The Effect of Student–Tutor Ratios: Experimental Evidence From a Pilot Online Math Tutoring Program

IntroductionBurnout in medical students is extensive and a critical issue. It is associated with increased rates of depression, suicide, and poor perception of the educational environment. Enhancing resilience, the ability to adapt well in the face of adversity, is a potential tool to mitigate burnout and improve medical student wellness.MethodsOur resilience curriculum consisted of facilitated workshops to cultivate resilience in medical students during their core clerkship rotations. This curriculum served as an introduction to the concept of resilience and taught skills to cultivate resilience and promote wellness. The sessions allowed for identification of and reflection on stressors in the clinical learning environment, including straining team dynamics, disappointment, and uncertainty. Educational sessions included resilience skill-building exercises for managing expectations, letting go of negative emotions, dealing with setbacks, and finding meaning in daily work. Associated materials included lesson plans for small-group facilitators, learner pre- and postcurriculum surveys, and a social media activity guide.ResultsThis curriculum was delivered to 144 clerkship students at two academic institutions over the 2017–2018 academic year. Sessions were well received by medical students, with the majority of students stating that the sessions should continue. The majority of attendees found the sessions valuable and learned new ways to approach challenges.DiscussionStudents valued connecting with peers and feeling less alone through their participation. A challenge was constructing a setting conducive to comfortable reflection for all learners. Not all students found these sessions necessary. Sessions may have improved resilience levels.

Much has been written about individual tutoring in oral and silent reading, and in writing, for high-potential students with specific language disability. Less has been said or recorded about small group teaching for English-disabled children of all ages, especially middle school students who may be in grades six through nine. Since I have done diagnostic teaching with middle school groups for the past seven years in both public and private schools, it seems reasonable for me to write about the academic and personal gains students make and to share techniques that work. The diagnostic teaching referred to in this article is based on the English language continuum developed in both the green and red versions of the Gillingham-Stillman Manual: Remedial Techniques for Children with Specific Disability in Reading, Spelling, and Penmanship. A teacher needs an intimate knowledge of the sound/symbol relation ships of English words, and a facility with the structure of phrases, sentences, and paragraphs. He or she also needs skills in the dynamics of human relations in order to guide groups so that students learn to interact by taking from and giving to their peers. In the fall of 1969 I began teaching several public middle school stu dents. Five were 6th graders, two 7th graders, and one 8th grader. Two had been tutored before and had been diagnosed as dyslexic. One 6th grader had serious language problems but had not received extra help the year before because he had made it so difficult for a tutor. Five had no previous tutoring but were working at least two grades below level in reading and spelling. All had above-average to high potential. Work with these students was all on an individual basis, forty minutes per day, three days per week. Information sheets on all students were made out so that I would have

PURPOSE: This study examined differences in urban middle school students’ physical activity (PA), enjoyment, and self-efficacy during small-group and full-class exergaming sessions. METHODS: Forty-seven urban middle school students (83% African American; 25 females; X̅BMI = 24.3 ± 3.1 kg/m2) completed two separate 15-minute exergaming sessions: (1) Xbox One Kinect Just Dance in small groups (n = 3-4); and (2) Xbox One Kinect Just Dance as a full-class (n = 23-24). Participants’ time in sedentary behavior, light PA (LPA), and moderate-to-vigorous PA (MVPA) and steps were retrieved from ActiGraph GT3X+ accelerometers worn at the right hip, with enjoyment and self-efficacy assessed immediately after each exergaming session via validated Enjoyment and Self-efficacy Surveys. A dependent t-test examined mean differences for all outcomes between the two exergaming sessions with the significance level set at p < 0.05. Lastly, effect sizes were calculated using Cohen’s d. RESULTS: Significant differences between the two exergaming sessions were observed for time in sedentary behavior and MVPA, steps, and enjoyment (t = 3.9-7.4). In detail, participants spent significantly more time in sedentary behavior during the full-class session compared to the small-group session (5.9 ± 5.2 minutes; 3.5 ± 2.7 minutes, respectively: p < 0.001, d = 0.57) and significantly more time in MVPA during small-group session compared to full-class session (5.5 ± 2.2 minutes; 2.1 ± 2.8 minutes, respectively: p < 0.001, d = 0.85). Moreover, the small-group session resulted in significantly higher steps than the full-class session (504.2 ± 132.1; 387.8 ± 122.1, respectively: p = 0.01, d = 0.50). Lastly, participants reported significantly greater enjoyment during the small-group session compared to the full-class session (3.5 ± 1.1; 3.2 ± 1.0, respectively: p = 0.02, d = 0.37). There were no statistically significant differences between sessions for time in LPA and self-efficacy (p > 0.05). CONCLUSION: Findings suggested small-group exergaming offered less time in sedentary behavior, but had greater time in MVPA, greater steps, and greater enjoyment compared to full-class exergaming, suggesting small-group exergaming to be ideal for promoting enjoyable exercise at higher intensities and lower sedentary time in urban adolescents.

