tutors (e.g. basic science and clinical faculty staff). Given our uncommon pairing of senior medical students with faculty in an entirely PBL-based curriculum, we became interested in the impact of the student ‘near-peer’ co-tutors on the PBL tutorials. What was done To determine the impact of student near-peer co-tutors, we analysed existing course evaluation data. Our experimental group consisted of six tutorial groups comprising six students per group and co-tutored by a senior student)faculty pair between 2004 and 2006. The ideal control group would have comprised concurrent small groups led by faculty members alone. Unfortunately, the small size of our programme made this impossible. Thus, we identified three separate control groups (each con- trolling for different sources of variation) as follows: 1 the same faculty member tutoring solo in his or her immediate prior tutoring experience; 2 the same academic unit taught the prior academic year by a solo faculty tutor, and 3 the same student tutorial group with a different solo faculty tutor in the immediately preceding academic unit. To decrease the likelihood of false-positive results, we limited our analysis to two items on the tutors’ evaluations: overall effectiveness and time manage- ment. Comparisons of the mean numerical ratings (on a Likert scale of 1–7) of faculty members tutoring solo versus faculty paired with student co-tutors were made by independent Student’s t-tests. Our research was approved by the UC Berkeley Committee for the Protection of Human Subjects. Evaluation of results and impact There were no significant differences in ratings of overall effective- ness and time management among faculty)student co-tutor pairs and our three control groups. These pilot data suggest that, at a minimum, no detrimental impact is caused by using student near-peers as co-tutors in PBL tutorials. Additionally, training senior medical students to function effectively as PBL tutors increases the pool of available tutors and relieves some of the burden of faculty effort associated with PBL tutoring. Future work could include investigation of the impact of senior medical students tutoring PBL groups solo (i.e. without faculty presence). Correspondence: William Martinez, Department of Internal Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA. Tel: 00 1 617 732 5845; Fax: 00 1 617 264 6346; E-mail: wmartinez1@partners.org doi: 10.1111/j.1365-2923.2009.03315.x Improving medical students’ skills for counselling hypertensive patients Amam Mbakwem, Adewale Oke & Janet Ajuluchukwu Context and setting The curriculum of the College of Medicine, University of Lagos, Nigeria follows a 6-year, discipline-based programme. Training in communication skills, which are fundamental to the success of a medical career, is not included in the curriculum here or in any other medical school in Nigeria. Why the idea was necessary The high prevalence of hypertension in Nigeria (20–25%) is associated with high morbidity and mortality. Complications have been linked in most part to non-adherence to treatment and lack of adequate follow-up. The health information received from doctors is often full of technical jargon, which is above patient levels of comprehension, and is delivered in a threatening manner. This may reflect the lack of formal instruc- tion in communication skills. The aim of this study was to improve the ability of medical students to effectively counsel hypertensive patients and, conse- quently, to provide evidence to the school’s curricu- lum committee of the importance of communication skills training in support of its possible inclusion in the curriculum. What was done A needs assessment survey revealed that over 90% of students wanted formal training in communication and counselling skills. Two groups (intervention [n = 25] and controls [n = 34]) of Year 5 students (59 of 63) rotating through the Department of Medicine on a 13-week senior clerk- ship participated in this study. Five 90-minute training workshops were organised for interested faculty members (n = 3), senior registrars (n = 5), and registrars and house officers (n = 7), using materials developed for student training (lectures, videos and role play) and scenarios developed for an objective structured clinical examination (OSCE). The intervention group received 1-hour lectures on communication, counselling skills and theory of behaviour change, and video demonstration of these skills. This was followed by four 90-minute sessions of role play where each student was given the opportunity to act as counsellor, counselee or feedback reporter. Trained faculty and senior regis- trars acted as teachers during these sessions. The control group received no formal instructions. Pre- and post-rotation evaluations for both groups were carried out using multiple-choice questions (MCQs) and four 5-minute OSCEs. The trained registrars really good stuff 476 Ó Blackwell Publishing Ltd 2009. MEDICAL EDUCATION 2009; 43: 471–499