A “Safe Space” for Learning and Reflection: One Schoolʼs Design for Continuity With a Peer Group Across Clinical Clerkships

Abstract

The value of continuity in medical education, particularly during clerkships, is increasingly recognized. Previous clerkship-based models have described changes that emphasize continuity in patient care, learner supervision, and curriculum. The creation of continuous student peer groups can foster interactions that enhance mutual support through uncomfortable professional transitions during the clerkship years. Here, the authors describe a third-year clerkship model based at the San Francisco Veterans Affairs (VA) Medical Center called VA Longitudinal Rotations (VALOR), designed explicitly to establish a supportive learning environment for small peer groups.Seven groups of medical students (42 total) completed VALOR across three academic years between 2007 and 2009. On clerkships during VALOR, one hour per week was designated for faculty-facilitated sessions amongst peer groups. Students' perceptions of peer group support and overall program satisfaction were determined with immediate post surveys and focus groups at the end of VALOR, and with follow-up surveys 5 to 27 months after completing VALOR. Students strongly valued several elements of VALOR peer groups, including support through clerkship challenges, meeting for facilitated reflection, and appreciating patient experiences across the continuum of care. Students' appreciation for their peer group experiences persisted well after the conclusion of VALOR. VALOR students performed the same as or better than traditional clerkship students on knowledge and skill-based outcomes. The authors demonstrate that their third-year clerkship program using peer groups has built supportive learning networks and facilitated reflection, allowing students to develop critical professional skills. Student communication around patient care was also feasible and highly valued.

Workplace learning through peer groups in medical school clerkships

“…Although students do not rely on WPGs to provide all workplace learning needs, WPGs confer the supported participation that enables students to share best practices with each other on how to integrate into their communities of clinical practice (9, 25). Finally, here and in prior studies, students appreciated the increased social support provided by their WPGs (14, 15), a key feature of medical student well-being. It remains to be seen whether students truly become less burnt-out and more resilient as a result of participating in WPGs (26, 27).…”

“…Regardless of format, workplace-based peer learning in groups will occur, with more well-connected students accessing more resources, potentially leading to disparities in learning. With minimal redesign effort (14, 29), medical schools can decrease these differences in clerkships by incorporating continuity with peers, whether through CMCs, extensions of previously established learning communities explicitly in workplace settings, or other novel structures.…”

“…One CMC was a yearlong longitudinal integrated clerkship based at the university medical center and integrated all core clerkships by assigning students to preceptors in each discipline (15). The other two CMCs were 6 months in length and occurred at other local major urban teaching hospitals (13, 14). …”

Teaching patient-centered communication skills: a telephone follow-up curriculum for medical students

“…In 2008–2009, we implemented the TFC for MS3s in a 6-month site-based program ( Intervention Group 1, or IG-1 ). Students in this program, called VALOR, completed their medicine, neurology, psychiatry, and surgery clerkships at a Veterans Affairs Hospital (15). In 2009–2010, we expanded the TFC to include that year's MS3s in VALOR and the LIC ( Intervention Group 2, or IG-2 ) (14).…”

Using Narratives to Create a Framework to Analyze Professional Growth of Third Year Medical Students

“…The anchoring educational component of Drexel's professional formation curriculum are small group discussions that support self-reflection and opportunities to discuss professionalism issues that affect students in the clinical years (Chou et al 2011, Rosentyal et al 2011. Because students are distributed among 21 affiliates, faculty facilitate these groups virtually, using Google Hangouts, and an online learning management system.…”