Medical Students as Educators - Why it Matters (10 Jul 2024)

SPEAKER_01 0:13

Welcome to this episode of the RCPE Student Conversations Podcast titled Medical Students as Educators. My name is Edward Fu, a final year medical student at the University of Edinburgh, and student observer on the RCPE Trainees and Members Committee. Today, I am delighted to be joined by Ian Lee, lecturer in medical education at the University of Edinburgh and Senior Fellow of the Higher Education Academy. Ian mainly works on the University of Edinburgh's Clinical Educator Program, a staff development program that supports clinical educators in their development as a teacher. He volunteers on the steering group and is a student mentor for Edinburgh Medical School's undergraduate certificate in medical education or the UGCME, and in fact mentored me throughout the program when I did the UGCME last year. Ian was also involved in designing some of the original lessons that formed the first iteration of the university's Doctor as an Educator module, which is a component of the MBCHB Medicine Degree Program, and continues to support that module where possible. Ian, it's genuinely always such a pleasure to see you. So why don't we jump right into it? In your view, why does earlier involvement of medical students in medical education matter?

SPEAKER_00 1:27

Thanks, Edward, for your kind words and your warm introduction. Always a pleasure to be working with you as well, and an absolute privilege to be invited to speak at a podcast. Before answering your question, again, just reiterating from your warm introduction there, my main role is in the educational staff development of postgraduate doctors. My role in undergraduate teaching medical students, as you say, is somewhat limited to volunteering on the UGCME, which is an extracurricular activity, as well as, as you say, teaching on the doctor as educator module, which I expect we might expand on later. Going back to your question, I think there are a few reasons why we might introduce medical education to undergraduate medical students. Firstly, it matters because there's an expectation from the GMC for healthcare professionals to support less experienced colleagues. That comes from their Achieving Good Medical Practice document from 2023. More specifically, the GMC stipulates that graduates should inverted commas here demonstrate appropriate teaching skills. And that comes again from the GMC, this time they're tomorrow's doctors document from 2003. That raises the question from me, how are students expected to develop those skills if they're not being taught? And that's really relevant because of the growing prevalence of near-peer teaching in many or certainly most medical schools. What is unclear though is whether opportunities to engage in near-peer teaching alone is sufficient enough to develop the skills relevant to demonstrating that appropriate teaching that the GMC stipulate. Both common sense and the literature would tell us that people who are taught by trained teachers outperform people who are taught by untrained educators. I think that goes some way to saying why we should be training undergraduate medical students to teach. And lastly, there is some evidence that students developing their teaching skills doesn't just benefit those they teach, the near peer learners. It also develops their own knowledge and their own preparedness for their postgraduate roles. I realise I'm quite vague saying their knowledge and preparedness for postgraduate roles. I'm happy to expand on that, Edward, if needs be, but I'm happy to be led by you.

SPEAKER_01 3:42

Why don't we explore it a little bit further in terms of the knowledge and competence side of things? What exactly do you mean?

SPEAKER_00 3:49

We could look at this from three elements. So looking at the students developing as educators and how that affects them as learners themselves, how it prepares them for their teaching roles, as well as how it might prepare them for their clinical roles. I should start by explaining that the majority of the focus of the research in near-peer learning has been on the learner rather than the near-peer teacher, which is what we're discussing today. But where students have been taught how to teach, there are a range of various resources, and I'll make some references available, that show improvements in lesson facilitation in teaching small groups and presentation skills. Again, various resources report improvement in mentoring in one-to-one situations. There are also reports of a better understanding and improved grades of the subjects that those near peer teacher students teach. So an interesting study from 2014 by Stoico et al. I found that students who studied a topic with a view to teaching it outperformed their peers who studied the topic with a view to passing the test. So I suppose that causes us to reflect on historical statements such as Socrates, you know, the best way to learn is to teach, or a French philosopher whose name escapes me, to teach is to learn twice. In terms of developing as clinicians, there was another study from 2013, again I'll make it available in the references, which looked at developing students as teachers, and they found that those students felt better prepared for their clinical roles. With all of that in mind, developing students as educators positively impacts on them, as I said earlier, as learners, teachers, and as clinicians.

SPEAKER_01 5:34

You've made a really interesting point there. Some of that will be attributable to the fact that in order to teach, you will need a higher level of understanding. Thinking back to Bloom's taxonomy, you may need to be able to integrate some of the knowledge, as it were, into a format that's processable by other people, and that might explain things to an extent, the benefits that we see with teaching. It's certainly something that seems relatively untapped, teaching as a learning tool. Is there any other thoughts around this?

