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1.  Effects of participation in a cross year peer tutoring programme in clinical examination skills on volunteer tutors' skills and attitudes towards teachers and teaching 
Background
Development of students' teaching skills is increasingly recognised as an important component of UK undergraduate medical curricula and, in consequence, there is renewed interest in the potential benefits of cross-year peer tutoring. Whilst several studies have described the use of cross-year peer tutoring in undergraduate medical courses, its use in the clinical setting is less well reported, particularly the effects of peer tutoring on volunteer tutors' views of teachers and teaching. This study explored the effects of participation in a cross-year peer tutoring programme in clinical examination skills ('OSCE tutor') on volunteer tutors' own skills and on their attitudes towards teachers and teaching.
Methods
Volunteer tutors were final year MBChB students who took part in the programme as part of a Student Selected Component (SSC). Tutees were year 3 MBChB students preparing for their end of year 'OSCE' examination. Pre and post participation questionnaires, including both Likert-type and open response questions, were used. Paired data was compared using the Wilcoxon signed-rank test. All tests were two-tailed with 5% significance level.
Results
Tutors reflected their cohort in terms of gender but were drawn from among the more academically successful final year students. Most had previous teaching experience. They were influenced to participate in 'OSCE tutor' by a desire to improve their own teaching and associated generic skills and by contextual factors relating to the organisation or previous experience of the OSCE tutor programme. Issues relating to longer term career aspirations were less important. After the event, tutors felt that participation had enhanced their skills in various areas, including practical teaching skills, confidence in speaking to groups and communication skills; and that as a result of taking part, they were now more likely to undertake further teacher training and to make teaching a major part of their career. However, whilst a number of students reported that their views of teachers and teaching had changed as a result of participation, this did not translate into significant changes in responses to questions that explored their views of the roles and qualities required of a good clinical teacher.
Conclusion
Findings affirm the benefits to volunteer tutors of cross-year peer tutoring, particularly in terms of skills enhancement and reinforcement of positive attitudes towards future teaching responsibilities, and have implications for the design and organisation of such programmes.
doi:10.1186/1472-6920-7-20
PMCID: PMC1925072  PMID: 17598885
2.  Peer tutoring among elementary students: educational benefits to the tutor1 
To determine whether tutoring might be academically beneficial to the tutor, this study investigated the acquisition of spelling words by three elementary students in a peer tutoring program. The experimental design allowed a simultaneous comparison of each child's gain in performance on comparable word lists on which the child tutored another child, was tutored by another child, or neither gave nor received tutoring. The children's spelling improved nearly an equivalent amount on those words on which they tutored another child as on the words on which they were tutored; no such change was noted on the words on which they neither gave nor received tutoring. These findings, that peer tutoring is profitable for the tutor as well as the tutee, provide a basis for recommending peer tutoring as one method of individualizing education.
doi:10.1901/jaba.1977.10-231
PMCID: PMC1311174  PMID: 16795552
academic behavior; individualized instruction; tutoring; group consequences; primary classroom; methodology; experimental design; peers; students
3.  Effects of tutor-related behaviours on the process of problem-based learning 
Tutors in a Problem-Based Learning (PBL) curriculum are thought to play active roles in guiding students to develop frameworks for use in the construction of knowledge. This implies that both subject-matter expertise and the ability of tutors to facilitate the learning process must be important in helping students learn. This study examines the behavioural effects of tutors in terms of subject-matter expertise, social congruence and cognitive congruence on students’ learning process and on their final achievement. The extent of students’ learning at each PBL phase was estimated by tracking the number of relevant concepts recalled at the end of each learning phase, while student achievement was based on students’ ability to describe and elaborate upon the relationship between relevant concepts learned. By using Analysis of Covariance, social congruence of the tutor was found to have a significant influence on learning in each PBL phase while all of the tutor-related behaviours had a significant impact on student achievement. The results suggest that the ability of tutors to communicate informally with students and hence create a less threatening learning environment that promotes a free flow exchange of ideas, has a greater impact on learning at each of the PBL phases as compared to tutors’ subject-matter expertise and their ability to explain concepts in a way that is easily understood by students. The data presented indicates that these tutor-related behaviours are determinants of learning in a PBL curriculum, with social congruence having a greater influence on learning in the different PBL phases.
doi:10.1007/s10459-011-9282-7
PMCID: PMC3167390  PMID: 21547499
Problem-based learning; Social congruence; Cognitive congruence; Subject-matter expertise; Tutor behaviour
4.  Consumers as tutors – legitimate teachers? 
Background
The aim of this study was to research the feasibility of training mental health consumers as tutors for 4th year medical students in psychiatry.
