Differential impact of student behaviours on group interaction and collaborative learning: medical students' and tutors' perspectives

Barriers and Facilitators to the Learning and Acquisition of Research Competencies among Nursing Students through Active Methodologies: A Qualitative Study Using Reflective Writing

BACKGROUND

The development of educational research, critical thinking skills, and evidence-based practice requires proposals for educational innovation. The purpose of this study was to explore the perspectives of undergraduate nursing students on the barriers and facilitators after the implementation of a novel activity within the course of research methodology, composed of three active learning strategies: (a) project-based learning; (b) small-group learning; and (c) self-directed learning.

METHODS

A qualitative exploratory study using reflective writing was conducted at the Nursing Department of the Red Cross School (Spain). Seventy-four nursing students participated in the study, enrolled in the research methodology course. Purposive sampling was used. Online reflective notes were collected from a script of open-ended questions. An inductive thematic analysis was performed.

RESULTS

The new proposals facilitated learning of the subject matter and its contents. They were useful and enabled the students to put the contents into practice. In addition, they improved the students' organization, planning, and involvement. The barriers identified were a lack of time, ambiguity, inadequate tutoring or novelty of the work, and inequity in the distribution of tasks and workloads.

CONCLUSIONS

Our findings shed light on the barriers and facilitators identified by nursing students when implementing an educational innovation proposal, using three active learning methodologies as learning tools for the subject of nursing research.

A webinar series to educate applicants about the UK academic foundation programme: a longitudinal cross-sectional study

BACKGROUND

The UK academic foundation programme (AFP) is a competitive programme for medical graduates and forms the initial stage of the integrated clinical academic pathway. The application is complex and targeted education is beneficial. As online technologies improve, virtual medical education is becoming more common. Currently, webinar education, particularly that of webinar series, are poorly evidenced. An online course was created to investigate the acceptability and effectiveness of webinars for medical education.

METHODS

A six-part, one-hour sessional webinar course was developed following a focus group with academic foundation doctors. A pre- and post-course cross-sectional questionnaire study evaluated participant demographics, webinar opinion and self-rated understanding of the AFP via Google Form (Google, USA). Where applicable a five-point Likert scale (1-Strongly disagree to 5-strongly agree) was utilised and analysis using non-parametric paired statistical analysis.

RESULTS

Medical students (n=303) from 35 UK universities completed the pre-course questionnaire. Most students had not received targeted education on the AFP. They rated webinars useful for education (mean=4.2 s.d. 0.7). After the course, participants (n=66) expressed it was significantly convenient (mean=4.7), effective (mean=4.7) and suitably interactive (mean=4.4) (p<0.001 compared to neutral). Participants preferred short sessions over multiple days to the concept of a full-day event (mean=4.6 vs 3.1, p<0.001). Paired analysis of participants completing both forms (n=47) demonstrates a significant increase in self-rated understanding of AFP content, portfolio building, application process, acute clinical scenarios, interview technique and overall confidence in acquiring an AFP post (p<0.001). Follow-up identified 43 participants who completed the course were successful in their AFP application. This represents 7.8% of all successful AFP applicants in 2021.

CONCLUSIONS

This study evidences an accessible and effective webinar series for AFP education. Comprehensive webinar courses for similar topics and demographics may provide valuable utility in the provision of future medical education.

TRIAL REGISTRATION

Ethics requirements were waived for this study by Bristol University Ethics Committee. All participants in this study consented for anonymous use of their data. As such the trial is not registered.

Does your group matter? How group function impacts educational outcomes in problem-based learning: a scoping review

BACKGROUND

Problem-based learning (PBL) is a common instructional method in undergraduate health professions training. Group interactions with and within PBL curricula may influence learning outcomes, yet few studies have synthesized the existing evidence. This scoping review summarized the literature examining the influence of group function on individual student PBL outcomes. Following Kirkpatrick's framework, experiential, academic, and behavioral outcomes were considered. The impacts of three aspects of group function were explored: (1) Group Composition (identities and diversity), (2) Group Processes (conduct and climate, motivation and confidence, and facilitation), and (3) PBL Processes (tutorial activities).

METHODS

A literature search was conducted using Medline, CINAHL, and APA PsychInfo from 1980-2021, with the help of a librarian. English-language empirical studies and reviews that related group function to learning outcome, as defined, in undergraduate health professions PBL curricula were included. Relevant references from included articles were also added if eligibility criteria were met. The methods, results, discussions, and limitations of the sample were summarized narratively.

