Near-peer Teaching Programme Research Articles

Quality improvement education for medical students: a near-peer pilot study

BackgroundQuality improvement (QI) is an essential component of modern clinical practice. Front-line professionals offer valuable perspectives on areas for improvement and are motivated to deliver change. In the UK, all junior doctors are expected to participate in QI in order to advance to the next stage of their training. However, UK undergraduates receive no standardized training in QI methods. This is perpetuated within medical schools by a lack of teaching capacity and competing priorities, and may lead to tokenistic engagement with future QI projects.MethodsWe describe a near-peer teaching programme designed to introduce students to QI methods. This pilot study was conceived and delivered in full by junior doctors and used existing resources to ensure high quality teaching content. 111 fifth-year medical students from the University of Cambridge were taught in interactive, participative workshops that encourage them to develop their own QI change ideas and projects. Core topics included the model for improvement, driver diagrams, stakeholder engagement, measurement for improvement and analysing and presenting data. Students completed surveys before and immediately after this intervention to assess their understanding of and confidence in utilizing QI methods. Questionnaires were also completed by junior doctor tutors.ResultsAnalysis of questionnaires completed before and immediately after the intervention revealed statistically significant improvements in students’ self-reported understanding of QI (p < 0.05) and confidence in applying techniques to their own work (p < 0.05). Students expressed a preference for QI teaching delivered by junior doctors, citing a relaxed learning environment and greater relevance to their stage of training. Tutors reported increased confidence in using QI techniques and a greater willingness to engage with QI in future.ConclusionsIn this single-centre study, near-peer teaching produced significant improvements in students’ self-reported understanding of QI and confidence in applying QI methods. Near-peer teaching may constitute a sustainable means of teaching essential QI skills at undergraduate level. Future work must evaluate objective measures of student engagement with and competence in conducting QI.

Analysis of a Near Peer Tutoring Program to Improve Medical Students’ Note Writing Skills

Problem: The ability to document a patient encounter is integral for any physician. Previous studies indicate that medical students’ note writing skills are poor due to a lack of formal clinical documentation instruction. Barriers to formally teaching students how to write patient notes include the significant time burden and variability in faculty feedback. Implementing a near-peer teaching program to teach students how to write a patient note can overcome these barriers and fill this curricular gap. Intervention: Fourth year medical students who completed a Teaching in Medicine elective course were trained to provide individual feedback to 1st and 2nd year students on note writing as a part of their Introduction to Clinical Medicine course. In order to determine the effect of this two year, near-peer feedback program on note writing skills, we analyzed students’ scores on the note writing portion of two Objective Structured Clinical Exams that took place at the end of the 2nd and 3rd years of medical school. Context: The near-peer feedback sessions were implemented in the Fall of 2013 during the preclinical years of the medical school curriculum. Data from students who received near-peer feedback (N = 112) were compared to a historical control group who did not receive near-peer feedback on their note writing (N = 110). Objective Structured Clinical Exam scores that were specific to note writing skills, including the history, physical exam, and differential diagnosis subscales were examined. Impact: The near-peer feedback had a positive impact on the quality of patient notes. On the end of the 2nd year Objective Structured Clinical Exam, the near-peer feedback intervention group outperformed the no feedback group on the history and physical exam subscale scores but not on the differential diagnosis subscale score. One year later, the near-peer feedback intervention group continued to outperform the no feedback group on the physical exam subscale score, but not the history or the differential diagnosis subscale scores. Lessons Learned: Near-peer teaching improves student documentation of the history and physical exam, however only the effects on the physical exam portion persist into the clinical years of training. Writing up a differential diagnosis is a skill that develops through the clerkship experience regardless of exposure to feedback in the preclinical years. Implementing near-peer teaching in the medical school setting is feasible and can provide students with valuable learning experiences without relying on clinical faculty.

Implementing Change in Neuroanatomy Education: Organization, Evolution, and Assessment of a Near-Peer Teaching Program in an Undergraduate Medical School in Greece.

