Table 4 Citations related to categories derived from qualitative analyses of tutor statements(N=6; T1 – T6)

Theme “Subject-based preparation” (16 statements)

•

“To be able to practice the practical skills in advance in a quiet environment.” (T5)

•

“If a medical clerk has already mastered certain skills, he can relieve the medical personnel of a lot of work, which is rewarded with more time for teaching and a higher motivation of the teachers; this in turn fosters the clerks’ motivation and confidence in their own abilities; good preparation therefore increases the likelihood of benefiting from the clerkship.” (T4)

•

“In the hospital, often nobody has any time to show you something, but if you have already had practice in some things and you say that, then the physicians let you perform measures earlier, under observation, and this saves the physicians’ time, and on occasion you are asked to do certain things. Also, I find that you are not so overexerted because you’ve already been able to practice the different skills, and then in the practicum/clerkship, you can concentrate on the new things you are learning.” (T3)

•

“Through our preparation course, the students are already able to learn practical skills before their practicum. They can learn this in what I believe to be a very pleasant environment (namely from us student tutors), and at the same time also make mistakes without ‘looking stupid’.” (T6)

•

“Preparation imparts the necessary background knowledge behind the clinical skills. Why am I doing what I am currently doing? Why won’t something else work as an alternative? E.g. Stitching instead of letting a wound heal by itself.” (T2)

•

“Yes, I find the course useful as you are taught important skills as compactly as possible, which might be useful in the clerkship. Such a course offers the possibility to learn skills in a protected environment (not directly on the patient in the clinic); by taking place at uni and being led by tutors, you don’t have the feeling you have to do it well or that you can’t ask any questions, in contrast to learning in the clinic. In such a course, you have time to perform things correctly and carefully and to ask questions. In the course, you get taught the skills according to a standardized schema. In the clinic, by contrast, every physician does things differently, some don’t pay attention to important things like wearing gloves or disinfecting.” (T6)

•

“Because through preparation, self-confidence is increased and disappointments due to poor guidance in the clerkship are prevented.” (T4)

•

“The most important skills for the clerkship are taken into account.” (T4)

Theme “Preparation for patient contact” (8 statements)

•

“Often, you perform the clinical skills for the first time on the patent and under time pressure, which turns the patient into a ‘guinea pig’ and also doesn’t impart any feeling of confidence to the student. Practice also imparts a certain confidence to the patients. He feels he is in good hands in the care of a student, which increases the relationship of trust between the two parties.” (T5)

•

“Lastly, I find it particularly important so that you feel surer of yourself and can face the patient in a confident manner.” (T3)

•

“Because in this way, the students can deal with patients more appropriately and competently and so the patients’ appreciation for care by students increases in the long term.” (T4)

•

“You can practice the skills on mannequins and in this way don’t have to be scared of hurting the patient. Moreover, in our course, you practice communicating well with the patients. We try to show the students that you can both conduct a conversation and perform the skill quickly and correctly.” (T6)

Theme “Facilitation of the daily routine on ward” (6 statements)

•

“Through such a preparation course, we try to take away some of the students’ fears regarding their practicum. On the first days of a practicum you are confronted with lots of new things anyway, so you’re happy if you have already, for example, practiced drawing blood and are allowed to do it right away and it works.” (T6)

•

“It spares embarrassing situations and takes away or at least reduces the nerves, which then again leads to more confidence.” (T3)

•

“So that you don’t go under in the daily routine on ward.” (T1)

•

“I find a preparation for practica and clerkships useful because you then find it easier to integrate yourself.” (T3)

•

“Also, you can relieve the sisters of some work, e.g. measuring blood pressure, taking ECG etc., which fosters the work climate and takes some burden off the sisters.” (T3)

Category 2: Leadership of the course by student tutors (19 statements)

Theme “Fewer inhibitions towards student tutors” (6 statements)

•

“I find it useful that the course is led by tutors, as it makes the atmosphere really relaxed. The students have the courage to ask questions, and also ask questions which they would not ask a lecturer/professor as they would find it awkward.” (T3)

•

“Also, the inhibition threshold towards other students is not so high, meaning that also in this environment, errors are allowed to take place which can be calmly corrected – without the student possibly feeling labeled as ‘incapable’ by a person of authority with whom he/she is confronted in the next clerkship.” (T5)

•

“Students are possibly more likely to ask something than would be the case with a medical lecturer.” (T1)

•

“You’re more likely to have the courage to ask questions to a student, particularly if you are afraid they might be ‘stupid’ questions.” (T2)

•

“The hierarchical gulf between tutors and tutees is clearly lower than with lecturers; this can ensure more trust and facilitate the disclosure of weaknesses or knowledge gaps and making queries or accepting help.” (T4)

Theme “Tutors’ closeness to being students” (5 statements)

•

“Students are mostly closer to the subject matter – for example in the case of a clerkship. Physicians mostly delegate these tasks, meaning that practiced students are more likely to spontaneously have tips and tricks to hand and to be aware of possible obstacles within these skills – simply because they are constantly confronted with this subject matter.” (T5)

•

“For physicians, things have often already become routine, so often they don’t understand the problems of beginners.” (T1)

•

“We are more likely to be able to remember what we found difficult the first time we performed the skills and can point this out directly.” (T2)

