What follows is the third in a series of posts that form the conclusion of the Purple Sticker Pilot Project, an initiative designed to highlight hot topics of discussion at the 2015 ASME Annual Scientific Meeting and continue the conversation after the event. This blog is a guest post by Dr Helen Watson, Lecturer in Biomedical Sciences at the University of Exeter Medical School; it follows on from the presentation that she and Timo Tolppa delivered at the conference. You will then find a number of links to related journal articles from Medical Education and The Clinical Teacher that provide a basis for further reading around the topic. These articles are all free to access for the next month. Please have a look through the blog and related articles then share your thoughts, either in the comments section below or on Twitter (#ASMEpspp) – make sure to mention our Twitter account in your tweet: @mededuceeditor.
The General Medical Council (GMC) states in “Tomorrow’s Doctors” that medical graduates must be able to “function effectively as a mentor and teacher”1. The concept of mentorship is as old as education itself, but here I will discuss how it has changed and adapted to new trends and challenges in medical education.
At the 2015 ASME Annual Scientific Meeting we presented a summary and evaluation of a student led, near-peer mentoring scheme which has been running for two years at the Peninsula College of Medicine and Dentistry (PCMD) in Devon and Cornwall, UK2. The Peninsula student body faces several specific challenges, which this mentoring scheme helped address. PCMD split into the University of Exeter Medical School (UEMS) and the Plymouth University Peninsula Schools of Medicine and Dentistry (PUPSMD) in 2012, with students in 2013 entering one of these new schools. Therefore, for the last few years we have been teaching the remaining PCMD students as well as the new students in UEMS and PUPSMD. Another challenge facing students in Peninsula is the large geographical spread of our campuses over North and South Devon and Cornwall, with students in PCMD moving sites between year two and three as well as between year four and five. Problem based learning (PBL) is central to our curriculum, something which first year students are unlikely to have met in their education to date. In addition, our integrated curriculum requires students to be in a professional setting right from their first year. The near-peer mentoring scheme was set up by Peninsula Student Parliament to support all students and to address some of these challenges. There was some staff input into the training sessions and the evaluation but this was initiated by the students.
The undergraduate PCMD near-peer mentoring initiative was piloted in 2013-14 and then rolled out across all five years of study and all three campuses (Exeter, Plymouth and Truro) the following year. The scheme worked by pairing mentees with a mentor in the year above, resulting in very near-peer mentoring. The rationale was that this closeness in experience would help the mentee to gain valuable insights from the mentor who had only just been in the very same situation. The following evaluation and discussion refers to the roll-out of the scheme rather than the pilot. Mentors were recruited early in the academic year. 228 undergraduate students volunteered to be mentors and attended training sessions led by the student mentoring committee with talks from university counsellors, pastoral and academic tutors. Mentors were put into pairs and each pair allocated four mentees. This grouping allowed students to further provide peer support but also introduced flexibility so that the mentees could swap mentors, and vice versa, if they felt the relationship was not productive. 436 mentees were involved in the scheme, over all five years and all three campuses. A total of 664 undergraduate students were involved in the scheme during the first full implementation which makes it, to our knowledge, the largest initiative of this type to be used in medical education so far.
There was a mid-year meeting held for all mentors where they were able to share ideas and give feedback to the committee. This helped the students to clarify their role and to take new ideas to their mentees. The scheme was evaluated at the end of the academic year. Out of those that responded to the survey, all mentors had been in touch with all of their mentees by email or Facebook. Only 6% of mentors met none of their students face to face and 77% of mentors enjoyed being a mentor. 34% of mentees enjoyed having a mentor and 19% neither enjoyed nor disliked having a mentor. These lower numbers have likely resulted from those students who did not meet their mentors and perhaps did not see the need for the relationship. Some mentors commented that it was hard to arrange meetings with all of their mentees. Despite this, 100% of eligible mentors and 78% of mentees said they wanted to engage with the scheme the following year. As the mentoring was organised and led by the students with no demand for specific topics to be explored, we carried out a thorough evaluation of the scheme to find out more about what they were discussing when they met or exchanged emails.
The nature of the meetings was informal, with many of the students saying they had met over coffee or in the pub. In terms of the topic of conversation, assessments were identified by 49% of mentees and 47% of mentors. The structure of the year ahead for the mentees was discussed often, perhaps unsurprisingly as the curriculum and types of session vary considerably over the five year course. Personal issues and work life balance were less commonly discussed, with academic issues being most commonly explored. There were many positive comments from students in the evaluation, see figure 1 for some examples.
