Nichola C. Wilson

Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school

Introduction International interest in peer-teaching and peer-assisted learning (PAL) during undergraduate medical programs has grown in recent years, reflected both in literature and in practice. There, remains however, a distinct lack of objective clarity and consensus on the true effectiveness of peer-teaching and its short- and long-term impacts on learning outcomes and clinical practice. Objective To summarize and critically appraise evidence presented on peer-teaching effectiveness and its impact on objective learning outcomes of medical students. Method A literature search was conducted in four electronic databases. Titles and abstracts were screened and selection was based on strict eligibility criteria after examining full-texts. Two reviewers used a standard review and analysis framework to independently extract data from each study. Discrepancies in opinions were resolved by discussion in consultation with other reviewers. Adapted models of “Kirkpatrick’s Levels of Learning” were used to grade the impact size of study outcomes. Results From 127 potential titles, 41 were obtained as full-texts, and 19 selected after close examination and group deliberation. Fifteen studies focused on student-learner outcomes and four on student-teacher learning outcomes. Ten studies utilized randomized allocation and the majority of study participants were self-selected volunteers. Written examinations and observed clinical evaluations were common study outcome assessments. Eleven studies provided student-teachers with formal teacher training. Overall, results suggest that peer-teaching, in highly selective contexts, achieves short-term learner outcomes that are comparable with those produced by faculty-based teaching. Furthermore, peer-teaching has beneficial effects on student-teacher learning outcomes. Conclusions Peer-teaching in undergraduate medical programs is comparable to conventional teaching when utilized in selected contexts. There is evidence to suggest that participating student-teachers benefit academically and professionally. Long-term effects of peer-teaching during medical school remain poorly understood and future research should aim to address this.

The relationship between academic assessment and psychological distress among medical students: a systematic review

A systematic review was conducted to determine the relationship between academic assessment and medical student psychological distress with the aim of informing assessment practices. A systematic literature search of six electronic databases (Medline, Medline IN PROCESS, PubMed, EMBASE, Psychinfo, ERIC) from 1991 to May 2014 was completed. Articles focusing on academic assessment and its relation to stress or anxiety of medical students were included. From 3,986 potential titles, 82 full-text articles were assessed for eligibility, and 23 studies met review inclusion criteria. Studies focused on assessment stress or anxiety, and assessment performance. Consistent among the studies was the finding that assessment invokes stress or anxiety, perhaps more so for female medical students. A relationship may exist between assessment stress or anxiety and impaired performance. Significant risks of bias were common in study methodologies. There is evidence to suggest academic assessment is associated with psychological distress among medical students. However, differences in the types of measures used by researchers limited our ability to draw conclusions about which methods of assessment invoke greater distress. More rigorous study designs and the use of standardized measures are required. Future research should consider differences in students’ perceived significance of assessments, the psychological effects of constant exposure to assessment, and the role of assessment in preparing students for clinical practice.

Factors Influencing Intentions of Female Medical Students to Pursue a Surgical Career

abstracts for potentially relevant articles and these wereobtained in full text for closer inspection. The final selec-tion of articles was based on the following criteria:1. Published in English after 1990.2. Study results not duplicated in earlier publications.3. A significant proportion of study participants (>60%)were students enrolled in a medical program.4. Study results identified factors that influence studentintentions to pursue a career in surgery, and in partic-ular, general surgery. Studies that focused on interestin surgical specialties were included, given that thisalways included general surgery, but those that focusedon only 1 surgical subspecialty other than generalsurgery (eg, orthopaedics, urology, cardiothoracic,vascular) were excluded. No standard definitions wereapplied to the terms surgery and surgical specialties.5. If participants included women and men, study inves-tigators analyzed the data by sex to identify sex-specificfactors and draw separate conclusions about womenand men.Data management techniquesData extractionA standardized data extraction and critical appraisalinstrument was constructed by the investigators usingan electronic spreadsheet (Microsoft Excel Mac OS X2008, Microsoft Corporation) for the purpose of thisreview and included the following sections andcomponents:1. Study introduction: research objectives and rationale.2. Study context: study setting, details of study partici-pants, description of medical program.3. Study methods and materials: study design, participantrecruitment and sampling, study duration and follow-up, method(s) of data collection, psychometric proper-ties of data collection instruments, resources used, anddata analysis.4. Study results: main study findings, measures of func-tional significance (effect size, proportion of variance),attendance and drop-out rates.5. Discussion of study results: significance and practicalimplications of study findings, study strengths andlimitations, guidance on future research topics.6. Study conclusions.7. Appraisal for risks of bias: recruitment or selectionbias, data analysis and interpretation bias, incompleteand selective reporting bias, other sources of bias.Each selected article was analyzed independently by atleast 2 investigators (TY, AJ, and MC) and data wereextracted using the instrument described above.Data analysisDiscrepancies in opinions between 2 investigators wereidentified and final consensus was reached through face-to-face discussions and mediation by the other investiga-tors. The investigators analyzed study methodologies,defined common themes from study findings, and triedto find chronologic patterns in their occurrence. Selectedstudies were divided into 2 groups: those published beforeand during the year 2000 and those published after 2000.Career-influencing factors directly reported by studentparticipants were differentiated from factors that wereidentified indirectly through means such as data correla-tion and association analysis.

