Diversity & Equality in Health and Care Open Access

Keywords

Peer Assisted Learning, Under Graduate Medical Student, Clinical Years, Small Group

Background

The term Peer-Assisted Learning (PAL) as an educational concept in the medical education where students tutor or teach their peers. The big challenges of teaching and learning are how students can effectively interpreted knowledge in real practice to improve patient care. Medical education is changed from didactic teacher centered teaching to the use of interactive, problem based, student centered learning [1]. Modern medical education is giving more emphasis on student centered teaching and learning. Students become self- directed learner identify educational resources available to help, self-motivated and assessing their own strength and weaknesses to create a flexible and relevant curriculum [2]. The General Medical Council recognizes that teaching is vital to medical practice, and graduates are asked to demonstrate competent teaching abilities [3-4].

PAL is one the method in medical school which can improve teaching and learning, provides a safe learning environment to promote learning and retention of knowledge. Students feel more comfortable asking questions to another student who will also better prepared for continuing education after graduation because they are allowed to be more actively involved in their own learning and so take more responsibility for it[5]. The PAL environment may allow students to ask questions with less fear of being judged. This also provides opportunities for networking within the class [6].

Discussions in peer groups are a valuable teaching and learning opportunity to retain the information prepared, and provide a safe environment in which they can experiment and develop their teaching skills [7]. PAL offers the chance to develop these skills and to help fellow students with their learning. Student learn in a relaxed environment with PAL and learn skills including leadership, presentation, and communication, all of which are essential to practice medicine [8].

This is true that Peer-tutors cannot provide the same clinical experience as a faculty, sometime groups led by students find analyzing clinical problems more difficult. Medical students are future residents and faculty members and will have teaching roles; medical students may become more effective communicators as a result of such training, as teaching is an essential aspect of physician–patient interaction [9]. Better understanding of teaching and learning principles during PAL session may make them better learners. PAL is an exciting teaching-learning method in Family Medicine and has the benefits of increasing teaching skills of students. Peer teachers are closer to the students than faculty and can better understand the problems and challenges students face [10]. Also being at a closer level in education and training they can explain difficult concepts at an appropriate level. The purpose of this study was to identify medical students’ perception regarding peer assisted teaching and learning in family medicine rotation.

Family medicine rotation has main objective of handling common problems in primary care. Year 6 is the first clinical year at Oman Medical College (OMC). In 8 weeks of family medicine rotation students placed in primary health care set up for clinical learning. Small group discussion conducted daily in the afternoon and facilitated by the family medicine faculty. Some of the sessions are presented by students as facilitator. All students receive a list of website and name of standardized books for learning at the time of Family medicine rotation orientation and they are supposed to make their presentation according to the guidelines given to them. Faculty in charge distributes the topic to the students from the identified topic list (from modules) for small group presentation. PAL is conducted at least twice a week and each student has a chance to present minimum once, followed by peer feedback and faculty feedback as well.

Methodology

This cross sectional study was conducted at Rustaq campus OMC. All students in 6^th year(first clinical year) were invited to participate in this study. All Year 6 students were invited to act as tutors. Tutors were provided with a 1hour information session detailing the objectives and organization of the program, and the format of the teaching. Teaching sessions were approximately 1 hour long, covering clinically relevant content. The topic of the tutorial was identified by tutees, who notified the tutors of this topic several days in advance of the tutorial, allowing them adequate time to prepare. Data was collected through selffilled questionnaire by the participant, included demographic characteristics (age, gender) and questions regarding knowledge and perception of PAL. At the end of the last session of family medicine rotation student feedback about the PAL sessions was obtained using a questionnaire. Principal investigator ensured uniformity, explained the questionnaire, objectives to the participant and obtain a written informed consent before collecting the data. Survey instrument was made after literature search reviewed by and agreed on via several brain storming sessions. Validation of questionnaire on small group was also completed. Student agreement with a set of 18 statements was measured using a Likert-type scale.

