Teaching as a Medical Student (12 July 2024)

SPEAKER_01 0:13

Welcome to this episode of the RCPE Student Conversations Podcast titled Teaching as a Medical Student. My name is Edward Fu, final year medical student at the University of Edinburgh and student observer on the RCP Trainees and Members Committee. Today I am delighted to be joined by Reagan Lee, fifth-year medical student at the University of Edinburgh and an associate fellow of the Higher Education Academy. Reagan has been involved in various medical education projects through the Edinburgh Medical School and various student societies. He has worked on integrating components of social sciences and ethics into the MBCHB curriculum. He is also involved in the Accessibility in Medicine or AIM Society as previous tutorials lead and current president, and as a previous tutorials coordinator for the Edinburgh University Cardiovascular Society, organizing and teaching tutorials tailored to various groups of preclinical and clinical year medical students. Reagan, it's genuinely always a pleasure to be here working with you. I hope you won't mind me embarrassing you slightly here, but you are quite plainly one of the most prolific medical students I know out there when it comes to conducting teaching, both in terms of actual student facing teaching roles as well as the actual planning bits as well. In fact, that's probably how we first got to know each other really. So why don't we jump right into it and focus on the actual student facing teaching to begin with? When you agree to do a tutorial, what goes through your head and how do you prepare?

SPEAKER_02 1:32

Thanks for inviting me to this podcast today and that really flattering introduction. It's a pleasure to be chatting to you about this. So about your question, just a disclaimer that whatever I say next is from my personal experience tutoring students and an interpretation of whatever literature that I've read over the years. On broadly student-facing teaching, I feel that the most important points for a tutor to know is what your students want, and by association, what you think your students want, how you're going to achieve that. So on what your students want, it's pretty well known that most students want to one pass exams to get better at what they're doing and learn more, which is idealistically more in the vein of what you think your students want. Judging by how the attendance in my tutorials always increases nearer to the exam period. I think most but not all students have generally voted with their feet on what they feel about this. So we have to be realistic in achieving aim number one, ensuring that the long-term effect of aim number two is somehow met. So, what we can do to achieve this, regarding planning the curriculum in line with the first aim, we need to know what's coming up in their next exams, and this can be done through personal experience or working with the medical school, which I've done so by requesting copies of their curriculum before planning any teaching. This can be used as somewhat of a course C on where you can estimate the ballpark the content is going to fall in. The fine sieve on how to limit your content given the limits of your session comes with your own personal experiences in your exams and your decision on pastworks exams, as this is the most valuable tool you can use to identify the high-you things. This case being so, you have a better idea of the hidden curriculum compared to others, and this includes the small things, approaching a patient from their right side in OSCE, talking through your findings or examining someone or small things like that. On the flip side, regarding using learning objectives from a medical school to plan teaching, it's always worth considering the resources available to students where pitfalls can include going through things that students already know through either the uni teaching or medical revision applications that shall not be named without value adding in terms of improving clarity or knowledge. So the key point here is that we should always aim to have students leaving with a better baseline of knowledge or a clearer understanding that they can apply. Regarding fostering long-term learning, we just have to understand that everyone has their interests. People may just be there to pass exams and they just want to attend your tutorials to do that. However, this is mostly an issue to resolve through execution of the session itself.

SPEAKER_01 4:02

Yeah, no, I think you've raised a number of like really good points that, as I'm sure you've kind of picked up by now, a lot of the times when we do these tutorials close to exam season, it is fairly close to when we do our exams as well. And often it's trying to learn the balance that's likely. Given the obvious time constraints with having to do your own education while also educating other people, I was wondering how you tend to structure sessions given you've not got a huge amount of time to try and fit so much content in.