SPEAKER_00 6:03

I will have put forward the argument that it develops students on those three different planes as learners, teachers, and clinicians. At the same time, it's difficult to try and separate those elements in the same way that if you take me on a communications course today to make my communication with patients better, that development is going to seep out into other aspects of my life, whether it's social, domestic, or other professional elements. And I think the same thing goes here. Just because we're looking at teaching students how to become better teachers, the sort of collateral learning that goes on there is almost guaranteed to seep out into their clinical, their academic, and their professional lives as well as their teaching roles.

SPEAKER_01 6:43

I think you've made a really good point there as well in terms of the collateral learning. Certainly when we're designing, I suppose, undergraduate degree programs, for instance, whether that's something we can try and facilitate or enhance, it's certainly something that's worth looking into. Speaking of undergraduate medical programs, we've briefly touched on the doctors as an educator module, which is something that is run by the University of Edinburgh. Given this is a relatively new approach, I was curious to hear your thoughts on your own experiences with planning and implementing the Doctor as an Educator module at the university, specifically what some of the core challenges and lessons learned from this were. And I suspect some of our listeners who are already in roles with significant medical education responsibilities might be interested as well.

SPEAKER_00 7:25

Thanks, Edward. As I say again, just to be clear, my role in that was before we had a module organizer in place, the director of the Edinburgh MBCHB at the time spoke to me about it and we discussed he had some clear ideas about what sort of things he wanted to include. Subjects such as how do we learn, how do we teach, how do we assess? These were some of the key things that he was keen to build in there. So my role really was trying to develop some core or a skeleton of lessons so that when the module organizer came on board and was employed, they weren't necessarily starting with a completely blank canvas because time was running tight. So would it be unfair to describe the first iteration of that as a bit of a pilot? I don't know, though I think the fact that you do something for the first time, it's okay to describe it. It wasn't hugely experimental, but it probably was a bit of a pilot given that it hadn't been done before. Some of the big challenges were, and I think this is this is true to other similar programs of teaching students to teach, is where do you squeeze it in into an already busy syllabus? I think that was a particular challenge where students had maybe previously seen that the students that went before them maybe had preparation weeks or study weeks, that these weeks were now being taken up with another module. I don't have anything to back there, that's up, but I do wonder if they maybe felt a little bit short-changed by that. I'm also not sure, so in terms of challenges, just how relevant some of the students maybe found it. You don't have to look very far to find evidence of students being quite exam focused by year five. You'll know better than me, Edward, but I expect that the focus is on preparing for exams and preparing for clinical practice. Being taught how to teach maybe seemed less relevant to lots of students. That said, some of the students did find it was quite a nice break from the usual routine. While there is an assessed element to the doctor as educator module, it's a formative assessment. I would describe it as fairly low stakes. So I think students coming onto that module perhaps saw it as a bit of a break from the norm, something different. It was an opportunity to be back in Edinburgh if people had been on peripheral placement without it necessarily being too onerous of a module. Some students also maybe went into it feeling like this doesn't really have a place in my curriculum right now. But actually at the end of it, we've got some nice qualitative comments such as it was worthwhile developing these skills. So I think in retrospect, people saw the benefit of it. I think it's the right thing to do, and I think the the current module organizer is I think letting the the module evolve almost with every iteration, it's certainly become a bit shorter. I think some of the topics that are taught have changed a little bit since the first iteration, and I think that's in response to student feedback. So I hope that the students do feel that they're being listened to and that the module is being developed in a way that is useful to them both in terms of its content and how it might prepare them going forward.

SPEAKER_01 10:25

Certainly, as someone who was part of the initial cohort that went through the doctors as an educator module, I personally found it to be really quite illuminating. And as someone who's really been interested in exploring medical education for a good number of years now, I felt like it was a good step forward. I suspect that as the qualitative feedback from students continues to trickle in sort of year on year, the module continued to evolve. But certainly, you know, even with the initial iteration, it was a really good experience despite having many, many, many other things to be thinking about in year five.

SPEAKER_00 10:58

Yeah, I'd say I mean I guess that goes hand in hand with some of the feedback that the module received in terms of those people like you who have got an interest in teaching, they really welcomed the opportunity to develop those skills. And many again reported that it was useful to get an insight into some of the challenges of teaching, reiterating that notion that it's not good enough just to be an expert in your field, that in actual fact teaching is a discipline in its own right worthy of higher and postgraduate training and ongoing CPD.

SPEAKER_01 11:28

Yeah. And if you think about it, thinking back to Kirkpatrick's levels, which are a set of principles used to evaluate training programs, I suspect the reaction across the cohort may have been mixed. But for the people that were really quite interested in medical education or those who are really quite keen to learn more about it and to learn how they can take it forward, I suspect for those people, some of the lessons that we picked up during the Doctor as an educator module very much enabled us to change our teaching behaviors and learn best practices in a way that could potentially result in positive results in the future when we then go on to become medical educators in our own right. Again, I think that the evidence is very much evolving at the moment just given how novel everything is, but it is a space worth looking into to keep an eye on, even over the next five years, given how quickly things are progressing.

