1606 - "Wow, it’s just flowing. This is nice.” PM&R Residents’ Experiences in Becoming the Teacher Through Simulated Peer-Learning

Residents play a vital role as educators for both peers and medical students. Although "resident-as-teacher" curricula are increasingly implemented across GME, limited research exists examining the longitudinal development of residents in their teaching roles, particularly within PM&R. 

This qualitative study examines the experiences of PM&R residents as teachers during simulated cases with GME peer learners, to provide insight into the development of teaching identity, confidence, and skill acquisition within the unique context of PM&R training. 


Design:

Residents were trained by faculty to conduct simulated patient cases (undiagnosed knee OA, partial-thickness rotator cuff tear) during a recurring “Musculoskeletal Education Week” (October 2024–May 2025). Residents evaluated the physical examination and clinical reasoning skills of 55 learners, then debriefed each session with feedback and discussion. Qualitative comprised resident experiences captured through self-reflective interviews.  

Data were analyzed using conventional content analysis: four coders independently reviewed interview transcripts, met regularly to reconcile interpretations, and iteratively refined codes into categories that reflected key themes. 


Results: Conventional content analysis revealed three main domains of resident growth as educators: Co-Teaching, Teaching, and Influence. Co-Teaching reflected both change in residents (acknowledgement, peer learning) and reflection (aligned or challenged thinking). Teaching adaptations included strategies to improve efficiency, guide learner trajectories, and structure content through repetition, probing, algorithms, and frameworks. Influence encompassed prior experiences, learner perspective, and biases, as well as the emotional impact of learner energy, struggle, and positive experiences. 

Conclusions: Residents grew as educators through co-teaching, which fostered self-awareness and reflection that both aligned and challenged their thinking. Through recurring experiences, residents could adapt their teaching strategies to guide learners and build frameworks to inform future educational opportunities. Growth was also shaped by prior educational experiences and by the emotions of both the residents and the learners. When developing "resident-as-teacher" curricula, programs may benefit from using a framework incorporating these themes.