The Impact of a Peer-Tutoring Project on Academic Learning Skills in Speech-Language Pathology Students.

BACKGROUND/AIMS: Peer tutoring may advance learning experiences and academic performances of students. Moreover, it seems to be an effective strategy to develop new skills. This study aimed to explore the effects of peer tutoring on the competencies of first-year students (tutees) and final-year students (tutors) of a master program in speech-language pathology. METHODS: Questionnaires were used to investigate the motivation, expectations, learning success, and competencies of 69 tutees and 32 tutors regarding a peer-tutoring project to optimize the speech sound proficiency skills of the tutees. Their answers were statistically compared with those of a control group of students who did not participate in the peer-tutoring project. RESULTS: Tutees reported a significantly higher learning success compared to the control group, although their motivation and expectations were comparable at the start. The tutors, however, reported little motivation at the start and no improvement at the end of the project. CONCLUSION: Based on the positive effects reported by the tutees, this peer-tutoring program will be integrated in the speech-language training curriculum to improve the speech sound proficiency of first-year students. Nevertheless, adjustments will be needed to decrease the resistance in the final-year tutors. Further research may evaluate the effect of incorporated adjustments on this resistance.

Managing the complexity of doing it all: an exploratory study on students' experiences when trained stepwise in conducting consultations.

BACKGROUND: At most medical schools the components required to conduct a consultation, medical knowledge, communication, clinical reasoning and physical examination skills, are trained separately. Afterwards, all the knowledge and skills students acquired must be integrated into complete consultations, an art that lies at the heart of the medical profession. Inevitably, students experience conducting consultations as complex and challenging. Literature emphasizes the importance of three didactic course principles: moving from partial tasks to whole task learning, diminishing supervisors' support and gradually increasing students' responsibility. This study explores students' experiences of an integrated consultation course using these three didactic principles to support them in this difficult task. METHODS: Six focus groups were conducted with 20 pre-clerkship and 19 clerkship students in total. Discussions were audiotaped, transcribed and analysed by Nvivo using the constant comparative strategy within a thematic analysis. RESULTS: Conducting complete consultations motivated students in their learning process as future physician. Initially, students were very much focused on medical problem solving. Completing the whole task of a consultation obligated them to transfer their theoretical medical knowledge into applicable clinical knowledge on the spot. Furthermore, diminishing the support of a supervisor triggered students to reflect on their own actions but contrasted with their increased appreciation of critical feedback. Increasing students' responsibility stimulated their active learning but made some students feel overloaded. These students were anxious to miss patient information or not being able to take the right decisions or to answer patients' questions, which sometimes resulted in evasive coping techniques, such as talking faster to prevent the patient asking questions. CONCLUSION: The complex task of conducting complete consultations should be implemented early within medical curricula because students need time to organize their medical knowledge into applicable clinical knowledge. An integrated consultation course should comprise a step-by-step teaching strategy with a variety of supervisors' feedback modi, adapted to students' competence. Finally, students should be guided in formulating achievable standards to prevent them from feeling overloaded in practicing complete consultations with simulated or real patients.

A novel Medical Achievement Self-efficacy Scale (MASS): a valid and reliable tool.

In search for an instrument to measure overall curriculum impact, we developed a Medical Achievement Self-efficacy Scale (MASS) and presented it to medical students enrolled in the different years of the integrated Ghent curriculum. The research aim was to study the validity and reliability of this new scale. MASS items were constructed based on the end terms of the Ghent curriculum, as it is related to the general competency frameworks of CanMEDs and the Five-star Doctor. The scale includes at least two items for each CanMEDS competency domain. Items were examined by seven experts in view of content and face validity. This resulted in an MASS version, containing 18 items, to be rated on a five-point Likert scale. This version was piloted on 94 undergraduate medical students enrolled at the Catholic University of Leuven. The final version was presented to 1066 undergraduate medical students enrolled at Ghent University. Reliability of the MASS scale was high (α=0.89). As expected, self-efficacy scores increased significantly over the years (F=39.11, p<0.001). In view of determining predictive validity, regression analysis was carried out to predict students' academic achievement from self-efficacy scores. As expected, MASS scores significantly predicted Maastricht Progress Test scores (F=108.18, p<0.001).

