The global variation of medical student engagement in teaching: Implications for medical electives

Preparing medical students for their educational task as physicians: important, desirable and unexplored territory

BACKGROUND

Physicians engage in educational activities in daily practice and take over an important role in providing information and transferring knowledge to patients and medical students. Therefore, it is important to focus on methods to develop teaching skills during medical school. Peer-teaching is a teaching method that is connected to different positive learning outcomes. This study aims to investigate the perspective of medical students regarding teaching as a core competency of physicians and peer-teaching as an opportunity to acquire educational skills. The study also aims to examine to what extent medical students are prepared for their teaching role at medical schools.

METHODS

This cross-sectional study was performed by an online survey amongst Dutch medical students from all medical schools across all years of study. In total, 2666 medical students filled out the survey. The survey was part of the annual online survey of the Dutch medical advocacy group (DeGeneeskundestudent) amongst all medical students in the fall of 2017. The data were analysed with descriptive statistics and statistical tests (chi-squared-test and binomial test).

RESULTS

The results show that 49% of medical students see teaching as one of the core tasks of a physician. However, only 25% feel well prepared by their medical school for this teaching role. Instead, there are many students who gain experiences and teaching skills on their own outside medical schools. 64% of the respondents agrees that senior medical students can educate junior medical students well.

CONCLUSIONS

Implementing peer-teaching in the curricular of medical schools could be an effective teaching method to prepare medical students for their future teaching role. It is important that medical schools focus on enhancing educational quality and designing learning environments for best learning outcomes to better prepare medical students for professional life.

A scoping review of the ethical impacts of international medical electives on local students and patient care

BACKGROUND

International electives are often considered a valuable learning opportunity for medical students. Yet, as travelling to lower and middle income countries (LMICs) becomes more common, ethical considerations of such practices emerge. We conducted a scoping review to assess the extent to which five ethical themes were addressed in existing literature about electives, with the aim of investigating the ethical impacts of medical student electives on local resources, patients and clinicians in LMICs.

METHODS

We systematically searched PubMed, Global Health and Embase databases using the search terms "(ethics) AND (medical electives)". Thematic content analysis was undertaken using a combination of deductive and inductive themes. The deductive themes included: exceeding clinical competence, use of limited local resources, respect for patients and local culture, collaboration with local community/colleagues, and one-sided benefits in partnership. In addition, we also allowed for emerging themes within the data, and conducted a narrative synthesis of the results.

RESULTS

A total of 37 papers discussed ethical issues relating to medical student international electives to LMICs. More publications were written from the medical student perspective (n = 14), than by the host-institution (n = 5), with nearly half written from third-party perspectives (n = 18). Negative impacts on local host students and impact upon patient care were identified as additional ethical considerations.

CONCLUSIONS

Our review demonstrated that while there is a degree of awareness in the existing literature of the potential negative impacts of medical electives to local LMIC students' access to medical education and patient care, continued work is needed to ensure equitable partnerships. We recommend that these ethical themes should be further explored in pre-departure elective teaching courses and post-elective debriefs to increase medical students' awareness of the impact of their presence on host communities.

Teaching Medical Students to Teach: A Narrative Review and Literature-Informed Recommendations for Student-as-Teacher Curricula

PURPOSE

Medical students play an important role as teachers. This narrative review synthesizes the student-as-teacher (SaT) literature that incorporates formal teaching skills training, with the goal of proposing literature-informed recommendations for SaT curriculum development within the context of competency-based medical education.

METHOD

In January and August 2020, the authors searched Medline and Embase and conducted forward citation searches in Scopus to identify articles from 1985 to 2020 related to teaching medical students to teach. Search terms included "student(s) as teacher(s)," "near-peer teaching," and "teaching to teach." The findings from selected articles were summarized and synthesized.

RESULTS

Forty-three articles met the inclusion criteria: 33 papers describing specific SaT curricula, 3 literature reviews, 6 stakeholder surveys, and 1 Delphi study. While students often engage in teaching roles, formal teaching skills training is not always provided. Existing curricula are usually optional, delivered as short courses, and offered to senior students. Course content commonly includes topics related to planning and delivering learning activities and providing feedback. Of the numerous teaching modalities employed, students indicate a preference for interactive and experiential learning. Methods used to assess students' teaching skills vary; however, direct observation and feedback are valued assessment methods. Program evaluations have shown positive outcomes, including high student satisfaction and enhanced self-confidence as teachers.

CONCLUSIONS

Informed by these findings and outcome-based educational frameworks, the authors suggest 4 guiding principles for SaT curricula: (1) teaching skills training should be formally implemented in undergraduate medical education and should, whenever possible, be compulsory; (2) teaching skills should be taught longitudinally and progressively along the undergraduate to postgraduate continuum; (3) curriculum content should be aligned with a school's preexisting curriculum and local context; and (4) authentic opportunities for students to engage in teaching roles should be included. They also propose recommendations for curriculum content, teaching modalities, and assessment methods.