Near-peer bedside clinical teaching: example of a successful programme

To teach is to learn twice, revisited: a qualitative study of how residents learn through teaching in clinical environments

BACKGROUND

Teaching helps the teacher's own learning as a professional-as the saying goes, 'to teach is to learn twice'. Near-peer teaching in clinical practice has been shown to contribute to the development of both teaching skills and necessary competencies for doctors. Research on how near-peer teachers learn through their teaching roles has mainly focused on classroom learning. However, understanding how the phenomenon of 'teaching is learning twice' occurs in clinical settings and its influencing factors is important for the development of a quality workplace learning environment. Therefore, this study investigated how residents learn through teaching in clinical practice and the factors influencing this process.

METHODS

This study's methodology is based on the constructivist grounded theory from a social constructivist perspective. Several teaching hospitals in Japan were included, and the study participants were post-graduate year 2 residents (PGY2s) from these hospitals. The interviews were recorded, transcribed into text, and analysed by the first author.

RESULTS

From January 2016 to July 2022, 13 interviews were conducted with 11 PGY2s from nine educational hospitals. The PGY2s played diverse educational roles in clinical settings and learned competencies as physicians in almost all areas through such roles. We found that knowledge transfer and serving as role models stimulated PGY2s' intrinsic motivation, encouraged reflection on their own experiences, and promoted self-regulated learning. Further, educating about procedural skills and clinical reasoning prompted reflection on their own procedural skills and thought processes. Supporting post-graduate year 1 residents' reflections led to the refinement of PGY2s' knowledge and thought processes through the verbal expression of their learning experiences. Such processes required the formation of a community of practice. Thus, education promoted learning through reflection and clarified the expert images of themselves that PGY2s envisaged.

CONCLUSIONS

The study found that residents acquire various physician competencies through multiple processes by teaching as near-peer teachers in clinical settings, that a community of practice must be formed for near-peer teaching to occur in a clinical setting, and that teaching brings learning to those who teach by promoting reflection and helping them envision the professionals they aim to be.

Building upon the foundational science curriculum with physiology-based grand rounds: a multi-institutional program evaluation

Introduction: Vertically integrating physiology into patient care has the potential to improve clinical reasoning. Clinical Physiology Grand Rounds (CPGR) is a case-based teaching method that brings together students from all years of medical school to focus on linking clinical presentations to core basic science concepts including anatomy, physiology, and pathophysiology. In this study, we describe the implementation of CPGR at two different institutions in the United States and assess student-reported outcomes.Methods: We survey students who participated in CPGR at Columbia University College of Physicians & Surgeons (P&S) and Medical University of South Carolina (MUSC). Subjects were queried across three domains: the benefits of attending, the impact of concept maps, and the impact of the mixed-learner environment.Results: Despite differences in session leadership and the underlying medical school curricula, conference attendees reported similar benefits at the two schools included in this study. Students overwhelmingly (92.9%) reported that remembering clinical presentations was easier when they understood the underlying physiology. They also reported gaining a true understanding of concepts that were previously memorized (87.5%). Both clinical (92.5%) and preclinical students (93.1%) valued the mixed-learner environment as a component of the conference.Discussion: By assuring a mixed-learner environment with near-peer interactions, using concept maps as a teaching tool, and rigorously linking clinical presentation and management to physiological concepts, we found that the key benefits of CPGR were replicable across different institutions, despite several local differences in how CPGR was implemented, led, and conducted.

Implementing a unique immersive near-peer-led clinical skills educational bootcamp for early-year clinical medical students

We establish the development of a unique immersive clinical skills bootcamp for third-year medical students, with formal teaching under five key themes: procedural skills day, examinations, imaging, data interpretation and prescribing. Lastly a simulation event was developed to allow the participants to bring the different themes together, in order to successfully manage an acutely unwell patient for their stage of learning using the newly learnt skills. A 4-week bootcamp was developed and delivered to students. A curriculum was developed based on student's precourse answers to specific questions. Pre and post bootcamp questionnaires were used to assess participants confidence and knowledge using a 5-point Likert scale. A combination of objective structured examination, didactic lectures and group-based discussions were utilised. Tutors' teaching performance was also analysed. A focus group was held post bootcamp. Bootcamp was delivered to 15 students. Feedback was overwhelmingly positive. Students were more confident in all of the five key domains post bootcamp. All students feel more equipped to take opportunities that arise on medical wards as a result of the skills learnt. Participants were receptive to the combination of teaching methods used. All students would recommend this course to their peers. Early-year clinical students successfully received an immersive goal-directed course with formal teaching. The near-peer teaching model improved participants educational experience. We were able to successfully demonstrate that near-peer teaching is effective when it is goal directed, and further when it addresses areas of medical education whereby there is a disparity in the formal teaching available.

