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The benefits of near-peer learning are well established in several aspects of undergraduate medical education including preparing students for Objective Structured Clinical Examinations (OSCEs). The COVID-19 pandemic has resulted in a paradigm shift to predominantly online teaching.
This study aims to demonstrate the feasibility and benefits of an exclusively online near-peer OSCE teaching program in a time of significant face-to-face and senior-led teaching shortage.
A teaching program was delivered to penultimate-year students by final-year students at Manchester Medical School. Program development involved compiling a list of salient topics and seeking senior faculty approval. Teachers and students were recruited on Facebook. In total, 22 sessions and 42 talks were attended by 72 students and taught by 13 teachers over a 3-month period. Data collection involved anonymous weekly questionnaires and 2 separate anonymous student and teacher postcourse questionnaires including both quantitative and qualitative components.
On a scale of 1-10, students rated the quality of the program highly (mean 9.30, SD 1.15) and felt the sessions were highly useful in guiding their revision (mean 8.95, SD 0.94). There was a significant increase in perceived confidence ratings after delivery of the program (
This is the first study demonstrating the efficacy of a near-peer OSCE teaching program delivered exclusively online. This provides an exemplary framework for how similar programs should be encouraged given their efficacy and logistical viability in supplementing the undergraduate curriculum.
“Near-peer teaching” refers to a way of teaching where the teacher is a trainee who is at least 1 year senior to the student and on the same level of the medical education spectrum [
Near-peer teaching has grown in popularity in recent years within medical schools as a means of supplementing the formal curriculum. This paradigm shift was perhaps to be expected, given the sheer volume of literature advocating its benefits and effectiveness. For instance, Rodrigues et al [
Since the World Health Organization declared COVID-19 a global pandemic, widespread global lockdown restrictions resulted in a shift to online learning and cancellation of most face-to-face teaching and assessments [
In this paper, I aim to outline how an online near-peer Objective Structured Clinical Examination (OSCE) teaching program can enhance the preparedness, knowledge, and skills of both the student and the teacher. In doing so, I aim to demonstrate that such endeavors are practical, reproducible, easy to implement, and valuable adjuncts to the medical undergraduate curriculum.
Consultation with the University of Manchester’s ethics decision tool [
Manchester Medical Society page facilitated advertisement of the program to prospective NPTs and NPLs. NPTs expressing interest were added to a group chat, while NPLs followed a link to join a Facebook page. An instructional sheet was sent to all the NPTs. It incorporated reminders to include disclaimers, keep the presentations under 30 minutes, have them completed by a particular date before being sent for quality assurance by the head of clinical teaching, and include an OSCE practice scenario at the end of their presentations to contextualize the taught content. This ensured session standardization and OSCE relevance.
The fourth-year syllabus at Manchester Medical School is split into 2 distinct overarching themes: “families and children” (F&C) and “mind and movement” (M&M). The programs, therefore, consisted of 2 separate weekly, hour-long sessions on Zoom, 1 for each theme. Each session was split into 2 separate 30-minute lessons delivered by 2 NPTs. A total of 42 talks were delivered over 3 months, covering a range of topics within each theme (
List of topics covered over the course of the program.
Week number | F&Ca topics | M&Mb topics |
Week 1 |
Developmental milestones Gynecology history taking and menorrhagia |
Delirium Mental state examination |
Week 2 |
Breast medicine: triple assessment Pediatric examinations |
Weakness Loss of vision |
Week 3 |
Psychiatric history taking Common ear presentations and examination |
Pediatric history taking Dermatology: common presentations and their assessment |
Week 4 |
Oncological emergencies Infectious disease: a brief overview |
Parkinson disease and examination Osteoarthritis, rheumatoid arthritis, and hand examination |
Week 5 |
Cancer red flags Pediatric respiratory presentations and clinical assessment |
Prescribing Stroke medicine |
Week 6 |
Cervical health HIV |
Ethics and law Gout |
Week 7 |
Infertility Skin cancers |
Vasculitis Psychopharmacology |
Week 8 |
Pregnant abdomen examination and complications in pregnancy Pediatric gastroenterology and abdominal examination |
Falls Common fractures |
Week 9 |
Bleeding in early pregnancy Ethics and law |
Alcohol dependence Pediatric orthopedics and examination |
Week 10 |
Sexually transmitted infections and PV discharge Nonaccidental injury and safeguarding |
Dementia Cancelled |
Week 11 |
OSCEc example stations Cancelled |
SBARd handover OSCE example stations |
aF&C: families and children.
bM&M: mind and movement.
cOSCE: Objective Structured Clinical Examination.
dSBAR: Situation, Background, Assessment, Recommendation.
