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Problem-Based Learning: An Approach to Medical Education

The intracellular protozoan Toxoplasma gondii is a widespread opportunistic parasite of humans and animals. Normally, T. gondii establishes itself within brain and skeletal muscle tissues, persisting for the life of the host. Initiating and sustaining strong T-cell-mediated immunity is crucial in preventing the emergence of T. gondii as a serious pathogen. The parasite induces high levels of gamma interferon (IFN-γ) during initial infection as a result of early T-cell as well as natural killer (NK) cell activation. Induction of interleukin-12 by macrophages is a major mechanism driving early IFN-γ synthesis. The latter cytokine, in addition to promoting the differentiation of Th1 effectors, is important in macrophage activation and acquisition of microbicidal functions, such as nitric oxide release. During chronic infection, parasite-specific T lymphocytes release high levels of IFN-γ, which is required to prevent cyst reactivation. T-cell-mediated cytolytic activity against infected cells, while easily demonstrable, plays a secondary role to inflammatory cytokine production. While part of the clinical manifestations of toxoplasmosis results from direct tissue destruction by the parasite, inflammatory cytokine-mediated immunopathologic changes may also contribute to disease progression.

https://cmr.asm.org/content/cmr/11/4/569.full.pdf

Regulation and Function of T-Cell-Mediated Immunity during Toxoplasma gondii Infection

Objective: To provide an estimation of how often peer teaching is applied in medical education, based on reports in the literature and to summarize reasons that support the use of this form of teaching.Method: We surveyed the 2006 medical education literature and categorised reports of peer teaching according to educational distance between students teaching and students taught, group size, and level of formality of the teaching. Subsequently, we analysed the rationales for applying peer teaching.Results: Most reports were published abstracts in either Medical Education's annual feature ‘Really Good Stuff’ or the AMEE's annual conference proceedings. We identified twelve distinct reasons to apply peer teaching, including ‘alleviating faculty teaching burden’, ‘providing role models for junior students’, ‘enhancing intrinsic motivation’ and ‘preparing physicians for their future role as educators’.Discussion: Peer teaching appears to be practiced often, but many peer teaching reports do not become full len...

Peer teaching in medical education: twelve reasons to move from theory to practice

Background
Medical schools use supplemental peer-teaching programs even though there is little research on students’ actual experiences with this form of instruction.

Understanding the Experience of Being Taught by Peers: The Value of Social and Cognitive Congruence.

Introduction
International interest in peer-teaching and peer-assisted learning (PAL) during undergraduate medical programs has grown in recent years, reflected both in literature and in practice. There, remains however, a distinct lack of objective clarity and consensus on the true effectiveness of peer-teaching and its short- and long-term impacts on learning outcomes and clinical practice.

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Medical students-as-teachers: a systematic review of peer-assisted teaching during medical school

Objective This study aimed to determine whether peer-assisted learning (PAL) can enhance clinical examination skills training.

Methods  Three student trainers studied small-group theory and clinical examination and provided PAL as extra tuition for 86 trainees. Trainees watched an examination video, were videotaped practising the examination and, after constructive feedback, repeated the examination. Responses to PAL were evaluated to attain an overview of trainee and trainer performance using visual analogue and Likert scale analyses. Year-group review was undertaken using questionnaires.

Results  Trainees evaluated all aspects of PAL highly, including their post-training confidence in examination skills (mean > 7.7 on a 10-cm scale), indicating that the PAL was effective. Written comments confirmed the students perceived the sessions as well structured and of high quality. Compared with trainees in the first groups, those from later groups gave all parameters similar or higher gradings. Those for interest (P = 0.03) and appropriateness (P = 0.01) were significantly higher, suggesting that trainers may improve their technique with time. Students with previous degrees gave similar or lower gradings than standard entry students, with answers about post-training confidence and recommendation to friends being statistically lower (P < 0.006). Six months later, year-group analysis showed that 90% of trainees rated PAL highly, and 86% wished to become trainers. Of the trainers' year group, 79% perceived that PAL training could improve examination skills.

Conclusions  In the context of clinical skills training, PAL was highly evaluated across many parameters, including confidence after training. Student interest and enthusiasm supports suggestions that PAL could be a useful adjunct to clinical skills training.

Peer-assisted learning: a novel approach to clinical skills learning for medical students.

Background: This study evaluates whether peer-assisted learning (PAL) can be used to improve students’ clinical examination skills.Methods: Four year 4 students trained in PAL techniques and musculoskeletal (MSS) examination used the Gait, Arms, Legs and Spine (GALS) system in a five-week student selected module. These students then recruited and trained 28 second-year trainees. Trainees were evaluated using pre/post confidence questionnaires (100 mm visual analogue scale), a course experience questionnaire (five-point Likert scales) and end-of-year objective structured clinical examination (OSCE) scores.Results: Baseline data from the experimental group were no different from a separate control group, but after training a statistically significant difference in confidence levels was observed in all parts of GALS, 73 (p < 0.0001). Course experience questionnaires demonstrated benefits in all parameters including communication skills and group work with all students recommending PAL training. In en...

