Push for peer-assisted learning

INCREASED opportunities for peer-assisted learning in Australian medical schools and teaching hospitals are on the agenda, according to leaders in medical education.

The authors of Perspective article in the MJA have described early results of an extracurricular peer-assisted learning (PAL) program initiated at the University of WA as positive. (1)

The authors wrote that teaching was an essential skill for junior doctors, as it improved their interactions with patients and their efficacy as mentors for medical students.

“We believe Australian medical schools should strongly consider implementing a comprehensive, vertically integrated student teaching program employing PAL”, they wrote.

Evidence from European and US medical schools suggested PAL programs taught students how to “teach and give feedback” as well as giving them the chance to “practise and consolidate” their own skills, the authors wrote.

Professor Alistair Burt, the recently appointed dean of medicine at the University of Adelaide, told MJA InSight that a similar program to the University of WA was under consideration at his university.

“We believe [PAL] should be a really important element of a modern medical curriculum”, Professor Burt said.

“We see it as an important attribute of our graduates that they see themselves as teachers. At the moment we don’t have a formal training program but we have it in our sights as we renew our curriculum in the very near future.”

The University of Adelaide already offers a 9-week elective unit in the final year of its 6-year MBBS degree, in which students receive structured teaching training and the opportunity to teach second- and third-year students.

“In the last 2 years that it has been offered it has been taken up by 31% and 30% of students respectively, and the evaluation of that course has been very positive”, Professor Burt said.

“There are challenges — this kind of program needs committed medical educators to champion it, and you have to make sure the induction is solid and robust. There would be nothing worse than doing it piecemeal and getting it wrong.”

Dr Will Milford, chair of the AMA’s Council of Doctors in Training (CDIT), said his group “thoroughly supported” PAL programs, adding that major hospitals should share the responsibility with medical schools of giving junior doctors adequate training in teaching.

“There’s no question that a large amount of teaching is delivered by junior doctors, most of it on the job and informally, and that continues right through our medical training”, Dr Milford told MJA InSight.

“There is a large demand from the hospitals on the junior doctors to do this teaching but we’ve found that many juniors feel they don’t get much support from the hospitals.”

A 2012 survey by the CDIT of more than 1000 junior doctors across Australia highlighted the problem of a lack of training in teaching in hospitals. More than half (51%) of the respondents believed their hospital did not have processes in place to develop the teaching skills of junior doctors who were providing training, for example, to medical students. Forty-six per cent of respondents were unsure whether their hospital had processes in place to develop the teaching skills of more senior doctors who provided training to junior doctors. (2)

“It’s never too early to start teaching people to do this and that’s why PAL programs in medical schools are important, but hospitals need to support it as well”, Dr Milford said.

“Some hospitals are starting to introduce educational registrar positions, which allow the registrars to receive training in teaching as well as be involved in teaching programs within the hospital.”

Professor Peter Smith, president of the Medical Deans of Australia and New Zealand, and dean of the University of NSW Medical School, said PAL programs would need “very clear guidelines”.

“There would have to be very careful assessment of both the process and the outcomes”, he told MJA InSight. “We’d be generally supportive, however.”
 

1. MJA 2013; 199 (3): 164-165
2. AMA 2013; 2012 AMA junior doctor training, education and supervision survey