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1.  Evaluating professionalism in medical undergraduates using selected response questions: findings from an item response modelling study 
BMC Medical Education  2011;11:43.
Background
Professionalism is a difficult construct to define in medical students but aspects of this concept may be important in predicting the risk of postgraduate misconduct. For this reason attempts are being made to evaluate medical students' professionalism. This study investigated the psychometric properties of Selected Response Questions (SRQs) relating to the theme of professional conduct and ethics comparing them with two sets of control items: those testing pure knowledge of anatomy, and; items evaluating the ability to integrate and apply knowledge ("skills"). The performance of students on the SRQs was also compared with two external measures estimating aspects of professionalism in students; peer ratings of professionalism and their Conscientiousness Index, an objective measure of behaviours at medical school.
Methods
Item Response Theory (IRT) was used to analyse both question and student performance for SRQs relating to knowledge of professionalism, pure anatomy and skills. The relative difficulties, discrimination and 'guessabilities' of each theme of question were compared with each other using Analysis of Variance (ANOVA). Student performance on each topic was compared with the measures of conscientiousness and professionalism using parametric and non-parametric tests as appropriate. A post-hoc analysis of power for the IRT modelling was conducted using a Monte Carlo simulation.
Results
Professionalism items were less difficult compared to the anatomy and skills SRQs, poorer at discriminating between candidates and more erratically answered when compared to anatomy questions. Moreover professionalism item performance was uncorrelated with the standardised Conscientiousness Index scores (rho = 0.009, p = 0.90). In contrast there were modest but significant correlations between standardised Conscientiousness Index scores and performance at anatomy items (rho = 0.20, p = 0.006) though not skills (rho = .11, p = .1). Likewise, students with high peer ratings for professionalism had superior performance on anatomy SRQs but not professionalism themed questions. A trend of borderline significance (p = .07) was observed for performance on skills SRQs and professionalism nomination status.
Conclusions
SRQs related to professionalism are likely to have relatively poor psychometric properties and lack associations with other constructs associated with undergraduate professional behaviour. The findings suggest that such questions should not be included in undergraduate examinations and may raise issues with the introduction of Situational Judgement Tests into Foundation Years selection.
doi:10.1186/1472-6920-11-43
PMCID: PMC3146946  PMID: 21714870
2.  A holistic review of the medical school admission process: examining correlates of academic underperformance 
Medical Education Online  2014;19:10.3402/meo.v19.22919.
Background
Despite medical school admission committees’ best efforts, a handful of seemingly capable students invariably struggle during their first year of study. Yet, even as entrance criteria continue to broaden beyond cognitive qualifications, attention inevitably reverts back to such factors when seeking to understand these phenomena. Using a host of applicant, admission, and post-admission variables, the purpose of this inductive study, then, was to identify a constellation of student characteristics that, taken collectively, would be predictive of students at-risk of underperforming during the first year of medical school. In it, we hypothesize that a wider range of factors than previously recognized could conceivably play roles in understanding why students experience academic problems early in the medical educational continuum.
Methods
The study sample consisted of the five most recent matriculant cohorts from a large, southeastern medical school (n=537). Independent variables reflected: 1) the personal demographics of applicants (e.g., age, gender); 2) academic criteria (e.g., undergraduate grade point averages [GPA], medical college admission test); 3) selection processes (e.g., entrance track, interview scores, committee votes); and 4) other indicators of personality and professionalism (e.g., Mayer-Salovey-Caruso Emotional Intelligence Test™ emotional intelligence scores, NEO PI-R™ personality profiles, and appearances before the Professional Code Committee [PCC]). The dependent variable, first-year underperformance, was defined as ANY action (repeat, conditionally advance, or dismiss) by the college's Student Progress and Promotions Committee (SPPC) in response to predefined academic criteria. This study protocol was approved by the local medical institutional review board (IRB).
Results
Of the 537 students comprising the study sample, 61 (11.4%) met the specified criterion for academic underperformance. Significantly increased academic risks were identified among students who 1) had lower mean undergraduate science GPAs (OR=0.24, p=0.001); 2) entered medical school via an accelerated BS/MD track (OR=16.15, p=0.002); 3) were 31 years of age or older (OR=14.76, p=0.005); and 4) were non-unanimous admission committee admits (OR=0.53, p=0.042). Two dimensions of the NEO PI-R™ personality inventory, openness (+) and conscientiousness (−), were modestly but significantly correlated with academic underperformance. Only for the latter, however, were mean scores found to differ significantly between academic performers and underperformers. Finally, appearing before the college's PCC (OR=4.21, p=0.056) fell just short of statistical significance.
Conclusions
Our review of various correlates across the matriculation process highlights the heterogeneity of factors underlying students’ underperformance during the first year of medical school and challenges medical educators to understand the complexity of predicting who, among admitted matriculants, may be at future academic risk.
doi:10.3402/meo.v19.22919
PMCID: PMC3974177  PMID: 24695362
admissions; underperformance; selection; at-risk students
3.  Association of Medical Students' Reports of Interactions with the Pharmaceutical and Medical Device Industries and Medical School Policies and Characteristics: A Cross-Sectional Study 
PLoS Medicine  2014;11(10):e1001743.
Aaron Kesselheim and colleagues compared US medical students' survey responses regarding pharmaceutical company interactions with the schools' AMSA PharmFree scorecard and Institute on Medicine as a Profession's (IMAP) scores.
Please see later in the article for the Editors' Summary
Background
Professional societies use metrics to evaluate medical schools' policies regarding interactions of students and faculty with the pharmaceutical and medical device industries. We compared these metrics and determined which US medical schools' industry interaction policies were associated with student behaviors.
