Increasing Patient Acceptance of Medical Student Participation: Using Interactive Theatre for Faculty Development

Background : Interactive theatre (IT) has been used to train faculty the skills and strategies to address challenging dynamics in educational settings. Purpose : This study described the development, implementation, and evaluation of an IT approach to improve preceptors' skills for increasing patients' acceptance of medical student participation in clinical care. Methods : Focus groups were conducted with faculty, residents, medical students, and clinic staff to discuss issues related to patients declining medical student participation. Findings were used to develop a faculty development session using an IT approach. At a Family Medicine grand rounds presentation, faculty and resident preceptors (n = 42) participated in the IT workshop and completed a pre–post survey assessing skills specific to increasing students' training opportunities in patient care and educational impact of the session. Results : Following the IT session, preceptors reported greater self-efficacy for helping patients feel more comfortable with medical students in the exam room (p =.031, d = 0.338) and increased comfort level with talking to patients about medical students performing sensitive exams (p =.010, d = 0.357). Eighty-eight percent of preceptors agreed or strongly agreed that the session was relevant to improving clinical precepting skills and helped them develop strategies for enhancing medical student involvement in care. Conclusions : Findings suggest that the interactive theatre approach to faculty development is an innovative and effective method to increase preceptors' comfort with discussing medical student involvement with patients.     

Assessing Advanced Communication Skills via Objective Structured Clinical Examination: A Comparison of Faculty Versus Self,Peer, and Standardized Patient Assessors

Abstract

Construct: The construct addressed in this study is assessment of advanced communication skills among senior medical students. Background: The question of who should assess participants during objective structured clinical examinations (OSCEs) has been debated, and options discussed in the literature have included peer, self, standardized patient, and faculty assessment models. What is not known is whether same-level peer assisted learning can be utilized for formative assessment of advanced communication skills when no faculty, standardized patients, or other trained assessors are involved in providing feedback. If successful, such an educational model would optimize resource utilization and broaden the scope of topics that could be covered in formative OSCEs. Approach: The investigators developed a 4-station formative OSCE focused on advanced communication skills for senior medical students, and evaluated the concordance of assessment done by same-level peers, self, standardized patients, and faculty for 45 students. After each station, examinees completed a self-assessment checklist and received checklist-based assessment and verbal feedback from same-level peers only. Standardized patients completed checklist-based assessments outside the room, and faculty did so after the OSCE via video review; neither group provided direct feedback to examinees. The investigators assessed inter-rater agreement and mean difference scores on the checklists using faculty score as the gold standard. Findings: There was fair to good overall agreement among self, same-level peer, standardized patient, and faculty-assessment of advanced communication skills. Relative to faculty, peer and standardized patient assessors overestimated advanced communication skills, while self-assessments underestimated skills. Conclusions: Self and same-level peer-assessment may be a viable alternative to faculty assessment for a formative OSCE on advanced communication skills for senior medical students.     

Seeing Is Believing: Evaluating a Point-of-Care Ultrasound Curriculum for 1st-Year Medical Students

Problem: Point-of-care ultrasound has been a novel addition to undergraduate medical education at a few medical schools. The impact is not fully understood, and few rigorous assessments of educational outcomes exist. This study assessed the impact of a point-of-care ultrasound curriculum on image acquisition, interpretation, and student and faculty perceptions of the course. Intervention: All 142 first-year medical students completed a curriculum on ultrasound physics and instrumentation, cardiac, thoracic, and abdominal imaging. A flipped classroom model of preclass tutorials and tests augmenting live, hands-on scanning sessions was incorporated into the physical examination course. Students and faculty completed surveys on impressions of the curriculum, and all students under-went competency assessments with standardized patients. Context: The curriculum was a mandatory part of the physical examination course and was taught by experienced clinician-sonographers as well as faculty who do not routinely perform sonography in their clinical practice. Outcome: Students and faculty agreed that the physical examination course was the right time to introduce ultrasound (87% and 80%). Students demonstrated proper use of the ultrasound machine functions (M score = 91.55), and cardiac, thoracic, and abdominal system assessments (M score = 80.35, 79.58, and 71.57, respectively). Students and faculty valued the curriculum, and students demonstrated basic competency in performance and interpretation of ultrasound. Further study is needed to determine how to best incorporate this emerging technology into a robust learning experience for medical students.     

