teaching responsibilities in residency. We believed that the Mini-CPX would provide a rich teaching opportunity for selected fourth-year students without compromising the quality of the exam for the third- year students. What was done We created a programme for 8 fourth- year students to facilitate Mini-CPX teaching sessions for groups of 6 third-year students under faculty supervision. Faculty were expected primarily to observe, and to contribute only if clarification of teaching points were necessary. We also developed a syllabus for facilitators that included evidence-based strategies for teaching physical examination skills in a small group setting. In preparation for teaching, fourth-year students reviewed the syllabus and attended a brief orientation session run by the standardised patient trainer. Following the teaching session, third-year students completed a post-exam survey evaluating the effect- iveness of paired fourth-year student ⁄ faculty precep- tors compared with faculty preceptors alone. Additionally, fourth-year students completed a post- facilitation survey regarding their Mini-CPX teaching experience. Both surveys employed a 5-point (1 ¼ strongly disagree to 5 ¼ strongly agree) Likert scale format. A 2-tailed student’s t-test, carried out at the a ¼ 0.05 level, was used to determine statistically significant differences between satisfaction with fourth-year student preceptors and faculty precep- tors. Evaluation of results and impact Ninety-five per cent (141 ⁄ 149) of third-year students completed the post- exam survey. Third-year students agreed that feed- back (4.0 ± 0.8), instruction on history-taking (3.7 ± 0.8), and physical examination instruction (3.9 ± 0.9) were useful. Eighty-two students attended a Mini-CPX teaching session facilitated by a fourth- year student with faculty supervision, while 59 were taught by faculty alone. Importantly, there were no statistically significant differences in teaching ratings of fourth-year student preceptors and faculty pre- ceptors (overall debriefing: 4.0 vs. 4.0; history-taking: 3.8 vs. 3.7; and physical examination: 4.0 vs. 3.9). The 6 fourth-year students who completed a post-facilita- tion survey valued the opportunity to teach in the Mini-CPX (4.7 ± 0.5) and agreed that the teaching syllabus was a useful preparation tool (4.8 ± 0.4). Overall, these results suggest that trained fourth- year students can function as preceptors comparably to faculty facilitators in a clinical skills review course using standardised patients. This model reinforces clinical and teaching skills for student preceptors. Further, it may reduce recruitment needs for faculty preceptors and may enhance near-peer professional interactions. Correspondence: Shanthi M Colaco, Box 0131, U137, University of California at San Francisco, San Francisco, CA 94143-0131, USA. Tel.: 415 476–1964; Fax: 415 5027544; E-mail: shanthi.colaco@ucsf.edu doi: 10.1111/j.1365-2929.2006.02593.x Evaluating pre-clerkship professionalism in longitudinal small groups Cathy Risdon & Sue Baptiste Context and setting This report focuses on evaluation of professionalism within a new subcomponent of McMaster University’s redesigned (2005) curriculum, specifically exploring the use of a rating tool to evaluate and provide feedback on 4 domains of professionalism identified as critical to a Year 1 medical student’s performance in a competency- based, integrated professional skills curriculum. The ÔProfessional CompetencyÕ curriculum do- mains include: ethics and moral reasoning; commu- nication skills; self-awareness; self-care; professionalism; clinical skills; lifelong learning, and social and community contexts of health care. Groups of 10 students and 2 facilitators (1 doctor and 1 from a non-medical clinical discipline) meet for 3 hours per week; the group remains intact until clerkship. The format of each week’s session varies according to the identified domain(s) and may include practice sessions with standardised patients, case-based ethics or epidemiology problems, large- group sessions, personal reflections and critical incident reports. Why the idea was necessary New tools were necessary to monitor and evaluate performance within the new curriculum addressing pre-clerkship professionalism behaviours identified as essential for the foundations of collaborative practice. What was done Both facilitators completed weekly 10- point observational scales on each student. Students were informed that their performance on the fol- lowing 4 behaviours would provide the basis of their interim professionalism evaluation (satisfactory ⁄ pro- visional satisfactory): • accountability: showing up on time, informing group members of absences; • respectful listening: making good eye contact, mirroring non-verbal cues, not interrupting, allowing others to complete thoughts; • balancing inquiry and advocacy: respectfully holding dissenting opinion, exploring difference in others, generating ⁄ considering alternative perspectives; really good stuff 1130 Ó Blackwell Publishing Ltd 2006. MEDICAL EDUCATION 2006; 40: 1123–1147