Peer-assisted learning (PAL) in undergraduate medical education: An overview

The perceived long-term impact of peer teaching in the skills lab. A descriptive interview study

Teaching is an essential skill for future doctors. Peer-assisted learning (PAL)-where students take up a teaching role at an early stage of their training-is widely used in medical curricula. No studies have explored the long-term perceived impact of peer teaching. Therefore, we aimed to determine how former peer teachers reflected on PAL and its perceived long-term impact. In this longitudinal descriptive study, we conducted 42 semi-structured interviews with 11 former peer teachers at the University of Antwerp. Five of them were interviewed 6 months after PAL; 6 of them 9 years after PAL. This latter group was also interviewed during PAL in a previous study. We conducted secondary analyses of previously collected interviews, consistently comparing the findings with new data gathered from the current interviews. Using realist thematic analysis, topic summary themes were generated. Former peer teachers reflected on their PAL experience with a lot of satisfaction. Those meanwhile working as residents are still passionate about teaching. Peer teachers experienced a gain in clinical examination- and professional skills in the long-term, facilitating a smoother transition to their internship. Our findings suggest that PAL selects diverse but committed students. The longitudinal data demonstrate how PAL initiates or stimulates different skills in diverse students, including public speaking, teaching, time management, and self-efficacy in specific clinical skills. Regarding the chicken-and-egg question, our study encompasses both longitudinal cases illustrating the pre-existing skill theory and cases demonstrating how achieved competences were induced by PAL. Former peer teachers experienced long-term benefits of PAL, which eased their transition into the internship. PAL has the potential to ignite a lasting passion for teaching, providing diverse and unique learning opportunities not only for the most talented and 'pre-selected' medical students but also for a range of dedicated future clinicians.

Student Ultrasound Education, Current Views and Controversies; Who Should be Teaching?

Acquiring diagnostic ultrasound competencies and skills is crucial in modern health care, and achieving the practical experience is vital in developing the necessary anatomy interpretation and scan acquisition skills. However, traditional teaching methods may not be sufficient to provide hands-on practice, which is essential for this skill acquisition. This paper explores various modalities and instructors involved in ultrasound education to identify the most effective approaches. The field of ultrasound instruction is enriched by the diverse roles of physicians, anatomists, peer tutors, and sonographers. All these healthcare professionals can inspire and empower the next generation of ultrasound practitioners with continuous training and support. Physicians bring their clinical expertise to the table, while anatomists enhance the understanding of anatomical knowledge through ultrasound integration. Peer tutors, often medical students, provide a layer of social congruence and motivation to the learning process. Sonographers provide intensive practical experience and structured learning plans to students. By combining different instructors and teaching methods, success can be achieved in ultrasound education. An ultrasound curriculum organized by experts in the field can lead to more efficient use of resources and better learning outcomes. Empowering students through peer-assisted learning can also ease the burden on faculty. Every instructor must receive comprehensive didactic training to ensure high-quality education in diagnostic ultrasound.

Challenges in Learning Procedural Skills: Student Perspectives and Lessons Learned for Curricular Design

Phenomenon: Developing foundational clinical procedural skills is essential to becoming a competent physician. Prior work has shown that medical students and interns lack confidence and competence in these skills. Thus, understanding the student's perspective on why these skills are more difficult to acquire is vital for developing and reforming medical curricula. Approach: This study explored procedural skills learning experiences of medical students with qualitative methods. Through purposive sampling, 52 medical students from the third, fourth, and final years were selected for inclusion. Data were collected using six audio-recorded, semi-structured focus group discussions. Transcripts were manually coded and analyzed using inductive content analysis. Findings: Students provided rich and insightful perspectives regarding their experiences in learning procedural skills that fell into three broad categories: 1) barriers to procedural learning, 2) reasons for learning, and 3) suggestions for better learning outcomes. Students described a range of barriers that stemmed from both patient and clinician interactions. Students were reluctant to make demands for their own benefit during clerkships. The most commonly expressed reason for wanting to learn procedural skills was the desire to be a competent and independent intern. The motivators suggested that students felt empathetic toward interns and visualized a successful internship as a learning goal. Participants suggested peer learning, improved teaching of procedural skills, assessments, and feedback to improve their learning. Insights: This study generated valuable information to promote critical reflection on the existing curriculum and pedagogical approaches to procedural skills development. Medical educators need to sensitize the clinical teachers to student perspectives and what students are really learning to make impactful changes to teaching and learning procedural skills. Students' self-advocacy skills and self-directed learning skills need to be developed for them to seek out learning opportunities and to promote life-long learning. Lessons from this study may also apply to curriculum design in general, especially in teaching clinical skills. Empowering the learner and embracing a learner-centered approach to teaching and learning procedural skills will benefit future clinicians and their patients.

Mechanisms of Near-Peer Learning in a Longitudinal Clerkship: A Grounded Theory Study

PURPOSE

Many medical schools incorporate longitudinal clerkships, which promote continuity and may offer early clinical exposure during the preclinical curriculum. However, the mechanisms of near-peer learning and how it contributes to the development of clinical skills in longitudinal clinical experiences are less clear. The authors explored how peer-to-peer interactions among medical students influenced their developmental trajectories from nascent clinicians to more seasoned practitioners capable of juggling dual roles of clinical care and clinical supervision within longitudinal clerkships.