Introducing Final-Year Medical Students to Pocket-Sized Ultrasound Imaging: Teaching Transthoracic Echocardiography on a 2-Week Anesthesia Rotation

Problem: The availability of less expensive and smaller ultrasound machines has enabled the use of ultrasound in virtually all major medical/surgical disciplines. Some medical schools have incorporated point-of-care ultrasound training into their undergraduate curriculum, whereas many postgraduate programs have made ultrasound training a standard. The Chinese University of Hong Kong has charged its Department of Anaesthesia and Intensive Care to spearhead the introduction of ultrasound into the final-year medical curriculum by introducing handheld transthoracic echocardiography as part of perioperative assessment. Intervention: All 133 final-year students completed a 2-week anesthesia rotation, which began with a half-day session consisting of a lecture and hands-on practice session during which they learned 9 basic transthoracic echocardiography views using 4 basic ultrasound probe positions. Context: Each student was required to perform a transthoracic echocardiography-examine under supervision of 1 patient/week for 2 weeks, and their results were compared against that of the supervisor's. Most patients were elective cardiac surgery patients. One long question on transthoracic echocardiography was included in their end-of-year surgery examination paper. Students provided feedback on their experience. Outcome: Most students learned the basic transthoracic echocardiography views fairly efficiently and had variable, though generally favorable, success rates in identifying obvious cardiac anomalies, including use of color Doppler. A few common mistakes were identified but were easily correctable. Logistics for mobilizing enough bedside supervision were challenging. Students reported positive feedback on the teaching initiative. Lessons Learned: We were able to execute a successful short training course on transthoracic echocardiography during the final-year medical degree anesthesia rotation. Our initiative may set an example for other clinical departments to design similar courses pertinent to their specialties and syllabuses.     

Increasing Medical Students' Confidence in Procedural Skills Using a Junior Doctor-Delivered Bedside Supervision Program

Clinical procedural skills are formally taught to medical students in clinical skills centers using mannequins. Exposure to procedural skills involving patients and opportunities to practice under the supervision of doctors are limited. Intervention: A bedside supervision program was piloted at a district general hospital in the United Kingdom. The supervision model was chosen as the method to increase medical students' practice in basic procedural skills because it allowed safe practice with patients. Context: The program was an optional component of the medical students' clinical clerkships. Off-duty junior doctors were recruited as voluntary trainers. The trainers obtained requests for procedural tasks from the on-call doctors and ward nurses, following which the trainers supervised medical students performing the basic procedures with patient consent. Outcome: The pilot program was successfully run for 4 weeks. Fourteen students took part, and 9 (64%) completed a postintervention feedback questionnaire. The students' confidence (rating scale = 1–5) in performing procedural skills improved from a mean of 3.0 (SD ± 0.9) to 4.7 (SD ± 0.5) following a supervision session. Although the range of skills was limited to opportunistic encounters, the students reported high satisfaction and felt supervision enabled them to identify areas for improvement. Lessons Learned: It is feasible to implement a junior doctor-delivered bedside program to supplement procedural skills training provided by medical schools. The challenges include reconciling the tension between junior doctors' service work and their teaching commitment, logistical issues such as recruiting a sufficient number of trainers and ensuring adequate coverage of training tasks.     

