We invited 25 experienced (more than 6 months of teaching activity) student tutors who worked in our skills lab for Internal Medicine to participate voluntarily in this survey. A total of 23 tutors responded (11 females, 12 males). All study participants had received a didactic training targeted to their needs as a teacher in undergraduate skills lab training before their teaching activity (see below for further details on this training). The survey participants were from three different tutor cohorts, and therefore were trained on three separate occasions with a time lag of 6 months each. As not all modules were taught to every single student out of the 25 surveyed tutors in this pilot project, the number of participants for each of the modules slightly differs and is given separately in brackets.
General considerations on helpful didactic elements
The 1-day didactic training of student tutors was conducted in parallel groups of no more than 8 participants. The courses were held by two experienced instructors. If appropriate, e.g. for more extensive individual instruction, the groups were either divided in smaller groups, or they joined in a plenary session for theoretical input. The aim of the didactic training was to provide helpful didactic techniques and tips for the upcoming skills lab tutorial. In our opinion, student tutors not only need medical professional knowledge, but also social, communicative, and conflict solving competencies as well as knowledge about group dynamics and some insight into different learning theories. In our training, the tutors worked on the topics interactively (“learning by doing”) and transferred the new information learned to their own tutorial setting. In the following, the main training modules are presented in detail:
Description of the didactic training
Title: How to present and explain effectively (N=19)
- Demanding active knowledge from the students using activating teaching methods,
- Giving and receiving feedback effectively.
A tutorial simulation with 1:1 video analysis [23
] – The tutors were asked to simulate a 7 min-tutorial session that they had prepared at home (group size: no more than 8 participants). The module was focused on techniques like explaining, visualizing, questioning, impulse setting as well as important presentation aspects like e.g. eye contact and body language. Using the simulations as case model, we focused on one or two of the techniques and discussed alternatives. Giving and receiving feedback effectively was practiced extensively during these sessions. Peers provided systematic feedback with a structured observation sheet. The student tutors’ self reflections, their peers’ feedback as well as 1:1 trainer’s feedback during watching their own video ensured a comprehensive view on their acting as a teacher.
Title: How to explain precisely (N=21)
Objective: Getting aware of how difficult it is to describe a problem in such a way that the audience may understand correctly, and learning supportive as well as interfering aspects.
Method: In groups of four students, a one way-communication was constructed: One participant was asked to turn his/her back on the others and to describe a complex geometrical figure without any eye or reciprocal verbal contact. Two other participants were listening and tried to reconstruct the figure by means of given wooden pieces, by using sign language only. The fourth person observed and recorded positive and negative observations for further plenary discussion: What worked best? What impeded the understanding?
Title: How to explain on impulse (N=12; provided only for tutor cohort 3)
Objective: Answering questions by explaining in a structured, understandable and precise way.
Method: Spontaneous teaching presentations as might occur during the skills lab tutorial were simulated. The tutor had to explain on demand a FAQ, an abstract term, a defined clinical problem, a physiological or topographical background to each tutorial module. For the ad hoc-exercise, topics consented by the group were written on a piece of paper. In turn, any participant drew a task and started to “explain immediately and, if appropriate, visualize” in 2-3 minutes. Peer feedback was focused on structure, comprehensibility and visualization tools.
How to convey practical skills effectively with Peyton’s 4 Step Approach [20
Objective: Teaching complex practical skills.
Method: The tutors were asked to prepare any practical skill that they would like to teach their peers, as e.g. making a sailor’s knot, knitting, dancing, using chemical pipettes correctly, or suturing. In groups of 3, the tutors practiced by following the four steps of Peyton’s Method, with one person in each group observing. Finally, the positive and negative experiences were analyzed and the transfer into tutorial practice was discussed.
Title: How to deal with critical incidents (N=20)
Objective: Ensuring a conductive atmosphere in the tutorial group and handling difficult teaching situations.
Tutors need to perceive group processes in order to influence them as positive as possible. For reviewing group dynamics [24
], a trainer input to group development was integrated. In a brainstorming, the tutors collected situations that they perceived as difficult in earlier teaching or speaker situations. Critical incidents and the role occupied by certain participants (e.g. the “opposer”, the “troublemaker”, the “insensible”, etc.) were analyzed systematically. Supportive and interfering roles were worked out, and alternatives of reactions were discussed.
Retrospective evaluation was performed when tutors had at least six months experience as a teacher following the didactic course. We used an online questionnaire consisting of a 6-point Likert scale (1=totally agree, 6=totally disagree) for each provided module, a global rating of the didactic training and a text box for free comments. In this global rating, tutors were asked, which of the 5 distinct modules had mostly improved their didactic qualification. Furthermore, data on previous education in other medical specialties (nurse, paramedic) or previous teaching activities/experiences were obtained in order to avoid any systematic bias.