A Qualitative Analysis on the Effectiveness of Peer Feedback in Team-Based Learning.

Introduction: There is limited information on medical students' perceptions of peer feedback in team-based learning (TBL), both in terms of its value and how it has affected them as they move forward in their careers. The primary goals of this study were to examine students' perceptions about their peer feedback experiences throughout medical school and into residency and to identify areas for improvement to develop a more valuable experience. Materials and Methods: This study utilized exploratory qualitative research. A total of six focus group sessions were conducted, in which each group consisted of medical students or residents. All participants were asked for their thoughts about peer feedback using semi-structured interviews. The sessions were transcribed and thematic analysis of student responses was completed by independent reviewers. Results: A total of 11 first-year, 12 second-year, 12 rising third-year, and 10 rising fourth-year medical students participated in the focus groups. In addition, three graduates participated in the study. Overall, four key themes were identified regarding the peer feedback experience. These included (1) preparation and training, (2) procedure and implementation, (3) evaluation of student feedback, and (4) student considerations. Discussion: The participants indicated that the idea of providing and receiving effective peer feedback throughout the medical school curriculum was a valuable experience. This analysis raised awareness about several potential areas of difficulty for students in regard to the peer feedback process used in TBL. Quality improvement initiatives may include educating students about the use of constructive feedback, adding self-reflection, or using oral instead of written feedback.

Self-directed learning assessment practices in undergraduate health professions education: a systematic review.

PURPOSE: The goal of this systematic review was to examine self-directed learning (SDL) assessment practices in undergraduate health professions education. METHODS: Seven electronic databases were searched (PubMed, Embase, PsycINFO, ERIC, CINAHL, Scopus, and Web of Science) to retrieve English-language articles published between 2015 and July of 2022, investigating assessment of SDL learning outcomes. Extracted data included the sample size, field of study, study design, SDL activity type, SDL assessment method, number of SDL assessments used, study quality, number of SDL components present utilising the framework the authors developed, and SDL activity outcomes. We also assessed relationships between SDL assessment method and number of SDL components, study quality, field of study, and study outcomes. RESULTS: Of the 141 studies included, the majority of study participants were medical (51.8%) or nursing (34.8%) students. The most common SDL assessment method used was internally-developed perception surveys (49.6%). When evaluating outcomes for SDL activities, most studies reported a positive or mixed/neutral outcome (58.2% and 34.8%, respectively). There was a statistically significant relationship between both number and type of assessments used, and study quality, with knowledge assessments (median-IQR 11.5) being associated with higher study quality (p < 0.001). Less than half (48.9%) of the studies used more than one assessment method to evaluate the effectiveness of SDL activities. Having more than one assessment (mean 9.49) was associated with higher quality study (p < 0.001). CONCLUSIONS: The results of our systematic review suggest that SDL assessment practices within undergraduate health professions education vary greatly, as different aspects of SDL were leveraged and implemented by diverse groups of learners to meet different learning needs and professional accreditation requirements. Evidence-based best practices for the assessment of SDL across undergraduate healthcare professions education should include the use of multiple assessments, with direct and indirect measures, to more accurately assess student performance.

Teaching in Uncertain Times: Expanding the Scope of Extraneous Cognitive Load in the Cognitive Load Theory.

The COVID-19 pandemic caused an unprecedented and highly threatening, constrained, and confusing social and educational environment, we decided to expand the traditional focus of the extraneous load in Cognitive Load Theory (CLT) acknowledging the psychological environment in which learning occurs. We therefore adapted and implemented principles of the CLT to reduce extraneous load for our students by facilitating their educational activities. Given previous empirical support for the principles of CLT, it was expected that the adoption of these principles might enable our students to cultivate attitudes and skills across multiple domains such as online learning and presentation technologies, implementing and maintaining a "classroom atmosphere" in a virtual environment, participating in discussions among large online groups of students, facilitating group work, providing virtual office hours for students, and proactively planning for upcoming semesters.

Adapting Strategically to Changing Times in Health Professions Education: A Generational Workshop for Educators.

Introduction: Health professions classrooms are filled with a new generation of students: iGen/generation Z. Much is known about millennials' educational needs, but they no longer comprise the majority of student populations. Research indicates that curricular strategies once useful for millennials may be ineffective for iGen. Due to multiple and surprising generational differences including ubiquitous technology, verbal/social/reading skills, and attention spans, educators might struggle to reach iGen members and are encouraged to re-examine instructional methods with iGen in mind. Methods: We designed this 90-minute workshop to give educators an informed understanding of iGen and discuss curricular adaptations intended to maintain educational quality through a literature-based presentation, self-assessment activities, and case discussions. We delivered the session to multiple diverse groups of health professions educators and staff. The attendees evaluated the workshop's quality and its longitudinal impact using 5-point Likert-style agreement surveys. Results: Respondents deemed the topic crucial to professional development and rated the content highly relevant (100% agreement/strong agreement). Longitudinal respondents could recognize iGen and personal characteristics (79% agreement or strong agreement) and the majority (58%) agreed/strongly agreed they were able to implement new instructional strategies. Discussion: Although educators are aware of typical generational differences, many are surprised to learn the unique attributes of their iGen student population. Workshop participation allowed educators to better understand both iGen students as well as how their own generational characteristics might relate to iGen members. Gaining this perspective allows educators to more adeptly create and deliver content to current health professions students.