Incorporating Peer Assessments within a Clinical Practicum Course: Insights from a Clinical Faculty Initiative

IntroductionPeer assessments have been used within health professional programs to provide some degree of judgment of professional behavior and to facilitate feedback among peers. In an attempt to further support the clinical learning of our students, the clinical education team at the Odette Cancer Centre initiated a pilot to introduce peer assessments as a part of strategies for learning and engagement within laboratory sessions. The aim of our work was to retrospectively review peer assessments completed during these sessions in an attempt to identify professional behaviors, both positive and negative, and subsequently correlate the assessments with observed behaviors noted, both formally and anecdotally, within clinical faculty assessments. Further to this, our team attempted to explore student perceptions on the impact of peer assessments to their own learning.MethodsStudents in the final year of a 3-year undergraduate medical radiation sciences program were asked to assess their peers during laboratory sessions using a modified version of an assessment tool previously known to the students, the Assessment of Readiness for Clinical tool. Students (N = 14) were required to evaluate each of their peers who participated in the same session and provide supporting comments for their rating. For each student, responses from peer assessors were anonymized and collated. Comments and numerical ratings on the peer assessments were compared. The student assessments were subsequently compared with similar measures extracted from faculty assessments. Students also participated in a debriefing session to provide feedback regarding the integration of these assessments within the learning sessions and the potential impact they had on their own professional behaviors.ResultsThe majority of students rated their peers in all criteria at a score of 2 (performed or surpassed expectations). There was some correlation between numerical ratings and comments written in the assessments. Comments on peer assessments were in concordance with observations extracted from previous assessments by clinical faculty and teachers for 71% of the students. Students expressed a favorable attitude toward the use of the peer assessments but did not find the numerical ratings useful and instead valued supporting constructive comments that cited specific examples for improvement.ConclusionsPeer assessments were found to be of some benefit to the learning of our students, particularly the anecdotal supporting comments that accompanied the ratings. However, their use must be accompanied by formalized training and guidelines to teachers and learners as well as a careful consideration of the tool chosen to ensure the most purposeful impact on behavior change.     

Book reviews

Background: As medical schools continue to strive to deliver high quality education with diminishing resources, the need to evaluate long-standing teaching techniques becomes imperative. The use of gynecological teaching associates to teach pelvic exam skills to medical students is an example of an education intervention that deserves thorough evaluation. Purpose: The objective was to evaluate effects of two pelvic examination training methods on OB/GYN clerkship students with respect to costs, students’ performance, and perception. Method: During the academic year 2007–08, 106 medical students were randomized to receive either pelvic examination training by a gynecological teaching associate (GTA) alone or a standardized patient (SP) accompanied by an obstetrics and gynecology faculty member. Students participated in an objective structured clinical exam (OSCE) and completed questionnaires regarding the educational intervention at the end of the clerkship. Results: The two training methods produced comparable OSCE scores, and students in both groups felt more confident after training and found the training sessions to be valuable. There was a significant cost-savings associated with using GTAs for pelvic exam training. Conclusions: Faculty time and effort need not be utilized for pelvic exam training exercises, since using GTAs for pelvic exam training produces comparable results.     

Dynamic online peer evaluations to improve group assignments in nursing e-learning environment

ObjectivesThe purpose of this research was to evaluate the use of online peer evaluation forms for online group activities in improving group project outcomes.DesignThe investigator developed and used a web-based Google Forms® self and peer evaluation form of 2 group assignments' rubric for junior and senior nursing students. The form covered elements of the assignments including: research activity, analysis of the literature, writing of report, participation in making of presentation, overall contribution to the project, and participation in the weekly group discussions. Items were rated from 1 (did not contribute) to 5 (outstanding contribution) in addition to NA when one activity did not apply.ProcedureThe self and peer evaluation process was conducted twice: once after group assignment 1 and once after group assignment 2. The group assignments final products were done in the form of VoiceThread online presentations that were shared with the rest of the class reflecting the groups' work on a health informatics topic of interest.Data sourcesData collected as the students completed self and peer evaluations for group assignments 1 and 2. Also, optional comments regarding member performance were collected to add contextual information in addition to ratings. Students received credit for completing the peer evaluations and the grade for the particular assignment was affected by their performance based on peer evaluations of their contributions.ResultsStudents' peer evaluations showed in a color-coded spreadsheet which enabled the course faculty to view real time results of students' ratings after each assignment. The faculty provided timely and tailored feedback to groups or individuals as needed, using positive feedback and commending high performance while urging struggling individual students and groups to improve lower ratings in specific areas. Comparing evaluations of both assignments, there were statistically significant improvements among all students. The mean scores of the entire sample were skewed toward the higher end of the scale, suggesting an overall high performance group. However, analysis of the lower performing individuals showed consistent and statistically significant improvements in all areas of the evaluation criteria.ConclusionsAnonymous peer evaluation activities and timely faculty feedback in e-Learning environment can be a useful tool to faculty to improve group performance over time by engaging the learners within their groups. Peer evaluations provided real time view of group mid-semester formative evaluations that allowed the faculty to provide timely and tailored feedback on student performance which allowed for better outcomes.     