SPEAKER_02 4:29

On structuring sessions, I feel that one to two hour session should be sufficient with more time being inversely related to the level of interest your students will have regarding your content. I personally feel that there's not really a set right way to parcel your session time-wise, as different topics within your session will require different levels of attention. But it's really important to introduce what you're going to achieve and go through those points again at the end with key takeaways that students want to get out of the session. So 5 to 10 minutes should be enough at the end of the session. For slides, less wordy is always a good start with a good margin to include notes at the bottom section. And pictures are always good, but I've noticed that through my own personal experiences, people often forget to annotate the pictures, so remember to annotate them and always remember the issue of accessibility where clear color scheme and large fonts should be used for readability. On general format of a session, I am a huge supporter of experiential application of knowledge where interactivity is the key to the success of one session. This can be seen in Bloom's taxonomy, where the higher the levels of application of knowledge, the better, or the higher the level of knowledge is. So generally speaking, I feel that if you don't have people's attention at a 15-minute mark, you have probably lost them forever or for however long your tutorial is. I feel that students learn best through experience, similar to how I remember getting a consultant's question wrong a year ago, and my aim is to simulate these events but less traumatically and in a space where one will feel that you will not be judged. Before going to detail regarding that, an important thing to note: students absolutely hate being picked upon or singled out to answer questions, and forcing engagement is quite counterproductive, especially in large groups. Personally, I like writing out MCQs or short answer questions where students can answer electronically or anonymously through a link on their phones. And I like to space the questions out throughout the tutorial, perhaps every 7 to 10 minutes, to keep my audience's mind active throughout the tutorial. And this can naturally allow you to gauge the difficulty of your content as well. And you can visually tell how many people are understanding the content you're speaking about based on their scores. And I like about the 50 to 60% score rate in terms of correct answers, as it really means that there's some challenge to the question, but a good majority of the people are managing to follow the concept you're explaining. The explanation from the tutor should cover the rest of the people who don't get it.

SPEAKER_01 6:51

As tutors, we are quite encouraged when we see very, very high right answer rates, but that actually probably doesn't introduce the level of desirable difficulty that we want to into these sessions, which we know is a good way to get people to learn. Essentially, they need to be difficult enough for students to be engaged and to learn from it while also being encouraging enough for them to keep remaining engaged throughout the session.

SPEAKER_02 7:10

Yeah, that's true. A balance needs to be achieved in that respect. You don't make your questions too hard or people will simply just get it wrong and not have any idea what's going on. On that point where students may have some questions regarding the content that you're covering, I feel like I prefer answering as I go with the tutorial. It's really a personal preference. If someone has a question, it's better for them to raise it immediately to get it clarified instead of waiting to the end and they might forget about the point that they were wondering about.

SPEAKER_01 7:37

We're gonna step away from that slightly and talk a little bit more about near-peer teaching in general. Students teaching other students isn't really a new phenomenon. It's been around for quite a long time now. But that's it. What I fairly recently recognized through interacting with various members of the medical education community from across the various different UK medical schools, is that the different schools all seem to adopt slightly different approaches to students teaching students in terms of the extent to which the faculty are involved in planning the actual teaching itself. So in Edinburgh at least, a lot of the actual lesson planning for extracurricular lessons is actually student-led. For instance, the tutorials helped by Accessibility in Medicine AIM, which are part of all the various Edinburgh Cardiovascular Society tutorials we've done over the years, all of those were student planned as it were and student taught. And I was wondering if you have any thoughts in and around kind of why this is.

SPEAKER_02 8:26

I'm not sure for other medical schools, but I feel that in the University of Edinburgh, Edinburgh Medical School, the culture around here is really permissive and supporting with regards to medical education. This is shown through various modules that the school have organized for us, especially in fifth year. So we have the Doctors and Educator module and SSC5 teaching project where Edinburgh medical students are trained one way or another to carry out and plan teaching. And this really provides us with a good basis, at least in our medical school, to carry out teaching and plan and design sessions that may benefit your audience. So other programs within Edinburgh Medical School that certainly has helped me with learning to teach would be the UGCME program, where I feel that the basics of teaching were instilled in me at an early stage as well. It really helps to foster good practice in medical students who are at an early stage interested in teaching. Another aspect would be the support that the school has given us for the AFHCA, which is the Associate Fellow of the Higher Education Academy, where we get support from our UGCME mentors supporting us for the application. And I feel this really incentivizes students from Edinburgh Medical School to teach more and to improve their skills. Another aspect that I would like to highlight in Edinburgh would be the willingness for the teaching organization to help student societies to provide various curriculum points which allow us to plan our teaching around them and advertise our events as well.

SPEAKER_01 9:48

In a nutshell, you've kind of described why teaching, students teaching students is such a common thing here in Edinburgh, you know, and some of the systemic reasons behind that. I was wondering from your point of view as well, whether there are any challenges that you've kind of faced in terms of organizing teaching, say, for example, through your involvement in AIM and what sort of advice you would give to other medical students who are keen on the idea of planning some teaching of their role.

