Susan J. Hawken

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.

Academic dishonesty and ethical reasoning: Pharmacy and medical school students in New Zealand

Background: There is ample evidence to suggest that academic dishonesty remains an area of concern and interest for academic and professional bodies. There is also burgeoning research in the area of moral reasoning and its relevance to the teaching of pharmacy and medicine. Aims: To explore the associations between self-reported incidence of academic dishonesty and ethical reasoning in a professional student body. Methods: Responses were elicited from 433 pharmacy and medicine students. A questionnaire eliciting responses about academic dishonesty (copying, cheating, and collusion) and their decisions regarding an ethical dilemma was distributed. Multivariate analysis procedures were conducted. Results: The findings suggested that copying and collusion may be linked to the way students make ethical decisions. Students more likely to suggest unlawful solutions to the ethical dilemma were more likely to disclose engagement in copying information and colluding with other students. Conclusions: These findings imply that students engaging in academic dishonesty may be using different ethical frameworks. Therefore, employing ethical dilemmas would likely create a useful learning framework for identifying students employing dishonest strategies when coping with their studies. Increasing understanding through dialog about engagement in academic honesty will likely construct positive learning outcomes in the university with implications for future practice.

Changing the learning environment: the medical student voice.

Background:  Students’ perceptions of their learning environment influence both how they learn and the quality of their learning outcomes. The clinical component of undergraduate medical courses takes place in an environment designed for clinical service and not teaching. Tension results when these two activities compete for resources. An impending increase in medical student numbers led us to assess the learning environment with a view to planning for the future.

The Quality of Life of Medical Students Studying in New Zealand: A Comparison With Nonmedical Students and a General Population Reference Group

Background: Quality of life is an essential component of learning and has strong links with the practice and study of medicine. There is burgeoning evidence in the research literature to suggest that medical students are experiencing health-related problems such as anxiety, depression, and burnout. Purpose: The aim of the study was to investigate medical students’ perceptions concerning their quality of life. Methods: Two hundred seventy-four medical students studying in their early clinical years (response rate = 80%) participated in the present study. Medical students were asked to fill in the abbreviated version of the World Health Organization Quality of Life questionnaire to elicit information about their quality of life perceptions in relation to their physical health, psychological health, social relationships, and environment. Subsequently, their responses were compared with two nonmedical students groups studying at a different university in the same city and an Australian general population norm. The findings were compared using independent groups t tests, confidence intervals, and Cohens d. Results: The main finding of the study indicated that medical students had similar quality of life perceptions to nonmedical students except in relation to the environment domain. Furthermore, the medical student group scored lower than the general population reference group on the physical health, psychological health, and environment quality of life domains. Conclusions: The results suggest that all university students are expressing concerns related to quality of life, and thus their health might be at risk. The findings in this study provided no evidence to support the notion that medical students experience lower levels of quality of life compared to other university students. When compared to the general population, all student groups examined in this study appeared to be experiencing lower levels of quality of life. This has implications for pastoral support, educationalists, student support personnel, and the university system.

Quality of life: international and domestic students studying medicine in New Zealand

International students form a significant proportion of students studying within universities in Western countries. The quality of life perceptions of international medical students in comparison with domestic medical students has not been well documented. There is some evidence to suggest that international medical students may have different educational and social experiences in relation to their domestic peers. This study investigates the levels of quality of life experienced by international and domestic students studying medicine. A total of 548 medical students completed the abbreviated version of the World Health Organization Quality of Life questionnaire. The focus of the analysis was to evaluate differences between international and domestic students in their early clinical years. The responses were analysed using multivariate analysis of variance methods. International medical students are experiencing lower social and environmental quality of life compared with domestic peers. International medical students in New Zealand have expressed quality of life concerns, which likely have an impact on their academic achievement, feelings of wellness, acculturation, and social adaptation. The findings reinforce the need for creating stronger social networks and accessible accommodation, as well as developing systems to ensure safety, peer mentorship and student support.

Motivation to Learn, Quality of Life and Estimated Academic Achievement: Medical Students Studying in New Zealand

The quality of life of medical students and their motivation to learn are critical factors that have an impact on their ability to learn. The aim of this study was to investigate the associations between medical students’ perceptions of their quality of life, motivation to learn, and estimated grade at the end of the academic year. Two hundred and seventy-four medical students at years four and five of medical school participated in the study. Students filled in a demographic survey form, and shortened versions of the World Health Organization Quality of Life Questionnaire and the Motivated Strategies for Learning Questionnaire. Significant correlations between quality of life and motivation to learn measures were obtained. Second, students who scored high on aspects of quality of life and motivation to learn also scored significantly higher on estimates of written grade. In conclusion, the results suggest that medical students’ perceptions about quality of life and motivation to learn are linked to estimation of academic achievement. The findings of this study further resonate with a key conceptual model in the motivation literature, which promotes the importance of creating opportunities for mastery learning, engaging task value, producing optimal learning contexts, and creating mechanisms for coping with and managing the inevitable anxiety-provoking learning experiences that medical students face.

