Senior Peers Research Articles

Creating a “Safe and Supportive Environment:” Mentoring and Professional Development for Recent Black Women Doctoral Graduates

Formal structures that support doctoral student socialization are limited, while formal programs for Black women doctoral students specifically are even more scarce. The purpose of this research was to examine an early career professional development program for Black women doctoral students and its influence on the mentoring relationships developed by participants. We conducted individual interviews with six Black women who participated in the Research BootCamp®, an early career professional development program, as doctoral students. Two salient features of the program were identified, including its structure and intentional focus on intersectionality. Our findings also indicate that early career professional development provided opportunities for participants to develop sustainable mentoring relationships. The formal structure of the Research BootCamp® facilitated Black women doctoral students in developing mentoring networks through continued engagement with senior scholars and peers, provided social support, created outlets for professional development, built research capacity, and contributed to Black women’s overall socialization to the academy.

The near-peer tutoring programme: embracing the ‘doctors-to-teach’ philosophy – a comparison of the effects of participation between the senior and junior near-peer tutors

BackgroundWhile there is an increasing pool of literature documenting the benefits of near-peer tutoring programme, little is known about the benefits for junior and senior peer tutors. Knowledge of the peer tutors’ perceived benefits at different levels of seniority will aid in the development of a near-peer tutoring programme that will better fulfil both curricula and personal aspirations of near-peer tutors. We, therefore, investigated the perceived benefits of participation in a near-peer tutoring programme for junior as well as senior near-peer tutors.MethodsPre- and post-participation questionnaires were distributed to near-peer tutors after their clinical skills teaching sessions with Phase I undergraduate medical students. The Peer Tutor Assessment Instrument questionnaires were distributed to the 1) students, and to the 2) near-peer tutors (junior and senior) after each teaching and learning session for self-evaluation.ResultsThe senior near-peer tutors felt that their participation in the programme had enhanced their skills (p=0.03). As a whole, the near-peer tutors were more motivated (Pre 5.32±0.46; Post 5.47±0.50; p=0.210) to participate in future teaching sessions but did not expect that having teaching experiences would make teaching as their major career path in the future (Pre 4.63±1.07; Post 4.54±0.98; p=0.701). The senior near-peer tutors were evaluated significantly higher by the students (p=0.0001). Students’ evaluations of near-peer tutors on the domain of critical analysis was higher than self-evaluations (p=0.003).ConclusionsGenerally, the near-peer tutors perceived that they have benefited most in their skills enhancement and these near-peer tutors were scored highly by the students. However, senior near-peer tutors do not perceive that the programme has a lasting impact on their choice of career path.

Implementation of a Near-Peer Teaching Model in Pharmacy Education: Experiences and Challenges

There is an increasing demand for high-quality experiential placements for pharmacy students. As a result, pharmacy schools across Canada are confronted with the need to find innovative ways to expand experiential educational rotations. Near-peer teaching is one model with the potential to address this issue. Near-peer teaching involves the provision of learning support to junior students by their senior peers. This teaching methodology, which is common in many medical education programs, is thought to allow pharmacy students a unique learning environment for integrating pharmacy knowledge into pharmacy practice. It gives the student access to an additional potential learning environment without unduly increasing the preceptor’s workload. Although peer teaching has been well established in many health care communities, this approach has not been widely adopted in pharmacy education. This paper describes the experiences and challenges of this teaching model in pharmacy education within a specialized hospital setting.

