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Developing Opportunities For Observed History Taking Through Peer-assisted Learning: A Quality Improvement Project
Sophie Bowyer
Hampshire Hospitals Foundation Trust, United Kingdom
Background and Aim: Increasing medical student cohort sizes and limited faculty availability can reduce opportunities for directly observed history taking and structured feedback during early clinical skills training. At our institution, some first-year graduate-entry medical students completed patient histories without observation, with their first observed encounter occurring during mock Objective Structured Clinical Examinations (OSCEs). This quality improvement project evaluated the feasibility and acceptability of a peer-assisted history-taking workshop designed to increase opportunities for observed practice and feedback.
Methods: Twenty-six first-year graduate-entry medical students voluntarily attended a one-hour workshop facilitated by a Clinical Teaching Fellow. Students completed curriculum-aligned simulated history-taking scenarios while peers observed using a structured feedback tool. Participants reflected on their performance before receiving peer feedback moderated by the facilitator. Anonymous pre- and post-workshop questionnaires assessed confidence and gathered qualitative feedback.
Results: All 26 participants completed the pre-workshop questionnaire, and 16 (62%) completed the post-workshop questionnaire. Before the intervention, 61.5% agreed or strongly agreed that they felt confident taking a structured history, increasing to 100% of post-workshop respondents. Participants rated the workshop highly, particularly the facilitator’s feedback. Peer observation and feedback were also positively evaluated. Qualitative comments highlighted directly observed practice, structured feedback, and repeated rehearsal as key strengths, while suggestions included additional sessions and more OSCE-style scenarios.
Conclusions: This peer-assisted history-taking workshop provided a feasible, low-resource method of increasing opportunities for observed practice within a resource-constrained undergraduate medical programme. Participants reported improved confidence and high satisfaction. However, objective measures of clinical performance were not assessed, and findings were limited by voluntary participation and a 62% post-intervention response rate. Future work should include objective assessments of history-taking competence to determine whether perceived benefits translate into improved clinical performance.