Methods
A partnership between a consumer network and an academic unit in Psychological Medicine was formed to jointly develop a training package for consumer tutors and a curriculum in interviewing skills for medical students. Student attitudes to mental health consumers were measured pre and post the program. All tutorial evaluation data was analysed using univariate statistics. Both tutors and students evaluated the teaching program using a 4 point rating scale. The mean scores for teaching and content for both students and tutors were compared using an independent samples t-test.
Results
Consumer tutors were successfully trained and accredited as tutors and able to sustain delivery of tutorials over a 4 year period. The study found that whilst the medical students started with positive attitudes towards consumers prior to the program, there was a general trend towards improved attitude across all measures. Other outcomes for tutors and students (both positive and negative) are described.
Conclusions
Consumer tutors along with professional tutors have a place in the education of medical students, are an untapped resource and deliver largely positive outcomes for students and themselves. Further possible developments are described.
doi:10.1186/1472-6920-4-14
PMCID: PMC524164  PMID: 15377386
5.  An intelligent learning environment for advanced cardiac life support. 
Resuscitation from clinical cardiac arrest is complex and often takes several years to learn. This paper describes an intelligent simulation-based tutor for ACLS which increases students' opportunity to practice before, during and after the ACLS course, thus bridging the gap between studying theory and didactic textbook material and working with patients. Sophisticated reasoning about student performance, compared to an expert model, distinguishes this system from other computerized instruction systems. Intelligence in the tutor allows the system to make the simulation dynamically adaptive to focus on areas where the student's learning needs are greatest. A formative evaluation with two classes of fourth year medical students suggested that the tutor was helpful, realistic and effective. Positive reactions and strong student involvement with the simulation suggest that this simulation-based tutor may improve learning and retention while decreasing anxiety for most students.
PMCID: PMC2232984  PMID: 8947617
6.  Are tutor behaviors in problem-based learning stable? A generalizability study of social congruence, expertise and cognitive congruence 
The purpose of this study was to investigate the stability of three distinct tutor behaviors (1) use of subject-matter expertise, (2) social congruence and (3) cognitive congruence, in a problem-based learning (PBL) environment. The data comprised the input from 16,047 different students to a survey of 762 tutors administered in three consecutive semesters. Over the three semesters each tutor taught two of the same course and one different course. A generalizability study was conducted to determine whether the tutor behaviors were generalizable across the three measurement occasions. The results indicate that three semesters are sufficient to make generalizations about all three tutor behaviors. In addition the results show that individual differences between tutors account for the greatest differences in levels of expertise, social congruence and cognitive congruence. The study concludes that tutor behaviors are fairly consistent in PBL and somewhat impervious to change. Implications of these findings for tutor training are discussed.
doi:10.1007/s10459-011-9295-2
PMCID: PMC3167391  PMID: 21523614
Problem-based learning; Tutor performance; Expertise; Social congruence; Cognitive congruence
7.  Effects of peer tutoring and consequences on the math performance of elementary classroom students1 
The effects of unstructured peer-tutoring procedures on the math performance of fourth- and fifth-grade students were investigated. Students' performances in two daily math sessions, during which they worked problems of the same type and difficulty, were compared. When students tutored each other over the same math problems as they subsequently worked, higher accuracies and rates of performance were associated with the tutored math sessions. The use of consequences for accurate performance seemed to enhance the effects of tutoring on accuracy. The results from an independent-study control condition, which was the same peer-tutoring except that students did not interact with each other, suggested that interactions between students during the tutoring procedure were, in part, responsible for improved accuracy and rate of performance. When students tutored each other over different but related problems to those that they were subsequently asked to solve, accuracies and rates during tutored math sessions were also higher, suggesting the development of generalized skills in solving particular types of math problems.
doi:10.1901/jaba.1973.6-587
PMCID: PMC1310877  PMID: 16795443
8.  The Academic Success of East Asian American Youth: The Role of Shadow Education 
Sociology of education  2012;85(1):40-60.
