ABSTRACT
Background
Medical student electives play an important role in both personal and professional development. The need for medical students to have early exposure to teacher training skills has also been recognised. The Sydney Medical School elective in medical education was designed and implemented in 2021 in response to growing student interest in acquiring professional skills in teaching, as well as the global mobility restrictions at the time. We sought to explore students' perception of their experience.
Approach
The 4‐week elective was designed based on the successful ‘Peer Teacher Training’ programme for health professional students. Delivered online to 49/250 (20%) final year medical students, the programme consisted of 13 e‐learning modules with required asynchronous and synchronous activities and formative assessment.
Evaluation
We collected qualitative data from 34 participants (69%) using a postcourse questionnaire. Students valued learning about educational theory with opportunities to practice teaching and feedback with their peers. The elective was found to enhance participants' confidence in teaching. Although students valued the flexibility afforded by online delivery, some expressed a preference for the inclusion of in‐person learning activities.
Implications
The medical education elective provided students with dedicated time to develop knowledge and skills in clinical teaching and fostered engagement and interest in teaching activities. Such electives present a valuable alternative for students and may offer an initial entry point into the clinician educator pipeline.
Keywords: COVID‐19, e‐learning, elective, medical education, teacher training
1. Background
Electives are short‐term placements undertaken as part of the medical degree, usually occurring outside of a student's own medical school [1]. Within contemporary medical programmes, they play an important role in learning and promote personal and professional development by exposing students to alternative models of health care delivery and clinical areas of interest in considering future career pathways [2, 3]. However, relatively little emphasis has been placed on clinical education as an elective, despite its recognition as a legitimate career path and its frequent identification as an area of interest among medical students.
Relatively little emphasis has been placed on clinical education as an elective, despite its recognition as a legitimate career path and its frequent identification as an area of interest among medical students.
The literature suggests that education focused roles often arise through ‘serendipity’, rather than through deliberately crafted career pathways [4]. This underscores the need for institutional support to provide training during medical school, enabling students to conceptualise a clear and intentional pathway toward becoming clinical educators. Furthermore, within the Australian and New Zealand context, the growing medical workforce [5, 6], increasing student enrolments, and evolving teaching and assessment practices across medical schools and during postgraduate training, highlight the urgent need to build clinician educator capacity through formalised career pathways.
The literature suggests that education focused roles often arise through ‘serendipity’, rather than through deliberately crafted career pathways.
Sydney Medical School offers an 8‐week elective term during the final year (Year 4) of the graduate entry medical programme (MD), normally taken by completing two 4‐week electives. Traditionally, students self‐select and apply for local or international placements. Prior to the 2020 global pandemic, approximately 70%–80% of students would choose to undertake overseas placements in various clinical specialties. The COVID‐19 pandemic substantially disrupted the traditional model of elective placements, with government restrictions limiting travel, and many hospitals suspending external student placements. In response a range of strategies were implemented in 2021 to ensure the availability of adequate elective placements for students. Given the demonstrated interest in teaching among our students [7, 8], this context provided an opportunity to design an elective focussed on the development of professional skills in teaching and education. Accordingly, we developed an innovative ‘Medical Education’ elective and sought to explore students' perception of their experience using the conceptual lens of Biggs′ 3P model [9].
We developed an innovative ‘Medical Education’ elective and sought to explore students' perception of their experience using the conceptual lens of Biggs' 3P model.
Biggs' 3P model posits that learning experiences are shaped by prior experience, motivation and learning strategies. Students' characteristics, their values and the learning environment (presage) influence how they approach learning (process), which in turn influences the achievement of learning outcomes (product) [9]. We used Biggs' 3P model [9] to help conceptualise our specific research questions:
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How did the students' prior knowledge, skills and experience with teaching influence their learning experience?
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What was the students' experience of completing the elective online, including the value they placed on the content and the learning activities?
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What were the students' perceptions of attainment of the learning outcomes in terms of knowledge and skills in teaching, and how these skills may be used in the future?
2. Approach
2.1. ‘Medical Education Elective’ Design
Our design of the elective was guided by constructivist theory. Although delivered completely online, we encouraged active construction of knowledge through social interaction, collaboration and choice. Students could undertake the elective on a part‐time or full‐time basis across 4‐weeks. Students choosing ‘part‐time’ were expected to commit to 18 h per week and undertook the elective concurrently with another ‘part‐time’ elective (e.g., assisting at vaccination clinics). Students choosing ‘full‐time’ were also required to complete an education project (requiring an additional 18 h per week). Students could choose to complete an education project in pairs or individually. The scope of projects was reasonably open and could include development of teaching resources or contributing to an educational research project.
All students were required to submit a learning plan prior to commencing the medical education elective, stating their motivation for joining the elective and their individual learning outcomes. Those completing an education project were also required to provide an outline of their project, including the objective, steps and timeline for completion. Constructive feedback was provided for each learning plan. All students were required to attend an ‘Education Showcase’ at the end of the elective period, where the education projects were showcased with 15‐min presentations and discussion.
