLE 5. Program Directors’ Views on Resident-led Teaching*
Survey Statement
Strongly
Disagree
No. (%)
Disagree
No. (%)
Neutral
No. (%)
Agree
No. (%)
Strongly
Agree
No. (%)
Mean
Scorey
Views on resident role as teacher
It is important for residents to participate in a teaching role 0
(0)
0
(0)
2
(1.8)
45
(39.8)
66
(58.4)
4.6
Teaching experiences help residents become better
radiologists
0
(0)
2
(1.8)
4
(3.5)
43
(38.1)
64
(56.6)
4.5
Teaching done by residents complements teaching done by
faculty
0
(0)
4
(3.5)
8
(7.1)
52
(46.0)
49
(43.4)
4.3
My department should emphasize the importance of residents
as teachers
0
(0)
3
(2.7)
14
(12.4)
50
(44.2)
46
(40.7)
4.2
Teaching experiences increase resident satisfaction with
training
0
(0)
5
(4.4)
20
(17.7)
52
(46.0)
36
(31.9)
4.1
Teaching during residency was an important part of my own
training
18
(15.9)
26
(23.0)
22
(19.5)
28
(24.8)
19
(16.8)
3.0
Views on resident teaching skills
The teaching skills of my residents can be improved 0
(0)
0
(0)
7
(6.2)
62
(54.9)
44
(38.9)
4.3
Many residents could benefit from a program which provides
teacher skills training (i.e. teacher development course)
1
(0.9)
4
(3.5)
11
(9.7)
57
(50.4)
40
(35.4)
4.2
I believe teacher skills training should be started early in
residency training
2
(1.8)
8
(7.1)
19
(16.8)
59
(52.2)
25
(22.1)
3.9
I believe there is a need for more teacher skills training during
residency
0
(0)
10
(8.9)
18
(15.9)
58
(51.3)
27
(23.9)
3.9
I have been asked by my residents to include teacher skills
training in the residency curriculum
23
(20.4)
51
(45.1)
30
(26.6)
4
(3.5)
5
(4.4)
2.3
Views on program recognition for teaching efforts
Our program values teaching provided by faculty and
adequately recognizes faculty teaching efforts
3
(2.7)
20
(17.7)
14
(12.4)
54
(47.8)
22
(19.4)
3.6
Our program values teaching provided by residents and
adequately recognizes resident teaching efforts
6
(5.3)
35
(31.0)
33
(29.2)
31
(27.4)
8
(7.1)
3.0
*Reported numbers are based on 113 respondents.yResponses were made using a 5-point Likert scale: 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree.
Academic Radiology, Vol 17, No 7, July 2010 RESIDENT-TEACHER TRAINING IN RADIOLOGY
more formal resident-teacher skills training during residency
(85 of 113, 75.2%), and felt that a resident-teacher training
program should be started early in residency training (84 of
113, 74.3%) (Table 5). Only a minority of program directors
(9 of 113, 8.0%) had been directly asked by residents to include
teacher skills training in the residency curriculum (Table 5).
A sub-analysis of survey responses showed that respondents
from academic and private practice–based setting did not
differ in their responses to survey questions (data not shown).
Factors Associated with Establishment of Resident-teacher Training Programs
Several factors were associated with establishment of a resi-
dent-teacher training program. First, programs having
a teaching skills course for faculty were approximately twice
as likely to also have a resident teaching skills course (P =
.027). Second, the longer the program director had served
as program director, the more likely the residency program
was to have a resident-teacher training program (P = .038).
Furthermore, a trend was identified for larger radiology
programs to have a resident-teacher training program (P =
.073). The number of years the program director had prac-
ticed and the practice setting (academic versus private) were
not associated with establishment of a resident-teacher
training program.
To evaluate whether specific program director opinions
influenced the establishment of a resident-teacher training
program, a forward stepwise logistic regression was performed
based on the series of 13 possible statements included in
Table 5. This analysis showed that agreement with the state-
ment ‘‘My department should emphasize the importance of
residents as teachers’’ was the only significant independent
predictor (P = .05) of having a resident-teacher training
program among 13 statements.
DISCUSSION
Resident trainees frequently teach medical students and other
residents (1). In some institutions, resident-teachers provide
931
DONOVAN Academic Radiology, Vol 17, No 7, July 2010
up to 70% of the clinical teaching received by medical students
(7). Respondents to the present survey indicated that most
United States radiology residents teach medical students as
well as other radiology residents. Many studies suggest that
teaching performed by residents has a positive impact on
learners. For example, residents are frequently identified by
medical students and junior residents as being among their
most memorable teachers (13). Compared to attending faculty
members, residents may be able to better relate to their peers
and provide teaching in a safe, nonthreatening environment
(14). Residents may themselves benefit from teaching. For
example, residents’ medical knowledge and clinical compe-
tence were shown to increase by teaching others (15). In the
present study, the vast majority of radiology program directors
agreed that it is important for residents to participate in
a teaching role, and moreover that these teaching experiences
help residents to become better radiologists.
Although residents frequently provide teaching, many
trainees consider their repertoire of teaching skills to be inade-
quate (16). Observational studies of teaching skills among
internal medicine residents suggested that many residents teach
ineffectively (17). For example, it is uncommon for residents to
ask questions or to give feedback to learners (18). Furthermore,
residents do not teach problem-solving skills or address psycho-
social topics as often as attending physicians (19). A fundamental
goal of residency training is to achieve the key competencies
needed to practice medicine. In addition to clinical competence
and skills to conduct research (20), many accrediting bodies
now mandate that trainees achieve key competencies to teach
(5,6,21,22). These competencies include the demonstration
of effective teaching skills when teaching medical students,
peers, other health professionals and patients, as well as the
ability to self-evaluate teaching effectiveness.