Using data from the Education Longitudinal Study, this study assessed the relevance of shadow education to the high academic performance of East Asian American students by examining how East Asian American students differed from other racial/ethnic students in the prevalence, purpose, and effects of using the two forms – commercial test preparation service and private one-to-one tutoring – of SAT coaching, defined as the American style of shadow education. East Asian American students were most likely to take a commercial SAT test preparation course for the enrichment purpose, and benefited most from taking this particular form of SAT coaching. However, this was not the case for private SAT one-to-one tutoring. While black students were most likely to utilize private tutoring for the remedial purpose, the impact of private tutoring was trivial for all racial/ethnic groups including East Asian American students. The authors discussed broader implications of the findings on racial/ethnic inequalities in educational achievement beyond the relevance of shadow education for the academic success of East Asian American students.
doi:10.1177/0038040711417009
PMCID: PMC3806291  PMID: 24163483
Shadow education; East Asian American students; SAT coaching; Race and ethnicity
9.  Interactive film scenes for tutor training in problem-based learning (PBL): dealing with difficult situations 
BMC Medical Education  2010;10:52.
Background
In problem-based learning (PBL), tutors play an essential role in facilitating and efficiently structuring tutorials to enable students to construct individual cognitive networks, and have a significant impact on students' performance in subsequent assessments. The necessity of elaborate training to fulfil this complex role is undeniable. In the plethora of data on PBL however, little attention has been paid to tutor training which promotes competence in the moderation of specific difficult situations commonly encountered in PBL tutorials.
Methods
Major interactive obstacles arising in PBL tutorials were identified from prior publications. Potential solutions were defined by an expert group. Video clips were produced addressing the tutor's role and providing exemplary solutions. These clips were embedded in a PBL tutor-training course at our medical faculty combining PBL self-experience with a non-medical case. Trainees provided pre- and post-intervention self-efficacy ratings regarding their PBL-related knowledge, skills, and attitudes, as well as their acceptance and the feasibility of integrating the video clips into PBL tutor-training (all items: 100 = completely agree, 0 = don't agree at all).
Results
An interactive online tool for PBL tutor training was developed comprising 18 video clips highlighting difficult situations in PBL tutorials to encourage trainees to develop and formulate their own intervention strategies. In subsequent sequences, potential interventions are presented for the specific scenario, with a concluding discussion which addresses unresolved issues.
The tool was well accepted and considered worth the time spent on it (81.62 ± 16.91; 62.94 ± 16.76). Tutors considered the videos to prepare them well to respond to specific challenges in future tutorials (75.98 ± 19.46). The entire training, which comprised PBL self-experience and video clips as integral elements, improved tutor's self-efficacy with respect to dealing with problematic situations (pre: 36.47 ± 26.25, post: 66.99 ± 21.01; p < .0001) and significantly increased appreciation of PBL as a method (pre: 61.33 ± 24.84, post: 76.20 ± 20.12; p < .0001).
Conclusions
The interactive tool with instructional video clips is designed to broaden the view of future PBL tutors in terms of recognizing specific obstacles to functional group dynamics and developing individual intervention strategies. We show that this tool is well accepted and can be successfully integrated into PBL tutor-training. Free access is provided to the entire tool at http://www.medizinische-fakultaet-hd.uni-heidelberg.de/fileadmin/PBLTutorTraining/player.swf.
doi:10.1186/1472-6920-10-52
PMCID: PMC2909975  PMID: 20604927
10.  Undergraduate technical skills training guided by student tutors – Analysis of tutors' attitudes, tutees' acceptance and learning progress in an innovative teaching model 
Background
Skills labs provide a sheltered learning environment. As close supervision and individual feedback were proven to be important in ensuring effective skills training, we implemented a cross-year peer tutor system in our skills lab of internal medicine that allowed intense training sessions with small learning groups (3–4 students) taught by one student tutor.
Methods
The expectations, experiences and criticisms of peer tutors regarding the tutor system for undergraduate skills lab training were investigated in the context of a focus group. In addition, tutees' acceptance of this learning model and of their student tutors was evaluated by means of a pre/post web-based survey.