METHOD

The Education-Centered Medical Home (ECMH) at Northwestern University Feinberg School of Medicine is a longitudinal clerkship that represents an ideal setting to explore peer learning. At ECMH, continuity is established across all 4 years of medical school among small groups of students from each year, a preceptor, and a panel of outpatients. The authors conducted 6 focus groups and 9 individual interviews between March 2021 and February 2023 with medical students from all years. Using constructivist grounded theory, the authors collected and analyzed data iteratively using constant comparison to identify themes and explore their relationships.

RESULTS

Within ECMH, peer relationships fostered an informal learning culture that enabled meaningful peer interactions while reinforcing the established culture. The authors identified 3 essential learning practices between senior and junior medical students: preparing for patient encounters, shifting roles dynamically during the joint encounter, and debriefing encounters afterward. These practices strengthened learning relationships and supported students' developmental trajectories.

CONCLUSIONS

Longitudinal peer learning relationships enabled meaningful peer interaction that influenced medical students' clinical development and capability for clinical supervision. Mutual trust, familiarity, and continuity facilitate targeted feedback practices and growth at the edge of junior students' capabilities. Optimizing this peer learning environment and seeking new opportunities to use longitudinal peer learning in clinical environments could promote psychological safety and professional identity formation for medical students.

Three-dimensional modeling in anatomy-Tool or terror?

Three-dimensional (3D) modeling is a recent, innovative approach to teaching anatomy. There is little literature, however, to suggest how 3D modeling is best used to teach students and whether or not students can gain the same level of understanding as they might use more traditional, hands-on, teaching methods. This study evaluated the use of a 3D modeling software in both a flipped classroom curriculum and as an active learning tool in comparison to traditional, physical model-based teaching. Pre- and post-course content-based assessments were used to evaluate students' learning. Our findings indicated no significant difference between standard and flipped classroom learning; however, the students who used 3D modeling software as an active learning tool significantly underperformed students in the standard group (F(2,1060) = 112.43, p < 0.0001). These findings suggest that these technologies may not yet be useful as a primary means of instruction. Possible explanations may include cognitive overload in navigating the system, intrinsic limitations of the software, or other factors. Further development and research of these technologies is necessary prior to their adoption into teaching practices in anatomy.

The hidden curriculum of peer teaching in developing a professional identity: Perspectives of medical students and junior doctors

INTRODUCTION

Peer teaching has been utilised in the field of medical education to support learning of the curriculum in both pre-clinical and clinical contexts. The literature has shown that there is a hidden curriculum unique to peer teaching, but little is known about this from the peer learner perspective. This study explored the hidden curriculum of peer teaching and from the perspective of medical students and junior doctors.

METHODS

Data was collected via one-on-one interviews with 10 participants including junior doctors and medical students (n = 10). The interviews were transcribed, and thematic analysis was used to interpret the data.

RESULTS

Five themes were identified in relation to the hidden curriculum of peer teaching-specifically, learning how to be a professional; be a better learner; to care for self and others; to navigate career pathways; and to become a future teacher.

CONCLUSION

Peer teaching is a powerful resource for professional identity development in medicine and can be better leveraged to deliver on this potential.

How can peer teaching influence the development of medical students? a descriptive, longitudinal interview study

BACKGROUND

Peer-assisted learning (PAL) - where students take up a teaching role at an early stage of their training-is widely used in medical curricula. Many qualitative studies have investigated the perceptions and benefits of PAL, but no studies have longitudinally explored how peer teachers experienced their development. This could allow for a better understanding of PAL. In this study, we explored the perceived impact of being a peer teacher on the development of personal and professional competencies as a medical student.

METHODS

We longitudinally conducted semi-structured interviews with peer teachers, during their 2-year teaching period in the skills lab at the University of Antwerp and applied descriptive thematic analysis.

RESULTS

In total we gathered 47 interviews in 13 peer teachers (9 female, 4 male,. 1-7 interviews each). Peer teachers reported an increase in self-confidence, which gradually transformed into self-efficacy in clinical and teaching skills., Participants told us to be inspired by the previous generation of peer teachers. Their motivation shifted from personal benefits to benefiting others while becoming a role model themselves. The peer teachers illustrated how they developed maturity by integrating different CanMEDS roles. They grew in reflection, changed/transformed an initial mark-driven study drive into more patient-centered ambitions, and started developing a personal style.

CONCLUSIONS

Our study suggests that being a peer teacher leads to more self-efficacy, in clinical and teaching skills, to become a role model with as motivation to benefit others and to grow towards a good doctor maturity. Although the task is to teach peers, this opportunity nurtures the practice and integration of various CanMEDS roles, not only that of scholar but also communicator, collaborator and leader, thereby positively influencing their personal and professional development and their identity as a doctor (professional role).

Alfaisal University's Academic Success Center: An Individualized Peer-Assisted Learning Program for Mutual Tutor-Student Advancement

INTRODUCTION

Peer-assisted learning (PAL) is an educational strategy whereby students teach other students. PAL presents many advantages to the institution, tutors, and tutees. It can benefit the university by presenting a cost-effective approach where the efforts and time of faculty are reduced. We describe a retrospective analysis detailing the structure, function, and effectiveness of the Academic Success Center (ASC) at Alfaisal University, Riyadh, Saudi Arabia, since 2020. The ASC encompasses various types of PAL methods. It is the only PAL program in Saudi Arabia whereby its tutors, referred to as student consultants, are compensated financially.