Developing Professionalism via Multisource Feedbackin Team-Based Learning

CGEA 2015 CONFERENCE ABSTRACT (EDITED) A Novel Approach to Assessing Professionalism in Preclinical Medical Students Using Paired Self- and Peer Evaluations. Amanda R. Emke, Steven Cheng, and Carolyn Dufault Construct: This study sought to assess the professionalism of 2nd-year medical students in the context of team-based learning. Background: Professionalism is an important attribute for physicians and a core competency throughout medical education. Preclinical training often focuses on individual knowledge acquisition with students working only indirectly with faculty assessors. As such, the assessment of professionalism in preclinical training continues to present challenges. We propose a novel approach to preclinical assessment of medical student professionalism to address these challenges. Approach: Second-year medical students completed self- and peer assessments of professionalism in two courses (Pediatrics and Renal/Genitourinary Diseases) following a series of team-based learning exercises. Assessments were composed of nearly identical 9-point rating scales. Correlational analysis and linear regression were used to examine the associations between self- and peer assessments and the effects of predictor variables. Four subgroups were formed based on deviation from the median ratings, and logistic regression was used to assess stability of subgroup membership over time. A missing data analysis was conducted to examine differences between average peer-assessment scores as a function of selective nonparticipation. Results: There was a significant positive correlation (r = .62, p < .0001) between self-assessments completed alone and those completed at the time of peer assessment. There was also a significant positive correlation between average peer-assessment and self-assessment alone (r = .19, p < .0002) and self-assessment at the time of peer assessment (r = .27, p < .0001). Logistic regression revealed that subgroup membership was stable across measurement at two time points (T1 and T2) for all groups, except for members of the high self-assessment/low peer assessment at T1, who were significantly more likely to move to a new group at T2, χ²(3, N = 129) = 7.80, p < .05. Linear regression revealed that self-assessment alone and course were significant predictors of self-assessment at the time of peer assessment (F_{self_alone} = 144.74, p < .01 and F_course = 4.70, p < .05), whereas average peer rating, stage (T1, T2) and academic year (13–14, 14–15) were not. Linear regression also revealed that students who completed both self-assessments had significantly higher average peer assessment ratings (average peer rating in students with both self-assessments = 8.42, no self-assessments = 8.10, self_at_peer = 8.37, self_alone = 8.28) compared to students who completed one or no self-assessments (F = 5.34, p < .01). Conclusions: When used as a professionalism assessment within team-based learning, stand-alone and simultaneous peer and self-assessments are highly correlated within individuals across different courses. However, although self-assessment alone is a significant predictor of self-assessment made at the time of assessing one's peers, average peer assessment does not predict self-assessment. To explore this lack of predictive power, we classified students into four subgroups based on relative deviation from median peer and self-assessment scores. Group membership was found to be stable for all groups except for those initially sorted into the high self-assessment/low peer assessment subgroup. Members of this subgroup tended to move into the low self-assessment/low peer assessment group at T2, suggesting they became more accurate at self-assessing over time. A small group of individuals remained in the group that consistently rated themselves highly while their peers rated them poorly. Future studies will track these students to see if similar deviations from accurate professional self-assessment persist into the clinical years. In addition, given that students who fail to perform self-assessments had significantly lower peer assessment scores than their counterparts who completed self-assessments in this study, these students may also be at risk for similar professionalism concerns in the clinical years; follow-up studies will examine this possibility.     

