The medical student bedside mentoring program: a feasibility study
Emma Tucker BSc (Hons) PhD*, Dr Caroline Luke MBBS MOccMed, MHEd** |

*Medical Student, The Australian National University,
**Clinical Skills Tutor, The Australian National University

Abstract

Peer-assisted learning has many theoretical benefits both for the student tutor and tutee. During 2010 the Year 4 students at The Australian National University’s Medical School (ANUMS) conducted an informal bedside mentoring program for Year 2 students. All participating students perceived a benefit from the program and enjoyed the experience. No quantitative benefit to Objective Structured Clinical Examination (OSCE) scores could be determined. The majority of non-participating students cited time constraints as their primary reason for not doing so, however, approximately one quarter of students stated they lacked the confidence to participate. Expectations of new students to the program were assessed with 54-80% of future Year 4 students planning to participate. Given the theoretical and perceived benefits to students, continuation of the program is warranted and integration into the professionalism and leadership theme within the curriculum suggested.

Introduction

Peer-assisted learning is an integral part of medical student training. It occurs in the informal situation of approaching a peer for assistance, with students more likely to approach peers than faculty (1), in organised study groups, and in formalised Problem Based Learning (PBL) sessions. Peer-assisted learning has been shown to be as effective as the training provided by experienced faculty in learning anatomy (2–4), communication and history taking skills (5,6), laboratory skills (7) and clinical skills (8–11), as well as in the PBL setting (12). These are examples of the cognitive congruence hypothesis that suggests that a teacher with a similar knowledge base to a student is more effective than an expert in the field (13,14). However, research in the area of peer learning in clinical education is poor with no clear gold standard learning model (15).

Peer-assisted learning has been shown to be of benefit not only to those tutored but also to the tutors themselves (5,16). The tutoring experience helps students’ academic development, enhance their expertise and may help in the making of decisions regarding choice of career (16). Moreover, medical training in education principles have been proposed as: current students are the physicians and faculty members of the future and will have teaching roles; students may become more effective communicators; and students with a better understanding of teaching may become better learners (17). Other suggested benefits include alleviating teaching pressure for faculty, creating a comfortable and safe learning environment, providing junior students with role models, offering alternative study methods, enhancing motivation and preparing students to be teachers and leaders (13).

Near-peer teaching on the ward has been demonstrated to provide junior medical students with beneficial and valued learning experiences (18,19). In this setting, junior students attend the wards with an experienced student teacher. Students gain insights into the practice of medicine, the process of becoming a doctor, the nature of interaction with patients and clinical skills (18). In addition, students who receive bedside teaching also attain a higher level of self-confidence (19).

During 2010, the Year 4 medical students at the ANUMS conducted an informal bedside mentoring program for the Year 2 cohort. Given the theoretical benefits of such a program, this study was conducted to examine both the successful aspects of the program and opportunity for improvement with the overall goal of formalising this program to ensure its continuation if found to be successful. The aims of this study were:

  • Evaluate the experiences of the Year 2 and Year 4 students (both positive and negative).
  • Identify the reasons for non-participation for both the Year 2 and Year 4 students.
  • Determine the anticipated participation of future students and their expectations.
  • Provide a strategy to ensure the continuation and success of the program if warranted.

This article presents the investigation into the bedside mentoring program at the ANUMS. In Section II the study design is presented, followed by the results of this investigation in Section III. These results are discussed in Section IV and recommendations to the ANUMS are provided.

Methods

This study was conducted by a series of surveys sent to all students enrolled in the relevant year groups at the ANUMS. The Human Research Ethics Committee at the ANU approved this research (Protocol 2010/537).

The following surveys were conducted:

  • A retrospective survey of the nine participating Year 4 students in 2010 which focused on their experiences as teachers.
  • A retrospective survey of the 81 non-participating Year 4 students in 2010 which focused on their reasons why they did not participate.
  • A retrospective survey of all Year 2 students in 2010 to determine the level of participation, the experiences of those who participated and the reasons for non-participation.
  • A prospective survey of all Year 4 students in 2011 to determine their expectations of the bedside mentoring program.
  • A prospective survey of all Year 2 students in 2011 to determine their expectations of the bedside mentoring program.

