School of Medicine Resident Teaching Skills

About the Resident Teaching Skills Website and the History of the CTPI and BEST Curriculum

1985 – 1999: Development of the Clinical Teaching Perception Inventory

Originally developed in the mid-1980s by Maurice A. Hitchcock, Ed.D., Bill D. Lamkin, Ph.D., William K. Mygdal, Ed.D., Charles M. Clarke and Sharon O'Connor-Clarke, the Clinical Teaching Perception Inventory (CTPI^®), a 28-item Q-sort inventory that measures comfort with clinical teaching by comparing perceptions of the respondent’s "ideal clinical teacher" with his or her self-perceptions as a teacher. The CTPI can be completed in approximately 10 minutes. It asks respondents to place each of 28 single-word descriptors/items along a seven-point continuum ranging from "least like" to "most like”, then generates an individual explanation of your scores that can help improve teaching skills.

In 1999, a multidisciplinary group of medical educators first launched this site as a collaboration between the Association of American Medical Colleges, Group on Educational Affairs and the University of California, Irvine: 

• Elizabeth Morrison, M.D., M.S.Ed. (principal investigator)
• Joan A. Friedland, M.D., M.P.H.
• Maurice Hitchcock, Ed.D.
• John Boker, Ph.D.
• Karen Garman, Ed.D.
• Lloyd Rucker, M.D.
• Janet Palmer Hafler, Ed.D.

With the support of grants from the Robert Wood Johnson Foundation, the Bureau of Health Professions (U.S. Public Health Service), and the Tamkin Foundation, we created an electronic version of the CTPI and made it available free of charge to all medical educators.

2000–2005: Development of Bringing Education & Service Together (BEST)

With the addition of a few more medical education colleagues at the University of California, Irvine and the University of California, Los Angeles, we  conducted Bringing Education & Service Together (BEST), an interdisciplinary “service learning” project for primary care resident physicians:

• Elizabeth Morrison, M.D., M.S.Ed. (principal investigator)
• John R. Boker, Ph.D.
• Charles C. Gabbert
• Maurice A. Hitchcock, Ed.D.
• Judy Hollingshead, Ph.D., M.N.
• F. Allan Hubbell, M.D., M.P.H.
• Michael D. Prislin, M.D.
• Lloyd Rucker, M.D.
• LuAnn Wilkerson, Ed.D.

The BEST project’s main objective was to undertake and evaluate a longitudinal residents-as-teachers curriculum:

• We conducted 11 focus groups and 4 semi-structured key informant interviews with a total of 100 medical students, residents, and faculty in family medicine, internal medicine, and pediatrics.  Participants agreed that resident teachers fulfill important roles as practical clinical teachers and role models for junior learners, offering skills-based teaching that benefits the resident teachers as well as their learners
• We developed and validated a 3.5-hour, eight-station objective structured teaching examination (OSTE) that served as the primary outcome measure for a randomized, controlled trial of a longitudinal residents-as-teachers curriculum. Fifty medical students enacted and rated the OSTE with two trained, blinded raters independently assessing each station with an inter-rater reliability of 0.75.
• The randomized, controlled trial, conducted with 62 second-year residents at 4 generalist residency programs affiliated with an urban academic medical center, tested a 13-hour curriculum in which residents practiced teaching and received feedback in small-group sessions taught twice a month over 6 months. The medical student raters found that the residents who were randomly assigned to receive the residents-as-teachers curriculum consistently showed a ~28% improvement in teaching skills scores compared with residents who were randomly assigned to the control group.
• One year after the randomized trial, 23 of the residents participated in semi-structured interviews that were independently evaluated by blinded raters uses grounded theory techniques. Compared with control residents, the intervention residents expressed more enthusiasm for teaching, more learner-centered approaches and a greater understanding of teaching principles and skills. Most intervention residents wanted to continue teaching during and after training, while fewer control residents either enjoyed their current teaching or wanted to teach in the future.

2005-2016: Further Development of Curricula for Resident and Faculty Teachers

After publication of the BEST trial, medical educators at other institutions continued to develop their own curricula, including some curricula that were based in part on materials from the BEST project and adapted some of the materials to evaluate faculty teachers.

• Other medical education researchers continued to explore how the CTPIcan contribute to our understanding of clinical teaching skills.
• As educators developed more and more residents-as-teachers curricula, sufficient published data have allowed for systematic review of the literature.
• We migrated the BEST Residents’ Teaching Skills web site to the Keck School of Medicine of the University of Southern California with Raymond Lam and colleagues, then to the Ventura County Medical Center Family Medicine Residency Program, thanks to Jacob David, MD and colleagues.

2016 to the present

In the 2016-2017 academic year, a new web site team formed, based at the University of California, Riverside School of Medicine with participation of other colleagues:

• Elizabeth Morrison, M.D., M.S.Ed. (principal investigator)
• Maurice A. Hitchcock, Ed.D.
• Alina Popa, M.D.
• Lloyd Rucker, M.D.
• Rosemary Tyrell, Ph.D.

Visit the BEST Curriculum Content