Near Peer Educator SSC
The Near Peer Teaching SSC/Elective has created formal teaching opportunities for final year students. It is rapidly expanding and popular with both students and GP tutors. Students are allocated to GP practices for 4-6 weeks and assist the GP tutor to organise, plan and deliver teaching to more junior students as well as allied health professionals. They also have regular central catch up sessions and opportunities to collaborate and co-create with central academics. They also have the opportunity to attend CBME learning/teaching workshops/meetings. The assessment for the SSC/elective includes a creative enquiry piece and students are encouraged to develop a teaching portfolio and supported to apply for the QMUL SEED award. Research into the SSC has suggested an impact on the professional identity of student teachers helping them to prepare to be future doctors.
Creative Enquiry 2024
By Reem
The drawing of a medical student appearing calm but feeling anxious inside. This image is used to illustrate the internal struggle that many medical students face.
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The anxieties of medical students, especially third-year students starting clinical placements. The challenges include feeling overwhelmed, out of place, and like an imposter.
The challenges of transitioning from pre-clinical to clinical years. This can be a difficult time for students, as they are entering a new and unfamiliar environment and their role as a medical professional begins to grow.
The importance of near-peer support and mentorship. Older-year medical students can provide valuable support to younger students going through similar challenges. There is comfort in talking to older students who have been through similar experiences. Near-peer relationships can be a valuable tool for all medical students.
Imposter Syndrome: The feeling of inadequacy despite achievements can be especially prevalent in high-performing environments like medicine. Exploring its psychological roots (self-doubt, perfectionism) and philosophical perspectives (reframing success, embracing vulnerability) can offer coping mechanisms.
Hidden Curriculum: Beyond academic knowledge, medical students learn unspoken "rules" about hierarchy, professionalism, and emotional expression. This hidden curriculum can contribute to anxieties around fitting in and upholding expectations.
Resilience & Growth: While anxieties are inherent to the learning process, navigating them can build resilience and personal growth. By fostering supportive environments and equipping students with coping mechanisms, we can empower them to thrive in their challenging yet rewarding journey.
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Crossing the GP Bridge: Embracing Anxious Arrivals
The first steps onto the general practice bridge can feel precarious for medical students, anxiety humming like traffic beneath their feet. They're navigating uncharted territory, the map of pre-clinical years no longer holding sway. It's our duty, as GP guides, to anticipate this trepidation and pave the way for a smoother crossing.
From Invitations to Icebreakers:
The journey begins before the bridge is even in sight. We extend warm invitations, not sterile emails, weaving in personal anecdotes of our own student days. This sets the stage for a two-way dialogue, an exchange of lived experiences rather than a one-sided lecture. Vulnerability becomes our first offering, a bridge toll that eases anxieties by demonstrating: "We were once nervous too."
Embracing the Risk of the Real:
Medicine, like the bustling city below the bridge, is an inherently complex and risky business. Instead of shielding students from this reality, we must embrace it. Address their questions honestly, even when they expose the cracks in our knowledge. Create safe spaces where the occasional "wrong turn" can occur with grace and valuable feedback. Remember, these bumps are precisely what hone their judgment and resilience.
Tools for the Toolkit:
Equip them with practical tools: checklists for consultations, frameworks for navigating uncertainty, and even humor as a shield against stress. Foster a collaborative environment where students learn from each other, not just from us. Encourage peer support groups, informal coffee chats, and open-door policies to ensure no one navigates the bridge alone.
Beyond the Onboarding:
Remember, the bridge doesn't end with the introductory days. Ongoing mentorship, regular check-ins, and celebrations of small victories are vital. As we guide them across, let's celebrate not just their academic prowess, but also their emotional resilience, their ability to face anxieties head-on and emerge stronger, more competent practitioners.
By embracing vulnerabilities, creating supportive environments, and equipping students with the right tools, we can transform that initial anxiety into the fuel for growth. They'll cross the bridge, not just as competent doctors, but as individuals who have learned to navigate the uncertainties of medicine with grace and resilience.
The Hidden Curriculum
By Emily Taylor
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The above image compares the planned and actual curriculum in medical education, focusing on the concept of constructive alignment and the distinction between the planned and hidden curriculum.