Children who display symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in classrooms are reputed to display fewer symptoms in one-on-one interaction. We tested this hypothesis with children who received tutoring for reading and behavior problems. We selected 30 children whose teacher-rated ADHD symptoms fit a pattern consistent with DSM criteria for the diagnosis. Teachers rated the frequency of symptoms in classrooms before and after tutoring. Tutors rated the frequency of the same behaviors during individual tutoring sessions. Children's ADHD symptoms, as well as oppositional symptoms, were significantly lower in the tutoring sessions than in the classrooms. The effect sizes for the difference between behavior in classrooms and in individual tutoring ranged from 0.7 to 2.5 standard deviations. These effect sizes appear as large as those reported for the effect of stimulant medication on ADHD symptoms. All 30 children at preintervention fit the pattern for ADHD using teachers' ratings of classroom behavior; 87% of them did not meet those DSM criteria using tutors' ratings of behavior in individual sessions. The confound of different raters for the two different settings must be resolved by another study with a new design.

Students engaged in problem-based learning (PBL) units solve ill-structured problems in small groups, and then present arguments in support of their solution. However, middle school students often struggle developing evidence-based arguments (Krajcik et al., J Learn Sci 7:313–350, 1998). Using a mixed method design, the researchers examined the use of computer-based argumentation scaffolds, called the Connection Log, to help middle school students build evidence-based arguments. Specifically we investigated (a) the impact of computer-based argumentation scaffolds on middle school students’ construction of evidence-based arguments during a PBL unit, and (b) scaffold use among members of two small groups purposefully chosen for case studies. Data sources included a test of argument evaluation ability, persuasive presentation rating scores, informal observations, videotaped class sessions, and retrospective interviews. Findings included a significant simple main effect on argument evaluation ability among lower-achieving students, and use of the scaffolds by the small groups to communicate and keep organized.

This study examined the features of peer argumentation in middle school students' scientific inquiry. Participants were two boys and six girls in grade 8 of a middle school in Seoul, Korea. Students engaged in open inquiry activities in small groups. Each group prepared the report for peer review and then, during the peer discussion, presented their inquiry results while another group acted as critics, in a way similar to conference presentations by scientists. This study's data sources included audio- and video-tapes of discussions, copies of student reports, questionnaires completed by the students and transcripts of interviews with the students. It was found that the critical peer discussion in general proceeded through the following four stages: Focusing, Exchanging, Debating and Closing. In addition, 75.6% of evidence used in students' arguments was personal evidence and students used various cognitive and social strategies in the critical discussion. For an effective critical discussion, making good use of the Focusing Stage was found to be important factor. Students improved their interpretation and methods of experiment during the argumentation process and this feedback made the inquiry circular. Finally, we identify a model of argumentative scientific inquiry as an open inquiry that has the key components of authentic scientific inquiry.

This article provides case studies of three middle school students ‐ two female and one male ‐ who participated in an individual summer tutoring program designed to improve students’ reading comprehension and to encourage students to think critically about texts. With the researcher, students read and discussed Internet texts and wrote responses. An Informal Reading Inventory (Burns & Roe, 1999) was administered both prior to and at the conclusion of the program for measurement of improvement in reading comprehension. Using the four resources model (Freebody & Luke, 1990), this study illustrates possibilities for instruction in both comprehension and critical literacy.

