Survey of participants and near-peer instructors in an integrated bedside ultrasound course for family medicine residency program

Introduction Bedside ultrasound has undergone rapid expansion of its application in the last decade. Many have recognized its value in family medicine practice, leading to the integration of ultrasound training in some family... [ view full abstract ]

Introduction
Bedside ultrasound has undergone rapid expansion of its application in the last decade. Many have recognized its value in family medicine practice, leading to the integration of ultrasound training in some family medicine post-graduate programs. Due to its relative novelty in primary care, there are limited faculty available or qualified to teach this skill. Near-peer-assisted learning is a teaching strategy in which a fellow trainee more experienced in the subject matter acts as an instructor to their peers. The use of near peer teaching in medical education has been studied and shown to be effective for both a student learner’s as well as near peer instructor’s acquisition of knowledge in an anatomy course. However, the role of near peer-assisted learning in postgraduate bedside ultrasound education has not been studied.

Objective
To compare the perceptions of resident learners towards near-peer versus faculty instructors in a postgraduate family medicine bedside ultrasound course. To document the perceptions of near peer instructors on their skills in near peer teaching.

Design and Methodology
We carried out a cross-sectional survey comparing resident learner’s perceptions on near-peer versus faculty instructors in a bedside ultrasound course in the family medicine postgraduate program of McGill University. Near peer instructors were either residents themselves (11/12), or senior medical students (1/12) with bedside ultrasound experience. One questionnaire was distributed to resident learners, and a different questionnaire for near-peer instructors. The questionnaires mirror each other in their content and are designed to evaluate perceptions on near peer-teaching regards to: 1) knowledge, 2) preparedness, 3) teaching skills, and 4) rapport with learners. Questionnaires were distributed as web-based survey via internal mail list and by paper surveys at the end of the course. Participation for both forms of the survey is anonymous and voluntary.

Study Population
The study population were McGill Family Medicine residents who attended the whole-day core teaching in bedside ultrasound (n=146), as well as residents participating as peer-instructors for the course (n=12). Practicing physicians were excluded from this study. Residents who did not attend the course were also excluded from the study.

Data analysis
Our data was collected using Surveymonkey and from written surveys. Data were entered into an electronic database using Microsoft Excel. Likert scale answers were assigned numerical value and were compared using t-test, p value of less than 0.05 was considered statistically significant.

Results
As of now, 100% of near peer-instructors and 54.8% near peer-learners responded to our survey. The majority of instructors (82%) reported that near-peer teaching as “favourable” or “very favourable”. Instructors felt that their role as near-peer teachers lead led to significant improvement in knowledge (percent change pre- and post- teaching:15.4, p < 0.05) and teaching ability (percent change pre-post teaching:13.2, p < 0.05). The survey revealed that 93% of learners found the near-peer experience to be overall “good” or “very good”. Learners felt that compared to faculty instructors, near peer instructors were equal in their ability to establish good rapport with learners and make learners feel comfortable to ask questions. Frequent comments highlights that near-peer teachers were “less intimidating” and “made me feel that the material was accessible” and “they remember what it was like to be uncomfortable with ultrasound”. Although near-peers instructors are rated to have “good” or “very good” knowledge (94%) and teaching skills (89%), faculty instructors were perceived to have superior knowledge (percent difference:10.7%, p < 0.05), teaching skills (percent difference:5.7%, p < 0.05), and ability to stimulate interest (percent difference near-peer vs faculty 5.4%, p < 0.05). Common explanations for these findings in the comments section were that near peer instructors had less clinical experience, less specific clinical anecdotes and were less able to answer to more advanced questions.

Conclusions
Near-peer instructors were valued in their ability to develop rapport with learners and made learners feel comfortable to ask questions. However, they were less able than faculty instructors in their knowledge of the subject matter, teaching skills and ability to stimulate interest. Knowledge and teaching skills are the two areas in which near-peer instructors perceived significant improvement through their teaching experience. In conclusion, we believe that near-peer assisted learning can benefit both near-peer instructors and learners in context of post-graduate medical education ultrasound training.