Daniel S Furmedge

Peer-assisted learning – Beyond teaching: How can medical students contribute to the undergraduate curriculum?

Abstract Introduction: Peer-assisted learning (PAL) has become increasingly popular over recent years with many medical schools now formally incorporating peer-teaching programs into the curriculum. PAL has a sound evidence base with benefit to both peer-teacher and peer-learner. Aside from in teaching delivery, empowering students to develop education in its broadest sense has been much less extensively documented. Case studies: Five case studies with supportive evaluation evidence illustrate the success of a broad range of peer-led projects in the undergraduate medical curriculum, particularly where these have been embedded into formal teaching practices. Discussion: These case studies identify five domains of teaching and support of learning where PAL works well: teaching and learning, resource development, peer-assessment, education research and evaluation and mentoring and support. Each case offers ways of engaging students in each domain. Conclusions: Medical students can contribute significantly to the design and delivery of the undergraduate medical program above and beyond the simple delivery of peer-assisted “teaching”. In particular, they are in a prime position to develop resources and conduct research and evaluation within the program. Their participation in all stages enables them to feel involved in course development and education of their peers and ultimately leads to an increase in student satisfaction.

Do peer-tutors perform better in examinations? An analysis of medical school final examination results

Peer‐assisted learning (PAL) is recognised as an effective learning tool and its benefits are well documented in a range of educational settings. Learners find it enjoyable and their performances in assessments are comparable with those of students taught by faculty tutors. In addition, PAL tutors themselves report the development of improved clinical skills and confidence through tutoring. However, whether tutoring leads to actual improvement in performance has not been fully investigated.

Quality and impact of appraisal for revalidation: the perceptions of London’s responsible officers and their appraisers

BackgroundTo evaluate NHS England London region’s approach to the revalidation appraisal of responsible officers in London, exploring perceptions of the quality and impact of the appraisal process. Revalidation is the process which aims to ensure doctors in the UK are up-to-date and fit to practice medicine thus improving the quality of patient care. Revalidation recommendations are largely premised on the documentation included in annual appraisals, which includes the professional development a doctor has undertaken and supporting information about their practice.MethodsA pan-London qualitative study exploring the views of responsible officers and their appraisers about the revalidation appraisal process. The study aimed to gain an in-depth understanding of the experiences and perceptions of the participants. Responsible officers were purposefully sampled to represent the broadest range of designated bodies. Data analysis generated themes pertaining to quality and impact of appraisal for revalidation with the potential to feed into and shape the evolving system under investigation.ResultsThe central importance of highly skilled appraisers was highlighted. Both groups reported educational opportunities embedded within the appraisal process. Independent appraisers, not matched by clinical speciality or place of work, were considered to take a more objective view of a responsible officer’s practice by providing an ‘outsider perspective’. However, covering the breadth of roles, in sufficient depth, was challenging. Participants reported a bias favouring the appraisal of the responsible officer role above others including clinical work. Appraisal and revalidation was perceived to have the potential to improve the healthcare standards and support both personal development and institutional quality improvement.ConclusionsResponsible officers play a central role in the revalidation process. Getting responsible officer appraisal right is central to supporting those individuals to in turn support doctors and healthcare organisations in continuous quality improvement. The complexity and importance of the role of responsible officer may make achieving an appraisal of all roles of such individuals problematic. This evaluation suggests responsible officer appraisal was perceived as educational and effective.

Apprenticeship learning models in residents: are they transferable to medical students?

One growing concern for medical students is our increasing number. The mammoth numbers of medical students accepted into courses in the UK challenge medical school resources. This, in addition to decreasing numbers of in-patient beds and reductions in lengths of stay, makes student access to patients problematic. It is not uncommon for a patient to say you are the fourth student to approach him that day, demonstrating a situation that is both unfair and unreasonable for the patient and one that presents definite challenges to the student.

Computer based assessments--mind your eyes!

In researching the United States Medical Licensing Examination (USMLE), a predominantly computer based assessment, as a medical student, I have become conscious of my concerns about computer based examinations in medical education. Although I don’t have 20/20 vision, my eyes work fine. However, staring at a bright screen for long periods is difficult under normal circumstances, let alone whilst concentrating on an exam. As we become ever enveloped in the fantastic world of information technology, which offers countless innovative and exciting opportunities, it is important to remember that computers cause eye strain, dry irritated eyes and more (Blehm et al. 2005), making concentration quite challenging. Computer based assessment has really taken off with many institutions employing it as a means of progress testing or examining students. There has been research suggesting that medical and indeed other students enjoy computer based assessment and in fact prefer some aspects of being examined this way. The majority of these studies however, looked at ongoing small assessments rather than large end of year examinations. I would agree that for short tests or in selfassessment exercises, computers are a valuable resource with undisputed benefits, allowing access to certain media for example. Nevertheless, computer examinations are much more tiring than a traditional paper based examination. There is something quite demanding about reading from a lit screen, be it a paper, a magazine or an exam question. Some of the worst things about medical examinations on computers are the reams of text to be digested for each question, particularly relevant in the clinical years where patient histories may be extensive. When faced with blocks of text, question after question there is a sinking feeling in the stomach. I simply can’t focus on a screen full of text. Computers provide many advantages over paper-based assessment with excellent opportunities for teaching, ongoing assessment and short examinations. Despite this, thought must be given to subjecting students to long periods of assessment at computer screens. My plea therefore, to medical educators worldwide is to think of our eyes and concentration spans when choosing media for examinations. If exams are to be lengthy or will incorporate lots of text, please, spare us a thought and give us a pencil and some paper. Before we move to include computers in all our assessments in medical education, it is imperative that we further evaluate their use for this purpose.

