Actively Teaching Active Teaching Techniques.

Audience: The target audience for this small group workshop are interns and residents of any specialty.

Introduction: All residents are expected to become proficient teachers in a variety of settings as they progress in training, and many residency programs offer advanced training or credentialing in medical education.1,2 Recently, some emergency medicine programs have also begun to offer a formal medical education fellowship. Traditional resident education has been in the form of didactic lectures such as morning report, noon conference, and Grand Rounds as well as small group bedside teaching by attendings. Due to the COVID-19 pandemic, in many cases these learning structures have been reengineered into a hybrid or virtual model.3 This new educational paradigm has spurred the search for best practice teaching methods across a variety of situations. 4 Active teaching, characterized by audience engagement and self-directed learning, has been shown to promote deeper understanding and improved knowledge retention when compared to standard didactic teaching.5,6Educational curricula for residents now acknowledge the importance of audience participation, with more emphasis on the use of interactive teaching techniques. A review of residents-as-teachers curricula highlighted the importance of disseminating practical resources for how to effectively teach residents to be better educators.7 However, in the literature there are few examples of how to teach residents to implement these best practice interactive teaching methods. We designed a simple, interactive, and easily reproducible workshop for introducing the concepts of active teaching to residents that allows for active engagement with these techniques.

Educational objectives: By the end of this small group exercise, learners will be able to: 1) assess interactive teaching techniques that support learning in various environments; 2) incorporate active teaching techniques into a variety of real-world teaching scenarios; 3) implement selected techniques to enrich one's own teaching practice.

Educational methods: Our workshop was designed to include elements of gamification, which facilitates teamwork and competition and can be used to engage learners in higher levels of learning.8 We began by performing a literature search for descriptions of active teaching techniques that had been used in the medical setting.9-14 We developed a list of 15 popular active teaching strategies and created a one-page menu which briefly described each strategy. Utilizing the flipped classroom model, we identified three articles (references 10, 11, and 14) which reviewed active teaching techniques and sent these articles to our participants via email one week before our session with instructions to read the articles and come prepared to discuss them at our session. We created two sets of playing cards for our activity. The first set of playing cards was titled "teaching setting" and included common venues for teaching in clinical medicine: morning report, grand rounds warm-up (which at our institution consists of a 15-minute lecture given to a large audience in a formal setting), small group, bedside teaching, journal club, and an online/virtual lecture. The second set of playing cards included simulated audiences that could be present at a teaching session: peers (residents), medical students, attendings, or mixed audience. To account for larger groups of residents, we made multiple copies of each card within the respective card set.At the beginning of the workshop, the learning objectives were discussed and the menu with the 15 active teaching techniques was reviewed along with the assigned pre-reading articles. Residents were asked to name different active teaching techniques and give examples they experienced during their residency or medical school education. Participants (pediatric and medicine-pediatric residents) were then placed in groups of three or four, and each group drew one teaching setting card and one audience card. All groups were given the same general topic (diabetic ketoacidosis) and each group was challenged to design a short teaching activity relevant to the topic that incorporated active teaching techniques appropriate for their setting and audience. After a short period of planning, each group reported how they would teach the topic and which active teaching strategies they would use. After each group described their approach, they received peer feedback from the other groups' participants. Key aspects of the proposed active teaching techniques and any barriers to implementation were discussed. The cards were then reshuffled for each group, and the exercise was repeated with a different general topic (in our session, we chose developmental milestones).

Research methods: Participants provided anonymous feedback in the form of surveys which assessed the efficacy of the workshop. Participants were also asked to commit to three active teaching techniques they would incorporate into teaching sessions within the next six months.

Results: Our workshop was presented for two sequential years: 2022 and 2023. Our workshop was attended by 32 residents in year one and 36 residents in year two. All participants filled out the anonymous evaluation survey at the conclusion of the exercise. Eighty-five percent of respondents rated the session as "highly organized," and a majority strongly agreed that the workshop was effective for learning active teaching techniques (78%) and taught them concrete techniques that they could incorporate into their future teaching (88%). Participants reported that they were most likely to utilize Jigsaw (31 respondents), Polling/audience response (29 respondents), case-based learning (25 respondents), role play (24 respondents) and small group activities (20 respondents) into their next teaching session. In our second workshop, there were 19 participants who had also attended the first workshop. All 19 of these residents reported using at least one active teaching technique during the previous year, and over half reported using at least three of the techniques.

Discussion: Participants reported high levels of satisfaction with the organization and efficacy of this workshop. The strategies of using sets of cards to randomize the process, adding time constraints, and having each group report their teaching plans increased overall participant interest and excitement in the workshop. Having all groups design teaching sessions using the same general topic was chosen intentionally to promote friendly competition and to allow for discussion among the groups about similarities and differences in the application of their chosen active teaching techniques. To apply our activity to other specialties, we recommend choosing general topics that are commonly encountered in that specialty; for example, the topic of "myocardial infarction" or "pediatric toxidromes" could be used for emergency medicine residents.

Topics: Active teaching, pediatrics, adult learning theory, graduate medical education, undergraduate medical education.