Methods and Findings
Using survey responses from a national sample of 1,610 US medical students, we compared their reported industry interactions with their schools' American Medical Student Association (AMSA) PharmFree Scorecard and average Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database score. We used hierarchical logistic regression models to determine the association between policies and students' gift acceptance, interactions with marketing representatives, and perceived adequacy of faculty–industry separation. We adjusted for year in training, medical school size, and level of US National Institutes of Health (NIH) funding. We used LASSO regression models to identify specific policies associated with the outcomes. We found that IMAP and AMSA scores had similar median values (1.75 [interquartile range 1.50–2.00] versus 1.77 [1.50–2.18], adjusted to compare scores on the same scale). Scores on AMSA and IMAP shared policy dimensions were not closely correlated (gift policies, r = 0.28, 95% CI 0.11–0.44; marketing representative access policies, r = 0.51, 95% CI 0.36–0.63). Students from schools with the most stringent industry interaction policies were less likely to report receiving gifts (AMSA score, odds ratio [OR]: 0.37, 95% CI 0.19–0.72; IMAP score, OR 0.45, 95% CI 0.19–1.04) and less likely to interact with marketing representatives (AMSA score, OR 0.33, 95% CI 0.15–0.69; IMAP score, OR 0.37, 95% CI 0.14–0.95) than students from schools with the lowest ranked policy scores. The association became nonsignificant when fully adjusted for NIH funding level, whereas adjusting for year of education, size of school, and publicly versus privately funded school did not alter the association. Policies limiting gifts, meals, and speaking bureaus were associated with students reporting having not received gifts and having not interacted with marketing representatives. Policy dimensions reflecting the regulation of industry involvement in educational activities (e.g., continuing medical education, travel compensation, and scholarships) were associated with perceived separation between faculty and industry. The study is limited by potential for recall bias and the cross-sectional nature of the survey, as school curricula and industry interaction policies may have changed since the time of the survey administration and study analysis.
Conclusions
As medical schools review policies regulating medical students' industry interactions, limitations on receipt of gifts and meals and participation of faculty in speaking bureaus should be emphasized, and policy makers should pay greater attention to less research-intensive institutions.
Please see later in the article for the Editors' Summary
Editors' Summary
Background
Making and selling prescription drugs and medical devices is big business. To promote their products, pharmaceutical and medical device companies build relationships with physicians by providing information on new drugs, by organizing educational meetings and sponsored events, and by giving gifts. Financial relationships begin early in physicians' careers, with companies providing textbooks and other gifts to first-year medical students. In medical school settings, manufacturers may help to inform trainees and physicians about developments in health care, but they also create the potential for harm to patients and health care systems. These interactions may, for example, reduce trainees' and trained physicians' skepticism about potentially misleading promotional claims and may encourage physicians to prescribe new medications, which are often more expensive than similar unbranded (generic) drugs and more likely to be recalled for safety reasons than older drugs. To address these and other concerns about the potential career-long effects of interactions between medical trainees and industry, many teaching hospitals and medical schools have introduced policies to limit such interactions. The development of these policies has been supported by expert professional groups and medical societies, some of which have created scales to evaluate the strength of the implemented industry interaction policies.
Why Was This Study Done?
The impact of policies designed to limit interactions between students and industry on student behavior is unclear, and it is not known which aspects of the policies are most predictive of student behavior. This information is needed to ensure that the policies are working and to identify ways to improve them. Here, the researchers investigate which medical school characteristics and which aspects of industry interaction policies are most predictive of students' reported behaviors and beliefs by comparing information collected in a national survey of US medical students with the strength of their schools' industry interaction policies measured on two scales—the American Medical Student Association (AMSA) PharmFree Scorecard and the Institute on Medicine as a Profession (IMAP) Conflicts of Interest Policy Database.
What Did the Researchers Do and Find?
The researchers compared information about reported gift acceptance, interactions with marketing representatives, and the perceived adequacy of faculty–industry separation collected from 1,610 medical students at 121 US medical schools with AMSA and IMAP scores for the schools evaluated a year earlier. Students at schools with the highest ranked interaction policies based on the AMSA score were 63% less likely to accept gifts as students at the lowest ranked schools. Students at the highest ranked schools based on the IMAP score were about half as likely to accept gifts as students at the lowest ranked schools, although this finding was not statistically significant (it could be a chance finding). Similarly, students at the highest ranked schools were 70% less likely to interact with sales representatives as students at the lowest ranked schools. These associations became statistically nonsignificant after controlling for the amount of research funding each school received from the US National Institutes of Health (NIH). Policies limiting gifts, meals, and being a part of speaking bureaus (where companies pay speakers to present information about the drugs for dinners and other events) were associated with students' reports of receiving no gifts and of non-interaction with sales representatives. Finally, policies regulating industry involvement in educational activities were associated with the perceived separation between faculty and industry, which was regarded as adequate by most of the students at schools with such policies.
What Do These Findings Mean?
These findings suggest that policies designed to limit industry interactions with medical students need to address multiple aspects of these interactions to achieve changes in the behavior and attitudes of trainees, but that policies limiting gifts, meals, and speaking bureaus may be particularly important. These findings also suggest that the level of NIH funding plays an important role in students' self-reported behaviors and their perceptions of industry, possibly because institutions with greater NIH funding have the resources needed to implement effective policies. The accuracy of these findings may be limited by recall bias (students may have reported their experiences inaccurately), and by the possibility that industry interaction policies may have changed in the year that elapsed between policy grading and the student survey. Nevertheless, these findings suggest that limitations on gifts should be emphasized when academic medical centers refine their policies on interactions between medical students and industry and that particular attention should be paid to the design and implementation of policies that regulate industry interactions in institutions with lower levels of NIH funding.
Additional Information
Please access these websites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.1001743.
The UK General Medical Council provides guidance on financial and commercial arrangements and conflicts of interest as part of its good medical practice document, which describes what is required of all registered doctors in the UK
Information about the American Medical Student Association (AMSA) Just Medicine campaign (formerly the PharmFree campaign) and about the AMSA Scorecard is available
Information about the Institute on Medicine as a Profession (IMAP) and about its Conflicts of Interest Policy Database is also available
“Understanding and Responding to Pharmaceutical Promotion: A Practical Guide” is a manual prepared by Health Action International and the World Health Organization that medical schools can use to train students how to recognize and respond to pharmaceutical promotion
The US Institute of Medicine's report “Conflict of Interest in Medical Research, Education, and Practice” recommends steps to identify, limit, and manage conflicts of interest
The ALOSA Foundation provides evidence-based, non-industry-funded education about treating common conditions and using prescription drugs
doi:10.1371/journal.pmed.1001743
PMCID: PMC4196737  PMID: 25314155
4.  Pilot study of the roles of personality, references, and personal statements in relation to performance over the five years of a medical degree 
BMJ : British Medical Journal  2003;326(7386):429-432.
Objectives
To compare the power of three traditional selection procedures (A levels, personal statements, and references) and one non-traditional selection procedure (personality) to predict performance over the five years of a medical degree.
Design
Cohort study over five years.
Setting
Nottingham medical school.
Participants
Entrants in 1995.
Main outcome measures
A level grades, amounts of information contained in teacher's reference and the student's personal statement, and personality scores examined in relation to 18 different assessments.
