Near-peer instruction, in which a more advanced trainee teaches a junior trainee, can be useful for teaching skills that progress along a continuum of proficiency, require stage-tailored feedback, and benefit from shared perspectives between instructors and learners. This common frame of reference, termed ‘social congruence’, is thought to enhance learners’ comprehension and may aid in teaching clinical skills that require comfort navigating new and unfamiliar skills, such as those of the physical exam (PE) among novice students. At our institution, pre-clerkship PE practice opportunities are limited after formal PE instruction by faculty exemplars. First-year and second-year pre-clerkship medical students (MS1s and MS2s) often practise their PE skills independently without receiving tailored feedback about attainment of benchmarks appropriate for their level of training. Although mastery of PE skills requires iterative practice, stage-specific feedback, and the chance to build comfort with PE skills that are brand-new to early students, our students find it challenging to find opportunities for PE skills practice that meet all these requirements. To supplement the formal PE curriculum, MS2s held voluntary PE review workshops during which MS1s had opportunities to practice PE skills on trained MS2 examinees. Training for volunteer MS2 examinees consisted of formal review of pertinent PE skills and practice providing constructive feedback. MS2s began the workshops by demonstrating a full physical exam and normalizing expectations for the upcoming MS1 observed final exam. Subsequently, 2 MS1s paired with every MS2 examinee, and each was allotted forty-five minutes to practice a full PE on the examinee with feedback. Fourth-year students and faculty were available during the workshops when needed as consultants. After the session, MS1s and MS2s completed 2 separate surveys assessing aspects of the workshops on a five-point Likert scale (1 = strongly disagree, 5 = strongly agree). Ethical approval for this study was given by the University of California San Francisco Committee on Human Research. Over three-quarters of MS1s (108/141; 77%) attended a workshop, and 30% of MS2s (43/141) volunteered as examinees. Sixty-eight (63%) of MS1 attendees and 31 (72%) of MS2 examinees completed surveys. MS1s strongly agreed that the workshops were helpful overall (mean±SD 4.69 ± 0.47), improved their comfort and confidence with PE skills (4.60 ± 0.55), and should be offered in the future (4.70 ± 0.53). They also rated feedback from MS2SPs as helpful (4.60 ± 0.58) and tailored to their needs (4.51 ± 0.71). MS2s felt comfortable providing feedback (4.39 ± 0.67) and wished the workshop had been offered in their first year (4.68 ± 0.48). Teaching during the workshop also improved MS2 examinees’ comfort with PE skills (4.07 ± 0.58). Based on these results, pre-clerkship students felt that supplemental near-peer workshops improved their basic PE skills and positively affected their self-assurance and comfort with PE skills. We postulate that the closeness of training levels and social congruence between learners and teachers in this near-peer PE instructional intervention may have been especially beneficial for bolstering learners’ comfort and confidence with these skills. Future studies should examine the efficacy of these workshops for objectively measured PE skill improvement and the effects of students’ comfort on PE performance.
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Kim et al. (2010) studied this question.