Lavjay Butani, MD, Debora Paterniti, PhD, Department of Internal Medicine and Sociology, Daniel J. Tancredi, PhD, Su-Ting Li, MD, MPH, UC Davis Medical Center, Sacramento, CA
Background: Effectiveness of resident teachers has not been well studied due to lack of tools to assess resident performance. Objective: To develop a valid evaluation tool for assessment of residents as educators. Methods: Semi-structured focus groups of purposefully sampled pediatric residents and 3rd/4th year medical students explored desired qualities in good resident teachers and role-models using grounded theory. Iterative analysis indicated thematic saturation. A list of attributes was generated and reviewed for exhaustiveness by stakeholders (residents, students, and national educators). The list was ranked on a 5-point Likert scale by stakeholders based on 2 criteria: ‘importance’ (5=extremely important) and ‘accuracy of measurement’ (5=very accurate). Items which were both important (≥4.0, 4 being “Important”) and accurate (≥ 3.5, 4 being “Accurate” and 3 being “Somewhat accurate”) were selected for the final tool. Only items where the lower endpoint of the 95% confidence interval for the mean met the cutoffs were included. Results: Forty focus group participants identified 63 items; stakeholder input added 22 more attributes. The 85 item list was re-circulated among the educators (n=14) and an independent set of learners (n=13) for ranking. Twenty-two items met both importance and accuracy criteria. The items reflect the following themes: respect towards patients, families, and health care team, constructive feedback that matches written evaluation, direct supervision with balance of autonomy, leadership through patient ownership and soliciting of student opinions, creation of a safe learning environment, personal characteristics such as intellectual curiosity and a teaching style that is relevant to patient care and student goals using clinical problem solving. The 23 attributes deemed important but not accurately measurable fell into themes of cultural competence, shared decision making, professionalism and management skills. Discussion: Instruction to, and evaluation of, residents as teachers should emphasize areas outlined above to ensure teaching competence in graduation residents. Many attributes valued by the profession, including cultural competence, may not be reliably measured by learners. Additional validated tools to capture these aspects of resident performance are necessary. Next steps include assessing the tool’s reliability and it’s transportability to other disciplines/institutions.