Education Columns

Sukhjeet Kamboj, MD, Abdul Waheed, MD, Department of Family & Community Medicine, Penn State College of Medicine, Hershey PA, and WellSpan Good Samaritan Hospital Family Medicine Residency Program, Lebanon PA; Michael Malone, MD, Department of Family & Community Medicine, Penn State College of Medicine, Hershey PA, and Tidelands Health MUSC Family Medicine Residency Program; Tara Kennedy, MD, Department of Family & Community Medicine, Penn State College of Medicine, Hershey PA; Ayesha Abid, Department of Family & Community Medicine, Penn State College of Medicine, Hershey PA, and Department of Family Medicine, West Virginia University Potomac Valley Hospital, Keyser, WV

Background
Traditionally, North American graduate medical education—in both the clinic and the classroom—emphasizes the acquisition of patient care skills. For those who opt for careers in academic medicine, teaching skills are acquired via faculty development fellowships or through “on the job learning.” However, residents are involved on a daily basis in teaching their fellow residents, medical students, and patients.1 As a result, there is a growing emphasis on teaching residents to be good educators, particularly as related competency-based curricula are being rolled out.² Although there is an increasing trend toward having curricula for residents as teachers, there is a paucity of data on opportunities for residents to present at regional CME courses or to direct these courses in parallel with faculty.³

Intervention/Preparation and Methodology
The Penn State University Department of Family and Community Medicine developed a hands-on approach to teaching residents to teach and serve on the panel of course directors of a CME course. In 2012, a regional CME event was planned by several faculty members who were in the early stages of their academic family medicine careers. The conference was designed to serve as a junior faculty development tool, and provided opportunities for junior faculty to improve their speaking and presentation skills. It also allowed junior faculty to take the lead in directing and designing the course.4,5 Opportunities for collaboration were extended to residents in two phases. For the first 2 years, residents participated as speakers at the course. Subsequently, residents with an interest in academia were given the opportunity to partner with junior faculty as course codirectors.

Although the dominant mode was experiential learning, residents were also provided with mentorship and verbal and written guidance, including the following:

• Summary guide for the creation of course curriculum using David Kern’s model.⁶
• Short guide for preparation regarding CME accreditation, marketing and promotion.
• A list of literature search resources, including research help from the College of Medicine librarian.
• Best practices guidelines for the creation of PowerPoint presentations.
• The opportunity to present at practice sessions, and give and receive feedback. 

Impact
Resident CME Speakers
Twelve residents have presented over the course of the past 3 years, indicating an increasing number of opportunities for residents. The primary care practitioner audience scored resident speakers comparably to faculty presenting at the same conference.

Resident Course Codirectors
Three residents have served as course codirectors in the past 3 years, indicating successful and sustainable provision of such opportunities for family medicine residents. Every resident was able to report Kern’s six steps after going through 1 year of hands-on participation in the creation, implementation, and evaluation of the regional CME course. All three of these residents are now in academic careers.

Conclusion
Participation in a regional CME course has effectively served as a faculty development tool for residents. Since the expansion of the role of the residents in the course, three residents have participated as speakers each year, and one resident per year has participated as course codirector.

Although this regional CME activity has increased opportunities for interested residents to enhance their teaching skills, this platform does not have the capacity to accommodate all residents in its current form. Future efforts will be directed toward increasing the number of resident presenters or, possibly to dedicating a whole conference to resident speakers. One potential barrier to such a conference would be maintaining its commercial potential to attract primary care practitioners as an audience.

The residents who codirected the course informally expressed interest in learning the principles of curriculum development in a setting outside of the CME course. In the future, we are planning to include regular didactic teaching focused on this topic and to use this CME course to create an area of concentration in academic family medicine within our residency program.

References

1. Bing-You RG, Sproul MS. Medical students’ perceptions of themselves and residents as teachers. Med Teach. 1992;14(2-3):133-138. https://doi.org/10.3109/01421599209079479
2. Iobst WF, Sherbino J, Cate OT, et al. Competency-based medical education in postgraduate medical education. Med Teach. 2010;32(8):651-656. https://doi.org/10.3109/0142159X.2010.500709
3. Bree KK, Whicker SA, Fromme HB, Paik S, Greenberg L. Residents-as-teachers publications: what can programs learn from the literature when starting a new or refining an established curriculum? J Grad Med Educ. 2014;6(2):237-248. https://doi.org/10.4300/JGME-D-13-00308.1
4. Waheed A, Kamboj S, et al. Regional continuing medical education (CME) conference as junior faculty development tool: reflections of participating junior faculty. Poster presented at Annual Ed Venture Penn State Woodward Office of Excellence in Health Professions Education; Hershey, PA. April 2017.
5. Malone M, Waheed A, Pujalte G, Baker J, Kaushi N. Creation of primary care continuing medical education (CME) conference designed as a resident and junior faculty development tool. STFM Education Column. July 2015. http://www.stfm.org/NewsJournals/EducationColumns/July2015EducationColumn. Accessed August 13, 2018.
6. Kern D, Thomas PA, Hughes M. Curriculum Development for Medical Education: A Six Step Approach. 2nd Edition. Baltimore, MD: The John Hopkins University Press 2009.