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 Table of Contents  
ORIGINAL RESEARCH PAPER
Year : 2012  |  Volume : 25  |  Issue : 3  |  Page : 135-140

Medical Students as Learners: Transforming the Resident-Level Microskills of Teaching into a Parallel Curriculum for Medical Students to Aid the Transition from Classroom to OB/GYN Clerkship


1 Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, USA
2 Department of Psychiatry, Yale University, New Haven, Connecticut, USA

Date of Web Publication29-Mar-2013

Correspondence Address:
Jennifer MH Amorosa
Department of Obstetrics and Gynecology, 622 West 168th Street, PH-16, New York, NY-10032
USA
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Source of Support: Funded in part by the Center for Education Research and Evaluation, Columbia University Medical Center., Conflict of Interest: None


DOI: 10.4103/1357-6283.109766

  Abstract 

Introduction: The objective of the study was to describe and assess a brief curricular intervention designed to help medical students adopt active learning strategies. Methods: Based on student interest, we created a one-hour workshop that focused on seven microskills of learning and presented it to our medical students during their Obstetrics and Gynecology clerkship. The workshop utilized a modified version of the "Five-Step 'Microskills' Model of Clinical Teaching" first described by Neher in 1992 and paralleled the model our residents are taught as part of their "Resident-as-Teacher" curriculum. Students were surveyed at various time points following the workshop to evaluate the perceived usefuness, value, and durability of the skills taught. Results: Immediate postworkshop feedback was favorable with 93% of students expecting to use the skills taught. At the end of the rotation, students reported a significant increase in usage of each microskill via a retrospective pre/postquestionnaire. While response rates at 1, 3, and 6 months after the rotation were moderate, the majority of the students responding stated that they had utilized the microskills. Conclusions: In its pilot year, the Microskills of Learning workshop was a beneficial addition to our clinical clerkship curriculum. By utilizing a parallel curriculum to that of our residents, the workshop mutually enhanced the educational process by encouraging teachers and learners to speak the same language.

Keywords: Adult learning, medical education, medical students, microskills, one-minute preceptor


How to cite this article:
Amorosa JM, Graham MJ, Ratan RB. Medical Students as Learners: Transforming the Resident-Level Microskills of Teaching into a Parallel Curriculum for Medical Students to Aid the Transition from Classroom to OB/GYN Clerkship. Educ Health 2012;25:135-40

How to cite this URL:
Amorosa JM, Graham MJ, Ratan RB. Medical Students as Learners: Transforming the Resident-Level Microskills of Teaching into a Parallel Curriculum for Medical Students to Aid the Transition from Classroom to OB/GYN Clerkship. Educ Health [serial online] 2012 [cited 2020 Nov 30];25:135-40. Available from: https://www.educationforhealth.net/text.asp?2012/25/3/135/109766


  Introduction Top


The transition from the preclinical to the clinical years of medical school provides a formidable, albeit eagerly anticipated challenge for medical students. It requires students to move from the theoretical realm to the practical, clinical phase of the medical school curriculum. [2],[3] This transition has previously been described as "shock of practice". [4] The students' learning landscapes are no longer dominated by full days of lecture followed by evenings spent studying; nor is evaluation based solely on standardized examination scores. Instead they are expected to learn "on the job"- by participating in the diagnosis, care, and management of patients. Most teaching takes place at the bedside, in the hallways, or in the operating room. Evaluation methods become much more subjective, and are often based on limited interactions and short-term working relationships with interns, residents, and attendings. Some students make the transition easily and quickly, while others struggle through the clinical year, searching for a paradigm to guide their learning strategies.