Results
14 voluntary senior students were intensely prepared by consultants for their peer tutor activity. 127 students participated in the project, 66.9% of which responded to the web-based survey (23 topics with help of 6-point Likert scale + free comments). Acceptance was very high (5.69 ± 0.07, mean ± SEM), and self-confidence ratings increased significantly after the intervention for each of the trained skills (average 1.96 ± 0.08, all p < 0.002). Tutors received high global ratings (5.50 ± 0.07) and very positive anonymous individual feedback from participants. 82% of tutees considered the peer teaching model to be sufficient, and a mere 1% expressed the wish for skills training to be provided by faculty staff only. Focus group analyses with tutors revealed 18 different topics, including profit in personal knowledge and personal satisfaction through teaching activities. The ratio of 1:4 tutor/tutees was regarded to be very beneficial for effective feedback, and the personalized online evaluation by tutees to be a strong motivator and helpful for further improvements. The tutors ascribed great importance to the continuous availability of a contact doctor in case of uncertainties.
Conclusion
This study demonstrates that peer teaching in undergraduate technical clinical skills training is feasible and widely accepted among tutees, provided that the tutors receive sufficient training and supervision.
doi:10.1186/1472-6920-8-18
PMCID: PMC2324090  PMID: 18400106
11.  Students and tutors' social representations of assessment in problem-based learning tutorials supporting change 
Background
Medical programmes that implement problem-based learning (PBL) face several challenges when introducing this innovative learning method. PBL relies on small group as the foundation of study, and tutors facilitate learning by guiding the process rather than teaching the group. One of the major challenges is the use of strategies to assess students working in small groups. Self-, peer- and tutor-assessment are integral part of PBL tutorials and they're not easy to perform, especially for non experienced students and tutors. The undergraduate PBL medical programme was introduced in 2003, and after two years the curriculum committee decided to evaluate the tutorial assessment in the new program.
Methods
A random group of ten students, out of a cohort of sixty, and ten tutors (out of eighteen) were selected for semi-structured interviews. The social representations' theory was used to explore how the students and tutors made sense of "assessment in tutorials". The data were content analyzed using software for qualitative and quantitative processing of text according to lexicological distribution patterns.
Results
Even though students and tutors are aware of the broader purpose of assessment, they felt that they were not enough trained and confident to the tutorial assessment. Assigning numbers to complex behaviors on a regular basis, as in tutorials, is counter productive to cooperative group learning and self assessment. Tutors believe that students are immature and not able to assess themselves and tutors. Students believe that good grades are closely related to good oral presentation skills and also showed a corporative attitude among themselves (protecting each other from poor grades).
Conclusion
Faculty training on PBL tutorials' assessment process and a systematic strategy to evaluate new programs is absolutely necessary to review and correct directions. It is envisaged that planners can make better-informed decisions about curricular implementation, review and reform when information of this nature is made available to them.
doi:10.1186/1472-6920-9-30
PMCID: PMC2702354  PMID: 19500408
12.  Effects of Role and Assignment Rationale on Attitudes Formed During Peer Tutoring 
This study examined the role of contextual factors, such as assignment rationale, on the attitudinal effects of peer tutoring. Fourth-grade children engaged in brief tutoring experiences as either a tutor or tutee. Subjects received four rationales for being selected as tutor or tutee: (a) a competence rationale, (b) a physical characteristic rationale, (c) a chance rationale, or (d) no rationale. As predicted, tutors had more positive attitudes than tutees when they had been given a competence or physical characteristic rationale but not when the tutors were provided a chance rationale or no rationale. Additionally, the tutors’ and tutees’ attitudes were enhanced when no rationale was provided. Results are discussed in terms of their implications for a role-theory analysis of tutoring and their implications for applied programs.
doi:10.1037/0022-0663.73.1.33
PMCID: PMC3740407  PMID: 23946549
13.  "I couldn't do this with opposition from my colleagues": A qualitative study of physicians' experiences as clinical tutors 
BMC Medical Education  2011;11:79.
Background
Clinical contact in the early curriculum and workplace learning with active tutorship are important parts of modern medical education. In a previously published study, we found that medical students' tutors experienced a heavier workload, less reasonable demands and less encouragement, than students. The aim of this interview study was to further illuminate physicians' experiences as clinical tutors.
Methods
Twelve tutors in the Early Professional Contact course were interviewed. In the explorative interviews, they were asked to reflect upon their experiences of working as tutors in this course. Systematic text condensation was used as the analysis method.
