July 2021

posted in: 2021 Journal Clubs | 0

COMSEP Journal Club
July 2021
Editors: Karen Forbes, Jon Gold and Randy Rockney

Near Peers are No Worse Than Faculty (And Maybe Better!)

Student Perception of Case-based Teaching by Near-Peers and Faculty during the Internal Medicine Clerkship:  A Noninferiority Study.  Ahmad SE, Farina GA, Fornari A, Pearlman RE, Friedman K & Olvet DM. Journal of Medical Education and Curricular Development 2021: 8: 1-6.


Reviewed by: Janet Meller


What was the study question?

Are near-peers non-inferior to faculty in facilitating small group discussions during clinical rotations?


How was it done?

Seventy-five MS3 students enrolled in the Internal Medicine (IM) clerkship at one of two tertiary care sites were invited to participate. Twenty MS4 students who were rotating on their IM sub-internship (near-peers) were recruited with four being available as teachers at one site; at the other site four faculty served as teachers.  Students participated in a case-based interactive session during their core rotation. A faculty guide for a rheumatology case was developed and shared with the faculty and near-peer faculty.  The MS3 students were expected to work-up the case and ultimately discuss the diagnosis.  Following the session, the MS3 students were asked to complete a survey consisting of 18 items from the Stanford Faculty Development Program (SFDP-26) form. Data was statistically evaluated, and comparisons were made between faculty and near-peer facilitators regarding teacher performance and teaching effectiveness. Near-peer teachers were asked to self-reflect on their experience teaching.


What were the results?

There was no significant difference between the 2 groups in either teaching performance score or teaching effectiveness rating. An absolute difference of 14% favoring near-peers indicated there was noninferiority of the near-peer group (95%CI, -0.97%t0 4.99%) on teaching effectiveness scores.


What are the implications?

There was noninferiority of near-peer teachers and faculty in a clerkship setting, with a trend favoring near-peers in both teaching performance and teaching effectiveness.  Total teaching scores were high for both groups.  Near-peer instructors are able to teach at a level that is relatable to M3 students and appropriate for the exam.  This provides senior students with opportunity to practice teaching and can also relieve faculty burden.


Editor’s Comments: Fourth-year students who participated as teachers were not only highly rated as teachers, but also reported personal benefit including personal learning, clinical reasoning, and a connectedness with the third-year students due to a shared understanding of what students need to learn. This study demonstrates both effectiveness and feasibility of near-peer teaching. We might all consider ways to incorporate near-peer teaching and learning in our curricula. (KFo)


More Peering into Peer-to-Peer Teaching

 Learning through Teaching: Peer Teaching and Mentoring Experiences among Third-Year Medical Students. Yang MM, Golden BP, Cameron KA, Gard L, Bierman JA, Evan DB, Henschen BL (2021). Teaching and Learning in Medicine.


 Reviewed by: Neha S. Anand


What was the study question?

What are medical students’ perceptions of peer teaching and mentoring in longitudinal, outpatient clinical settings?


How was it done?

Matriculating medical students at a single institution were randomized to two different outpatient primary care clerkships. The individual preceptorship (IP) clerkship followed a more traditional model of one-on-one preceptorship for the first two years of medical school and a four-week primary care block during third year. The Education Centered Medical Home (ECMH) clerkship included students from all four years who worked together under a single preceptor throughout the duration of medical school. A subset of students in each setting participated in semi-structured interviews during their third year. Their responses were used for qualitative analysis to gain insight into their experiences peer teaching and serving as role models or mentors.


What were the results?

A total of 33 students (14 IP and 19 ECMH students) were interviewed. The authors identified three main themes. The first theme was “diversity of peer teaching and mentoring opportunities.” Students in both the IP and ECMH clerkships noted a variety of opportunities for peer teaching in areas related to medical knowledge, clinical skills, and general tips for being successful in medical school. ECMH students further cited the curriculum’s design of working with other medical students as a key promoter of peer teaching and mentoring. The next theme was “transitioning one’s role from learner to teacher.” While both IP and ECMH students commented on paying it forward through mentoring junior students and the importance of creating a comfortable learning environment, ECMH students further expressed personal responsibility for the success of mentees as well as a commitment to recreate meaningful experiences that were formative for their own learning. The last theme was “personal and professional development.” Students in both clerkships commented on enjoying teaching others, “learning through teaching,” and having a perceived sense of purpose through mentoring. ECMH students were more likely to describe increased confidence and independence with teaching. Many also reflected on their professional growth as teachers.


What are the implications?

Learning environments that promote peer teaching and mentoring in medical school are important for the professional and personal development of students into teachers. Curricula that incorporate peer teaching may better prepare students for their future roles as resident and physician teachers as well as patient educators. A longitudinal setting that allows students at different knowledge levels to interact could be one way to provide consistent opportunities for peer teaching and mentoring experiences.


Editor’s Note: This qualitative study adds to the study reviewed by Dr. Meller above.   I suspect that one of the key differences between the two groups is that the team approach put students in positions of responsibility.  Being responsible drives more authentic learning and also increases self-esteem.  Although this is a small sample of students, it is certainly encouraging to see them identify the satisfaction they get from teaching others. (JG)


Improving resident-to-student teaching?  There’s an app for that.

Teaching scripts via smartphone app facilitate resident-led teaching of medical students Zessis, N.R., Dube, A.R., Sadanand, A. et al. . BMC Med Educ 21, 331 (2021). https://doi.org/10.1186/s12909-021-02782-w

Reviewed by Nicole Meyers and Suzanne Friedman


What was the study question?

Does a smartphone app with teaching scripts on general pediatrics topics increase the duration and frequency of resident-reported teaching of medical students?


How was the study done?

Pediatric residents and hospitalists at a single institution created 12 teaching scripts on common general pediatric topics in one of three formats: outlines for “chalk-talks”, powerpoint slides for lectures, and question-and-answer cards.  They made the teaching scripts available to all pediatric residents via a smartphone app.  Authors compared pediatric residents’ self-reported duration and frequency of teaching medical students before and after the intervention.  Third-year medical students were asked to rank their core clerkships based on quality of resident teaching before and after the intervention.


What were the results?

There was a significant increase in time spent teaching post-intervention, but a non-significant increase in overall frequency of teaching. There was however a significant correlation between actual use of the app and increased frequency of teaching. A majority of residents used the app in at least some capacity and planned to use the app for medical student teaching in the future. There was a significant post-intervention improvement in medical student ranking of pediatric resident teaching compared to that on other clerkships.


What are the implications?

This study demonstrates the success of a smartphone app in enhancing resident-led medical student education. Pediatric residency programs and clerkship organizers must continue to think creatively about novel platforms for near-peer teaching. Specifically, educators should consider the use of smartphone apps such as the one studied here, as it provides relevant teaching materials through a portable and easily accessible medium.


Editor’s Note: In their discussion the authors’ note that the PGY1 residents used the app more frequently than the PGY3’s, suggesting that the teaching scripts provided scaffolding for early teachers that wasn’t needed by senior residents.

Shameless plug: if you are looking for another app to help medical students with their clinical reasoning skills (and one that can be easily used by residents) check out Pedscripts –available in IOS and webapp versions and free to COMSEP members. (JG)