In light of the current shifts in medical education from traditional lectures to more active teaching modalities, a peer-teaching program was introduced to a compulsory, second-year neuroanatomy course. A cross-sectional survey of 527 medical students in the six-year medical program of the National and Kapodistrian University of Athens was administered. The primary aim of the survey, which was distributed to second- through sixth-year medical students, who had completed the neuroanatomy course, was to assess student perception of peer teachers (PTs). Across the five years assessed, students increasingly acknowledged the contribution of PTs to their learning (P<0.001). Attributes of PTs (e.g., contribution to learning, motivation, effective usage of material, and team environment) were significantly related to the student's opinion of the importance of laboratory activities (P<0.001). Students who received "average" final grades scored the importance of laboratory exercises, and by inference PTs, significantly lower than students who received "excellent" final grades (P<0.05). The amount of training that PTs had received was also significantly related to student perceptions of a PT's contribution. Better trained PTs were associated with significantly higher scores regarding learning, motivation, and positive environment compared to less trained PTs (P<0.05). The results of the present study show that peer-teaching was well received by students attending the neuroanatomy course. While the results express the evolution of the program across the years, the findings also show that learners believed that PTs and the laboratory program contributed significantly to their understanding of neuroanatomy.

Peers as OSCE assessors for junior medical students \u2013 a review of routine use: a mixed methods study

BackgroundPeer-assisted learning is well established in medical education; however, peer tutors rarely act as assessors for the OSCE. In the compulsory, near-peer teaching programme covering basic medical skills at the University of Heidelberg, peer tutors serve as assessors on a formative OSCE. This study aimed to investigate the feasibility and acceptance of peer assessors and to survey the perceived advantages and disadvantages of their use.MethodsIn 2016 and 2017 all OSCE peer assessors (third to sixth-year medical students) and all of the peer-assessed students in 2017 (second-year-medical students) were invited to participate in a survey. Both groups were asked to complete a tablet-based questionnaire immediately after the OSCE. Peer assessors were asked to rate eight statements and the peer-assessed students to rate seven statements on a five-point Likert scale. Both were asked to comment on the advantages and disadvantages of peer-assessors.ResultsOverall, 74 of 76 peer assessors and 307 of 308 peer-assessed students participated in the study. 94% (67/74) of peer assessors and 90% (276/307) of the peer-assessed group thought that it is important to have peer tutors as assessors. Of the peer assessors, 92% (68/74) felt confident in giving structured feedback during the OSCE and 66% (49/74) felt they had improved their teaching skills. Of the peer-assessed students, 99% (306/307) were satisfied with their peers as OSCE assessors and 96% (292/307) considered the peer feedback during the OSCE as helpful. The participants mentioned structural benefits, such as lower costs, and suggested the quality of the OSCE was higher due to the use of peer assessors. The use of peer assessors was found to be beneficial for the learners in the form of high-quality feedback and an overall reduction in stress. Furthermore, the use of peer assessors was found to be beneficial for the peer assessors (improved teaching and clinical skills).ConclusionFrom a learner’s perspective, the use of peer assessors for a formative OSCE that is part of a near-peer teaching program aimed at junior medical students is favourable for all. A broad implementation of peer assessment in the formative OSCE should be encouraged to investigate effects on quality and stress-reduction.

Impact of Predoctoral Teaching Fellows on Osteopathic Medical Students: A Near-Peer Teaching Program Evaluation

