Abstract:

Despite the fact that commitment to teaching others forms a fundamental principle of the General Medical Council’s Good Medical Practice guidance, there is little data that indicates what prior training foundation year 1 (FY1) doctors have received on teaching methods before qualifying. The UK’s Foundation Programme curriculum further emphasises that doctors should be engaged in medical education and goes on to state that they ought to receive training on this as part of their foundation rotations.

One common way for FY1 doctors to become involved in teaching is through near-to-peer (NTP) teaching schemes, which are locally established in NHS trusts across the UK. This has become a popular form of learning in medical education, where foundation doctors lead tutorials for medical students on clinical attachment. As ‘near-peers’, newly qualified doctors are well placed to pass on recent experiences of assessments and tend to have a better grasp of the undergraduate curriculum.

Despite the popularity of these schemes, there are very few that offer any form of prior teacher training, an aspect which may leave prospective tutors feeling underprepared for delivering tutorials and undermine standards in undergraduate education. Moreover, the measure of improvement in NTP schemes tends to be skewed towards the experiences of the students rather than the tutors.

To address the issues described above, we established a FY1-led NTP teaching project for 3rd year (clinical phase) medical students based at Peterborough City Hospital, a large district general NHS trust in Cambridgeshire. Our scheme was two-fold. Firstly, our volunteer FY1 tutors completed a teacher-training workshop with a clinical teaching fellow, which included topics such as the undergraduate curriculum, how to give feedback and an introduction to medical education theories. Secondly, our tutors were allocated to groups of students and tasked with delivering tutorials on topics of their choosing. Student and tutor responses were recorded with pre- and post-encounter Likert questionnaires. Additionally, both tutors and three of the students participated in a semi-structured interview for qualitative analysis.

Our results demonstrated improved confidence amongst students following completion of the scheme, with 84.6% reporting increased confidence for their upcoming OSCEs (objective structured clinical examination) compared with 14.3% before the programme. A majority of students felt that the FY1 near-peers were better placed to prepare them for OSCEs than more senior doctors and all students selected for interview spoke of the ‘necessity’ of the teacher training workshop as a component of the scheme. Similarly, our tutors described the workshop as a ‘confidence boost’, and both felt they would be more comfortable organising teaching in the future as a result of the programme.

These results validate the use of near-peer tutoring as an education tool, particularly in a clinical setting where there is a loss of traditional learning structures found on a university campus. Though students were overwhelmingly positive about NTP teaching, there remained little appetite for this to replace mandatory aspects of the curriculum that were delivered by senior faculty. We also conclude that pre-scheme workshops are helpful in bridging the gap in teaching experience for new doctors and ought to be more widely applied to maintain standards in undergraduate education.

Keywords:

Near-to-peer, foundation year 1 doctors, undergraduate, teacher training workshop, medical education.