Developing curriculum for the resident teacher program

Literature review

Literature review is the most critical portion of a thesis as it revolves about and builds upon the work that has been antecedently done in the topic being researched. There are several articles available on the subject of REP nevertheless non all of them concentrate on developing a course of study for the occupant as instructor plan. A systematic reappraisal of literature was conducted utilizing PubMed and Google Scholar. Keywords used for the hunt were: occupant as instructor, learning accomplishments, course of study. A list of 223 articles published from 1950 to 2009 was retrieved which was cross checked with the published updated selected bibliography on the occupant as instructors subject. Extensive reappraisal of the full texts of the articles available and the abstracts resulted in choice of 29 articles which chiefly focused on enterprises for bettering the occupants learning accomplishments.

`` Residents in all subjects serve as instructors and function theoretical accounts for pupils, co-workers, and other staff '' . ( Residents-as-Teachers Programs in Psychiatry: A Systematic Review ) . Residents work closely with medical pupils in peculiar and have considerable chances to learn and act upon pupils ' cognition, attitudes, and behaviours. Since the early 1970s, the literature on the occupants ' learning function has emphasized the demand to develop occupants as instructors every bit good as to measure the content and results of instructional plans. Overall, the literature shows that occupants wish to educate ; they want to be qualified as 'teachers and leaders ' . Most of the research available has been conducted in USA, UK and other developed states, where the government organisations are back uping this function of `` occupants as instructors '' .

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`` Residency '' is a medical preparation phase of graduation. AA '' occupant doctor '' A orA merely resident ; A is person who has already completed the needed grade in medical specialty. They are besides referred to asA registrarsA in the U.K and other `` Commonwealth '' states. They besides pattern medical specialty under the disposal of the to the full licensedA doctors, by and large in infirmaries and clinics. A residence frequently comes after the internshipA twelvemonth or at some points includes the internship twelvemonth as the 'first twelvemonth ' of the plan. It can besides come after the phase ofA family. Here the general practician is trained or qualifies in a sub-specialty.

`` Surveies estimate that occupants spend up to 20 % of their clip on learning activities-regardless of their future calling programs '' ( `` Resident-as-Teacher '' Course of study: Do Teaching Courses Make a Difference? ) as suggested by Maria A. Wamsley, MD, Katherine A. Julian, MD, Joyce E. Wipf, MD in their article. Harmonizing to the writers all occupants know and understand their duty and function every bit far as learning the medical pupils is concerned. Apart from the pupils they besides teach housemans and other fellow occupants. As these research consequences were based on studies ; they have besides demonstrated how occupants non merely bask learning but see it an of import portion of their ain survey. Second, they indicate how much the occupants prefer learning on call patients instead than go toing talks etc. Another study that had been conducted for the research above highlighted how the medical pupils anticipated that 1/3 of their cognition was attributed to the instruction in the house.

A study was conducted in 2001 that showed that '55 % of residence managers ' idea that the plans offered to occupants were official instructions sing learning accomplishments. It is noticeable how `` resident as-teacher '' course of study is going more widespread in the different residence plans, still the managers of these surveyed plans communicate that there is a demand for `` more resident direction in learning '' . Another point is that apart from holding published surveies available that describe the classs, many of these, need to be evaluated for their effectivity.

Another cogent evidence is that these classs no uncertainty develop pupils ' rating of participants. There are 3 nonrandomized restricted surveies that calculate the evaluations for the pupils and they showed through statistics a noticeable betterment in resident ratings. `` However, when impact is assessed by consequence size, the per centum alteration in ratings after the intercession is little ( 2 % to 11 % ) , in portion due to the concentration of rating tonss in the upper half of the graduated table. Yet in the largest controlled survey, these differences resulted in occupants being perceived as `` first-class '' instead than `` really good '' instructors. ( Maria A. Wamsley ; et Al )