In the traditional model of training in the United States, it is well established that residents make a major contribution to medical student education in the clinical years. Students estimate that residents provide approximately 25-33% of the teaching on clinical clerkships [5],[6],[7],[8] while residency directors place this estimate much higher. Each year the obstetrics/gynecology department of the Columbia University College of Physicians and Surgeons in New York City addresses the contributions of residents to medical student education by conducting a series of Residents-as-Teachers workshops for the house staff. During one workshop, the Microskills of Teaching, which are based on the One-Minute Preceptor work of Neher et al. and adopted by the Association of Professors of Gynecology and Obstetrics (APGO) in the US in their "Effective Preceptor Series", were presented [1],[9] [Table 1]. The one-minute preceptor concept, which uses five "microskills" to facilitate efficient clinical teaching, was initially designed for use in busy ambulatory practices. It uses the microskills to help the mentor guide the teaching interaction and has been well described in the literature. [10],[11],[12],[13],[14],[15] Themedical students often attend the resident lecture series and were present for this particular session. Interestingly, the medical students were extremely engaged in the discussion and participated enthusiastically in the session. The students pointed out that many of the skills taught in the workshop applied to the learner as well as the teacher in that they promoted an active and proactive approach to learning. These were not skills that they had necessarily needed during their preclinical years, but skills that they had discovered through trial and error were necessary for success on the wards.
Table 1: Microskills of clinical teaching as designed by Neher et al.[1]

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Given the students' enthusiasm during the resident-as-teacher lecture and knowing that the skills required for medical students to become successful learners on the wards are substantially different from those required during the preclinical curriculum, we set out to create a workshop that would help third-year students become more effective learners on their clinical rotations. Our goal was to make the implicit explicit by providing third-year medical students with a model for active learning in the clinical setting. We based our strategies on adult learning theory, [16],[17],[18],[19],[20] and modified Neher'sMicroskills of Teaching to include some initial preparatory work such as assessing the learner's prior knowledge and setting a goal for the encounter. Additionally, we included time for reflection at the conclusion of a learning experience to create the "Seven Microskills of Learning" [Table 2], a curriculum parallel to the Microskills of Teaching that the residents are taught. In the setting of a lunchtime workshop, we presented the skills to the students via an interactive and multi-media presentation and then asked the students to apply the skills to a fictional case as a way of immediately reinforcing the skills taught. Since this is one of the first times in the literature that a resident-as-teacher curriculum has been transformed into a corresponding curriculum for medical students, we wanted to be rigorous in its implementation and evaluate its usefulness. The purpose of the present study is to describe the structure of the pilot program and report on the evaluation of one cohort of medical students' experiences.
Table 2: Microskills of clinical learning

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  Methods Top


Context

The study was conducted in the Ob/Gyn department at a single, private, urban, Northeastern US medical school.

Participants

The study subjects were third-year medical students rotating through their core Ob/Gyn clerkship during the 2008-2009 school year. Ten groups of approximately 6-9 students per group participated in the study over the course of the year. While not required, attendance was encouraged and 76 of86 eligible students chose to participate. As a curricular intervention, the study was exempt from Institutional Review Board approval.

Workshop materials

The core content of the workshop was presented via a PowerPoint presentation that first described the Microskills of Learning [Table 2] and then led students through a fictional case to which they could apply the microskills they had just learned. Additionally several video clips were shown to further illustrate the microskills. The videos were created at our institution, with scenarios realistic to our clerkship. In addition, the primary actors in the video clips were two Ob/ Gyn residents who were in the program at the time, which seemed to give the videos particular relevance for the student audience. At the conclusion of the workshop, the students were given a pocket card outlining the Microskills of Learning.

Program evaluation tools

Several self-report surveillance tools were designed and developed to evaluate the program. The initial perceived value and effectiveness of the workshop was assessed through anonymous surveys using both Likert scales and free text queries immediately after the seminar. Students were asked to respond via a 5-point rating system to the following three statements:

  • The workshop was relevant to my clinical learning as a medical student.
  • I expect to use the skills I learned in the workshop.
  • I would recommend this workshop to other medical students.


Additionally, a retrospective pre/postquestionnaire was designed to assess any overall change in learning behaviors from preintervention to postintervention. Essentially, the students were asked to rate how often they used each microskill, both from their recalled perspective prior to participating in the seminar and after they had explicitly been taught the material. Each item was coded from 1 (= strongly disagree) to 5 (=strongly agree). This questionnaire was first utilized with the third rotation group as we realized the need to include a measure of behavioral change in our evaluation of the program.

Finally, an electronic survey was created with questions related to the students' retention and usage of the skills taught in the workshop. Specifically, the students were asked the following questions:

  • Please name or describe as many of the Seven Microskills of Learning as you remember.
  • Have you applied any of the Microskills of Learning to your learning experiences on the wards?
  • If you have used the microskills, please describe how.