Positive outcomes for students
“Sense of community”
“Advice from a student perspective”
“Nice to have support moving into 3rd year in a new locality”
Positive outcomes for mentors
“It has been nice to get to know students in the year below and put our ‘wisdom’ into use and pass it on. The feeling of ‘paying it back’.”
“Being an older role model for peers. Communication & reflection on own experiences”
“Got more confidence in my own skills and knowledge”
Figure 1 – positive outcomes of the PCMD scheme from the end of year evaluation
We also asked students about the skills they thought they had accrued from the scheme. Mentees cited increased confidence, reduction in stress and an increase in clinical skills and medical knowledge as key benefits. The mentors felt they had improved their networking, teaching and organisational skills. Importantly, some mentors arranged extra activities for their mentees including tours of the hospital, bedside teaching and involvement with audits. Our near-peer mentoring scheme is just one example of how mentoring can support students through the many challenges of medical education. I will now explore some other methods of implementing mentoring and peer tutoring in other institutions, before discussing some common themes and questions.
Salerno-Kennedy et al have used peer tutoring as part of their graduate medical programme at University College Cork, Ireland3. This scheme is more focussed on teaching than mentoring but it makes use of fairly near peer relationships. Fourth year medical students tutored more junior students with medical educators alongside. Interestingly, the tutors were paid for their time. This may affect the dynamic of the relationship and the motivation of the tutors, although the authors say that the tutors were motivated by wanting to help fellow students and a desire to further their own teaching skills. The training in this tutoring scheme was given by LTHE trained medical educators and is described in detail in the paper. It is appropriately very much angled at preparing the students to be teachers, rather than mentors. The evaluation demonstrated the benefits of the thorough training, as the junior students found their student tutors to be very well prepared.
Another scheme, this time at the University of Iowa Carver College of Medicine, USA, has been introduced to support students through the pre-clinical to clinical transition. Brauer et al used a student initiated near-peer shadowing scheme where 62 pre-clinical students were given the opportunity to shadow 34 clinical student teachers over a four week period during their final pre-clinical semester4. Over 90% of pre-clinical students reported that they felt more aware of what their role in a hospital team would be and what would be expected of them. This pre-clinical to clinical transition is a challenging one and seems to be a particularly useful point to introduce peer support.
Doumouras et al have used peer tutoring between senior and junior medical undergraduates at Queen’s University in Ontario, Canada5. Again, this is more of a tutoring scheme than a mentoring scheme but, like ours, it relied on near-peer relationships with first and second years being taught by third and fourth years. 70 junior medical students and 15 senior medical students were involved in a two year programme. The outcomes seemed very positive for both junior and senior students. Increased confidence was seen in both sets of students, for the juniors feeling more confident in the hospital setting, and for the seniors in teaching in that setting. Unlike the Cork tutoring scheme above3, students in Ontario had no specific training in teaching but the preparation they needed to do was communicated to them in advance. The junior medical students found these sessions useful and a unique experience, reporting a high regard for the senior student teachers.
Saunders et al have initiated an interdisciplinary peer-assisted learning programme at the University of Edinburgh, UK6. Rather than using near-peer relationships, this scheme delivered training in specific skills to an interdisciplinary group of fourth year medical students and nursing students. These sessions were developed and delivered by medical and nursing students with guidance from teaching staff. The students were encouraged to work together and were asked to answer questions which related to the careers of both doctors and nurses. Students reported increased confidence in the specific skills taught and, crucially, also said they had a better awareness of the role of the other discipline. The authors of this paper encourage their readers to try using this type of teaching for different topics in order to improve interdisciplinary working in the clinical environment.
I have explored a range of mentoring and tutoring schemes here, each implemented in a different way. Although the aims of the initiatives differ, with some being focussed towards teaching and others on mentoring, the wider benefits seem to be shared amongst them all. Overwhelmingly positively, all of the schemes described here report mutual benefit for both sides of the mentoring or tutoring relationship. Another common theme is increased confidence amongst students in various domains. Possibly the benefit of near-peer mentoring and tutoring is that there is less pressure on students from senior teaching staff, allowing them to take more risks in raising difficult questions or discussing areas where they have a lack of knowledge.