RESULTS

The final sample (n = 48) varied greatly in context, design, and results. Most studies examined junior medical students (n = 32), used questionnaires for data collection (n = 29), and reported immediate cross-sectional outcomes (n = 34). Group Processes was the most frequently examined aspect of group function (n = 29), followed by Group Composition (n = 26) and PBL Processes (n = 12). The relationships between group function and outcomes were not consistent across studies. PBL experiences were generally highly rated, but favorable student experiences were not reliable indicators of better academic or behavioral outcomes. Conversely, problematic group behaviors were not predictors of poorer grades. Common confounders of outcome measurements included exam pressure and self-study.

CONCLUSIONS

The main findings of the review suggested that (1) group function is more predictive of experiential than academic or behavioral PBL outcomes, and (2) different Kirkpatrick levels of outcomes are not highly correlated to each other. More research is needed to understand the complexity of group function in PBL tutorials under variable study contexts and better inform curricular training and design. Standardized tools for measuring PBL group function may be required for more conclusive findings.

Ethnicity-related stereotypes and their impacts on medical students: A critical narrative review of health professions education literature

BACKGROUND

Stereotypes are oversimplified beliefs about groups of people. Social psychology concepts and theories describing ethnicity-related stereotypes are well reported in non-medical educational settings. In contrast, the full impact of stereotyping on medical students, and the extent to which they were represented in health professions education (HPE) is less well-described. Using the lens of social psychological theory, this review aimed to describe ethnicity-related stereotypes about medical students portrayed in HPE literature and the impacts of those stereotypes.

METHODS

A critical narrative approach was undertaken. Social psychology concepts and theories were used as a framework through which to review the impacts of ethnicity-related stereotypes on medical students as described in HPE literature. A database search of Ovid MEDLINE, JSTOR, Project Muse, and PsychINFO was conducted to identify both theoretical and empirical articles relating to this topic in the HPE literature. Data was synthesised using thematic analysis, giving particular care to appraise the evidence from perspectives in social psychology.

FINDINGS

In HPE, the experiences and impact of stereotyping on learners from minority ethnic groups was explained by social psychology concepts such as stereotype threat, stereotype reactance, attributional ambiguity, self-fulfilling prophecy, stereotype boost, stereotype lift, and stereotype masking. Stereotype boost and stereotype lift were particularly described among students who identified as White, whereas stereotype threat was described more commonly among students from minority ethnics groups. The impact of stereotyping is not just on assessment, but may be across all teaching and learning activities at medical school.

INTERPRETATION

Social psychology concepts and theories can be used to describe the experience and impact of ethnicity-related stereotypes in HPE. Educators can better support learners from minority ethnic groups by self-reflecting over assumptions about individuals from minority ethnic groups, as well as minimise the impact of stereotyping and bias to create more inclusive learning environments.

Perceived quality of collaboration in dehydration care among Dutch nursing home professionals: A cross-sectional study

Aim

To explore the perceived quality of collaboration in dehydration care among nursing and medical staff in Dutch nursing homes.

Design

A cross‐sectional study.

Methods

An online questionnaire was administered to nursing and medical staff in February 2020 to assess the quality of collaboration in dehydration care and its influencing factors. Descriptive statistics, chi‐square tests and multinomial logistic regression analysis were used to describe the results and examine differences between groups.

Results

In total, 695 questionnaires were completed by multiple levels of (specialized) nursing staff and nursing home physicians. The quality of collaboration was assessed as good (23.2%), sufficient (59.4%) and insufficient (17.4%). Predicting factors related to perceiving the quality of collaboration as good were working experience, dehydration training during education and the presence of a dehydration protocol/guideline in the nursing home. Enabling factors related to collaboration in dehydration care were ‘availability of sufficient aids to detect dehydration’, ‘continuity in the care relationship’ and ‘sufficient background data of the resident in the care record’. Factors that hinder collaboration were ‘insufficient knowledge about dehydration among nursing and medical staff’, ‘the absence of a team meeting in which the topic dehydration is discussed’ and ‘insufficient staffing level among nursing and medical staff’.