Results
Information in the teacher's reference did not consistently predict performance. Information in the personal statement was predictive of clinical aspects of training, whereas A level grades primarily predicted preclinical performance. The personality domain of conscientiousness was consistently the best predictor across the course. A structural model indicated that conscientiousness was positively related to A level grades and preclinical performance but was negatively related to clinical grades.
Conclusion
A teacher's reference is of no practical use in predicting clinical performance of medical students, in contrast to the amount of information contained in the personal statement. Therefore, simple quantification of the personal statement should aid selection. Personality factors, in particular conscientiousness, need to be considered and integrated into selection procedures.
PMCID: PMC163931  PMID: 12595384
5.  Exploring reflective 'critical incident' documentation of professionalism lapses in a medical undergraduate setting 
Background
Measuring professionalism in undergraduate medical students is a difficult process, and no one method has currently emerged as the definitive means of assessment in this field. Student skills in reflection have been shown to be highly important in the development of professional behaviours. By studying student reflections on lapses in professional judgement, recorded as 'critical incidents', it is possible to explore themes which are significant for the development of professional behaviour in an undergraduate setting.
Methods
We examined critical incident reporting combined with optional written student reflection as a method for exploring professionalism in undergraduate medical students. 228 students split between Year 1 and 2 of one academic year of undergraduate medicine were studied retrospectively and a grounded theory approach to analysis was employed.
Results
This year generated 16 critical incident reports and corresponding student reflections, all of which were considered. In addition to identifying the nature of the critical incidents, 3 principal themes emerged. These were the impact and consequences of the report having been made, student reactions to the events (both positive and negative), and student responses regarding future actions.
Conclusion
This study indicates that unprofessional behaviour can be identified and challenged by both the faculty and the students involved, and suggests that positive behavioural changes might be made with the aim of preventing future occurrences. We provide a low cost approach of measuring and recording professional behaviour.
doi:10.1186/1472-6920-9-44
PMCID: PMC2714848  PMID: 19604378
6.  Individual characteristics and student’s engagement in scientific research: a cross-sectional study 
BMC Medical Education  2012;12:95.
Background
In light of the increasing recognition of the importance of physician scientists, and given the association between undergraduate research experiences with future scientific activity, it is important to identify and understand variables related to undergraduate students’ decision to engage in scientific research activities. The present study assessed the influence of individual characteristics, including personality traits and socio-demographic characteristics, on voluntary engagement in scientific research of undergraduate medical students.
Methods
For this study, all undergraduate students and alumni of the School of Health Sciences in Minho, Portugal were invited to participate in a survey about voluntary engagement in scientific research activities. Data were available on socio-demographic, personality and university admission variables, as part of an ongoing longitudinal study. A regression model was used to compare (1) engaged with (2) not engaged students. A classification and regression tree model was used to compare students engaged in (3) elective curricular research (4) and extra-curricular research.
Results
A total of 466 students (88%) answered the survey. A complete set of data was available for 435 students (83%).
Higher scores in admission grade point average and the personality dimensions of “openness to experience” and “conscientiousness” increased chances of engagement. Higher “extraversion” scores had the opposite effect. Male undergraduate students were two times more likely than females to engage in curricular elective scientific research and were also more likely to engage in extra-curricular research activities.
Conclusions
This study demonstrated that student’ grade point average and individual characteristics, like gender, openness and consciousness have a unique and statistically significant contribution to students’ involvement in undergraduate scientific research activities.
doi:10.1186/1472-6920-12-95
PMCID: PMC3515434  PMID: 23066758
7.  Summative assessments are more powerful drivers of student learning than resource intensive teaching formats 
BMC Medicine  2013;11:61.
Background
Electrocardiogram (ECG) interpretation is a core clinical skill that needs to be acquired during undergraduate medical education. Intensive teaching is generally assumed to produce more favorable learning outcomes, but recent research suggests that examinations are more powerful drivers of student learning than instructional format. This study assessed the differential contribution of teaching format and examination consequences to learning outcome regarding ECG interpretation skills in undergraduate medical students.
Methods
A total of 534 fourth-year medical students participated in a six-group (two sets of three), partially randomized trial. Students received three levels of teaching intensity: self-directed learning (two groups), lectures (two groups) or small-group peer teaching facilitated by more advanced students (two groups). One of the two groups on each level of teaching intensity was assessed in a formative, the other in a summative written ECG examination, which provided a maximum of 1% credit points of the total curriculum. The formative examination provided individual feedback without credit points. Main outcome was the correct identification of ≥3 out of 5 diagnoses in original ECG tracings. Secondary outcome measures were time spent on independent study and use of additional study material.
Results
Compared with formative assessments, summative assessments increased the odds of correctly identifying at least three out of five ECG diagnoses (OR 5.14; 95% CI 3.26 to 8.09), of spending at least 2 h/week extra on ECG self-study (OR 4.02; 95% CI 2.65 to 6.12) and of using additional learning material (OR 2.86; 95% CI 1.92 to 4.24). Lectures and peer teaching were associated with increased learning effort only, but did not augment examination performance.
Conclusions
Medical educators need to be aware of the paramount role of summative assessments in promoting student learning. Consequently, examinations within medical schools need to be closely matched to the desired learning outcomes. Shifting resources from implementing innovative and costly teaching formats to designing more high-quality summative examinations warrants further investigation.
doi:10.1186/1741-7015-11-61
PMCID: PMC3635879  PMID: 23497243
assessment; electrocardiogram; medical education; teaching
8.  Can personal qualities of medical students predict in-course examination success and professional behaviour? An exploratory prospective cohort study 
BMC Medical Education  2012;12:69.
Background
Over two-thirds of UK medical schools are augmenting their selection procedures for medical students by using the United Kingdom Clinical Aptitude Test (UKCAT), which employs tests of cognitive and non-cognitive personal qualities, but clear evidence of the tests’ predictive validity is lacking. This study explores whether academic performance and professional behaviours that are important in a health professional context can be predicted by these measures, when taken before or very early in the medical course.
Methods
This prospective cohort study follows the progress of the entire student cohort who entered Hull York Medical School in September 2007, having taken the UKCAT cognitive tests in 2006 and the non-cognitive tests a year later. This paper reports on the students’ first and second academic years of study. The main outcome measures were regular, repeated tutor assessment of individual students’ interpersonal skills and professional behaviour, and annual examination performance in the three domains of recall and application of knowledge, evaluation of data, and communication and practical clinical skills. The relationships between non-cognitive test scores, cognitive test scores, tutor assessments and examination results were explored using the Pearson product–moment correlations for each group of data; the data for students obtaining the top and bottom 20% of the summative examination results were compared using Analysis of Variance.