Twelve tips for interfacing with the new generation of medical students: iGen.

iGen, or Generation Z, is the newest generation of health professions students to enter the classroom. This generation represents the first cohort of students in which technology has been present in all aspects of their lives. Since birth, they have been influenced by the boom of social media and wide-spread internet availability, leading to decreased face-to-face interactions and a desire for immediate access to information. Health professions educators should recognize the unique attributes of iGen students in order to foster student success and create a more positive learning environment. The following twelve tips examine the research-based distinctive characteristics of iGen students and highlight important concepts to consider when modifying current pedagogy to better support their needs. Incorporating these tips as an educator can promote lifelong learning and skill development for iGen students and empower this generation to thrive.

Best Practices in Peer Assessment: Training Tomorrow's Physicians to Obtain and Provide Quality Feedback.

Peer assessment, also known as peer feedback or peer evaluation, is a tool used in medical education for students to provide and receive constructive feedback. In undergraduate medical education, peer feedback is a method of assessment that is not used commonly; however, its use is on the rise. In this literature-based guide, we discuss the advantages of peer assessment, as well as tips for implementation (including training of students and faculty and assessment tools/instruments) and strategies to overcome barriers to its use. Effective utilization of peer feedback can provide educators with an opportunity to evaluate attributes that are often difficult to assess, including professionalism, teamwork, work habits, and communication skills. Constructive feedback can raise learner awareness about performance and guide future decisions and action plans for improvement. Overall, when used appropriately, peer feedback can be a valuable and effective addition to the arsenal of assessments in medical education.

Suicide Assessment and Management Team-Based Learning Module.

Introduction: Suicide is a global health problem that health care providers must feel comfortable addressing. Unfortunately, many health care providers are not equipped to assess and treat patients at risk for suicide due to lack of training and education. Interactive resources are needed to educate health professions students about the management of suicidal patients. Methods: The suicide assessment and management team-based learning (TBL) module was developed to address the gap in suicide education. After completing the module, students were able to identify key elements for a comprehensive assessment of a patient's risk for suicide and to discuss clinical management for a suicidal patient. The activity was designed for second-year medical students during a psychopathology course, the last organ-system course prior to clerkships. This module could also be used or modified to meet the educational requirements for other health professions, including medical residents, nurse practitioner students, and physician assistant students. Results: A total of 342 students among 62 teams participated in the TBL over a period of 3 consecutive years. The class averages for the individual Readiness Assurance Test ranged from 80% to 88%. The class averages for the team Readiness Assurance Test and application questions were comparable across all 3 years. Course evaluations showed the TBL helped students think critically and integrate information to prepare them for their future careers. Discussion: Overall, this TBL was an effective educational tool that stimulated high-quality discussion, in which students remained engaged and asked thought-provoking questions.

The utilization of peer feedback during collaborative learning in undergraduate medical education: a systematic review.

BACKGROUND: Peer evaluation can provide valuable feedback to medical students, and increase student confidence and quality of work. The objective of this systematic review was to examine the utilization, effectiveness, and quality of peer feedback during collaborative learning in medical education. METHODS: The PRISMA statement for reporting in systematic reviews and meta-analysis was used to guide the process of conducting the systematic review. Evaluation of level of evidence (Colthart) and types of outcomes (Kirkpatrick) were used. Two main authors reviewed articles with a third deciding on conflicting results. RESULTS: The final review included 31 studies. Problem-based learning and team-based learning were the most common collaborative learning settings. Eleven studies reported that students received instruction on how to provide appropriate peer feedback. No studies provided descriptions on whether or not the quality of feedback was evaluated by faculty. Seventeen studies evaluated the effect of peer feedback on professionalism; 12 of those studies evaluated its effectiveness for assessing professionalism and eight evaluated the use of peer feedback for professional behavior development. Ten studies examined the effect of peer feedback on student learning. Six studies examined the role of peer feedback on team dynamics. CONCLUSIONS: This systematic review indicates that peer feedback in a collaborative learning environment may be a reliable assessment for professionalism and may aid in the development of professional behavior. The review suggests implications for further research on the impact of peer feedback, including the effectiveness of providing instruction on how to provide appropriate peer feedback.

A Survey of Health Sciences Faculty Practices and Attitudes Regarding the Peer Feedback Component of Team-Based Learning.