Formal Peer-Teaching in Medical School Improves Academic Performance: The MUSC Supplemental Instructor Program

Background: Formal systems of peer teaching are common in many advanced-degree graduate school programs but are less prevalent in medical schools. In 1997, The Medical University of South Carolina's Center for Academic Excellence created a Supplemental Instructor (SI) program in which interested upper-level medical students are hired to teach a small group of junior peers, primarily in basic science topics.

Purpose: The purpose of this study was to examine if participation as an SI leader resulted in measurable academic improvement for those students. This study examined if participation as a teacher in the SI program (SI leader) resulted in measurable academic improvement for those students.

Methods: Admission characteristics (grade point average [GPA], Medical College Aptitude Test score, age, year of enrollment, and gender) of all SI leaders were compiled from the academic years 1996–2001. A second cohort of students, who shared the first group's admission characteristics but who chose not to teach as SIs, was identified as a comparison control group. Outcome measures included United States Medical Licensing Examination (USMLE) Step 1 and 2 scores and final medical school GPA. Paired student two-tailed t-test statistics compared group means on all outcome variables.

Results: There were 199 SI leaders with non-SI students matched controls studied. There were no significant differences upon admission between the two groups; however, the SI leader group had significantly higher USMLE Step 1 and Step 2 scores and final medical school GPA compared to the non-SI group.

Conclusions: The activity of formal peer-teaching was beneficial to the SI leaders' own academic success as measured by GPA and USMLE test scores.     

Using peer feedback to enhance nursing students’ reflective abilities,clinical competencies,and sense of empowerment: A mixed-methods study

AimTo assess the use of a framework to provide structured peer feedback and compare the effects of peer video feedback, peer verbal feedback versus faculty feedback on nursing students and peer tutors’ learning outcomes and experiencesBackgroundPeer feedback has been utilized widely in health professions education to fill the gap for timely feedback, but some students were concerned with its quality, leading to perceptions that peer feedback may not be useful.DesignSequential explanatory mixed-methods studyMethodsThe study took place from January to February 2022. In phase 1, a quasi-experimental pretest-posttest design was used. First-year nursing students (n = 164) were allocated to peer video feedback, peer verbal feedback or faculty feedback arms. Senior nursing students (n = 69) were recruited to be peer tutors or the control group. The Groningen Reflective Ability Scale was used by first-year students to assess their reflective abilities, while the Simulation-based Assessment Tool was used by peer or faculty tutors to evaluate nursing students’ clinical competence of a nursing skill during the simulation. The Debriefing Assessment for Simulation in Healthcare-Student Version was used by students to assess their peer/faculty tutors’ feedback quality. Senior students’ empowerment levels were measured using the Qualities of an Empowered Nurse scale. In phase 2, six semi-structured focus group discussions with peer tutors (n = 29) were conducted and thematically analyzed.ResultsPeer video feedback and peer verbal feedback significantly improved students’ reflective abilities but not in the faculty feedback arm. Students’ clinical competence in a technical nursing skill significantly improved in all three arms. Improvements were significantly larger in those receiving peer video feedback and peer verbal feedback than faculty feedback, with no significant differences between peer video feedback and peer verbal feedback. Debriefing Assessment for Simulation in Healthcare-Student Version scores were not significantly different among the 3 arms. Empowerment levels of peer tutors significantly improved after providing peer feedback but not those in the control group. Seven themes were generated from the focus group discussions.ConclusionsAlthough peer video feedback and peer verbal feedback were similarly effective in improving clinical competencies, peer video feedback was more time-consuming and stressful to students. The use of structured peer feedback improved peer tutors’ feedback practices and were comparable to quality of faculty feedback. It also significantly increased their sense of empowerment. Peer feedback was widely supported by peer tutors who agreed that it should supplement faculty teaching.     