Abstract Context The Touro University California College of Osteopathic Medicine (TUCOM-CA) is one of many colleges of osteopathic medicine with osteopathic manipulative medicine (OMM) predoctoral teaching fellowship programs. OMM fellows serve as near-peer teachers for preclinical osteopathic medical students (OMS) at TUCOM-CA, with the objectives of increasing student satisfaction with and understanding of the OMM curriculum. Our aim was to assess whether the TUCOM-CA fellowship program has achieved these objectives. Methods All osteopathic medical students at TUCOM-CA were sent an electronic survey. The survey items queried: frequency of and type of interaction; impact on satisfaction with and understanding of the OMM curriculum; impact on confidence in using osteopathic manipulative treatment (OMT); valuation of OMT and intention to use OMT in future clinical practice. Frequencies, means and standard deviations were calculated, omitting “no basis for evaluation” responses. Two-tailed Z-tests of proportions were utilized for analysis of statistical significance, with significance set at 95% (P&amp;lt;.05 ). Results In total, 156 of 538 (29.0%) responses were received, and 150 had sufficient data to analyze. Respondents reported varied rates and modes of interaction with OMM fellows (OMM lab table-training [97.3%] to early clinical experiences [30.9%]). Response means for items regarding satisfaction with and understanding of the OMM curriculum fell between “strongly agree” and “agree” for all activities. Many respondents (82.5%–83.8%) reported that interaction with OMM fellows increased their confidence in using OMT. Additionally, respondents who were treated with OMT by OMM fellows reported significantly higher agreement with statements about clinical utility of OMT (Z=2.6, P&amp;lt;.05) and intention to use OMT in future practice (Z=2.3, P&amp;lt;.05). Conclusions The majority of osteopathic medical students at TUCOM-CA reported significant agreement with the positive impact of interaction with OMM fellows on satisfaction with and understanding of the OMM curriculum. This supports the conclusion that the OMM predoctoral teaching fellowship program achieves its objectives to increase student satisfaction with and understanding of the OMM curriculum. The survey data also showed significantly stronger agreement with statements supporting valuation of OMT in clinical practice and intention to use OMT in the future, among respondents treated with OMT by OMM fellows.

A near-peer regional surgical teaching programme designed by medical students, delivered by junior doctors

ABSTRACTBackground: Near-peer teaching initiatives has been shown to be a highly successful method of improving student learning. There has been little data on surgical teaching initiatives of this kind and little data to show if this improves student confidence in surgical topics. This study was designed to show whether a regional surgical teaching programme, delivered by junior doctors, improves confidence levels of students prior to their final examinations. Method: Final year medical students were invited from four hospitals in the Northern deanery of England to participate in a voluntary surgical teaching day. Junior doctors were then recruited to present on various surgical topics based on their own knowledge and experience of finals examinations and working on the wards. A pre and post-course questionnaire was designed, validated and distributed to the students to assess their confidence on a five-point Likert scale of 1–5 (1- most confidence, 5- least confidence) levels in each of the 11 chosen topics. Other variables were also measured relating to the topics including visual material, enthusiasm, content relevance and communication. Results: 53 students completed the questionnaire (n = 53). There were 31 females and 22 males with a mean age of 24.7. A mean level of confidence of 2.7 pre-course and 1.6 post-course showed an increase in confidence by 68.8%. All eleven topics covered showed improvement in confidence. General Surgical Principles showed the lowest improvement in confidence from 2.683 to 1.917 (p = <0.001) compared to endocrine which showed the maximum increased in confidence from 3.650 to 1.694 (p = <0.0001). Orthopedics showed an increased in confidence from 3.010 to 1.62 (p = <0.0001). Conclusion: Near-peer education designed by medical students and delivered by junior doctors is an effective way for improving confidence levels and test results prior to finals examination and is also valuable for junior doctors.

Improving Academic Performance of Sport and Exercise Science Undergraduate Students in Gross Anatomy Using a Near-Peer Teaching Program.

Peer and near-peer teaching programs are common in medical undergraduate courses. However, there are no studies that have investigated the effectiveness of a near-peer teaching program on the academic performance of undergraduate students pursuing sport and exercise science coursework. This study was conducted to analyze the effectiveness of such a program for students who participated in a course on the functional anatomy of the locomotor apparatus. A total of 39 student participants were divided into two groups: students in one group voluntarily attended at least one session of a near-peer teaching program, and students in the other group attended no sessions. The final grade (range 0-100%) was recorded and used as an indicator of academic performance. The final grade of students who attended the near-peer teaching program (69.5 ± 16.0%) was 38.7% higher (P = 0.002, d = 1.06) than those who did not (50.1 ± 20.4%). When the academic performance of the same students was evaluated in another course (exercise physiology) that did not offer a near-peer teaching program, there were no significant differences between the groups (students who attended or did not attend the near-peer teaching program). A significant positive association was found between near-peer teaching program frequency and the number of students approved and not approved in the course (P = 0.041). A significant difference (P = 0.001) was found in the attendance at regular classes between the group who participated in the near-peer teaching program (median: 62 hours; IQR [interquartile ranges]: 4.0 hours) and those who did not (median: 58 hours; IQR: 4.0 hours). Gender was not a moderating factor on academic performance or near-peer teaching program attendance. These results highlight the effectiveness of a near-peer teaching program on the academic performance of students from a sport and exercise science degree program while enrolled in an anatomy course. Anat Sci Educ. © 2018 American Association of Anatomists.

