Annette Burgess

Medical students as peer tutors: a systematic review

BackgroundWhile Peer Assisted Learning (PAL) has long occurred informally in medical education, in the past ten years, there has been increasing international interest in formally organised PAL, with many benefits for both the students and institutions. We conducted a systematic review of the literature to establish why and how PAL has been implemented, focussing on the recruitment and training process for peer tutors, the benefits for peer tutors, and the competency of peer tutors.MethodA literature search was conducted in three electronic databases. Selection of titles and abstracts were made based on pre-determined eligibility criteria. We utilized the ‘AMEE Peer assisted learning: a planning and implementation framework: AMEE Guide no. 30’ to assist us in establishing the review aims in a systematic review of the literature between 2002 and 2012. Six key questions were developed and used in our analysis of particular aspects of PAL programs within medical degree programs.ResultsWe found nineteen articles that satisfied our inclusion criteria. The PAL activities fell into three broad categories of teacher training, peer teaching and peer assessment. Variability was found in the reporting of tutor recruitment and training processes, tutor outcomes, and tutor competencies.ConclusionResults from this review suggest that there are many perceived learning benefits for student tutors. However, there were mixed results regarding the accuracy of peer assessment and feedback, and no substantial evidence to conclude that participation as a peer tutor improves one’s own examination performance. Further research into PAL in medicine is required if we are to better understand the relative impact and benefits for student tutors.

Applying established guidelines to team-based learning programs in medical schools: a systematic review.

Purpose Team-based learning (TBL), a structured form of small-group learning, has gained popularity in medical education in recent years. A growing number of medical schools have adopted TBL in a variety of combinations and permutations across a diversity of settings, learners, and content areas. The authors conducted this systematic review to establish the extent, design, and practice of TBL programs within medical schools to inform curriculum planners and education designers. Method The authors searched the MEDLINE, PubMed, Web of Knowledge, and ERIC databases for articles on TBL in undergraduate medical education published between 2002 and 2012. They selected and reviewed articles that included original research on TBL programs and assessed the articles according to the seven core TBL design elements (team formation, readiness assurance, immediate feedback, sequencing of in-class problem solving, the four S’s [significant problem, same problem, specific choice, and simultaneous reporting], incentive structure, and peer review) described in established guidelines. Results The authors identified 20 articles that satisfied the inclusion criteria. They found significant variability across the articles in terms of the application of the seven core design elements and the depth with which they were described. The majority of the articles, however, reported that TBL provided a positive learning experience for students. Conclusions In the future, faculty should adhere to a standardized TBL framework to better understand the impact and relative merits of each feature of their program.

Team-based learning methods in teaching topographical anatomy by dissection

Background:  While the effectiveness of teaching human topographical anatomy by groups of medical students carrying out embalmed cadaver dissections has been recognized for centuries, the mechanisms by which this teaching is so effective have not been well described.

Senior medical students as peer examiners in an OSCE

Background: At Sydney Medical School, we have recently introduced a practice Objective Structured Clinical Examination (OSCE) where our junior medical students are assessed by the senior peers. Aim: We sought to evaluate the efficacy of the programme. Methods: The study took place in 2010 and 2011, with two cohorts of final-year students participating. A total of 40/98 (41%) of final-year students chose to participate as examiners. Following the completion of standardised marking sheets by the student examiners, the marking sheets were reviewed by a senior academic examiner, and the ‘global’ mark was adjusted in accordance with the marking criteria. Student examiners also completed an open and closed-ended questionnaire regarding their experience as an examiner. A total of 105/115 (91%) of year 2 medical students were examined in the OSCE over the two-year period. Results: The senior academic changed a total of 94 ‘global’ marks, reducing the majority (55%) from ‘Satisfactory’ to ‘Borderline’; 12% were reduced from ‘Satisfactory’ to ‘Not Satisfactory’ and 33% from ‘Borderline’ to ‘Not Satisfactory’. Student questionnaire results showed a high level of engagement with their examiner experience overall, and it was regarded as a useful learning experience. Conclusion: Student examiners found peer assessment to be a very useful learning activity. However, our students need further training in how to globally assess a fellow students overall performance objectively and to provide accurate feedback.

The validity of a behavioural multiple-mini-interview within an assessment centre for selection into specialty training.

BackgroundEntry into specialty training was determined by a National Assessment Centre (NAC) approach using a combination of a behavioural Multiple-Mini-Interview (MMI) and a written Situational Judgement Test (SJT). We wanted to know if interviewers could make reliable and valid decisions about the non-cognitive characteristics of candidates with the purpose of selecting them into general practice specialty training using the MMI. Second, we explored the concurrent validity of the MMI with the SJT.MethodsA variance components analysis estimated the reliability and sources of measurement error. Further modelling estimated the optimal configurations for future MMI iterations. We calculated the relationship of the MMI with the SJT.ResultsData were available from 1382 candidates, 254 interviewers, six MMI questions, five alternate forms of a 50-item SJT, and 11 assessment centres. For a single MMI question and one assessor, 28% of the variance between scores was due to candidate-to-candidate variation. Interviewer subjectivity, in particular the varying views that interviewer had for particular candidates accounted for 40% of the variance in scores. The generalisability co-efficient for a six question MMI was 0.7; to achieve 0.8 would require ten questions. A disattenuated correlation with the SJT (r = 0.35), and in particular a raw score correlation with the subdomain related to clinical knowledge (r = 0.25) demonstrated evidence for construct and concurrent validity. Less than two per cent of candidates would have failed the MMI.ConclusionThe MMI is a moderately reliable method of assessment in the context of a National Assessment Centre approach. The largest source of error relates to aspects of interviewer subjectivity, suggesting enhanced interviewer training would be beneficial. MMIs need to be sufficiently long for precise comparison for ranking purposes. In order to justify long term sustainable use of the MMI in a postgraduate assessment centre approach, more theoretical work is required to understand how written and performance based test of non-cognitive attributes can be combined, in a way that achieves acceptable generalizability, and has validity.