Results
In the analysis, five main themes of physicians' experiences as clinical tutors in the medical education emerged: (a) Pleasure and stimulation. Informants appreciated tutorship and meeting both students and fellow tutors, (b) Disappointment and stagnation. Occasionally, tutors were frustrated and expressed negative feelings, (c) Demands and duty. Informants articulated an ambition to give students their best; a desire to provide better medical education but also a duty to meet demands of the course management, (d) Impact of workplace relations. Tutoring was made easier when the clinic's management provided active support and colleagues accepted students at the clinic, and (e) Multitasking difficulties. Combining several duties with those of a tutorship was often reported as difficult.
Conclusions
It is important that tutors' tasks are given adequate time, support and preparation. Accordingly, it appears highly important to avoid multitasking and too heavy a workload among tutors in order to facilitate tutoring. A crucial factor is acceptance and active organizational support from the clinic's management. This implies that tutoring by workplace learning in medical education should play an integrated and accepted role in the healthcare system.
doi:10.1186/1472-6920-11-79
PMCID: PMC3212900  PMID: 21975057
14.  Peer Teaching in Paediatrics - Medical Students as Learners and Teachers on a Paediatric Course 
Background: Peer assisted learning is known as an effective educational strategy in medical teaching. We established a peer assisted teaching program by student tutors with a focus on clinical competencies for students during their practical training on paediatric wards. It was the purpose of this study to investigate the effects of a clinical skills training by tutors, residents and consultants on students evaluations of the teaching quality and the effects of a peer teaching program on self assessed clinical competencies by the students.
Methods: Medical student peers in their 6th year were trained by an intensive instruction program for teaching clinical skills by paediatric consultants, doctors and psychologists. 109 students in their 5th year (study group) participated in a peer assisted teaching program for training clinical skills in paediatrics. The skills training by student peer teachers were supervised by paediatric doctors. 45 students (control group) participated in a conventional paediatric skills training by paediatric doctors and consultants. Students from both groups, which were consecutively investigated, completed a questionnaire with an evaluation of the satisfaction with their practical training and a self assessment of their practical competencies.
Results: The paediatric skills training with student peer teachers received significantly better ratings than the conventional skills training by paediatric doctors concerning both the quality of the practical training and the support by the teaching medical staff. Self assessed learning success in practical skills was higher rated in the peer teaching program than in the conventional training.
Conclusions: The peer assisted teaching program of paediatric skills training was rated higher by the students regarding their satisfaction with the teaching quality and their self assessment of the acquired skills. Clinical skills training by student peer teachers have to be supervised by paediatric doctors. Paediatric doctors seem to be more motivated for their own teaching tasks if they are assisted by student peer teachers. More research is needed to investigate the influence of peer teaching on the motivation of paediatric doctors to teach medical students und the academic performance of the student peers.
doi:10.3205/zma000708
PMCID: PMC3140377  PMID: 21818216
Peer assisted learning; clinical skills training in paediatrics; student evaluation; student self assessment
15.  Remediating Number Combination and Word Problem Deficits Among Students With Mathematics Difficulties: A Randomized Control Trial 
Journal of educational psychology  2009;101(3):561-576.
The purposes of this study were to assess the efficacy of remedial tutoring for 3rd graders with mathematics difficulty, to investigate whether tutoring is differentially efficacious depending on students’ math difficulty status (mathematics difficulty alone vs. mathematics plus reading difficulty), to explore transfer from number combination (NC) remediation, and to examine the transportability of the tutoring protocols. At 2 sites, 133 students were stratified on mathematics difficulty status and site and then randomly assigned to 3 conditions: control (no tutoring), tutoring on automatic retrieval of NCs (i.e., Math Flash), or tutoring on word problems with attention to the foundational skills of NCs, procedural calculations, and algebra (i.e., Pirate Math). Tutoring occurred for 16 weeks, 3 sessions per week and 20–30 min per session. Math Flash enhanced fluency with NCs with transfer to procedural computation but without transfer to algebra or word problems. Pirate Math enhanced word problem skill as well as fluency with NCs, procedural computation, and algebra. Tutoring was not differentially efficacious as a function of students’ mathematics difficulty status. The tutoring protocols proved transportable across sites.
doi:10.1037/a0014701
PMCID: PMC2768320  PMID: 19865600
mathematics disability; validated mathematics tutoring; word problems; number combinations
16.  Improvement in Generic Problem-Solving Abilities of Students by Use of Tutor-less Problem-Based Learning in a Large Classroom Setting 
CBE Life Sciences Education  2013;12(1):73-79.