METHODS

We retrospectively analyzed the total number of appointments, the total number of students who accessed the center, as well as the breakdown between different colleges and academic years, and their satisfaction level with the PAL mode of teaching.

RESULTS

Our results indicate a high level of appointments for these PAL sessions increasing on a yearly basis and a high level of satisfaction from both the tutors and the tutees.

CONCLUSION

PAL is an effective teaching and mentoring modality with high retention rates that has contributed to an increased sense of well-being among students who have utilized these services.

Quality Assessment and Modulating Factors on Self-Regulatory Behavior in Peer-Assisted Medical Learning

OBJECTIVES

Standardized extracurricular skills labs courses have been developed in recent decades and are important approaches in peer-assisted medical learning (PAL). To provide high quality training and achieve effective learning strategies, continuous evaluations and quality assessments are essential. This research aims to evaluate quality data from medical students participating in extracurricular skills labs courses at Ruhr-University Bochum to prospectively optimize concepts and didactical training and standardize processes. Additionally, we set out to assess and quantify drivers that are influencing factors of the self-reflection of competencies.

METHODS

The analysis was based on a routine assessment of n = 503 attendees of the PAL courses in the skills labs in three consecutive semesters, who voluntarily participated in the evaluation. We analyzed the effects of age, semester and their interaction on the self-reflection of competencies in technical skills courses using moderated regression and simple slope analyses, as previously published. A univariate analysis of variance (ANOVA) with post hoc Tukey HSD testing was used to analyze group means in estimated competencies using IBM SPSS Statistics V.28.

RESULTS

An analysis of variance revealed a significant increase in self-assessed competencies when comparing pre- vs. post-course evaluation data in all 35 depicted items (all p < 0.001). A total of 65.5% of the items were adjusted significantly differently, revealing modified self-reflected pre-course levels compared to those stated before. A moderated regression analysis revealed that age (R2 = 0.001, F(1;2347) = 1.88, p < 0.665), semester of study (∆R2 = 0.001, ∆F (1;2346) = 0.012, p < 0.912) and their interaction (∆R2 = 0.001, ∆F (1;2345) = 10.72, p < 0.227) did not explain a significant amount of the variance in self-reflection variance. A simple slope analysis of earlier (b = 0.07, t = 0.29, p < 0.773) and later semesters of study (b = 0.06, t = 0.07, p < 0.941) did not differentiate from zero.

CONCLUSIONS

The presented evaluation paradigm proved to be a useful tool to encourage students to initiate self-regulatory and self-reflective behavior. The cohesive evaluation of the large cohort of attendees in extracurricular, facultative skills labs courses was helpful in terms of quality assessments and future adaptations. Further evaluation paradigms should be implemented to assess other influencing factors, such as gender, on self-reflection, since age and semester did not explain significant differences in the model.

Tutors´ and Students' Agreement on Social and Cognitive Congruence in a Sonography Peer-assisted-learning Scenario

Purpose

Peer-assisted learning has become an integral part within medical education and has been proven to be effective in teaching medical skills. Cognitive and social congruence are important factors that explain the effectiveness of peer-assisted learning. However, although theory suggests this, there is no study to date that demonstrates that students and tutors agree upon the level of cognitive and social congruence. Thus, we compared tutors' and students' perception of cognitive and social congruence and their agreement on the causes of congruence.

Methods

36 students and 9 tutors from 9 courses were asked to answer questionnaires for their perception of cognitive and social congruence in a peer-assisted learning sonography scenario.

Results

Students and tutors experienced cognitive congruence (t = 0.8277, df = 8, p = .4318, 95% CI = [-0.232; 0.491]) and social congruence (t = 0.962, df = 8, p = .364, 95% CI = [-0.145; 0.354]) similarly. In contrast, students and tutors disagreed on causes of cognitive congruence (agreement = 53.90%) and social congruence (agreement = 58.49%). Tutors rated their empathy and interest toward students as the main cause. Students rated the helpfulness, effectiveness, and approachableness of the tutor as the main cause.

Conclusions

Our study filled the gap in previous research on cognitive and social congruence. Consistent with theoretical considerations, it was shown that students and tutors do indeed experience cognitive and social congruence similarly. Nevertheless, differences also emerged that may carry more or less weight depending on the research question. Future studies should therefore carefully examine whether the assessment of cognitive and social congruence of students and tutors is necessary.

Integrating New Learning Methods into Equine Nutrition Classrooms: The Importance of Students' Perceptions

Despite greater efforts made over recent years to teach animal nutrition to veterinary students, more needs to be done to develop teaching methods and improve education on equine nutrition. The flipped classroom and peer-assisted learning (FC/PAL) approach is a teaching technique suggested to support learning; however, research into FC/PAL in veterinary education is scarce and little is known about students' views on this approach. This study examined the results of a questionnaire administered to assess veterinary students' perceptions of/views about the suitability of FC/PAL applied in an equine nutrition course. Correlation analysis of students' responses to questionnaire items and principal component analysis (PCA) was performed to analyze the variability in student perceptions. The results showed that although half the students reported to be uninterested in equine nutrition, most expressed positive attitudes towards FC/PAL. Comparing the perceptions/views towards FC/PAL among low and high achievers, a significant difference was found for the item considering the duration of FC/PAL (P = .002). Correlation analysis between questionnaire items showed a predominance of positive moderate correlations among high achievers and weak correlations among low achievers. PCA revealed three important findings. First, student interest towards equine nutrition explains the response variability among low achievers. Second, there was significant agreement among almost all high achievers regarding the duration of the FC/PAL. Third, in the item evaluating the usefulness of collaborating with peers, disagreement was only found among low achievers. In summary, a flipped classroom combined with the same level peer-assisted learning appears to encourage student interaction and collaboration in the classroom.

