Impact of Near-Peer Education in a Student-Run Free Ophthalmology Clinic on Medical Student Teaching Skills

Clinical learning experiences of healthcare professional students in a student-led clinical learning environment (SLCLE) - A mixed methods evaluation

AIM

To evaluate healthcare professional (HCP) students clinical learning experiences' whilst undertaking placements in a student-led clinical learning environment (SLCLE) and any changes in self-reported ratings of confidence.

BACKGROUND

The English NHS Long Term Workforce Plan (2023) highlights the need to expand domestic education of HCPs to meet workforce shortages. The demand for quality clinical placements to support the preparation of HCP students remains a challenge globally. A creative solution has been the development of student-led learning clinical environments in healthcare settings. SLCLEs provide high-quality learning experience, increase clinical placement capacity whilst maintaining patient care standards. A multisite NHS Trust adopted this model as evidence suggests HCP students will be better prepared on qualification to adopt registered practitioner professional responsibilities. This model has been integrated across three hospital sites within a large teaching hospital, providing care for a diverse population and designed to accommodate students from a range of HCP disciplines and higher educational institutions.

DESIGN

A mixed methods convergent design.

METHODS

An online survey was administered to SLCLE allocated nursing and allied health profession (AHP) undergraduate and graduate-entry first, second and third-year students (n=132). Face to face focus groups/individual interviews were undertaken with a purposive sample of student participants (n=80) to evaluate their experiences of clinical learning in SLCLEs. Survey data were analysed using descriptive statistics and paired t-tests, interviews using framework method.

RESULTS

Undergraduate and graduate-entry students from four UK universities completed the survey (n=132), 103 students (78 %) responded. Most were year 2 students (n=43/42 %), pursuing nursing programmes (n=82/80 %). Most considered the SLCLE met their expectations (n=76/74 %), reported increased confidence post-placement (n=84/82 %), felt supported by staff (n=80/78 %), peers (n=93/90 %) and clinical educators (n=93/90 %). Self-reported confidence scores post-SLCLE were significantly higher than pre-SLCLE. On-line pre-placement information was infrequently accessed yet identified as an omission. Four themes were identified: (i) preconceptions and initial anxiety; (ii) empowerment, growth and a unique learning experience; (iii) collaborative inter-professional learning and support; and (iv) insights and anticipations.

CONCLUSIONS

The SLCLE allocation enhanced students' confidence and knowledge. Support from clinical educators, ward staff and doctors was perceived as invaluable for creating a positive learning culture. Peer support and opportunities to lead care delivery contributed to students' professional development. The format and method for providing pre-placement information needs review as do strategies for avoiding delays in completing assessment documentation. Overall, the SLCLE experience offers much potential as a nurturing and effective learning environment for HCP students.

The Decline of Basic Ophthalmology in General Medical Education: A Scoping Review and Recommended Potential Solutions

OBJECTIVE

This literature review aims to explore research and conceptual pieces on the state of ophthalmology education and suggest potential ways to address current challenges.

METHODS

A search was conducted in PubMed, ERIC, Web of Science, and Google Scholar with combinations of the following search terms: "ophthalmology education," "undergraduate medical education," "medical student," "United States," and "Canada." Eliminating irrelevant articles yielded 47 articles. Three were excluded because of region and focus, leaving 44. After examining the citations, we generated an additional 22 texts for review, totaling 66 articles.

RESULTS

Four primary themes were identified: (1) challenges to ophthalmological education in the U.S. and Canada, (2) potential remedies for optimizing ophthalmology curriculum, (3) technology in ophthalmology education, and (4) innovative ophthalmology teaching approaches. Major challenges included the lack of a standardized curriculum and inadequate clinical exposure and skills training. A number of remedies were proposed, such as standardizing curriculum and furthering faculty involvement, utilizing technology as time-effective learning aids, and employing innovative teaching approaches such as service learning.

