Identifying opportunities for peer learning: an observational study of medical students on clinical placements

Phenomenon: Peer assisted learning (PAL) is frequently employed and researched in preclinical medical education. Fewer studies have examined PAL in the clinical context: These have focused mainly on the accuracy of peer assessment and potential benefits to learner communication and teamwork skills. Research has also examined the positive and negative effects of formal, structured PAL activities in the clinical setting. Given the prevalence of PAL activities during preclinical years, and the unstructured nature of clinical placements, it is likely that nonformal PAL activities are also undertaken. How PAL happens formally and informally and why students find PAL useful in this clinical setting remain poorly understood. APPROACH: This study aimed to describe PAL activities within the context of clinical placement learning and to explore students\u27 perceptions of these activities. An ethnographic study was conducted to gather empirical data on engagement in clinical placement learning activities, including observations and interviews with students in their 1st clinical year, along with their supervising clinicians. Thematic analysis was used to interrogate the data. FINDINGS: On average, students used PAL for 5.19 hours per week in a range of activities, of a total of 29.29 hours undertaking placements. PAL was recognized as a means of vicarious learning and had greater perceived value when an educator was present to guide or moderate the learning. Trust between students was seen as a requirement for PAL to be effective. Students found passive observation a barrier to PAL and were able to identify ways to adopt an active stance when observing peers interacting with patients. For example, learners reported that the expectation that they had to provide feedback to peers after task observation, resulted in them taking on a more critical gaze where they were encouraged to consider notions of good practice. Insights: Students use PAL in formal (i.e., tutorial) and nonformal (e.g., peer observation and feedback on the ward; discussion during lunch) situations in clinical education and find it useful. The educator is crucial in fostering PAL through providing opportunities for learners to practice together and in helping to moderate discussions about quality of performance. Student engagement in PAL may reduce passivity commonly reported in clinical rotations. Further directions for research into PAL in clinical education are identified along with potential strategies that may maximize the benefits of peer to peer learning

A study of medical students\u27 peer learning on clinical placements: What they have taught themselves to do

Peer assisted learning (PAL) is implemented in many undergraduate medical programs, largely in classroom-based learning. There is relatively less knowledge about the use of PAL in clinical education environments. This study explores how PAL is experienced and perceived by Year 3 medical students who are new to the clinical environment. Students across urban/metropolitan sites, rural sites, and an international site (Malaysia) were invited to participate in a cross-sectional survey; 54 of a potential 415 students responded. We found that students are already using PAL on their clinical placements and can see its value. PAL not only occurs in structured events within the curriculum, such as Problem Based Learning (PBL) or bedside tutorials, but also in unstructured and student-prompted ways, such as debriefing cases at lunch time, observation of practice on the ward, and self-selected study groups outside clinical placement. These PAL activities in the clinical environment are yet to be mapped within the literature. Importantly, contrary to previous studies, PAL was not reported to increase competition amongst students and a drive for social acceptance was not reported to hinder honest peer-to-peer feedback. Despite the “organic” episodes of PAL on clinical placements, students reported that they needed more PAL education and training. Students are reticent to judge their peers’ performance, not because of social pressures, but due to a lack of confidence in knowing performance targets. Observational research is suggested as a way to further explore these trends and to inform development of helpful PAL strategies for learners

Interprofessional education for interprofessional practice:Does it make a difference?

Much of the rhetoric on interprofessional learning is not underpinned by high-level evidenceInterprofessional education (IPE) has been identified as a critical component in the development of a collaborative, practice-ready health care workforce in Australia.1 According to the Centre for the Advancement of Interprofessional Education in the United Kingdom, IPE “occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care”.2 Its purpose is to improve patient outcomes by providing a learning environment that enables undergraduates (and postgraduates, where appropriate) to gain a better understanding of teamwork, and of how each discipline contributes to team-based care without losing its professional identity

Skeletal muscle neuronal nitric oxide synthase μ protein is reduced in people with impaired glucose homeostasis and is not normalized by exercise training