2.2. Learning Activities and Completion Requirements
We used a mix of asynchronous and synchronous learning activities (outlined in Table 1), with feedback provided from both peers and faculty throughout the elective. All students were required to complete 13 e‐learning modules, which were adapted from the previously described and successful Peer Teacher Training programme [7, 8], with content informed by evidence‐based, peer reviewed literature [10, 11, 12]. The modules incorporated multimedia elements, with the inclusion of videos, infographics and discussion boards. The e‐learning modules covered the following topics:
Introduction to the medical education elective
Feedback in the clinical setting
Planning, preparing and structuring a small group teaching session
Facilitating small group learning in the health professions
Key tips for teaching in the clinical setting
Tips for teaching procedural skills
Effective clinical handover
Team‐based learning: design, facilitation and participation
Journal Club and critical appraisal
Mentorship
Leadership in healthcare education
Case‐based learning (CBL)
Interprofessional Education: tips for design and implementation
TABLE 1.
Medical education elective 4‐week programme outline.
| Week | E‐learning modules | Asynchronous learning activities | Synchronous learning activities (via Zoom) |
|---|---|---|---|
| 1 |
|
|
|
| 2 |
|
|
|
| 3 |
|
|
|
| 4 |
|
|
|
Key requirements included submission and peer review of a lesson plan, using the ‘Outcomes, Activities, Summary ‘OAS’ model, the creation of a teaching video of a nonhealthcare procedural skill (using Peyton's 4‐step approach to teaching a skill) and engagement in feedback using Pendleton's model [11]. In addition, all students participated in five interactive Zoom sessions (approximately 2 h each in duration), which required active engagement. These sessions comprised (1) introduction to the elective, (2) Journal Club and critical appraisal, (3) tips on online teaching, (4) small group teaching where students were required to teach a 5‐min healthcare topic and provide feedback to peers, and (5) education project showcase. Students were also required to attend a medical education research seminar. Upon successful completion of the elective, participants received a certificate.
2.3. Facilitation
Academics and clinicians facilitated the elective. Participation and completion of all learning activities were closely monitored by a senior academic.
3. Evaluation
3.1. Recruitment and Participation
In total, 49/250 (20%) final year (Year 4) medical students chose to complete the medical education elective. Of these, 19/49 (39%) students completed the elective on a part‐time basis and 30/49 (51%) on a full‐time basis by including an education project.
3.2. Methods
3.2.1. Questionnaire
The questionnaire design was guided by the three key elements of Biggs' 3P model: presage, process and product [9]. Participants were invited to respond to four open‐ended questions addressing their prior experience in teaching and prior training, the most useful aspects of the elective programme and suggestions for improvement, their experience of online participation and intention to apply teaching skills in future practice. Thematic analysis was used to code and categorise qualitative data and build an understanding of the students' experience. A portion of the data was read by three authors (AB, AWB and KB) to identify initial themes. Following negotiation of meaning between these authors, a coding framework was developed and applied to the full data set by the first author (AB) [13].
3.3. Ethics Statement
The University of Sydney Human Research Ethics Committee approved the study.
3.4. Results
Of the 49 students who completed the medical education elective, 34 (69%) completed the postcourse questionnaire. Among respondents, 18 (53%) were female, 15 (44%) were male and 1 (3%) preferred not to say. The majority of students reported some prior teaching experience (n = 27, 79%), although only a quarter had received prior training in teaching (n = 8, 24%).
Participants' responses to four open‐ended questions are summarised in Tables 2, 4 below; Table 2 presents participants' perceived ‘most useful aspects of the elective programme’ and suggestions for improvement, Table 3 presents participants' perceptions of ‘participating in the elective programme completely online’, and Table 4 presents participants' perception of how they will ‘use skills learnt from the elective programme in the future’.
TABLE 2.
Participant responses regarding the most useful aspects of the elective programme and suggestions for improvement.
| Theme | Example of comments relating to theme |
|---|---|
| Creating a learning project |
I really enjoyed the educational project. It challenged me to think critically about my teaching style and what knowledge I wanted to impart. [The programme] pushed me to create a learning project which was good revision for my degree. |
| The theory of medical education |
I found the theory of education really useful. It's more like now I feel confident, I can teach, I've got more background behind me, and theory of how to teach. |
| Formal frameworks for designing a teaching session |
Having a formal framework for teaching, particularly the feedback elements. It was great to have a structure to fall back on, in terms of teaching in the future. |
| Learning more about e‐learning |
I thoroughly enjoyed the e‐learning zoom and the feedback practice involved in the 5‐min teaching a healthcare topic session. I really enjoyed the session on e‐learning. |
| Learning more about the medical education field |
Learning about opportunities to be involved in medical education. I did not realise that it was possible to be so involved in teaching and education. |
| Theme | Example of comments relating to theme |
|---|---|
| Additional opportunities to apply teaching skills |
More group activities that simulate real life teaching exercises. More practical activities, more teaching about clinical skills, e.g., taking a history, examination skills, etc. Discussion forums being replaced by Zoom live discussions would've been a good idea too. |
TABLE 4.
