Turning interns into senior residents: preparing residents for their teaching and leadership roles

To assist new senior residents with their transition from internship to ward-team leadership, a practical teaching course has been implemented at the University of Washington that integrates the residents' roles as teachers and team supervisors. Residents develop leadership and problem-solving skills by discussing sample cases and videotaped vignettes of typical situations they will encounter. Teaching skills are practiced through small-group role-plays, which illustrate brief teaching opportunities in patient care. Residents learn managerial techniques, including how to clarify goals and expectations with team members, to conduct work rounds efficiently, to provide ongoing feedback as well as formal evaluation, and to develop criteria for grading. Emphasis is also given to residents' communication with attending physicians and ways residents can increase the attending physicians' effectiveness on the teams. Residents learn to teach and direct medical students, to refine case presentations, and to include students as valued team members. Because residency stresses can lead to coping problems, residents are taught to recognize burn-out, depression, and signs of substance abuse. Residents have been overwhelmingly positive in their evaluations of and responses to the teaching course. By working to develop problem-solving and teaching skills prior to undertaking their new responsibilities, residents are better prepared to be ward-team leaders. Factors in developing such a teaching course for residents are reviewed.