Stakes of Assessments in Residency: Influence on Previous and Current Self-Regulated Learning and Co-Regulated Learning in Early Career Specialists

Introduction

Assessments drive learning but the influence of the stakes of the assessments on self-regulated (SRL) during and after residency are unknown. As early career specialists (ECS) must continue learning independently, the answer to this is important as it may inform future assessments with the potential to promote life-long learning after graduation.

Methods

We utilized constructivist grounded theory to explore the perspectives of eighteen ECS on the influence of stakes of assessments within residency on their SRL during training and in current practice. We conducted semi-structured interviews.

Results

We initially set out to examine the influence of the stakes of assessments on SRL during residency and after graduation. However, it was apparent that learners increasingly engaged with others in co-regulated learning (CRL) as the perceived stakes of the assessments increased. The individual learner's SRL was embedded in CRL in preparation for the various assessments in residency. For low-stakes assessments, the learner engaged in less CRL, taking less cues from others. As stakes increased, the learner engaged in more CRL with peers with similar intellectual level and supervisors to prepare for these assessments. SRL and CRL influenced by assessments in residency had a knock-on effect in clinical practice as ECS in: 1) developing clinical reasoning, 2) improving doctor-patient communication and negotiation skills, and 3) self-reflections and seeking feedback to deal with expectations of self or others.

Discussion

Our study supported that the stakes of assessments within residency reinforced SRL and CRL during residency with a continued effect on learning as ECS.

The Utilization of Animals as Models for Human Autopsies in Medical Education, Supported by Peer-Assisted Tutoring

Background

Human autopsy is widely used to investigate and confirm the causes of death. Commonly reported cases involve the cardiovascular and cerebral systems. However, human autopsy practices have been restricted due to ethical and religious implications in many countries.

Aim

The study aims to know if using human autopsy techniques on animal models might be an effective way for teaching post-mortem autopsy to medical students and exposing them to clinical pathology involving vital organs in medical education and find out the role of peer-assisted learning in improving the process.

Methods

Two pre-lab sessions were conducted to emphasize the embryological and structural similarities and explain the differences between the human brain and heart and animal models: cow brain and sheep heart. Other two sessions of organ dissection were provided to perform human autopsy techniques on animal models practically for educational purposes. Peer-assisted tutoring was implemented. Questionnaires, interviews, and the Delphi technique were used to triangulate the assessment. A year later, participating foreign exchange students were interviewed to evaluate the long-term impacts based on Kirkpatrick models.

Results

The questionnaire showed students' satisfaction with the autopsy workshops and peer-assisted tutoring. The last session was attended by foreign exchange students whose feedback proves the implementation can be done in different medical education systems around the globe.

Conclusion

This study shows that animal model autopsy provides a valuable alternative in medical education and improves the students' comprehension and clinical skills, and peer-assisted learning has a secondary role in enhancing it.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40670-023-01735-w.

Peer-Assisted Learning in Undergraduate Medical Education for Resilience and Well-being

Peers are a powerful resource in the learning process. Peer-assisted learning (PAL) is a high value activity for the peer and the coach. We report here a PAL activity focused on resilience and well-being for first-year undergraduate medical students. The model and lessons learned are described.

Collaborative Learning Communities With Medical Students as Teachers

In recent years, peer-assisted learning has emerged as a new and effective medical education modality. Near-peer tutoring utilizes a senior student serving as an instructor to a junior student. In 2019, the University of California, Irvine, School of Medicine (UCISOM) implemented a near-peer tutoring model beginning with first-year anatomy and physiology curricula. Following a successful pilot program, UCISOM launched a full-fledged near-peer tutoring program in 2020 named Collaborative Learning Communities (CLC) with Medical Students as Teachers. The rollout of CLC occurred in phases. In 2020, second-year medical students led the program for first-year students; in 2021, an additional program was led by third-year medical students for second-year students; in 2022, the program expanded to third-year medical students led by fourth-year students. Each program serves the unique learning needs of each student class, utilizing evidence-based teaching practices while allowing the opportunity for mentorship, interclass connectedness, and refinement of the tutor's teaching skills. In this paper, we describe the creation of CLC, its goals, leadership and curricular structure, and its various benefits, challenges, and limitations.

