The most important tool to train medical professionals is clinical teaching. It begins on the first day of medical school and extends through fellowship. Interactions between attendings and residents are a critical aspect of postgraduate training. In turn, attending-resident interactions are among the best assessments of resident competency.
Unfortunately, bedside teaching has declined in recent years. Perceived time constraints and patient census may be contributing factors. Teaching residents is no small task. It takes years to train a specialist, and the best attendings possess skill sets and strategies to teach residents. Both are within reach with training and study.
When teaching postgraduate trainees, trust is integral. The teacher-student relationship must be supportive and collegial to instill learning, professional development, and a commitment to lifelong learning.
“Learners have a tendency to mirror the behavior of instructors they feel are professional and competent. In knowing this, instructors should demonstrate empathy and compassion, teaching both medical knowledge and professionalism skills,” according to the Council of Emergency Medicine Residency Directors in an article published in the Western Journal of Emergency Medicine.
Ultimately, learners appreciate teachers who can challenge them within their zone of professional development, which straddles the line between what a learner can do independently and what they need help learning.
In their guidance, the authors provided various approaches for educating residents, including:
Preparation. Attendings should adequately plan before resident didactics and practicum. This could involve preparing teaching scripts or brushing up on physical examination skills.
Priming. Attendings should prepare residents for the upcoming lesson by setting clear expectations and goals. This step can include securing buy-in from the learner and setting achievable endpoints that align with the instructor’s and the learner’s goals.
Knowledge integration. Various strategies may improve knowledge integration and retention. One concept to keep in mind is the cognitive-load theory, which posits that people can process only so much information at once, and anything beyond this tipping point results in decreased performance and learning. Consequently, it may be a good idea to focus on relevant clinical pearls and teach only so much in one interaction.
Interprofessional teaching. Nurses, PAs, pharmacists, and technicians can all play valuable educational roles. Involving them better reflects the multidisciplinary nature of teams and has been found to promote the delivery of safe, cost-effective, efficient, and patient-centered care. It also helps to improve communication regarding the care plan, shorten length of stay, and decrease errors.
Debriefing. Debriefing is necessary after critically ill patient visits.
Teaching guidance from the AMA suggests developing lesson plans that “keep it simple” and that prioritize differential diagnoses; learners who are struggling can be asked to teach back the learning objectives.
Perceived drawbacks and potential benefits
Attending physicians may be concerned that teaching residents may detract from their patient care or expose them to liability.
Patient care aspects were assessed in a 2019 observational study among emergency physicians, published in AEM Education and Training. Investigators found that emergency physicians who taught in a community-academic setting spent about 14.2% of their time supervising residents, with activities including data presentation, medical decision-making, and treatment. However, this sacrifice was offset with time saved on indirect patient-care activities, thus not compromising direct patient care.
Some attendings may have liability concerns regarding medical errors made by residents. It is true that residents are named as defendants in lawsuits, with residents in surgical specialties most prone to this, according to research cited by the AMA. Residents do have occurrence coverage, however. The Accreditation Council for Graduate Medical Education requires that residency programs provide medical liability coverage for their residents and fellows.
“Residents can and do get sued. If a resident is sued, it is likely that his or her malpractice coverage will cover most of the claim,” writes Regina Bailey, MD, JD. “Lawsuits are timely and stressful and, regardless of outcome, will affect the remainder of a medical career. To avoid being sued, residents should keep up to date with the recent guidelines, communicate well with patients, document well, and ask for help when they need it.”
Many attendings have altruistic motivations for getting involved in teaching. Their intrinsic rewards are enhanced by the fact that they can receive CME credit for their efforts, as detailed by the AMA.
Bailey RE. Resident Liability in Medical Malpractice. Annals of Emergency Medicine. 2013;61:114-117.
Murphy B. Resident medical liability lawsuits: Why and how often they happen. AMA. 2022
Natesan S, et al. Clinical Teaching: An Evidence-based Guide to Best Practices from the Council of Emergency Medicine Residency Directors. Western Journal of Emergency Medicine. 2020;21(4):985-998.
Smith TM. Building lesson plans to make medical residents better teachers. AMA. 2022.
Wang EE, et al. Resident Supervision and Patient Care: A Comparative Time Study in a Community-Academic Versus a Community Emergency Department. AEM Education and Training. 2019;3(4):308-316.