The concept of constructive alignment, introduced by Biggs, emphasises the coherence between learning outcomes, teaching activities, and assessment tasks. This coherence is essential in medical education, where integrating knowledge, skills, and professional attitudes is necessary for forming competent and reflective practitioners. The metaphor of a jigsaw that illustrates how various components of the curriculum interlock to support the achievement of learning outcomes encapsulates the essence of constructive alignment.
The distinction between the planned and hidden curriculum is particularly relevant in medical education. The planned curriculum refers to the explicit content and skills that are formally taught and assessed, while the hidden curriculum encompasses the unwritten, unofficial, and often unintended lessons, values, and perspectives that students learn during their education. The challenge of assessing the hidden curriculum is due to its variability and personal nature, as it shapes students' professional identity and ethical perspectives.
Contemporary trends in medical education reflect a shift towards more experiential, constructivist, and facilitative teaching methods, which align with adult learning theories such as Knowles' principles of andragogy. These methods emphasise self-directed, experiential, relevant, and problem-oriented learning that fits the needs of adult learners. The constructivist theory posits that learners construct knowledge through experiences and interactions with the environment, which is particularly suited to medical education, where applying knowledge in clinical contexts is a crucial learning component.
However, there is an inherent tension between the need for structured, aligned curriculum design, the flexibility required to accommodate the hidden curriculum, and the unpredictable nature of learning in clinical environments. This tension reflects the ongoing debate within medical education about balancing the transmission of core knowledge and skills with the cultivation of critical thinking, adaptability, and professional values.
References
Dong, H., Lio, J., Sherer, R., Jiang, I., 2021. Some Learning Theories for Medical Educators. Med Sci Educ 31, 1157–1172. https://doi.org/10.1007/s40670-021-01270-6
Mackin, R., Baptiste, S., Niec, A., Kam, A.J., n.d. The Hidden Curriculum: A Good Thing? Cureus 11, e6305. https://doi.org/10.7759/cureus.6305
Mukhalalati, B.A., Taylor, A., 2019. Adult Learning Theories in Context: A Quick Guide for Healthcare Professional Educators. J Med Educ Curric Dev 6, 2382120519840332. https://doi.org/10.1177/2382120519840332
Stamov Roßnagel, C., Lo Baido, K., Fitzallen, N., 2021. Revisiting the relationship between constructive alignment and learning approaches: A perceived alignment perspective. PLoS One 16, e0253949. https://doi.org/10.1371/journal.pone.0253949
I like, I wish, I wonder
By Jonathan Chan
I like
How you explained to me
This confusing ECG
Despite the incessant ringing of your bleep
And your never-ending list of jobs
I wish
We had more time
So I could learn more from you
And know what to improve
I wonder
If I will ever be like you
Standing in your shoes
Helping other souls
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I like, I wish I wonder is actually a framework to give and receive feedback that I learnt during this SSC. I really liked the simplicity of the framework and how it helped to improve my feedback skills. I think giving constructive feedback is something that is difficult and using this framework has really helped me. Just reflecting on the times that I as a medical student have been given feedback, I know how useful constructive feedback can be. At the same time, I also understand that most professionals are busy and often do not have time to give specific feedback. I feel that using this framework has really helped me to structure how I give feedback when I was teaching the medical students and its something that I am really glad to have learnt because I know it is a very useful skill.
At the same time, this poem is also a tribute to all the people who I have met so far on my journey to become a medical professional. Despite many of them juggling many other responsibilities, they still stop to teach us medical students whenever they can, sometimes even sacrificing their free time. Going through this journey as a budding educator has made me appreciate their efforts even more now that I can stand in their shoes. I aspire to take all the lessons and values that I have learnt in this SSC and from others to become a better educator so that I can impart my knowledge to others in the future.
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In communication, feedback plays a pivotal role in fostering growth and improvement. However, delivering feedback can be daunting, often fraught with the challenge of striking a balance between constructive criticism and positive reinforcement. The "I like, I wish, I wonder" feedback system emerges as a simple yet powerful framework to navigate this delicate process.
Grounded in the principles of specificity, actionability, and forward-thinking, this framework prompts individuals to focus on three key aspects:
"I like": Identifying the positive aspects of the feedback recipient's work. This serves to acknowledge their strengths, build rapport, and boost their confidence.
"I wish": Highlighting areas that could be improved, providing actionable suggestions for enhancement. The focus remains on the work itself, not on personal judgments or criticisms.