Senior medical student perceived ability and experience in giving peer feedback in formative long case examinations

BackgroundLearning to provide feedback on a peer’s performance in formative clinical assessments can be a valuable way of enriching the students’ own learning experience. Students are often reluctant to provide honest, critical feedback to their peers. Nevertheless, it is an area of practice that is important to develop as students report feeling ill prepared in feedback techniques when entering the medical workforce. We sought to investigate students’ perceptions of their ability to provide feedback to their peers using the positive critique method, and their perceived benefits and challenges during the experience.MethodsOver a two year period (2011 to 2012), senior medical students assessed and gave feedback to their peers alongside academic examiners during formative long case clinical examinations. Rating scales, open ended questions and focus group discussions were used to evaluate student perceptions.ResultsOf the 94 participants, 89/94 (95%) completed the questionnaire, and 39/94 (41%) participated in focus groups. Students found the positive critique method provided a useful framework. Some students raised concerns about the accuracy of their feedback, and felt that further training was required. A substantial number of respondents (42%) did not report feeling confident providing negative feedback to their peers, and qualitative analysis indicated concerns around potential impacts on social relationships. Despite these concerns, the majority (90%) of respondents found the exercise useful, identifying several benefits, including development in the understanding of knowledge content; development of professionalism skills, and increased responsibility.ConclusionStudents identified several challenging aspects to providing feedback to their peers. While the experience of giving feedback to peers was perceived by students to provide a valuable learning experience, further training in this area may help to improve the learning experience for students and better prepare them for their future careers.

Feedback and assessment for clinical placements: achieving the right balance

During clinical placements, the provision of feedback forms an integral part of the learning process and enriches students’ learning experiences. The purpose of feedback is to improve the learner’s knowledge, skills, or behavior. Receipt of accurate feedback can help to narrow the gap between actual and desired performance. Effective and regular feedback has the potential to reinforce good practice and motivate the learner toward the desired outcome. Despite the obvious role of feedback in effective teaching and learning, a common complaint from students is that they do not receive adequate feedback. Unfortunately, skills in giving and receiving feedback are rarely taught to students or clinicians. This study aims to provide an understanding of the role of feedback within the learning process, consider consequences of inadequate or poorly given feedback, consider the barriers to the feedback process, provide practical guidelines for providing feedback, and consider the need for student and faculty development in feedback skills.

Facilitating the development of professional identity through peer assisted learning in medical education

Peer assisted learning (PAL) is well documented in the medical education literature. In this paper, the authors explored the role of PAL in a graduate entry medical program with respect to the development of professional identity. The paper draws on several publications of PAL from one medical school, but here uses the theoretical notion of legitimate peripheral participation in a medical school community of practice to shed light on learning through participation. As medical educators, the authors were particularly interested in the development of educational expertise in medical students, and the social constructs that facilitate this academic development.

Teaching skills for students: our future educators

Background:  The future of medical education is under increasing strain from a paucity of clinical educators with formal teaching experience and time to fulfil their teaching roles. ‘Teaching on the Run’ (TOR), is a programme aimed at improving the quality of teaching by medical educators. We hypothesised that the completion of the TOR programme by senior medical students would increase student awareness of quality educational practice, thereby improving their competence and confidence in teaching and assessing their peers.

Role modelling of clinical tutors: a focus group study among medical students

BackgroundRole modelling by clinicians assists in development of medical students’ professional competencies, values and attitudes. Three core characteristics of a positive role model include 1) clinical attributes, 2) teaching skills, and 3) personal qualities. This study was designed to explore medical students’ perceptions of their bedside clinical tutors as role models during the first year of a medical program.MethodsThe study was conducted with one cohort (n = 301) of students who had completed Year 1 of the Sydney Medical Program in 2013. A total of nine focus groups (n = 59) were conducted with medical students following completion of Year 1. Data were transcribed verbatim. Thematic analysis was used to code and categorise data into themes.ResultsStudents identified both positive and negative characteristics and behaviour displayed by their clinical tutors. Characteristics and behaviour that students would like to emulate as medical practitioners in the future included:1) Clinical attributes: a good knowledge base; articulate history taking skills; the ability to explain and demonstrate skills at the appropriate level for students; and empathy, respect and genuine compassion for patients.2) Teaching skills: development of a rapport with students; provision of time towards the growth of students academically and professionally; provision of a positive learning environment; an understanding of the student curriculum and assessment requirements; immediate and useful feedback; and provision of patient interaction.3) Personal qualities: respectful interprofessional staff interactions; preparedness for tutorials; demonstration of a passion for teaching; and demonstration of a passion for their career choice.ConclusionExcellence in role modelling entails demonstration of excellent clinical care, teaching skills and personal characteristics. Our findings reinforce the important function of clinical bedside tutors as role models, which has implications for faculty development and recruitment.