Procedures

The one-hour workshop was taught midway through the five- week Ob/Gyn core clerkship and was repeated for each of the ten rotation groups. Each session was strategically timed to take place at the mid-point of the rotation, coincident with the time at which students received mid-clerkship feedback. Our thought was that the students might be able to use the microskills to improve on any shortcomings identified at their mid-clerkship feedback session. The lunchtime seminar began with an introduction of the workshop's co-presenters (the clerkship director and a 4 th year medical student with a master's degree in teaching) followed by an explanation of the workshop's origins. From the beginning of the session students were encouraged to participate and ask questions freely. The seven Microskills of Learning were presented in detail and then the students were asked to apply the Microskills to a fictional case. At the end of the workshop, the students were given a pocket card outlining the Microskills to take home. Post workshop evaluation took place immediately after the workshop (perceived value and effectiveness), 2.5 weeks later at the end of the clinical rotation (retrospective pre/ postquestionnaire) and at 1, 3, and 6 months postworkshop (electronic survey regarding retention and usage).

Analysis

Data collected immediately after the workshop was analyzed to determine what percentage of students responded favorably to each question. Numeric data from the retrospective pre/ postquestionnaire was analyzed using the students paired t-test to determine how often students used the various microskills before and after they had participated in the workshop and to determine if any statistical differences existed. Finally, for each time period, the data from the first questionnaire item (Name the Seven Microskills of Learning) was compiled into a master list and the number of times that each microskill was named was calculated. The second question generated a yes or no answer, leading to a straightforward calculation of favorable responses compared with responses on the whole. Responses to the third question (Describe how you have used the microskills) were coded for the number of times each microskill was mentioned using a variant of grounded theory [21],[22] and frequency counts. One researcher (JA) initially read a sample of responses from the first time point and developed an initial coding scheme based on the microskills. A second researcher (RR) worked with the first investigator to review the codes. Each comment was then analyzed for one or more codes. When consensus was reached, the remaining comments from the other time points were coded jointly by these two investigators.

Participation in the follow-up surveys was both voluntary and anonymous with no identifying information included on the surveys so that students could not be linked to their answers. Numeric data was analyzed using SPSS version16.


  Results Top


All of the students who participated in the workshop (n=76) completed an initial survey, and the vast majority of the students responded favorably to the learning experience of these respondents, 72 (95%) either agreed or strongly agreed that the workshop was relevant to their clinical learning as a medical student; 71 (93%) agreed or strongly agreed that they expected to use the skills presented in the workshop; and, 72 of the participating students (95%) agreed or strongly agreed that they would recommend the workshop to other medical students.

For the retrospective pre/postquestionnaire, 50 out of 59 (85%) students participated. Students uniformly reported more frequent usage of each behavior associated with a microskill after the workshop when compared with prior to the workshop. All pre/post mean differences for each of the seven questions were significant - with each meeting the more conservative Bonferroni-adjusted threshold P-value level of 0.007 [Table 3]. The largest changes were associated with how often students felt they were committing to a position and asking for feedback (mean difference of 0.76).{Table 3}

Frequency count data of the thematically-coded mentions of microskills from the electronic follow-up surveys is presented in [Figure 1] and [Figure 2]. At 1, 3, and 6 months, 38 (50%), 30 (39%), and 27 (36%) of the students who had participated in the workshop, responded to the electronic surveys. Due to the anonymous nature of the survey methodology, we could not track respondents longitudinally over each time period. While the overall response rates were moderate, the majority of the students who did respond stated that they had used the skills taught in the workshop (76%, 70%, and 56%, respectively). When asked to name the microskills, the skills mentioned most frequently across all three surveys were "assess prior knowledge/set a goal for the encounter" and "ask for feedback". Not surprisingly, when the students were asked how they had used the microskills, the above microskills were again most frequently named.
Figure 1: Name the Microskills of Learning

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Figure 2: Describe how you have used the Microskills of Learning

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  Discussion Top


Based on student enthusiasm for a resident training session, we took a well-established teaching paradigm (the one-minute preceptor) and transformed it into a set of learning tools for medical students to use on the wards. By giving students a paradigm for learning in the clinical setting we hoped to help them become more active and confident learners.