Results
Personal qualities measured by non-cognitive tests showed a number of statistically significant relationships with ratings of behaviour made by tutors, with performance in each year’s objective structured clinical examinations (OSCEs), and with themed written summative examination marks in each year. Cognitive ability scores were also significantly related to each year’s examination results, but seldom to professional behaviours. The top 20% of examination achievers could be differentiated from the bottom 20% on both non-cognitive and cognitive measures.
Conclusions
This study shows numerous significant relationships between both cognitive and non-cognitive test scores, academic examination scores and indicators of professional behaviours in medical students. This suggests that measurement of non-cognitive personal qualities in applicants to medical school could make a useful contribution to selection and admission decisions. Further research is required in larger representative groups, and with more refined predictor measures and behavioural assessment methods, to establish beyond doubt the incremental validity of such measures over conventional cognitive assessments.
doi:10.1186/1472-6920-12-69
PMCID: PMC3473297  PMID: 22873571
9.  Factors in Medical Student Beliefs about Electronic Health Record Use 
Healthcare providers’ ongoing investment in electronic health records (EHRs) necessitates an understanding of physicians’ expectations about using EHRs. Such understanding may aid educators and administrators when utilizing scarce resources during EHR training and implementation activities. This study aimed to link individual medical student characteristics to their perceptions of EHRs’ ease of use and usefulness. This study employed a cross-sectional survey of 126 third-year medical students at a large southeastern university. Using a questionnaire designed for this study and containing previously validated items, the study team measured and related students’ expectations about EHR ease of use and usefulness to their computer self-efficacy, openness to change, personality traits, and demographic characteristics. On a seven-point scale, men reported, on average, ease-of-use scores that were 0.71 higher than women's (p < .001). Also, increased computer self-efficacy related to higher expectations of EHR ease of use (p < .01) and usefulness (p < .05). Openness-to-change scores were also associated with higher expectations of EHR ease of use (p < .01) and usefulness (p < .001). Finally, a more conscientious personality was positively associated with EHR ease of use (p < .01). Our findings suggest that medical educators and administrators may consider targeting EHR management strategies on the basis of individual differences. Enhanced training and support interventions may be helpful to women or to clinicians with lower computer self-efficacy, lower openness to change, or less conscientious personalities. Also, current and future physicians who rate higher in terms of self-efficacy, openness to change, or conscientiousness may be useful as champions of EHR use among their peers.
PMCID: PMC3995485  PMID: 24808813
electronic health records; organizational management; medical education; training; user acceptance
10.  Attitudes of Pakistani and Pakistani heritage medical students regarding professionalism at a medical college in Karachi, Pakistan 
BMC Research Notes  2014;7:150.
Background
An increased interest in professionalism has been reported in the field of medical education due to concerns regarding deterioration of humanism and professional values in the teaching and practice of medicine. The primary aim of this study was to assess attitudes of Pakistani and Pakistani heritage students at a medical college in Pakistan about important elements of professionalism that an ideal medical doctor should possess. A further objective of the study was to determine students’ preferred ways of learning professionalism.
Methods
A written survey was distributed to undergraduate medical students at a public sector medical college at Karachi, Pakistan in 2011. Using the Penn State College of Medicine (PSCOM) Professionalism Questionnaire, attitudes of medical students of semester 1, 5, and 8 regarding professionalism were assessed anonymously.
Results
The mean age of the students was 21.11 ± 2.72 years. Forty-three percent of the respondents were male. Forty percent of the students held Pakistani citizenship. Thirty-five percent students were US citizens with Pakistani parents and twenty-five percent were Pakistani heritage students that had dual citizenships. No significant differences in the elements of professionalism (Accountability, Altruism, Duty, Excellence, Honesty & Integrity and Respect) mean scores or in the overall mean score of professionalism among the various classes were found. The total overall Cronbach alpha value for all elements of the professionalism in the selected classes was above 0.9. The most preferred methods for learning professionalism were role modeling by faculty, case based scenarios and role plays.
Conclusion
The students rated all the attributes of professionalism as important and there was no difference across the study years. The overall internal consistency of each element of professionalism was high in different classes. Faculty role models, case based scenarios and role plays may be used to teach professionalism. As a great majority of students were having a Pakistani heritage rather than complete Pakistani born and bred background, hence findings of the survey may not be taken as representative of typical Pakistani medical students.
doi:10.1186/1756-0500-7-150
PMCID: PMC3995519  PMID: 24628768
Professionalism; Attributes; Medical education; Undergraduate medical students; Pakistan
11.  Personality Traits Affect Teaching Performance of Attending Physicians: Results of a Multi-Center Observational Study 
PLoS ONE  2014;9(5):e98107.
Background
Worldwide, attending physicians train residents to become competent providers of patient care. To assess adequate training, attending physicians are increasingly evaluated on their teaching performance. Research suggests that personality traits affect teaching performance, consistent with studied effects of personality traits on job performance and academic performance in medicine. However, up till date, research in clinical teaching practice did not use quantitative methods and did not account for specialty differences. We empirically studied the relationship of attending physicians' personality traits with their teaching performance across surgical and non-surgical specialties.
Method
We conducted a survey across surgical and non-surgical specialties in eighteen medical centers in the Netherlands. Residents evaluated attending physicians' overall teaching performance, as well as the specific domains learning climate, professional attitude, communication, evaluation, and feedback, using the validated 21-item System for Evaluation of Teaching Qualities (SETQ). Attending physicians self-evaluated their personality traits on a 5-point scale using the validated 10-item Big Five Inventory (BFI), yielding the Five Factor model: extraversion, conscientiousness, neuroticism, agreeableness and openness.
Results
Overall, 622 (77%) attending physicians and 549 (68%) residents participated. Extraversion positively related to overall teaching performance (regression coefficient, B: 0.05, 95% CI: 0.01 to 0.10, P = 0.02). Openness was negatively associated with scores on feedback for surgical specialties only (B: −0.10, 95% CI: −0.15 to −0.05, P<0.001) and conscientiousness was positively related to evaluation of residents for non-surgical specialties only (B: 0.13, 95% CI: 0.03 to 0.22, p = 0.01).
