Near‐peer teaching in a formative clinical skills examination

Abstract

Context and setting The Clinical Performance Exam (CPX) is a formative standardised patient exam that was designed by a consortium of medical educators from all 8 California Medical schools to assess history-taking, physical examination, and communication skills of third-year medical students. The Mini-CPX consists of 3 clinical cases and is designed to prepare students for the full-length CPX (8 cases) and the USMLE Step 2 Clinical Skills Exam. Following the Mini-CPX, third-year students attend a faculty-led 60-minute teaching session during which they receive feedback, review history-taking and physical examination skills with a standardised patient, and learn test-taking strategies. Why the change was necessary Fourth-year medical students often lack opportunities to gain bedside teaching experience before they assume primary teaching responsibilities in residency. We believed that the Mini-CPX would provide a rich teaching opportunity for selected fourth-year students without compromising the quality of the exam for the third-year students. What was done We created a programme for 8 fourth-year students to facilitate Mini-CPX teaching sessions for groups of 6 third-year students under faculty supervision. Faculty were expected primarily to observe, and to contribute only if clarification of teaching points were necessary. We also developed a syllabus for facilitators that included evidence-based strategies for teaching physical examination skills in a small group setting. In preparation for teaching, fourth-year students reviewed the syllabus and attended a brief orientation session run by the standardised patient trainer. Following the teaching session, third-year students completed a post-exam survey evaluating the effectiveness of paired fourth-year student/faculty preceptors compared with faculty preceptors alone. Additionally, fourth-year students completed a post-facilitation survey regarding their Mini-CPX teaching experience. Both surveys employed a 5-point (1 = strongly disagree to 5 = strongly agree) Likert scale format. A 2-tailed student's t-test, carried out at the α = 0.05 level, was used to determine statistically significant differences between satisfaction with fourth-year student preceptors and faculty preceptors. Evaluation of results and impact Ninety-five per cent (141/149) of third-year students completed the post-exam survey. Third-year students agreed that feedback (4.0 ± 0.8), instruction on history-taking (3.7 ± 0.8), and physical examination instruction (3.9 ± 0.9) were useful. Eighty-two students attended a Mini-CPX teaching session facilitated by a fourth-year student with faculty supervision, while 59 were taught by faculty alone. Importantly, there were no statistically significant differences in teaching ratings of fourth-year student preceptors and faculty preceptors (overall debriefing: 4.0 vs. 4.0; history-taking: 3.8 vs. 3.7; and physical examination: 4.0 vs. 3.9). The 6 fourth-year students who completed a post-facilitation survey valued the opportunity to teach in the Mini-CPX (4.7 ± 0.5) and agreed that the teaching syllabus was a useful preparation tool (4.8 ± 0.4). Overall, these results suggest that trained fourth-year students can function as preceptors comparably to faculty facilitators in a clinical skills review course using standardised patients. This model reinforces clinical and teaching skills for student preceptors. Further, it may reduce recruitment needs for faculty preceptors and may enhance near-peer professional interactions.