While Peer Assisted Learning (PAL) has long occurred informally in medical education, in the past ten years, there has been increasing international interest in formally organised PAL, with many benefits for both the students and institutions. We conducted a systematic review of the literature to establish why and how PAL has been implemented, focussing on the recruitment and training process for peer tutors, the benefits for peer tutors, and the competency of peer tutors.
A literature search was conducted in three electronic databases. Selection of titles and abstracts were made based on pre-determined eligibility criteria. We utilized the ‘AMEE Peer assisted learning: a planning and implementation framework: AMEE Guide no. 30’ to assist us in establishing the review aims in a systematic review of the literature between 2002 and 2012. Six key questions were developed and used in our analysis of particular aspects of PAL programs within medical degree programs.
We found nineteen articles that satisfied our inclusion criteria. The PAL activities fell into three broad categories of teacher training, peer teaching and peer assessment. Variability was found in the reporting of tutor recruitment and training processes, tutor outcomes, and tutor competencies.
Results from this review suggest that there are many perceived learning benefits for student tutors. However, there were mixed results regarding the accuracy of peer assessment and feedback, and no substantial evidence to conclude that participation as a peer tutor improves one’s own examination performance. Further research into PAL in medicine is required if we are to better understand the relative impact and benefits for student tutors.
There is increasing evidence that simulation provides high-quality, time-effective training in an era of resident duty-hour restrictions. Simulation may also permit trainees to acquire key skills in a safe environment, important in a specialty such as neurosurgery, where technical error can result in devastating consequences. The authors systematically reviewed the application of simulation within neurosurgical training and explored the state of the art in simulation within this specialty. To their knowledge this is the first systematic review published on this topic to date.
The authors searched the Ovid MEDLINE, Embase, and PsycINFO databases and identified 4101 articles; 195 abstracts were screened by 2 authors for inclusion. The authors reviewed data on study population, study design and setting, outcome measures, key findings, and limitations.
Twenty-eight articles formed the basis of this systematic review. Several different simulators are at the neurosurgeon’s disposal, including those for ventriculostomy, neuroendoscopic procedures, and spinal surgery, with evidence for improved performance in a range of procedures. Feedback from participants has generally been favorable. However, study quality was found to be poor overall, with many studies hampered by nonrandomized design, presenting normal rather than abnormal anatomy, lack of control groups and long-term follow-up, poor study reporting, lack of evidence of improved simulator performance translating into clinical benefit, and poor reliability and validity evidence. The mean Medical Education Research Study Quality Instrument score of included studies was 9.21 ± 1.95 (± SD) out of a possible score of 18.
The authors demonstrate qualitative and quantitative benefits of a range of neurosurgical simulators but find significant shortfalls in methodology and design. Future studies should seek to improve study design and reporting, and provide long-term follow-up data on simulated and ideally patient outcomes.
ABSTRACT: Residents’ Views of the Role of Classroom-Based Learning in Graduate Medical Education Through the Lens of Academic Half Days.
To examine the role of classroom-based learning in graduate medical education through the lens of academic half days (AHDs) by exploring residents’ perceptions of AHDs’ purpose and relevance and the effectiveness of teaching and learning in AHDs.
The authors invited a total of 186 residents in three programs (internal medicine, orthopedic surgery, and hematology) at the University of British Columbia Faculty of Medicine to participate in semistructured focus groups from October 2010 to February 2011. Verbatim transcripts of the interviews underwent inductive analysis.
Twenty-seven residents across the three programs volunteered to participate. Two major findings emerged. Purpose and relevance of AHDs: Residents believed that AHDs are primarily for knowledge acquisition and should complement clinical learning. Classroom learning facilitated consolidation of clinical experiences with expert clinical reasoning. Social aspects of AHDs were highly valued as an important secondary purpose. Perceived effectiveness of teaching and learning: Case-based teaching engaged residents in critical thinking; active learning was valued. Knowledge retention was considered suboptimal. Perspectives on the concept of AHDs as “protected time” varied in the three programs.
Findings suggest that (1) engagement in classroom learning occurs through participation in clinically oriented discussions that highlight expert reasoning processes; (2) formal classroom teaching, which focuses on knowledge acquisition, can enhance informal learning occurring during clinical activity; and (3) social aspects of AHDs, including their role in creating communities of practice in residency programs and in professional identity formation, are an important, underappreciated asset for residency programs.