'Student tutors go online' - Investigation of cognitive and social congruence in online student tutorials - a longitudinal study

The concept of peer-assisted learning (PAL) has been implemented at many medical faculties. Due to the Covid-19 pandemic, parts of the medical education experience transitioned to digital formats. However, little is known about PAL and online student tutorials. PAL is effective due to cognitive and social congruence. This study aims to investigate these concepts in an online student tutorial on taking a patient's medical history. This longitudinal study took place in a preclinical communication course on how to take a patient's medical history. In an online student tutorial, the students learned how to take a patient's psychosocial medical history. Using standardised questionnaires, cognitive and social congruence were assessed. T-tests of independent samples were performed for data comparison. The participants included 128 second-year medical students and 5 student tutors. Cognitive congruence (M_student = 4.19 ± 0.56; M_studenttutor = 4.04 ± 0.57) and social congruence (M_Student = 4.25 ± 0.56; M_Studenttutor = 4.06 ± 0.57) were high for both students and student tutors in the online setting. In comparison to the face-to-face group, students in the online setting considered the student tutors to be significantly (p < .05) more socially congruent. Learning success increased during the course; however, it was not influenced by cognitive congruence. Cognitive and social congruence are high in an online setting. The students' learning success increased during the online tutorial. Based on the higher level of social congruence, student tutors might be very motivated to be open and approachable in an online setting. Simultaneously, students might pay more attention and participate actively in the online setting. Social and cognitive congruence contribute to the effectiveness of online student tutorials and, thus, online student tutorials should be integrated into medical training.

What Makes a Near-Peer Learning and Tutoring Program Effective in Undergraduate Medical Education: a Qualitative Analysis

Peer tutoring can benefit both learners and peer teachers that are distinct from the learning that occurs in expert-guided learning environments. This study sought to evaluate the peer tutoring program at a large public medical school to determine the strengths and weaknesses of a near-peer tutoring program and its benefits beyond students' typical classroom-based learning. This was a survey-based study of learners and tutors participating in the peer tutoring program. Fifty-six learners and 20 tutors participated in the survey; most learners received tutoring in the preclinical phase of the curriculum. Narrative responses were thematically analyzed to identify themes for both groups. Learners' responses about the benefit of the near-peer tutoring program were in three primary categories: creating a safe learning environment, direct coaching skills, and pitfalls around the need for individualized direction. Tutors' responses about what made a successful tutoring relationship centered around crucial activities used to engage with learners, beneficial intrinsic qualities of learners such as motivation, and qualifications of tutors that were most helpful such as knowledge base. Peer tutoring programs should emphasize individualized feedback for learners that focuses on metacognitive, content-based, and socio-emotional support. In doing so, such programs can provide a well-structured approach to improve learner success.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01680-0.

Online student tutorials for effective peer teaching in digital times: a longitudinal quantitative study

BACKGROUND

Peer-assisted learning represents a favoured method of teaching in universities. The COVID-19 pandemic has necessitated transferring medical education to digital formats, and subsequently, the question has arisen of whether online tutorials might be effective. This study, thus, investigated the efficacy of online tutorials in a communication course by assessing the interaction, verbal communication, and nonverbal communication of tutors and students.

METHODS

Second-year medical students were invited to participate in this longitudinal quantitative study. Validated and self-developed questionnaires (e.g., Jefferson Empathy Scale) including 39 questions (rated on a 7- or 5-point Likert scale) were used to assess the different variables including interaction, verbal and nonverbal communication and students' learning success.

RESULTS

Out of 165 medical students, 128 took part in the study. The students as well as tutors reported that they found each other likeable (M_students = 4.60±0.71; M_tutors = 4.38±0.53; p > .05). Learning success increased throughout the communication course (Cohen's d = 0.36-0.74). The nonverbal and verbal communication in the simulated patient (SP) encounter was also rated as high by all three groups (M_nonverbal = 3.90±0.83; M_verbal = 4.88±0.35).

CONCLUSIONS

Interaction as well as nonverbal and verbal communication occurred in the online format, indicating that online tutorials can be effective. The implementation of SPs increases the efficiency of synchronous online learning as it enhances the simulation of a real patient-physician encounter. Thus, online tutorials are a valuable amendment to medical education.

The development, implementation, and evaluation of a medical student peer teaching training curriculum during a high-fidelity prehospital trauma simulation

Objectives

While peer teaching has been found to be an effective technique during simulation, no peer teaching training curriculum (PTTC) has been developed for simulation-based learning. The objective of this study, therefore, was to develop, implement, and evaluate a PTTC during a high-fidelity trauma simulation.

Methods

When developing the PTTC, we combined several validated learning models for teaching and learning procedural skills. We then implemented it over 6 days in two phases: instructional (learning how to teach) and experiential (practicing teaching). Our research team conducted a qualitative evaluation to evaluate the effectiveness of the PTTC. We analyzed written self-reflections from 20 second-year medical students who completed the PTTC. Using an iterative inductive approach to data analysis, our research team first individually coded the reflection papers. We then met to define and categorize the codes into themes. Finally, we compared these themes to the PTTC's objectives to evaluate the curriculum's effectiveness.

Results

The following themes emerged from the data: 1) learning through teaching; 2) self-actualization as an educator; and 3) role of physician as leader, advocate, and educator. The students described how the peer teaching experience improved their own procedural knowledge and skills. They also reported an increase in their leadership and communication skills as they effectively provided guidance and feedback to their peers, which led to their self-actualization as an educator. This self-actualization inspired the peer teachers' professional identity formation as leaders and educators in medicine.

Conclusions

Based on these themes, we found our PTTC to be an effective curricular design. Our results reinforce previously described benefits to both peer teachers and learners in regard to medical knowledge and skills acquisition and furthers the academic emergency medicine community's understanding of how students' involvement as peer teachers in simulation-based education impacts their professional development.