SPEAKER_00 12:19

You're right, Edward, it is an evolving thing. I think I mentioned earlier that most of the research around developing undergraduate students as clinical educators focuses on the people that they teach. So I think looking at the impact that it has on the near-peer teachers themselves is definitely worthy of study. There are some studies out there that have looked at the impact of teaching students to teach. The ones that I've come across tend to be smaller studies. They tend to rely a bit on the perceptions and self-reporting. So I suppose there's some of the limitations. Nevertheless, when we look at the evidence on the whole, it certainly points in the direction of teaching undergraduate students to teach as being generally positive, I would say.

SPEAKER_01 13:06

We've explored in some depth both the rationale and the evidence behind early involvement in medical education, as well as some of the key challenges towards implementing this at an undergraduate level. I was wondering if I could pick your brain a little bit more and ask you if you can think of any evidence-based approaches to learning and teaching that you feel anyone who's interested in medical education should have an awareness of when planning and implementing their teaching.

SPEAKER_00 13:31

First of all, I would say that asking me to identify sort of preferable educational theories or evidence-based approaches is a bit like asking someone to identify or to choose their favourite child. There are so many theories that regardless of what your teaching approach is, you could probably find a theory or a set of principles that underpin it. For developing healthcare professionals in their teaching roles, though, there are certainly a couple of things that spring to mind. Theories that underpin adult learning principles are a good place to start. When I first started teaching, I found Malcolm Knowles' theory of andragogy useful. Again, if I can go through some of the theories and principles that I think are useful, and if you want to pin me down on any of them and ask a little bit more about them, I think that's okay. I found androgogy useful and some of the things that underpin adult learning. Lots of my early teaching was in clinical environments before moving on to sort of simulation-based education. And for that reason, I find David Kolb's experiential cycle really useful, and I think it seems to pop up, or I notice it seems to pop up a lot in the medical education literature. When we speak about teaching and learning, they they might reflect on the sort of classic lecture or tutorial. When it comes to teaching in in those environments, I think that Mayer's theory of multimedia learning is worthwhile, and that's something that I've relied on quite a lot in the past. Again, as I say, pin me down on these things if you want. Lastly, principle that I recommend to any educator, regardless of their experience or discipline, would be that of active learning. Active learning doesn't necessarily always need to mean busy, chaotic groups of vocal learners, build instructors with spaghetti and blue tack, even though I love that sort of thing. It can still be active learning where we've got students or or learners, learning as individuals in isolated activities where there may be deepened contemplation, reflection, or creative thought. Anything that requires activation of the cognitive processes rather than being a passive recipient of information, I think is key. It's interesting actually that you ask me about evidence-based practices or theories. I'm absolutely in favour of evidence-based teaching approaches. That said, I think if you were to ask any established teacher, or more importantly, ask any learner what really matters in teaching and learning, they'll probably always come back to something about strong relationships, rapport, mutual respect and trust. And I think for that reason, my view is that regardless of what sort of evidence approaches somebody wants to apply to their teaching, I think that good teaching really actually comes from the heart. And it relies on warmth, humility, and the other sort of non-technical aspects of teacher integrity, I would say.

SPEAKER_01 16:22

I think that was really beautifully put, Ian. And certainly, you know, just going off that quip of yours, it seems as though you've got a number of favourite children here, which I think is fair enough. It's been a real pleasure having you on the podcast. Some of the key takeaways from all this are that good teachers are good learners, and that teaching students to teach is valuable because it enhances their learning as well as their own competence at performing educational roles, roles that are very much expected of them by regulatory bodies like the GMC. It can be difficult to implement formal teaching programs around teaching in a busy undergraduate curriculum, but it may be worthwhile trying to achieve this despite it being more time and labor intensive. It might just be worthwhile trying to supercharge your students' ability to learn by teaching them to teach. And lastly, that good educators probably do need to be taught formal medical education principles for implementation in their teaching so as to enable them to be effective, but that that should never really take away from the human aspects of teaching. Would you say that's fair?

SPEAKER_00 17:24

Yeah, I think that's an excellent summary, Edward. So much so that I don't think I've got anything to add to that. Thank you very much, and thanks for having me along today.

SPEAKER_01 17:31

Ian, it's genuinely always a pleasure to have you on. If anyone would like to leave any feedback on this podcast, or suggest further topics that you might be interested in, then do reach out through the RCPE Trainees Members Committee Twitter account. Alternatively, we'd welcome any contact through our website or emails too. Thanks very much for listening.