Anonymized weekly feedback questionnaires, 1 for the M&M and 1 for the F&C theme, were distributed using Google Forms following each session. This functioned as a means of tailoring future sessions toward the needs and wishes of the NPLs.
In addition, 2 separate postcourse questionnaires were distributed to NPLs and NPTs at the end of the program (
A paired 2-tailed
Two NPTs conducted qualitative analysis of the free-text sections in the NPL and NPT postcourse questionnaires. This involved identifying and agreeing on common themes and categorizing each response appropriately.
The 22 sessions (11 for F&C and M&M each) were attended by a total of 72 different NPLs and taught by 13 NPTs. The F&C weekly session attendance ranged from 8-26 NPLs (mean 14.64, SD 4.41). The M&M weekly session attendance ranged from 11-26 NPLs (mean 14.45, SD 4.63). Overall weekly attendance across the 2 themes ranged from 21-49 NPLs (mean 29.09, SD 8.64).
In total, 37 NPL postcourse evaluative questionnaires were completed equating to a 51.39% feedback response rate. A paired 2-tailed
There was considerable variation in likelihood of organizing a similar program, with the majority taking a neutral stance (n=23), and the remaining indicating it is either somewhat likely or very likely (n=13), or it is somewhat unlikely (n=1). Of 37 students, 23 (62.16%) left comments in the free-text sections. Qualitative analysis revealed 8 broad themes with some overlap (
Of 13 NPTs, 11 (84.62%) completed the NPT postcourse questionnaire. Respondents unanimously agreed that engaging with the program helped them better understand the material taught (mean 9.45, SD 0.86), facilitated long-term retention of the content (mean 9.36, SD 0.81), helped them develop their teaching skills (mean 9.00, SD 1), was rewarding and motivational in engaging in more teaching in the future (mean 9.27, SD 0.79), and was highly enjoyable (mean 9.30, SD 1.15) (
Thematic analysis of the 2 free-text sections mostly reinforced findings from these rating questions. When asked what the NPTs felt the greatest benefit of the program was, 3 broad themes emerged, with some overlap (
The “any positive comments/areas for improvement” section comprised of 3 comments expressing gratitude for organizing the program. A summary of the key findings from both questionnaires can be seen in
Findings from rating questions in the near-peer learner postcourse questionnaires.
Questions | Responses, mean (SD) |
How confident did you feel about your OSCEa examinations prior to these teaching sessions? | 4.51 (1.41) |
How confident do you feel about your OSCE examinations now? | 8.24 (0.93) |
How would you rate the overall quality of the sessions? | 9.30 (1.15) |
How would you rate the usefulness of the OSCE practice scenarios at the end of each session in consolidating your learning? | 8.92 (0.95) |
How useful did you find the sessions in guiding your revision? | 8.95 (0.94) |
aOSCE: Objective Structured Clinical Examination.
Qualitative analysis of free-text sections in near-peer learner postcourse questionnaires in response to the question “Any positive comments/areas for improvement?”
Theme | Examples of comments | Responses, n |
Thanks, or expressions of gratitude | “Thank you so much to all the speakers and organizers for the effort through the semester!” | 8 |
Praising the quality, organization, or structure of the teaching | “Really liked how the sessions were structured with a [sic] OSCE scenario at the end to consolidate the topic being taught. Really great stuff.” | 7 |
Helped in getting ahead with revision or placement | “Attending the sessions helped me get a head start on the placement I hadn’t attended yet as everything was pitched at the correct level and at a good pace.” | 4 |
Advice to include more multiple-choice questions | “The only thing I could suggest to improve if [sic] more MCQ’sa but I do understand that it was a more OSCE focused program which you guys hit the nail on the head. Thanks!” | 3 |
Praising the top tips provided | “Really well organized and taught. You really provided some great OSCE tips throughout!” | 3 |
Beneficial, given limited clinical exposure due to COVID-19 | “The sessions have been particularly valuable with the reduced clinical opportunities we’ve had at placement with COVID.” | 2 |
Request for more sessions | “Would love some more sessions in the new year–found this really helpful in consolidating the TCDb cases.” | 2 |
Connection or technical issues | “Although the technical issues did sometimes interfere the sessions have been a great addition to the online cases.” | 2 |
aMCQ: multiple-choice question.
bTCD: Themed Case Discussion.