Does peer teaching improve academic results and competencies during medical school? A mixed methods study

BACKGROUND

This study investigates the impact of Peer-Assisted Learning (PAL) in clinical skills on peer teachers' academic scores and competencies; however, controversy remains on this topic, and concrete evidence on its impact lacking.

METHODS

We performed a mixed methods study combining a retrospective cohort study with a modified Delphi survey. Peer teachers and Skills Lab faculty members participated in this study. A validated questionnaire, the CanMEDS Competency Based Inventory (CCBI), and group interviews were used to assess the outcomes of PAL. Our results were also triangulated with literature data.

RESULTS

In 3 consecutive cohorts of medical students (n = 311), 78 participated in PAL. Peer teachers obtained higher scores from the start of the study, at different timepoints in medical school, and on their final scores compared to all other students. Interestingly their progress followed the same path and magnitude as other well-performing students. However, based on our findings from a modified Delphi survey (CCBI interviews) and a literature review, we found further supporting evidence for a positive impact of PAL on the competencies of physical skills (medical expert), teamwork and leadership (collaborator), lifelong learning (scholar), and for admitting uncertainty/limits (professional) within the CanMEDS roles.

CONCLUSIONS

We conclude that higher achieving students are more likely to volunteer for a peer tutoring program; however this does not significantly augment their academic scores as compared to above well-performing non-teaching fellow students. Importantly, our modified Delphi survey indicated which CanMEDS roles were positively impacted by PAL: medical expert, collaborator, scholar and professional.

Blended (online and in-person) Women's Health Interprofessional Learning by Simulation (WHIPLS) for medical and midwifery students

BACKGROUND

Blended teaching combines traditional in-person components (simulation-based training and clinical-based placement) with online resources. Due to the COVID-19 pandemic, we modified our Women's Health Interprofessional Learning through Simulation (WHIPLS) program - to develop core obstetric and gynaecological skills - into a blended teaching program. There is limited literature reporting the observations of blended teaching on learning.

AIMS

To qualitatively evaluate the blended teaching program and explore how it contributes to learning.

MATERIALS AND METHODS

This study was performed at Monash University in Melbourne, Australia. A total of 98 medical students and 39 midwifery students participated. Data were collected by written survey and analysed by authors using a thematic analysis framework.

RESULTS

Students reported that in-person teaching remains a vital aspect of their curriculum, contributing an averaged 63.2% toward an individual's learning, compared with online. Five substantial themes demonstrate how students learnt and maximised education opportunities using a blended teaching program: 'low-pressure simulation environments', 'peer-assisted learning', 'haptic learning', 'scaffolded learning' and 'the impact of online discourse'.

DISCUSSION

In-person teaching remains a cornerstone of obstetric and gynaecological clinical skills education, of which interprofessional simulation and clinical-based placement are key components. Teaching via online discourse alone, is not sufficient to completely replace and provide comparable learning outcomes, but certainly plays an important role to prime students' learning and to maximise in-person opportunities and resources. Our study reveals key pedagogies of a blended (online and in-person) learning program, providing further evidence to support its ongoing utility as a feasible and warranted approach to learning.

Factors associated with medical students' self-regulated learning and its relationship with clinical performance: a cross-sectional study

BACKGROUND

The importance of self-regulated learning (SRL) has been broadly recognised by medical education institutions and medical professionals. Self-regulated learning, which is a context-specific process, is affected by personal, contextual and social factors. Although many studies on exploring the factors that influenced SRL and the relationship of between SRL and clinical achievement levels have been carried out in western countries, little is known about the factors associated with self-regulated learning and its relationship with clinical performance among medical students in China.

METHODS

A cross-sectional online survey was distributed to 3rd year clinical medicine students who were in the clinical clerkship stage in a medical college in Wuhan. We used Self-regulated Learning Scale for Undergraduates (SLSU) to measure the self-regulated learning of students and Objective Structured Clinical Examination (OSCE) in the national proficiency test to assess the clinical performance of students. The participation rate was 73.95% (193 students). An independent t-test and analysis of variance were used to analyse the factors associated with self-regulated learning. The relationship between self-regulated learning and clinical performance was analysed with multilinear regression analysis.

RESULTS

Univariate analysis showed that having a clear career planning and a professional idol, providing full-time teaching clinical teachers in the clerkship department and seeking the help of the surrounding classmates and the guidance of teachers or senior students were significant predictors of self-regulated learning. Multilinear regression analysis has revealed a positive relationship among extrinsic goals (partial r = 0.171), clinical clerkship evaluation (partial r = 0.197) and clinical performance (F = 4.070, p = 0.004).

CONCLUSIONS

Motivation-related personal and social factors related to clinical context could promote the SRL level of medical students in China. Extrinsic goals and clinical clerkship evaluation could facilitate students' clinical achievements on clinical skills. External support, such as clinical clerkship management, might improve clinical performance on clinical skills in clinical clerkship context.

Learning pharmacology through peer tutoring

OBJECTIVE

Knowing the effectiveness of peer tutoring methods in pharmacology learning for medical students.

METHOD

This was a quasi-experimental study with a post-test only design. Subjects were second-year medical students who were divided into four control groups and four experimental groups. Students in the experimental group experienced peer tutoring methods. The difference in motivation and performance scores in both groups was analyzed using t-tests.