Crash call: hospital staff need training with cardiac arrest simulations.

With cardiac arrest becoming a rare event in hospital, staff need more in situ simulation for training, argues Daniel Furmedge

Paper trials: a qualitative study exploring the place of portfolios in making revalidation recommendations for Responsible Officers

BackgroundA portfolio of supporting information (SI) reflecting a doctor’s entire medical practice is now a central aspect of UK appraisal for revalidation. Medical revalidation, introduced in 2012, is an assessment of a doctor’s competence and passing results in a five yearly license to practice medicine. It assesses of a doctor’s professional development, workplace performance and reflection and aims to provide assurance that doctors are up-to-date and fit to practice. The dominant assessment mechanism is a portfolio. The content of the revalidation portfolio has been increasingly prescribed and the assessment of the SI is a fundamental aspect of the appraisal process which ultimately allows Responsible Officers (ROs) to make recommendations on revalidation. ROs, themselves doctors, were the first to undergo UK revalidation. This qualitative study explored the perceptions of ROs and their appraisers about the use of this portfolio of evidence in a summative revalidation appraisal.Methods28 purposefully sampled London ROs were interviewed following their revalidation appraisal and 17 of their appraisers participated in focus groups and interviews. Thematic analysis was used to identify commonalities and differences of experience.ResultsSI was mostly easy to provide but there were challenges in gathering certain aspects. ROs did not understand in what quantities they should supply SI or what it should look like. Appraisers were concerned about making robust judgements based on the evidence supplied. A lack of reflection from the process of collating SI and preparing for appraisal was noted and learning came more from the appraisal interview itself.ConclusionsMore explicit guidance must be available to both appraisee and appraiser about what SI is required, how much, how it should be used and, how it will be assessed. The role of SI in professional learning and revalidation must be clarified and further empirical research is required to examine how best to use this evidence to make judgments as part of this type of appraisal.

The hidden value of a mock OSCE

Such is the demand,these sessions are frequentlyoffered by medical schools andhospitals hosting clinicalstudents.As foundation year (FY) doc-tors, we volunteered to organise amock OSCE for the final-yearstudents at our hospital. Initiallywe had expected it to be aimedprimarily at the students prepar-ing to sit their examination, andfor their sole benefit; however, aswe realised how large the organi-sational task was, we appreciatedhow much we could learn from ourown involvement, and also thelearning opportunities for ourmock examiners and third-year‘helpers’. We therefore tailoredour organisation in order thatthe OSCE day would be of edu-cational value to all involved. Weaimed to engage all participants,encouraging them to use theirparticipation as a tool forlearning and to contribute totheir continuing professionaldevelopment.Our main outcome was thatfinal-year medical students wereable to experience a simulatedexamination at the level expectedin their end-of-year examina-tions. They were observed per-forming and received feedback onthis. As mock OSCE organisers whohad recently taken the examina-tion ourselves, we got a differentperspective. In addition to gen-eral skills such as leadership andlogistic planning, we encountereda new, more specific, skills set.Planning an educational inter-vention, creating educationalresources to a realistic standard,liaising with senior medical staffand acquiring patients all

Teaching skills: a school‐based special study module

educator). Students and faculty members developedand taught the programme. It started with a com-pulsory introduction forum entitled ‘How to bestprofit from your clerkships’, which was followed byan elective programme of five 2-hour interactiveworkshops addressing the following six themes: one-to-one peer teaching; training in procedural skills;giving feedback; orienting peers in a new clinicalenvironment; interprofessional communication, andreflective practice based on logbook recordings.The programme ended with a formative assessmentagainst predefined criteria during a simulatedteaching interaction with a ‘standardised peer’. Theprogramme evaluation was based on students’ratings on a 12-item questionnaire (global evalua-tion, objectives, expectations, usefulness, format,etc.) and their oral feedback at the end of the course.Evaluation of results and impact We implemented theprogramme in 2006–07 with 16 elective Year 4students in a 6-year curriculum. All of them success-fully reached the predetermined performance levelsand impressed examiners during their interactionswith standardised peers. Students expressed highlevels of satisfaction, both during the oral feedbacksession and in the evaluation questionnaire (meanrange among the tested dimensions 4.1 [standarddeviation, SD 0.26] to 4.8 [SD 0.45], on a Likert scaleof 1–5, 5 being the highest level). Our first experiencewas thus encouraging and we are currently offeringthe programme for a second year, during which threeformer students have become coaches for the newstudents. In conclusion, students successfully initiatedan undergraduate elective programme providingtools for peer teaching in real clinical practice. Itspotential impact on preparing future residents’teaching skills requires further research.