Peer-assisted learning in the acquisition of clinical skills: a supplementary approach to musculoskeletal system training

Mice infected with the protozoan parasite Trypanosoma brucei brucei and treated subcuratively with the trypanocidal drug diminazene aceturate develop an acute inflammatory meningoencephalitis with associated astrocytic proliferation. This reaction is very similar to that seen in the fatal posttreatment reactive encephalopathies that can occur in human African trypanosomiasis. The 11-amino acid neuropeptide substance P (SP) has recently been identified as a mediator in many inflammatory responses, and the development of potent, highly specific, nonpeptide SP antagonists has provided a new opportunity to investigate the possible involvement of SP in a variety of pathological conditions. We therefore postulated that SP may play a role in the development of the posttreatment inflammatory encephalopathy found in this experimental mouse model of African trypanosomiasis. In the present study RP-67,580, a SP antagonist that binds specifically to NK-1 receptors, was given intraperitoneally at a dose of 2 mg/kg twice daily to mice in which a severe meningoencephalitis had been produced. A significant reduction in both the severity of the inflammatory response (P = 0.0001) as well as the degree of astrocyte activation (P < 0.001) was found in the brains of these animals as compared with control mice that had not received RP-67,580. An inactive enantiomer of this SP antagonist, RP-68,651, had no effect on the central nervous system inflammatory reaction. We conclude from these findings that the neuropeptide SP plays a key role in the development of the severe central nervous system inflammatory response associated with African trypanosomiasis.

https://www.pnas.org/content/pnas/94/8/4167.full.pdf

A substance P antagonist, RP-67,580, ameliorates a mouse meningoencephalitic response to Trypanosoma brucei brucei

Objective. This study addressed whether medical students using peer-assisted learning (PAL) can deliver training comparable with didactic teaching provided by a specialist. Methods. Twelve senior students were trained in PAL and the gait, arms, legs, spine (GALS) screening technique for musculoskeletal system (MSS) examination. The students recruited and trained 45 year-2 students in the use of GALS. Nineteen students were recruited by a physiotherapist for GALS training tutorials. Trainee responses were compared by analysis of pre/post training confidence (using 100 mm visual analogue scale), course experience questionnaires (using a 5-point Likert scale) including free text comments, and in end of year examinations. Results. Trainee confidence increased after PAL training from 3.7 to 89.9 (P < 0.0001). There were no significant differences in confidence levels from student trainees after PAL when compared with expert-led teaching. Results from course experience questionnaires demonstrated benefits in all parameters investigated with all students recommending PAL training. No differences between PAL and expertled training were observed. Free-text comments showed that PAL-trained students perceived that this learning technique has potential to be applied to other areas of training, an observation not raised by expert-trained students. Examination results revealed that PAL-trained and expert-tutored students were respectively, 1.4 and 1.3 times more likely to pass the MSS examination, when compared with students undertaking standard training (P < 0.002 and P ¼ 0.0001, respectively). Conclusion. PAL is a useful adjunct to musculoskeletal clinical skills training. Students using PAL techniques offered a comparable level of training with that provided by an expert.

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Undergraduate rheumatology: can peer-assisted learning by medical students deliver equivalent training to that provided by specialist staff?

Increasing numbers of ‘teaching-only’ staff are being appointed in higher education institutions in the UK. At one research-intensive university, a new category of academic staff was recently introduced: University Teachers, who are required to engage in scholarly activity as part of their conditions of employment. For many this scholarly activity equates to the Scholarship of Teaching and Learning (SoTL). In an attempt to support this growing body of staff in their engagement with SoTL, a year-long Learning Community (LC) was formed. This paper outlines the activities of the LC and presents the outcomes of a collaborative project to explore its members' experiences. We describe the developmental process of LC membership and consider the parallels between our findings and theories of social capital and transformative learning. We conclude with a consideration of how LCs might be used as an engaging form of academic staff development.

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Joanne Burke

Papers

Peer-assisted learning: a novel approach to clinical skills learning for medical students.

Peer-assisted learning in the acquisition of clinical skills: a supplementary approach to musculoskeletal system training

A substance P antagonist, RP-67,580, ameliorates a mouse meningoencephalitic response to Trypanosoma brucei brucei

Undergraduate rheumatology: can peer-assisted learning by medical students deliver equivalent training to that provided by specialist staff?

From anxiety to empowerment: a learning community of university teachers