BACKGROUND: Peer feedback, an essential component of team-based learning (TBL), fosters accountability among team members. Effective utilization can be advantageous for both students and faculty, although there may be many implementation challenges. Our study objectives were to (1) identify current practices of peer feedback in TBL, (2) identify curricular assessment related to peer feedback, and (3) identify challenges with peer feedback in TBL. METHODS: A survey link was sent via medical and TBL web boards. The survey asked for both quantitative and qualitative information regarding the peer feedback process. Quantitative results were analyzed using SPSS®. NVivo® was used to identify and code themes in open-ended responses. Both investigators reviewed and agreed upon themes. RESULTS: Sixty-one TBL users in health professions completed the survey. Multiple health professions were represented with medicine and pharmacy being the most common. Information on current practices showed a wide variety of implementation. Curricular alignment was common. Time and training were the most common challenges and difficulties. CONCLUSIONS: Meaningful feedback should be considered an important curricular outcome. Specific learning objectives and appropriate assessment strategies should be developed to meet the mission of the program. Students must receive guidance from faculty members on how to improve their skills in providing effective feedback. Overall, faculty saw peer evaluation as valuable. However, the time commitment, lack of student training, and student attitudes make implementation difficult. Future research should focus on best practices to streamline the TBL feedback process and on student training regarding how to provide effective feedback.

Use of Prescription Assistance Programs After the Affordable Health Care Act.

BACKGROUND: Insurance coverage in the United States seems to be in a state of unrest. The 2010 passage of the Patient Protection and Affordable Health Care Act (ACA) extended health insurance coverage to roughly 32 million people. An increase in the number of people with health insurance benefits raised the question of whether prescription assistance programs (PAPs) would still be used after ACA implementation. OBJECTIVE: To evaluate the use of PAPs following the implementation of the ACA insurance mandate. METHODS: Health insurance was not required by the ACA until January 2014, so we retrospectively examined the use of drug company-sponsored PAPs before and after the ACA implementation. Since each PAP had its own qualifying criteria, any person who used a PAP through the assistance of NeedyMeds and its PAPTracker between the years of 2011 and 2016 were included for analysis. Data were pulled by NeedyMeds from the PAPTracker software, which produces completed PAP applications from drug manufacturer forms for PAPs. The number of PAP orders, number of unique patient orders, and annual patient prescription savings were assessed. RESULTS: Between 2011 and 2013, there was an average of 4.2 annual PAP orders per patient; however, annual PAP orders decreased to 3.1 per patient between 2014 and 2016 (P < 0.001). PAP orders declined by an average of 3.0% per month between 2014 and 2016 (P < 0.001), and average prescription savings per order increased from $870.40 before the ACA to $1,086.40 after ACA implementation (P = 0.0024). Patients saved an average of over $3,000 on prescriptions annually with the use of PAPs after the ACA mandate. CONCLUSIONS: Although health care reform is inevitable, our study showed that PAPs remain important to help cover prescription drug costs for eligible patients, even with invariable changes to health insurance, including a health insurance requirement. While the ACA may have been an important step forward in extending health insurance coverage to millions, PAPs are still used to help U.S. patients obtain their medications at no cost or very low cost. These programs will most likely remain relevant until other approaches are taken to help alleviate the effects of increasing drug prices in the United States. DISCLOSURES: No outside funding supported this research. The authors have no relevant financial or nonfinancial relationships to disclose. Study concept and design were contributed by Khan, Lerchenfeldt, and Karabon. Khan collected the data, and all authors participated in data analysis. The manuscript was primarily written by Lerchenfeldt, along with Khan and Karabon, and revised by Lerchenfeldt, along with Karabon and Khan.

Autonomic Nervous System Team-Based Learning Module.

INTRODUCTION: The team-based learning (TBL) instructional strategy promotes learning and retention, enhances student engagement, allows for a deeper understanding of foundational and applied concepts, and helps students' develop lifelong learning skills. The autonomic nervous system (ANS) TBL was created for first-year medical students in the Neuroscience 1 course at Oakland University William Beaumont School of Medicine. METHODS: The module covered the pathophysiology of ANS-related diseases and therapeutic agents that impact ANS function. By the conclusion of the module, students were able to diagnose different disease processes of the ANS, identify potential complications, and formulate appropriate management strategies. Four faculty members used backward design to create the ANS TBL. The preparatory assignment included reviewing content from previous didactic lectures and consolidating key information in provided tables. Key concepts were evaluated with readiness assurance tests. All application exercises adhered to the 4 S's. RESULTS: Over the course of 2 years, the class averages for the individual readiness assurance test were 79.8% and 87.6%. The class averages for the team readiness assurance test and application exercises were similar across both years. Course evaluations revealed that students found the TBL relevant and valuable. DISCUSSION: Similar TBL modules available on MedEdPORTAL are not integrated to include different aspects of the basic and clinical sciences. This ANS TBL was used to help students integrate several essential concepts, including neuroanatomy, neurophysiology, neuropharmacology, and clinical neurology. Students were very enthusiastic and engaged throughout the ANS TBL as it contained relevant case-based scenarios with questions that were meaningful for clinical practice.