"I wonder": Posing open-ended questions to gain a deeper understanding of the recipient's intentions, processes, and challenges. This fosters curiosity, encourages exploration, and opens the door to innovative solutions.
The simplicity of the "I like, I wish, I wonder" framework lies in its ease of recall and adaptability. The three categories, clearly defined and straightforward, can be readily applied to a wide range of feedback scenarios, from academic evaluations to professional performance reviews.
Furthermore, the framework aligns seamlessly with the principles of design thinking, a human-centered approach to problem-solving that emphasizes empathy, collaboration, and experimentation. The emphasis on understanding the recipient's perspective, asking questions to uncover their needs, and encouraging creative solutions mirrors the core tenets of design thinking.
The "I like, I wish, I wonder" feedback system also possesses a temporal dimension, looking both back and forward. By appreciating the positive aspects of the recipient's work (the "I like" component), the framework fosters a sense of appreciation and validation. Simultaneously, by encouraging critical thinking and exploration (the "I wonder" component), it paves the way for future growth and improvement.
The versatility and effectiveness of the "I like, I wish, I wonder" feedback system have led to its adoption across various domains, including education, business, and healthcare. Its simplicity, adaptability, and alignment with design thinking principles make it an useful tool for enhancing communication and fostering personal and professional development.
Other feedback systems to consider include:
The sandwich method: This feedback system involves giving a positive piece of feedback, followed by a constructive piece of feedback, followed by another positive piece of feedback. This method can be helpful for delivering negative feedback in a more palatable way.
The feedback loop: This feedback system involves giving feedback to the feedback giver, so that they can improve their own feedback skills. This can be done in a formal or informal setting.
The 360-degree review: This feedback system involves collecting feedback from a variety of sources, such as peers, managers, and customers. This can provide a more comprehensive view of the feedback recipient's performance.
The best feedback system to use will depend on the specific context. However, the "I like, I wish, I wonder" feedback system is a good starting point for anyone who wants to give and receive more effective feedback.
Reference
wonder (2023). 2061Design - I like..I wish..I wonder. [online] Google.com. Available at: https://sites.google.com/view/2061design/i-like-i-wish-i-wonder [Accessed 12 Nov. 2023].
Final year medical students: 2022
Mood board on the lived experience of the first week as final year medical students
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Diagnostic uncertainty
Professional coolness
Head spinning but grounded
Learning
Being frazzled
Burden of learning
Growth and progress
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The Patient's partner calls to request a medical certificate and medications. Worried about the weekend. The Patient is in hospital.
Consent
Autonomy: Ethics & Law
Tips and traps
The finishing line
by Zaynab Mustafa
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The drawing provided is an illustration of myself as the winner of a race crossing a finish line and
becoming a medical student. The ribbon at the finish line has the word “start” on it rather than “finish”
because although becoming a medical student is a great achievement, it is the beginning of a new
journey.
In the drawing, there are black words on the racetrack before the “start” line. These words highlight
what I expected being a medical student was like. One assumption was that choosing a speciality is
important to do from an early stage. Other smaller expectations included spending lots of time in
libraries.
The words in red on the racetrack summarise my current experience as a medical student such as
“professional “and “responsible”. I have learnt that you are professionally required to be responsible
when communicating with others, but also with yourself. This is vital as by neglecting yourself, you can
put others at risk as you are responsible for taking care of them. To do this, it is important to have a
good work life balance through good time management and discipline.
I have also included other words such as “adult learning” and “independent”. Before medical school, I
was accustomed to facilitated learning with a specification. In university, it is important to take your
own initiative to seek information and hold yourself accountable. I am still learning how to become an
independent learner and am trying to develop my studying techniques by testing different techniques.
Furthermore, I now understand the importance of gaining experience of different specialities and then
making an informed decision rather than choosing too early. I have also found that I find studying in
libraries to be an intimidating experience and so I prefer to study in other settings.
The words in red on the racetrack are larger than the black words as they highlight how my expectations
prior to medical school were merely touching the surface of what being a medical student is and that
there is much more to it than what meets the eye.
In the background there is an audience watching me. Some of the members of the audience are holding
up boards with phrases that highlight what others perceive my identity to be, prior to attending medical
school, in black, and now being a medical student, in red. Now that I am a medical student, I am met
with this assumption that I am already a doctor and can answer medical questions despite being in my
first year. Becoming a medical student has also made others now view me as a responsible adult where
they used to previously view me as a child.