Conclusion

Collaboration in dehydration care was generally assessed as sufficient. Participants with >10 years of working experience, who received dehydration training during their education and had a dehydration protocol/guideline available in the nursing home, perceived the quality of collaboration more often as good. Experienced barriers and enablers for collaboration in dehydration care varied between professional groups. Therefore, it is important to gain more insight into (informal) caregivers’ perceptions on what is expected from each other about dehydration care.

Impact

Care professionals experience several limiting factors in collaborating in dehydration care. Addressing these factors could optimize dehydration care in Dutch nursing homes.

Tips for Building a Community for Incoming Medical Students Virtually in the COVID-19 Era

A sense of community benefits medical trainees by preserving mental well-being, nurturing collegiality and mentorship, and grounding ties with partnering organizations and services. Within medical school, building these support relationships often begins shortly after matriculation. In the current pandemic and the accompanying shift to a virtual class format, we believe that a dedicated effort to foster this sense of community is crucial for students who otherwise may feel untethered to their new learning environment. Here, we detail tips for building a medical school community virtually in the COVID-19 era between peers, within the school institution, and within the surrounding environment.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-021-01447-z.

Enhanced learning strategies of undergraduate medical students with a structured case presentation format

BACKGROUND

Improvement of the learning in undergraduate bedside teaching needs to be promoted through innovative interventions. Changes in the structured format (SF) for bedside case discussion may help students improve their learning experience and gain insights into collaborative self-directed learning. The aim of the present study was to encourage collaborative and self-directed learning strategies by MBBS undergraduate students through a new case presentation format structured for this purpose.

MATERIALS AND METHODS

This was an interventional study carried out in the year 2010-2011. A new SF for bedside cases presentation was developed. A comparison with the traditional format was done by holding one session in each format. Uniformity of topic and teaching style was ensured by having the sessions on pulmonary medicine cases with the same teacher. The student perspective of the educational process was analyzed using evaluation pro forma, Likert scale, and narratives.

RESULTS

Ninety final year and prefinal year MBBS students participated in this study. There was significantly higher participation in history taking (50.7%) and clinical examination (60%) in the SF. A higher statistically significant number of clinical possibilities were considered in the SF (85.3% vs. 66.6%). Similarly, significantly higher number of students indulged in self-directed learning and referred to learning resources in the SF. The SF provided students an active role (96.9%), encouraged access to resources (93.9%), and control of learning (75.7%). The additional interactive session was productive (90.9%), discussions were streamlined (66.6%), and the role of a teacher was considered important (75.7%).

CONCLUSION

The SF generated higher participation in the aspects of history taking, clinical examination, and consideration of differential diagnoses. It led to a perceived improvement in self-directed and collaborative learning among students.

Participatory approaches, local stakeholders and cultural relevance facilitate an impactful community-based project in Uganda

Sanitation is a major global challenge that is often addressed at national and international levels, while community opinions and beliefs are neglected. To promote water, sanitation and hygiene (WASH) we organized a cross-cultural knowledge exchange workshop to assess participatory methods for engaging local stakeholders. The workshop included 22 participants from all sectors of society. Practical solutions to sanitation challenges were identified and later shared with a local community. Qualitative and quantitative analyses were used to assess impact and showed participatory methods were highly valued to encourage information sharing among widely varied stakeholders, and that video was a particularly successful approach when engaging with local communities. An 8-month follow-up survey of village members revealed excellent information recall, positive behaviour changes and a desire for future visits. Our evidence suggests that community-based participation helped identify solutions to WASH issues affecting rural communities in resource-poor settings. Engaging in a multicultural knowledge-share was particularly valuable as it enabled participants to recognize they have common challenges and allowed them to share low-cost solutions from their different communities. Our use of video was widely viewed as an ideal means of circulating findings, as it communicated information to people with a wide variety of community roles and to all age groups. Its relevance was increased by adopting a culturally appropriate context by involving local communities in workshop activities. We recommend that research in low- and middle-income countries should be mindful of the environmental context in which WASH is implemented, and encourage acceptance by engaging with communities through the use of varied participatory methods.

Formative peer assessment in higher healthcare education programmes: a scoping review

OBJECTIVES

Formative peer assessment focuses on learning and development of the student learning process. This implies that students are taking responsibility for assessing the work of their peers by giving and receiving feedback to each other. The aim was to compile research about formative peer assessment presented in higher healthcare education, focusing on the rationale, the interventions, the experiences of students and teachers and the outcomes of formative assessment interventions.

DESIGN

A scoping review.