Results

A total of 68 students participated in the study. The survey achieved a 100% response rate. Students were asked multiple questions regarding their perception about peer assisted teaching and learning in family medicine rotation. Their answers were coded into strongly agree, agree, neutral, disagree and strongly disagree. Over all 53 female(77.9%) and 15 male(22.1%) were participated. More than half (51.4%) of the participants agreed that teaching was focused on must know things and number of slides were adequate. About two third of the students agreed that teaching material was taken from books. Nearly sixty six per cent of students agreed that PAL session had friendly environment. Response about teaching competency and adequate knowledge and skills was positive from 50% students. 44.3% agreed that sessions had appropriate organization of contents for lecture. Nearly 38.5% per cent of students said that teaching contents comprised of updated evidence based materials (Figure 1).

Figure 1:

Less than half (42.6%) of the students agreed that the sessions were interactive with appropriate answers. More than fifty per cent commended that student teachers showed good presentation skills and self-confidence. Less than half (47.1%) agreed that the teaching was scenario based learning. The rate of agreement with a statement regarding problem solving and integrated presentation was 34.4%. Twenty six percent of students agreed, the option that lecture presentation is problem solving and integrated. About two third of students have given positive response about need of similar sessions in the future (Figure 2).

Figure 2:

Discussion

Peer assisted learning is known as an effective educational strategy in medical teaching and is an effective tool to promote learning and retention of knowledge. This strategy develops professionalism in student tutors and contributes to a sense of teaching responsibilities [11].

Our medical students generally show positive perception. By preparing to teach, students are encouraged to construct their own learning program, so that they can explain effectively to fellow learners. Studies have shown positive outcome with strategy [12].

Half of the participants agreed that teaching focused on must know thing with appropriate teaching competency and number of slides were adequate. Similar finding was seen in one of the study done in Nepal [13]. (Fig I)

Nearly one third participants mentioned that most of the material taken from book and 38.5% agreed organization of the content was appropriate with evidence based information. Half of the participants agreed that student teachers had good presentation skills with self-confidence. PAL is an exciting teaching-learning method which increases the in depth learning. In a study conducted in Netherlands and Uniformed Services University in the United States, majority of students agreed that peer teachers performed well in their teaching roles and can serve as effective teachers. Peer teachers are closer to the students than faculty and can better understand the problems and challenges students face [14].

Peer instructors may be used in practice to reinforce and review the assessment. More than half participants of our study agreed that teaching was focused on must know things and the environment was very friendly for learning. Students are more open with peers and more likely to share their difficulties and concerns [15]. PAL has the benefits of increasing teaching skills of students, their knowledge of educational theories and their application in teaching.

Nearly half of them mentioned that presentations were interactive clinical scenario based with appropriate answers and clear concepts. Teaching skills increases knowledge also being at a closer level in education and training they can explain difficult concepts at an appropriate level [16-17].

PAL is very useful motivating our students and refining their competency in teaching. More than one third students in our study agreed that the sessions should be done in future also. Similar findings have shown in one study published recently that actively involving students in leadership practices can contribute to the promotion of a culture of excellence in teaching [18].(Fig2)

Medical students play an important role as communicators and educators in health care system to educate patients as a physician in near future. They must have adequate time and opportunity to practice and develop this skill during medical school in a comfortable and safe educational environment [19-21].

Limitation

We recognize some limitations in this study such as small number of participants and this study is done only in one campus. Moreover, respondents are selected based on their ability to inform a topic of interest rather than for their generalizability to a larger population.

Conclusion

PAL could play a useful role in an undergraduate medical education and teaching can stimulate further learning. Students have positive perceptions toward PAL and more sessions can be considered in future. Peer-assisted learning can be tried and encouraged in other medical schools. Medical students’ informal teaching activities accompany, facilitate, and complement many important aspects of their medical education. Formally developing medical students’ knowledge, skills, and attitudes in education may further stimulate these aspects. Further studies are required.

