121Reasons Why Residents May Be Advantaged as Teachers
A number of theories have been put forth regarding why residents may have such a
strong influence on the education of more junior house staff and medical students.
These include theories related to skill development and deconstructive skill, peer
relationship and social theory, and time pressure considerations related to alterna-
tive teachers, notably surgical faculty.
Conscious vs. Unconscious Performance
One commonly held theory suggests that surgical residents, who themselves are still
in a training environment, require ongoing conscious thought to perform most of
their skills and daily activities. In contrast, attending surgeons, by virtue of their
larger volume of experience, have become less cognizant of the steps and process-
ing required in performing a particular skill. That is, in terms of the four stages of
competence described by Burch in the 1970s, the resident is still engaged in the
“consciously competent” phase of their own development, in which understanding
and decision making are detached, whereas many attendings function in the “uncon-
sciously competent” sphere in which responses are intuitive based on experience
[ 10 , 11 ]. Accordingly, the resident’s proximity in relation to their student learner’s
zone of skill acquisition allows them to more readily deconstruct and verbalize to
junior learners the individual steps of a process, particularly with reference to per-
forming technical skills [ 5 ].
For example, a junior resident teaching a medical student how to tie square knots
would be more likely to go through each individual step, as the resident would still
themselves be progressing toward automaticity. Conversely, an attending surgeon
who has tied thousands of surgical knots in their career is more removed from such
sequencing and deconstructive analysis and may struggle more with teaching indi-
vidual steps and sequencing to a novice learner. While skilled teachers learn to
develop such deconstructive skills even after achieving personal mastery, resident
teachers typically have a shorter bridge to the level of the novice or junior learner
and cross that gap more instinctively.
“Near-Peer” Relationship
Another theory is based on the relative age difference between the learner and the
teacher. Surgical residents are closer in age and generational status to other resi-
dents and medical students than are the attending surgeons. Attending surgeons
typically come from the baby boomer era and Generation X, while most residents
come from the millennial generation. The relative closeness in age between a medi-
cal student and a resident allows for a “near-peer” relationship that enables under-
standing of generational norms and contributes to open conversations and questions
from the student [ 5 , 12 ]. A question that a student might not feel comfortable asking
7 Teaching Residents to Teach: Why and How