Conclusions
Extraverted attending physicians were consistently evaluated as better supervisors. Surgical attending physicians who display high levels of openness were evaluated as less adequate feedback-givers. Non-surgical attending physicians who were conscientious seem to be good at evaluating residents. These insights could contribute to future work on development paths of attending physicians in medical education.
doi:10.1371/journal.pone.0098107
PMCID: PMC4028262  PMID: 24844725
12.  The evolution of global health teaching in undergraduate medical curricula 
Background
Since the early 1990s there has been a burgeoning interest in global health teaching in undergraduate medical curricula. In this article we trace the evolution of this teaching and present recommendations for how the discipline might develop in future years.
Discussion
Undergraduate global health teaching has seen a marked growth over the past ten years, partly as a response to student demand and partly due to increasing globalization, cross-border movement of pathogens and international migration of health care workers. This teaching has many different strands and types in terms of topic focus, disciplinary background, the point in medical studies in which it is taught and whether it is compulsory or optional.
We carried out a survey of medical schools across the world in an effort to analyse their teaching of global health. Results indicate that this teaching is rising in prominence, particularly through global health elective/exchange programmes and increasing teaching of subjects such as globalization and health and international comparison of health systems. Our findings indicate that global health teaching is moving away from its previous focus on tropical medicine towards issues of more global relevance.
We suggest that there are three types of doctor who may wish to work in global health – the ‘globalised doctor’, ‘humanitarian doctor’ and ‘policy doctor’ – and that each of these three types will require different teaching in order to meet the required competencies. This teaching needs to be inserted into medical curricula in different ways, notably into core curricula, a special overseas doctor track, optional student selected components, elective programmes, optional intercalated degrees and postgraduate study.
Summary
We argue that teaching of global health in undergraduate medical curricula must respond to changing understandings of the term global health. In particular it must be taught from the perspective of more disciplines than just biomedicine, in order to reflect the social, political and economic causes of ill health. In this way global health can provide valuable training for all doctors, whether they choose to remain in their countries of origin or work abroad.
doi:10.1186/1744-8603-8-35
PMCID: PMC3539925  PMID: 23148763
Global health; International health; Medical education; Undergraduate; Curriculum
13.  Western medical ethics taught to junior medical students can cross cultural and linguistic boundaries 
BMC Medical Ethics  2004;5:4.
Background
Little is known about teaching medical ethics across cultural and linguistic boundaries. This study examined two successive cohorts of first year medical students in a six year undergraduate MBBS program.
Methods
The objective was to investigate whether Arabic speaking students studying medicine in an Arabic country would be able to correctly identify some of the principles of Western medical ethical reasoning. This cohort study was conducted on first year students in a six-year undergraduate program studying medicine in English, their second language at a medical school in the Arabian Gulf. The ethics teaching was based on the four-principle approach (autonomy, beneficence, non-malfeasance and justice) and delivered by a non-Muslim native English speaker with no knowledge of the Arabic language. Although the course was respectful of Arabic culture and tradition, the content excluded an analysis of Islamic medical ethics and focused on Western ethical reasoning. Following two 45-minute interactive seminars, students in groups of 3 or 4 visited a primary health care centre for one morning, sitting in with an attending physician seeing his or her patients in Arabic. Each student submitted a personal report for summative assessment detailing the ethical issues they had observed.
Results
All 62 students enrolled in these courses participated. Each student acting independently was able to correctly identify a median number of 4 different medical ethical issues (range 2–9) and correctly identify and label accurately a median of 2 different medical ethical issues (range 2–7) There were no significant correlations between their English language skills or general academic ability and the number or accuracy of ethical issues identified.
Conclusions
This study has demonstrated that these students could identify medical ethical issues based on Western constructs, despite learning in English, their second language, being in the third week of their medical school experience and with minimal instruction. This result was independent of their academic and English language skills suggesting that ethical principles as espoused in the four principal approach may be common to the students' Islamic religious beliefs, allowing them to access complex medical ethical reasoning skills at an early stage in the medical curriculum.
doi:10.1186/1472-6939-5-4
PMCID: PMC509252  PMID: 15283868
14.  Deficiency areas in decision making in undergraduate medical students 
Background
In family medicine, decisions can be difficult due to the early presentation of often poorly developed symptoms or the presentation of undifferentiated conditions that require competencies unique to family medicine, such as; primary care management, specific problem-solving skills, and a comprehensive and holistic approach to be taught to medical students.
Purpose
The aim of this study was to assess the decision-making process covering all theoretical aspects of family practice consultation and to recognize possible areas of deficiency in undergraduate medical students.
Materials and methods
This was a cross-sectional, observational study performed at the Medical School of the University of Maribor in Slovenia. The study population consisted of 159 fourth-year medical students attending a family medicine class. The main outcome measure was the scores of the students’ written reports on solving the virtual clinical case. An assessment tool consisted of ten items that could be graded on a 5-point Likert scale.
Results
The final sample consisted of 147 (92.5%) student reports. There were 95 (64.6%) female students in the sample. The mean total score on the assessment scale was 35.1±7.0 points of a maximum 50 points. Students scored higher in the initial assessment items and lower in the patient education/involvement items. Female students scored significantly higher in terms of total assessment score and in terms of initial assessment and patient education/involvement.
Conclusion
Undergraduate medical education should devote more time to teaching a comprehensive approach to consultation, especially modification of the health behavior of patients and opportunistic health promotion to patients. Possible sex differences in students’ performance should be further evaluated.
doi:10.2147/AMEP.S64920
PMCID: PMC4105214  PMID: 25053897
assessment; family medicine; undergraduate medical education; decision making
15.  Cohort study of examination performance of undergraduate medical students learning in community settings 
BMJ : British Medical Journal  2004;328(7433):207-209.
Objectives To determine whether moving clinical medical education out of the tertiary hospital into a community setting compromises academic standards.
Design Cohort study.
Setting Flinders University four year graduate entry medical course. In their third year, students are able to choose to study at the tertiary teaching hospital in Adelaide, in rural general practices, or at Royal Darwin Hospital, a regional secondary referral hospital.
Participants All 371 medical students who did their year 3 study from 1998-2002.
Main outcome measures Mean student examination score (%) at the end of year 3.
Results The unadjusted mean year 3 scores at each location differed significantly (P < 0.001); the mean score was 65.2 (SE = 0.43) for Adelaide students, 68.2 (0.83) for Darwin students, and 69.3 (0.97) for students on the rural programme. Mean year 2 scores were similar for each location. Post hoc tests of means adjusted for sex, age, year 2 score, and cohort year showed that the rural and Darwin groups had a significantly improved score in year 3 compared with the Adelaide group (adjusted mean difference = 3.08, 95% confidence interval 1.25 to 4.90, P < 0.001 for rural group; 1.91, 0.47 to 3.36, P = 0.001 for Darwin group).