CONCLUSION

In light of challenges in ophthalmology education, curriculum designers should consider Cognitive Load Theory (CLT) to assist students to remember meaningful exposures to ophthalmology knowledge and techniques. Based on CLT, we suggest two potential approaches to incorporating ophthalmology curriculum. The first is to embrace interdisciplinary collaborations and place ophthalmology knowledge in varied contexts to facilitate schema construction. The second is to incorporate ophthalmology diagnostics requirements into OSCEs and utilize simulation models for students to gradually increase the fidelity of tasks and devote cognitive resources fully to learning.

Peer Teaching in Undergraduate Medical Education: What are the Learning Outputs for the Student-Teachers? A Systematic Review

Introduction

To achieve quality in medical education, peer teaching, understood as students taking on roles as educators for peers, is frequently used as a teaching intervention. While the benefits of peer teaching for learners and faculty are described in detail in the literature, less attention is given to the learning outputs for the student-teachers. This systematic review focuses on the learning outputs for medical undergraduates acting as student-teachers in the last decade (2012-2022).

Aim

Our aim is to describe what learning outputs student-teachers have from peer teaching, and map what research methods are used to assess the outputs. We defined learning outputs in a broad sense, including all types of learning experiences, intended and non-intended, associated with being a peer teacher.

Methods

A literature search was conducted in four electronic databases. Title, abstract and full text were screened by 8 independent reviewers and selection was based on predefined eligibility criteria. We excluded papers not describing structured peer teaching interventions with student-teachers in a formalized role. From the included articles we extracted information about the learning outputs of being a student-teacher as medical undergraduate.

Results

From 668 potential titles, 100 were obtained as full-texts, and 45 selected after close examination, group deliberation, updated search and quality assessment using MERSQI score (average score 10/18). Most articles reported learning outputs using mixed methods (67%). Student-teachers reported an increase in subject-specific learning (62%), pedagogical knowledge and skills (49%), personal outputs (31%) and generic skills (38%). Most articles reported outputs using self-reported data (91%).

Conclusion

Although there are few studies that systematically investigate student-teachers learning outputs, evidence suggests that peer teaching offers learning outputs for the student-teachers and helps them become better physicians. Further research is needed to enhance learning outputs for student-teachers and systematically investigate student-teachers' learning outputs and its impact on student-teachers.

Learning Outcomes from Participation in Student-Run Health Clinics: A Systematic Review

Student-run clinics (SRCs) offer unique opportunities for students to engage in healthcare delivery, but the student learning outcomes of such clinics have not yet been systematically examined in a comprehensive manner. The purpose of this review was to appraise and synthesize existing literature pertaining to student learning outcomes associated with participation in SRCs. A systematic review was undertaken using PubMed, CINAHL, and Web of Science databases. The quality of articles that met inclusion criteria articles was appraised using the Mixed Methods Appraisal Tool (MMAT). Study details, such as learning outcomes, were also extracted. Ninety-two studies met inclusion criteria. Most studies were conducted in North America (n = 73, 79.3%), and related to clinics involving solely medical students (n = 35, 38.0%) or multi-professional clinics (n = 34, 37.0%). Demonstrated learning outcomes of SRC participation include clinical skills, interprofessional skills, empathy/compassion for underserved patients, and leadership. SRC participation had little apparent impact on students' future career directions. Quality appraisal via the MMAT found mixed levels of research quality amongst reviewed studies. In summary, while SRC participation appears to offer benefits for student learning, improved study design and research outside of North American contexts would further advance knowledge.

Demographics, clinical interests, and ophthalmology skills confidence of medical student volunteers and non-volunteers in an extracurricular community vision screening service-learning program

BACKGROUND

Medical school curricular hours dedicated to ophthalmology are low and declining. Extracurricular ophthalmology activities, such as participation in community vision screenings, may serve an important adjunctive role in medical school curricula. The Johns Hopkins University (JHU) Vision Screening In Our Neighborhoods (ViSION) Program is an example of a voluntary medical student-directed community service-learning program.