RESULTS

Motivation in the experimental group was higher than in the control group, for interest motivation (79.09±13.11 vs 75.24±13.46; p=0.411), value motivation (80.89±11.57 vs 76.54±12.20; p=0.292), perceived motivation (66.26±7.44 vs 666.20±10.09; p=0.977), and as well as total (76.33±9.33 vs 73.31±10.30; p=0.159). The performance score in the control group was higher than the treatment group (60.45±6.39 vs 60.67±4.72; p=0.649).

CONCLUSION

Quality control, monitoring, and evaluation are required to produce an effective peer tutoring program. One of which is through rigorous peer tutor recruitment, tutor training, and ensuring the commitment of the peer tutors.

The peer teachers' perception of intrinsic motivation and rewards

Peer-assisted learning (PAL) is an educational method commonly applied in academic teaching. It is characterized by the interplay between peer teachers and learners who are at a similar academic level. Although it has been shown that peer teachers benefit from participating in PAL, little is known about their perception of motivation and rewards. Here we designed a questionnaire and measured the perception of intrinsic motivation and rewards of peer teachers from three different PAL programs. Overall, peer teachers were highly intrinsically motivated. The reward category Supporting Others was appreciated the most, followed by the reward categories Self-Improvement, Feedback, and Financial. The perception of rewards reflected the features of the three PAL programs. For example, the item "learning the teaching matter themselves" was most valued by peer teachers who were enrolled in a PAL program that deployed their peer teachers primarily to convey knowledge. In contrast, "actively shaping the teaching situation" was appreciated most by peer teachers of the PAL program that enables their peer teachers to conceive their teaching sessions independently. These findings go toward recommendations of the implementation and further development of PAL programs. If PAL programs clearly define their features and aims, they could specifically attract (and select) peer teachers and meet their needs as well as expectations, providing opportunities to gain knowledge and teaching experience. Ultimately, these PAL programs could better support the learners.

Evaluating the effectiveness of a structured, simulator-assisted, peer-led training on cardiovascular physical examination in third-year medical students: a prospective, randomized, controlled trial

Background: Previous research suggests that cardiac examination skills in undergraduate medical students frequently need improvement. There are different ways to enhance physical examination (PE) skills such as simulator-based training or peer-assisted learning (PAL). Aim: The aim of this study was to evaluate the effectiveness of a structured, simulator-assisted, peer-led training on cardiovascular PE. Methods: Participants were third-year medical students at Leipzig University Faculty of Medicine. Students were randomly assigned to an intervention group (IG) and a control group (CG). In addition to standard curricular training, IG received a peer-led, simulator-based training in cardiac PE. Participant performance in cardiac PE was assessed using a standardized checklist with a maximum of 25 points. Primary outcome was assessed via checklist point distribution. Results: 89 students were randomised to either CG (n=43) or IG (n=46) with 70 completing the study. Overall, IG students performed significantly better than CG students did (max. points: 25, M±SD in IG was 17±3, in CG 12±4, p<.0001). Simple mistakes such as not using the stethoscope correctly were more frequent in CG students. Prior experience did not lead to a significant difference in performance. Conclusions: Structured, peer-led and simulator-assisted teaching sessions improve cardiac PE skills in this setting compared to control students that did not receive this training.

Medical Education in Pathology: General Concepts and Strategies for Implementation

CONTEXT.—

Pathology education must evolve as medical knowledge expands and disruptive technologies emerge. The evolution in pathology teaching practices accelerated as traditional teaching modalities were suspended in March 2020 during the coronavirus disease 2019 (COVID-19) pandemic.

OBJECTIVES.—

To provide pathologists an overview of established teaching paradigms and practical examples of how these paradigms may be applied to pathology education, emphasizing differences in graduate and undergraduate medical education as well as the challenges and promises of remote learning, as revealed by the COVID-19 pandemic.

DATA SOURCES.—

Selected peer-reviewed publications representing the field of educational social science.

CONCLUSIONS.—

Evidence-based methods described in education and social sciences can be effectively deployed in pathology education and especially remote learning, as necessitated by the current COVID-19 pandemic. Understanding established principles, such as cognitive load, competency-based learning, peer-assisted learning, and flipped classrooms may prove useful in developing effective, learner-centric content for pathology education.

What about the supervisor? Clinical supervisors' role in student nurses' peer learning: A phenomenographic study

INTRODUCTION

Peer learning is increasingly used for healthcare students in the clinical setting. However, as peer learning between students involves students taking a teaching role, it is unclear what the supervisor's role then becomes. It is vital to determine the role of the supervisor in student peer learning to ensure high quality learning and patient safety.

METHODS

Semi-structured interviews were performed with 15 student nurse supervisors (nurses and assistant nurses) from two hospital wards that practice peer learning to investigate the different ways clinical supervisors view their role in students' peer learning. Transcribed data were coded and analysed using a phenomenographic approach.

RESULTS

Four hierarchical levels of the supervisor's understanding of their role in students' peer learning were identified: the teacher; the facilitator; the stimulator; and the team player. These categories represent an increasingly inclusive view of which people present on the ward play a role in enabling effective peer learning.

CONCLUSIONS

The various understandings of supervisor roles have implications for how supervision of peer learning could be implemented in the future.