Problem-based learning (PBL) was introduced in a large classroom setting. Two generic problem-solving tests were administered at the beginning and end of the term, and a statistically significant 13% increase in the test scores of students exposed to PBL was demonstrated; no change in test scores was observed in the control groups not using PBL.
Problem-based learning (PBL) was originally introduced in medical education programs as a form of small-group learning, but its use has now spread to large undergraduate classrooms in various other disciplines. Introduction of new teaching techniques, including PBL-based methods, needs to be justified by demonstrating the benefits of such techniques over classical teaching styles. Previously, we demonstrated that introduction of tutor-less PBL in a large third-year biochemistry undergraduate class increased student satisfaction and attendance. The current study assessed the generic problem-solving abilities of students from the same class at the beginning and end of the term, and compared student scores with similar data obtained in three classes not using PBL. Two generic problem-solving tests of equal difficulty were administered such that students took different tests at the beginning and the end of the term. Blinded marking showed a statistically significant 13% increase in the test scores of the biochemistry students exposed to PBL, while no trend toward significant change in scores was observed in any of the control groups not using PBL. Our study is among the first to demonstrate that use of tutor-less PBL in a large classroom leads to statistically significant improvement in generic problem-solving skills of students.
doi:10.1187/cbe.12-06-0081
PMCID: PMC3587858  PMID: 23463230
17.  Effects of First-Grade Number Knowledge Tutoring With Contrasting Forms of Practice 
The purpose of this study was to investigate the effects of 1st-grade number knowledge tutoring with contrasting forms of practice. Tutoring occurred 3 times per week for 16 weeks. In each 30-min session, the major emphasis (25 min) was number knowledge; the other 5 min provided practice in 1 of 2 forms. Nonspeeded practice reinforced relations and principles addressed in number knowledge tutoring. Speeded practice promoted quick responding and use of efficient counting procedures to generate many correct responses. At-risk students were randomly assigned to number knowledge tutoring with speeded practice (n = 195), number knowledge tutoring with nonspeeded practice (n = 190), and control (no tutoring, n = 206). Each tutoring condition produced stronger learning than control on all 4 mathematics outcomes. Speeded practice produced stronger learning than nonspeeded practice on arithmetic and 2-digit calculations, but effects were comparable on number knowledge and word problems. Effects of both practice conditions on arithmetic were partially mediated by increased reliance on retrieval, but only speeded practice helped at-risk children compensate for weak reasoning ability.
doi:10.1037/a0030127
PMCID: PMC3779611  PMID: 24065865
mathematics; practice; fluency; arithmetic; word problems
18.  Contribution of Equal-Sign Instruction beyond Word-Problem Tutoring for Third-Grade Students with Mathematics Difficulty 
Journal of educational psychology  2010;102(2):381-394.
Elementary school students often misinterpret the equal sign (=) as an operational rather than a relational symbol. Such misunderstanding is problematic because solving equations with missing numbers may be important for higher-order mathematics skills including word problems. Research indicates equal-sign instruction can alter how typically-developing students use the equal sign, but no study has examined effects for students with mathematics difficulty (MD) or how equal-sign instruction contributes to word-problem skill for students with or without MD. The present study assessed the efficacy of equal-sign instruction within word-problem tutoring. Third-grade students with MD (n = 80) were assigned to word-problem tutoring, word-problem tutoring plus equal-sign instruction (combined) tutoring, or no-tutoring control. Combined tutoring produced better improvement on equal sign tasks and open equations compared to the other 2 conditions. On certain forms of word problems, combined tutoring but not word-problem tutoring alone produced better improvement than control. When compared at posttest to 3rd-grade students without MD on equal sign tasks and open equations, only combined tutoring students with MD performed comparably.