Reasons for academic honesty and dishonesty with solutions: a study of pharmacy and medical students in New Zealand

This paper presents students’ views about honest and dishonest actions within the pharmacy and medical learning environments. Students also offered their views on solutions to ameliorating dishonest action. Three research questions were posed in this paper: (1) what reasons would students articulate in reference to engaging in dishonest behaviours? (2) What reasons would students articulate in reference to maintaining high levels of integrity? (3) What strategies would students suggest to decrease engagement in dishonest behaviours and/or promote honest behaviours? The design of the study incorporated an initial descriptive analysis to interpret students’ responses to an 18-item questionnaire about justifications for dishonest action. This was followed by a qualitative analysis of students’ commentaries in reference to why students would engage in either honest or dishonest action. Finally a qualitative analysis was conducted on students’ views regarding solutions to dishonest action. The quantitative results showed that students were more likely to use time management and seriousness justifications for dishonest actions. The qualitative findings found that students’ actions (honest or dishonest) were guided by family and friends, the need to do well, issues of morality and institutional guidelines. Students suggested that dishonest action could be ameliorated by external agencies and polarised views between punitive and rewards-based mechanisms were offered. These results suggest that these students engaged in dishonest action for various reasons and solutions addressing dishonest action need to consider diverse mechanisms that likely extend beyond the educational institution.

Medical Students in Early Clinical Training and Achievement Motivation: Variations According to Gender, Enrollment Status, and Age

The purpose of this study was to examine the achievement motivation perceptions of medical students in early clinical training, to find out if variations in such perceptions may relate to students’ gender, age, ethnicity, or enrolment status (domestic or international). The participants were 272 4th and 5th year medical students who voluntarily completed the short version of the Motivated Strategies for Learning Questionnaire. The students’ scores in self-efficacy, intrinsic value, test anxiety, cognitive strategy use, and self-regulation, derived from the questionnaire, were analyzed in relation to the students’ gender, ethnicity, and enrolment status, along with their age as a possible covariate. Female students evidenced lower self-efficacy and higher test anxiety compared to their male counterparts. Likewise, international students were found to have lower self-efficacy and higher test anxiety compared to domestic students; the international students also scored lower in intrinsic value perception. Age was found to significantly correlate with self-efficacy, test anxiety, and intrinsic value perception. The findings suggest a need to use strategies like role-modeling to counteract the possible detrimental effects of negative gender stereotyping on female students’ self-efficacy — especially female students from non-Western cultural backgrounds. The higher levels of test anxiety evidenced by some groups may be understandable in the context of clinical training, but nevertheless indicate a need for the formulation and provision of appropriate forms of skills training and support for students — including communication skills training and support for international students.

General surgical interns contributing to the clerkship learning environment of medical students

Background: Junior doctors are increasingly promoted as clinical teachers but there is limited understanding of how they contribute to medical student clerkship learning. Aim: To describe contributions made by general surgical interns to the student clerkship learning environment. Methods: The mixed-methods study involved two focus groups attended by volunteer interns and Year 4 students, and a student questionnaire collecting quantitative data. Focus group transcripts were evaluated using a qualitative analysis system. Results: Six interns and five students attended focus groups in June and August 2011. Qualitative analysis found that intern contributions to student learning can be grouped under four distinct roles: physician, supervisor, teacher and person. Data from 85 questionnaires (response rate 57%) revealed that intern-student encounters occurred daily in the surgical wards and emergency department. Interns demonstrated bedside procedures, clerical/administrative tasks and interpretation of laboratory and radiological investigations. Appreciated for approachability, friendliness and ability to relate to students, interns also played a crucial role in integrating students into the surgical team. This significantly correlated to clerkship enjoyment. Conclusions: Surgical interns improve clerkship learning environments by demonstrating “personal” skills such as friendliness, approachability and relatedness. This has important implications for preparing interns as clinical preceptors.

Exploring educational interventions to facilitate health professional students’ professionally safe online presence

Abstract Objective: To establish the most effective approach and type of educational intervention for health professional students, to enable them to maintain a professionally safe online presence. Method: This was a qualitative, multinational, multi-institutional, multiprofessional study. Practical considerations (availability of participants) led us to use a combination of focus groups and individual interviews, strengthening our findings by triangulating our method of data collection. The study gathered data from 57 nursing, medical and paramedical students across four sites in three countries (Aotearoa/New Zealand, Australia and Wales). A content analysis was conducted to clarify how and why students used Facebook and what strategies they thought might be useful to ensure professional usage. A series of emergent codes were examined and a thematic analysis undertaken from which key themes were crystallized. Results: The results illuminated the ways in which students use social networking sites (SNS). The three key themes to emerge from the data analysis were negotiating identities, distancing and risks. Students expressed the wish to have material about professional safety on SNS taught to them by authoritative figures to explain “the rules” as well as by peers to assist with practicalities. Our interactive research method demonstrated the transformative capacity of the students working in groups. Conclusions: Our study supports the need for an educational intervention to assist health professional students to navigate SNS safely and in a manner appropriate to their future roles as health professionals. Because health professional students develop their professional identity throughout their training, we suggest that the most appropriate intervention incorporate small group interactive sessions from those in authority, and from peers, combined with group work that facilitates and enhances the students’ development of a professional identity.