In an editor's preface regarding the recent 10-fold increase in resident tuition fees (from $190 to $1950) at the University of Toronto,1 you referred to an article on the teaching activities of attending staff and stated that you were "unaware of any published attempts to create a similar accounting of residents' contributions to teaching."
Numerous reports on the extent, quality and impact of the teaching performed by residents have been published. The time residents spend in teaching activities, which includes supervising, instructing and evaluating students and junior residents, has been estimated to be as high as 25% of all resident activities[3, 4] and is likely to exceed the teaching time of attending staff. Medical students have rated teaching by residents to be an important source of learning; they have estimated that one third of their knowledge is derived from teaching by residents.[5, 6] Resident and faculty teaching behaviours are different and complementary.6 Students have responded that residents contribute more to their learning in the clinical setting than do faculty members.[7, 8] Investigators are exploring means by which resident teaching may be improved[9, 10] as well as evaluating the relationship between teaching and learning in residency.11 Although no study has fully documented the number of hours residents spend teaching by year or discipline, and no study has ever evaluated the monetary value of residents' contributions to teaching, there is little doubt that residents are expected to perform a great deal and are recognized by medical students as an important source of learning.
The fact that residents perform a great deal of teaching is a separate issue from that of resident tuition fees. There is a lack of acknowledgement and remuneration for clinical teaching activities performed by both attending staff and residents. The decrease in government revenue for medical schools is also an important issue that needs to be addressed. However, to increase resident tuition fees, especially as dramatically as has been attempted, is not an appropriate, effective or fair response. As noted in your editor's preface, teaching must remain a privilege and a duty for both faculty and residents; a concentrated effort to evaluate, promote, improve and increase teaching performed by residents and staff would better support this goal.
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