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Markus Krautter,1 Sven Andreesen,2 Nadja Köhl-Hackert,2 Katja Hoffmann,3 Wolfgang Herzog,2 Christoph Nikendei2 1Department of Nephrology, University of Heidelberg, 2Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, 3Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany Background: Peer-assisted learning (PAL) has become a well-accepted teaching method within medical education. However, descriptions of on-ward PAL programs are rare. A focus group analysis of a newly established PAL program on an internal medicine ward was conducted to provide insights into PAL teaching from a student perspective.Purpose: To provide insights into students' experiences regarding their on-ward training with and without accompanying PAL tutors.Methods: A total of N=168 medical students in their sixth semester participated in the investigation (intervention group: N=88; control group: N=80). The intervention group took part in the PAL program, while the control group received standard on-ward training. There were seven focus groups with N=43 participants (intervention group: four focus groups, N=28 participants; control group: three focus groups, N=15 participants). The discussions were analyzed using content analysis.Results: The intervention group emphasized the role of the tutors as competent and well-trained teachers, most beneficial in supervising clinical skills. Tutors motivate students, help them to integrate into the ward team, and provide a non-fear-based working relationship whereby students' anxiety regarding working on ward decreases. The control group had to rely on autodidactic learning strategies when neither supervising physicians nor final-year students were available.Conclusion: On-ward PAL programs represent a particularly valuable tool for students' support in training clinical competencies on ward. The tutor–student working alliance acts through its flat hierarchy. Nevertheless, tutors cannot represent an adequate substitute for experienced physicians. Keywords: peer-assisted learning, cross-year peer tutoring, undergraduate medical education, final year, internal medicine, clinical skills training

Background: Learning on the ward as a practice-oriented preparation for the future workplace plays a crucial role in the medical education of future physicians. However, students' ward internship is partially problematic due to condensed workflows on the ward and the high workload of supervising physicians. For the first time in a German-speaking setting, students' expectations and concerns about their internship on the ward are examined in a qualitative analysis regarding their internal medicine rotation within clinical medical education., Methods: Of a total of 168 medical students in their 6th semester at the Medical Faculty of Heidelberg, 28 students (m=8, f=20, Ø 23.6 years) took part in focus group interviews 3 to 5 days prior to their internship on the internal medicine ward within their clinical internal medicine rotation. Students were divided into four different focus groups. The protocols were transcribed and a content analysis was conducted based on grounded theory., Results: We gathered a total of 489 relevant individual statements. The students hope for a successful integration within the ward team, reliable and supportive supervisors and supervision in small groups. They expect to face the most common diseases, to train the most important medical skills, to assume full responsibility for their own patients and to acquire their own medical identity. The students fear an insufficient time frame to achieve their aims. They are also concerned they will have too little contact with patients and inadequate supervision., Conclusion: For the development and standardization of effective student internships, the greatest relevance should be attributed to guidance and supervision by professionally trained and well-prepared medical teachers, entailing a significant increase in staff and costs. A structural framework is required in order to transfer the responsibility for the treatment of patients to the students at an early stage in medical education and in a longitudinal manner. The data suggest that the development and establishment of guidelines for medical teachers associated with clearly defined learning objectives for the students' internships are urgently needed. Based on our findings, we provide first recommendations and suggest possible solutions.

Introduction: Peer-assisted learning is a common feature of medical education and proves to be highly effective in many areas. So far there have been no reports on on-ward tutorials held by final-year students to promote the clinical competencies of medical undergraduates. The aim of the current investigation was to both evaluate undergraduate and tutor acceptance of a peer-assisted learning programme performed by final-year students and to examine the perception of the role of final-year students within an intervention and a control group., Method: 88 medical students (51 female, 37 male; mean age 23.6 years) were assigned to one of seven intervention wards where 10 student-led, patient-centred tutorials were held. 80 medical students (58 female, 22 male; mean age 23.3 years) were assigned to one of seven control wards. Tutorials were held by 14 volunteer final-year student tutors (8 female, 6 male; mean age 26.2 years). Acceptance of the peer-assisted learning programme and ratings of the role of final-year students were evaluated on a six-point Likert scale (ranging from 1 = very good to 6 = unsatisfactory and 1 = completely agree to 6 = completely disagree)., Results: Medical undergraduates rated student-led tutorials and tutors rated the introductory course and the complete programme as extremely positive (1.14 +/- 0.36 to 2.34 +/- 1.15). The role of final-year students as role model, teacher, contact person and integrator was rated as being significantly more relevant by students in the intervention group than by those in the control group (p < 0.02 in each case)., Discussion: Patient-centred, student-led on-ward tutorials designed to promote undergraduate clinical competencies received extremely positive ratings from both medical undergraduates and tutors and enable final-year tutors to assume important roles.