We can further understand the importance of REP with the statement that these occupants are non merely specializer in their chosen Fieldss but they are besides learners or scholars i.e. `` larning on the occupation '' . ( Basuri ; et Al ) Majority of their acquisition takes topographic point while they are executing their clinical responsibilities and pattern. The latter can be farther illustrated by the undermentioned illustration. The infusion was taken from the article related to Mount Sinai Hospital and the Resident Education Program. The Institute for Medical Education at the Mount Sinai School had developed a `` Resident Teaching Development Program ( RTDP ) '' in the twelvemonth 2001. It was a 7 hr multidisciplinary plan that had been initiated in this country of module development. The intent was to concentrate on the significance of the occupants as `` medical pedagogues '' in IME. The chief aim of this plan was to construct learning accomplishments in the occupants who wished to learn the pupils at the school of Medicine at Mount Sinai. It would in bend prove beneficial for the betterment of the `` quality of clinical instruction at the Mount Sinai Hospital and its affiliates '' . The development portion of the plan had the squad reexamining all go outing work that had been done in the country. What were the other establishments making and how they were making it, and so on? They besides consulted pedagogues and conducted `` needs appraisal '' studies. After all the work they structured the class in a manner that it non merely included `` active acquisition and chances for pattern, integrating of the occupants ' ain experiences, feedback on their usage of learning behaviours, and job resolution activities '' . Another of import portion of all this is that the autonomous acquisition encourages the occupants `` to self-assess and make individualised instruction ends for themselves '' . The above clearly explains how of import the REP is non merely for any infirmary or medical school but for the practicing occupants every bit good as the housemans and pupils who are go toing these classs.

A research done on the competence based construction ( B. Kanna ; et Al ) suggested in its decision that `` Internal medical specialty occupants mentality in research can be significantly improved utilizing a research course of study offered through a structured and dedicated research rotary motion '' . It is further demonstrated by the advancement that can be seen in the satisfaction of the occupants, the rate of engagement in assorted academic activities and result of the research for occupants since the beginning of the `` research rotary motion '' in different countries of the plans and preparations

It is an established fact that occupants as pedagogues plan was a alone thought that has been at work since 1960 's. It has resulted in a positive bend out of the occupants and the pupils who are both profiting from such acquisition and skill based plans. All the research that has been conducted resulted in the same thought that more and more chances should be given to these occupants and their accomplishments and capablenesss should be improved so that larning can increase. One interesting fact was frequently highlighted by different research workers in their studies. It was whether learning improves the accomplishments of the practicing occupants or non? A hypothesis for a research highlights the undermentioned by saying that whether a `` skilled instructor has an increased likeliness of going a competent instructor '' or is the instance face-to-face. Their probe and studies lead them to happen that their consequence supported the hypothesis. `` learning improved the sensed professional competence of medical doctor. `` ( Basuri et al ) . However it was mostly subjective with small quantitative grounds, still they did non happen any survey that disproved this point. In the first chapter we had established in the issues sing the function of the occupants that emphasis needs to be given on how to construction a more efficient REP plan that will heighten non merely the accomplishments of these occupants but in bend improve the quality of larning that takes topographic point.

Another survey found in Medical Teacher ( Vol. 24, No. 1, 2002 ; Busari et Al ) indicated that the occupants non merely idea of learning the medical pupils as their chief duty but that they besides learnt in the procedure. However, it is noticeable that learning is limited due to clip restrictions that may be needed for the readying and conductivity of the class coupled with better instruction accomplishments. In this survey the positions of Stewart & A ; Feltovich ( 1988 ) were besides confirmed who stated that `` occupants are in a alone place to learn and measure pupils because of their propinquity to the pupils '' . Many of the positions by the occupants supported this impression and included the undermentioned points:

• They felt that the occupants were voluntarily available and had more contact clip with pupils
• They were in a better place every bit far as the rating of the pupils was concerned.
• They were easy to near as they were ever in the infirmary and on responsibility
• From the pupils point of position the occupants were better at explicating things.

Even though there was a common understanding that instruction was the one of the chief functions that occupants had, there was a significant deficiency of the instruction clip and the know-how which caused hinderances in their function. This lowered their place to person merely as an attending staff member. Many a times it was noted by the occupants that while learning the pupils their ain accomplishments were tested and they has clip to critically reflect on their ain cognition. One should see it to be an of import motivational point which leads these occupants to constantly update themselves and therefore the procedure of acquisition goes on.

Decision

From the treatment and positions presented above the decision is obvious. Before get downing the chapter it was established that work in this country was required for Pakistan as this construct is new to this portion of the universe. Although establishments like AKU and ISRA are sREPping up their work in the field of REP much more has to be done. Developing a course of study for this country is so a challenge as to understand the significance of the attempts is required. From the above and many other treatments already published it is observed that occupants were non given the really accredited for the work that they have done or the occupation they perform. They have non been provided adequate clip to better their accomplishments and these consequences in certain oversights in the instruction of assorted plans. We can see this from the survey conducted in another article which stated that there was cogent evidence that `` instruction classs improve resident self-assessed instruction behaviours, assurance as a instructor, and consequence in higher scholar ratings of occupants. '' ( Wamsley et al. ) it can be stated `` that based on the seen 'positive effects ' , one might reason that all residence plans should necessitate occupant learning direction. '' There are many obstructions nevertheless, sing the execution of the class. Teaching different plans prove to be 'time intensive ' for both the occupants and module. It is besides a challenge to supply the occupants with uninterrupted larning clip. Majority of the clip there is no support for making and learning these classs. `` Competing curricular demands for preparation may ensue in fewer time-intensive course of study. '' Furthermore we can set up that these limitations might be a contributional factor towards the fact that about `` half of all residence plans do non supply formal direction in learning. ''