•

“Student tutors frequently know better which points might be difficult for beginners and what can help them to master these.” (T4)

Theme “Competence of the tutors” (5 statements)

•

“I see it as a disadvantage that we student tutors don’t have so much experience ourselves (so it’s both an advantage and disadvantage). There are some questions we can’t answer, where a physician would certainly know the answer. Moreover, a physician sometimes has a few ‘secret’ tips through which a skill is suddenly much easier, but you have to have already performed this skill a thousand times in order to find such tricks.” (T6)

•

We teach the skills according to standardized processes, and not how we would prefer to do it.” (T2)

•

Trained student tutors tend to teach more according to a standardized protocol than more experienced physicians, who often set subjective focuses.” (T4)

•

“A lecturer is better able to answer content-based questions which go beyond the regular content – but are equally of little relevance.” (T4)

Theme “Exchange and collaboration of students” (2 statements)

•

“A preparation through tutors is useful, as one rarely gets the chance to ask students from a higher semester for their experiences and tips; particularly regarding applying for a medical clerkship, be it at home or abroad, younger students often have no idea how a clerkship proceeds, what one has to be able to do or how one should behave, and contact with older students is also useful for this.” (T2)

•

“Students train students – and this strengthens not only the collaboration among clerks in the daily routine in the clinic, but also the mutual respect.” (T5)

Theme “Further development of the tutors” (1 statement)

•

“The tutors are given the possibility for personal and professional development and to assume responsibility” (T4)

Category 3: General aspects of the training (4 statements)

•

“The small group situation and the format on two afternoons is also expedient, as the contents can be imparted in a structured and compact manner, without overexerting or sacrificing too much of the valuable free time in the pre-clinic”. (T4)

•

“Through student tutors, the course can be organized more cheaply and flexibly.” (T4)

•

“And moreover, such a course is a welcome change from the great amount of theoretical learning, which indeed more or less dominates our whole degree course.” (T4)

•

“As a change in the theory-laden pre-clinical everyday routine, in order to keep in view the later clinical activity.” (T4)

Category 4: Quality assurance and possibilities for improvement (21 statements)

Theme “Skills” (9 statements)

•

“Personally, I would remove skills like blood pressure measurement. These are things which one already performs several times a day on ward and which are also not difficult to learn. It would be good if other skills, such as surgical suture, can be further extended, so that the various suturing techniques could be consolidated.” (T5)

•

“The Schellong test is also a station that is unnecessarily long. In practice, the Schellong test is very easy to perform, as it only consists of multiple blood pressure measurement. In my view, these two skills should at least be merged (RR and Schellong).” (T2)

•

“Behavior in the operating theatre is a very important but not very well thought-out station. In my view, one would need sterile gloves to show how one puts these on (so far I have also refolded non-sterile ones to show it, but this doesn’t work so well). Moreover, I think it would be good if one had sterile surgical gowns, at least for the tutors for each group in order to show how to put these on. In terms of behavior in the operating theatre, the only thing that one can explain is all the things you’re not allowed to touch. I find it important to show how to make yourself sterile: correct washing (which we do), putting on the surgical gowns. This is precisely where I had problems my first time in the operating theatre.” (T2)

•

“Possibly combine RR-measurement and Schellong test and incorporate gastric tube as an additional skill; alternatively, maybe combine blood pressure or Schellong with Doppler examination of the vessels (ABI determination), as at these stations, frustration often arises due to redundancy.” (T4)

•

“Possibly introduce physical examination stations (heart, lungs, neurol. status), as this is only begun in the block practicum, but is hugely important for clerks, and indeed in all subjects (there, the students should perform admission examinations, and should therefore be able to perform a complete physical exam independently) – you can never begin too early with the physical exam, and never practice it enough.” (T4)

Theme “Organization” (8 statements)

•

“As certificates are issued, through keeping signature lists for purposes of checking attendance, it should be ensured that the enrolled person also gets the certificate (it’s annoying but indispensable for quality assurance reasons).” (T4)

•

“Checklists for all skills should be printed out and distributed in good time and completely. For the suture course, better and more material should be procured (re-order suture in good time! Preferably procure sufficient reserves from the outset! Possibly order a suture leg from the company Fleximodell?).” (T4)

•

“The students’ enrolment one week before the start is really short notice! It’s particularly unfavorable in the lecture-free period because in this way the students cannot sufficiently plan because they can’t be certain of getting a place.” (T4)

•

“Generally, I think we should sound out more precisely how much time one needs for the individual stations. For example, one needs lots of time for ECG, permanent venous catheter and drawing blood, but very little time for behavior in the operating theatre, measuring blood pressure, injections and Schellong. Then, for example for injections, one could add a bit of theory on the flipchart to fill the time.” (T2)

•

I don’t know whether clerkship basics has already been evaluated by the students but if not, I think it should be done.” (T2)

Theme “Further training of the students” (4 statements)

•

“Standardization of the tutors.” (T1)

•

“I find it important that we student tutors constantly teach other skills in the course (so rotate in some way) so that we learn all the skills better ourselves and are then better able to teach them to others.” (T6)

•

“2nd training for all. One training session is not enough to be confident and thus also radiate confidence and really explain things correctly…” (T1)

•

“Nevertheless, regular training of the students should take place so that this competence continues to be guaranteed in all medical areas.” (T5)