A RESIDENT-AS-TEACHER CURRICULUM DURING AMBULATORY BLOCK. T.L. Simon 1 ; 1 Mount Sinai School of Medicine, New York, NY STATEMENT OF PROBLEM OR QUESTION: Residents are expected to teach interns and medical students, yet receive no training to help improve their skills as teachers. An effective resident-as-teacher (RAT) program needs to utilize protected time and provide sufficient opportunity for skills practice, reflection, and reinforcement. OBJECTIVES OF PROGRAM/INTERVENTION: (1) To prepare residents for their role as teachers in the medical setting. (2) To enable residents to examine their own teaching skills and behaviors, and take active steps to improve their teaching effectiveness. (3) To improve clinical teaching in the Department of Medicine. DESCRIPTION OF PROGRAM/INTERVENTION: The RAT curriculum consisted of four consecutive 2.5 hour weekly workshops, repeated monthly, during the PGY2 ambulatory block rotation in the first half of the academic year. A group of 5-6 residents met with one faculty member for sessions utilizing interactive techniques such as facilitated discussion, videotape review, and role-play. The workshops covered the following content areas: (1) Introduction to Teaching Principles/Diagnosing the Learner, (2) Microskills of Clinical Teaching/Giving a Microlecture, (3) Resident as Team Leader, and (4) Evaluation and Feedback. Teaching homework assignments were completed between sessions and reviewed as part of the next workshop. Reinforcement materials were sent to the residents 1, 2, and 3 months after completion of the curriculum. FINDINGS TO DATE: The program was well-received, with a mean``overall rating'' score of 4.5 on a 5 point scale (n=33). A pre-test rating scale of teaching behaviors was also administered at the beginning of the curriculum, and a post-test will be distributed to each group four months after completion. Qualitative data was collected during workshop discussions, on topics such as`O vercoming Barriers to Teaching on the Wards'' and``Characteristics of the Ideal Resident''. In addition, residents completed self-assessment checklists of their own performance as clinic preceptors. Finally, there is a long term plan to analyze resident teaching evaluations from interns and medical students before and after the institution of this curriculum. KEY LESSONS LEARNED: RAT programs have traditionally been done in either a single 1 ± 2 day block, or``longitudinally'' with discrete sessions in each year of training. Utilizing the ambulatory rotation allows for protected time with small groups of residents in a more relaxed setting. Weekly workshops provide the opportunity for practice teaching exercises, review, and reflection. Residents are eager for this type of training, participate enthusiastically, and rate the program highly. Whether this will translate into measurable improvement in teaching months to years later will be assessed. Traditionally, faculty observe residents interviewing and examining patients and discuss further care with the resident. Time pressures have led to difficulty recruiting adequate numbers of faculty to participate in the traditional CEX at one institution. An alternative format became a necessity. OBJECTIVES OF PROGRAM/INTERVENTION: Our primary objective was to develop a more reliable and reproducible test using standardized patients that successfully assessed the same skill areas as the traditional CEX. We also wanted to obtain data on resident competency that would be better suited to use for program evaluation. DESCRIPTION OF PROGRAM/INTERVENTION: Four SP cases (chest pain/unstable angina, headache/tension, chest pain/pulmonary embolus and abdominal pain/dyspepsia) were developed. The residents were instructed to obtain a history of present illness, past medical and psychosocial history, perform a comprehensive physical examination (PE) and write an assessment and plan (AP). SPs completed the history (Hx) and PE checklists (yes/no, yes = done and done correctly, no = omitted or done incorrectly). The SP rated PE technique (6 questions) on a 5-point Likert scale e.g.``the resident minimized patient movements'', interpersonal skills (5 questions) on a 5-point Likert scale, e.g.``the resident demonstrates a professional demeanor'', and nonverbal communication skills (16 questions) e.g. "the resident's tone of voice was 1=unfriendly, cold, 7=friendly, warm". AP score was based on key developed by 5 faculty. FINDINGS TO DATE: 50/52 intern and senior residents participated. Mean (SD) percent sub-scale scores were Hx 58.4 (7.0), PE 72.2 (15.8), AP 42.7 (18.5), technique 94.0 (4.9), interpersonal skills 94.9 (5.1), and non-verbal communication skills 83.8 (16.7). The scores on the Hx, PE, and AP were lower than expected and ratings of technique, interpersonal and nonverbal communication skills were acceptable. KEY LESSONS LEARNED: The SP CEX is a feasible alternative to the traditional CEX. However, a considerable amount of time and effort is required to establish an examination using this format. A pre-existing SP program is a helpful to this process. The SP CEX enables residency programs to standardize the CEX and avoid variability from different raters (faculty). The SP CEX provides more detailed information on resident performance than the traditional format, which will be useful in providing more specific feedback to examinees and directing curricular development within a program. STATEMENT OF PROBLEM OR QUESTION: In the care of patients with chronic diseases, no doctor is an island. This is particularly true in group practices, clinics and health centers where a number of professionals and support staff interact with each patient. When a large resident component is added to the provider base, there is increased demand on all staff to understand the content and process of caring for individuals with common chronic diseases. Educating residents in the care of multisystem chronic conditions in outpatients is also vital to successful care, particularly with evolving changes in management.