Improving agreement in assessment of synovitis in rheumatoid arthritis

ObjectiveSynovitis assessment through evaluation of swollen joints is integral in steering treatment decisions in rheumatoid arthritis (RA). However, there is high inter-observer variation. The objective was to assess if a short collegiate consensus would improve swollen joint agreement between rheumatologists and whether this was affected by experience. MethodsEighteen rheumatologists from French university rheumatology units participated in three 30minutes rounds over a half day meeting evaluating joint counts of RA patients in small groups, followed by short consensus discussions. Agreement was evaluated at the end of each round as follows: (i) global agreement of swollen joints (ii) swollen joint agreement according to level of experience of the rheumatologist (iii) swollen joint count and (iv) agreement of disease activity state according to the Disease Activity Score (DAS28). Agreement was calculated using percentage agreement and kappa. ResultsGlobal agreement of swollen joints failed to improve (kappa 0.50 to 0.52) at the joint level. Agreement between seniors did not improve but agreement between newly qualified rheumatologists and their senior peer, which was initially poor (kappa 0.28), improved significantly (to 0.54) at the end of the consensus exercises. Concordance of DAS28 activity states improved from 71% to 87%. ConclusionConsensus exercises for swollen joint assessment is worthwhile and may potentially improve agreement between clinicians in clinical synovitis and disease activity state, benefit was mostly observed in newly qualified rheumatologists.

Academic Work in Canada: the Perceptions of Early‐Career Academics

AbstractThis paper analyses junior academic staff's (assistant professors) perceptions of academic work in a highly decentralised Canadian ‘system’. Drawing on recent work by the authors on Canadian university tenure processes and remuneration, the paper compares the perceptions of assistant professor respondents with senior (associate full professor) peers to the Canadian component of the Changing Academic Professions (CAP) survey. The analysis suggests that junior academic staff perceive the academic workplace as reasonably positive and supportive. In addition to relatively high levels of satisfaction, institutional support and remuneration, the findings suggest that there are minimal substantive differences in levels of work and work patterns between junior and more senior academic staff, a finding at odds with the general literature and common sentiment, which suggests junior staff work longer hours. The differences that do emerge appear to be more modest and nuanced than is popularly characterised.

Senior Peer Counseling by Telephone for Psychosocial Support After Breast Cancer Surgery: Effects at Six Months

To evaluate the efficacy of senior peer counseling by telephone for supplemental psychosocial support of older women after breast cancer surgery. Experimental, randomized block, longitudinal. A community-based senior service agency and a community hospital-based breast surgical oncology practice in an urban area of California. 142 women newly diagnosed and scheduled for surgery for stage 0-III breast cancer (X age = 61.8, range = 50-94). Participants were stratified by age and randomized to receive telephone calls from a peer counselor (a) once per week for five weeks beginning within 72 hours postsurgery, (b) once weekly for five weeks beginning six weeks postsurgery, and (c) by request. Assessments were conducted before surgery, postintervention, and six months after surgery. Questionnaires included the Hospital Anxiety and Depression Scale, the Interpersonal Relationship Inventory, and the Brief COPE. Anxious mood, social support, and coping by seeking instrumental support. At six months, significant main effects of age were noted for social support, fear of recurrence, and resource use. Significant independent effects of age and intervention were noted for coping by seeking instrumental support. After controlling for age, a significant interaction effect of intervention and time was observed for coping by seeking instrumental support. Peer counseling may affect instrumental support seeking and appears to be differentially received by age group. Additional study is needed to better understand who benefits most and how from peer counseling. Trained senior peer counselor volunteers, supervised by a skilled clinical team, may be a useful adjunct in addressing psychosocial needs of women after breast cancer surgery.

Pain management in Australian emergency departments: Current practice, enablers, barriers and future directions

To explore current pain management practice in Australian EDs and identify enablers and barriers for best-practice pain management. Five focus groups and two in-depth interviews were held with ED clinical staff (n= 47) from six hospitals in three states. Participants were asked open-ended questions to determine current pain management practices, enablers and barriers to implementing best-practice pain management, and understand change in practice within the ED setting. Emergency department staff identified a gap between evidence-based pain management recommendations and everyday practice. Perceived barriers to improving pain management included a lack of time and resources, a greater number of urgent and serious presentations that place pain management as a lower priority, organizational protocols and legislative issues. All groups noted difficulty in applying pain management guidelines in the context of competing priorities in the challenging ED environment. A culture of learning clinical practice from respected senior staff and peers was perceived to be a key enabler. Participants consistently expressed the view that evidence-based practice improvement should be championed by senior clinical staff, and that evidence to demonstrate the benefits of change must be presented to support the need for change. Effective and sustainable system change requires a strategy that is initiated within the ED, targets opinion leaders, is supported by evidence, and engages all levels of ED staff.