Findings from rating questions in the near-peer teacher postcourse questionnaires.
Questions or statements | Responses, mean (SD) |
Getting involved with the teaching has helped me better understand the subject material I taught. | 9.45 (0.68) |
Getting involved in the teaching has helped with my long-term retention of the subject material I taught. | 9.36 (0.81) |
I have found this teaching experience to be rewarding, and it has motivated me to get involved in more teaching in the future. | 9.00 (1.00) |
As a result of this experience, I have developed teaching skills that I will use in the future as a doctor. | 9.27 (0.79) |
On a scale of 1-10, how enjoyable did you find this teaching experience? | 9.30 (1.15) |
Qualitative analysis of the free-text sections in the near-peer teacher postcourse questionnaires in response to the question “What do you think has been the greatest benefit of teaching in this program?”
Theme | Examples of comments | Responses, n |
Beneficial to learning or guiding revision | “I think teaching is a very effective way of deepening your own understanding of a topic as well as identifying any gaps in your knowledge. If you are able to explain a complex topic as well as answer specific questions, this shows you have a very good level of knowledge. Therefore, this teaching program allows the tutors to expand on their understanding.” | 6 |
Enhancing or developing teaching skills | “Helpful feedback form students which I have reflected on to improve my teaching skills.” | 6 |
Increased self-confidence in teaching ability | “Over the course of the program, I’ve felt more confident and less nervous whilst teaching and ended up enjoying it a lot more than I would have expected!” | 2 |
Summary of the key findings from near-peer learner and near-peer teacher questionnaires.
Items in the questionnaires | Key findings | ||
|
|||
|
Change in perceived confidence to sit the OSCEa examination |
Precourse: mean 4.51, SD 1.41 Postcourse: mean 8.24, SD 0.93 |
|
|
“Any positive comments/areas for improvement?” |
Thanks/expression of gratitude (n=8) Praising the quality/organization/structure of teaching (n=7) |
|
|
|||
|
Getting involved with the teaching has helped me better understand the subject material I taught |
Mean 9.45, SD 0.68 |
|
|
“What do you think has been the greatest benefit of teaching in this program?” |
Beneficial to learning/revision (n=6) Enhancing/developing teaching skills (n=6) |
aOSCE: Objective Structured Clinical Examination.
In line with the existing body of literature, this study clearly demonstrates the value of undergraduate near-peer programs for both the student and the teacher. Crucially, it demonstrates a significant increase in NPLs’ perceived confidence to sit their OSCE examinations. Simulated OSCE scenarios and the setup of the sessions in helping guide revisions explain this finding. The study also demonstrates numerous benefits obtained by NPTs including enhanced comprehension and retention of the taught materials, development of teaching skills, and increased motivation in engaging with future teaching endeavors.
A variety of reasons can account for the significant increase (
Rashid et al [
NPTs also obtained multiple benefits, with engagement shown to enable better understanding (mean 9.45, SD 0.86) and long-term retention (mean 9.36, SD 0.81) of the taught material. These findings are supported by multiple prior studies [
First, the data collected and interpreted from the questionnaires in this study mostly deal with perceptions and lack objective measures. Future endeavors will look to collect data from tangible objective outcomes (ie, achieved OSCE marks of NPLs). Second, connectivity issues occasionally interfered with the delivery of teaching and our ability to share media and video clips—a drawback also identified by Mageswaran and Ismail [
Numerous studies have established the value of the near-peer model in undergraduate medical education, including facilitation of OSCE preparedness [
Pediatric milestones presentation.
Falls presentation.
Near-peer teacher postcourse questionnaire.
Near-peer learner postcourse questionnaire.
families and children
mind and movement
near-peer learner
near-peer teacher
Objective Structured Clinical Examination
The author would like to thank Nick Smith for assisting with quality assurance of the teaching materials and all the student teachers that made the program possible.
None declared.