We have at the beginning of this chapter highlighted the importance for REP with respects to Pakistan and besides have identified countries where work needs to be done. Pakistani universities particularly those covering with medical specialty and infirmaries like Aga Khan need to set in more attempt in bettering the position of occupants as instructors. Intelligibly we have sREPped into this sphere and no uncertainty worked increasingly but every bit compared to what other states have done we are still far behind. Thus we will reason our reappraisal here and further this research thesis to chapter 3 which will concentrate on the demand appraisal for the occupant as pedagogue plan and the development of the course of study for the said.

Medical pupils often consider occupants to be their most of import instructors and look frontward to a teaching function during residence ( Barrow, 1966 ) . Another survey, conducted more than twenty five old ages subsequently, confirms these findings ( Bing-You & A ; Sproul, 1992 ) . Brown ( 1970 ) , in a survey of housestaff attitude towards instruction, found that occupants provide the bulk of clinical direction. Harmonizing to his findings, no 1 is more available to pupils and junior housestaff through all facets of medical attention, even through the dark. He argues that without occupants, clinical module would necessitate to be available 24 hours a twenty-four hours. He found that all occupants consider themselves to be instructors, and pass 20A­25 % of their clip supervision, measuring, or learning others. Residents besides attribute 40-50 % of their ain instruction to other housestaff. These findings are in maintaining with more recent surveies. Undergraduate surgery pupils credited housestaff for supplying about one tierce of the cognition acquired during their rotary motion ( Lowry, 1976 ) . In another survey ( Bing- You & amp ; Harvey, 1991 ) , pupils estimated that one tierce of their cognition could be attributed to housestaff instruction.

Steward and Feltovich ( 1988 ) argue that `` for learning medical pupils, no 1 is more available or better qualified than a occupant ''. Residents occupy an intermediate place between module and pupils in footings of cognition, authorization, experience, and are less intimidating to pupils. Their propinquity, in footings of degree of preparation, enables them to better understand the practical demands and jobs of pupils. Tremonti and Biddle ( 1982 ) emphasis that occupants ' functions as instructors are complimentary, and non redundant, with that of module. Residents concentrate on day-to-day patient attention issues on a big figure of patients and pass more clip on the ward and at the bedside. Faculty, on the other manus, emphasis in depth treatment, psychosocial issues, and job work outing accomplishments on a little figure of patients.

The fact that occupants spend more clip with pupils and are `` closer '' to their degree does non needfully do them effectual instructors. Irby ( 1978 ) found that although pupils rated occupants as being more involved in their clinical instruction, occupants were thought to be less effectual than module. Merely 10 % of pupils in another survey ( Brown, 1971 ) `` felt that housestaff instruction was peculiarly effectual when it was done at all '' ( p. 93 ) . Wilkerson, Lesky, and Medio, ( 1986 ) studied the learning accomplishments of occupants during work unit of ammunitions. `` The consequences aˆ¦indicated that during work rounds the occupants exhibited few of the instruction behaviours that can heighten acquisition in a patient attention puting... , that pupils and housemans were frequently inactive members of the work squad, with the bulk of clinical determinations being made by occupants Clinical logical thinking, job resolution and supervised determination doing were non recognized as acquisition ends that might be pursued while charts were being reviewed and patients were being visited... .The occupant appeared to gestate instruction as a schoolroom activity and compare it to talking '' ( p. 827 ) . Lewis and Kappelman ( 1984 ) noted that occupants most often use an autocratic talk manner in learning. Ironically, this was occupants ' least favorite attack as scholars. Medio, Wilkerson, Lesky, and Borkan ( 1988 ) observed occupants during work unit of ammunitions.

Residents did non frequently deliberately use day-to-day patient brushs for learning. When they did mean to learn during work unit of ammunitions, they normally provided brief talks. Not merely did the survey show the limited repertory of learning accomplishments used by most occupants, but it besides delineated the many instruction chances that were being overlooked. For most occupants, learning had become synonymous with prepared talks and was, hence, incompatible with the unpredictable demands of patient attention ( p. 215 ) .