Although residents have expressed a need to improve their
teaching skills (4), they are unlikely to be aware of available
methods to improve these skills. Indeed, only 8% of surveyed
program directors had been directly asked by residents to
incorporate a resident-teacher training program into the resi-
dency curriculum. Three-quarters of respondents agreed or
strongly agreed that there is a need for resident-teacher
training during residency and believed that this training
should be started early in residency. It may be helpful to
develop and disseminate a sample teaching curriculum to
radiology program directors, because not all may be familiar
with the opportunities that exist for resident-teacher training.
This curriculum would be designed with the primary goal to
help residents achieve key competencies as teachers, but could
also serve a secondary goal to increase awareness of a radiology
clinician-educator track, inform residents of opportunities to
obtain funding for medical education research, and promote
educational scholarship (23). It is possible that residents who
are exposed to teaching opportunities and mentoring early
in their training, and who enjoy it, may be more likely to
consider a career in an academic teaching center (13,24,25).
Other authors concur, and have cited teaching as being one
of the top reasons that radiologists choose an academic
932
career (Collins J, presented at the 2009 annual meeting of
the Association of University Radiologists).
To the best of the author’s knowledge, this is the first study
to evaluate the prevalence of resident-teacher training
programs in radiology. In this study, approximately one-
third of program directors indicated that their program
provided instruction to residents on teaching skills. The
most common method of delivery was a 1-day workshop.
Although longer educational electives may offer more oppor-
tunities for feedback, it is often difficult to free residents from
clinical service for extended period. Previous studies sug-
gested that both short courses and longer electives improve
resident teaching skills and satisfaction with teaching
(8,9,26). In one study, residents who completed a teaching
skills training course expressed greater enthusiasm for
teaching, demonstrated more learner-centered and empathic
teaching approaches, and had a richer understanding of
teaching principles and skills (13). Perhaps most importantly,
residents who participated in the teaching skills course wanted
to continue teaching during and after residency training (13).
Improvement in resident teaching skills may also lead to better
doctor-patient communication (27), enhanced patient
satisfaction, and possibly improved clinical outcomes (23,28).
This study highlighted several barriers to developing work-
shops or courses on teaching skills for residents. The majority
of respondents felt that time constraints imposed by the clin-
ical and research duties of faculty, and lack of trained medical
educators in radiology hindered implementation of resident
focused instruction on teaching skills. Inadequate recognition
of faculty who might ultimately lead such a course is another
barrier that needs to be overcome (29). Potential solutions
include collaboration between radiologists and medical
educators at one’s institution (30) or establishment of teaching
skills workshops led by experienced medical educators from
other institutions (23).
Many residents and faculty consider teaching to be under-
valued (2). Only one-third of program directors in the present
study felt that teaching performed by residents was adequately
recognized. Most respondents felt that their department
should emphasize the importance of residents as teachers.
How best to increase recognition of the teaching efforts of
radiology residents and faculty remains to be determined.
Recognition of outstanding resident and faculty teachers,
with local and national awards for teaching excellence, may
offer an immediate strategy. However, fostering an environ-
ment that supports and promotes teachers continues to be
a fundamentally important goal for the specialty of radiology.
It is interesting that institutions that had a faculty teaching
skills course were more likely to have a resident-teacher
training course. It is possible that academic institutions that
value the contributions of their teachers are interested to
develop teaching skills of all members of the department.
Institutions seeking to develop a resident teaching skills course
might consider initially implementing a faculty teacher
development course. Thereafter, radiology faculty could be
identified to lead a resident-teacher training course.
Academic Radiology, Vol 17, No 7, July 2010 RESIDENT-TEACHER TRAINING IN RADIOLOGY
There are several limitations to this study. First, a potential
response bias from program directors interested in resident-led
teaching may have overestimated the importance placed on
the role of resident teaching during radiology residency
training and the prevalence of resident-teacher training
programs in radiology. The response rate of 56% in the current
study is similar to a response rate of a prior survey of program
directors in the APDR (31). The proportion of respondents in
this survey who identified themselves as practicing radiology
in an academic setting (83%) parallels the current proportion
of academic programs in the entire APDR (84%). Second, this
study evaluated the prevalence of resident-teacher training
programs at individual institutions, but did not seek to assess
resident-teacher training opportunities available through
national radiology societies. Select radiology residents have
the opportunity to participate in teacher training at the Asso-
ciation of University Radiologists (AUR) annual meeting
through the Siemens AUR Radiology Resident Academic
Development Program and the American Association of
Academic Chief Residents in Radiology program.
In conclusion, program directors valued the role that radi-
ology residents play in medical education and felt that
teaching experiences helped residents become better radiol-
ogists. Most believed that residents would benefit from
structured training to enhance teaching skills. A minority
of residency programs had established a teaching skills
program for their residents. There is an expressed need for
additional strategies to develop the teaching skills of
radiology residents.
ACKNOWLEDGMENTS
The author is indebted to Marko Katic, biostatistician with
the Institute for Clinical Evaluative Sciences, Toronto, for
assistance with data analysis.
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