In August 2006 eighteen clinical teachers from emergency medicine and anaesthesiology were matched with respect to their clinical experience and teaching experience, and then randomly assigned to a session of teacher training lasting two days (‘trained group’) or no training (‘untrained group’). In anticipation of organizational shortcomings within the department, we planned one additional pair of teachers as backup. From October 2006 to June 2007, all of the teachers in the sample were routinely scheduled to teach emergency medicine to 3rd year students. [In Germany, medical students start their curriculum after 13 years of school. Their first two years at university predominantly cover basic science].
Characteristics of teachers
All clinical teachers were employees of a university teaching hospital. None had received any teacher training prior to the study. For each emergency medicine course, a team of three teachers was responsible, at three different levels of clinical experience. These levels were defined by the learning content, which each teacher had to cover in his or her specific sessions: ‘juniors’ had a clinical experience of 0–1 years (in clinical anaesthesiology), ‘intermediates’ 3–6 years (additional experience in intensive care and emergency room service), and ‘seniors’ 7 or more years (additional experience in pre-hospital emergency medicine). In terms of teaching experience, the ‘junior’ group did not have any, ‘intermediates’ had 1–4 years, and ‘seniors’ had 5 or more years.
Teacher training
Teachers who were assigned to the intervention group attended a two-day clinical teacher training, which was part of the faculty development programme of the Charité –Medical University of Berlin. Training was carried out by one to two experienced educators with a background in educational psychology (generic adult learning) or clinical teaching (clinical application). The learning contents were: ‘role of the teacher’, ‘needs of learners’, ‘providing feedback’, ‘structure of session’, ‘defining learning objectives’, ‘activating learners’, ‘teaching of skills’, ‘teaching with patients’. The courses contained 10–14 participants, the training involved discussion groups, role-play, and reflection exercises (for details see Additional file 1: Table S1). The training was well received, attaining an overall rating by participants of 85-90% of the possible maximum.
Teaching sessions for the assessment of teaching performance after the training were scheduled two to three weeks later.
Emergency medicine course
The course of 12 full hours within two days followed a pre-defined structure. For a total of 16–18 students, each course involved a team of three teachers (junior, intermediate, senior). After an introductory interactive plenary session, students were divided into groups of 5–6. These groups rotated through 6 teaching sessions, each of which was taught by one member of the teacher team. Teaching formats were based on scenario teaching and discussion groups and focussed on the acquisition of practical skills. Learning objectives (in accordance with the guidelines of the European Resuscitation Council) were: ‘initial assessment of the emergency patient’, ‘management of unconsciousness’, ‘basic life support (BLS)’, ‘use of automated external defibrillator (AED)’, ‘bag-mask-ventilation’, and ‘basic trauma management’. There was a formative assessment of BLS at the end of day 1 and a three-station standardized clinical examination (SCE) at the end of day 2. The SCE was mandatory to pass the course, but failure rates were known to be low from previous student cohorts.
Characteristics of students
We included only data from students who regularly completed the entire emergency medicine course and who were not enrolled in any external students’ exchange program.
Measures of evaluation
Assessment of student skills and knowledge
After the emergency medicine course student performance was assessed by a three-station SCE (structured clinical examination) and an MCQ test. The SCE was the official assessment at the end of the course, while the MCQ was an additional test.
From the SCE, we extracted four domains of skills, which were relevant within the test setting. This was done because scenario testing does not necessarily exhibit good content validity for all checklist items (e.g. ‘check for safety’ cannot easily be assessed under the safe conditions of an assessment situation). To enhance clinical relevance we only chose skills related to patient safety based on international resuscitation guidelines. Skill domains were: ‘alarm call’, ’chest compressions’, ‘use of AED’, ‘bag-mask ventilation’. Each domain was analysed separately. For the total SCE score single domains were summed up.
The MCQ included 14 single-choice questions, covering relevant content of the course, partly factual, partly procedural knowledge. We limited the number of questions for reasons of time constraints and to ensure students’ acceptance. The MCQ was validated by comparison with final year students within their anaesthesia clerkship (with 97% of answers being correct).
Evaluation of teachers by students
The 30-item questionnaire was based on a review of the literature on teaching quality in medical education [5, 17–22]. In accordance with two reviews in this field [17, 20], we also linked our questions to two main fields of teaching performance: ‘interpersonal communication’ and ‘structural aspects of teaching’. Ten questions dealt with student-teacher interaction, and 13 questions with teaching structure. Also, general acceptance of individual clinical teachers was rated (questionnaire see Additional file 2: Figure S1). Answers were given on a 7-point Likert-like scale (from +3 ‘strongly agree’ to −3 ‘strongly disagree’).
Teacher self-perception
Teachers reported their perceptions of competence, self-confidence, and their overall satisfaction with their teaching session on a 7-point Likert-like scale.
Informed consent
All individual data of students and teachers were transformed into a pseudonymous format for all further steps of data processing to ensure that individuals could not be identified later. Teachers and students were formally asked to participate with the option to prohibit the use of their data at any time. All gave verbal consent. They were told that the study aimed to explore the effect of the composition of the group of teachers. In order to minimize instrumentation bias they were not informed that the focus of the study was the teacher training. Approval was given by the educational board of Charité – Medical University of Berlin.
Statistical analysis
The sample size was calculated for a 15% difference of the total score of all four SCE domains. At a power level of 0.9 with an assumed alpha of 0.05, the sample size was set at 75 students per group.
Results of SCE and MCQ were transformed into percentages of the achievable maximum, and then medians, 25th and 75th percentiles were calculated. Groups were compared using a Mann–Whitney-U-test. Significance was assumed at p-values below 0.05. The analyses were performed using SPSS 14.0.