reSident aS teacher: tiPS to imProve teaching during new Patient admiSSionS

Sir William Osler, one of modern medicine’s greatest teachers, said “To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all” [1]. Indeed, medical students arriving on the wards for the first time are acutely aware that they are embarking on a new voyage, and their excitement is palpable. As they set sail, with knowledge from lectures and textbooks to help them navigate, students need feedback on their performance during real-world clinical encounters so that they can develop and fine-tune their clinical skills. There is no better place to teach these skills than on the wards during new patient admissions. Even the best standardized patient or objective structured clinical examination cannot replicate the excitement and anxiety of trying to solve an actual clinical case involving a real patient. The greatest learning on any case occurs within those critical first few hours when a student gathers the data and grapples to create a coherent narrative of the patient’s presentation. Residents serve on the front lines of these clinical encounters and usually are involved when students admit patients. In fact, medical students view residents as their most important teachers during clerkship rotations [2]. However, residents who feel poorly prepared to teach may avoid or not recognize teaching opportunities during patient admissions. Common barriers to teaching include lack of time, fear of not knowing the answer to a student’s question, and lack of formal training in strategies for effective teaching. Residents can benefit from the process of teaching. Since teaching requires an understanding of clinical skills and disease processes, residents who teach are more likely to learn and retain information needed to be an effective clinician and, thus, may be more likely to become better clinicians themselves [3]. In addition, residents can apply the same teaching techniques to become better patient educators and therefore potentially improve health care outcomes for their patients [4]. However, the best gift that a resident teacher receives is the joy of seeing a student comprehend a new concept or master a skill. This article highlights some of the key challenges residents face in teaching during new patient admissions and offers practical strategies for overcoming these barriers so that students may maximize their learning in these encounters. To begin, consider the following scenario: