Peer observation of student-led teaching.

INTRODUCTION: The use of near-peer teaching in medical schools is increasing internationally. Peer observation of teaching (POT) is a useful and effective method for enhancing teaching experiences and quality, but its use among student peer teachers is not well documented. The aim of the study was to explore medical student perceptions on the value and limitations of POT. METHODS: Ten medical students were trained as observers. Using a previously developed model, they observed 27 teaching sessions led by other students (observees), with a pre- and post-observation meeting. Observers and observees completed a survey and group interview to explore their experiences. Descriptive analysis of survey data and thematic analysis of qualitative data were conducted. RESULTS: Observees found feedback valuable in learning about, reflecting on, and increasing confidence in teaching practice. They felt comfortable receiving feedback and reported positively about the observers in terms of: expertise, relatability, non-intimidating presence, and awareness of the target audience. Observers reported learning more about good teaching practice. While most observers found it enjoyable, several found some aspects of giving feedback uncomfortable. Most found it difficult to establish a satisfactory dynamic, citing lack of credibility and difficulty in eliminating hierarchies. Pre-existing friendships were reported by observers as both helping and hindering the dynamic. DISCUSSION: Both observers and observees gained from the experience of POT. However, observers lacked confidence in their credibility. Further work should address how best to implement POT into the curriculum to improve teaching practice in medical students. Further training or coaching could be considered to overcome observers' concerns.[Box: see text].

High-Sensitivity Cardiac Troponin I and Clinical Risk Scores in Patients With Suspected Acute Coronary Syndrome.

BACKGROUND: High-sensitivity cardiac troponin assays can help to identify patients who are at low risk of myocardial infarction in the emergency department. We aimed to determine whether the addition of clinical risk scores would improve the safety of early rule-out pathways for myocardial infarction. METHODS: In 1935 patients with suspected acute coronary syndrome, we evaluated the safety and efficacy of 2 rule-out pathways alone or in conjunction with low-risk TIMI (Thrombolysis In Myocardial Infarction) (0 or 1), GRACE (Global Registry of Acute Coronary Events) (≤108), EDACS (Emergency Department Assessment of Chest Pain Score) (<16), or HEART (History, ECG, Age, Risk factors, Troponin) (≤3) scores. The European Society of Cardiology 3-hour pathway uses a single diagnostic threshold (99th percentile), whereas the High-STEACS (High-Sensitivity Troponin in the Evaluation of Patients With Acute Coronary Syndrome) pathway applies different thresholds to rule out (<5 ng/L) and rule in (>99th percentile) myocardial infarction. RESULTS: Myocardial infarction or cardiac death during the index presentation or at 30 days occurred in 14.3% of patients (276/1935). The European Society of Cardiology pathway ruled out 70%, with 27 missed events giving a negative predictive value of 97.9% (95% CI, 97.1-98.6). The addition of a HEART score ≤3 reduced the proportion ruled out by the European Society of Cardiology pathway to 25% but improved the negative predictive value to 99.7% (95% CI, 99.0-100; P<0.001). The High-STEACS pathway ruled out 65%, with 3 missed events for a negative predictive value of 99.7% (95% CI, 99.4-99.9). No risk score improved the negative predictive value of the High-STEACS pathways, but all reduced the proportion ruled out (24% to 47%; P<0.001 for all). CONCLUSIONS: Clinical risk scores significantly improved the safety of the European Society of Cardiology 3-hour pathway, which relies on a single cardiac troponin threshold at the 99th percentile to rule in and rule out myocardial infarction. Where lower thresholds are used to rule out myocardial infarction, as applied in the High-STEACS pathway, risk scores halve the proportion of patients ruled out without improving safety. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01852123.