Participant perceptions of how they will ‘use skills learnt from the elective programme in the future’.
| Theme | Example of comments relating to theme |
|---|---|
| Increased confidence to participate in teaching |
Made me feel more confident and inclined to do teaching as a junior doctor. I am going to get involved in more teaching of medical students in younger years. |
| A starting point toward more formal roles |
I would love to become a tutor for medical students in the future, and extra teaching. Planning on taking on more leadership and teaching roles for other medical students next year and looking forward to taking small groups as a JMO. |
TABLE 3.
Participant perceptions of participating in the elective programme completely online.
| Theme | Example of comments relating to theme |
|---|---|
| A unique opportunity with dedicated time |
It was good to have time to really focus and give our attention, which I otherwise would not have done. This was great as there is not anything like this in the curriculum. |
| Self‐paced and flexible programme |
It worked well. This programme was flexible, and I learnt a lot despite fitting it around a number of other jobs. I really enjoyed the flexibility of a completely online programme as it allowed me to work at my own pace, getting ahead of schedule when I had extra time. |
| The option of some face‐to‐face activities |
If students chose to, there could also be an option for a face‐to‐face component. Any face‐to‐face sessions would be great! This could include lectures and activities, e.g., 5‐min teaching session. |
4. Implications
We sought to explore student perception of the medical education elective, which was designed to provide dedicated time for the development of knowledge and skills in clinical teaching. Students valued the opportunity to engage with educational theory while practising teaching and feedback with peers. Participation in the elective was found to enhance their confidence in teaching and to serve as an initial step toward more formal roles. Although students valued the flexibility of online learning, some indicated that the addition of ‘in‐person’ sessions would increase engagement. We used the conceptual lens of Biggs' 3P model to consider the implication of our findings.
4.1. Presage
The medical education elective represented a popular alternative to traditional elective placements, with 20% of the final year student cohort choosing to participate. However, it should be noted that travel restrictions were in place at the time. Although most students reported having some teaching experience, few had received formal training. While the majority of elective placements are conducted in‐person involving clinical work, this elective provided a meaningful avenue for professional development—an area currently underexplored in the literature [1, 14]. Institutional expectations and relevance have a strong influence on student engagement and participation in programmes [15]. The medical education elective allowed students to demonstrate shared interest in medical education and provided the University with an additional opportunity to highlight alternative avenues for engagement.
The medical education elective allowed students to demonstrate shared interest in medical education and provided the University with an additional opportunity to highlight alternative avenues for engagement.
4.2. Process
Most students found the online delivery of the elective to be beneficial, citing its flexibility, accessibility and the ability to pace their learning according to their needs. They particularly valued opportunities to practice teaching and feedback during the synchronous sessions. However, some students indicated that their experience could be enhanced by the inclusion of ‘in‐person’ components. Evidence suggests that although online training is convenient and helpful in improving knowledge, it may be less effective in developing practical skills [15] and in building peer relationships [16]. Encouragingly, students responded positively to the education technology session, which addressed the growing need for clinicians to be prepared to teach in online environments [17].
Most students found the online delivery of the elective to be beneficial, citing its flexibility, accessibility and the ability to pace their learning according to their needs.
4.3. Product
Students reported that participation in the elective increased their confidence in teaching and provided them with formal frameworks, particularly for delivering feedback. They valued the opportunity to consolidate their medical knowledge and explore diverse health topics in greater depth while preparing their education projects. Students expressed particular interest in mentoring junior medical students and engaging in teaching activities as early career doctors. Given that most doctors are involved in at least some teaching, this elective programme may be particularly timely and well‐received by students preparing for postgraduate roles or considering a career in medical education. These findings underscore the benefits of embedding teacher training programmes in medical curricula [8].
Students reported that participation in the elective increased their confidence in teaching and provided them with formal frameworks, particularly for delivering feedback.
Our results suggest that electives in medical education may help to provide an initial pipeline for future clinical educators. Additionally, they create opportunities for global engagement with other ‘like‐minded’ medical schools and facilitate the expansion of local and international clinical educator networks. Further evaluations that include knowledge and skills acquisition data analysis, and long‐term outcomes will help to determine the effectiveness and guide optimal design of medical education elective programmes.
Our results suggest that electives in medical education may help to provide an initial pipeline for future clinical educators.
Author Contributions
Akhil Bansal: conceptualization, investigation, methodology, formal analysis, visualization, data curation, writing – original draft, writing – review and editing. Kirsten I. Black: formal analysis, project administration, writing – original draft, writing – review and editing. Jane Bleasel: conceptualization, project administration, formal analysis, writing – review and editing. Annette W. Burgess: conceptualization, investigation, methodology, project administration, supervision, formal analysis, data curation, writing – original draft, writing – review and editing.
Funding
The authors have nothing to report.
Ethics Statement
This study was approved by the University of Sydney Human Research Ethics Committee.
Conflicts of Interest
The authors declare no conflicts of interest.
Acknowledgements
We would like to thank the students who participated in the medical education elective. Open access publishing facilitated by The University of Sydney, as part of the Wiley‐The University of Sydney agreement via the Council of Australasian University Librarians.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.