Residents as Educators: Preparing Fourth-Year MD Students for Intern Year

Clinical simulation - Intern Preparation Course

Photo caption: During a clinical simulation with actors or medical mannequins as patients, fourth-year medical students gain hands-on skills in common procedures used during the first year of residency. Their work is coached by residents who participated in a resident-as-educator curriculum and overseen by faculty in a control room who direct the simulated responses of medical equipment. Credit: Clint Thayer/Department of Medicine  

“Emotions of graduating medical students run high this time of year - it's a big change,” said Sara Johnson, MD, assistant professor (CHS), Hematology, Medical Oncology and Palliative Care. 

Within a few weeks, medical students will receive their degree and enter their first year of residency training (referred to as their “intern” year), with greater responsibility for patient care than they have ever experienced in their professional lives. At the UW School of Medicine and Public Health (UW SMPH), one strategy to ease the transition is the intern preparation course. This hands-on, technically-oriented course is designed to provide practical know-how and interpersonal communication skills that are essential for the first year of residency. 

The SMPH Medical Sciences Intern Preparation Course is co-directed by Dr. Johnson at the Madison campus in collaboration with Jamie Hess, MD, Department of Emergency Medicine and Amy Liepert, MD, Department of Surgery. Additional sections of the course are offered in La Crosse by Kyla Lee, MD, clinical adjunct associate professor, and Kim Lansing, MD, clinical adjunct assistant professor and in Marshfield by Lori Remeika, MD, clinical adjunct professor. 

With core sessions of more than 120 students and smaller specialty sessions, the course covers both broadly essential concepts and procedural-based instruction for those who are pursuing medical or surgical specialties.

However, the experience has a twist: Internal Medicine residents involved in a resident-as-educator curriculum occupy a leadership role, taking the helm both at the whiteboard during lectures and in exam rooms during clinical simulations.  

“Everything about this course is practical, not esoteric,” said Dr. Johnson. “It’s focused on what a new intern needs to know in the first 10 minutes after they’ve been paged in the middle of the night during their first few weeks. And as ‘near-peers,’ the residents do a great job of role modeling for the students.”

Residents Find their Voice as Educators

medical student Emily OlsonFacilitating the teaching skills of internal medicine residents was the focus of a new Resident as Educator curriculum that was launched in 2015 by Dr. Johnson and former chief resident Jessica Tischendorf, MD, who is currently an honorary/associate fellow in Infectious Disease and VA Women’s Health fellow. 

Over the span of up to three years, residents choosing this opportunity engage in graduated teaching responsibilities and hone their instructional skills through principles of situated learning, task deconstruction, and peer mentorship. The program has become so popular that it has expanded from 8 trainees in 2015 to 23 internal medicine residents in 2017-18, with parallel programs initiated in the pediatric residency program and the family medicine residency program. Key steps in the development of the Resident as Educator program have been funded by pilot grants from the Department of Medicine Education Committee. Recently, to facilitate further expansion, Drs. Johnson and Tischendorf began developing a blended learning approach, which includes web content with online “train the trainer” modules that will augment face-to-face instruction.

The scale-up of the resident-as-educator program parallels the shift in the Intern Preparation Course from an elective for medical students to a requirement. In year one of the resident-as-educator journey, residents prepare and deliver a session in the intern course. "This allows them to develop and practice a structure for giving, receiving and utilizing feedback on teaching skills," said Dr. Tischendorf. Year two focuses on understanding the role of evaluation tools in teaching as well as management of large classes, and year three is dedicated to advanced knowledge about educational topics and serving as a peer mentor to a junior educator. 

Residents report high satisfaction with their teaching experiences. "Some of the comments reported by those we surveyed included taking joy in knowing that they had made a difference and helped a student progress along in their education, as well as the connection when students' eyes light up and you can tell they are genuinely interested," said Dr. Tischendorf. 

Active Approaches to Student Learning

intern preparation course - clinical simulationFor medical students, moving one’s own journey to clinical competency requires jumping in with both feet – something the intern preparation course is designed to do. Dr. Johnson explained, “We use active learning methods, which focus on integration of many new intern skills: how do you talk to nursing professionals, patients, decide on diagnoses, order tests, and examine the patient. What do you do first, and how do you prioritize, particularly in a stressful situation?” 

Helping to hone these skills takes a village of medical educators and administrators. “We have many, many resident and faculty volunteers in the Department of Medicine who help teach these situations in acute medical simulation cases, mock paging sessions, and the like,” said Dr. Johnson. Coordinating all individuals involved involves careful planning by instructional administrative professionals Tara Loushine and Abigail Douglas.   

Toward the Future: New Approaches to Medical Education

Dr. Sara JohnsonThe dual focus on developing the teaching skills of early-career physicians at the same time as fostering the clinical skills of fourth-year medical students has been an engaging journey for many involved. 

“Two of our internal medicine chief residents this year — Scott Saunders and Peter Kleinschmidt — were in our very first cohort of the Resident of Educators, as was Jess Tischendorf. Current internal medicine resident Dr. Ann Chodara (another Resident as Educator member) was in the very first intern prep course that we offered in SMPH. Resident Dr. Elizabeth Mathieu was in the second intern prep course and also went on to join the Resident as Educator team. It really has created a circle of education,” said Dr. Johnson.

It’s also an effort that is turning heads nationally. In 2017, a poster that Dr. Tischendorf, Dr. Johnson, and former Resident as Educator Melissa MacDonald, MD (who is now a Pulmonary and Critical Care Medicine fellow) presented about the intern preparation course to the Alliance for Academic Internal Medicine was selected for a National Clerkship Directors in Internal Medicine (CDIM) Award for Innovations in Medical Education—the only award of its type bestowed at the conference. 

Together with Amy Zelenski, PhD, assistant professor (CHS), General Internal Medicine, the team also co-presented a workshop at the Association of Program Directors of Internal Medicine conference about how embedding a resident-as-educator curriculum created synergy between graduate and undergraduate medical education programs. 

“This has been such a positive journey for everyone involved. We’re so grateful for the energy that members of the department and school have devoted to this effort,” said Dr. Johnson.