A step ahead: Teaching undergraduate students to be peer teachers

Nurses have a responsibility to share knowledge with others. However, many are reluctant to undertake teaching, feeling unprepared for the responsibility. With this in mind, a semester-long compulsory core unit was designed and implemented in 2009 to equip final year students with knowledge and skills to enable facilitation of teaching and learning in practice. As part of the summative assessment, third (final) year students taught vital signs in first year skills laboratories. To evaluate the strategy, the Peer Teaching Experience Questionnaire (adapted from Iwasiw and Goldenberg, 1993) was administered to third year students and Clinical Teaching Preference Questionnaire ( Iwasiw and Goldenberg, 1993) to first years. Focus groups were conducted with third year volunteers to explore issues in greater detail. One hundred and five (75%) third year and 112 (52%) first year students completed questionnaires. In addition, 11 third year students participated in a focus group. Overall, third year students reported increased confidence in their knowledge and teaching abilities, reflected on their own learning and found the experience rewarding, acquiring skills they considered would be helpful in graduate years. Many suggested there should be more opportunities for such types of learning and interaction. First year students reported feeling comfortable learning skills with senior peers, as well as being able to learn from their experiences. Overall, both groups recognised strongly that teaching was part of nurses’ roles.

A three-day anatomy revision course taught by senior peers effectively prepares junior students for their national anatomy exam

this study examines whether peer-teaching, in the setting of a three-day revision course in anatomy, is effective in preparing medical students for their national anatomy exam. the anatomy course was designed for candidates taking the first part of the German national medical exam. Increase of knowledge during the course was assessed by tests before and after the course (group A). To test equivalence, two control groups participated in the pre-test (group B) or in the course and in the post-test (group C). Participants anonymously rated 14 feedback items on a five-point Likert scale ranging from 1 (full agreement) to 5 (full disagreement). group A students' performance improved significantly during the course with a mean increase of 7.15 points (11.9% improvement; p<0.001). Equivalence testing showed that performance of group A students in the pre-/post-tests was equal to those of group B pre-tests and group C post-tests, respectively. Agreement on the 14 feedback items was highly significant (p<0.001 for all items), with a global median of 1. this study shows that a three-day anatomy revision course is effective and highly appreciated by medical students in their preparation for the national exam. Moreover, peer-teaching is reliable at this stage of the medical curriculum.

Training Senior Peer Counselors to Provide Telephone Support for Newly Diagnosed Breast Cancer Survivors

Volunteers require carefully designed and evaluable training before providing support to newly diagnosed older breast cancer survivors (BCS) after surgery. A training module and 20-h course incorporating discussion, role plays, dyads, and written material were created to supplement core training of senior peer counselors, who provided a telephone support intervention in a randomized controlled trial. Twelve volunteers began the training, ten completed the course, and six of the ten subsequently provided telephone support to 107 BCS. Specialized supplemental training, along with ongoing supervision, effectively prepared volunteers to provide support via telephone to BCS, augmenting professional support.