Conclusions These findings show that the concern that student academic performance in the tertiary hospital would be better than that of students in the regional hospital and community settings is not justified. This challenges the orthodoxy of a tertiary hospital education being the gold standard for undergraduate medical students.
PMCID: PMC318489  PMID: 14739189
16.  Does Gender Moderate Medical Students’ Assessments of Unprofessional Behavior? 
Journal of General Internal Medicine  2012;27(12):1643-1648.
ABSTRACT
BACKGROUND
Despite widespread acceptance of professionalism as a clinical competency, the role of certain contextual factors in assessing certain behaviors remains unknown.
OBJECTIVE
To examine the potential moderating role of gender in assessing unprofessional behaviors during undergraduate medical training.
DESIGN
Randomized, anonymous, self-administered questionnaire.
PARTICIPANTS
Ninety seven (97) third-year students from a southeastern U.S. medical school (participation rate = 95.1 %).
MAIN MEASURES
Using a 4-point Likert-type scale, subjects reviewed two subsets of randomly administered, equally weighted hypothetical vignettes depicting potentially unprofessional behaviors that could occur during medical students’ clinical training. Ratings were categorized from 1 –“Not a Problem” to 4 –“A Severe Problem”, based on the perceived degree of unprofessionalism. In each written scenario, trainee gender was systematically varied.
KEY RESULTS
Across all scenario subsets, male and female students’ mean ratings of hypothetical behaviors did not differ significantly. Further, male and female students tended, on average, to rate behaviors similarly regardless of the trainee’s gender.
CONCLUSION
Study findings suggest that: (1) neither students’ gender nor that of the hypothetical “actor” moderates the assessment of unprofessional behaviors; and (2) male and female students assign roughly the same overall rankings to potentially unprofessional behaviors.
Electronic supplementary material
The online version of this article (doi:10.1007/s11606-012-2152-z) contains supplementary material, which is available to authorized users.
doi:10.1007/s11606-012-2152-z
PMCID: PMC3509307  PMID: 22829292
professionalism; gender; medical education; unprofessional behavior
17.  A preliminary investigation on the relationship between virtues and pathological internet use among Chinese adolescents 
Background
Pathological Internet Use (PIU) has become a global issue associated with the increasing number of Internet users. Previous studies concerned both the interpersonal and intrapersonal vulnerable factors and the corresponding models. However, a limited amount of research has explored the relationship between positive factors and PIU.
Objective
The current investigation attempted to clarify the relationship between virtues and PIU among Chinese adolescents; it also sought to explore the specific contributions of the three virtues. Virtue was the core concept in positive psychology and the Values in Action Classification. A recent study demonstrated that there might be three universal virtues (relationship, vitality, and conscientiousness).
Methods
A cross-sectional sample of adolescents aged 12-17 years were recruited in 2013. A total of 674 adolescents (males = 302, females = 372; junior high school = 296, senior high school = 378) from eight junior and senior high schools in four provinces of Mainland China completed a package of psychological inventories, including the Chinese Virtues Questionnaire (CVQ) and the Adolescent Pathological Internet Use Scale (APIUS). The mean age of the current sample was 15.10 years (SD = 1.81) with an average of 5.31 years’ length (SD = 2.09) of Internet use.
Results
A total of 9.50% participants exhibited significant symptoms of PIU. Male students (Mmale = 2.50) had significantly higher scores on PIU than female students (Mfemale = 2.25). Relationship (β = -.24) and conscientiousness (β = -.21) negatively predicted PIU, whereas vitality (β = .25) positively predicted PIU. Dominance analysis further revealed that relationship and conscientiousness could explain 81% variance of PIU, and vitality only accounted for another 19%.
Conclusions
Relationship and conscientiousness were possible protective factors of pathological Internet users, while vitality was vulnerable. The results could be helpful in screening “at-risk” Internet users (low relationship and conscientiousness as well as high vitality). Future intervention strategies could focus on how to enhance relationship and conscientiousness and on how to reduce vitality.
doi:10.1186/1753-2000-8-8
PMCID: PMC3995982  PMID: 24594317
Virtue; Pathological Internet use; Vitality; Conscientiousness; Relationship
18.  Do different medical curricula influence self-assessed clinical thinking of students? 
Objectives: As a fundamental element of medical practice, clinical reasoning should be cultivated in courses of study in human medicine. To date, however, no conclusive evidence has been offered as to what forms of teaching and learning are most effective in achieving this goal. The Diagnostic Thinking Inventory (DTI) was developed as a means of measuring knowledge-unrelated components of clinical reasoning. The present pilot study examines the adequacy of this instrument in measuring differences in the clinical reasoning of students in varying stages of education in three curricula of medical studies.
Methods: The Diagnostic Thinking Inventory (DTI) comprises 41 items in two subscales (“Flexibility in Thinking” and “Structure of Knowledge in Memory”). Each item contains a statement or finding concerning clinical reasoning in the form of a stem under which a 6-point scale presents opposing conclusions. The subjects are asked to assess their clinical thinking within this range. The German-language version of the DTI was completed by 247 student volunteers from three schools and varying clinical semesters. In a quasi-experimental design, 219 subjects from traditional and model courses of study in the German state of North Rhine-Westphalia took part. Specifically, these were 5th, 6th and 8th semester students from the model course of study at Witten/Herdecke University (W/HU), from the model (7th and 9th semester) and traditional (7th semester) courses of study at the Ruhr University Bochum (RUB) and from the model course of study (9th semester) at the University of Cologne (UoC). The data retrieved were quantitatively assessed.
Results: The reliability of the questionnaire in its entirety was good (Cronbach’s alpha between 0.71 and 0.83); the reliability of the subscales ranged between 0.49 and 0.75. The different groups were compared using the Mann-Whitney test, revealing significant differences among semester cohorts within a school as well as between students from similar academic years in different schools. Among the participants from the model course of study at the W/HU, scores increased from the 5th to the 6th semester and from the 5th to the 9th semester. Among individual cohorts at RUB, no differences could be established between model and traditional courses of study or between 7th and 9th semester students in model courses of study. Comparing all participating highest semester students, the 8th semester participants from the W/HU achieved the highest scores – significantly higher than those of 9th semester RUB students or 9th semester UoC students. Scores from the RUB 9th semester participants were significantly higher than those of the 9th semester UoC participants.