Impact of three alternative consultation training formats on self-efficacy and consultation skills of medical students.

BACKGROUND: Conducting a consultation is a core competence of medical professionals. Consultation training of medical students centers on clinical, communication, reasoning and reflection skills. The training incorporates practice with a standardized simulated patient and supervising physician, to prepare for real patient encounters. To meet the request for more training, while dealing with an increasing student population and limited staff availability, alternative formats of consultation training were developed and evaluated. AIM: To investigate the impact of three consultation training formats on students' self-efficacy beliefs and their consultation skills acquisition. The three formats comprised (1) traditional training with supervising physician, (2) autonomous training with feedback from simulated patients and peers, without direct supervision and (3) online training based on video fragments and answering guiding questions. METHODS: A quasi-experimental pre/posttest study was set up, with random assignment of students to a training condition. The differential impact was tested on two dependent measures: self-efficacy and consultation performance. Self-efficacy was tested with a nine-item scale and the cognitive component of consultation performance was tested on the base of responses to a standardized video case. RESULTS: The autonomous training has a significant positive effect on students' self-efficacy (p=0.016). The traditional training and the online training did only positively influence the cognitive component of the consultation competence (p<0.001 and p=0.003). CONCLUSIONS: Each consultation training contributes to the learning process in a different way. In order to achieve optimum learning effects, medical educators should be aware of the particular impact of specific trainings on the cognitive and motivational side of skills and pursue a balanced mixture of instructional formats.

Six formats in simulated and standardized patients use, based on experiences of 13 undergraduate medical curricula in Belgium and the Netherlands.

BACKGROUND: In Belgium and the Netherlands, 13 medical schools collaborate with regard to the use of simulated patients (SPs) and standardized patients in their undergraduate curricula. All schools use SPs in their curriculum but schools differ in (a) the timing or placement of the SPs and (b) the way they are used. AIM: To give an overview of the formats used most in undergraduate medical education with SPs, including a description of the impact of these formats on the different aspects of SPs. METHODS: Representatives of all medical schools in Belgium and The Netherlands all provided a structured overview of their use of SPs. We then collectively made a description of the main working formats. For each format we identified salient consequences on the SP level, including whether the format requires simulated or standardized patients or patient-actors, what is the impact of a format on the selection of SPs, content and duration of SP training, whether or not to use checklists in role training, feedback training or not, debriefing of training, impact on the case (role) description (e.g. free or structured), the number of SPs needed, and the selection criteria for SPs. CONCLUSION: The working format with SPs more or less determines the whole process of selection, training, performance, and logistics of SPs.

Does reflection have an effect upon case-solving abilities of undergraduate medical students?

BACKGROUND: Reflection on professional experience is increasingly accepted as a critical attribute for health care practice; however, evidence that it has a positive impact on performance remains scarce. This study investigated whether, after allowing for the effects of knowledge and consultation skills, reflection had an independent effect on students' ability to solve problem cases. METHODS: Data was collected from 362 undergraduate medical students at Ghent University solving video cases and reflected on the experience of doing so. For knowledge and consultation skills results on a progress test and a course teaching consultation skills were used respectively. Stepwise multiple linear regression analysis was used to test the relationship between the quality of case-solving (dependent variable) and reflection skills, knowledge, and consultation skills (dependent variables). RESULTS: Only students with data on all variables available (n = 270) were included for analysis. The model was significant (Anova F(3,269) = 11.00, p < 0.001, adjusted R square 0.10) with all variables significantly contributing. CONCLUSION: Medical students' reflection had a small but significant effect on case-solving, which supports reflection as an attribute for performance. These findings suggest that it would be worthwhile testing the effect of reflection skills training on clinical competence.

Using video-cases to assess student reflection: development and validation of an instrument.

