Elective in primary care medicine and teaching

Awardees: Kristen Goodell (HMS), Barbara Ogur (HMS-CHA), Sara Fazio (HMS-BIDMC), Barbara Gottlieb (SPH/HMS-BWH), Valeria Pazo (HMS-BWH), Colleen Farrell (HMS), and Lydia Flier (HMS)

Summary: Awardees will pilot an advanced elective in primary care medicine and teaching, where senior medical students tutor junior medical students in clinical skills, with assessment of its benefits to both students enrolled in the elective and the junior students they tutor.

Kristen Goodell and team aimed to incorporate peer-teaching strategies—which evidence suggests can improve cognitive gains, increase collegiality, and increase student satisfaction—in medical education. They leveraged the recent revision of the HMS curriculum to pilot a course employing two forward-thinking features together for the first time at HMS: a multi-year primary care experience and near-peer teaching. The course provides an opportunity for senior students to return to their primary care continuity clinics as tutors, ensuring longitudinal experiences with their patients while developing teaching skills. The course, which piloted in AY16, consisted of:

  1. eight 2-hour training sessions on pedagogical principles, including observation and feedback, incorporating evidence-based medicine, and the creation of compelling large-group presentations;
  2. 2-6 clinical sessions in which participants tutored 1st or 2nd year HMS students in clinical skills such as history-taking and physical exam, including observation of and feedback to their junior colleagues and assisting them in creating and researching clinical questions based on the patients they have seen; and
  3. a case-conference series in which each senior student presented a patient case involving a major topic in primary care.

The team planned to assess the success of the new course via direct observations of students with their mentees, an evaluation of their presentation and concept video, and an Objective Structured Teaching Exam (OSTE—modeled after the OSCE standard method of assessment) administered at the end of the course. The small participant numbers, however, meant there could be no sufficient statistical analysis of learning outcomes between those who enrolled in the course and those who did not.

Student and faculty testimonial about the course was positive, most notably the longitudinal relationships between junior and senior students, some of whom continue to meet on a semi-regular basis. According to medical student and senior mentor Colleen Farrell, “There is just something really special about sharing a patient encounter with someone.” These relationships were especially important, according to Bobby Gottlieb, to help alleviate some of the concerns of junior students: “Sometimes they feel like they’re in the way and not sure how to contribute. Having senior students as an extra set of hands was beneficial. I can’t imagine doing this without them now.” Farrell also felt that she learned more by simply explaining concepts to junior mentees—the exercise helped her realize that she knew more answers than she thought initially, and forced her to return to the literature when she did not. She has also received positive feedback from faculty on her teaching skills, which she attributes to this unique experience.

Awardees hope to run the course again next academic year but would like to expand the number of clinical sessions (which were difficult to schedule for some students) and have students develop concept videos as a part of their course deliverable.