by Sophia Archuleta, Derek Soon, Clement Tan, Dujeepa Samarasekera
ncreasingly, undergraduate medical education is moving
from unstructured didactic large group and minimally
supervised clinical lessons to small, closely supervised
as well as structured clinical sessions1. Part of this transition was
to promote deep learning amongst the students, by encouraging
them to have more discussions and interactions with their seniors
or supervisors to understand the context in which certain clinical
approaches are taken. However, this is hindered by many clinicians
and senior clinical teachers' extremely busy schedule. They have
to treat a large number of patients, participate in higher level
management and translational research.
At the same time, it has been reported that teaching activities
could take up as much as 20% of the residents' time, and this
contributes to one-third of the knowledge acquired by the
medical students2. It is thus crucial that we ensure that they are
well-versed in teaching. However, besides providing their service
to hospitals, these residents also have to receive their regular and
sometimes intensive training in areas like domain-specific skills
and knowledge, which poses a challenge.
At the Yong Loo Lin School of Medicine (NUS Medicine), National
University of Singapore (NUS), there was an imperative need
for us to design a program that has a practical approach to
equip the residents to teach their juniors with the foundational
understanding of the medical and health professions education
framework. This was due to varying factors listed below.
We will share in this paper, an innovative program we have
developed to nurture and equip our residents teaching medical
students with the foundational understanding of the medical
and health professions education framework, to enhance their
effectiveness in educating medical students and other residents
given the time constraints and limited resources.
- As part of our quality improvement efforts and 2020
goals to enhance the student learning environment to give
undergraduates a WOW learning experience.
- Development of residents' teaching skills in order to achieve
competency in Practice-Based Learning and Improvement
as part of the Accreditation Council for Graduate Medical
- Residents are more involved in teaching, assessing and
providing feedback to learners since they often have
more direct contact time with students than senior faculty
in an academic medical center with learners of various
seniorities embedded in nearly all clinical teams.
- To integrate a residents-as-teachers (RaTs) workshop into
the curriculum of all residency programs offered at our
We developed an eight-hour, interactive and practical training
program incorporated into the main learning context for all
residents and specialists at the National University Health System
(NUHS) academic centre. The first workshop was conducted in
2012 and four more sessions had been run up to 2014.
Experiential learning theory was used to impart best-practices
and hone skills in: (a) effective bedside teaching; (b) formative
work-based assessment; and (c) providing feedback to enhance
student learning, (d) contemporary clinical-assessment practices
and (e) managing time effectively.
The program was built around discussion on actual cases in
clinical education, with the facilitators highlighting the principles
and theories behind some of the best practices and theories and
discussing challenges residents encountered during the session.
The format included interactive small group discussion with
problem-based scenarios, role-play, direct observation and videoed
micro-teaching exercises incorporating techniques such as the
RIME model, 1-minute preceptor and modified Pendleton feedback
model. We selected these practical techniques to promote timely,
concise teaching output relevant to a busy resident and to address
the challenges of effectively engaging learners at multiple levels.
Multimedia, especially videos were used to complement the
content delivered. Participants were also given a short handout
from which certain elements were highlighted during the workshop
and they were encouraged to read it afterwards.
During the hands-on microteaching sessions, trained
standardized participants acting as patients or students were
involved. Participants were encouraged to reflect on their
experience before and during the workshop. The resource person
also highlighted the key points as tips towards the end of the
From the second workshop onwards, we introduced a postworkshop
assignment consisting of video recording and analysis
(with workshop faculty feedback) of a resident-delivered, bedside
teaching session that is required for certification of the resident
as teacher. This is for them to apply what they have learnt to
their daily practice.
The workshop has been offered five times since, with a total
attendance of 87 residents to date. Seventy-eight residents (92%) completed feedback on their RaTs workshop experience with 99%
of them rating it as good, very good or excellent. Many found the
role-play and microteaching activities very engaging. Participants
also found the content simulating, which prompted them to think
about teaching in new ways.
Additionally, they rated the workshop especially highly in terms
of helping them to plan and implement teaching activities in
their daily practice more effectively. When asked what immediate
changes they would implement, most comments focused on
integrating the specific, practical techniques shared in the
workshop into their routine student contact, particularly on giving
feedback using techniques like the sandwich model.
Despite the relatively positive feedback, we encountered
difficulties with the post-workshop assignment that was designed
to complete the learning cycle. Only 21 participants completed
since it was introduced. Anticipated next steps include peer
observation and feedback of resident teaching for the ongoing
development of our residents as faculty.
In conclusion, the practical and hands-on nature of the workshop
was well received with participants feeling empowered and
requesting even more practical exposure.
Click here to download the full issue for USD 6.50