Discussion: The German-language version of the DTI measures self-assessed differences in diagnostic reasoning among students from various semesters and different model and traditional courses of study with satisfactory reliability. The results can be used for discussion in the context of diverse curricula. The DTI is therefore appropriate for further research that can then be correlated with the different teaching method characteristics and outcomes of various curricula.
doi:10.3205/zma000915
PMCID: PMC4027808  PMID: 24872858
clinical thinking; clinical reasoning; PBL; diagnostic thinking inventory
19.  Teaching medical students on the ethical dimensions of human rights: meeting the challenge in South Africa. 
Journal of Medical Ethics  1998;24(4):257-262.
SETTING: Previous health policies in South Africa neglected the teaching of ethics and human rights to health professionals. In April 1995, a pilot course was run at the University of Cape Town in which the ethical dimensions of human rights issues in South Africa were explored. OBJECTIVES: To compare knowledge and attitudes of participating students with a group of control students. DESIGN: Retrospective cohort study. SUBJECTS: Seventeen fourth-year medical students who participated in the course and 13 control students from the same class, matched for gender. INTERVENTIONS: Students participated in a one-week module on ethics and human rights. Five months after the course had been run, students completed a semi-structured questionnaire exploring their knowledge and attitudes with regards to ethics and human rights issues. MAIN OUTCOME MEASURES: Knowledge scores, attitude scores and various individual indicators of attitude. RESULTS: Clear benefits for overall knowledge score, for four out of five individual knowledge questions and for one of the attitude questions, were demonstrated. Participating students also appeared to be more convinced of the need for teaching on the ethical dimensions of human rights at postgraduate level and that such teaching should also be integrated in the curriculum. The low response rate amongst controls may have selected students who were more socially conscious, thereby leading to an underestimate of the true impact of the course. CONCLUSION: The evaluation indicates clear benefits of the course for undergraduate students, and supports arguments for the inclusion of such courses in the training of health professionals. This is particularly important given the challenges posed by the Truth and Reconciliation Commission to the health professions to address past complicity in human rights abuses through reorientation of medical training in South Africa.
PMCID: PMC1377678  PMID: 9752629
20.  Low Conscientiousness and Risk of All-Cause, Cardiovascular and Cancer Mortality over 17 Years: Whitehall II Cohort Study 
Objective
To examine the personality trait conscientiousness as a risk factor for mortality and to identify candidate explanatory mechanisms.
Methods
Participants in the Whitehall II cohort study (N = 6800, aged 34 to 55 at recruitment in 1985) completed two self-reported items measuring conscientiousness in 1991–1993 (‘I am overly conscientious’ and ‘I am overly perfectionistic’, Cronbach's α = .72), the baseline for this study. Age, socio-economic status (SES), social support, health behaviours, physiological variables and minor psychiatric morbidity were also recorded at baseline. The vital status of participants was then monitored for a mean of 17 years. All-cause and cause-specific mortality was ascertained through linkage to a national mortality register until January 2010.
Results
Each 1 standard deviation decrease in conscientiousness was associated with a 10% increase in all-cause (hazard ratio [HR] = 1.10, 95% CI 1.003, 1.20) mortality. Patterns were similar for cardiovascular (HR = 1.17, 95% CI 0.98, 1.39) and cancer mortality (HR = 1.10, 95% CI 0.96, 1.25), not reaching statistical significance. The association with all-cause mortality was attenuated by 5% after adjustment for SES, 13% for health behaviours, 14% for cardiovascular risk factors, 5% for minor psychiatric morbidity, 29% for all variables. Repeating analyses with each item separately and excluding participants who died within five years of personality assessment did not change the results materially.
Conclusion
Low conscientiousness in midlife is a risk factor for all-cause mortality. This association is only partly explained by health behaviours, SES, cardiovascular disease risk factors and minor psychiatric morbidity in midlife.
doi:10.1016/j.jpsychores.2012.05.007
PMCID: PMC3936113  PMID: 22789411
cohort study; conscientiousness; mortality; perfectionism; personality traits; socio-economic status
21.  Health-promoting factors in medical students and students of science, technology, engineering, and mathematics: design and baseline results of a comparative longitudinal study 
BMC Medical Education  2014;14:134.
Background
The negative impact of medical school on students' general and mental health has often been reported. Compared to students of other subjects, or employed peers, medical students face an increased risk of developing depression, anxiety and burnout. While pathogenetic factors have been studied extensively, less is known about health-promoting factors for medical students' health. This longitudinal study aims to identify predictors for maintaining good general and mental health during medical education. We report here the design of the study and its baseline results.
Methods
We initiated a prospective longitudinal cohort study at the University of Lübeck, Germany. Two consecutive classes of students, entering the university in 2011 and 2012, were recruited. Participants will be assessed annually for the duration of their course. We use validated psychometric instruments covering health outcomes (general and mental health) and personality traits, as well as self-developed, pre-tested items covering leisure activities and sociodemographic data.
Results
At baseline, compared to students of STEM (science, technology, engineering, and mathematics) subjects (n = 531; 60.8% response rate), a larger proportion of medical students (n = 350; 93.0% response rate) showed good general health (90.9% vs. 79.7%) and a similar proportion was in good mental health (88.3% vs. 86.3%). Medical students scored significantly higher in the personality traits of extraversion, conscientiousness, openness to experience and agreeableness. Neuroticism proved to be a statistically significant negative predictor for mental health in the logistic regression analyses. Satisfaction with life as a dimension of study-related behaviour and experience predicted general health at baseline. Physical activity was a statistically significant predictor for general health in medical students.
Conclusions
Baseline data revealed that medical students reported better general and similar mental health compared to STEM students. The annual follow-up questionnaires, combined with qualitative approaches, should clarify wether these differences reflect a higher resilience, a tendency to neglect personal health problems - as has been described for physicians - before entering medical school, or both. The final results may aid decision-makers in developing health-promotion programmes for medical students.
doi:10.1186/1472-6920-14-134
PMCID: PMC4096732  PMID: 24996637
Medical students; Medical education; Mental health; Health promotion; Prevention; Personality assessment
22.  Regression of Moral Reasoning during Medical Education: Combined Design Study to Evaluate the Effect of Clinical Study Years 
PLoS ONE  2011;6(3):e17406.
Background
Moral reasoning is important for developing medical professionalism but current evidence for the relationship between education and moral reasoning does not clearly apply to medical students. We used a combined study design to test the effect of clinical teaching on moral reasoning.