Educational opportunities on a ward round; utilising near-peer teaching

Near-peer teaching (NPT) has been shown to be useful in undergraduate and postgraduate medical teaching, but there is sparse knowledge of its applicability in clinical settings, such as the ward round. The current study assessed the suitability of NPT on a consultant ward round and ascertained its advantages and disadvantages as a teaching method in this setting. NPT was trialled on three consecutive consultant ward rounds on a palliative medicine inpatient unit in a cancer centre. Both learner (three junior doctors) and facilitator (one consultant) views were sought via questionnaires and interviews. Data were analysed using thematic content analysis. All participants felt that NPT gave a better educational experience compared with traditional ward rounds. Participants found NPT improved their own teaching ability, was quick and easy to use, and was tailored to the learner. More advantages were cited than disadvantages. Disadvantages were only mentioned by senior doctors and included time off the ward round and lack of teaching for the senior member of the near-peer pair. Thus, NPT could be a useful educational tool to provide differentiated learning in busy clinical settings. However, more research is needed to ensure that it can meet the learning needs of senior trainees.

Medical students' perceptions of bedside teaching

BACKGROUND

Bedside teaching is recognised as a valuable tool in medical education by both students and faculty members. Bedside teaching is frequently delivered by consultants; however, junior doctors are increasingly engaging in this form of clinical teaching, and their value in this respect is becoming more widely recognised. The aim of this study was to supplement work completed by previous authors who have begun to explore students' satisfaction with bedside teaching, and their perceptions of the relationship with the clinical teachers. Specifically, we aimed to identify how students perceive bedside teaching delivered by junior doctors compared with consultants. We aimed to identify how students perceived bedside teaching delivered by junior doctors compared with consultants METHODS: A questionnaire was distributed to all third-year medical students at Keele University via e-mail. Responses were submitted anonymously.

RESULTS

Forty-six students responded (37.4%), 73.3 per cent of whom said that they felt more comfortable having bedside teaching delivered by junior doctors than by consultants. Consultants were perceived as more challenging by 60 per cent of respondents. Students appeared to value feedback on their performance, trust the validity of taught information, and to value the overall educational experience equally, regardless of the clinical grade of the teacher.

DISCUSSION

Student preference does not equate to the value that they place on their bedside teaching. Junior doctors are perceived as being more in touch with students and the curriculum, whereas consultants are perceived as having higher expectations and as being both stricter and more knowledgeable. The clinical teacher's approachable manner and enthusiasm for teaching are more important than clinical grade, as is the ability to deliver well-structured constructive feedback.

Evaluation of a combined approach of clinical skills training utilizing near-peers, in-campus faculty and clinicians: An innovative integrated model

INTRODUCTION

Training clinical skills is essential in medicine. Different models of clinical skills courses have been previously suggested. Here, we report an innovative approach adopted to train junior medical students in clinical skills in a multimodal fashion by near-peers, basic scientists with clinical background and senior clinicians.

METHODS

This quasi-experimental study was conducted at Alfaisal University College of Medicine at Riyadh. An electronic survey was conducted among year-2 and year-3 medical students seeking their perception about the (a) organization, (b) delivery, (c&d) self- and peer-assessment in clinical skills courses. Total 298 male and female medical students (91%), consisting of 164 from year 2 and 134 from year 3, participated by filling out a questionnaire (Cronbach's alpha 0.93).

RESULTS

Out of maximum five, the average ratings for the course were 3.81, 3.72, 3.67 and 3.73 in organization, delivery, self-evaluation and peer-assessment respectively, with no significant difference between both subgroups. The in-campus sessions rated higher than hospital sessions (p < 0.001). As tutors, interns were rated higher than clinicians (p < 0.001). The qualitative analysis suggested high satisfaction.

CONCLUSIONS

The clinical skills course that was conducted in a multimodal fashion utilizing diverse tutors showed a positive attitude of students toward the organization and delivery of the course.