By Dr David Ng

The words "teacher" and "mentor" often bring to mind wisened professors, regally robed in their impeccably pressed white coats, with thick glasses and a full crown of silver, ready to dispense truth and clarity. However, as the saying goes, not all heroes wear capes, and this is indeed true for education in our medical profession.

The medical practice is a fluid paradigm, and one cannot set sail across this ocean, as goes William Osler's metaphor, without guidance and a navigator. As new discoveries are made, this ocean of clinical knowledge and decision-making skills rapidly widens and deepens each day.

For medical students, junior doctors, and specialists in-training, the task can be daunting. What better way for a fresh seaman to learn the ropes (quite literally), than from the one next to him who has been at it for years!

While the term "Near-peer teaching", the passing of knowledge from trainees to their juniors, was first formally coined by Whitman in 1988, this mode of instruction has been around in various forms for as long as hospital practice has.

"Some of my fondest memories in both medical school and my house officer stint were unexpected moments where I was taught things that no textbook held."

From junior doctors guiding fledgling medical students in their first few patient encounters, to medical officers (MOs) helping their house officers' (HOs) survive life on the wards, to registrars supervising medical officers for invasive procedures; near-peer teaching has been the yarn connecting the dots towards proficiency.

Some of my fondest memories in both medical school and my house officer stint were unexpected moments where I was taught things that no textbook held: how to look for veins in a patient with edema, evaluate patients holistically when they come in looking fresh, and write a comprehensive, concise plans and problem list that can be quickly understood.

Notwithstanding the prevalence and value of these ad-hoc learning opportunities, near-peer teaching has the potential to be so much more.

All teachers desire the same outcome of their students: be it through didactic lectures or simulation sessions, through seasoned senior consultants or modest medical officers, we all aim for students to become competent, confident, and, albeit secretly, inspired to do the same for their peers/juniors.

It is however, the teaching method and environment which affects how much is absorbed and more importantly, retained.  This is where the value of near-peer teaching lies, encapsulated in the word "proximity".

1. Proximity of experience

For the student, they feel the standards set by someone only one or two years their senior is more attainable. For the tutor, the memory of the roadblocks faced as a student is more recent and thus he/she is better poised to help.

2. Proximity of collegiality/hierarchy

A more relaxed and informal environment without the presence of senior staff encourages more basic questions which junior doctors might otherwise feel inappropriate to ask a professor.

3. Proximity of journey 

There is comfort and solidarity in knowing that both student and teacher are often on similar journeys, and that the teaching experience also grows the tutor. For example, when an MO teaches an HO how to handle a hypotensive patient, he too cements his own confidence in managing similar patients.

Right here in SingHealth, while near-peer teaching has been around informally, it is only in recent years that it has been employed intentionally and given structure and form. For example, through the CADENCE program where recent MRCP graduates guide their juniors who are taking the famed Practical Assessment of Clinical Examination Skills (PACES) exam, Project Equip where Senior Residents and faculty prep newly-minted Senior Residents to handle the night calls and Project Inspire, the latter which I and my colleagues found to prime final-year students for their MBBS exam and prepare them for life ahead in the wards post-graduation.

"While medical education used to be purely the purview of only the most senior, it is time we turned this notion on its head."

I can honestly say that although giving informal ward tutorials and clearing the doubts of students give me great joy, there is a higher satisfaction in setting up a programme that reaches a large group of students, improves quantity while retaining quality of mentorship, and also runs like clockwork, paving the way for the next generation of tutors to take over. 

Passion and consistency form the bedrock of our commitment to this journey. When we look to those who have sailed far and wide and carried a huge load to boot, we must remember that it is the culmination of small steps that make the journey.

Medical education is in many ways more than just another entry on the curriculum vitae; it is an outpouring of a desire to guide and journey with others. 

While medical education used to be purely the purview of only the most senior, it is time we turned this notion on its head, and have it transform from being the delivery of a present, to the passing of the baton. 

Dr David Ng graduated from the National University of Singapore Yong Loo Lin School of Medicine (YLLSoM) in 2016 and is currently a Year 2 Internal Medicine resident in SingHealth. 

Having been at the receiving end of inspiring mentorship from excellent educators, he started teaching and mentorship of medical students from his senior days in medical school and is currently involved in teaching within SingHealth. He has found teaching to have multi-fold benefits, going beyond imparting knowledge to building confidence and forming lasting relationships at work.