A multisite randomized trial of implicit versus explicit modeling in clinical teaching

Abstract

Purpose

Faculty modeling of desired behaviors has historically been a part of the apprenticeship model of clinical teaching, yet little is known about best practices for modeling. This study compared the educational impact of implicitly versus explicitly modeled communication skills among U.S. medical students.

Method

Fourth-year medical students from six U.S. academic medical centers were randomly assigned one simulated clinical encounter in which faculty provided either implicit or explicit modeling of important communication skills. Outcomes were assessed by electronic surveys immediately before and after the simulations. Students were blinded to the purpose of the study.

Results

Students in the explicit arm were more likely to correctly cite two of the three key specific communication elements modeled by faculty: deliberate body position (53.3% vs. 18.6%, p < 0.001) and summarizing patient understanding (62.2% vs. 11.6%, p < 0.001). More students in the explicit study arm reported faculty ‘demonstrated a key behavior that they wanted me to be able to perform in the future’ (93.2% versus 62.8%, p = 0.002). Participating faculty stated they would modify their teaching approach in response to their experiences in the study.

Conclusions

In a multi-center randomized trial, explicit faculty role-modeling led to greater uptake of communication knowledge, greater recognition of skills, and a greater sense that faculty expected these skills to be adopted by students. These results must be considered in the context, however, of a simulated environment and a short timeframe for assessing learning with students who volunteered for a simulated experience.

Keywords:

• Role-modeling
• faculty development
• bedside teaching
• communication

Acknowledgements

The authors wish to thank the medical students participating in this study and the administrative staff at the Carl J. Shapiro Institute for Education and Research.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Glossary

Explicit Role Modeling: Role modeling has been described as the process by which faculty members demonstrate clinical skills, model and articulate expert thought processes, and manifest positive professional characteristics. Explicit role modeling includes intentional description of key aspects of what is modeled (Irby 1986, Passi et al. 2013).

Additional information

Notes on contributors

Mel L. Anderson

Mel L. Anderson, MD, is Associate Professor of Medicine, Department of Medicine, University of Colorado School of Medicine and Rocky Mountain Regional VA Medical Center, Aurora, CO.

Christine P. Beltran

Christine P. Beltran, EdM, is a Research Manager, Shapiro Institute for Education and Research, Beth Israel Deaconess Medical Center, Boston, MA.

Victoria Harnik

Victoria Harnik, PhD, is Associate Dean for Curriculum and Associate professor of Cell Biology, New York University Grossman School of Medicine, New York, New York.

Meredith Atkins

Meredith Atkins, MD, is Assistant Professor and Associate Dean for Undergraduate Medical Education, Harvard Medical School, Boston, MA.

Janet Corral

Janet Corral, PhD, is Associate Professor and Associate Dean of Curricular Affairs, University of Arizona College of Medicine Tucson, Tucson, Arizona.

Gino Farina

Gino Farina, MD, is Professor of Science Education and Emergency Medicine, The Donald and Barbara Zucker School of Medicine Hofstra/Northwell, Hempstead, NY.

Alice Fornari

Alice Fornari, EdD, RD, is Associated Dean for Educational Skills Development, Professor of Science Education, Occupational Medicine, Epidemiology and Prevention and Family Medicine, The Donald and Barbara Zucker School of Medicine Hofstra/Northwell, Hempstead, NY.

Marcelle Hamburger

Marcelle Hamburger, MS, is Senior Program Manager of Standardized Patient Program, UTHealth McGovern Medical School, Houston, Texas.

Scott Holliday

Scott A. Holliday, MD, is Associate Dean for Graduate Medical Education and Associate Clinical Professor of Pediatrics and Internal Medicine, The Ohio State University College of Medicine, Columbus, OH.

Jeff Manko

Jeff A. Manko, MD is the director of Professional Development in Graduate Medical Education and associate professor of Emergency Medicine, New York University Grossman School of Medicine, New York, New York.

Katherine Normand

Katherine Normand, MD, is Associate Professor, Department of Anesthesiology and Medical Director of Surgical and Clinical Skills Center (SCSC), McGovern Medical School, Houston, TX.

Alisson Ownby

Alisson R. Ownby, PhD, MEd, is Assistant Dean for Faculty and Educational Development and Associate Professor of Pediatrics, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, TX.

Sheryl Pfeil

Sheryl A. Pfeil, MD, is Professor of Internal Medicine and Medical Director of the Clinical Skills Education and Assessment Center, The Ohio State University College of Medicine, Columbus, OH.

Demicha Rankin

Demicha Rankin, MD, is Associate Professor of Anesthesiology and Associate Dean for Admissions, The Ohio State University College of Medicine, Columbus, OH.

Amy Cohen

Amy P. Cohen is an instructor at the Harvard Chan School of Public Health, Boston, MA.

Richard M. Schwartzstein

Richard M. Schwartzstein, MD, is Executive Director, Carl J. Shapiro Institute for Education and Research at Harvard Medical School and Beth Israel Deaconess Medical Center, and Professor of Medicine and Medical Education, Harvard Medical School, Boston, MA.

Margaret M. Hayes

Margaret Hayes, MD, is Assistant Professor of Medicine, Harvard Medical School, Boston MA.