Student-led Clerks as Teachers program is easing the transition to clerkship and residency

Clerks as Teachers is a near-peer teaching program in Internal Medicine that focuses on fulfilling two main objectives: 1) to provide senior medical students who are transitioning into residency with opportunities to practice their skills as teachers; and 2) to aid junior medical students who are transitioning into clerkship to develop approaches to medical cases commonly encountered on the wards during core Internal Medicine rotations.

A student-led near-peer teaching program in internal medicine is helping to prepare University of Toronto medical students for the next phase of their training. Co-led by medical student Eshita Kapoor and first-year internal medicine resident Dr. Arnav Agarwal, the program is offering second- and fourth-year students training-specific opportunities before embarking on their clerkships and residencies.

“Although residents and physicians are expected to teach throughout their training and practice, medical students don’t have much protected time to prepare for such responsibilities,” Kapoor says, now wrapping up her third year of medical school. “As well, outside of formal case-based learning sessions, junior medical students don’t receive many opportunities to work through clinical cases in order to deliberately practice their clinical reasoning skills.”

Kapoor was in her second year of medical school when she recognized the need for more teaching and learning opportunities for her peers preparing for clerkship and residency. To fill the gaps for both second-year students wanting to practice clinical reasoning and fourth-year students wanting to nurture teaching and facilitation skills, Kapoor came up with the idea for the Clerks as Teachers program. Based off of a ‘near-peer’ teaching model, the program teams up groups of junior and senior students who are close in training, knowledge base and experience to work together to teach and learn.

The program provides senior medical students who are transitioning into residency with opportunities to practice their skills as teachers. It also aids junior medical students who are transitioning into clerkship to work through medical cases commonly encountered on the wards during internal medicine rotations.

“I proposed this program in the hopes that it would be an innovative way to address the existing gaps,” says Kapoor. She approached Agarwal and Dr. Rupal Shah, a staff physician at Toronto Western Hospital and assistant professor in the Department of Medicine, for their support. Together, the three worked closely to bring the program to life and launched its first iteration in January 2019.

The premise of the Clerks as Teachers program is simple: situated in what Agarwal describes as a “low-pressure, peer-based learning environment,” fourth-year students, who already have experience as clerks on the wards, take on the role of teachers for their junior counterparts. They are provided with structured teaching guides and a primer on effective teaching strategies. They are then matched with second-year students to lead case-based discussions on common presentations, such as a 70-year-old man with a history of heavy smoking presenting with worsening shortness of breath. The fourth-year student-teachers guide second-year students as they work through the cases and arrive at a diagnosis based on the information they gather on history, physical exam and investigations.

“The program aims to help fourth-year medical students become comfortable in their roles as teachers as they support second-year medical students in developing strategies that will enable success in ward medicine,” Agarwal explains.

When the first round of the program ended in April, the team was overwhelmed by the positive responses they received.

“We anticipated significant interest, but to have close to half of the second-year cohort and a large proportion of the fourth-year cohort voluntarily participate after hours was fantastic,” says Agarwal.

By the time the program wrapped up, more than 100 second-year and 64 fourth-year students took part. Many of them say that it has helped ease their transition into clerkship or residency, and solidified the skills they had learned through the formal medical school curriculum.

“It was very effective at taking that foundational knowledge and making us think about how to use it in a clinical context,” says Ruben Kalaichandran, a second-year medical student. He says the experience made him appreciate why certain questions are asked or tests are ordered when caring for a patient. He also says the near-peer model itself was a benefit of the program.

“Fourth-year students, having recently been in our shoes, understand not only our level of training in terms of medical knowledge, but also the multitude of non-medical fears - one being the transition to clerkship.”

For many of the fourth-year students, most of whom will be starting their residency in internal medicine this summer, the program was an ideal setting to practice teaching within a medical setting.

“It seemed like the perfect opportunity to further develop my teaching and facilitation skills in a safe and enjoyable space,” says Neha Puri. She adds it was also a chance to give back to the Department of Medicine, where, equipped with the skills she learned in the Clerks as Techers program, she hopes to one day be a clinician-teacher.

With the success of the first round of the Clerks as Teachers program, Kapoor and Agarwal are already thinking about what to do next. For subsequent iterations, they intend to continue developing the internal medicine curriculum of the program under the guidance of Dr. Shah, and plan to extend the program to the U of T Mississauga Campus.

“While this program is currently focused on Internal Medicine, it definitely has the potential to expand and include other specialities in the near future as well,” notes Kapoor.

“The positive feedback we received gives us a direction to continue building forward as the program grows in future years,” Agarwal says.