Medical faculty opinions of peer tutoring.

CONTEXT AND OBJECTIVES: Peer tutoring is a well-researched and established method of learning defined as 'a medical student facilitating the learning of another medical student'. While it has been adopted in many medical schools, other schools may be reluctant to embrace this approach. The attitude of the teaching staff, responsible for organizing and or teaching students in an undergraduate medical course to formal peer teaching will affect how it is introduced and operationalized. This study elicits faculty opinions on how best to introduce peer tutoring for medical students. METHODS: Structured telephone interviews were recorded, transcribed and analyzed using thematic analysis. The interviews were with medically qualified staff responsible for organizing or teaching undergraduate medical students at a New Zealand medical school. Six questions were posed regarding perceived advantages and disadvantages of peer tutoring and how the school and staff could support a peer-tutoring scheme if one was introduced. FINDINGS: Staff generally supported the peer tutoring concept, offering a safe environment for learning with its teachers being so close in career stage to the learners. They also say disadvantages when the student-teachers imparted wrong information and when schools used peer tutoring to justify a reduction in teaching staff. Subjects felt that faculty would be more accepting of peer tutoring if efforts were made to build staff 'buy in' and empowerment, train peer tutors and introduce a solid evaluation process. CONCLUSIONS: Staff of our school expressed some concerns about peer tutoring that are not supported in the literature, signaling a need for better communication about the benefits and disadvantages of peer tutoring.

Medical students and informed consent-response to "Consent for Teaching".

Nil.

Defining decision making: a qualitative study of international experts' views on surgical trainee decision making.

BACKGROUND: Decision making is a key competency of surgeons; however, how best to assess decisions and decision makers is not clearly established. The aim of the present study was to identify criteria that inform judgments about surgical trainees' decision-making skills. METHODS: A qualitative free text web-based survey was distributed to recognized international experts in Surgery, Medical Education, and Cognitive Research. Half the participants were asked to identify features of good decisions, characteristics of good decision makers, and essential factors for developing good decision-making skills. The other half were asked to consider these areas in relation to poor decision making. Template analysis of free text responses was performed. RESULTS: Twenty-nine (52%) experts responded to the survey, identifying 13 categories for judging a decision and 14 for judging a decision maker. Twelve features/characteristics overlapped (considered, informed, well timed, aware of limitations, communicated, knowledgeable, collaborative, patient-focused, flexible, able to act on the decision, evidence-based, and coherent). Fifteen categories were generated for essential factors leading to development of decision-making skills that fall into three major themes (personal qualities, training, and culture). The categories compiled from the perspectives of good/poor were predominantly the inverse of each other; however, the weighting given to some categories varied. CONCLUSIONS: This study provides criteria described by experts when considering surgical decisions, decision makers, and development of decision-making skills. It proposes a working definition of a good decision maker. Understanding these criteria will enable clinical teachers to better recognize and encourage good decision-making skills and identify poor decision-making skills for remediation.

Leadership and surgical training part 2: training toolkit for leadership development during surgical training.

The Royal Australasian College of Surgeons identifies leadership as an everyday surgical skill and one of the 10 key competences expected of surgeons. However, there is limited opportunity for formal leadership training and development prior to becoming a consultant, with surgical leadership curricula within worldwide training programmes often poorly defined. As a consequence of a focus on general professional skill development, rather than specific training and assessment in leadership, observed trainee leadership skills show scope for improvement. Many studies indicate trainees report leadership skills training as beneficial and are receptive to interventions. However, most surgical leadership development courses prepare pre-identified leaders for formal leadership positions rather than developing all surgical trainees leadership skills. Although the recently established Royal Australasian College of Surgeons 'Surgeons as Leaders in Everyday Practice' course helps to fill this gap, it is aimed at consultant surgeons. Most successful leadership development programmes are also longitudinal throughout surgical training and multi-faceted.

Leadership and surgical training part 1: preparing to lead the way?

Every day surgeons lead teams on the wards, in clinics and operating theatres, but most trainees and some surgeons do not consider themselves as leaders. Leadership skills are increasingly important for surgeons, who need knowledge of organizational structure and policy, management strategy and team dynamics to deliver and improve health care in resource-constrained environments. The Royal Australasian College of Surgeons recognizes leadership as one of 10 core surgical competencies but leadership curricula within surgical training programmes are not well defined. There is limited opportunity for formal leadership training and development prior to becoming a consultant.

A Tool for Rating the Value of Health Education Mobile Apps to Enhance Student Learning (MARuL): Development and Usability Study.

