Background: Near-peer teaching is an educational relationship among students close in experience that has gained increasing recognition in medical education and has been shown to be as effective as traditional teaching methods. A sub-internship is a clinical rotation where senior medical students perform the role of an intern under housestaff and attending supervision. Many sub-interns are assigned to teams with junior medical students on their core clerkships. This setting creates an opportunity for near-peer teaching on wards which has never been characterized or evaluated.
Methods: Electronic surveys were sent to 130 core clerkship students and 91 sub-interns who completed an internal medicine clerkship from March through October 2022. The survey examined barriers, motivating factors, and expectations of the teaching relationship between sub-interns and core medical students. Response frequencies were calculated for multiple choice and Likert scale questions. Reviewers analyzed free-text answers to identify themes, which were then coded via consensus theme bank and reviewed to reach consensus.
Results: Forty-two of 130 (32%) core clerkship students and 48 of 91 (53%) sub-interns completed surveys. Though only 33% of sub-interns agreed that they are expected to teach core clerkship students on their team, 63% agreed that they should teach core clerkship students on their team. All except one sub-intern reported they taught core clerkship students during their rotation, with informal teaching outside rounds being the most frequently reported method (44/48). The majority of sub-interns reported they were motivated to teach for personal satisfaction (35/48) and the opportunity to practice teaching skills (37/48). The most frequent barriers to teaching were time (34/48), team/interpersonal dynamics (30/48), and comfort with teaching (25/48). Among core clerkship students, 71% believed the sub-intern should teach them, but only 26% expected them to. The majority of core clerkship students reported they were motivated to learn from a sub-intern because they were closer to their level (34/42) and did not evaluate them (33/42). Qualitative analysis of free-text responses revealed similar themes, including the value of the sub-intern in teaching “tips and tricks” (8/23).
Conclusions: Among surveyed students, the near-peer teaching relationship is a positive experience and uniquely positioned for learning on wards teams. Our findings suggest that sub-interns consider teaching as part of their role, but there remain significant logistical and educational challenges that necessitate adequate training and clearer expectations of their role on the team as teacher. Our study was limited by small sample size and limited generalizability to other specialties and institutions.