Students not only found the workshop useful,but they also reported a change in their learning behaviors, particularly in the areas of asking for feedback, setting goals for an encounter and committing to a position. While the changes in behavior are self-reported and not independently observed, such reported changes do suggest that even a brief intervention can have a positive and lasting impact on learning.

In extremely dynamic and busy surgical fields such as Obstetrics and Gynecology, formal teaching rounds are often brief at best and feedback is many times given on the fly, if at all. Students must learn how to proactively guide their own clinical learning experiences as well as to ask for productive and useful feedback. The Microskills of Learning give students a series of explicit learning tools that they can use to do so.

The Microskills are consistent with current learning theory which suggests that students learn by "constructing" their own knowledge of a topic, as opposed to being passive recipients with instructors perceived as dispensers of knowledge. [17] Within a constructivist paradigm, students are responsible for their own learning by taking an active role, while teachers serve as mentors and guides. Our model not only equipped our students with a systematic approach to active learning; it also acknowledged the need for a common language between learner and teacher.

Medical students who are new to the wards face a new learning paradigm, and also a new set of usually inexperienced teachers (residents). The Microskills of Learning model parallels the Microskills of Teaching that residents in our and many other institutions and specialties use, thereby giving both groups similar methodologies by which to teach and learn.

Limitations

In evaluating the initial year of our program, we only asked students if they noticed any behavioral changes in their own learning patterns. We did not ask residents and attendings to comment on any changes that they noticed in the learning styles of their students. Additionally, we cannot comment on the actual efficacy of the intervention. We assume that students who adopt a more active learning style will be more successful in their clerkships; however, we did not compare the evaluations or grades of students who participated in the intervention against students from a prior year who did not participate in the intervention. Finally, our study was performed at a single medical school during a single clerkship (Ob/Gyn), which generated a relatively small number of participants. While it could be argued that the results may not be generalizable to other clerkships, our own institution will be incorporating the workshop into the curriculum for all of our medical students at an early point in their major clinical year.


  Conclusions Top


During the preclinical years of medical school, students historically are subjected to a multitude of lectures, rote memorization, and book learning rather than experiential learning. This routine changes drastically when students begin their clinical clerkships, and many students may initially have trouble making the adjustment to the more active learning style that is required to be a successful learner on the wards, particularly on extremely busy services such as Ob/Gyn. The Microskills of Learning seminar transformed a set of well-established teaching principles from the Resident-as-Teacher literature (one-minute preceptor) into a series of tools for medical students to use in making the transition from the classroom to the clinical clerkships. Students in our school found the curriculum useful and noted changes in their own learning behaviors following the workshop. While the intervention was brief in nature, the implications for practice are clear: A focused session on learning skills can be helpful for medical students as they enter the major clinical year and begin to navigate the unchartered waters of the clinical wards. Our workshop was tailored to be given during the Ob/ Gyn clerkship, but is germane to all medical specialties. When given in parallel to the Microskills of Teaching training that residents receive, it can help to create a common language between teacher and learner.[23]

 
  References Top

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5.Barrow MV.Medical student opinions of the house officer as a medical educator. J Med Educ 1966;41:807-10.  Back to cited text no. 5
    
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11.Salerno SM, O'Malley PG, Pangaro LN, Wheeler GA, Moores LK, Jackson JL. Faculty development seminars based on the one minute preceptor improve feedback in the ambulatory setting. J Gen Intern Med 2002;17:779-87.  Back to cited text no. 11
    
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16.Brooks JG, Brooks MG. In search of understanding: The case for constructivist classrooms. Alexandria, Virginia: Association for Supervision and Curriculum Development; 1993.  Back to cited text no. 16
    
17.Biggs J. Teaching for quality learning at university. 3rd ed. The Society for Research into High Education. Berkshire, UK: Open University Press; 2003. p. 22-6.  Back to cited text no. 17
    
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21.Ginsburg S, Regehr G,Stern D, Lingard L.The anatomy of the professional lapse: Bridging the gap between traditional frameworks and students' perceptions. Acad Med 2002;77:516-22.  Back to cited text no. 21
    
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    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 2]



 

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