Evaluating Fellows as Teachers

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You thought the fellow would handle it. During ICU rounds yesterday, none of your residents could identify the target tidal volume for your newly admitted patient with ARDS, so you told the fellow to review it with the team that afternoon.  Today it's clear that the residents barely understand what part of the ventilator attaches to the patient, yet your fellow swears that they discussed ARDS for an hour yesterday!  Perhaps you just drew the unlucky month to have all the apathetic residents, but what if your fellow actually isn't that good of a teacher?  Should faculty expect that their fellows are able to teach?  If we find out they can't, do we have some responsibility to train them to do so?  How can we do that?  The curriculum is already full!

Well it turns out this stuff is important.  Fellows want to learn these skills and there seems to be more demand for this than supply.  In fact, recent survey data estimate that over 70% of fellows want to learn teaching skills yet only 33% of fellowships have formal teaching curricula to accomplish this.  And as if that weren’t enough, the ACGME says it’s important to both teach and assess these skills in our fellows as outlined directly in the program requirements:

“IV.A.5.c  Fellows are expected to:  participate in the education of patients, families, students, fellows and other health professionals”
“V.A.2.b).(1).(c).(iii)   The program must use performance data to assess each fellow in:  teaching skills involving peers and patients”

Furthermore, we believe that fellows become better learners and better students of lifelong medicine when they teach.  To teach well, fellows need a complete understanding and excellent command of the topic, which further promotes their learning.

Good teaching, like good clinical performance, is something we and our faculty "know when we see it."  As with other competencies, our fellows benefit from assessments that are authentic to the task and provide a framework for their achievement.  In other words, everyone likes an "'atta boy" but nonspecific feedback doesn't show you how to further improve.  Evaluating teaching depends on many factors, including the type of learner, the type of content being taught, and the available time and resources.  Because of this, no single assessment method works for every situation.  We separate the types of teaching done by fellows into four domains:  teaching large groups, teaching small groups, teaching of procedures (typically one-on-one), and teaching patients.  At the 2017 Spring APCCMPD meeting, input from dozens of program directors was compiled to create evaluations specific for each of these areas.  You can find the result of this effort in the APCCMPD toolbox  as a benefit of your membership: Large Group Teaching Evaluation/ Small Group Teaching EvaluationProcedural Teaching Evaluation, Patient Teaching Evaluation. Each of these evaluations contains useful grading scales and anchors that provide fellows with discrete areas for improvement. They are also fully editable Word documents, so you can customize them for your program’s specific needs.

“Wait a minute,” the fellow said.  “You mean you want me to actually teach the whole session to the residents?”
“Yes absolutely,” the attending replied.  “I will be there to observe you and give you feedback.  But the teaching will be all on you.”
“But there will be 30 or so residents there.”
“Yes,” the attending stated.  “You’d better know this stuff well.”

Considerable learning is achieved when someone must actually perform the task that is being taught.  For this reason, one of the most transformative experiences our fellows can have is to serve as teaching faculty.  Think about this:  Involve your fellow the next time you have a teaching engagement on your calendar and have the fellow be responsible for delivering a substantial portion of the talk.  It will be a real-world experience for them and will allow them to showcase their mastery of that particular subject matter.  We hope the evaluations in the APCCMPD toolbox will make it easier to show your fellows their teaching progress over time.

Peter Lenz, MD, M.Ed.
Associate Professor of Clinical Medicine
Program Director PCCM Fellowship
University of Cincinnati

Matthew Miles, MD, M.Ed.
Assistant Professor
Program Director PCCM Fellowship
Wake Forest University