Residents as Teachers in postgraduate medical education: a structured review of global evidence and emerging gaps

Residents serve as frontline educators in contemporary healthcare systems, yet formal preparation for this role remains uncommon globally. The persistent gap between teaching responsibility and structured institutional support represents a significant concern for educational quality, resident professional development, and patient safety.

To synthesize the current evidence on residents' involvement in teaching, their perceptions of the educator role, factors influencing teaching effectiveness, and the outcomes of formal Residents as Teachers (RaT) programs.

A structured narrative review was conducted using PubMed, Embase, and ERIC from 2010 to 2025, guided by a PCO (Population, Concept, Outcome) framework. Studies involving medical or surgical residents in postgraduate years 1-6 examining teaching roles, perceptions, or RaT program outcomes were included. Systematic reviews and studies focused on faculty or undergraduate populations were excluded. The screening and reporting process was informed by PRISMA principles; narrative synthesis with thematic organization was applied.

Thirty-two studies met inclusion criteria, yielding four interconnected themes: (1) residents universally recognize teaching as central to their professional identity yet carry substantial informal teaching loads without formal preparation; (2) institutional culture, prior experience, and motivational profiles significantly shape teaching effectiveness; (3) residents across specialties and regions consistently request structured training with explicit objectives; and (4) longitudinal, integrated programs produce more durable skill gains than brief stand-alone workshops.

Despite substantial informal teaching activity, residents remain underprepared for their educator role. Structured, longitudinal RaT programs are needed, particularly in under-researched healthcare systems, where unique cultural, institutional, and workforce characteristics call for locally developed approaches.