SPEAKER_02 10:09

Of course. I have quite a long list of challenges regarding organizing teaching. The organization of teaching really takes a top-down approach as opposed to directly organizing perhaps one session. So I think the first aspect that we have to cover is curriculum development. So we need to pitch it at the correct level, especially since, for example, preclinical students have not done preclinical work in quite a while. And we need to tailor the curriculum of our tutorials to that group of students. And I think that's one of the more difficult challenges that I face because obviously I haven't been studying preclinical concepts in a while, and the curriculum has changed, especially since the introduction of the UK MLA as well. There are a few ways that I've tried to address this challenge, consulting students from earlier years just to get a better idea of how they find their curriculum and key points of which they would find useful to cover in a revision tutorial. Another aspect to address regarding challenges is to decide whether a tutorial would be in person or online. And I think since COVID has blown past, at least most of the COVID period has blown past, we have transitioned more to in-person learning instead of an online environment. And it really depends on the content as to which modality we choose because you can't do some things in person, such as OSCE practice. It would be a nightmare to go through an OSCE examination of the cardiovascular system online, as there's simply no way to practice the physical skills that's required for that station. Other things such as theoretical content, more prevalent in the preclinical curriculum, I think that would be more suitable for an online session. Another challenge that I felt was particularly relevant would be recruitment. So it really depends on who's interested in teaching. I understand that different medical schools will have a different environment regarding that, and therefore it can be hard for people from other medical schools to find tutors. In the case of Edinburgh Medical School, the peers I've worked with have all been excellent and they have all been quite proactive in volunteering for recruitment. But this is a potential problem that other people may face, but I can't really comment too much into that because I've not faced that problem personally. The next aspect would be publicity. I find that quite difficult because it's basically getting people to attend your tutorials and how you sell it to them. It can be quite difficult without a dedicated person to do such a task. At the end of the day, sometimes the task has fallen to me and I have to advertise the tutorials that I run on all the group chats, and it can be quite daunting, especially if you don't get warm response, particularly at the start of the year before exams. Some other aspects regarding challenges would be communicating with tutors. You have to be really clear with the learning objectives at the beginning when you organize the curriculum. If not, if you don't give tutors a clear set of instructions, they might just go off tangent and cover more or less than what's necessary. Another aspect would be how to achieve it. So if you want your tutorial to be interactive, you have to specify to your tutors just to make sure that the expectation is out there, just to ensure that what you envision within your original plan is carried out. But I understand this might be quite tough as different people have different styles of working, and it really depends on how you communicate with the people you work with. A few other challenges that I can think of would be planning for unexpected events. People can cancel on you last minute, you can't get a venue last minute, or something happens and you have to postpone the tutorial. Success really depends on how you react, and I can't really give much advice on that.

SPEAKER_01 13:36

One challenge that maybe you've not mentioned is with regards to feedback.

SPEAKER_02 13:39

So yeah, that's true. Feedback is quite a challenge. Sometimes you put a feedback format and people don't really respond to that. It does require a bit of creativity regarding obtaining feedback. A year ago, a person I worked with suggested holding the resources that we created as hostage in exchange for the feedback. I'm not sure how ethical that is, but it definitely worked in that context. Feedback's hard to get. Always make sure that your students know the importance of the feedback and the role it takes in improving your teaching.

SPEAKER_01 14:08

I think it's been quite pragmatic there in terms of mentioning some of the challenges. For those of us out there who are keen on doing teaching, what sort of advice would you give us?

SPEAKER_02 14:17

I feel that anyone can do teaching as medical students. We we all do it in some form or another. As clinical medical students, we just do peer practice, OSCE preparation, and that's really one of the examples that medical students do teaching regularly. The biggest piece of advice that I would give to medical students who are interested in teaching and wanting to plan, for example, a series would be just to start small. So they can start with potentially one session with a small group and work their way up slowly. That's not really a hard and fast rule on how you do teaching, but my advice would be just to start slowly and work your way up and you can do big things from that.

SPEAKER_01 14:53

Yeah, and I think you know you've highlighted a really good point that you just need to start and then things will kind of come along in and around that. So thanks for that. We've got a bit more time to delve a bit deeper and I wanted to pick your brain specifically on how your approach differs depending on you teaching different subjects or the teaching modality being used. For instance, how the tutorial targeted towards students in preclinical years differs from one that's targeted more towards students in clinical years, and also you know whether there's any difference between online and in-person tutorials in your experience.

