• Elizabeth H Morrison, Lloyd Rucker, John R Boker, Charles C Gabbert, F Allan Hubbell, Maurice A Hitchcock, and Michael D Prislin.
• Department of Family Medicine, College of Medicine, University of California, Irvine, Irvine, California 92868-3298, USA. ehmorris@uci.edu
• Ann. Intern. Med. 2004 Aug 17;141(4):257-63.

BackgroundAlthough resident physicians often teach, few trials have tested interventions to improve residents' teaching skills. A pilot trial in 2001-2002 found that 13 trained resident teachers taught better than did untrained control residents.ObjectiveTo determine whether a longitudinal residents-as-teachers curriculum improves residents' teaching skills.DesignRandomized, controlled trial from May 2001 to February 2002 (pilot trial) and March 2002 to April 2003.Setting4 generalist residencies affiliated with an urban academic medical center.Participants62 second-year residents: 23 in the 2001-2002 pilot trial and 39 more in 2002-2003; 27 of the 39 participants were medicine residents required to learn teaching skills.InterventionA 13-hour curriculum in which residents practiced teaching and received feedback during 1-hour small-group sessions taught twice monthly for 6 months.MeasurementsA 3.5-hour, 8-station, objective structured teaching examination that was enacted and rated by 50 medical students before and after the intervention. Two trained, blinded raters independently assessed each station (inter-rater reliability, 0.75).ResultsIn the combined results for 2001-2003, the intervention group (n = 33) and control group (n = 29) were similar in sex, specialty, and academic performance. On a 1 to 5 Likert scale, intervention residents outscored controls on overall improvement score (post-test-pretest difference, 0.74 vs. 0.07; difference between intervention and control groups, 0.68 [95% CI, 0.55 to 0.81]; P < 0.001) by a magnitude of 2.8 standard deviations and on all 8 individual stations. The intervention residents improved 28.5% overall, whereas the scores of control residents did not increase significantly (2.7%). In 2002-2003, 19 intervention residents similarly outscored 19 controls (post-test-pretest difference, 0.83 vs. 0.14; difference between intervention and control groups, 0.69 [CI, 0.53 to 0.84]; P < 0.001). Twenty-seven medicine residents required to learn teaching skills achieved scores similar to those of volunteers.LimitationsThe study was conducted at a single institution. No "real life" assessment with which to compare the results of the objective structured teaching examination was available.ConclusionsGeneralist residents randomly assigned to receive a 13-hour longitudinal residents-as-teachers curriculum consistently showed improved teaching skills, as judged by medical student raters. Residents required to participate improved as much as volunteers did.

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