The question of what is the best gap between mentor and mentee is an interesting one. Our very near-peer scheme helped students solve problems which were very specific to their point of study, for example what a particular assessment involved or how the curriculum is laid out. It might be that a bigger gap, for example between pre-clinical and clinical students, or students and junior doctors, may change the topics of conversation if the scheme was left flexible as ours was. It would be easy to imagine that a more junior student talking to a junior doctor may ask more about, for example, the doctor’s experience of particular situations or what was expected of them in the hospital rather than what would be in their next exam. In addition, regarding the hidden curriculum, what students or mentees might learn about values or how to behave from a junior doctor mentor is likely to be quite different from the cues they may pick up from a student just one year ahead of them.
Something which differs significantly between these papers is the level of training provided to students. The scheme at the University of Cork provided students with thorough teacher training, whereas in Ontario the students were required to take the initiative a little more in terms of preparing themselves to teach3,5. Our scheme included a training day at the beginning of the scheme and a mid-year meeting to address any issues that had arisen during the intervening period. These sessions were student led and very flexible to allow discussion. Despite our lack of rigorous training in comparison to Cork, our students still felt that they developed important skills. The need for training may depend on what the students are asked to deliver, for example formal teaching versus informal mentoring.
Transitional periods seem to be eased by the introduction of mentoring initiatives. The pre-clinical students in the Iowa scheme showed an impressive increase in awareness of what was required in the clinical setting they were about to find themselves in4. Similarly, our students remarked that their mentors helped them through the transition to a new geographical location as they moved from year two to year three. Mentees from all years said that they discussed what the following year would entail, indicating that mentoring also helps with smaller transitions for example between year three and four. We could extend this so that the mentee receives support from their mentor before they move to a new locality as well as when they arrive.
Peer mentoring and tutoring schemes, such as those discussed here, have wide reaching benefits for both the mentee or student and the mentor or teacher. Although there is a variation in the amount and types of training received prior to the schemes, the increase in confidence, skills and knowledge is a common factor, as is the mutually beneficial nature of these relationships. The use of these schemes seems particularly important during periods of transition and also to enhance interdisciplinary practice in medicine6. In my opinion, one of the most impressive factors of these schemes is the ability of students to initiate and drive them forward. In the case of our scheme and also that devised by Brauer et al in Iowa4, the schemes can be entirely student driven with minimal input from staff and minimal or no need for resources from the institution. Hopefully these case studies of mentoring and tutoring schemes will inspire you to try them yourselves, or to build on your existing structures and continue the conversation.
- General Medical Council, Tomorrow’s Doctors outcomes and standards for undergraduate medical education. (2009).
- Tolppa, T., Watson, H. R. in Annual Scientific Meeting of ASME (Edinburgh, 2015).
- Salerno-Kennedy, R., Henn, P. & O’Flynn, S. Implementing peer tutoring in a graduate medical education programme. The clinical teacher 7, 83-89, doi:10.1111/j.1743-498X.2010.00354.x (2010).
- Brauer, D. G., Axelson, R., Emrich, J., Rowat, J. & Stafford, H. A. Enhanced clinical preparation using near-peer shadowing. Med Educ 48, 1116, doi:10.1111/medu.12589 (2014).
- Doumouras, A., Rush, R., Campbell, A. & Taylor, D. Peer-assisted bedside teaching rounds. The clinical teacher 12, 197-202, doi:10.1111/tct.12296 (2015).
- Saunders, C. et al. The experience of interdisciplinary peer-assisted learning (PAL). The clinical teacher 9, 398-402, doi:10.1111/j.1743-498X.2012.00568.x (2012).
Brauer, D. G., Axelson, R., Emrich, J., Rowat, J. and Stafford, H. A. (2014), Enhanced clinical preparation using near-peer shadowing. Medical Education, 48: 1116. doi: 10.1111/medu.12589
Doumouras, A., Rush, R., Campbell, A. and Taylor, D. (2015), Peer-assisted bedside teaching rounds. The Clinical Teacher, 12: 197–202. doi: 10.1111/tct.12296
Salerno-Kennedy, R., Henn, P. and O’Flynn, S. (2010), Implementing peer tutoring in a graduate medical education programme. The Clinical Teacher, 7: 83–89. doi: 10.1111/j.1743-498X.2010.00354.x
Saunders, C., Smith, A., Watson, H., Nimmo, A., Morrison, M., Fawcett, T., Tocher, J. and Ross, M. (2012), The experience of interdisciplinary peer-assisted learning (PAL). The Clinical Teacher, 9: 398–402. doi: 10.1111/j.1743-498X.2012.00568.x