|Year : 2013 | Volume
| Issue : 1 | Page : 38-43
Differences in the perception of characteristics of excellence of clinical tutors among residents and consultants at an emergency medicine residency program a qualitative research
Muna Saleem Aljahany, Mohammed Abdullah Al Sultan
Department of Emergency Medicine, King Abdulaziz Medical City, Saudi Arabia
|Date of Web Publication||17-Apr-2013|
Muna Saleem Aljahany
King Abdulaziz Medical City, Riyadh, P. O. Box 22490, Riyadh 11426
Introduction: Defining exactly what characterizes a clinical tutor as excellent and another less effective, is an important task in assessing the effectiveness of clinical training and guiding faculty development.
Aim: We aimed to evaluate those characteristics and measure differences in their perception among accomplished and non-accomplished consultants and residents in the Emergency Department. We also compared perceptions between the different groups of participants.
Methods: The characteristics measured were extracted from an extensive search of previously published studies summarized in a review article. A qualitative study was conducted, using a 20 item questionnaire piloted from the refined characteristics (good indicator of reliability; Cronbach's Alpha = 0.86). The questionnaire was distributed among all consultants and residents in Saudi Board of Emergency Medicine.
Results: No significant difference between consultants' and residents' perception was found. "Sincere" was an exception 87.8% versus 55.1%, P = 0.013. Consultants' specifications did not seem to affect perception on overall scores and its component sub-scores.
Conclusion: Since results showed no relation between accomplished and non-accomplished consultants in perceiving those qualities, we excluded the lack of knowledge of those characteristics as a cause of being accomplished or non-accomplished. We suggest a greater dedication from program developers towards creating more opportunities to involve more consultants in basic Emergency Medicine training.
Keywords: Clinical tutors, characteristics, emergency program, teaching
|How to cite this article:|
Aljahany MS, Al Sultan MA. Differences in the perception of characteristics of excellence of clinical tutors among residents and consultants at an emergency medicine residency program a qualitative research. J Health Spec 2013;1:38-43
|How to cite this URL:|
Aljahany MS, Al Sultan MA. Differences in the perception of characteristics of excellence of clinical tutors among residents and consultants at an emergency medicine residency program a qualitative research. J Health Spec [serial online] 2013 [cited 2020 Aug 6];1:38-43. Available from: http://www.thejhs.org/text.asp?2013/1/1/38/110672
| Introduction|| |
Defining exactly what characterizes a clinical tutor as excellent and another less effective, is an important task in assessing effectiveness of clinical training. This has a great impact on guiding faculty development and subsequently, the overall quality of training.
Many attempts have been made to find out the behaviours and characteristics of excellent clinical tutors. Most studies have focused on the clinical tutors' perception of these characteristics, while others focused on resident, student perceptions or both. ,,,,
Most of these studies were carried out in ambulatory care settings. ,,,, Other well-defined studies were carried out in ward settings in medicine, paediatrics, and surgery and one studied all healthcare professions including, nursing, and schools of thought in counseling and psychotherapy. ,,,,,,,
Despite the paucity of related published studies in all departments, to our knowledge there is only one published Emergency Department (ED) research on the characteristics of clinical tutors.  However, the study involved only accomplished clinical tutors' perception with no comparison of other tutors' or residents' opinions.
The present study was carried out to measure and evaluate the differences in the perception of characteristics of excellence for accomplished (those who had received any teaching awards or have been promoted on the basis of their teaching activity) and non-accomplished consultants and residents in ED. There was also an attempt to compare the perception between the different groups of participants. The characteristics, we measured were extracted from an extensive search of previously published studies summarized in the review article. 
| Methods|| |
A qualitative research method was implemented, using a well-constructed measuring survey tool. The data were collected through the survey questionnaire that was distributed by papers, E-mail id, or through the Survey Monkey collecting tool to all attending consultants and residents working in the Saudi Commission for Health Specialties accredited Emergency Medicine (EM) training centers in Riyadh.
The perception of characteristics of excellence of clinical tutors was assessed using a 20-item self-administered questionnaire. The questionnaire items were based on our review article in which we collected characteristics identified in the literature as potentially important; the list was composed of 20 attributes of effective clinical teachers.  The list was reviewed and agreed upon subsequent to several brainstorming sessions involving both faculty members and residents from different residency training programs. 
Each item (question) has five possible graded responses (Likert scale): not important, less important, undecided, important, and very important. The questionnaire items were categorized into four components; teaching skill (5 items), personality (7 items), attitude (6 items), others (2 items). The questionnaire had a good indicator for reliability (Cronbach alpha, 0.86).
