An anonymous survey instrument was developed by researchers with expertise in health policy and Medicare Part D. Questions were tested for content and face validity during the inaugural presentation to the nurse practitioner students to assess the effectiveness of the presentation and learners' attitudes toward the peer-to-peer instructional format. Learners completed the survey instrument at the conclusion of each presentation. Participation in the survey was voluntary, and the UCSF institutional review board approved the study protocol.
Basic demographic information about learners was collected, including age, gender, and health professional school affiliation/year. Learners were asked about prior exposure to Part D. There also were 2 open-ended questions, providing space for learners to write comments about the presentation. The survey instrument included questions, on a 4- and 5-point Likert scale, which focused on 3 domains: quality of instruction (1 = poor, 5 = excellent); usefulness of the information presented (1 = not at all useful, 5 = extremely useful); and the effectiveness of the peer-to-peer teaching format, which was measured by rating agreement with 3 statements (1 = strongly disagree, 4 = strongly agree).
The survey metrics for quality of instruction, usefulness of information, and effectiveness of teaching format were taken from survey instruments used in faculty course evaluations. After 4 lectures were completed, an interim review of the qualitative data was conducted which found that some learners referenced a change in opinion about pharmacists' roles and contributions as a result of the lecture. Therefore, in October 2007, an additional 7 statements were added to the survey instrument to collect this information systematically from all learners. Learners were asked to rate their level of agreement using a 4-point scale (1 = strongly disagree, 4 = strongly agree). These statements were tested for face validity by a group of medical residents, and modifications were made based on their feedback.
Data analyses were performed using SPSS software, version 15.0 (SPSS, Inc., Chicago, IL). Descriptive statistics were used to summarize learners' demographic characteristics and present frequency distributions of responses. For the qualitative analysis, all written responses to the open-ended questions were manually coded and analyzed using grounded-theory methods. 21
Two investigators independently analyzed the responses and met to refine the coding and develop a consensus.
From November 2006 to June 2008 12 peer-to-peer presentations were delivered to audiences of 6 to 125 learners, to a total of 453 health professional students and medical residents from 4 academic medical centers. The survey response rate was close to 100% of attendees (survey instruments were collected as learners exited the presentation), and the response rate for each survey item ranged from 97% to 100%. The mean age of all learners was 30.3 ± 6.4 years, and 71% (n = 320) were female. Of the 453 learners, 44% (n = 201) were nurse practitioner students; 43% (n = 196) were medical students; 13% (n = 53) were internal medicine residents; and the remaining 3 students were from other programs. Of the 196 medical students, 7% (n = 13) were in their first year, 8% (n = 16) in their second year, 46% (n = 91) in their third year, and 39% (n = 77) in their fourth year. Approximately 60% of all learners (n = 277) stated that they had no prior experience with Part D, and only 16% (n = 74) reported exposure to Part D through their health professional coursework.
Ninety-five percent of learners rated the overall quality of instruction as either “excellent” or “very good.” Similarly, 89% rated the information presented as “extremely useful” or “very useful.” As shown in Table , 100% of learners strongly or somewhat agreed that they would recommend the lecture to other health professionals; 99.6% strongly or somewhat agreed the peer-to-peer format was an effective way to provide education about Medicare Part D; and 99.8% strongly or somewhat agreed that the peer-to-peer lecture promoted collaboration among health professionals.
Learners' Assessments of the Medicare Part D Peer-to-Peer Presentation
A total of 255 learners attended 1 of 8 lectures delivered after additional items were added to the survey instrument. Of this subset of 255 learners, 98% strongly or somewhat agreed that their opinion of pharmacists improved, and 99% strongly or somewhat agreed that they learned how pharmacists could help advocate for patients. Further, learners strongly or somewhat agreed that, as a result of the lecture, they were more likely to collaborate with pharmacists about drug selection (95%), drug costs (97%), formularies (96%), drug policy (96%), and insurance plans (96%). When this subset of 255 learners was compared with the 198 learners who attended 1 of the first 4 presentations, there were no significant differences in age, gender, and professional school affiliation/year.
Data also were stratified by health professional school. Compared to nursing students, medical students were more likely to be male (8.4% vs. 45.2%, p < 0.0001), younger (28.4 ± 4.5 years vs. 33.5 ± 8.0 years, p < 0.0001) and have prior experience with Part D (31.2% vs. 47.7%, p < 0.0001). However, when individual survey items were analyzed, no significant differences emerged based on health professional school, gender, and age.
Thirty-eight percent (n = 173) of learners, including 50% (n = 100) of nursing students, 30% (n = 59) of medical students, and 26% (n = 14) of medical residents, provided optional written comments, with 92% providing positive feedback about the presentation. Qualitative analysis of the open-ended comments (Table ) revealed themes that emerged across all groups of learners. Major themes included: (1) the quality, usefulness, and clinical relevance of the material; (2) the value of interprofessional education and collaboration; and (3) changed views about the roles and contributions of pharmacists. Suggestions for improving the lecture were incorporated into subsequent presentations, including devoting more time to answering learners' questions, providing more case-based examples, and increasing the length of the lecture.
Major Themes in Assessments From Learners About the Medicare Part D Lecture
Another dimension of the success of the peer educator program was its rapid dissemination by invitation across departments, schools, and academic medical centers. The peer educators' first presentation outside our institution was to a small cohort of internal medicine residents at a nearby academic medical center, which was followed by a request to deliver the presentation to all internal medicine and family medicine residents as part of their core residency curricula. Additionally, the peer educators presented at other institutions' medical grand rounds and internal medicine residency programs, which led to invitations to return yearly. Based on these successes, the program expanded statewide, disseminating to 6 additional colleges or schools of pharmacy, that would, in turn, train peer educators to deliver the Part D presentation to their affiliated nursing schools, medical schools, and residency programs.