BACKGROUND: To realize the potential for mobile learning in clinical skills acquisition, medical students and their teachers should be able to evaluate the value of an app to support student learning of clinical skills. To our knowledge, there is currently no rubric for evaluation of quality or value that is specific for apps to support medical student learning. Such a rubric might assist students to be more confident in using apps to support their learning. OBJECTIVE: The objective of this study was to develop an instrument that can be used by health professional educators to rate the value of a mobile app to support health professional student learning. METHODS: Using the literature, we developed a list of potential criteria for the evaluation of educational app value, which were then refined with a student group using a modified nominal group technique. The refined list was organized into themes, and the initial rubric, Mobile App Rubric for Learning (MARuL, version 1), was developed. iOS and Android app stores were searched for clinical skills apps that met our inclusion criteria. After the 2 reviewers were trained and the item descriptions were refined (version 2), a random sample of 10 included apps, 5 for each mobile operating system, was reviewed. Interitem and interrater analyses and discussions with the reviewers resulted in refinement of MARuL to version 3. The reviewers completed a review of 41 clinical skills mobile apps, and a second round of interitem and interrater reliability testing was performed, leading to version 4 of the MARuL. RESULTS: Students identified 28 items (from an initial set of 144 possible items) during the nominal group phase, and these were then grouped into 4 themes: teaching and learning, user centered, professional, and usability. Testing and refinement with reviewers reduced the list to 26 items. Internal consistency for MARuL was excellent (α=.96), and the interrater reliability as measured by the intraclass correlation coefficient (ICC) was good (ICC=0.66). CONCLUSIONS: MARuL offers a fast and user-friendly method for teachers to select valuable apps to enhance student learning.

A dedicated dermatology clinic for renal transplant recipients: first 5 years of a New Zealand experience.

AIM: Cancer following organ transplantation is a growing public health concern. We describe the first 5 years' experience of a dedicated dermatology clinic for renal transplant recipients, the first of its type in New Zealand. METHODS: Data from patients seen in the clinic were collected on a nephrology/dermatology database. RESULTS: 86 of 99 transplant recipients had a baseline dermatology assessment. Seventy-one skin cancers (45 squamous, 25 basal cell carcinomas, 1 melanoma) were found in 17 patients. Eighteen of these were an incidental finding at the baseline post-transplant examination of 7 patients: they had not been noted either by the patient or by their nephrologist. A further 44 cancers were found in 13 patients at follow-up examinations in the dedicated clinic. Squamous and basal cell carcinomas received definitive treatment after 26 and 38 days (median) respectively. A brief analysis showed this to be a cost-effective way of diagnosing and treating skin cancer in this cohort of patients. CONCLUSION: The clinic is enabling prompt diagnosis and cost-effective treatment of skin cancers developing in renal transplant recipients and is also identifying significant numbers of pre-existing skin cancers in these patients.

Assessment and management of leg ulcers in the community and an outpatient clinic.

AIM: To compare the assessment and treatment of leg ulcers seen in the community and subsequently reviewed in an outpatient clinic, to the New Zealand Guidelines. METHODS: An observational study including consecutive patients presenting to vascular surgery outpatients with at least one leg ulcer. Outcomes included the clinical descriptions of ulcers, use of an Ankle Brachial Index (ABI) test and compression therapy for mixed and venous ulcers. RESULTS: The study included seventy-six patients. Every ulcer had an adequate clinical description. An ABI investigation was carried out in 9.1% and 66.7% of the patients in the community and outpatient clinic, respectively. Among 31 patients with venous or mixed ulcers in the community, 7 (22.6%) were initiated on compression therapy, and 1 (3.2%) on compression bandaging. Following outpatient clinic appointments, 29 (76.3%) of the 38 patients diagnosed with venous or mixed ulcers were on compression therapy with 20 (52.6%) on compression bandaging. CONCLUSION: There are low rates of ABI measurements and initiation of compression therapy for patients with leg ulcers in the Otago regional community. This may be due to low accessibility to expertise in ABI measurements delaying initiation of compression therapy. Innovations in facilitating ABI investigation in the community and promoting the use of compression therapy are indicated.

Comparison of opinions and profiles of late or non-responding medical students with initial responders to a course evaluation questionnaire.

This study examined whether students requiring prompting to evaluate an educational module differed from initial responders in their rating of the experience and their profile (academic ability, age and gender). At the end of a 4th year induction Module, medical students completed an evaluation questionnaire. Those who did not respond were followed-up. Fifty-nine percent responded immediately, 34% after first or second prompts (late responders) and 7% were non-responders. Late responders rated the module significantly lower than initial responders. Late and non-responders were academically weaker than initial responders, but were similar in age and gender. Academically weaker students in the non- or late responders groups, may be less willing to reflect on their experience, and may require new strategies to encourage a response.

Students' perceptions of whistle blowing: implications for self-regulation. A questionnaire and focus group survey.

AIM: The aims of this study are to gauge and use the views of medical students to elaborate on the concept of whistle blowing and to give an indication of its role in self-regulation. METHODS: An anonymous questionnaire survey was conducted among medical students from a Scottish medical school. Students were asked (i) whether they should, and (ii) whether they would report to faculty academic misconduct by other students. Comparisons were made between all five year groups. Subsequently students in focus groups were asked to give their reasons for whistle-blowing or not doing so. RESULTS: Of the students, 40% felt they should whistle-blow, with 13% saying they would actually do so. The numbers of students who felt they should or would whistle blow were smaller in the later year groups. Focus groups identified positive and negative reasons for whistle blowing or not, and reasons connected to the process itself. Reasons given for not whistle blowing included camaraderie, retaliation by peers, self-preservation and a belief that it is not a student's responsibility to report the misconduct of others. CONCLUSIONS: The results have two important implications. First, medical schools have to decide whether students have a duty to whistle blow and/or whether there is a need to devise clear procedures. Any procedures should take into account the reasons given for not whistle blowing, but should concentrate on positive motivating factors. Secondly the medical profession needs to consider the role of whistle blowing, as the results suggest that whistle blowing should not be the only method of detection of misconduct in an undergraduate setting.