Meleca and Pearsol ( 1988 ) impulse that occupants be made cognizant of and take advantage of their duties and `` docile minutes '' ( i.e. , learning chances ) . One survey ( Bergen, Stratos, Berman, & A ; Skeff, 1993 ) compared the clinical instruction abilities of occupants and go toing doctors in the inmate and talk scenes. Overall, occupants and attentions received similar evaluations. Where there was a difference, module were rated higher than occupants. Of note, evaluations for both groups were by and large low in each class proposing the demand for engagement in REPs by both groups.

Residents by and large have a positive `` attitude '' towards their function as instructors. The huge bulk of occupants enjoy learning ( 89 % of 68 respondents ) ( Apter, et al. , 1988 ) . In this survey, enjoyment of instruction was positively associated with increased readying clip and perceptual experience of positive consequences of learning. Bing-You and Harvey ( 1991 ) are the first to turn to whether an association between a positive attitude towards learning and perceptual experiences towards learning are associated with

better pupil ratings of learning. Twenty one ( of 24 ) occupants completed a questionnaire in order to study their attitude towards learning. They were later evaluated by 3rd twelvemonth medical pupils over a one twelvemonth period. Residents ' desire to learn was most strongly correlated ( 0.77 ) with active engagement of pupils and was the lone `` attitude '' correlating with overall learning effectivity ( 0.54 ) . Unfortunately, no correlativity was found between pupil evaluations of occupants as instructors and occupants ' self- appraisal of learning effectivity. Of note, occupants holding participated in a REP were more confident as instructors, were rated more extremely in actively affecting pupils and in supplying way and feedback, and were besides more confident as instructors.

Although occupants have major learning duties, grounds exists that they may non have adequate support or readying for this function and that barriers hinder optimum instruction. A US national study of general surgical residence plan managers ( Anderson, Anderson, & A ; Scholten, 1990 ) posed three inquiries:

•  To what extent do surgical occupants Teach and measure medical pupils?
• How are surgical occupants prepared for and evaluated on their instruction duties?
• What are the surgical plan managers sentiments approximately occupants as instructors?

Virtually all ( 98 % ) surgical occupants had learning duties. However, merely 36 % of plans provided occupants with written ratings of their instruction, and 60 % of plan managers did non believe it was of import for occupants to have formal preparation in learning accomplishments. Merely 14 % of occupants in this survey had attended workshops on learning. Two other surveies ( Callen & A ; Roberts, 1980, Brown, 1971 ) study similar findings. Thirteen per centum of 136 psychopathology occupants, and 15 % of 28 surgery occupants had anterior teacher preparation. A more favorable proportion ( i.e. , 38 % of 21 occupants ) is cited in one survey ( Bing-You & A ; Harvey, 1991 ) . This likely reflects the writer 's outstanding function in advancing and developing resident instruction accomplishments at his establishment. Schiffman ( 1986 ) asks: `` How so do house officers learn how to learn? The obvious reply is that the house officer has had twenty old ages of observation of his or her ain instructors upon which to pattern his or her manner '' ( p. 55 ) . This remains unequal.

If most occupants do non hold prior teacher instruction, do they at least receive utile feedback on the instruction that they do? In 1978, the American Association of Medical Colleges ( AAMC ) surveyed sections of internal medical specialty, paediatricss, psychopathology, surgery, and household medical specialty ( Tonesk, 1979 ) . Merely 87 of 319 ( 27 % ) plans included learning

public presentation as portion of occupants ' ratings, and those that did normally merely required a planetary appraisal of learning ability. The information on supervising of instruction is every bit black. Apter, Metzger, and Glassroth ( 1988 ) study that merely 13 % ( of 68 ) occupants felt that module supervising of their instruction was optimum, and 58 % indicated that they had ne'er been supervised. In one survey ( Callen & A ; Roberts, 1980 ) , 78 % ( of 136 ) psychopathology occupants thought that `` the chief ground occupants are required to learn medical pupils is to liberate up clip, clip for module to make research and other things. '' On norm, these occupants estimated that they spent 9 hours per hebdomad in learning activities. Despite this big learning committedness, merely 32 % of occupants thought that they should be required to go to REPs. When the inquiry of go toing a resident REP is posed otherwise, 53 % ( Apter, et al. , 1988 ) to 66 % ( Brown, 1970 ) of occupants stated they would be interested in go toing a workshop if it were offered.