Supervising the Supervisors—Procedural Training and Supervision in Internal Medicine Residency

BACKGROUNDAt teaching hospitals, bedside procedures (paracentesis, thoracentesis, lumbar puncture, arthrocentesis and central venous catheter insertion) are performed by junior residents and supervised by senior peers. Residents’ perceptions about supervision or how often peer supervision produces unsafe clinical situations are unknown.OBJECTIVETo examine the experience and practice patterns of residents performing bedside procedures.DESIGN AND PARTICIPANTSCross-sectional e-mail survey of 653 internal medicine (IM) residents at seven California teaching hospitals.MEASUREMENTSSurveys asked questions in three areas: (1) resident experience performing procedures: numbers of procedures performed and whether they received other (e.g., simulator) training; (2) resident comfort performing and supervising procedures; (3) resident reports of their current level of supervision doing procedures, experience with complications as well as perceptions of factors that may have contributed to complications.RESULTSThree hundred sixty-seven (56%) of the residents responded. Most PGY1 residents had performed fewer than five of any of the procedures, but most PGY-3 residents had performed at least ten by the end of their training. Resident comfort for each procedure increased with the number of procedures performed (p < 0.001). Although residents reported that peer supervision happened often, they also reported high rates of supervising a procedure before feeling comfortable with proper technique. The majority of residents (64%) reported at least one complication and did not feel supervision would have prevented complications, even though many reported complications represented technique- or preparation-related problems.CONCLUSIONSResidents report low levels of comfort and experience with procedures, and frequently report supervising prior to feeling comfortable. Our findings suggest a need to examine best practices for procedural supervision of trainees.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-009-1226-z) contains supplementary material, which is available to authorized users.

Clinical skills education: outcomes of relationships between junior medical students, senior peers, and simulated patients.

Clinical skills education: outcomes of relationships between junior medical students, senior peers, and simulated patients.

Clinical skills education: outcomes of relationships between junior medical students, senior peers and simulated patients

Peer-assisted learning (PAL) has been reported to have educational benefits in cross-year, small-group teaching in other contexts. Accordingly, we explored whether senior medical students are effective tutors for their junior peers in clinical skills education, and how the participants in the learning triad (tutors, learners and simulated patients [SPs]) perceive the learning environment created in PAL. Year 2 students were randomly allocated to one of two groups for skills training. Group 1 (n = 64) were tutored by volunteer Year 6 students, and Group 2 (n = 67) by paid doctors. The results of both groups in a clinical skills examination were compared using an independent samples t-test. Qualitative data, obtained from Year 2 students (n = 125) by written questionnaire and Year 6 students (n = 11) and SPs (n = 3) by focus group interviews, were analysed for themes. Students receiving PAL did at least as well in the clinical skills examination as students with qualified tutors (difference in mean total score: 0.7 marks out of 112; 95% confidence interval--8 to 2.4). The PAL environment was perceived as 'comfortable' and fostered the development of confidence in all participants. Peer tutors created a more active learning environment than doctor tutors for both learners and SPs and reported personal benefits from teaching. With appropriate support, volunteer Year 6 student tutors are as effective as graduate doctors for small-group structured tutorials in clinical skills. Educational relationships were forged between all participants in the learning triad.

Asian models of excellence in psychiatric care and rehabilitation

In Asia, like other regions, the circumstances for psychiatric care and rehabilitation impose various limitations on us. However, committed professionals have been creating innovative models of excellence, which are culturally appropriate and clinically effective. In this paper, seven innovative models of psychiatric care and rehabilitation are presented.The Nitte project in India provides a comprehensive free rural psychiatric service, while transforming the ‘brain drain’ problem to ‘brain circulation’ cooperation. Through Social Enterprises in Hong Kong recovered clients are trained and employed. Senior Peer Counselling in Singapore emphasizes the relief of emotional distress by psychological methods and the primacy of communication in the healing or therapeutic relationship. Seoul Mental Health 2020, an epoch-making project in Korea, has increased the coverage rate of community mental health centres remarkably. Yuli Psychiatric Rehabilitation Model in Taiwan helps long-term inpatients to get reintegrated into the community. In Japan, models of excellence for community-based psychiatry have been developed at local government, hospital and community/NGO levels. Chinese Psychiatry Online, an excellent website, provides public education, resource searching, self-testing and consultation services for the public along with various contents for professionals.We must disseminate information about models of excellence which provide great benefit to the people who suffer from psychiatric illness without high expenses.