Yoga therapy DYADS: A novel approach to chronic pain management in underserved populations

Wood, W. B., & Tanner, K. D. (2012). The role of the lecturer as tutor: doing what effective tutors do in a large lecture class. CBE-Life Sciences Education, 11(1), 3-9. Retrieved from https://dx.doi.org/10.1187%2Fcbe.11-12-0110

Curriculum evaluations are used to plan future revisions and other improvements in curriculum design. Most models are summative and occur at the end of a course, so improvements in instruction may be delayed. In this article, the authors describe the formative curriculum evaluation model adopted at the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania. In their model, representative student feedback is gathered in real time and used to modify courses and improve instruction. The central features of their continuous feedback model include developing a small cadre of preclinical and clinical student evaluators who are trained to obtain classwide input regarding all aspects of the curriculum, including teacher effectiveness, and meet regularly (weekly or monthly) with relevant faculty and administrators. The authors show how this curriculum evaluation approach maximizes student involvement in course development and provides opportunities for rapid improvements in course content and instruction as well as for the identification of barriers to effective clinical and preclinical educational experiences.

A large body of evidence links exposure to childhood trauma with negative health outcomes. Training future physicians to recognize and respond to trauma is paramount, and engaging medical students in the preclinical years affords the opportunity to foster the development of a trauma-informed lens that can then be solidified during clinical clerkships. We developed and implemented a 4-hour trauma-informed care (TIC) symposium for 179 second-year medical students at the George Washington University School of Medicine and Health Sciences during the Patients, Populations, and Systems course. The symposium included three interactive didactic sessions focusing on the connection between trauma and health and TIC principles. A facilitated small-group discussion allowed students to apply TIC principles to a patient case, followed by reflection and evaluation. The overall rating of the TIC symposium was 4 out of 5. Strengths included integration of a small-group case with discussion on application of TIC in practice, experience of the lecturers and small-group facilitators, and review of research relating adversity to specific health outcomes. Suggestions for improvement included incorporating role-play and standardized patients. Content analysis of student reflections mapped to the domains of physician competency. A 4-hour symposium can affect student knowledge and understanding of TIC. Teaching TIC presents an opportunity to prepare medical students for a career in medicine through cultivation of required physician competencies. Next steps include enhanced opportunities to practice TIC and follow-up analysis of participants to determine behavior change during clinical years.

PURPOSEMany medical schools have adopted a shortened basic science curriculum in favor of a longer clinical curriculum. In an attempt to reduce required contact hours without compromising important high‐yield content, programs have developed and implemented specific learner‐centered teaching strategies We sought to utilize peer‐directed small‐group sessions to enhance student learning in anatomy within a condensed pre‐clinical curriculum . Sessions were designed to guide learners through specific cadaveric prosections.METHODSThree voluntary small‐group sessions were designed to correlate with spinal cord, facial nerve/orbit, and ischioanal fossa prosections in a Medical Gross Anatomy course for first‐year medical students. There was no penalty or reward for attending these sessions, and the prosections were made available to all students, regardless of participation. A short survey was administered after each session. This survey assessed students perceived comfort level with the content area before and after the small‐group session. Student performance on specific test questions related to sessions topics was analyzed and compared between those who attended the small group sessions, and those who did not to determine patterns of performance on the specific topics.RESULTSThere was an increase in the student perceived level of comfort with the material after each of the three small group sessions for both the 2017 and 2018 M1 classes. On a 1‐to‐5 Likert scale (1 lowest; 5 highest) of perceived comfort level with session content, averages before the three small group sessions were significantly increased for each small group session for both years. Analysis of changes in student performance regarding test performance resulted in a slight increase in performance on most questions for those who attended the small groups compared to those who did not. Word cloud analysis of the write‐in portion of the survey revealed several common themes that students thought the small group setting was a strength, and having the facilitator ask more questions of the participants, being a common area for improvement.CONCLUSIONThis work supports peer‐directed and small group learning as an effective avenue for student success in M1 Gross Anatomy. Further analysis of student performance and future studies will help determine whether this could be an effective teaching strategy utilized by other courses during the basic science years.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Do You See What I See? Standardized Imaging Education for Therapists