BACKGROUND: Reflection is a meta-cognitive process, characterized by: 1. Awareness of self and the situation; 2. Critical analysis and understanding of both self and the situation; 3. Development of new perspectives to inform future actions. Assessors can only access reflections indirectly through learners' verbal and/or written expressions. Being privy to the situation that triggered reflection could place reflective materials into context. Video-cases make that possible and, coupled with a scoring rubric, offer a reliable way of assessing reflection. METHODS: Fourth and fifth year undergraduate medical students were shown two interactive video-cases and asked to reflect on this experience, guided by six standard questions. The quality of students' reflections were scored using a specially developed Student Assessment of Reflection Scoring rubric (StARS®). Reflection scores were analyzed concerning interrater reliability and ability to discriminate between students. Further, the intra-rater reliability and case specificity were estimated by means of a generalizability study with rating and case scenario as facets. RESULTS: Reflection scores of 270 students ranged widely and interrater reliability was acceptable (Krippendorff's alpha = 0.88). The generalizability study suggested 3 or 4 cases were needed to obtain reliable ratings from 4th year students and ≥ 6 cases from 5th year students. CONCLUSION: Use of StARS® to assess student reflections triggered by standardized video-cases had acceptable discriminative ability and reliability. We offer this practical method for assessing reflection summatively, and providing formative feedback in training situations.

Factors confounding the assessment of reflection: a critical review.

BACKGROUND: Reflection on experience is an increasingly critical part of professional development and lifelong learning. There is, however, continuing uncertainty about how best to put principle into practice, particularly as regards assessment. This article explores those uncertainties in order to find practical ways of assessing reflection. DISCUSSION: We critically review four problems: 1. Inconsistent definitions of reflection; 2. Lack of standards to determine (in)adequate reflection; 3. Factors that complicate assessment; 4. Internal and external contextual factors affecting the assessment of reflection. SUMMARY: To address the problem of inconsistency, we identified processes that were common to a number of widely quoted theories and synthesised a model, which yielded six indicators that could be used in assessment instruments. We arrived at the conclusion that, until further progress has been made in defining standards, assessment must depend on developing and communicating local consensus between stakeholders (students, practitioners, teachers, supervisors, curriculum developers) about what is expected in exercises and formal tests. Major factors that complicate assessment are the subjective nature of reflection's content and the dependency on descriptions by persons being assessed about their reflection process, without any objective means of verification. To counter these validity threats, we suggest that assessment should focus on generic process skills rather than the subjective content of reflection and where possible to consider objective information about the triggering situation to verify described reflections. Finally, internal and external contextual factors such as motivation, instruction, character of assessment (formative or summative) and the ability of individual learning environments to stimulate reflection should be considered.

"Should I prioritize medical problem solving or attentive listening?": the dilemmas and challenges that medical students experience when learning to conduct consultations.

OBJECTIVE: Communication skills can be trained alongside clinical reasoning, history taking or clinical examination skills. This is advocated as a solution to the low transfer of communication skills. Still, students have to integrate the knowledge/skills acquired during different curriculum parts in patient consultations at some point. How do medical students experience these integrated consultations within a simulated environment and in real practice when dealing with responsibility? METHODS: Six focus groups were conducted with (pre-)/clerkship students. RESULTS: Students were motivated to practice integrated consultations with simulated patients and felt like 'real physicians'. However, their focus on medical problem solving drew attention away from improving their communication skills. Responsibility for real patients triggered students' identity development. This identity formation guided the development of an own consultation style, a process that was hampered by conflicting demands of role models. CONCLUSION: Practicing complete consultations results in the dilemma of prioritizing medical problem solving above attention for patient communication. Integrated consultation training advances this dilemma to the pre-clerkship period. During clerkships this dilemma is heightened because real patients trigger empathy and responsibility, which invites students to define their role as doctor. PRACTICE IMPLICATIONS: When training integrated consultations, educators should pay attention to students' learning priorities and support the development of students' professional identity.