Methods
We used the Defining Issues Test-2 as a measure of moral judgment, with 3 general moral schemas: Personal Interest, Maintaining Norms, and Postconventional Schema. The test was applied to 3 consecutive cohorts of second year students in 2002 (n = 207), 2003 (n = 192), and 2004 (n = 139), and to 707 students of all 6 study years in 2004 cross-sectional study. We also tested 298 age-matched controls without university education.
Results
In the cross-sectional study, there was significant main effect of the study year for Postconventional (F(5,679) = 3.67, P = 0.003) and Personal Interest scores (F(5,679) = 3.38, P = 0.005). There was no effect of the study year for Maintaining Norms scores. 3rd year medical students scored higher on Postconventional schema score than all other study years (p<0.001). There were no statistically significant differences among 3 cohorts of 2nd year medical students, demonstrating the absence of cohort or point-of-measurement effects. Longitudinal study of 3 cohorts demonstrated that students regressed from Postconventional to Maintaining Norms schema-based reasoning after entering the clinical part of the curriculum.
Interpretation
Our study demonstrated direct causative relationship between the regression in moral reasoning development and clinical teaching during medical curriculum. The reasons may include hierarchical organization of clinical practice, specific nature of moral dilemmas faced by medical students, and hidden medical curriculum.
doi:10.1371/journal.pone.0017406
PMCID: PMC3068134  PMID: 21479204
23.  Traditional microscopy instruction versus process-oriented virtual microscopy instruction: a naturalistic experiment with control group 
Diagnostic Pathology  2011;6(Suppl 1):S8.
Background
Virtual microscopy is being introduced in medical education as an approach for learning how to interpret information in microscopic specimens. It is, however, far from evident how to incorporate its use into existing teaching practice. The aim of the study was to explore the consequences of introducing virtual microscopy tasks into an undergraduate pathology course in an attempt to render the instruction more process-oriented. The research questions were: 1) How is virtual microscopy perceived by students? 2) Does work on virtual microscopy tasks contribute to improvement in performance in microscopic pathology in comparison with attending assistant-led demonstrations only?
Method
During a one-week period, an experimental group completed three sets of virtual microscopy homework assignments in addition to attending demonstrations. A control group attended the demonstrations only. Performance in microscopic pathology was measured by a pre-test and a post-test. Student perceptions of regular instruction and virtual microscopy were collected one month later by administering the Inventory of Intrinsic Motivation and open-ended questions.
Results
The students voiced an appreciation for virtual microscopy for the purposes of the course and for self-study. As for learning gains, the results indicated that learning was speeded up in a subgroup of students consisting of conscientious high achievers.
Conclusions
The enriched instruction model may be suited as such for elective courses following the basic course. However, the instructional model needs further development to be suited for basic courses.
doi:10.1186/1746-1596-6-S1-S8
PMCID: PMC3073226  PMID: 21489203
24.  Role modelling of clinical tutors: a focus group study among medical students 
BMC Medical Education  2015;15:17.
Background
Role modelling by clinicians assists in development of medical students’ professional competencies, values and attitudes. Three core characteristics of a positive role model include 1) clinical attributes, 2) teaching skills, and 3) personal qualities. This study was designed to explore medical students’ perceptions of their bedside clinical tutors as role models during the first year of a medical program.
Methods
The study was conducted with one cohort (n = 301) of students who had completed Year 1 of the Sydney Medical Program in 2013. A total of nine focus groups (n = 59) were conducted with medical students following completion of Year 1. Data were transcribed verbatim. Thematic analysis was used to code and categorise data into themes.
Results
Students identified both positive and negative characteristics and behaviour displayed by their clinical tutors. Characteristics and behaviour that students would like to emulate as medical practitioners in the future included:
1) Clinical attributes: a good knowledge base; articulate history taking skills; the ability to explain and demonstrate skills at the appropriate level for students; and empathy, respect and genuine compassion for patients.
2) Teaching skills: development of a rapport with students; provision of time towards the growth of students academically and professionally; provision of a positive learning environment; an understanding of the student curriculum and assessment requirements; immediate and useful feedback; and provision of patient interaction.
3) Personal qualities: respectful interprofessional staff interactions; preparedness for tutorials; demonstration of a passion for teaching; and demonstration of a passion for their career choice.
Conclusion
Excellence in role modelling entails demonstration of excellent clinical care, teaching skills and personal characteristics. Our findings reinforce the important function of clinical bedside tutors as role models, which has implications for faculty development and recruitment.
doi:10.1186/s12909-015-0303-8
PMCID: PMC4335700
Role modelling; Medical students; Clinical tutors
25.  Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school 
Introduction
International interest in peer-teaching and peer-assisted learning (PAL) during undergraduate medical programs has grown in recent years, reflected both in literature and in practice. There, remains however, a distinct lack of objective clarity and consensus on the true effectiveness of peer-teaching and its short- and long-term impacts on learning outcomes and clinical practice.
Objective
To summarize and critically appraise evidence presented on peer-teaching effectiveness and its impact on objective learning outcomes of medical students.
Method
A literature search was conducted in four electronic databases. Titles and abstracts were screened and selection was based on strict eligibility criteria after examining full-texts. Two reviewers used a standard review and analysis framework to independently extract data from each study. Discrepancies in opinions were resolved by discussion in consultation with other reviewers. Adapted models of “Kirkpatrick’s Levels of Learning” were used to grade the impact size of study outcomes.
Results
From 127 potential titles, 41 were obtained as full-texts, and 19 selected after close examination and group deliberation. Fifteen studies focused on student-learner outcomes and four on student-teacher learning outcomes. Ten studies utilized randomized allocation and the majority of study participants were self-selected volunteers. Written examinations and observed clinical evaluations were common study outcome assessments. Eleven studies provided student-teachers with formal teacher training. Overall, results suggest that peer-teaching, in highly selective contexts, achieves short-term learner outcomes that are comparable with those produced by faculty-based teaching. Furthermore, peer-teaching has beneficial effects on student-teacher learning outcomes.
Conclusions
Peer-teaching in undergraduate medical programs is comparable to conventional teaching when utilized in selected contexts. There is evidence to suggest that participating student-teachers benefit academically and professionally. Long-term effects of peer-teaching during medical school remain poorly understood and future research should aim to address this.
doi:10.2147/AMEP.S14383
PMCID: PMC3661256  PMID: 23745087
peer-teaching; peer-assisted learning; near-peer teaching; medical student; medical school

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