The purpose of this project was to teach students how to work effectively with patients in the area of health-behavior change. As part of the patient-doctor course, first-year medical students worked with diabetic patients who were selected by their primary physicians. In preparation for their patient interactions, students were taught basic communication concepts and the role of the relationship in improving patient outcomes, and continuity issues were addressed as students learned to collaboratively develop behavioral-change plans with their patients and then followed their patients' progress over the course of the year. An educational research trial was conducted to compare the traditional community placement track (shadowing) with the health-coaches track. Students were randomly assigned to the two educational tracks. Health coaches were assigned in pairs to a family medicine patient with diabetes. Under supervision by the patient's medical provider, student pairs worked with the patient in an area of health-behavior change (i.e., weight loss, smoking cessation, exercise, or adherence to medication regimen). Students were required to have at least six patient contacts over the course of a year, consisting of at least three face-to-face visits and including one home visit. Didactic sessions with health coaches taught by either a behavioral consultant or health educator covered the basics of diabetes and behavior-change areas appropriate to respective patients. Students were also given reading assignments from communication and health-behavior change literature and handouts for patients. Behavior-change specialists were available as needed for consultation. In support of the health coaching process, students participated in eight small-group discussion sessions (eight students each) led by a behavioral change specialist. Small-group sessions lasted approximately 90 minutes each and contained didactic and experiential elements. Topics were: "Getting Started" (interviewing, the patient's story), "Fundamentals of a Home Visit," "Changing Behaviors" (stages of change, relapse prevention), "Home Visit Feedback" (report and reflections), "Challenging Patients to Change" (difficulties, challenging irrational ideas), "Giving Direct Guidance," "Non-verbal Skills," "Ending and Celebrating" (terminating the helping relationship). Evaluation methods included a pre- and post-physician belief scale completed by students, pre- and post-provider's evaluation of patient, and a patient-completed health behavior questionnaire. As available, patients' HbA1C levels were compared pre- and post-intervention. As expected, initially some health coach students complained about their perceived increased workloads compared with the workloads of students in the shadowing track. Some students also expressed reservations about their abilities to be effective with their patients, but these complaints diminished as students made contact with patients. For many, this opportunity to establish continuity relationships with patients helped students begin to understand difficulties inherent in effecting health-behavior change. Some students expressed appreciation for the opportunity to discuss their increased self-awareness about communication as well as relationship difficulties and strengths during the small-group sessions. Data analysis is under way. Lessons learned from this project influenced a major first-year curriculum revision the following year, resulting in increased emphasis on basic communication skills and the use of small groups to reach a variety of curricular objectives.

The concept of peer-assisted learning (PAL) has been implemented at many medical faculties. Due to the Covid-19 pandemic, parts of the medical education experience transitioned to digital formats. However, little is known about PAL and online student tutorials. PAL is effective due to cognitive and social congruence. This study aims to investigate these concepts in an online student tutorial on taking a patient’s medical history. This longitudinal study took place in a preclinical communication course on how to take a patient’s medical history. In an online student tutorial, the students learned how to take a patient’s psychosocial medical history. Using standardised questionnaires, cognitive and social congruence were assessed. T-tests of independent samples were performed for data comparison. The participants included 128 second-year medical students and 5 student tutors. Cognitive congruence (Mstudent = 4.19 ± 0.56; Mstudenttutor = 4.04 ± 0.57) and social congruence (MStudent = 4.25 ± 0.56; MStudenttutor = 4.06 ± 0.57) were high for both students and student tutors in the online setting. In comparison to the face-to-face group, students in the online setting considered the student tutors to be significantly (p < .05) more socially congruent. Learning success increased during the course; however, it was not influenced by cognitive congruence. Cognitive and social congruence are high in an online setting. The students’ learning success increased during the online tutorial. Based on the higher level of social congruence, student tutors might be very motivated to be open and approachable in an online setting. Simultaneously, students might pay more attention and participate actively in the online setting. Social and cognitive congruence contribute to the effectiveness of online student tutorials and, thus, online student tutorials should be integrated into medical training.