Questionnaire: Students Perception regarding Peer assisted Learning (PAL)
Age: ----- Gender: ----M --------F

References

1. Durning SJ, Ten cate OTJ. Peer teaching in medical education. Med Teach. 2007;29:523-4. 
2. Ten Cate O, Durning S. Peer teaching in medical education: twelve reasons to move from theory to practice. Med Teach. 2007;29:591-599.
3. General Medical Council. Tomorrow’s doctors: recommendations on undergraduate medical education. London: General Medical Council, 2003.
4. Undergraduate medical education, General Medical Council London. [Accessed on June 9, 2006]. Available at: https://www.gmc-uk.org.
5. Gordon J, Hazlett C, Cate OT, Mann K, Kilminster S, Prince K, O’driscoll E, SNELL L, Newble D. Strategic planning in medical education: enhancing the Learning environment for students in clinical settings. Med Educ. 2000;34:841–850.
6. Field M, Burke J. M, McAllister D, Lloyd D M.  Peer-assisted learning: a novel approach to clinical skills learning for medical students.  Medical Education 2007, 41: 411-418
7. Samarakoon L, Fernando T, Rodrigo C.  Learning styles and approaches to learning among medical undergraduates and postgraduates. BMC Med Educ. 2013 Mar 25;13:42. doi: 10.1186/1472-6920-13-42.
8. Harden RM, Laidlaw JM, Hesketh EA. Study guides: their use and preparation. Med Teach 1999;21:7-14.
9. Topping K. The effectiveness of peer tutoring in further and higher education: a typology and review of the literature. Higher Education 1996;32:321-45.
10. Ross MT, Cameron HS. Peer assisted learning: a planning and implementation framework: AMEE Guide no. 30. Med Teach 2007;29(6):527-45.
11. Kassab S, Abu-Hijleh MF, Al-Shboul Q, Hamdy H. Student-led tutorials in problem-based learning: educational outcomes and students’ perceptions. Med Teach 2005;27(6):521-6.
12. Hudson NJ, Tonkin AL. Clinical skills education: outcomes of relationships between junior medical students, senior peers and simulated patients. Med Educ 2008;42(9):901-8.
13. Shankar P, Singh B, Singh AK, Karki BS, Thapa TP. Student Perception About Peer-Assisted Learning Sessions in a Medical School in Nepal. Web med Central: Education in Medicine Journal 2011;2(10):WMC002370
14. Bulte C, Betts A, Garner K, Durning S. Student teaching: views of student near-peer teachers and learners. Med Teach. 2007;29 :583-90.
15. Weidner TG, Popp JK. Peer-Assisted Learning and orthopedic evaluation psychomotor skills. J Athl Train. 2007; 42(1): 113–9.
16. Aba Alkhail B. Near-peer-assisted learning (NPAL) in undergraduate medical students and their perception of having medical interns as their near peer teacher. Med Teach. 2015 Apr;37 Suppl 1:S33-9. doi: 10.3109/0142159X.2015.1006602. Epub 2015 Feb 5.
17. Clarke AJ, Burgess A, Menezes A, Mellis C.  Senior students' experience as tutors of their junior peers in the hospital setting. BMC Res Notes. 2015 Dec 2;8(1):743. doi: 10.1186/s13104-015-1729-0.
18. Burgess A, van Diggele C, Mellis C. Students as facilitators in a teacher training program: motivation for leadership roles. Adv Med Educ Pract. 2015 Nov 13;6:615-20. doi: 10.2147/AMEP.S92804.
19. Srivastava TK, Waghmare LS, Mishra VP, Rawekar AT, Quazi N, Jagzape AT. Peer Teaching to Foster Learning in Physiology. J Clin Diagn Res. 2015 Aug;9(8):JC01-6. doi: 10.7860/JCDR/2015/15018.6323.
20. Sahoo S, Venkatesan P, Myint KT, Moe S. Peer-Assisted Learning Activities During Undergraduate Ophthalmology Training: How the Medical Students of Asia Pacific Region Perceive.Asia Pac J Ophthalmol (Phila). 2015 Mar-Apr;4(2):76-9. doi: 10.1097/APO.0000000000000094.
21. Riaz I. Peer assisted versus expert assisted learning: a comparison of effectiveness in terms of academic scores. J Coll Physicians Surg Pak. 2014 Nov;24(11):825-9. doi: 11.2014/JCPSP.825829.