The surveys were advertised by the ANUMS online discussion board (MedOnline) and via email, and were conducted using an online polling system. The student responses were anonymous and voluntarily completed. Consent to participate was given implicitly by the submission of the survey.

Results

The student experience
During 2010 nine Year 4 students participated in bedside mentoring, of which six responded to the survey. All six respondents would have liked to have received bedside mentoring themselves when they were in Year 2. The six responders conducted 29 bedside mentoring sessions with approximately 65 Year 2 attendees (some of which would have been the same student attending multiple times). Extrapolating from the six respondents, it is estimated that a total of approximately 40 sessions were conducted in 2010 with approximately 100 Year 2 participant attendances. The Likert scale responses by the Year 4 students are listed in Table 1.

Stroke death rates by sex, 1987-2007. Sourced from AIHW (6, p. 81.)
Table 1. Year 4 student experiences of bedside mentoring

The Year 4 participants were also asked to provide comments about their experiences. The majority of comments (four respondents) were in regards to the time pressures in Year 4 making it difficult to schedule bedside mentoring sessions. The other two respondents stressed that the program should remain with optional participation.

The Year 2 students of 2010 were also surveyed to find out the experiences of students who participated in the program. The survey was sent to the 100 students enrolled in the year, of which 28 responded. Of these respondents, 15 participated in bedside mentoring (53%). The average OSCE score at the end of Year 2 for these 15 students was 184.7 (standard error 3.3), and the correlation between the number of bedside mentoring sessions attended and OSCE score received was low (correlation coefficient of 0.3). The Likert scale responses by the Year 2 students are listed in Table 2, which shows the majority of students enjoyed bedside teaching and found it beneficial to their learning.

Stroke death rates by sex, 1987-2007. Sourced from AIHW (6, p. 81.)
Table 2. Year 2 student experience of bedside mentoring

The Year 2 participants of 2010 were asked to provide comments on their experiences. Several commented that they found the process gave them more confidence to attend the wards without the formality of a supervising consultant. Two students noted that the program needed to be advertised better and the sessions spread more fairly amongst the participants.

Reasons for non-participation
During 2010, 81 Year 4 students did not participate in the bedside mentoring program, of whom 20 responded to our survey. Seventy percent of these students stated that they would have liked to have received bedside mentoring themselves during their Year 2 program despite not providing it during their final year. The students were asked to choose from a list of statements as to why they did not participate, the results of which are listed in Table 3.

Stroke death rates by sex, 1987-2007. Sourced from AIHW (6, p. 81.)
Table 3. Reasons for not participating in bedside mentoring by Year 4 students in 2010

Ninety percent of non-participating Year 4 respondents gave ‘other reasons’ which largely fell into two groups, first, those who were too busy with other learning commitments (12 respondents, 60%), and second, those who were not confident enough to mentor Year 2 students (five respondents, 25%). The Year 4 students were also asked if they had any other comments about the program. Comments were made by five students, two of which were about the time constraints in the Year 4 schedule. One student stated that with hindsight they wished they had provided bedside mentoring, another student stated that bedside mentoring should not be compulsory and one other stated that they thought it was an excellent program which should be formally supported.

The Year 2 students of 2010 were surveyed to find out why some students did not participate. The survey was sent to the 100 students enrolled in the year, of whom 28 responded. Out of these respondents, 13 did not participate in bedside mentoring (46%) and were asked to choose from a list of statements about why they were not involved. The majority of Year 2 non-participants stated “they did not get around to it”. These results are listed in Table 4.

