Office of Undergraduate Medical Education
Melissa A. Fischer
Medical Subject Headings
Education, Medical, Undergraduate; Teaching; Students, Medical; Patient Education as Topic
Life Sciences | Medical Education | Medicine and Health Sciences
Background: Though the practical and philosophical importance of teaching educational skills to students of medicine has been widely acknowledged, the principle accrediting bodies of resident and medical student training in the U.S. do not require medical schools to offer formal training in how to teach. Both recognize resident teaching in their competencies: the Accreditation Council for Graduate Medical Education (ACGME) requires all residencies to have a formal program in teaching; the Liaison Committee on Medical Education (LCME) mandates that all residents and faculty charged with teaching medical students “be prepared for their roles in teaching and assessment.” But many medical students begin to teach their peers and junior students during medical school. In a 2008 poll of 130 accredited, M.D.-granting US medical schools, all 99 responding institutions reported using their students as teachers, though less than half offered formal curriculum in teaching, and among them, the majority of curricula reached only a fraction of graduating students, usually toward the end of their final year. In addition, students teach patients from early in their training, and formal teaching skills may support this activity and thus enhance patient care. Despite favorable argument for the value and efficacy of such programs in the literature of the past three decades, U.S. medical education has largely deferred the formal instruction of educational skills to the postgraduate level.
UMMS offers its students a patchwork of peer and patient educational opportunities without presently offering formal background in evidence-based teaching skills. While this type of scattered elective experience can be immensely valuable to students, further formalization may better prepare UMMS students to satisfy the institutional competency of “assuming the role of teacher when appropriate.” The introduction and refinement of teaching skills may in turn benefit the quality of the educational program, the wider institutional and interprofessional learning environment, and patient care and health education across the Commonwealth. Many UMMS students stay on to become teaching residents and faculty, and remain – or later return – to the state to practice and teach. In a demanding era of expanding biomedical complexity, reduced resident duty hours, collaborative health care delivery, and patient-centered decision-making, offering or requiring relevant educational training to our clinicians early in their development may provide substantial benefit to our health care system and patients.
Objectives: The objectives of this project were: 1) Quantify the existence of peer and patient teaching opportunities within and outside the formal UMMS educational program at all levels of the curriculum; 2) Describe the receptiveness of faculty and students toward institution of a formal program preparing all UMMS students to teach both peers and patients in a variety of settings common to residency and clinical practice in any field; 3) Report arguments for and against such a program from the vantage of faculty and students, including barriers specific to UMMS; and 4) Propose a blueprint for such a program based on the opportunities already offered, new ideas from faculty and students, and models culled both from the educational literature and from other institutions.
Methods: Short online surveys were sent to course-directing faculty and to all currently enrolled UMMS students in years 1-4 of the curriculum using a combination of Likert-scale and open response items. Per the IRB, the survey did not require a formal approval or exemption process.
Results: FACULTY: 58% of all course and clerkship faculty responded; 48% stated that their courses already offer some opportunity in peer and patient teaching, though only in select cases do students receive formal training in educational methodology and thorough feedback on their performance as educators. Often, these programs do not apply to all students. 50% of faculty were most (4-5 on a 5-point scale) “interested in incorporating a formal student teaching component into [their] course,” and when asked whether they had particular “ideas for how students might practice their peer education or patient teaching skills within [their] course?” 67% answered “yes,” posing a variety of possibilities for peer and patient education, both familiar and innovative.
Students: 143 responses (28%) were received from currently enrolled students, constituting 17.6% of MS1, 25.4% of MS2, 26.9% of MS3, and 39.6% of MS4 and extending students. Self-reported comfort as a peer and patient educator increased modestly over class years, when expressed as an average of responses on a 1-5 Likert scale (Peer: MS1 3.00, MS2 3.13, MS3 3.13, MS4 3.47, MS4 extended 3.57; Patient: MS1 3.32, MS2 3.75, MS3 3.88, MS4 3.95, MS4 extended 4.21). 30.8% of students identified some opportunity to teach within the formal curriculum; outside the formal curriculum, 28.7% of students listed no opportunity, while the rest listed different amounts and frequencies ranging from daily to once a year, depending on how they defined teaching. 75.6% of responding students emphasized the value of “learn[ing] formal teaching skills - small group, lecture, bedside - in medical school” and 77.7% emphasized the value of opportunities to “practice formal teaching skills” (4-5 on a 5-point scale). 41.3% indicated that they would “actively create time to learn, practice, and refine these skills prior to residency if it were not included in the formal academic program.”
Conclusion: Though teaching opportunities exist at UMMS, most are not formalized, and those offered reach less than a third of students. While comfort with peer and patient teaching increases across the educational continuum from first to fourth year, the increase remains modest. 84% of graduates report that they felt prepared to teach as interns based on their 2011 AAMC graduation questionnaire responses, but given the importance of teaching in many aspects of medicine, we see room for improvement. Overall, there is a strong call both from both faculty and students at UMMS for formally incorporating educational training into the curriculum, with a particular focus on teaching practice. Free-response items emphasized dramatic differences in student and faculty understanding and recognition of teaching as a professional role among both peers and patients. These discrepancies highlight a need for increased awareness of the teaching responsibilities of medical students, and of the possibilities that are open to them during medical school. A structured approach to medical student teaching skills across the continuum of undergraduate medical education is the first step in this process.
Bradley, Joel and Fischer, Melissa A., "Are Our Students Teachers?" (2012). University of Massachusetts Medical School. Senior Scholars Program. Paper 121.