Salma Faghri 1, Nitin Aggarwal 1, Kimberly Zeller, MD 1,2, Julie Taylor, MD, MSc 1,2 1 Warren Alpert School of Medicine at Brown University, Providence, RI; 2 Memorial Hospital, Pawtucket, RI Society of Teachers of Family Medicine 35 th Annual Predoctoral Education Conference; January 24, 2008 Teaching Medical Students to Teach

Brown Medical School Providence, RI Approximately 96 students per class “Doctoring” Course 2-year integrated medical interviewing and physical diagnosis course for 1 st - and 2 nd - yr medical students Implemented Fall 2005

2 nd - yr students who peer mentor 1 st - yr students Provide extra opportunities for 1 st - year students to practice interviewing & physical exam skills 24 total TA Fellows (2 per small group) TA Fellows nominated by small group faculty for their exemplary performance in the first year of the “Doctoring” course Teaching Academy (TA) Fellows

TA Fellows continued Each TA Fellow mentors 4 students and meets with 2 students at a time, outside of class, for 3 sessions/ semester TA Fellows already trained in Full history (including counseling & motivational interviewing) Partial physical exam (Vitals,HEENT,Neuro) = 3 rd year of Teaching Academy

Needs Assessment Based on pilot data from 2006 – 2008 TA Fellows have varying prior teaching experiences. TA Fellows lack formal training for their peer- mentoring role. First - year students report varied experiences when meeting with TA Fellows.

TA Fellow Orientation Workshop PROPOSAL: To conduct a standardized 1.5-hour orientation workshop for TA Fellows Evaluate workshop using 3 separate anonymous written student surveys

Workshop Overview 1. Motivation (10 min) 2. Goals and Expectations (10 min) 3. Constructive Feedback (35 min) 4. Role playing / Small group (35 min)

1. Motivation = Value x Expectancy* Ideal motivation = adequate challenge of instruction. Why is learning history & exam skills and having practice sessions important? How confident are first year students in their ability to learn these skills? * Fishbein et al. Belief, Attitude, Intention, and Behavior: An Introduction to Theory and Research. Massachusetts: Addison Wesley Publishing Co., 1975.

2. Goals & Expectations At your first session: Expectations of TA Fellow & 1 st -year students Role of TA Fellow as peer-mentor Why feedback is important Before each session: 1 st -year students to set personal goals for session Ex. Make better eye contact, Perform more thorough HPI, etc.

3. Constructive Feedback 15-min video from University of Michigan! At the end of the interview, start feedback with learner self-assessment Sandwich technique 4. Role playing / Small group

Evaluating the workshop 24 TA Fellows (led by Aggarwal) 95 First-year students 1. After workshop (N = 24) 3. End of semester (N = 54 – 61)* 1.5 hr orientation by Faghri 3 SURVEYS: 2. Mid-semester (N = 19) *Some students did not finish the survey

How confident were you in your ability to give feedback before the workshop? 1. TA FELLOWS AFTER WORKSHOP: Mean 3.8

How confident are you in your ability to give feedback after the workshop? TA FELLOWS AFTER WORKSHOP: Mean 4.5 P<0.001

Quotes from TA Fellow Survey “The interactive nature of the workshop... hearing others' ideas is always an effective way to learn” “The videos were great. It provided a good background for discussion.” “Chance to try out feedback right away.” “The opportunity to review some of our interviewing skills in small groups.” “Good pointers on effective feedback (asking person how they felt to frame your feedback) and giving attainable goals.” 1. TA FELLOWS AFTER WORKSHOP:

2. Mid-semester TA Fellow survey Did you feel the orientation was useful in preparing you for your role as a TA Fellow? Mean 3.7 / 5.0 (N = 19 / 24) (Scale: 1 - Not at All, 3- Moderately, 5- Extremely) 18 of 19 students would recommend this workshop for future TA Fellows Recommendations for next year: Shorter / more concise Scheduling

No 17% Yes, every time 77% Yes, but only first session 6% Did you set goals with your TA Fellow? 3. FIRST YR SURVEY DATA (N = 54 / 95) How would you describe the feedback from your TA Fellow? GOAL SETTING:FEEDBACK:

1 3 5 Mean 3.1 How confident did you feel in your ability to conduct a medical interview before your TA Fellow sessions? 3. FIRST YR SURVEY DATA (N = 61 / 95)

How confident did you feel in your ability to conduct a medical interview after your TA Fellow sessions? Mean 4.1 P< FIRST YR SURVEY DATA (N = 61 / 95)

How confident did you feel in your ability to perform components of PE before your TA Fellow sessions? Mean FIRST YR SURVEY DATA (N = 61 / 95)

How confident did you feel in your ability to perform components of PE after your TA Fellow sessions? Mean 4.0 P< FIRST YR SURVEY DATA (N = 61 / 95)

A standardized orientation can teach TA Fellows skills in motivation, goal setting & effective feedback. Formalized training significantly increases TA Fellows’ confidence in their ability to provide feedback. Effective mentoring sessions increase confidence levels of 1 st -year students in both history taking and physical exam. Take home points

TEACHING ACADEMY FELLOWS