Stroke death rates by sex, 1987-2007. Sourced from AIHW (6, p. 81.)
Table 4. Reasons for not participating in bedside mentoring by Year 2 students in 2010

Three of the five ‘other reasons’ for non-participation were the same, that is “the program was not well advertised”. Two students commented that there should have been a fairer way to allocate the spaces as they would have liked to attend but were unable to allocate themselves early enough. The average OSCE score of the 13 non-participants was 183.8 (standard error of the mean = 1.6).

Future student participation and expectations
The Year 2 students of 2010 and 2011 as well as the Year 4 of 2011 were surveyed to determine how many students wanted to provide bedside mentoring during their Year 4 schedule. The survey was conducted prior to the Year 4 students commencing bedside mentoring. The anticipated participation rates of future students is high with 54%, 80% and 67% of the Year 2 students of 2010, 2011 and Year 4 students of 2011 respectively indicating that they would like to participate.

The Year 2 students of 2011 were surveyed about their expectations of being tutored in the bedside mentoring program, of which 21 responded. The students were asked to provide comments on their expectations of the program. More than half of the comments (55%) described general positive expectations of the program. Several students suggested that there would not be enough Year 4 students available due to time constraints. The Likert scale results are listed in Table 5.

Stroke death rates by sex, 1987-2007. Sourced from AIHW (6, p. 81.)
Table 5. Year 2 student expectations of bedside mentoring

The Year 4 students of 2011 were surveyed about their expectations of teaching in the bedside mentoring program, of which six responded. All six students stated that they would have liked to receive bedside mentoring themselves when in Year 2. Comments on their expectations of the program revolved around a perceived difficulty due to time constraints. The Likert scale results are listed in Table 6.

Stroke death rates by sex, 1987-2007. Sourced from AIHW (6, p. 81.)
Table 6. Year 4 student expectations of bedside mentoring

Continuation of the program
All students surveyed were asked to offer suggestions to improve the program and ensure a positive learning experience. The following suggestions were received.

  • Hold a social event to introduce the Year 2 and 4 students to each other and follow up with further social events.
  • Offer bedside mentoring outside of the Year 2 lunch break.
  • Offer an incentive to the Year 4 students (eg not having to do an associated portfolio item such as the PAL review article).

Discussion

Peer-assisted learning has many theoretical benefits to both the senior student tutors (16,17) and the junior student tutees (18,19). All students (both Year 2 and Year 4) who participated in the ANUMS bedside mentoring program in 2010 either agreed or strongly agreed that they enjoyed and benefited from the experience. Interestingly, while all students stated that they benefited from being involved, many students did not see the benefit to the other party (i.e. Year 2 students did not unanimously see benefit to Year 4 students and vice versa). All students either agreed or strongly agreed that they would recommend participation to future students. Not one student stated that the bedside mentoring program took up too much time.

The results show that, for the participating students, it was a useful program. This perceived benefit however, could not be differentiated for the Year 2 students by OSCE scores with participants having an average of 184.7 (standard error in the mean = 3.3) and non-participants having 183.8 (standard error in the mean 1.6) and low correlation between the number of sessions attended and OSCE score (correlation coefficient of 0.3). To investigate this matter further, an increased number of survey participants are required due to the low statistical significance of the results. It should also be noted that OSCEs are only one method of testing a student’s knowledge and do not examine all potential benefits from bedside mentoring (eg confidence in interacting with patients).

Recommendations to improve the bedside mentoring program

As future registrars, specialists and potential lecturers in medicine, current medical students will be required to teach others (20), yet the educational skills required are not taught in the curriculum of medical schools. For example, while the ANUMS dedicates approximately 10% of its curriculum to a ‘professionalism and leadership’ theme (21), there are no formal classes on teaching.  This professionalism and leadership theme is common to most medical programs and would be ideally suited to include teaching as part of students’ development into future doctors.

The students who tutored in the bedside mentoring program all perceived that they benefited from the experience. Most of the students who did not participate would have liked to, however, were unable due to time constraints in the Year 4 schedule. In addition, about one quarter of those surveyed stated they did not participate due to lack of confidence in their own ability to teach, although only one out of six Year 4 students stated they would have liked a teacher training session. Therefore, it is argued that these students will be graduating from the medical school without the skills required to perform teaching, as will be expected from them as a doctor.