Characteristics of residents and consultants working in the Saudi Board of Emergency Medicine (SBEM) program were described as a proportion for categorical data and means and standard deviations for continuous data. The percentages of the five possible responses of each of the 20 items of the perception questionnaire were compared between residents and consultants using the Chi-square test. Possible responses were given a score of one for not important, two for less important, three for undecided, four for important, and five for very important. Overall score and component sub-scores were estimated by summing up individual item scores and were expressed as mean and standard deviations. The maximum overall score was 100 points. Higher scores represent a higher perception of the importance of excellent tutor characteristics under study. Differences of overall score and component sub-scores by different characteristics of residents and consultants were tested using non-parametric tests: Mann-Whitney U test for two-level characteristics and Kruskal-Wallis ANOVA for more than two-level characteristics. All tests were two-tailed and the P value <0.05 was considered significant. SPSS software (release 18.0, SPSS Inc., Chicago, USA) was used for all statistical analyses.
| Results|| |
The questionnaire was distributed to a total of 50 consultants, 30 of whom replied (response rate = 60%), there were difficulties reaching all consultants in different centers at an early stage of the study. Using the Survey Monkey tool at later stage of the study improved the overall response. A total of 70 residents received the questionnaire, 49 of them responded (response rate = 70%). Residents response was better probably due to the easy access to all program residents during joint program activities of the total participants. Of the 49 (62.0%) residents and 30 (38.0%) consultants who completed the perception questionnaire [Table 1], the majority (78.5%) were males. Females were more likely to be residents (26.5%) than consultants (13.3%), however, this did not reach statistical significance (P = 0.166). About one-third (34.5%) of the consultants had Fellowships of the Royal College of Physicians, UK or Fellowships of the American College of Emergency Physicians and another one-third (34.5%) had SBEM certification. Only 44.8% of the consultants obtained additional training in the form of subspecialty training (20.7%), teaching courses (13.8%), or master's degree (10.3%). A total of 10 (34.5%) consultants had won teaching awards. Almost one-third (32.0%) of the consultants had ≥10 years in practice. All residency levels were represented among resident respondents with 28.6%, R1; 30.6%, R2; 24.5%, R3; and 16.3% of R4. Only 14 (28.6%) out of the 40 residents had some ER service before starting the SBEM program.
The majority of consultants and residents considered all characteristics examined of an excellent clinical tutor as either very important or as less important [Table 2]. There were no significant differences of perception for overall teaching-skill characteristics, including being prepared, updated, effective, reflective, and accessible, between consultants and residents who perceived all of them as very important characteristics. With the exception of being sincere that was considered a significantly more important characteristic by consultants compared to residents (86.7% vs. 55.1%, respectively, P = 0.013), all other personality characteristics, including being enthusiastic, respectful, confident, humble, humanitarian, and compassionate, were equally valued as very important or as less important by both consultants and residents. Likewise, a similar perception of attitude characteristics, including being a health advocate, encouraging, non-judgmental, aware, and tidy, was observed in both groups. However, being a good role model was marginally more valued as a very important characteristic by consultants compared to residents (76.7% vs. 53.1%, respectively, P = 0.070). Being healthily or scholarly active were not considered as very important characteristics by consultants and were perceived to a lesser extent by residents.
|Table 2: Responses to different items of the questionnaire by the position of participant|
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The overall score of all study participants who represented a higher perception for the importance of the constituents of excellent tutor characteristics was 88.2 ± 7.3. The possible sub-scores were the highest for teaching skills (93.3%), followed by personality (90.1%), attitude (85.9%), and finally other characteristics (75.1%). Overall score as well as sub-scores of teaching skills, personality, and attitude were similar for consultants and residents. The overall score was 88.5 ± 7.6 for the consultants and 87.9 ± 7.2 for the residents, NS. The sub-score determined by the last 2 items, being healthily or scholarly active, was slightly lower among the consultants compared to the residents (7.1 ± 1.7 vs. 7.8 ± 1.4, P = 0.047, respectively) [Table 3]. Males had a slightly higher perception of the attitude sub-score compared to females (26.1 ± 3.2 vs. 24.7 ± 2.2, P = 0.032, respectively). The overall score and component sub-scores were not significantly different after stratification by consultants' characteristics (including qualifications, additional training, winning teaching awards, and years in practice). Similarly, overall scores and component sub-scores were not significantly different after stratification by residents' characteristics (including resident levels and having some pre-program emergency resident service) [Figure 1].
|Figure 1: Overall score and component sub-scores of the perception of consultants and residents|
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|Table 3: Overall score and its component sub-scores for the perception of consultants and residents|
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| Discussion|| |
Surprisingly, this study did not find any difference between the perception of importance of characteristics for the excellence of clinical tutors between consultants and residents in an EM residency program, unlike family medicine residency program where residents and their faculty showed a strong level of disagreement for some qualities as showed by Buchel and Edwards.  Family medicine residents valued qualities like being "accessible" and "non-judgmental" unlike their faculty respondents. 