Reported outcomes of lower limb orthopaedic surgery in children and adolescents with cerebral palsy: A mapping review

Lower limb surgery is often performed in ambulatory children with cerebral palsy (CP) to improve walking ability. This mapping review reports on outcome measures used in the published literature to assess surgical results, determine range and frequency of use, and map each measure to the International Classification of Functioning, Disability and Health.

Radiological outcome of reconstructive hip surgery in children with gross motor function classification system IV and V cerebral palsy.

Hip subluxation is common in children with cerebral palsy (CP). The aim of this study was to describe the radiological outcome of reconstructive hip surgery in children with CP, gross motor function classification system (GMFCS) level IV and V, and determine whether the GMFCS level plays a predictive role in outcome. This was a retrospective cohort study conducted at a tertiary-level pediatric hospital with a CP hip surveillance program. Of 110 children with GMFCS IV and V CP registered for hip surveillance, 45 underwent reconstructive hip surgery between 1997 and 2009, defined as varus derotational proximal femoral osteotomy with or without additional pelvic osteotomy. Eleven children were excluded because of lack of 12-month follow-up (n=10) or missing clinical records (n=1). Thus, 21 GMFCS IV children (median age 6 years at surgery) and 13 GMFCS V children (median age 5 years at surgery), who underwent 58 index surgeries, were included in the study. Clinical records and radiology were reviewed. The two surgical groups were femoral osteotomy (varus derotational femoral osteotomy with an AO blade plate or femoral locking plate fixation), or femoral ostetotomy with additional pelvic osteotomy. Reimer’s migration percentage (MP) was calculated from anteroposterior pelvis radiographs to determine the outcome for each hip independently. Failure was defined as MP of greater than 60% or further operation on the hip. Reconstructive surgeries were performed for 58 hips with a median preoperative MP of 55%. There were 15 failures at a median of 62 months, including nine failures in 35 GMFCS IV hips and six failures in 23 GMFCS V hips. Overall, GMFCS V hips tended to fail earlier, (hazard ratio 2.3) with a median time to failure of 78 and 39 months for GMFCS IV and V hips, respectively. Combined femoral and pelvic osteotomies had the lowest failure rates in both groups of patients. The GMFCS classification may have some predictive value for outcomes following reconstructive hip surgery, with surgery for GMFCS V hips tending to fail earlier.

How does the functional mobility scale relate to capacity-based measures of walking ability in children and youth with cerebral palsy?

ABSTRACT This study examined the relationship between walking performance rated on the Functional Mobility Scale (FMS) and measures of walking capacity in children with cerebral palsy (CP). A total of 143 participants with spastic CP (GMFCS levels I to III) were rated on the FMS and had assessment of self-selected walking speed (WS), fast 1 minute walk test (1MWT) and six minute walk test (6MWT). For each FMS distance, children rated 6 had significantly better 6MWT than children scored 5; children rated FMS 2, 3, or 4 had lower walking capacity measures but were not clearly distinguishable from each other. The 6MWT was an independent predictor of variation in FMS score, accounting for 20% to 27% of the variance across the three FMS distances. While walking capacity impacts on community mobility in children with CP much of the variance remains unexplained, suggesting that other factors play an important role.

The effect of a non‐surgical orthopaedic physician on wait times to see a paediatric orthopaedic surgeon

High referral volumes to paediatric orthopaedic surgeons create long clinic waiting lists. The use of extended scope roles for doctors and health professionals is one strategy to address these wait times. We completed a 6‐month trial of a non‐surgical paediatric orthopaedic physician role (NSP) to help manage non‐urgent referrals to our service from local general practitioners (GPs).