We found a non-statistically significant increase inmean scores on examination 1, which were 2.6%higher in students who had attended the MPI ses-sion than in those who had not (85.2% versus82.6%). On examination 2, the mean score of stu-dents who had attended the MPI session was 6.9%higher (statistically significant) than that of thosewho had not attended the session (83.5% versus76.6%). Although the difference is not statisticallysignificant, examination 3 mean scores were 3.9%higher in those who had attended than in thosewho had not (91.2% versus 87.3%). Examination 4mean scores indicated a statistically significantimprovement of 7.1% in those who had attendedover those who had not (88.1% versus 81.0%).When we looked at cumulative mean final examina-tion performance, we found that students who hadattended at least one MPI session achieved a highlystatistically significant improvement of 8.2% in theirexamination score compared with those who hadnot attended any MPI sessions (82.1% versus73.9%). Although attendance diminished as the ses-sions progressed, the improvement in examinationperformance was maintained. When we examinedattendance by upper quartile ranking at the end ofYear 1, the majority of students who had attendedthe sessions were found NOT to come from theupper quartile, indicating that the gain in examina-tion performance was not solely attributable to theacademic calibre of students attending.What lessons were learned? Attending at least oneMPI session did improve examination performanceon similar pharmacology-related content. We alsolearned that because of the number of totalengaged learning activities, students did not feelthere was adequate time to prepare for all sessions.Subsequently, the timing and number of sessionswill be reorganised next year and students will begiven credit for participation.

REFERENCE

1 Mazur E. Peer Instruction: A User’s Manual. UpperSaddle River, NJ: Prentice Hall 1997.

Correspondence: Mary Jo Trout, Department of Pharmacology andToxicology, Boonshoft School of Medicine, Wright StateUniversity, 290L White Hall, Office of Academic Affairs, 3640Colonel Glenn Highway, Dayton, Ohio 45435, USA. Tel: +1 937775 3820; E-mail: mary.trout@wright.edu

doi: 10.1111/medu.12590

Perspectives on the Pathway to ParamedicineProgramme

Linda Ross & Jessica Bertucci

What problems were addressed? Current para-medic practice has evolved to reflect evidence-basedresearch and advances in pharmacotherapy andmedical technology. In addition to a greater scopeof clinical practice, paramedics are required toperform an ever-increasing ‘educator’ role. Theresponsibilities of this role may range from theformal preception or mentoring of junior para-medics to the informal education of patients abouttheir conditions and resources available to assistthem. Given the significance of this role and theimpact it can have on patient care, it is vital thatundergraduate programmes adequately preparefuture practitioners for this responsibility.Peer-assisted learning (PAL) is one pedagogical

approach that has proven to be invaluable inassisting mentors to develop necessary teachingskills.1

What was tried? The Pathway to ParamedicineProgramme is a PAL initiative that was introducedinto the undergraduate paramedic programme atMonash University’s Department of CommunityEmergency Health and Paramedic Practice in2013. This programme aimed to equip futuregraduates with the skills and confidence they willrequire to become effective educators as well asclinicians.It involved paramedic students in teaching and

mentoring high school students with an interestin paramedicine. The programme ran for 2 hoursper week over 10 weeks. The paramedic studentsplanned and conducted theoretical sessions forthe group, covering core paramedic practice(including patient assessment), cardiovascularrespiratory diseases, and cardiac arrest), These the-ory sessions were supported by small-group practi-cal sessions in which the secondary schoolstudents gained hands-on experience in practisingclinical skills and using medical equipment. Theprocess also gave the paramedic students opportu-nities to form strong mentoring relationships andhone their teaching skills. At the completion ofthe programme, a paper-based survey utilising a5-point Likert scale and a free-text question wasdistributed to gain participants’ perspectives of theprogramme.What lessons were learned? The results from thesurveys were overwhelmingly positive. The para-

ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 1104–1132 1113

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medic students thoroughly enjoyed the teacher andmentor experience and found it to be very benefi-cial. They indicated that the programme hadimproved their interpersonal communication skillsand reinforced their own skills and knowledge. Theyalso enjoyed working in small groups as this builttheir confidence as mentors.The secondary school students also enjoyed the

programme and the rare insight it gave them intoparamedic education and practice. They found theparamedic students to be very friendly, knowledge-able and approachable, and gained from theirinteraction with them.The Pathway to Paramedicine Programme has proven

to be very beneficial to both mentors and mentees.The success of the programme has seen it embed-ded into the undergraduate paramedic degree atMonash University. The programme has alsoexpanded to include greater numbers and has beenbolstered by the inclusion of the pre-training ofmentors in basic teaching principles.