In add-on to less than satisfactory support for their instruction function, occupants face other hindrances. Time and conflicting demands seem to be most of import. Eighty seven per centum of occupants cited either their ain or their pupils ' time- devouring ward responsibilities as the greatest obstruction to learning ( Apter, et al. , 1988 ) . Post call exhaustion was besides an of import factor ( 49 % ) doing learning hard.

Kates and Lesser ( 1985 ) place what they consider to be major jobs faced by occupants when learning. They quote the AAMC study cited above ( Tonesk, 1979) and admonish station alumnus plans for the deficiency of accent placed on occupants ' learning function. Beyond this, occupants ' may be ill-defined about what their existent function is in footings of oversing - learning junior housestaff, and every bit mentioned, they are normally unprepared for their instruction map. Residents are normally unfamiliar with the larning aims of the juniors they supervise and teach. Despite this, they are normally called upon to assist measure them. The occupants ' ain supervisors frequently provide unequal supervising and support for occupants. This, in itself, may understate the importance of learning for the occupant. Finally, few plans make any specific attempts to organize instruction chances for occupants with a particular involvement in instruction.

Admiting the many jobs faced by occupants when instruction, and their less than optimum readying for their instruction function, non much is known sing the demands of occupants in footings of planing a REP. Boule and Chamberland ( in imperativeness ) addressed this issue from a occupants ' position by

inquiring them `` What sort of preparation do you necessitate to learn more efficaciously? '' Eighty occupants responded. Two tierces of their replies corresponded with demands normally addressed by REPs, while one third were concerned with medical competence and clip direction. Nine cardinal words were most often cited in their responses ( in order of precedence ) :

1. division of work / instruction clip,
2. instruction methods,
3. medical cognition,
4. aims,
5. synthesis accomplishments,
6. feedback,
7. motive,
8. psychological science applied to instruction,
9. pupil jobs.

More research needs to be done in the country of the instructor instruction demands of occupants. Other positions and other beginnings of information should congratulate that of occupants.

Empirical Research on Resident REPs

An extended reappraisal of the medical instruction literature was undertaken to place bing surveies of resident REPs. Twenty-six mentions were identified between 1963 and 1991. Of the 26 studies, one survey was described in three different publications ( Greenberg, et al. , 1984 ; Greenberg, Jewett, & A ; Goldberg, 1988 ; Jewett, et al. , 1982 ) , and two surveies were reported twice ( Camp & A ; Hoban, 1988 ; Camp, Hoban, & A ; Katz, 1985 ) and ( Lazerson, 1972 ; Lazerson, 1973 ) . Furthermore,chapter nine ( Edwards, Kissling, Paluche, & A ; Marier, 1988b ) of Edwards and Marier 's ( 1988 ) book, Clinical Teaching for Medical Residents: Roles Techniques, and Programs, outlines a resident REP used for two surveies ( `` Phase I '' and `` Phase II ) that were reported elsewhere ( Edwards, Kissling, Brannan, Plauche, & A ; Marier, 1988a ; Edwards, Kissling, Plauche, & A ; Marier, 1988 ) . This plan was besides used for a 3rd survey ( Edwards, Kissling, Plauche, & A ; Marier, 1986 ) . Therefore, a sum of 21 different surveies and 19 different resident REPs were identified. Of the 19 resident REPs, two really depict undergraduate medical school electives: one offered as a 3rd twelvemonth elective ( Craig & A ; Page, 1987 ) , the other as a 4th twelvemonth elective ( Sobral, 1989 ) . Another plan ( Lazerson, 1972 ; Lazerson, 1973 ) can be more accurately described as a learning experience under supervising instead than a resident REP. This survey describes the experience of psychopathology occupants given the chance to learn undergraduate psychological science at a community college. Although these occupants received feedback on their instruction accomplishments, no formal instructor preparation was undertaken. Consequently, merely 18 surveies described 16 plans in which occupants underwent a course of study with a specific end of developing learning accomplishments.

The first occupant REP reported ( Husted & A ; Hawkins, 1963 ) dates back to 1963. This instance survey was initiated as a pilot undertaking. The research workers asked section presidents to ask for two occupants each to take part in the plan. Give the voluntary nature of the class, occupants could worsen the invitation. A sum of seven occupants participated in the six `` lecture-discussion '' Sessionss. No effort was made to measure outcome steps. Even the plan itself was non assessed with any asperity. The writers conclude that `` participants were certain plenty that the pilot venture was of sufficient benefit to them to take to the suggestion that the orientation be repeated and the invitations expanded... '' ( p. 115 ) . The learning function of occupants has become progressively more

prominent over the old ages, with 17 of the 26 mentions being published since 1985, and the recent publication of books on the topic. A sum-up of the medical instruction literature on this topic will be the focal point of the balance of chapter two.