SPEAKER_02 15:25

Basically, we want to look at the academic assessment format at each part of the course. Regarding the preclinical aspect, we need to understand that not all medical schools have this preclinical. Some medical schools do mix in clinical with preclinical work. Regarding medical schools that start purely with preclinical curriculum, it's mainly focused on road learning and it's exam-based. It may also involve a bit of um spot the correct anatomy part in that sort of format regarding their exams. So we can only do so much through passive learning, for example, through lectures. The preferred format to enhance preclinical learning in the context of extra-curricular tutorials include stepping up levels of learning regarding the use of MCQs, anatomy spot questions, anything to simulate an exam. This really involves putting questions out there for your students to do and giving feedback on it. Regarding the clinical curriculum, where it's mainly based around OSCIS and written exams, it's not too much different from planning around the preclinical curriculum. So the only difference is the inclusion of more clinical-style questions and presentation of content regarding etiology, epidemiology, presentation, investigations and management, and the use of patient vine acts or cases. Regarding the OSCE aspect of clinical years, the only way to get better is to practice. I appreciate we can't really give everyone personalized feedback in a large group. If we're doing OSCI revision session in a larger group, we need to explain more on what to look out in terms of a lecture format, and that's unavoidable. The best case scenario would be just to do a session in person, get them out there, see what these students do in the context of an actual OSCE station and give them feedback. Regarding the clinical curriculum, there's quite a focus on the hidden curriculum. People might know of what to do in the context of an S-bar, but they might not know the exact details on how to keep it short and concise. Or talking through their findings on an examination station in an OSCE. These things would be quite important for a clinical student to know. Regarding online sessions, it's quite easy to organize. You just really need an online link and slides. Some disadvantages can include limited interactivity because everyone's anonymous, you're speaking to a laptop or computer.

SPEAKER_01 17:36

Yeah, speaking to the voicemail.

SPEAKER_02 17:37

Yeah. You can't do anything physical at all. So you can't do an OSCI station, you can't do examinations. Taking a history may be a bit weird compared to what you're used to in an exam. Accessibility is excellent because you have a Wi-Fi connection and you can just do it anywhere. Regarding in-person sessions, it provides really good interactivity. You can cover all sorts of content regarding OSCIS. You can also monitor your participants' body language. You can really sense the mood in a room whether someone's getting bored, and you can take steps to address that, perhaps asking them some questions or something like that. Some disadvantages can include logistics, so you need to book a place, you need to get equipment in, and there are more moving parts to the plant, so things might go wrong on a day. It's not really convenient if someone's off on a peripheral placement.

SPEAKER_01 18:24

I definitely resonate a lot with what you've mentioned there, and you've provided some really good insights. I don't know if you remember kind of the more narrative-driven online tutorials that we tried last year as part of the Cardiovascular Teaching Series, the one where we kind of based our tutorials around the medical student experience. There is a lot of space for medical students to drive innovation within teaching, irrespective of whatever modality of teaching you end up trying to adopt, whether it's online or in person. As with most things, I think knowing the right way to teach a certain subject is probably key and it does unfortunately come with experience. So putting yourself out there and starting, I think, is important. The last thing to say, I guess, is regardless of how talented an educated you are, it's probably quite impossible to say teach the cardio exam online through Microsoft Teams or something like that.

SPEAKER_02 19:06

Yeah, that's definitely true. I remember the format working really well as it contextualized and allowed us to put yourself in the situation of a doctor on the ward and work through the problems from there.

SPEAKER_01 19:17

Well, it's been a real pleasure having you on the podcast, Reagan. And I suppose some of the key takeaways we've discussed to have a structure in terms of planning your sessions and knowing that certain subjects warrant more attention than others and structuring on that basis, being a bit flexible in terms of the modality that you apply and being conscious that different modalities, whether it's online or in-person, have their own pros and cons. It's not as though online teaching is always less good than in-person teaching. It very much depends on what you're trying to achieve. Being willing to put yourself out there, innovate, and really start teaching, because that's how you get good, as it were. Well, Regan, it's been a real pleasure, as always. And I do hope that our listeners have learned a thing or two about planning and executing teaching as medical students are hopefully now encouraged to put themselves out there and really get involved in teaching as well.

SPEAKER_02 20:01

Thanks for inviting me to this podcast. I hope everyone will get some key takeaways from this session. And good luck to everyone.

SPEAKER_01 20:07

Yeah, all the best to everyone. If anyone would like to leave any feedback on this podcast or suggest further topics you might be interested in, then do reach out through the RCP Trainees and Members Committee Twitter account. Alternatively, we welcome any contact through our website or emails too. Thanks very much for listening.

SPEAKER_00 20:31

The TNMC Sister Podcast, Career Conversations, which supports medical students and trainees with career guidance and progression as well as professional development. We wish to recommend our Demystifying PACES podcast series on career conversations. As some of you may know, in late 2023, MRCP UK updated the PACES exam format. So we developed this new series to support PACES candidates. Episodes cover exam organization, calibration, every PACE citation, including key changes and candidate perspectives.