While volunteering to help with a Medicine Taster Day for college students at university, I introduced
myself to others as a medical student for the first time. This was a surreal experience. It made me realise
how being a medical student has become an integral part of my identity and how it has changed.
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Medical school is not the finish line. It's the start of a new journey
The student had expectations of medical school prior to attending, but those expectations changed quickly. They initially thought that choosing a speciality was important to do from an early stage, but now understand that it's better to gain experience with different specialities first. They also found that studying in libraries was an intimidating experience, and so they preferred to study in other settings.
The student's identity has also changed since becoming a medical student. They are now met with the assumption that they are already a doctor and can answer medical questions, despite being in their first year. They are also viewed as a responsible adult, rather than a child.
The student concludes by describing a surreal experience they had when introducing themselves as a medical student for the first time. This made them realize how being a medical student has become an integral part of their identity.
The student's experience of transitioning to medical school relates to several ideas in medicine:
Professionalism: The student has learned that professionalism is essential in medical school and the medical profession. This means being responsible, ethical, and respectful.
Social cognitive theory: This theory explains how people learn by observing and imitating others. The student is learning about professionalism, responsibility, and communication by observing and imitating their role models, such as their professors and clinical instructors.
Self-determination theory: This theory explains how motivation is influenced by three basic needs: autonomy, competence, and relatedness. The student's motivation to succeed in medical school is likely influenced by their need to feel autonomous, competent, and connected to others.
Transformative learning theory: This theory explains how people can experience profound changes in their understanding of themselves and the world due to a learning experience. The student's transition to medical school has been a transformative experience, as it has led to changes in their identity, expectations, and understanding of the medical profession.
Research on medical student transition: Much research has been conducted on the transition experience. This research has shown that the transition can be a challenging one but that most students can successfully adapt.
Research on professional development in medical school: Research has also been conducted on the development of professionalism in medical school. This research has shown that professionalism can be taught and developed through various methods, such as role modelling, mentoring, and reflective practice.
Tensions and dilemmas:
Tension between expectations and reality: The student had certain expectations of medical school prior to attending, such as the importance of choosing a specialty early on and spending lots of time in libraries. However, they have come to realize that medical school is much more than just academics, and that it is important to develop professional skills such as responsibility and communication. They have also learned that it is not necessary to choose a specialty right away, and that it is important to gain experience of different specialties before making a decision.
Dilemma of identity change: The student describes how their identity has changed since becoming a medical student. They are now met with the assumption that they are already a doctor and can answer medical questions, despite being in their first year. They are also viewed as a responsible adult, rather than a child. This change in identity can be challenging to navigate, as the author must balance the expectations of others with their own personal development.
Tension between work-life balance and academic demands: Medical school is a demanding program, and it can be difficult to maintain a work-life balance. The student describes how they have had to learn how to manage their time effectively and to prioritize their tasks. They have also had to learn how to say no and to take care of themselves.
Dilemma of navigating professional relationships: Medical students interact with a variety of professionals, including professors, clinical instructors, and other students. The student describes how they have had to learn how to navigate these relationships in a professional manner. This has included learning how to communicate effectively, how to give and receive feedback, and how to resolve conflict.
Reference
Chang, L., Eliasz, K.L., Cacciatore, D.T. and Abigail Ford Winkel (2020). The Transition From Medical Student to Resident: A Qualitative Study of New Residents’ Perspectives. Academic Medicine, [online] 95(9), pp.1421–1427. doi:https://doi.org/10.1097/acm.0000000000003474.
Eric Nkansah Opoku, Lee‐Ann Jacobs‐Nzuzi Khuabi and Lana van Niekerk (2021). Exploring the factors that affect the transition from student to health professional: an Integrative review. BMC Medical Education, [online] 21(1). doi:https://doi.org/10.1186/s12909-021-02978-0.
The formation of professional identity in medical students: Considerations for educators. (2023). Medical Teacher. [online] doi:https://doi.org/10.3109//0142159X.2012.687476.
Today’s students, tomorrow’s doctors
By Abirami Ganesh Kumar
‘Today’s students, tomorrow’s doctors’ is a story of struggle, heartache and perseverance, Our eduction is compromised, out mental health suffers, and our burden grows only larger. Who will answer our call for action?