Engagement

Engagement in the REP was `` voluntary '' in 9 surveies, `` mandatary '' in 6, and non stated in the staying 7. Assorted statements can be made for and against both schemes, but no decisions can be drawn from these surveies. Leting occupants to `` opt-out '' of REPs, nevertheless, may ensue in pretermiting those occupants who need it most.

Forte

General internal medical specialty is the most represented of all fortes among the surveies reviewed. Internal medical specialty occupants were involved in 11 of the 22 plans. Those surveies ( e.g. , Edwards, et al. , 1988 ) looking for differentiations between fortes by and large found no important differences.

No consensus exists as to when is the best clip to present a occupant REP. A speedy glimpse at the mark audience ( i.e. , station alumnus twelvemonth of preparation ) of the assorted REPs outlined makes this clear. Five plans were geared to PGY 1 occupants and four plans were geared to all degrees of residence. Two

plans were undergraduate medical school electives. Other degrees were the mark in five plans and no information was available for the staying six. Merely one survey ( Bing-You, 1990 ) addressed plan results in relation to degree of preparation. Further surveies are needed to specify the best clip to implement REPs. `` Readiness '' to larn, degree of professional competency, viing demands / handiness, and cost effectivity ( e.g. , concluding twelvemonth occupants merely have a short instruction calling staying ) are merely a few of the factors to be considered.

Goals and aims

Goals and Aims varied well between plans. Although none of the plans officially stated the theoretical underpinnings from which the ends and aims emanated, the linguistic communication used to depict them is uncovering. The desire to

`` transportation '' information is outstanding. Programs instead wanted to `` introduce occupants with '' ( Husted & A ; Hawkins, 1963 ) , `` supply information '' ( Brown, 1971 ) , `` introduce constructs '' ( Lewis & A ; Kappleman, 1984 ) , or have occupants `` gain cognition / become familiar with".

Methodology

It is beyond the range of this thesis to discourse the methodologic defects of the surveies reviewed. The patient- centred gait of infirmary pattern and postgraduate medical developing do it hard to run educational experiments in this context. The writers of the reviewed surveies should be commended for their attempts and advanced efforts to present and reply inquiries. Of the 22 database entries, 19 are instance surveies. Two of these make an effort at an experimental design: `` quasi-experimental '' ( Snell, 1989 ) , and `` case-control, pre- and post- observation '' ( Medio, et al. , 1988 ) . Both of these surveies used occupants who did non go to the REP as a comparing ( i.e. , control ) group.

The mere fact that they did non take to go to makes them different ; any differences found between the two groups may merely as probably be attributed to the features of the persons in the several groups as to the intercession ( i.e. , REP ) . Decision from these surveies should be interpreted with cautiousness. One of the database references is a simple plan description with survey consequences reported elsewhere. The staying two surveies ( one of which is reported three times ) ( Edwards, et al. , 1988a ; Greenberg, et al. , 1984 ; Greenberg, et al. , 1988 ; Jewett, et al. , 1982 ) have a randomised instance control design. Both have a comparatively little entire figure of survey topics, 22 and 53 severally.

Format

Overall, an effort was made to utilize instructional methods that actively involve occupants. For the most portion, nevertheless, this merely meant holding occupants take portion in group treatments ( cf. , reliable activities e.g. , Collins, et al. , 1991 ) . Lave and Wenger ( 1991 ) , in their treatment of discourse and pattern, stress the of import differences `` between speaking about a pattern from outside and speaking within it '' ( p. 107 ) . They argue `` that for fledglings so the intent is non to larn from talk as a replacement for legitimate peripheral engagement ; it is to larn to speak as a key to legalize peripheral engagement '' ( original accent ) ( p. 109 ) . As discussed in an earlier subdivision of this chapter, Lave and Wenger ( 1991 ) distinguish between a acquisition course of study dwelling of located chances and a instruction course of study constructed for direction. From their position, so, larning becomes a inquiry of entree to legalize pattern as a larning resource instead than supplying direction. Most of the plans described, it seems, hold small foundation in a societal / situated position of grownup instruction. A few surveies, nevertheless, did effort to stress the of import function of experience as portion of the REP: microteaching, with and without video playback ( Lawson & A ; Harvill, 1980 ; Medio, et al. , 1988 ; Pristach, et al. , 1991 ; Snell, 1989 ) , and function playing ( Edwards, et al. , 1988b ; Sobral, 1989 ) .

