The majority of practices supported near peer teaching (NPT) amongst their learners. Most commonly this involved the ST3s teaching medical students, though on occasions STs would also teach FYs and FYs could be involved in teaching undergraduates. On one occasion, a GP described an enthusiastic 4th year student on a student selected component (SSC)1 teaching 3rd year students
1 SSCs offer students the opportunity to study a topic of their choice for a 5 week block during their
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on placement, though this had been prompted by the individual’s desire to teach, rather than a culture of NPT in that practice.
We had a 3rd year who was very good and he came back…to do an SSC [in 4th year]…He was absolutely brilliant…he actually wanted to teach the students. So I said ‘that’s fine, brilliant’ and he…did some
neurology examination with them…and he talked to them about how you do the OSCEs and what might come up in the OSCEs and…I thought that was actually a really good way of using him, and the students got a lot out of it. We’ve never used the trainees for that…but having this conversation now, it’s something we maybe should be thinking about getting them involved [in]. I don’t know, is there any specific
guidance from yourselves about that? (M5)
7.7.1 The benefits of NPT
GPs varied in their opinion on the utility of NPT. Some felt it simply allowed the senior learner to “tick a box” for their e portfolio.
I would have to say that the FY2 tutorials for the students [are] more of an exercise for the benefit of the FY2 so that they can practice their teaching skills than it is particularly because that’s the best way of teaching the students. (M10)
Others felt it facilitated a richer and mutually beneficial exchange between learners. They believed the students appreciated speaking to someone nearer to them in age, which gave them the opportunity to get both relevant career and exam preparation advice. They also noted that trainees had often been through the same course and exams and could discuss colleagues and placements they had in common with the students.
If you’re getting peer teaching that works really well…I think students maybe feel more comfortable with someone who’s younger. And they can also say to them, well this is what my last few years have been like. This is what hospital is like. This is what practice is like. Rather than somebody like me going ‘Oh, you know, it was never like that in my day’. (M5)
The GPs also appreciated the potential for role modelling to occur, not only between the junior doctors and the medical students, but also for school pupils potentially interested in applying to medical school.
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I think it's actually helpful for the likes of the third year students to see … younger doctors…if [they] hear what jobs the FY2s [have] done or what they are doing next… they often will chat about that. It’s the same…if we have [school] students who are coming, who are hoping to do medicine then you…try and link them in to get a chat with
somebody like that…Young people tend to [appreciate that]. I think it's a role model type thing. (M7)
Another perceived advantage was that NPT gives students the opportunity to ask a junior doctor questions that they may not want to ask the GP.
I suppose sometimes if they think there is [a silly question] that they will be less afraid to ask…They may not want to ask a more senior clinician but they are happy to ask someone more junior…Obviously, it’s not a silly question but if they think it’s a silly question then they might feel a bit more open to ask a bit more. (M4)
It was reported that trainees benefit by developing their leadership skills and NPT also allowed those interested in teaching to get some experience of this. There was a hope that this may be a way to engage GP educators of the future.
I think [for an ST3 it is] good from a leadership point of view. I think it’s good to encourage them to start [teaching] and… you then hope that maybe they quite enjoy it and they think ‘Actually… at some point [in the future I] want to take on an educational role. (F6)
7.7.2 Approaches and challenges to NPT
There was variation in supervisors’ approaches to supporting the STs to teach. Some described providing a briefing prior to the teaching, to either the student or the teacher, while others seemed to simply instruct them to “sit in”.
I try to have a chat with them about what they’re actually doing…we talk about different things, so we talk about observe the doctor…how they are consulting? What kind of skills are they using to consult or what kind of communication skills? What kind of questions are they using when they are consulting? And then also think about the diseases they are seeing and try and keep notes. (M8)
Occasionally, junior doctors were also involved in delivering tutorials to their more junior colleagues. As discussed in 7.6.3.2, when a fully qualified GP was delivering the tutorial, topic selection aimed to be learner-centred though was often based on their area of expertise. In the following example, the tutorial
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topic choice is restricted to a match between what the FY feels confident to teach about and the students want to learn about.
Our current FY is very interested in stroke so he was talking about stroke and one of the previous [ones]… was something to do with pharmacology and prescribing…It is random, it depends on what the FY2 is going to be able to teach on [and what] the students want the tutorial on. So it can be tricky to tie the two up. (M10)
The same GP was critical of GPs teaching clinical skills as he felt that GPs daily clinical examination practice is different to the requirements for assessment. He commented that FY2s would be much better placed to teach this but hadn’t used his own FY2s to do this.
I mean surely there is an FY2 somewhere in Glasgow that can teach clinical examination skills better than we can. (M10)
Another challenge to making NPT a more regular occurrence was whether the learners’ placements actually overlap. An ST3 will typically be placed at the same practice for at least a year, so will most likely encounter other learners at some point in these joint teaching practices. In contrast, FY2s are placed for four months and ST1s for six months so may not overlap with those more junior depending on placement capacity. Furthermore, GPs seemed quite cautious about when it would be suitable for students to “sit in” with trainees. Most identified this as an activity only suitable for the ST3 year, often only in the last few months of the training year.
When the ST3s come back…quite often we… ask them…, suggest that it’s a good idea…that they do some teaching with the undergraduates, especially after they’ve done their ESR in May. We quite often get them involved in having them in consultations. (F3)
Variation in the ability and confidence of trainees to teach was described. For one tutor, it was the calibre of recent ST3s that influenced whether to involve them in teaching or not.
We tend not to get the ST3s involved in the undergraduate
teaching…but that might change if the calibre of STs was different. But the FY2s, paradoxically, I have usually invited them to do some teaching with the 4th/5th year students. Because, to be perfectly honest, they are much better that the STs we have been having. (M10)
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Several tutors commented that trainees could be nervous about teaching and sometimes needed encouragement to do so.
Some of them were a wee bit more nervous about the idea of
someone watching them but…I still involve them. I still get them to do it and I think you just have to remind them that you are taking
someone who is more junior…It’s not a peer that is sitting in watching you, which is quite different…They wouldn’t be able to do it any better than you. (M8)
Expectations of the ST3s teaching could be limited. One tutor expected the trainee to impart knowledge but not to give feedback to the student.
The ST3 doesn’t always get involved…but if they’re happy enough to do it…I would have a chat with them…and say ‘there’s not really anything, I wouldn’t expect them to be…giving feedback…to the students…It’s more just allowing…the student to be in and trying to use the teaching opportunities that…they feel they want to have…and they might pick up…and the student might ask them some questions. (F5)
7.7.2.1 Activity Theory interpretation - NPT
AT enables identification of the tools of NPT and also facilitates reflection on the different intended outcomes of this activity (Figure 7-27). Whilst some tutors see this merely as a “tick box exercise”, others recognise opportunities for
learning and benefits extending beyond simply the transfer of knowledge on the subject area being taught. By understanding the difference in intended
outcomes, the differences in perceived value and approaches to NPT can be better understood. For example, if a supervisor sees it simply as a “tick box exercise”, then they may not promote this beyond a simple session ‘sitting in’ and may not support the near peer teacher to reflect on and develop their teaching skills and experience.
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Figure 7-27 The activity system of near peer teaching in general practice
7.7.3 Theme 5 Summary: Near peer teaching in general practice
Trainees in the majority of these MLL practices were involved in NPT and GPs reported a range of benefits that could be derived from this. However, formal NPT was often ad hoc and limited in time and expectations.