doi:10.1037/a0018447
PMCID: PMC2904558  PMID: 20640240
19.  Teaching Math Skills to At-risk Students Using Home-based Peer Tutoring 
Home-based peer tutoring was used to teach math skills to 4 girls with deficits in mathematics and histories of abuse or neglect. Girls living in the same home formed tutoring dyads, and each participant served as both the peer tutor and the tutee during the course of the study. At the initiation of the tutoring intervention, an expert tutor provided multiple 3-min tutoring sessions to the designated peer tutor on three or four mathematics skills. The peer tutor concurrently provided 3-min tutoring sessions on the same skills to the tutee using a multiple baseline design. Results showed that participants improved their performance on all target skills. Additional interventions were implemented for some skills to improve accuracy further. Maintenance tests were also administered after 3 to 5 months of no practice on the skills. Results showed that tutors and tutees maintained their accuracy on 7 of the 12 skills assessed.
doi:10.1901/jaba.2007.108-05
PMCID: PMC1885408  PMID: 17624064
maltreated youth; mathematics; peer tutoring
20.  Evaluation of an Intelligent Tutoring System in Pathology: Effects of External Representation on Performance Gains, Metacognition, and Acceptance 
Objective
Determine effects of computer-based tutoring on diagnostic performance gains, meta-cognition, and acceptance using two different problem representations. Describe impact of tutoring on spectrum of diagnostic skills required for task performance. Identify key features of student-tutor interaction contributing to learning gains.
Design
Prospective, between-subjects study, controlled for participant level of training. Resident physicians in two academic pathology programs spent four hours using one of two interfaces which differed mainly in external problem representation. The case-focused representation provided an open-learning environment in which students were free to explore evidence-hypothesis relationships within a case, but could not visualize the entire diagnostic space. The knowledge-focused representation provided an interactive representation of the entire diagnostic space, which more tightly constrained student actions.
Measurements
Metrics included results of pretest, post-test and retention-test for multiple choice and case diagnosis tests, ratios of performance to student reported certainty, results of participant survey, learning curves, and interaction behaviors during tutoring.
Results
Students had highly significant learning gains after one tutoring session. Learning was retained at one week. There were no differences between the two interfaces in learning gains on post-test or retention test. Only students in the knowledge-focused interface exhibited significant metacognitive gains from pretest to post-test and pretest to retention test. Students rated the knowledge-focused interface significantly higher than the case-focused interface.
Conclusions
Cognitive tutoring is associated with improved diagnostic performance in a complex medical domain. The effect is retained at one-week post-training. Knowledge-focused external problem representation shows an advantage over case-focused representation for metacognitive effects and user acceptance.
doi:10.1197/jamia.M2241
PMCID: PMC2213473  PMID: 17213494
21.  A prospective randomized trial of content expertise versus process expertise in small group teaching 
BMC Medical Education  2010;10:70.
Background
Effective teaching requires an understanding of both what (content knowledge) and how (process knowledge) to teach. While previous studies involving medical students have compared preceptors with greater or lesser content knowledge, it is unclear whether process expertise can compensate for deficient content expertise. Therefore, the objective of our study was to compare the effect of preceptors with process expertise to those with content expertise on medical students' learning outcomes in a structured small group environment.
Methods
One hundred and fifty-one first year medical students were randomized to 11 groups for the small group component of the Cardiovascular-Respiratory course at the University of Calgary. Each group was then block randomized to one of three streams for the entire course: tutoring exclusively by physicians with content expertise (n = 5), tutoring exclusively by physicians with process expertise (n = 3), and tutoring by content experts for 11 sessions and process experts for 10 sessions (n = 3). After each of the 21 small group sessions, students evaluated their preceptors' teaching with a standardized instrument. Students' knowledge acquisition was assessed by an end-of-course multiple choice (EOC-MCQ) examination.
Results
Students rated the process experts significantly higher on each of the instrument's 15 items, including the overall rating. Students' mean score (±SD) on the EOC-MCQ exam was 76.1% (8.1) for groups taught by content experts, 78.2% (7.8) for the combination group and 79.5% (9.2) for process expert groups (p = 0.11). By linear regression student performance was higher if they had been taught by process experts (regression coefficient 2.7 [0.1, 5.4], p < .05), but not content experts (p = .09).