Timeline

In Jarvis ' ( 1992 ) treatment of larning in the workplace, he reminds us `` that there are two basic signifiers of experience: primary and secondary experience. The former involves the existent experience people have in a given state of affairs ; this type of experience molds their self-identity to a great extent. The latter involves experiences in which interaction or instruction occurs over and above the primary experience '' ( p. 108-181 ) . Although microteaching and function playing may be ( or come near to being ) reliable activities, they would still be classified as secondary experiences from Jarvis ' point of position. It must be remembered that whether or non residency plans decide to develop and implement REPs, occupants will still hold major learning duties ( and chances ) . Most plans did non take specific advantage of occupants ' current learning assignments as a acquisition resource. One plan ( Snell, 1989 ) did reference that occupants had `` an chance to pattern the ( freshly learned learning ) accomplishments on

the wards during the hebdomads between Sessionss '' ( italics mine ) ( p. 125 ) . Another plan, dwelling of two three-hour workshops, separated both workshops by 5 months so that `` the experimental group had an chance to use these ( learning ) accomplishments in their day-to-day activities ''. Unfortunately, without construction and followup, pupils ( including occupants ) do non ever take advantage of chances. None of the plans specifically structured and included such learning activities.

The first determination when make up one's minding on a timeline for a plan is make up one's minding whether to offer a `` one-shot '' or a longitudinal experience. A 2nd determination besides involves timing: should occupants take portion in a REP merely while they have learning duties? A plan based on a longitudinal experience while occupants have learning duties can take advantage of Jarvis ' alleged primary experiences. The plan developed as portion of this thesis was specifically designed with these thoughts in head and included a `` Undertaking for the Week '' between Sessionss ( see chapter three ) . A learning `` undertaking '' was assigned at the terminal of the each seminar based on that seminar 's content. A lab-coat pocket sized reminder card was handed out to occupants. The undertaking became the focal point of a contemplation ( and reappraisal ) exercising at the beginning of the following hebdomadal session.

Program Evaluation

All plans were rated favorably ; there was a high grade of satisfaction with both direction and content. Residents considered the experience valuable and utile.

Study Results

Impact of resident REPs.

All but one of the surveies designed to look into the impact of resident REP demonstrated a positive consequence. Brown ( 1971 ) used a pre- and post- 50 point multiple pick trial to measure alterations in occupants ' cognition of instruction and acquisition. No important difference was found at the 0.05 degree ( i.e. , average 24.0 vs. 24.7 ) . On the other manus, Edwards, Kissling, Plauche, & A ; Marier ( 1986 ) study that after one twelvemonth, 67 % of occupants could still remember specific points presented, and 61 % reported utilizing thoughts from the class in their instruction. Overall, cognition was non an of import results step in the surveies reviewed.

Improvements in learning behaviors have been the chief focal point of most surveies measuring results. Beginnings of perceptual experiences have included occupants ( i.e. , self ) , pupils, equals ( i.e. , other occupants and module ) , every bit good as professional pedagogues. Improvements in self-concept and self-reported behaviors were demonstrated in four surveies ( Bing-You & A ; Greenberg, 1990 ; Edwards, et al. , 1986 ; Edwards, et al. , 1988 ; Snell, 1989 ) . Student evaluations of occupants who attended a instruction accomplishments workshop were significantly higher ( p & lt ; 0.05 ) on

four of nine dimensions including `` overall instruction effectivity '' ( Edwards, et al. , 1988 ) . In another survey ( Edwards, et al. , 1986 ) an effort was made to analyze the consequence of a resident REP on pupil evaluations of occupant instruction ; unluckily, the information was excessively `` bare '' to be interpreted validly.

Improvements in resident instruction behaviors have besides been studied by observation methods. One survey ( Camp & A ; Hoban, 1988 ; Camp, et al. , 1985 ) used direct informal observation of occupant instruction by pedagogues to measure alteration. Faculty perceivers `` believed that the participants showed that they had put into pattern many of the accomplishments that had been discussed and demonstrated in the class on learning... '' ( p. 212 ) . More formal efforts to detect and step alterations in occupant instruction behavior, utilizing observation instruments, exist. A case-control pre- and post- observation survey ( Medio, et al. , 1988 ) demonstrated an betterment in the `` intervention '' group as compared to `` controls. '' Each occupant ( 6 intervention and 6 controls ) was observed during one work unit of ammunition while reexamining an norm of 10 patients. Unfortunately, the little sample size, and the fact that `` controls '' consisted of occupants non take parting in the plan ( i.e. , non-random ) make reading of the consequences hard. Snell ( 1989 ) , utilizing a similar experimental design with 9 topics and 5 controls

showed that post-intervention tonss increased in all three countries measured ( i.e. , talk, tutorial, and treatment) . Observation surveies utilizing videotaped occupant instruction besides demonstrated a positive impact of REPs on learning behaviors.

