Can a Residents as Teachers Program Impact a Department's Educational Transformation?.

Faculty development has been a force in medical education since the twentieth century, evolving through workshops and academies that promote the educational growth of faculty, longitudinal programs, and dedicated master degrees (Steinert, 2014). Many faculty members still do not embrace adult learning principles and evidence-based educational frameworks (Lowenthal, 2008; Berk, 2010; Steinert, et al., 2010; Skeff, et al., 2003). The focus on the teacher rather than the learner results in trainees not feeling empowered as they develop their professional identity (Shanafelt, 2009; Pratt, et al. 2006; Spencer & Jordan, 1999).Despite a considerable body of literature on faculty development, no studies have reported a residents as teachers (RATs) intervention as a positive vector impacting on faculty teaching and understanding of learning. The objectives of this commentary are to 1) describe a department's educational transformation that occurred as an unanticipated secondary benefit of a residents as teachers (RATs) program, providing anecdotal commentaries from stakeholders and medical student Graduation Questionnaire (GQ) and end-of-clerkship evaluations (ECE) responses; 2) explain the theoretical construct for why change occurred; and 3) provide personal reflections on why this program worked and can be a model for others. Kotter's change management theory represents the theoretical construct to explain how our initial efforts in creating a sustainable RATS program evolved into a change in a department's culture (Kotter & Rathgerber, 2006).The ProblemHistorically, our Ob-Gyn department has had a negative reputation among GWU medical students, most notably seen on end-of-rotation evaluations and the AAMC graduation questionnaire. The primary reasons were student perceptions that residents were poor teachers, and non-professional behavior of residents in student interactions. These problems, although apparent over time, had persisted over many years, and seemed to be part of the hidden curriculum, i.e., do as I say, not as I do (Hafler, et al., 2011).In response to pressure from the medical school leadership to 'fix' this problem, two of the authors in the Ob-Gyn department determined that change was necessary. To problem-solve the best approach to address this issue, two other authors who had experience in faculty development programming were recruited and the consensus was to focus on the residents, those working most closely with medical students. Based on previous experience, the authors created a tailor-made RATs curriculum that fit the resident's schedules, being mindful of the 80-hour workweek.InterventionOur work has been previously published and is based on Morrison's content in her study (Morrison, et al., 2004; Gaba, et al., 2007). The curriculum that we established and implemented in 3-hour sessions over 2 half-days occurred on designated educational days; i.e., protected time. We focused on areas that were integral to residents' everyday teaching experiences. In concert with the outlining the details of the intervention, the step(s) in Kotter's change management theory that is (are) illustrated.Kotter's long-enduring approach to change management in his eight step model emphasizes establishing a sense of urgency, forming a guiding coalition, creating a clear vision, empowering others to act on the vision, plan and create short-term wins, consolidate improvements, and institutionalize new approaches. Most of the published papers on the application of his model have been from the business literature; there have been a few in health care (Campbell, 2005; Periyakoil, 2009; Steinert, et al., 2007). Kotter's model takes into account emotional and situational components when change is occurring and specifies how emotions such as anxiety, uncertainty and cynicism can be barriers in the change process. The model helps to turn negative feelings into positive ones to enable change to happen. …