Recently, a number of articles have surfaced reporting the ineffectiveness of note taking with laptops, in keeping with the findings of Pam Mueller and Daniel Oppenheimer detailed in The Pen Is Mightier Than the Keyboard. These authors assert that when students used laptops in lecture courses, they transcribed notes rather than synthesized information. As a result, those students then performed poorly on cognitively demanding tasks.However, before making a blanket statement that one device may be better than another e.g. pen vs. laptop or calling into question what may be the best note-taking system, what if we approach the concept by identifying what is best for individual students? In other words, does the system . . .Adequately support the students’ learning needs?Allow students to save their notes to multiple locations?Let students search for salient points?Permit students to share with peers and teachers?
The twentieth century saw a paradigm shift in medical education, with acceptance that ‘knowledge’ and ‘truth’ are contextual, in flux and always evolving. The twenty-first century has seen a greater explosion in computer technology leading to a massive increase in information and an ease of availability, both offering great potential to future research. However, for many decades, there have been voices within the health care system raising an alarm at the lack of evidence to support widespread clinical practice; from these voices, the concept of and need for evidence-based health-care has grown. Parallel to this development has been the emergence of evidence-based medical education; if healthcare is evidence-based, then the training of practitioners who provide this healthcare must equally be evidence-based. Evidence-based medical education involves the systematic collection, synthesis and application of all available evidence, when available, and not just the opinion of experts. This represented a seismic shift from a position of expert based consensus guidance to evidence led guidance for evolving clinical knowledge. The aim of this guide is to provide a practical approach to the development and application of a systematic review in medical education; a valid method used in this guide to seek and substantiate the effects of interventions in medical education.
MANUSCRIPT: Real-time use of the iPad by third-year medical students for clinical decision support and learning: a mixed methods study.
Despite widespread use of mobile technology in medical education, medical students’ use of mobile technology for clinical decision support and learning is not well understood. Three key questions were explored in this extensive mixed methods study: 1) how medical students used mobile technology in the care of patients, 2) the mobile applications (apps) used and 3) how expertise and time spent changed overtime.
This year-long (July 2012-June 2013) mixed methods study explored the use of the iPad, using four data collection instruments: 1) beginning and end-of-year questionnaires, 2) iPad usage logs, 3) weekly rounding observations, and 4) weekly medical student interviews. Descriptive statistics were generated for the questionnaires and apps reported in the usage logs. The iPad usage logs, observation logs, and weekly interviews were analyzed via inductive thematic analysis.
Students predominantly used mobile technology to obtain real-time patient data via the electronic health record (EHR), to access medical knowledge resources for learning, and to inform patient care. The top four apps used were Epocrates(®), PDF Expert(®), VisualDx(®), and Micromedex(®). The majority of students indicated that their use (71%) and expertise (75%) using mobile technology grew overtime.
This mixed methods study provides substantial evidence that medical students used mobile technology for clinical decision support and learning. Integrating its use into the medical student’s daily workflow was essential for achieving these outcomes. Developing expertise in using mobile technology and various apps was critical for effective and efficient support of real-time clinical decisions.
ABSTRACT: “Teaching is like nightshifts …”: a focus group study on the teaching motivations of clinicians.
To ensure the highest quality of education, medical schools have to be aware of factors that influence the motivation of teachers to perform their educational tasks. Although several studies have investigated motivations for teaching among community-based practitioners, there is little data available for hospital-based physicians.
This study aimed to identify factors influencing hospital-based physicians’ motivations to teach.
We conducted 3 focus group discussions with 15 clinical teachers from the Medical Faculty at Hamburg University. Using a qualitative inductive approach, we extracted motivation-related factors from the transcripts of the audio-recorded discussions.
Three main multifaceted categories influencing the motivation of teachers were identified: the teachers themselves, the students, and the medical faculty as an organization. Participants showed individual sets of values and beliefs about their roles as teachers as well as personal notions of what comprises a “good” medical education. Their personal motives to teach comprised a range of factors from intrinsic, such as the joy of teaching itself, to more extrinsic motives, such as the perception of teaching as an occupational duty. Teachers were also influenced by the perceived values and beliefs of their students, as well as their perceived discipline and motivation. The curriculum organization and aspects of leadership, human resource development, and the evaluation system proved to be relevant factors as well, whereas extrinsic incentives had no reported impact.