Skeletal muscle inducible nitric oxide synthase (NOS) protein is greatly elevated in people with type 2 diabetes mellitus, whereas endothelial NOS is at normal levels. Diabetic rat studies suggest that skeletal muscle neuronal NOS (nNOS) μ protein expression may be reduced in human insulin resistance. The aim of this study was to determine whether skeletal muscle nNOSμ protein expression is reduced in people with impaired glucose homeostasis and whether exercise training increases nNOSμ protein expression in these individuals because exercise training increases skeletal muscle nNOSμ protein in rats. Seven people with type 2 diabetes mellitus or prediabetes (impaired fasting glucose and/or impaired glucose tolerance) and 7 matched (sex, age, fitness, body mass index, blood pressure, lipid profile) healthy controls aged 36 to 60 years participated in this study. Vastus lateralis muscle biopsies for nNOSμ protein determination were obtained, aerobic fitness was measured (peak pulmonary oxygen uptake [Vo2 peak]), and glucose tolerance and insulin homeostasis were assessed before and after 1 and 4 weeks of cycling exercise training (60% Vo2 peak, 50 minutes × 5 d wk−1). Skeletal muscle nNOSμ protein was significantly lower (by 32%) in subjects with type 2 diabetes mellitus or prediabetes compared with that in controls before training (17.7 ± 1.2 vs 26.2 ± 3.4 arbitrary units, P < .05). The Vo2 peak and indicators of insulin sensitivity improved with exercise training in both groups (P < .05), but there was no effect of exercise training on skeletal muscle nNOSμ protein in either group. In conclusion, individuals with impaired glucose homeostasis have reduced skeletal muscle nNOSμ protein content. However, because exercise training improves insulin sensitivity without influencing skeletal muscle nNOSμ protein expression, it seems that changes in skeletal muscle nNOSμ protein are not central to the control of insulin sensitivity in humans and therefore may be a consequence rather than a cause of diabetes

Acute exercise does not cause sustained elevations in AMPK signaling or expression

No study has examined the response of skeletal muscle AMP-activated protein kinase (AMPK) signaling beyond the first 3 h after an acute exercise bout in humans. The purpose of this study was to assess AMPK signaling in human skeletal muscle immediately after a single bout of moderate-intensity endurance exercise and 3 and 24 h after the exercise bout

AMPK activation is fiber type specific in human skeletal muscle: effects of exercise and short-term exercise training

AMP-activated protein kinase (AMPK) has been extensively studied in whole muscle biopsy samples of humans, yet the fiber type-specific expression and/or activation of AMPK is unknown. We examined basal and exercise AMPK-α Thr172 phosphorylation and AMPK subunit expression (α1, α2, and γ3) in type I, IIa, and IIx fibers of human skeletal muscle before and after 10 days of exercise training. Before training basal AMPK phosphorylation was greatest in type IIa fibers (P type IIa > type I), irrespective of training status. Thus skeletal muscle AMPK phosphorylation and AMPK expression are fiber type specific in humans in the basal state, as well as during exercise. Our findings reveal fiber type-specific differences that have been masked in previous studies examining mixed muscle samples

Assessment of medical students' learning outcomes in Australia : current practice, future possibilities

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Neuroendocrine and subjective responses to pharmacological challenge with citalopram: a controlled study in male and female ecstasy/MDMA users

Despite evidence that ±3,4-methylenedioxymethamphetamine (MDMA; ‘ecstasy’) causes persistent alterations to the serotonergic system of animals, evidence for long-term neurological effects of ecstasy/MDMA in humans remains equivocal. The current study assessed serotonin functioning of nine male and 11 female recreational ecstasy polydrug users by measuring neuroendocrine (prolactin, cortisol) responses to pharmacological challenge with the selective serotonin reuptake inhibitor citalopram, compared with nine male and five female cannabis polydrug users and 11 male and 11 female non-drug using controls. A single-blind, randomised, placebo-controlled design was used. Subjective responses, other substance use, mood, personality traits and demographic variables were measured to control for potentially confounding variables. There were no significant differences between ecstasy polydrug users, cannabis polydrug users and non-drug using controls in neuroendocrine or subjective responses to serotonergic challenge, and there were no sex by drug group interactions. There was no relationship between extent of ecstasy use and neuroendocrine functioning, alone or in combination with potential confounding variables. Subjective responses to the pharmacological challenge (nausea, tremor, dry mouth), novelty seeking and lifetime dose of alcohol were the only variables that contributed to one or more of the neuroendocrine outcome variables. These data do not support the premise that recreational ecstasy/MDMA use results in measurable impairment of serotonergic control of endocrine activity