A Controlled Trial to Compare the Teaching Quality of Clinical-Skills Training Faculty: The Clinician-Educator Career Path in China

Background: Full-time clinician educators are becoming more predominant in China, yet their effect is unknown. Purposes: The purpose of this study was to compare the teaching quality of full-time (FT) faculty with that of part-time (PT) faculty in one Chinese medical school. Methods: In 3 consecutive years, 881 3rd year medical students were enrolled and randomly distributed into two groups, being taught by either a FT faculty member or a PT faculty member. Their teaching quality was evaluated with student performance on a written exam, the standardized patient exam, and student satisfaction. Results: The students in the FT group always scored better on the written exam (1st year = 79.82 ± 9.2 vs. 81.26 ± 8.2, p < .188; 2nd year = 73.10 ± 9.8 vs. 76.51 ± 7.9, p = .001; 3rd year = 75.15 ± 9.0 vs. 79.51 ± 8.7, p < .0001). In the standardized patient exam, the students from FT groups always showed better performance in history taking and physical examination. Students continually gave higher evaluations to FT faculty in questionnaires (1st year = 76.8 ± 6.5 vs. 84.3 ± 2.2; 2nd year = 78.6 ± 3.9 vs. 89.7 ± 4.2; 3rd year = 75.8 ± 3.9 vs. 88.5 ± 3.5, all ps < .001). Conclusions: The teaching quality of FT faculty in clinical-skills training is better than PT faculty in this study.     

A Novel Approach to Assessing Professionalism in Preclinical Medical Students Using Multisource Feedback Through Paired Self- and Peer Evaluations

Phenomenon: Professionalism is integral to the role of the physician. Most professionalism assessments in medical training are delayed until clinical rotations where multisource feedback is available. This leaves a gap in student assessment portfolios and potentially delays professional development. Approach: A total of 246 second-year medical students (2013–2015) completed self- and peer assessments of professional behaviors in 2 courses following a series of Team-Based Learning exercises. Correlation and regression analyses were used to examine the alignment or misalignment in the relationship between the 2 types of assessments. Four subgroups were formed based on observed patterns of initial self- and peer assessment alignment or misalignment, and subgroup membership stability over time was assessed. A missing data analysis examined differences between average peer assessment scores as a function of selective nonparticipation. Findings: Spearman correlation demonstrated moderate to strong correlation between self-assessments completed alone (no simultaneous peer assessment) and self-assessments completed at the time of peer assessments (ρ = .59, p < .0001) but weak correlation between the two self-assessments and peer assessments (alone: ρ = .13, p < .013; at time of peer: ρ = .21, p < .0001). Generalized estimating equation models revealed that self-assessments done alone (p < .0001) were a significant predictor of self-assessments done at the time of peer. Course was also a significant predictor (p = .01) of self-assessment scores done at the time of peer. Peer assessment score was not a significant predictor. Bhapkar's test revealed subgroup membership based on the relationship between self- and peer ratings was relatively stable across Time 1 and Time 2 assessments (χ² = 0.83, p = .84) for all but one subgroup; members of the subgroup with initially high self-assessment and low peer assessment were significantly more likely to move to a new classification at the second measurement. A missing data analysis revealed that students who completed all self-assessments had significantly higher average peer assessment ratings compared to students who completed one or no self-assessments with a difference of –0.32, 95% confidence interval [–0.48, –0.15]. Insights: Multiple measurements of simultaneous self- and peer assessment identified a subgroup of students who consistently rated themselves higher on professionalism attributes relative to the low ratings given by their peers. This subgroup of preclinical students, along with those who elected to not complete self-assessments, may be at risk for professionalism concerns. Use of this multisource feedback tool to measure perceptual stability of professionalism behaviors is a new approach that may assist with early identification of at-risk students during preclinical years.     