Evaluation of ‘Asked to see patient’: a regional near-peer teaching programme

'Asked to see patient' (ATSP) is a near-peer teaching programme that aims to address the anxiety experienced during the transition from medical student to newly qualified foundation year 1 (FY1) doctor. It is delivered annually in the North West of England Foundation School just prior to the August changeover date when new doctors may feel the most stressed. Each spring, a 'Teach the teachers' training day is advertised to existing FY1 doctors; the training equips them with the knowledge to become certified ATSP teachers. Teachers subsequently deliver ATSP to incoming FY1 doctors at their trusts. Feedback on ATSP is collected from new FY1 doctors via an electronic survey. Results show that ATSP is well received, with 77% of newly qualified doctors engaging with the programme in 2016. 'Asked to see patient' is a Health Education England-endorsed teaching programme that develops clinicians who are structured and confident in their approach, and cultivates the clinical teacher in existing doctors.

Junior doctor teaching delivered by near peers.

Near-peer teaching - trainees teaching more juniortrainee colleagues - hasbeenwidely described inundergraduate medical education. Several benefits havebeen reported, including a more comfortable learning environment for learners and the development of tutors' teaching skills. Near-peer teaching programmes in postgraduate training are less commonly described in the existing literature, however. This article outlines a pilot study of a postgraduate near-peer teaching programme implemented at the Royal Victoria Infirmary, Newcastle, UK. A 16-week teaching programme was developed in which core medical trainees delivered teaching sessions to their more junior Foundation Year-2 colleagues. The teaching was based on cases that the Foundation Year-2 doctors frequently manage during clinical practice. Evaluation questionnaires were completed and learners were asked to rate their confidence in managing the cases before and after each session. Furthermore, each tutor underwent a standardised teaching assessment during their first and final sessions. Fifteen sessions were delivered by four tutors. All sessions received positive feedback from learners with nine sessions receiving a five out of five rating. In addition, the confidence ratings of the learners increased following each session. The tutors improved in all items of the teaching assessments and the overall rating of their teaching. Near-peer teaching could enhance the training of junior doctors DISCUSSION: The results of this pilot study suggest that the benefits described in undergraduate near-peer teaching programmes may also be seen in postgraduate medical education. Thus near-peer teaching could enhance the training of junior doctors, and we encourage the proliferation of such programmes to further evaluate their benefits in this setting.

Near-Peer Teaching Program for First Year Residents in Medicine

Near-Peer Teaching Program for First Year Residents in Medicine

Ten considerations for implementing effective and sustainable near-peer teaching in clinical anatomy education.

This article was migrated. The article was marked as recommended. Near-peer teaching (NPT) is becoming increasing popular in medical education. The rationale and benefits of introducing such programs have been well documented and are usually described in terms of their advantages to the teacher, students and faculty. As a team that have successfully introduced two NPT anatomy programs in the last six years at the University of Southampton, we have taken a largely evidenced based approach in offering 10 considerations to ensure the implementation of a sustainable and effective NPT program in anatomical sciences. We have highlighted important aspects of NPT that will help maximise the benefit of such programs and emphasised particular areas where careful thought is necessary. We conclude that to safeguard sustainability and consistency of any given NPT program, faculty and student partnership is required, as is the maintenance of quality control and evaluative techniques.

Near-peer teaching programme for medical students.