However, we found that being "sincere" was an exception as it was more significantly valued as important by consultants compared to residents (87.8% vs. 55.1%, respectively). A similarly strong agreement in medical student responses was shown by Haghdoost and Shakibi in their comparison of the value of qualities of good clinical lecturers by medical students and their academic staff.  A published general surgery residents' experience by Robert Patterson also showed how residents value the quality of being non-judgmental in their tutors and how a resident remembered his residency as a negative experience probably because of the judgments made by his attendant. 
Unlike previous assumptions, consultants' specifications (i.e., qualifications, additional training, wining teaching awards, and years in practice) did not seem to affect the perception of the characteristics of excellence on the overall score and in its component sub-scores. Experience was linked to the lesser value of being "available" as shown in the family-residency program in contrast to our finding.  Unfortunately, we do not have a comparison to be based on teaching award winners versus the others who did not as the only published ED research has evaluated only the accomplished "teaching award winning" consultants' perception. 
Small gender differences were found, males had slightly but significantly higher perception of the attitude sub-score compared to females (26.1 ± 3.2 vs. 24.7 ± 2.2). In a previous comparison, the only difference was found to be higher in valuing autonomy by female trainees. 
| Conclusion|| |
The study showed no difference in the perception of characteristics of excellence of clinical teachers between consultants and residents in an EM residency program. Since results also confirm that there is no relation between accomplished and non-accomplished consultants in perceiving those qualities, we exclude the lack of knowledge of those characteristics as a cause of being accomplished or not accomplished. We suggest a greater dedication from program developers toward creating more opportunities to involve more consultants in basic EM training. However, further studies are needed to explore the consistency and differences among other specialty residency programs.
| References|| |
|1.||Griscti O, Jacono B, Jacono J. The nurse educator's clinical role. J Adv Nurs 2005;50:84-92. |
|2.||Irby DM. Clinical teacher effectiveness in medicine. J Med Educ 1978;53:808-15. |
|3.||Irby DM, Ramsey PG, Gillmore GM, Schaad D. Characteristics of effective clinical teachers of ambulatory care medicine. Acad Med 1991;66:54-5. |
|4.||Irby DM. Teaching and learning in ambulatory care settings: A thematic review of the literature. Acad Med 1995;70:898-931. |
|5.||Irby DM. What clinical teachers in medicine need to know. Acad Med 1994;69:333-42. |
|6.||Sutkin G, Wagner E, Harris I, Schiffer R. What makes a good clinical teacher in medicine? A review of the literature. Acad Med 2008;83:452-66. |
|7.||Wright SM, Kern DE, Kolodner K, Howard DM, Brancati FL. Attributes of excellent attending-physician role models. N Engl J Med 1998;339:1986-93. |
|8.||Wright SM, Carrese JA. Excellence in role modelling: Insight and perspectives from the pros. CMAJ 2002;167:638-43. |
|9.||Hilliard RI. The good and effective teacher as perceived by pediatric residents and by faculty. Am J Dis Child 1990;144:1106-10. |
|10.||Bandiera G, Lee S, Tiberius R. Creating effective learning in today's emergency departments: How accomplished teachers get it done. Ann Emerg Med 2005;45:253-61. |
|11.||Boendermaker PM, Schuling J, Meyboom-de Jong BM, Zwierstra RP, Metz JC. What are the characteristics of the competent general practitioner trainer? Fam Pract 2000;17:547-53. |
|12.||Buchel TL, Edwards FD. Characteristics of effective clinical teachers. Fam Med 2005;37:30-5. |
|13.||Patterson R. "You're the worst goddamn resident I've ever had". CMAJ 1998;159:823-5. |
|14.||Stack SJ, Watson MJ. Enriching the resident-faculty relationship. Ann Emerg Med 2001;38:336-8. |
|15.||Cox SS, Swanson MS. Identification of teaching excellence in operating room and clinic settings. Am J Surg 2002;183:251-5. |
|16.||Stritter FT, Hain JD, Grimes DA. Clinical teaching reexamined. J Med Educ 1975;50:876-82. |
|17.||Alsultan M. What makes an effective clinical trainer? Saudi J Kidney Dis Transpl 2011;22:1229-35. |
|18.||Haghdoost AA, Shakibi MR. Medical student and academic staff perceptions of role models: An analytical cross-sectional study. BMC Med Educ 2006;6:9. |
[Table 1], [Table 2], [Table 3]