REFERENCE

1 Hryciw DH, Tangalakis K, Supple B, Best G.Evaluation of a peer mentoring programme for amature cohort of first-year undergraduate paramedicstudents. Adv Physiol Educ 2013;37 (1):80–4.

Correspondence: Linda Ross, Community Emergency Health andParamedic Practice, Monash University, Melbourne, Victoria3199, Australia. Tel: 00 61 3 9904 4407;E-mail: linda.ross@monash.edu

doi: 10.1111/medu.12563

What is the diagnosis?

Wouter A A de Steenhuijsen Piters, Joost Frenkel,Paul L P Brand & Martine F Raphael

What problems were addressed? Lifelong learningis a frequently cited goal in both undergraduateand postgraduate medical education, and repetitivetesting has been shown to be effective in increasingfactual knowledge and the retention of informa-tion.1 By initiating a weekly, multicentre, quiz-basede-learning system in paediatrics, we integrated con-tinuous learning into daily practice.What was tried? Between May 2011 and March2014, paediatricians, paediatric residents andresearchers in paediatrics at three large (univer-

sity) hospitals in the Netherlands were given theopportunity to voluntarily subscribe to a weeklye-mail-based quiz entitled ‘What is the Diagnosis?’(WitD?). The e-mail consisted of a brief clinicalcase description with an image or laboratory resulton a general or subspecialty paediatric topic, andconcluded with the question: ‘What is thediagnosis?’ Participants were requested to respondwithin 5 days, after which they were sent an e-mailcontaining the correct answer, a short explanation,relevant literature references for the diagnosisand a new WitD? case. This cycle was repeatedevery week.What lessons were learned? Over the course ofalmost 3 years, a total of 100 WitD? cases weremailed. Within this period, the number of subscrib-ers rose from 360 at the end of the first year to 632in March 2014. Many subscribers participated irreg-ularly. Across all cases, an average of 27 subscribers(4% of all subscribers; range: nine to 52 subscrib-ers) submitted answers for each WitD? case. Ofthese, 41% were paediatricians, 43% were paediatricresidents, 11% were researchers and 6% had otheror unknown roles. Of all answers given, 66% werecorrect (63% in researchers, 65% in paediatriciansand 67% in paediatric residents).We observed a low response rate; however, many

non-responders were exposed to WitD? cases in ple-nary settings such as clinical teaching rounds andmorning reports.Cases with a low number of participants generated

fewer correct answers (< 20 participants: 25% cor-rect answers) than cases with a high response rate(> 35 participants: 75% correct answers) (chi-squared test, p < 0.0005). All answers were analysedanonymously to secure a safe learning environment,but anxiety associated with the submission of awrong answer may still have caused some subscribersto hesitate in responding.Its dependence on cases submitted by participants

represents both a strength and a limitation of theWitD? approach. The method is ‘owned’ by its con-tributors, which ensures their engagement, butwhen time constraints and the non-binding requestto submit cases led to the presentation of insuffi-cient numbers of WitD? cases, the WitD? teamscheduled participating centres to present new caseswithin predefined timeframes.In conclusion, we successfully initiated a weekly,

multicentre, e-mail-based quiz to promote knowledgeacquisition in paediatrics. Despite a low responserate, we believe the WitD? tool represents a promis-ing educational initiative to support individual andgroup learning processes in clinical reasoning.

1114 ª 2014 John Wiley & Sons Ltd. MEDICAL EDUCATION 2014; 48: 1104–1132

really good stuff