Most Year 4 students were not in favour of making bedside mentoring mandatory in the curriculum despite stating that participating was to their benefit. However, it is proposed that participation in the bedside mentoring program could be an attractive and suitable alternative to existing assessment for the professionalism and leadership theme. With a suitable framework (such as minimum number of sessions requirement and a reflection on teaching experiences), the bedside mentoring program could be a valuable addition to the professionalism and leadership theme and to the general education of ANUMS students.

In addition to providing academic credit to Year 4 students who learn important teaching skills, the following recommendations are made to ensure that the program continues and provides this beneficial experience to future years:

  • Hold a social event to introduce the Year 2 and 4 students to each other. This occasion could be used to highlight the potential benefits to students in both year groups and to inform students of the experiences of previous participants. Such an event could increase confidence of Year 4 students in their own abilities to teach and would ensure that the program is well advertised to students (approximately 35% of Year 4 students and 60% of Year 2 students wanted to participate but forgot about the program).
  • The current scheduling of bedside mentoring at lunch time on Tuesdays is too restrictive. Many students wanted to participate but were too busy with other learning commitments (60% of Year 4 students). Extending the bedside mentoring program to Tuesday afternoons after scheduled Year 2 classes would be an easy solution to this problem.
  • Offer a short training session to Year 4 participants on how to teach students. Attendance could be a requirement if bedside mentoring becomes an option within the professionalism and leadership theme.

Limitations of this study

This study has several limitations. First and foremost, the study had a small number of survey respondents. While two-thirds of the Year 4 participants of 2010 responded, only one quarter of the non-particpants replied. Similarly only 28 out of 100 and 21 out of 95 students enrolled in Year 2 in 2010 and 2011 respectively provided survey responses. The worst response was received from the Year 4 students of 2011, with only 6 of the 79 students responding.

The students who responded to the surveys were a self selected group and, hence, may have replied due to a greater interest (and possibly perceived benefit) of the bedside mentoring program. Similarly, for those who participated, they did so voluntarily presumably for the same reason. The study only considered one year group of students’ experiences and examined the expectations of a different but also singular year group. Therefore, these results may have a significant selection and measurement bias. Finally the study did not consider the potential impact on patients having an increased number of students interviewing and examining them and is an area which requires further research.

It is suggested that the study be repeated for future cohorts of students. Further research would also allow investigation into the effects of implementing the proposed changes and determining if extra changes are required.

Conclusion

This paper has presented the results of an investigation into a novel near-peer teaching program conducted at the ANUMS. Near-peer teaching in the ward environment has been demonstrated in the literature to provide beneficial learning experiences both for the tutor and tutee. This study investigated the informal bedside mentoring program conducted by the Year 4 students for the Year 2 cohort to examine the successful aspects of the program and look for opportunities for improvement with the overall goal of formalising the program if warranted.

All participating students (Years 2 and 4) enjoyed the experience and perceived a benefit. Moreover, all participants stated that they would recommend the program to future students. The perceived benefit by the students did not translate to a measurable difference in OSCE scores between participants and non-participants.

Most non-participating students were unable to take part due to time constraints. Some Year 4 students stated that they did not have confidence in their own abilities to carry out this task. It is anticipated that 54-80% of future Year 4 students would provide bedside mentoring. All Year 2 students indicated that they would like to receive bedside mentoring.

It is suggested that Year 4 participation is rewarded by receiving academic credit through the professionalism and leadership theme of the curriculum. Students were strongly against mandatory participation and therefore it is proposed that it could be alternative to an existing assessment item. In addition it is suggested that the program include a social event at the beginning of the year to increase the confidence and collegiality of the Year 4 students and ensure the program is well advertised, increase scheduling of bedside mentoring to an afternoon in addition to the current lunch time period, and finally, provide a short training session to Year 4 participants on how to teach students.

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