Peer Observation of Rounds Leads to Collegial Discussion of Teaching

Problem: Faculty in the Division of Hospital Medicine provide most of the clinical teaching for learners at our institution. The majority of these faculty are Assistant Professors with limited formal instruction in clinical teaching. Previous Divisional strategies to improve clinical teaching ability included discussion of effective teaching behaviors, developing written expectations for teaching faculty, and instituting seminars on effective clinical teaching. Heretofore, the Division had not utilized a direct observation exercise. Intervention: We developed a direct observation exercise to encourage discussion of teaching techniques and contemplation of change. Using a social learning model, we developed a peer-to-peer observation followed by a nonevaluative discussion. We created a tool for describing teaching behaviors in 5 domains that were similar to or different from the usual behavior of the observing peer: learner presentations, team leadership, bedside teaching, professionalism, and other. After the observation, the observing and observed faculty met to discuss observed teaching behaviors. Both faculty members discussed and then recorded any teaching behaviors that they planned to adopt or change. Context: We implemented this intervention in a 22-member Academic Division of Hospital Medicine at a tertiary care medical center in the United States. A high proportion were junior faculty and graduates of our residency program. Outcome: We reviewed records of 28 of 31 observations that were completed during the initial 9-month period of implementation and later surveyed faculty. The exercise resulted in planned changes in teaching behaviors that included instituting new methods to improve teaching team leadership, triaging of patients seen on rounds, faculty behaviors during oral presentations, giving real-time feedback, use of technology and humor, demonstrating physical examination findings, and modeling professional behaviors. Faculty later reported adoption of new teaching behaviors that were important to them. Lessons Learned: This exercise was easily implemented, resulted in planned changes by both observed and observing peers, and resulted in widespread adoption of some specific teaching behaviors. The most commonly planned change dealt with team leadership or organizational issues. When given the freedom to choose, junior faculty were more likely to observe senior faculty.     

Developing a Peer-Mentor Program for Medical Students

Background: Doctoring is a 2-year preclinical course designed to teach medical students fundamental clinical skills. Purpose: We designed, implemented, and evaluated an innovative and cost-effective peer-mentoring program embedded within Doctoring. Our Teaching Academy (TA) included a formal orientation for teaching “Fellows.” Methods: During academic years 2008–09 and 2009–10, 2nd-year students were systematically selected by course faculty and then trained as TA Fellows to peer-mentor 1st-year students. Both TA Fellows and 1st-year medical students completed anonymous written surveys. Results: Peer-mentors reported a significant increase of confidence in their ability to provide feedback (p < .001). First-year students reported a significant increase of confidence in their ability to conduct a medical interview and perform a physical exam (p < .001 for each). Conclusions: Student participation in a formal peer-mentor program embedded within a clinical skills course significantly increased, for both teachers and learners, confidence in their skills. Our program is easily transferrable to other courses and institutions.     

Graduate students' experiences with standardized patients as adjuncts for teaching pelvic examinations

PURPOSE: To explore graduate nurse practitioner students' perceptions of their experiences when learning to perform pelvic examinations in the laboratory and performing them in subsequent clinical rotations. One group was taught by faculty with voluntary peer examination, and the other two groups were taught by standardized patients (SPs). DATA SOURCES: Surveys with open- and closed-ended (responses on Likert scales) items administered twice during 3 consecutive years to students enrolled in an advanced health assessment course. CONCLUSIONS: All groups reported feeling anxious while learning pelvic exam techniques and in subsequent clinical experiences. SPs provided immediate feedback to students, decreased their feelings of anxiety, and increased their confidence in performing examinations. Students who were taught pelvic examination techniques by SPs rated their learning experiences more positively and reported a better understanding of exam techniques than students who learned to perform exams by voluntary examination of classmates. IMPLICATIONS FOR PRACTICE: Graduate nursing programs should consider locating and using SP programs for teaching pelvic examinations in advanced health assessment courses. Although more cost-effective, voluntary peer examination was a less effective teaching method.