Conclusions
When preceptors are physicians, content expertise is not a prerequisite to teach first year medical students within a structured small group environment; preceptors with process expertise result in at least equivalent, if not superior, student outcomes in this setting.
doi:10.1186/1472-6920-10-70
PMCID: PMC2966459  PMID: 20946674
22.  Comparison of a web-based package with tutor-based methods of teaching respiratory medicine: subjective and objective evaluations 
Background
Respiratory disease is a major cause of morbidity and mortality not only in the United Kingdom, but globally. A good understanding of respiratory disease and its treatment is essential for all medical graduates. As a result of changes in clinical practice, patients with some common respiratory illnesses are less often admitted to hospital, restricting the experience available to undergraduate students. Combined with a potential shortage of clinical teachers, this means that new methods of teaching need to be developed and appraised. The aim of this study was to establish whether a web-based package on the diagnosis of respiratory disease would be as effective and as acceptable to final year medical students as tutor-led methods of teaching the same material.
Methods
137 out of 315 final year undergraduate students in a single medical school volunteered to take part. Each received up to two hours of tutor-lead interactive, tutor-lead didactic or electronic, Web-based teaching on the accurate diagnosis and management of respiratory disease. Post teaching performance was assessed by multiple true/false questions and data interpretation exercises, whilst students' teaching preferences were assessed by questionnaire.
Results
Despite a high knowledge baseline before the study, there was a small, but statistically significant increase in knowledge score after all forms of teaching. Similarly, data interpretation skills improved in all groups, irrespective of teaching format, Although paradoxically most students expressed a preference for interactive tutor-lead teaching, spirometry interpretation in those receiving web-based teaching improved significantly more [p = 0.041] than in those in the interactive group.
Conclusion
Web-based teaching is at least as good as other teaching formats, but we need to overcome students' reluctance to engage with this teaching method.
doi:10.1186/1472-6920-7-41
PMCID: PMC2180172  PMID: 17976233
23.  An Intelligent Tutoring System for Antibody Identification 
Empirical studies of medical technology students indicate that there is considerable need for additional skill development in performing tasks such as antibody identification. While this need is currently met by on-the-job training after employment, computer-based tutoring systems offer an alternative or supplemental problem-based learning environment that could be more cost effective.
We have developed a prototype for such a tutoring system as part of a project to develop educational tools for the field of transfusion medicine. This system provides a microworld in which students can explore and solve cases, receiving assistance and tutoring from the computer as needed.
PMCID: PMC2245473
24.  General practitioners and their learning styles. 
Continuing medical education sessions are often poorly attended by general practitioners. One reason may be that these traditionally consist of lectures by hospital consultants with a strong theoretical bias which may have little relevance to the learning needs of general practitioners. To compare the learning styles of teachers and learners in general practice, learning style questionnaires were administered to 50 hospital clinical tutors, 78 general practitioner trainers, 63 trainees and 47 non-trainer principals. The questionnaire covered four different learning preferences: activist, reflector, theorist and pragmatist. The findings showed that the learning styles of hospital tutors and general practitioner trainers were statistically significantly different to those of non-trainer principals and trainees. The tutors and trainers scored much higher on theorist styles and to a lesser extent on reflector and pragmatist styles. There were no significant differences on activist scores. Since teachers tend to teach in their preferred learning style, which may not match the style of the recipients, these findings have implications for continuing medical education in general practice. These implications are discussed.
PMCID: PMC1711996  PMID: 2560001
25.  Effect of worksheet scaffolds on student learning in problem-based learning 
The purpose of this study was to investigate the effect of worksheets as a scaffolding tool on students’ learning achievement in a problem-based learning (PBL) environment. Seventeen PBL classes (N = 241) were randomly assigned to two experimental groups—one with a worksheet provided and the other without. Students’ learning of the topic at hand was evaluated by comparing results from pre- and post-lesson concept recall tests. We also obtained information about students’ perceptions of factors impacting their learning using a Learning Impact Questionnaire. The data was analyzed by means of analyses of variance. Results of the study indicated that there was no statistically significant difference between the levels of understanding for both groups of students. In addition, survey results revealed that the strongest factor perceived by students to impact their learning in a PBL context is the tutor followed by team and class dynamics, while the influence of the worksheet was rated lowest. These findings suggest that scaffolds such as worksheets may not play a significant role in enhancing students’ learning within the social constructivist framework of problem-based learning. On the other hand, the importance of the role of tutor and collaborative small group learning which are key features of PBL is reinforced.
doi:10.1007/s10459-011-9288-1
PMCID: PMC3167389  PMID: 21409538
Collaborative small group learning; Tutor; Problem-based learning; Student learning; Scaffolds; Worksheet

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