Middle managers' uncertainty management during organizational change

PurposeThis study aims to identify factors that facilitate or inhibit middle managers' experience of uncertainty management during organizational change.Design/methodology/approachThe approach is qualitative and involved interviews with 40 middle managers from a range of organizations.FindingsAnalysis revealed that at the pre‐implementation stage, uncertainty focused on the strategic concept of the change, whereas at implementation, uncertainty related to the appropriate procedures to implement. Middle managers’ uncertainty management was found to be important in assisting their employees in the change transition. The factors identified as being either facilitators or barriers to uncertainty management focused on themes related to the design of change, communication with both senior management and their own staff, support from senior management, role conflict, and peer interaction. A model was created to link facilitators and barriers with uncertainty to guide future research.Research limitations/implicationsImplications for organizational change research along with practical implications are discussed.Originality/valueThis study provides insight into the positive contributions middle managers can make during change, along with suggesting what factors are facilitators or barriers to this positive role.

Evaluation of an Audit With Feedback Continuing Medical Education Program for Radiation Oncologists

Meta-analyses demonstrate audit with feedback (AWF) is effective continuing medical education (CME). However, efficacy varies between specialties, with little published radiation oncologist (RO)-specific evidence. We evaluated an AWF CME intervention for ROs determining efficacy, cost-effectiveness, and participant satisfaction. CME program: The CME incorporated fortnightly random patient chart audit, scoring management adequacy via a checklist. Scores were presented at a same-day institutional meeting, and case management discussed. Senior peers provided individualized, educational feedback. Changes in behavior and performance were evaluated by chart review of new patients seen by ROs in the 2 months before commencement of AWF (T0), and at months 13-14 of the program (T1). Behavior and performance were evaluated with a validated, reproducible, 19-item instrument. Criteria for each case audited included 10 targeted and 3 nontargeted behavior items and 6 performance items; each scored 1 point if deemed adequate (maximum score 19). Cost-effectiveness was reported as cost to the institution per item point gained. The mean score (out of 5) of a 14-item questionnaire evaluated program perception. A total of 113 and 118 charts were evaluated at T0 and T1, respectively. Mean score of targeted behavior improved between T0 and T1 (from 8.7 to 9.2 out of 10, P = .0001), with no significant improvement of nontargeted behavior/performance items. Annual costs and cost-per-point gained were US 7,897 dollars and 15 dollars. Participant satisfaction was positive, increasing after efficacy result distribution (P = .0001). Audit with comparative, individualized, educational feedback is cost-effective and positively perceived CME, significantly improving targeted RO behavior. Oncologists' CME design and evaluation require further research.

Influence of role models and hospital design on hand hygiene of healthcare workers.

We assessed the effect of medical staff role models and the number of health-care worker sinks on hand-hygiene compliance before and after construction of a new hospital designed for increased access to handwashing sinks. We observed health-care worker hand hygiene in four nursing units that provided similar patient care in both the old and new hospitals: medical and surgical intensive care, hematology/oncology, and solid organ transplant units. Of 721 hand-hygiene opportunities, 304 (42%) were observed in the old hospital and 417 (58%) in the new hospital. Hand-hygiene compliance was significantly better in the old hospital (161/304; 53%) compared to the new hospital (97/417; 23.3%) (p<0.001). Health-care workers in a room with a senior (e.g., higher ranking) medical staff person or peer who did not wash hands were significantly less likely to wash their own hands (odds ratio 0.2; confidence interval 0.1 to 0.5); p<0.001). Our results suggest that health-care worker hand-hygiene compliance is influenced significantly by the behavior of other health-care workers. An increased number of hand-washing sinks, as a sole measure, did not increase hand-hygiene compliance.