METHODS

We used a mixed-methods cross-sectional approach, including an online survey and semi-structured interviews. JHU School of Medicine students enrolled in MD or MD/PhD programs during the 2019-2020 academic year were surveyed regarding demographics, career and service interests, involvement in ophthalmology-related activities, and confidence in their ophthalmology-related skills. Survey responses were compared between ViSION volunteers and non-volunteers using Fisher's exact chi-square tests. Semi-structured interviews were conducted via webconference with 8 prior or current ViSION volunteers and responses analyzed using inductive thematic analysis. Data were collected when ViSION volunteers were in variable stages of their medical education and involvement with the ViSION program.

RESULTS

A total of 118 medical students were included, representing an overall response rate of 24.6% of JHU medical students. ViSION volunteers reported greater involvement in ophthalmology-related research (42% vs. 4%, p < 0.001), intent to apply to ophthalmology residency programs (35% vs. 1%, p = 0.001), and confidence with multiple ophthalmology knowledge and clinical skill domains. In particular, ViSION volunteers were more likely to feel confident estimating cup-to-disc ratio using direct ophthalmoscopy (20% vs. 0%, p < 0.001). In open-ended survey and interview questions, most volunteers attributed at least some degree of their ophthalmology skill development and desire to pursue ophthalmology and public health careers to their ViSION experience.

CONCLUSIONS

Medical students who volunteered with a student-led community vision screening program were more likely to have a prior interest in ophthalmology than those who did not volunteer, but only 1/3 of volunteers planned to pursue a career in ophthalmology. Overall, volunteers reported higher confidence performing ophthalmology-related clinical skills, suggesting that student-led community vision screening programs may provide an important avenue for medical students to explore public health aspects of ophthalmology, while practicing ophthalmology exam skills and learning about common ophthalmic pathologies, regardless of their career intentions.

A seven-year analysis of the role and impact of a free community eye clinic

BACKGROUND

The Indiana University Student Outreach Clinic (IUSOC) Eye Clinic is a monthly student-run eye clinic that provides free visual screening to the Near East Side community of Indianapolis, IN, USA. Screening includes assessments of visual acuity, intraocular pressure, peripheral visual fields, refraction, and non-mydriatic fundus photography.

METHODS

This is a retrospective chart review of 875 patients seen at the IUSOC Eye Clinic from October 2013 to February 2020. Data on demographics, insurance coverage, ocular history, physical examination, suspected diagnosis, referral status, and glasses provided were collected and analyzed.

RESULTS

875 patients were seen at the IUSOC Eye Clinic from October 2013 to February 2020. 39.2% of the patients seen at the clinic reported being uninsured. 61.4% of patients were found to have visual acuity of 20/40 or worse, while 51.3% of patients were found to have a near visual acuity of 20/40 or worse. 20.3% of patients were referred to the local county hospital for further evaluation by an ophthalmologist, 14.4% of patients received free glasses prescriptions, and 27.9% of patients received free reading glasses. Common reasons for referral for further ophthalmology evaluation included glaucoma, decreased visual acuity, and diabetic retinopathy. An estimated value of services provided over the seven years of the clinic was 1271 relative value units.

CONCLUSION

The IUSOC Eye Clinic fills an important role in advancing ocular health and preventing irreversible blindness in an underserved Indianapolis community. Additionally, the clinic demonstrates an educational model for involving medical student volunteers.

Student-Led Clinics in Aotearoa New Zealand: A Scoping Review with Stakeholder Consultation

Background

Student-led clinics have gained increasing attention as a mechanism for students across various health professions to gain authentic interprofessional clinical placement experience during their educational programme.

Purpose

This scoping review is designed to identify and describe experiences relating to student-led clinics in Aotearoa New Zealand.

Methods

The review involved five key steps: 1) identifying the research question; 2) identifying relevant studies; 3) study selection; 4) charting the data; and 5) collating, summarising and reporting the results.

Discussion

Student-led health clinics present invaluable educational opportunities for authentic collaborative practice and capacity to improve population health and well-being, especially in marginalised and disadvantaged communities. Clinic establishment and operation require consideration of a complex set of factors.

Conclusion

Community consultation (including with Indigenous populations) should precede establishment of clinics. There is scope for more reporting and objective evaluation to ensure best practice is being determined, developed, and achieved.