Near-peer teaching (NPT) is increasingly recognised as an effective method for teaching and learning within medical education. We describe a student-as-teacher programme developed for fourth-year students (MS4s) helping to deliver the second-year Respiratory Pathophysiology course at our medical school. Twelve MS4s were paired with faculty members to co-teach one or two small group case-based sessions for second-year students (MS2s). Beforehand, MS4s attended an orientation session and workshop, reviewing skills and strategies for teaching effectively. Following each teaching session co-taught by MS4s, both MS4s and MS2s completed multiple-choice surveys evaluating the MS4's teaching skills and the experience overall. MS4s also wrote reflection essays describing their experiences. Faculty member co-teachers completed a 12-question feedback form for MS4s during the session. We received 114 post-session MS2 surveys, 13 post-session MS4 surveys and 13 post-session faculty staff evaluations. The majority of MS2s reported that MS4s enhanced their understanding of the material, and considered the quality of MS4 teaching to be 'good' or 'outstanding'. Nearly all of the MS4s enjoyed their experiences and believed that the programme improved their teaching skills. Time management was the most common challenge cited by both MS4s and faculty member co-teachers. These data demonstrate that NPT is valuable for both MS2s and MS4s: MS2s benefited from the social and cognitive congruence afforded by near-peer teachers, whereas MS4s used this experience to build and enhance their skills as educators. These results support the continued involvement of MS4s in this second-year course, as well as broadening the scope of and opportunities for student teaching at our medical school and beyond. Near-peer teaching is recognised as an effective method for teaching and learning within medical education.

Near Peer Teaching of Surgical Physical Examination Skills in a Large Academic Medical Centre in Asia

The surgical physical examination is a fundamental part of medical training. We describe our experience with a near-peer teaching program for surgical physical examination skills, which involved senior medical students tutoring junior students starting their clinical rotations. We assessed scores on an Objective Structured Clinical Examination of the abdominal, vascular, and lumps examination before and after teaching. There was improvement in scores for all examinations and overall positive feedback from all students. This suggests that near-peer teaching may be a useful adjunct to faculty-led teaching of clinical skills.

Near-peer education: a novel teaching program

ObjectivesThis study aims to: 1) Evaluate whether a near-peer program improves perceived OSCE performance; 2) Identify factors motivating students to teach; 3) Evaluate role of near-peer teaching in medical education.MethodsA near-peer OSCE teaching program was implemented at Monash University’s Peninsula Clinical School over the 2013 academic year. Forty 3rd-year and thirty final-year medical students were recruited as near-peer learners and educators, respectively. A post-program questionnaire was completed by learners prior to summative OSCEs (n=31), followed by post-OSCE focus groups (n=10). Near-peer teachers were interviewed at the program’s conclusion (n=10). Qualitative data was analysed for emerging themes to assess the perceived value of the program.ResultsLearners felt peer-led teaching was more relevant to assessment, at an appropriate level of difficulty and delivered in a less threatening environment than other methods of teaching. They valued consistent practice and felt confident approaching their summative OSCEs. Educators enjoyed the opportunity to develop their teaching skills, citing mutual benefit and gratitude to past peer-educators as strong motivators to teach others.Conclusions Near-peer education, valued by near-peer learners and teachers alike, was a useful method to improve preparation and perceived performance in summative examinations. In particular, a novel year-long, student-run initiative was regarded as a valuable and feasible adjunct to faculty teaching.

Investigating the effect of distance between the teacher and learner on the student perception of a neuroanatomical near-peer teaching programme.

PurposeNear-peer teaching (NPT) is a highly valuable resource for the education of medical undergraduates with benefits to the students, teachers themselves, and the faculty. To maximise the effectiveness of such teaching programmes, the aim of this study was to determine how the student learning experience, and underpinning social and cognitive congruencies changes as the learner–teacher distance increases.MethodsSecond-year medical students at the University of Southampton participated in a series of neuroanatomy, extra-curricular revision sessions taught by the third-, fourth-, and fifth-year medical students and junior doctors. The students completed a validated questionnaire after the session rating various aspects of the teaching.ResultsAlthough all teachers delivered sessions that we rated highly with a mean perceived gain in knowledge of 18 % amongst all students, it was found that the third- and fourth-year medical students delivered a session that was rated significantly better than the fifth-year students and junior doctors across all, but one areas of feedback.ConclusionsWe believe that these findings may be explained by the diminishing social and cognitive congruencies shared between learner and teacher with increasing distance. From our results, we hypothesise that graduation is an important threshold, where there is a significant drop in congruencies between the learner and teacher, therefore, having a significant impact on the perception of the NPT session.