Need for reinforcement / long term consequence

How long are betterments in learning accomplishments maintained after a REP? One group of research workers ( Edwards, et al. , 1988a ) noted that betterment in occupants ' accomplishments ( videotaped learning ) had declined when steps were repeated six months subsequently ; evaluations were, nevertheless, still higher than pre- direction. The writers suggest that occupants may necessitate periodic short `` refresher '' classs to reenforce learning accomplishments throughout their residence. Of involvement, another survey ( Edwards, et al. , 1986 ) utilizing the same REP found that station class betterments in self-rated instruction accomplishments `` endured without decay for at least a twelvemonth and a half '' ( p. 970 ) . Furthermore, `` occupants could still remember and explicate major learning points and reported that they had used these learning points 18 months after the class '' ( p. 970 ) . Similarly, Snell ( 1989 ) found that increased evaluations of

learning behaviors ( based on observations ) were maintained for eight months after a REP. Overall, small is known about the rate of `` decay '' of occupants ' learning accomplishments after a REP. An interesting, and unreciprocated, inquiry is whether or non concentrating on `` attitude '' and `` self-efficacy '' ( cf. , specific learning behavior ) has any consequence on the rate of decay.

Although the concept of self-efficacy has non specifically been used as an outcomes step, self-reported `` self- assurance '' has. Interestingly, those surveies measuring alterations in assurance did non seek to show an association with alterations in instruction behavior. Further, the impact of a instruction assignment itself ( i.e. , experience ) on assurance has non been explicitly addressed. All three of these issues are specifically addressed in the survey described in this thesis.

Snell ( 1989 ) measured self-confidence pre- and post-course by self appraisal questionnaire. Significant additions in `` assurance in learning '' were found in the intervention group ( P & lt ; 0.05 ) . Snell goes on to notice that `` eight months after the class, the occupants all thought that they were more

confident in their instruction '' ( p. 126 ) . Unfortunately, the information is non presented nor is the analysis. Besides, no reference of `` control '' group comparing is made.

Bing-You and Greenberg ( 1990 ) assessed occupants ' assurance as instructors and perceptual experiences toward learning utilizing a pre- workshop questionnaire. However, no post-workshop questionnaire was given ; hence, no remark on the impact of the REP on assurance can be made. At the beginning of the plan, 25 % of occupants felt confident or really confident as instructors ( 68 % slightly confident, and 7 % non confident ) . Perceived feedback of their instruction was similar to assurance degrees, with 32 % describing positive or really positive feedback.

Bing-You ( 1990 ) used a pre- and post-workshop questionnaire to measure occupants ' `` attitude towards learning. '' In add-on, trained raters assessed videotapes of occupant instruction at the terminal of the workshop and once more at a mean of 6.3 months subsequently ( 2-11 months ) . However, no illations can be made sing the relationship between learning attitude and instruction behaviors given the two different survey designs for each results step ( i.e., pre-post vs. immediate and delayed station ) . After the workshop, both occupants and housemans rated themselves as more effectual ( p & lt ; 0.05 ) as instructors in the country of cognition ( utilizing mentions ) but merely the housemans felt more effectual in their proficient accomplishments ( P & lt ; 0.01 ) . Without direct entree to the questionnaire points, it is hard to find whether `` usage of mentions '' and `` proficient accomplishments '' represent attitude or self-reported behaviors.

After the class, module, pupils, and equals rated 52 % of experimental occupants as `` effectual '' ( vs. 27 % of controls ; nearing statistical significance ) . No effort was made to show an association of alteration in attitude with a alteration in behavior.

Camp and Hoban ( 1988 ) identified the instruction scenes encountered by occupants:

• Case presentations ;
• Teaching on work unit of ammunitions ;
• Teaching clinical accomplishments class to undergraduate medical pupils ;
• Large group presentations / talks ;
• Small group presentations / seminars.

Although occupants are on occasion called upon to talk and make presentations, most of their instruction occurs in little groups utilizing a dynamic tutorial manner. Apter, Metzger, and Glassroth ( 1988 ) quantified the most frequent instruction scenes among occupants: patients ' bedside ( 45.5 % ) ; one-to-one supervising of junior squad members ( 25.5 % ) ; `` sit-down '' ward rounds ( 23.6 % ) .

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