A SENIOR PEER COUNSELING PROGRAM: EVALUATION OF TRAINING AND BENEFITS TO COUNSELORS

A study was conducted to evaluate the training component of a senior peer counseling program and its benefits to peer counselors. The intended focus of the program was on seniors experiencing depression, suicidal feelings, and other emotional crises. Seventeen out of 20 applicants were selected by a screening committee of social workers and mental health professionals. Of the 17 counselors selected for training, 3 males and 10 females, average age 65 years, completed the 72‐hr program. The program was assessed by external evaluators using quantitative and qualitative methods. Counselors assessed with mild levels of depression at pretest scored in the normal range at posttest and reported a lower number of depressive symptoms. The ratings ascribed to the training components were consistently positive. The qualitative component included individual interviews to assess counselors’ perceptions of the training program, the groups, their clients, and their roles as counselors. A content analysis revealed the dominant theme of personal experience. The components of this theme were categorized as the training experience, the group experience, experiencing the first client, and experiencing the “self as counselor.” An analysis of the counselor interviews suggested that one of the major benefits of the training and counseling experience was increased self‐confidence and self‐efficacy.

Attitudes and behaviors towards clinical guidelines: the clinicians' perspective.

Objectives--To find out what attitudes hospital doctors have towards the culture of clinical guidelines; to ascertain perceived knowledge and use of clinical guidelines; and to investigate why hospital doctors think that clinical guidelines may not be used and how they think that the use of guidelines can be encouraged. Design--Postal questionnaire survey be tween October 1993 and January 1994. Setting--Hospitals within Oxford region. Subjects--409 doctors of all grades working in one of six specialties (anaesthetics, paediatrics, general surgery, general medicine, obstetrics and gynaecology and accident and emergency medicine). 47 were randomly picked as part of the pilot study, 362 were extracted from hospital staffing lists. Results--268 clinicians (66%) responded to the questionnaire. Most respondents (77%, 208) expressed welcoming attitudes towards guidelines but 51%(136) perceived the attitudes of their colleagues as being less favourable. Over three quarters of respondents claimed to use guidelines at least once a month. Most respondents learnt about guidelines from discussions with their peers (50%, 134 respondents) or senior doctors 37%, 99) or from journals (39%, 105). Reasons why guidelines may not be used included being unaware of particular guidelines (80%, 213 respondents) and the fact that guidelines had been poorly developed (64%, 171) or were impractical (49%, 132). The best ways to encourage the use of guidelines were thought to be encouragement from senior doctors (72%, 193 respondents) and peers (59%, 157) and by monitoring behaviour and providing feedback (68%, 181). Conclusion--The decision to use a guide line was based on the perceived value of each guideline and was influenced by other clinicians' behaviour. The results provide an insight into aspects of dissemination and implementation which are perceived as influential by the recipients of guidelines.

Assessment of physician competence in prehospital trauma care

In an attempt to develop a model to measure the competence of physicians providing emergency care under difficult field conditions, 75 Israeli army medical corps physicians were evaluated through the use of four instruments: a debriefing interview, peer assessment, selfassessment and written examination. The special on-site assessment model was designed to examine actual events, enabling an assessment of performance in real situations rather than simulated cases. Significant positive correlations were found between the results of the written examination and the peer evaluation on two of four measures ( r = 0.36, P = 0.001; r = 0.23, P = 0.05) as well as on the two measures regarding self-evaluation and peer evaluation ( r = 0.54, P = 0.001; r = 0.38, P = 0.05). It was found that those physicians who were trained in the army's medical officer course scored significantly higher on the written examination ( P = 0.001) and were rated more highly by their senior peers ( P = 0.048) than those who did not receive such training. It was concluded that it is advantageous to use a combination of knowledge (written examination) and performance (peer assessment or self-assessment) measures in order to arrive at a more comprehensive assessment of competence. In addition, the written examination format should be expanded and developed to include more clinical vignettes requiring treatment decisions, making this instrument a more clinically oriented measure of physician competence in trauma care.