DATA SOURCES

Searches were conducted until May 2019 in PubMed, Cumulative Index to Nursing and Allied Health Literature, Education Research Complete and Education Research Centre. Grey literature was searched in Library Search, Google Scholar and Science Direct.

ELIGIBILITY CRITERIA

Studies addressing formative peer assessment in higher education, focusing on medicine, nursing, midwifery, dentistry, physical or occupational therapy and radiology published in peer-reviewed articles or in grey literature.

DATA EXTRACTIONS AND SYNTHESIS

Out of 1452 studies, 37 met the inclusion criteria and were critically appraised using relevant Critical Appraisal Skills Programme, Joanna Briggs Institute and Mixed Methods Appraisal Tool tools. The pertinent data were analysed using thematic analysis.

RESULT

The critical appraisal resulted in 18 included studies with high and moderate quality. The rationale for using formative peer assessment relates to giving and receiving constructive feedback as a means to promote learning. The experience and outcome of formative peer assessment interventions from the perspective of students and teachers are presented within three themes: (1) organisation and structure of the formative peer assessment activities, (2) personal attributes and consequences for oneself and relationships and (3) experience and outcome of feedback and learning.

CONCLUSION

Healthcare education must consider preparing and introducing students to collaborative learning, and thus develop well-designed learning activities aligned with the learning outcomes. Since peer collaboration seems to affect students' and teachers' experiences of formative peer assessment, empirical investigations exploring collaboration between students are of utmost importance.

The Relation between Social Capital and Academic Motivation of Students: A Study of Health Professional Education in Japan

Academic motivation consists of reward-based extrinsic motivation and curiosity-based intrinsic motivation. Students studying at university or college develop several new social connections with friends, classmates, and teachers, in addition to their family and community. Belonging to their networks, students acquire opinions, appreciation, trust, and norms of the society. Whether those social connections enhance the motivation of university students for academic work is a question yet to be answered in the context of health profession education in Japan. Judo-therapist education is a form of health profession education in Japan. This study aimed to measure the academic motivation and social capital (SC) of judo-therapist students in Japan, and to find the relation between social capital and academic motivation. This cross-sectional study recruited a total of 2247 students applying multi-stage sampling across Japan. A Japanese version Academic Motivation Scale (AMS) measured the learning motivation in three constructs: (1) intrinsic motivation (IM); (2) extrinsic motivation (EM); and (3) amotivation (alpha 0.94). A newly-developed 46-itemed, 4-pointed scale measured social capital (SC) in five constructs: (1) family relations, (2) on-campus friends, (3) off-campus friends, (4) classroom social capital; and (5) regional social capital (alpha 0.85). Robust regression analysis treated all constructs of SC as independent variables and IM and EM as dependent variables respectively in the three models. Among the average level of constructs, the family SC average level was the highest. Classroom SC was less than family SC and community SC was the lowest. Intrinsic motivation is positively influenced by classroom SC the most, followed by family SC, on-campus friends’ SC, and community SC. Extrinsic motivation is positively influenced by classroom SC the most, followed by family SC, on-campus friends’ SC, and community SC. Amotivation is negatively influenced by social capital constructs except external friends’ SC. In conclusion, social connections have the power to enhance the motivation of university students’ academic work within health profession education. The relations, trust and bonds developed in the classroom may allow an adult learner’s motivation to evolve into autonomous intrinsic motivation and prevent amotivation.

An evaluation of early career academic nurses' perceptions of a support program designed to build career-resilience

Early career academic nurses can struggle to meet the demands of career development due to feelings of being overwhelmed. Studies indicate that programs targeting these challenges are often sporadic and inconsistent, leading to dissatisfaction and missed opportunities.This paper reports on findings evaluating a program designed to build career-resilience in a group of early career academic nurses who, through the provision of a structured program of support, were enabled to succeed and thrive in the academy. This six session program was informed by Knowles' adult learning theory, Mezirow's transformational learning theory and Lord's reliance on critical transactions.This study was undertaken in a large metropolitan university in Sydney, Australia. Participants included nine early career academic nurses. All had been full-time academics from one to six years. A qualitative descriptive design was employed using Braun and Clarke's six stage process for data analyses. Three themes emerged: the program fostered connections, strengthened expertise and clarified directions. This analysis provided deep insights into the value of collegial relationships to galvanise career success. The program's strength was its ability to lessen participants' feelings of isolation and to develop behaviours that enhance career-resilience.

