Students as facilitators in a teacher training program: motivation for leadership roles

Introduction

Although students often partake in peer-teaching activities during medical school, they are rarely provided with formal training in teaching.¹ We have previously described our teacher training (TT) program for medical students.² The purpose of the program is to assist senior students in preparation for their roles as peer teachers within medical school^3,4 and also to better prepare them for their future roles as medical practitioners with teaching, supervision, and assessment responsibilities.⁵ The TT program is delivered face-to-face, with topics including skills teaching, small group teaching, bedside teaching, assessment, and feedback. Implemented across two 3-hour sessions, delivery includes both large group interactive teaching and small group active learning. The program is resource-intensive to run, requiring at least seven facilitators for each session, in particular for the small group activities.

In order to alleviate the academic teaching load required to run the course, and at the same time to provide our final-year (year 4) students with practical opportunities to develop their leadership skills, we engaged a core group of students as co-facilitators of our TT program alongside two academic staff. While traditional approaches to development of leadership skills involve “courses” in leadership, it has been suggested that development of leadership skills should be addressed within the early stages of medical education and continued throughout a doctor’s career.⁶ Further, this development should be nurtured and supported by the organization in which they learn and work.⁶ These newly created leadership roles, we felt, would highlight for students the importance of promoting excellence in teaching skills within the medical profession.⁷

By developing an understanding of students’ motivation to assume such roles, we may be able to promote an interest within leadership in teaching among other students. Motivation has been described as a person’s willingness to apply effort in order to achieve a particular goal,⁸ but it is a complex concept. While both extrinsic and intrinsic motivators are evident, intrinsic motivation is a powerful influence.⁹ Self-determination theory (SDT)⁹ offers a conceptual lens to view facilitators’ intrinsic motivation. SDT poses that three elements are key to intrinsic motivation: autonomy, competence, and relatedness. Autonomy relates to students’ sense of independence and choice. Competence relates to students’ aim to gain mastery of a subject. Relatedness refers to students’ sense of community among others with similar interests.

Our study sought to examine students’ motivation to take part as facilitators in the TT program.

Methods

Context

The TT program was conducted in March 2014 at Sydney Medical School – Central, based at Royal Prince Alfred Hospital (Camperdown, NSW, Australia), where year 3 and year 4 students gain clinical experience in their final 2 years of the graduate-entry medical program. Participants enrolled in the program were from year 3 of the medical program and facilitators were from year 4.

Structure and content of the program

The program was run across two 3-hour sessions. In total, 23 year 3 students voluntarily participated in the program. The program was delivered as a four-module face-to-face program, providing theoretical background, practical examples, and active participation in “skills teaching”, “small group teaching”, “clinical teaching”, and “assessment and feedback”.² Facilitation included interactive large-group PowerPoint presentations as well as two small-group sessions. Each small-group session consisted of three to four participants. During the small-group sessions, participants were required to teach their peers a short 5–10 minute microteaching activity. The first activity was to teach a nonmedical skill and the second activity was a teaching presentation on a medical topic. Participants were required to provide feedback to their peers during the small-group sessions.

Facilitators

Two senior academic staff led facilitation. In total, at least seven facilitators were required to run the sessions, including the two senior academic facilitators. We invited eight of our year 4 students by email to assist in facilitation, and in particular, to supervise the small-group sessions. Students selected to facilitate were those with a good academic record, with a good attendance and participation record, and who had previously completed the TT program themselves as year 3 students. We limited the initial invitation to eight students as we felt that five to eight students would provide adequate resources, and we were unsure of the likely response.

Facilitator responsibilities

Although the senior academic staff (two associate deans) led the large group sessions, the students had minor roles within these sessions, such as speaking to some of the PowerPoint slides and demonstrating the teaching of a skill. Student facilitators had independent responsibilities for facilitation of their own small groups. They were required to facilitate each student in teaching a skill within the group, give a short tutorial, and ensure correct feedback by other members of the group (as well as their own feedback). Students were thanked by the associate dean of the school and given a certificate at the end of the course.

