Objective Assessment of Resident Teaching Competency Through a Longitudinal, Clinically Integrated, Resident-as-Teacher Curriculum.

OBJECTIVE: Competency-based training should be paired with objective assessments. To date, there has been limited objective assessment of resident-as-teacher curricula (RATC). We sought to assess the impact of a longitudinal RATC on postgraduate year-1 (PGY1) resident teaching competency using Observed Structured Teaching Encounters (OSTEs) for the skills of 1) brief didactic teaching [DT], 2) feedback [FB], and 3) precepting [PR]. METHODS: A controlled, prospective, educational study was conducted from May 2015 to June 2016. The RATC consisted of a workshop series with reinforcement of key skills (DT, FB) during clinical rotations. Intervention residents participated in the RATC and completed OSTEs at the beginning and end of the academic year. A control group, PGY1 residents that matriculated the year previously, completed the OSTEs before starting their PGY2 year. OSTEs were reviewed by 2 blinded study personnel. We assessed reliability between raters via intraclass correlation coefficients and differences in OSTE scores via least squared mean differences (LSMD). RESULTS: In total, 92.5% (n = 37) of eligible control and 100% (n = 41) of eligible intervention residents participated. The OSTEs demonstrated excellent agreement between reviewers (DT: 0.99, FB: 0.89, PR: 0.98). A significant pre-post difference was demonstrated in the intervention group for DT (LSMD [95% confidence interval], 3.14 [2.49-3.79], P < .0001), FB (0.93 [0.49-1.37], P < .0001), and PR (0.64 [0.09-1.18], P < .022). A significant difference between the control and intervention groups was demonstrated for DT (3.00 [2.05-3.96], P < .0001). CONCLUSIONS: Skill-based OSTEs can be used to detect changes in residents' teaching competency and may represent a potential component of programmatic evaluation of resident-as-teacher curricula.

Impact of a Neighborhood-Based Curriculum on the Helpfulness of Pediatric Residents' Anticipatory Guidance to Impoverished Families.

Introduction Neighborhood location has been shown to impact childhood health and well-being. It follows that neighborhood context-the risks and assets present within a patient's neighborhood-may be an important consideration during provision of primary care. Pediatric residents often serve as the primary care physicians for high risk populations though are often unfamiliar with local neighborhoods. As such, education interventions that deepen residents' understanding of a patient's neighborhood context may allow for targeted care provision. A neighborhood-based curriculum was therefore created to improve residents' familiarity with local neighborhoods. Methods The neighborhood-based curriculum utilized a shared interactive presentation to address the topics of housing, nutrition, safe play, pharmacies, and transportation. Education modules included introduction to readily available on-line resources. A pre-post survey assessed resident self-perceived competence on the curricular topics of interest. Caregivers were interviewed in the post-curriculum period to rate the helpfulness of resident-administered advice. Results Following the curriculum, residents reported improved competence on the topics of safe play and transportation (p < 0.05). When addressed in the clinical setting, the large majority of families felt that residents' advice on curricular topics was helpful; however, individual curricular topics were not consistently addressed during clinical encounters. Discussion A neighborhood-based education curriculum can be effective in teaching pediatric residents about the social determinants of health and local neighborhood resources. As research increasingly demonstrates the impact of neighborhood on health, we expect further educational focus on neighborhood as a means from which to educate residents who often care for an impoverished population.