Determining the effectiveness of peer-assisted learning in medical education: A systematic review and meta-analysis

OBJECTIVE

Despite the popularity of peer-assisted learning (PAL), existing literature has not shown enough evidence that can validate its impact on students' active learning. This meta-analysis aims to quantitatively analyse the effectiveness of PAL in medical education.

METHODS

We searched selected databases using the Medical Subject Headings (MeSH) terms 'peer-assisted', 'learning', 'active learning', 'teaching strategy', 'peer mentoring', and 'peer instructions' for full-text English language studies with a pre-post design. Following a systematic protocol, we selected 11 articles for final analysis. A meta-analysis was done using Review Manager (RevMan) 5.3 from Cochrane Training and the final output was presented by a forest plot.

RESULTS

The results showed a significant effectiveness of PAL; notably, there was a standardised mean difference of 1.26 with a confidence interval of 0.58-1.94. The Cochran's Q test showed a 5% level of significance as measured by Chi2 = 449.46. Besides, the results of the I2 test were significant (98%); moreover, a z value of 3.65 validated the effectiveness of PAL.

CONCLUSION

This research has shown that PAL can be used as a valuable learning tool in the medical field. Educational interventions in curricula for incorporating PAL strategies can potentially enhance the learning experience of the medical students.

Elements of group dynamics that influence learning in small groups in undergraduate students: A scoping review

BACKGROUND

Learning in small groups is a frequent activity in undergraduate programs to enrich learning, as well as in nursing programs during clinical experiences. Being in a small group adds elements of group dynamics that influence learning. Research into the influence of these elements on learning in small groups is not clear in the literature. This makes it challenging for educators to promote the optimal environment for learning.

OBJECTIVE

To explore the literature on elements of group dynamics that influence learning in small groups among undergraduate students.

DESIGN AND DATA SOURCES

A scoping review was performed, inspired by the five-stage approach of Arksey and O'Malley and the methodology outlined by the Joanna Briggs Institute. Various databases were used including CINAHL, ERIC, psycINFO, PubMed and Science Direct.

REVIEW METHOD

Our research question was: What are the elements of group dynamics that influence learning in small groups among undergraduate students? At least two authors analyzed the relevant studies and data were extracted to describe the elements of group dynamics that influence learning in small groups among undergraduate students.

RESULTS

Thirty papers were included in our review. Five elements emerged: engagement, openness, support, quality of communication and style of dominant behavior.

CONCLUSIONS

The results suggested the utilization of these elements in establishing a group dynamic favorable for learning in small groups. Since little research has been done into group dynamics in nursing education, it was useful to explore this concept in other disciplines. Further research is needed with a focus on clinical education for nursing students.

The collaborative learning development exercise (CLeD-EX): an educational instrument to promote key collaborative learning behaviours in medical students

BACKGROUND

Modern clinical practice increasingly relies on collaborative and team-based approaches to care. Regulatory bodies in medical education emphasise the need to develop collaboration and teamwork competencies and highlight the need to do so from an early stage of medical training. In undergraduate medical education, the focus is usually on collaborative learning, associated with feedback and reflection on this learning This article describes a novel educational instrument, the Collaborative Learning Development Exercise (CLeD-EX), which aims to foster the development of key collaborative learning competencies in medical students. In this article we report on the effectiveness, feasibility and educational impact of the CLeD-EX.

METHODS

In this study, the "educational design research" framework was used to develop, implement and evaluate the CLeD-EX. This involved adopting a systematic approach towards designing a creative and innovative instrument which would help solve a real-world challenge in developing collaborative learning skills. The systematic approach involved a qualitative exploration of key collaborative learning behaviours which are influential in effective collaborative learning contexts. The identified competencies were employed in the design of the CLeD-EX. The design of the CLeD-EX included features to facilitate structured feedback by tutors to students, complemented by self-evaluation and reflection. The CLeD-EX was field-tested with volunteer junior medical students, using a controlled pre-test post-test design. Analysis of the completed CLeD-EX forms, self-perception surveys (i.e. pre-test and post-test surveys) and analyses of reflective reports were used to explore the educational impact of CLeD-EX, as well as its utility and practicality.