To prepare for their facilitator roles, students were required to attend a 1-hour meeting where they were briefed on their responsibilities and how to teach within the small groups and were provided with facilitator packages containing the PowerPoint presentations, facilitator guidelines, and a detailed schedule.

Data collection and analysis

Student facilitators were invited to attend a focus group. Data were transcribed verbatim. A thematic analysis of the qualitative data was done using Framework Analysis.¹⁰ SDT was used as the conceptual framework for this paper and to subsequently develop a thematic framework, which was applied to a portion of the dataset by two authors to determine its trustworthiness. Subsequently, a coding framework was developed to code the entire dataset in order to identify and code recurrent themes in the data.¹⁰

Ethics approval was obtained from the University of Sydney Human Research Ethics Committee.

Results

Of the eight students who were invited to be facilitators, five agreed to participate.

All five student facilitators attended the focus group. Of the five, four were female and one was male.

Using the components of SDT, including autonomy, competence, and relatedness, as the conceptual framework, students’ motivation to take part as facilitators is demonstrated in Tables 1–3.

Table 1 Students’ motivation in relation to autonomy

Table 2 Students’ motivation in relation to competence Abbreviation: CV, curriculum vitae.

Table 3 Students’ motivation in relation to relatedness Abbreviations: RPA, Royal Prince Alfred Hospital; TT, teacher training.

Discussion

Our final-year students were provided with an opportunity to undertake important leadership roles as facilitators. Their participation provided a crucial resource to run our TT program. Using SDT as a conceptual framework, this study sought to explore students’ motivation to facilitate the TT program for their junior peers.

Autonomy

A sense of choice is desired by most people,¹¹ and students were free to choose whether or not to accept the invitation to facilitate. Although autonomy does not mean working separately from others,¹² autonomy was fostered by providing students with the opportunity to use their knowledge and prior training in teaching to take responsibility for their own small groups. Some were also given a role within the large group teaching alongside the senior academic staff. By choosing to be facilitators in the TT program, students felt they were able to help shape the quality of teaching for fellow students.¹³

Competence

Individuals enjoy mastering subjects in which they are engaged.¹⁴ Reflective practice has the potential to engage and motivate individuals to even higher levels of expertise.¹⁵ Although our facilitators had already completed the TT course themselves as year 3 students, they felt facilitation in TT provided them with opportunities to practice and reinforce their teaching skills. Certainly, facilitators expressed a sense of achievement and enjoyment in running their own small groups, stating that it presented new challenges to them. For example, our facilitators found it challenging to develop appropriate techniques to correct students’ teaching methods during these small-group activities. An optimum level of challenge is important in working toward mastery of a subject,¹¹ and our facilitators aspired to improve their professionalism skills in teaching, recognizing this as a graduate attribute that is required in future medical practice.

Relatedness

A sense of community may be fostered within groups of individuals with similar goals,^16,17 and medical education involves a process of socialization.¹⁸ The social context of the TT activities promoted communal engagement, not only among students, but also with senior academic staff. Student facilitators expressed an understanding of how their contributions as facilitators might impact on their school community at Royal Prince Alfred Hospital.⁶ By embedding leadership development in students’ hospital-based activities, students could see how their role as facilitators linked to the development of their school, their hospital, and the medical profession as a whole.¹⁹ Students recognized the importance of teaching in their future medical careers, realizing that teaching formed part of their professional identity.

Limitations

The major limitation of our study was the small number of participants. The views of these participants may not be generalizable to a wider student population.

Conclusion

An understanding of students’ motivation to participate in leadership roles may help to develop future opportunities for students within our medical school. Importantly, student facilitators conveyed an appreciation of the teaching and supervision responsibilities they will assume in their future careers as medical practitioners. Senior students’ motivation to assist with facilitation of the course was largely related to the opportunity to review and build on their own knowledge and skills in teaching practices; the recognition and acknowledgement received from school staff and fellow students; the opportunity to develop these relationships; and the desire to increase their peer-teaching responsibilities. By actively involving our senior students in leadership practices, we were able to not only engage the students, but also develop our student community and contribute to the promotion of a culture of excellence in teaching within the hospital.

Disclosure

The authors report no conflicts of interest in this work.

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