title: Cross-year peer tutoring on internal medicine wards: results of a qualitative focus group analysis.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Krautter
authors.affiliation: Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Andreesen
authors.affiliation: Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany.
authors.forename: Nadja
authors.initials: N
authors.lastname: Köhl-Hackert
authors.affiliation: Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Hoffmann
authors.affiliation: Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herzog
authors.affiliation: Department of General Internal Medicine and Psychosomatics, University of Heidelberg Medical Hospital, Heidelberg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Nikendei
keywords: clinical skills training; cross-year peer tutoring; final year; internal medicine; peer-assisted learning; undergraduate medical education