Individual values, beliefs, and personal motives constitute the mental framework upon which teachers perceive and assess motivational aspects for their teaching. The interaction between these personal dispositions and faculty-specific organizational structures can significantly impair or enhance the motivation of teachers and should therefore be accounted for in program and faculty development.
ABSTRACT: Expertise in medicine: using the expert performance approach to improve simulation training.
We critically review how medical education can benefit from systematic use of the expert performance approach as a framework for measuring and enhancing clinical practice. We discuss how the expert performance approach can be used to better understand the mechanisms underpinning superior performance among health care providers and how the framework can be applied to create simulated learning environments that present increased opportunities to engage in deliberate practice.
EXPERT PERFORMANCE APPROACH:
The expert performance approach is a systematic, evidence-based framework for measuring and analysing superior performance. It has been applied in a variety of domains, but has so far been relatively neglected in medicine and health care. Here we outline the framework and demonstrate how it can be effectively applied to medical education.
Deliberate practice is defined as a structured and reflective activity, which is designed to develop a critical aspect of performance. Deliberate practice provides an opportunity for error detection and correction, repetition, access to feedback and requires maximal effort, complete concentration and full attention. We provide guidance on how to structure simulated learning environments to encourage the accumulation of deliberate practice.
We highlight the role of simulation-based training in conjunction with deliberate practice activities such as reflection, rehearsal, trial-and-error learning and feedback in improving the quality of patient care. We argue that the development of expertise in health care is directly related to the systematic identification and improvement of quantifiable performance metrics. In order to optimise the training of expert health care providers, advances in simulation technology need to be coupled with effective instructional systems design, with the latter being strongly guided by empirical research from the learning and cognitive sciences.
The University of Virginia School of Medicine recently transformed its pre-clerkship medical education programme to emphasise student engagement and active learning in the classroom. As in other medical schools, many students are opting out of attending class and others are inattentive while in class. We sought to understand why, especially with a new student-centred curriculum, so many students were still opting to learn on their own outside of class or to disengage from educational activities while in class.
Focus groups were conducted with students from two classes who had participated in the new curriculum, which is designed to foster small-group and collaborative learning. The sessions were audio-recorded and then transcribed. The authors read through all of the transcripts and then reviewed them for themes. Quotes were analysed and organised by theme.
Interview transcripts revealed candid responses to questions about learning and the learning environment. The semi-structured nature of the interviews enabled the interviewers to probe unanticipated issues (e.g. reasons for choosing to sit with friends although that diminishes learning and attention). A content analysis of these transcripts ultimately identified three major themes embracing multiple sub-themes: (i) learning studio physical space; (ii) interaction patterns among learners, and (iii) the quality of and engagement in learning in the space.
Students’ reluctance to engage in class activities is not surprising if classroom exercises are passive and not consistently well designed or executed as active learning exercises that students perceive as enhancing their learning through collaboration. Students’ comments also suggest that their reluctance to participate regularly in class may be because they have not yet achieved the developmental level compatible with adult and active learning, on which the curriculum is based. Challenges include helping students better understand the nature of deep learning and their own developmental progress as learners, and providing robust faculty development to ensure the consistent deployment of higher-order learning activities linked with higher-order assessments.
ABSTRACT: The unique contribution of behavioral scientists to medical education: the top ten competencies
Understandably, the focus of most physicians is primarily on the biomedical-What is this disease or injury? Behavioral scientists from various disciplines in medical education generally have a broader approach-Who is this person with these symptoms and what is their story? Since behavioral scientists are often alone among U. S. residency faculty, physicians may fail to recognize the value of their approach to medical resident training. This review identifies and describes the top areas of expertise that behavioral scientists bring to medical education and how their training prepares them to think differently than other medical educators. In the course of identifying each competency, this review will emphasize the ways in which their skills and techniques are the origin of subtle impact in their teaching encounters, explore ways of targeting that impact, and discuss examples of this impact.