Two years of experience with near‐peer anatomists in a new medical school's setting

In response to the shortage of medical doctors in Israel, a new Faculty of Medicine was established in a remote locale (Galilee). Here we report on a 2 years of our near‐peer teaching program of cooperative learning. Our near‐peer teacher course was designed for 1st year medical students who successfully finished the Anatomy block, in order to develop their anatomy teaching skills, mostly for dissection, and their didactic ability, to be applied in the next academic year. In a debriefing questionnaire administered at the end of the course, on the five‐point Likert scale the overall rating for the “elective course” was 4.33. Learning prosection and anatomy demonstration skills scored 4.3 and 4.15, respectively. Importantly, the participants appeared at ease in the dissecting room amongst their peers; they were able to prepare and confidentially lead a case‐based learning session. The top course graduates (selected based on their peer evaluations to serve as near‐peer teachers) were then evaluated by their more junior peers (first‐year students), at the end of the next year's Anatomy block. On the Likert scale, the average score was 4.10, somewhat lower than the general satisfaction score for the preclinical teachers during the first‐year classes (4.22). We conclude that students as peer teachers can make a valuable contribution to the teaching faculty, especially in a new school. Personal gain in terms of confidence, focus and motivation are at least as important as practical dissection and teaching skills.

Can Near-Peer Teaching Improve Academic Performance?

Near peer teaching is becoming increasingly popular within healthcare education. The experiences and effects of near-peer teaching upon the near-peer teachers’ academic performance are poorly understood. In order to address this, the objective of this study was to examine whether a near-peer teaching program improved the overall clinical unit scores of undergraduate paramedic near-peer teachers. Students in their final year of an undergraduate paramedic, or nursing/paramedic degree were given the opportunity to volunteer as near-peer teachers for a first year clinical skills unit. The overall unit scores in a final year clinical unit of 74 students involved in the near-peer teaching program were compared with a randomly selected sample not involved. 74 students participated in this study as near-peer teachers between 2011-2013 (n=23 in 2011, n=18 in 2012, n=33 in 2013). In each year, the median clinical unit grade of participating near-peer teachers was significantly higher than that of the students not involved in the near-peer teaching program when examined using a Mann-Whitney U Test (71 vs 67, p=0.006 in 2011; 76 vs 72, p=0.007 in 2012; 75 vs 71, p=0.004 in 2013). This study has demonstrated that participation in a near-peer teaching program can result in improved overall clinical unit grades for undergraduate paramedic near-peer teachers. This study has added objective data to the variety of subjective information evaluating the effects of near-peer teaching upon the teachers themselves.

G199(P) Implementation of a Peer-Led Practice OSCE examination for Paediatric Medical Students at a busy Major Acute Trust

AimsPeer-graded practice examinations can help medical students to achieve higher results in their final exams,1 and peer-led exam revision courses have demonstrated high levels of satisfaction.2,3 Surveys show that the...

G277(P) Implementation of a Peer-Led Practice OSCE examination for Paediatric Medical Students at a busy Major Acute Trust

AimsPeer-graded practice examinations can help medical students to achieve higher results in their final exams (1), and peer-led exam revision courses have demonstrated high levels of satisfaction (2,3). Surveys show...

Near-peer teaching in clinical neuroanatomy

Near-peer teaching involves students being taught by more senior students and draws on their similar knowledge base and shared experiences. It has been used previously for teaching gross anatomy, but has not yet been reported specifically for neuroanatomy. At the University of Southampton there is no formal neuroanatomy teaching during the clinical years, and so a near-peer teaching programme was developed to support students, learning in between attending their clinical attachments. A series of seven sessions were organised and delivered by two medical students throughout the 2010/11 academic year, and each session was evaluated by using participant feedback forms. Sixty feedback forms were returned by the students, giving an average rating for the overall quality of the sessions of 4.3 out of 5.0. There was an 18 per cent increase in the student's perceived level of knowledge (p < 0.0001) as a result of our near-peer teaching sessions. The most common feedback received from our students related to the availability of handouts and expressions of gratitude. The results from this teaching development support the use of near-peer teaching in neuroanatomy. In this article we provide some evidence to suggest that students feel more confident with neuroanatomy after attending these sessions, and describe some unique advantages of this teaching programme over sessions led by faculty staff. The wider benefits to both faculty staff and student teachers are also considered.