Table 1.
Summary of characteristics of studies chosen for the clinical skills/knowledge meta-analysis
| Lead author (Year) | Sample size (Intervention) | Sample size (Control) | Subject | Grade of student | Grade of peer tutor | Level of control teacher | Nature of intervention | Duration of intervention | Tutor training mentioned | Objective outcomes measured (examinations) | Location of study | Any statistical significance | Reference # |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Büscher (2013) | 63 | 60 | Basic pediatric examination (newborns) and communication skills with parent | One year junior to tutors | Already completed semesters 4&5 (i.e. senior) | Senior lecturer | Student peer tutor teaching using checklist to groups of 2 students | 14 days pediatrics class | 2 weeks (80 hours) | OSCE (some videoed for expert validation) | Germany | No (p = 0.2) | [28] |
| Cremerius (2019) | 36 | 33 | Basic musculoskeletal ultrasound skills including shoulder | Elective from semester 4 onwards | Matched peer | Qualified doctor with several years ultrasound experience | Student peer tutor demonstrates patient positioning, device handling, 3 ultrasound views and explanations. Student practiced learnt skills with each other. Group size maximum 6. | one semester | 2 weeks in advance | MCQ & OSCE | Germany | MCQ - no (p = 0.75); OSCE - no (p = 1) | [29] |
| Heckmann (2008) | 66 | 56 | Neurology (neurological examination and lumbar puncture simulation) | Year 5 | Students who succesfully completed course one semester earlier (Year5/6) | Postgraduate tutors | Peer tutor instructs and demonstrates and subsequently oversees student practice. Groups 8-10. | one week | Briefed prior to course by neurologist (undefined further) | Written test & OSCE | Germany | Written test - no (p = 0.15); OSCE - no (p = 0.11) | [30] |
| Hudson (2008) | 64 | 67 | Basic clinical skills (medical history, patient examination and patient communication) | Year 2 | Year 6 | Paid doctors | Small-group structured tutorials for feedback on history taking and examination skills using simulated patient. | 14 weeks including 14x 1 hour small group tutorials | Training workshop and continued educational support | OSCE | Australia | OSCE - no overall difference (only 1 of 6 stations had difference p < 0.05) | [31] |
| Kassab (2005) | 44 | 47 | Hematology unit (clinical knowledge) PBL Health problems | Year 3 | Matched peer | Faculty tutor | 2 tutorials/week. Group size 8-10 students. | 5 weeks | Intensive one-day workshop and weekly tutor-briefing | End-unit exam: SAQ, MCQ & Observed Structural Practical Exam | Kingdom of Bahrain | SAQ and MCQ combined - no; OSPE - no; (p-values not given beyond >0.05) | [32] |
| Knobe (2010) | 75 | 76 | Musculoskeletal ultrasound of the shoulder (sports medicine) | Years 3 and 4 | Matched peer | Experienced doctor >6 years | Two x 120 minute teaching sessions: theory (30 min) practice (90 min). Group size 6-14 students | Two weeks (2 hours/week) | 30 minute training and 1 week self-teaching | MCQ & OCSE | Germany | MCQ - no (p = 0.64); OSCE - no (p = 0.13). | [33] |
| Kühl (2012) | 15 | 15 | Internal medicine (cardiology) - focused emergency echocardiography skills | Year 3-5 | Year 3-6 | Expert cardiographer | Three x 135 minute hands-on practical sessions. Student/instructor ratio 1:3. | Twelve hour course | 5h seminar, 3 week practical, 3h expert meeting, 12h didactic seninar | OSCE | Germany | Yes – p = 0.03 | [34] |
| Nomura (2017) | 58 | 58 | Communication skills - Medical interview training | Year 4 | Year 5 | Faculty physician | Small group role-play of a medical interview (3 hour session). Group size undefined | 4 week course | One hour tutor training | OSCE | Japan | No (p value not given but did not exceed 95% CI non-inferiority magin) | [35] |
| Rogers (2000) | 40 | 37 | Computer-assisted learning of a surgical skill | Year 1 | Matched peer | Not applicable (software) | Group size 8-10 where either 1 student:1 peer or individual student interacts with computer. Post session performance videotaped and validated by surgical faculty. | Undefined | Undefined (beyond computer assisted learning program for both) | Practical examination | USA | Yes but worse outcomes (p = 0.04) | [36] |
| Shah (2017) | 60 | 60 | Physical examination skills (surgery clerkship): examination of lump, limb, palpation and percussion of abdomen. | Year 5 | Matched peer | Expert (no further definition) | One hour clinical skills teaching sessions. Group size 5. | 4 weeks | Training given but extent not specified | OSCE | Pakistan | Yes – p = 0.00 | [37] |
| Steele (2000) | 64 (approx half of 127 cohort) | 64 (approx half of 127 cohort) | PBL case studies (clinical knowledge) | Year 2 | Matched peer | Faculty members | 11 case studies: Each inviolves 3x 1-2h PBL sessions. Group size = 10. | 11x 2 weeks | Pre-case orientation sessions | 15 item exam following each case, MCQ and matching questions | USA | No (No p-value given) | [38] |
| Weyrich (2009) | 31 | 28 | Basic clinical skills - internal medicine technical skills | Year 3 | Year 4 & 5 | Consultants in internal medicine | Two training units (each 2x 3-hour training sessions delivered one week apart. Group size 5-8 with 2 tutors. | 6 months | Two 3 hour skills training sessions & two 4-hour teaching sessions | OSCE | Germany | No (p = 0.11) | [39] |
| Widyahening (2019) | 241 | 241 | Clinical epidemiology and evidence-based medicine - critical appraisal skills | Year 4 | Newly graduated doctors | Medical Staff | Four 2-hour tutored group discussions. Group size 10-11 students | 4 weeks | 3 day training of teachers | MCQ & Fresno test | Indonesia | No (p = 0.12) | [40] |