RESULTS

After using the CLeD-EX, students showed a significant improvement in critical thinking and group process as measured by a previously validated instrument. Both students and tutors recognised CLeD-EX as an effective instrument, especially as a structured basis for giving and receiving feedback and for completing the feedback loop. CLeD-EX was also found to be feasible, practical and focused, while promoting learning and effective interactions in small group learning.

CONCLUSION

The findings of this study support the introduction of an effective and feasible educational instrument such as the CLeD-EX, to facilitate the development of students' skills in collaborative learning.

Twelve tips for developing and implementing curriculum in dedicated 'collaborative classrooms'

Many health professional schools may be investing time and resources on dedicated educational spaces intended to promote collaborative learning. Alone, innovative physical space or technologies are not sufficient to ensure success in this. Lesson plans informed by collaborative praxis, individual motivation, faculty development, learner feedback, and team interactions also play a necessary and substantial role. We have used faculty observations, quantitative and qualitative student evaluation data, and the existing educational literature to provide twelve tips on leveraging curricular content, activity setup, physical space, learner behavior, and faculty facilitation to make the most of collaborative learning spaces.

Improving diet quality among adolescents, using health belief model in a collaborative learning context: a randomized field trial study

This study aimed to assess the impact of educational intervention, based on health belief model (HBM) and collaborative learning techniques on diet quality in adolescents. In this field trial study, 311 students aged 13-15 years old were included, of which 163 and 148 allocated in the experimental and comparison groups, respectively. They were selected through a stratified random sampling from 16 urban, secondary schools in 4 educational districts of Shiraz, the largest city in southern Iran. The revised children diet quality index was used to assess their diet quality. Using HBM as a framework for targeting determinants of dietary behavior, the intervention was performed in a collaborative learning context during the educational year (2015-16). Constructs of HBM and diet quality were measured before and after the intervention. All HBM's constructs and knowledge had significantly improved in the experimental group and mean differences were increased after the intervention. Diet quality improved in the experimental group (P < 0.001), which was significantly different from the comparison group (P = 0.001). The findings support the integration of appropriate models/theories into the context of collaborative learning methods to target large number of behavioral determinants, and ultimately increase the effectiveness of the educational interventions amongst adolescents.

Voluntary attendance of small-group brainstorming tutoring courses intensify new clerk's "excellence in clinical care": a pilot study

BACKGROUND

Clerkship provides a unique way of transferring the knowledge and skills gathered during medical school's curriculum into real-ward clinical care environment. The annual program evaluation has indicated that the training of clerks in diagnostic and clinical reasoning skills needed to be enhanced. Recently, "clinical excellence" program have been promoted in our institution to augment the excellence in clinical care of new clerks. Current study aims to evaluate whether this pilot program improve the "clinical excellence" of new clerks.

METHODS

In a pilot study, groups of new clerks in years 2013 and 2014 voluntarily attended either a small-group brainstorming course or a didactic classroom tutoring courses as part of their 3-month internal medicine clinical rotation block. A third group of new clerks did not join either of the above courses and this group served as the control group. Pre-block/post-block self-assessment and post-block 5-station mini-Objective Subjective Clinical Examinations (OSCEs) were used to evaluate the effectiveness of these two additional courses that trained diagnostic and clinical reasoning skills.

RESULTS

Overtime, the percentages of new clerks that attended voluntarily either the small-group brainstorming or classroom tutoring courses were increased. Higher post-block self-assessed diagnostic and clinical reasoning skill scores were found among individuals who attended the small-group brainstorming courses compared to either the didactic group or the control group. In a corresponding manner, the small-group brainstorming group obtained higher summary OSCE_diag and OSCE_reason scores than either the didactic group or control group. For all basic images/laboratory OSCE stations, the individual diagnostic skill (OSCE_diag) scores of the small-group brainstorming group were higher than those of the didactic group. By way of contrast, only the clinical reasoning skill (OSCE_reason) scores of the basic electrocardiogram and complete blood count + biochemistry OSCE station of thesmall-group brainstorming group were higher than those of the didactic group. Among the small-group brainstorming group, clerks with higher cumulative learning hours (>30-h) had significant higher OSCE_diag and OSCE_reason scores (>400) than those with less cumulative learning hours.

CONCLUSION

Our pilot study provides a successful example of the use of a small-group tutoring courses for augmenting the diagnostic and clinical reasoning skills of new clerks. The positive results obtained during the initial 2-year long pilot "clinical excellence" program have encouraged the formal implementation of this course as part of the clerkship curriculum.