Initiating Students' Reflections on Life's Passing in the Anatomy Course - an International Observation at 14 Universities

BACKGROUND

Medical and dental students' feelings and thoughts about the topic of death and life's passing are often associated with learning in the gross anatomy course, when students begin working with a deceased body donor in order to study human anatomy. Little is known of whether the format of anatomy teaching has an impact on these experiences. An observational study was performed to capture the initiation of students' sentiments on the topic of life's passing during the anatomy course at 14 international universities, identify common themes regarding these thoughts, and to study the connection to variations in anatomy course formats and included elements.

METHOD

Preclinical anatomy students reflected on one question (i.e., "How did your experience in the anatomy laboratory bring about your reflections on the meaning of life and human existence as well as the sanctity of one's passing?"). Written assignments were collected and anonymously coded. Information on anatomy courses was obtained via faculty questionnaires.

RESULT

A variety of themes were identified at the different schools, correlated with different anatomy formats and elements. Results indicate that the courses that offer hands-on cadaveric dissections may play an important role in triggering these sentiments.

DISCUSSION

The initiation of students' sentiments about the topic of death varies and includes several themes. There can be a connection to the way anatomy is taught, particularly if hands-on comprehensive cadaveric dissection or prosections are included.

CONCLUSION

In summary, anatomy courses can initiate students' thinking about life's passing - particularly in schools that offer hands-on cadaveric dissections or prosections.

Validating the Use of Peer-Assisted Learning Laparoscopic Simulation Training for Medical Students

Medical students are often passive observers in laparoscopic theatres due to their lack of basic laparoscopic skill competence, which negatively impacts their education. This study aims to (1) validate the use of peer-assisted learning (PAL) to teach medical students basic laparoscopic skills on low-cost simulators and (2) compare the efficacy of PAL training between pre-clinical and clinical medical students to ascertain when this training should be introduced. Our results demonstrate significant training efficacy at both levels, suggesting that PAL simulation may be implemented at either stage of training, but may garner better retention of confidence and knowledge in the clinical medical students.

Peer teaching under pandemic conditions - options and challenges of online tutorials on practical skills

Background: Within days, the corona crisis has forced the "Lernzentrum", as well as all other places of training and further education, to discontinue classroom teaching at German universities and vocational schools. In order to start teaching online, tutors had to face the challenge to develop new digital learning formats (virtual classrooms) for the peer teaching of practical skills within a short time. This paper aims at outlining the project of developing e-tutorials with regard to the teaching of practical skills. Methodology: After analyzing the classroom lessons (n=30), some of the tutorials were transformed into digital formats. These so-called "e-tutorials" were held via a digital platform. They have been evaluated continuously with a standardized online questionnaire. The results of this evaluation have been analyzed descriptively. Results: From 27/04/2020 to 17/07/2020 eleven different e-tutorial formats were offered on 246 dates. The evaluation revealed a high degree of acceptance with these course offers as well as with the implementation by the tutors. Interpretation: During the pandemic crisis the substitution of peer teaching into forms of e-tutorials was considered valuable; however, these learning formats present challenges, especially with regard to the interaction between teachers and students. They cannot therefore fully replace the peer teaching of practical skills.

A Proposed Framework to Develop, Describe and Evaluate Peer-Assisted Learning Programs

PHENOMENON

Peer-assisted learning (PAL) is increasingly used in different fields of education, including medical education, due to its established advantages. However, there are scarce data about the best practice guidelines for PAL program evaluation. The aim of this work was to develop a framework that can describe and develop PAL programs and consequently provide a tool for evaluation and comparison of PAL programs among different institutions.

APPROACH

A thorough literature review was made for assessment of different PAL programs development and implementation strategies, and PAL leaders at the University of Umm Al-Qura in Saudi Arabia were interviewed for development and revision of a framework for PAL program development, description and evaluation.

FINDINGS

A framework of four sections was developed ie context, theory, implementation processes and outcomes, and emergence. The context includes the learning objectives and the logistics. The theory includes the content nature, program design, number of tutees and tutors, participation, program orientation, program duration and timing, tutor recruitment and preparation and faculty involvement. Implementation process and outcome section includes the feedback collection and the pre- and post-intervention students' assessment. The emergence includes tracking the program evolution.

INSIGHTS

Development of a clear well-defined framework for description, implementation and evaluation of a PAL educational program can provide a foundation to unify the terms organizations use to communicate the parameters of PAL programs and overcome the jargon about PAL in the literature. It also can provide comparisons between the programs in an attempt to set best practice guidelines in the future for PAL program developing and implementation.

Peer-assisted learning in simulation-based medical education: a mixed-methods exploratory study

Introduction

Peer-assisted learning (PAL) is well described in medical education but there has been little research on its application in simulation-based education (SBE). This exploratory study aimed to determine the perceptions of senior medical students at two universities to teaching and learning in SBE using PAL (PAL-SBE).

Methods

Ninety-seven medical students at two universities working in small groups with facilitator oversight wrote, ran and debriefed a simulation scenario for their peers.This was a mixed-methods study. Participants completed a written free-text and Likert survey instrument, and participated in a facilitated focus group immediately after the scenario. Thematic analysis was performed on the free-text and focus group transcripts.

Results

Student-led scenarios ran without major technical issues. Instructor presence was required throughout scenario delivery and debrief, making the exercise resource intensive. Participant responses were more positive regarding learning as peer teachers in simulation than they were regarding participation as a peer learner. Five themes were identified: learning in the simulated environment; teaching in the simulated environment; teaching peers and taking on an educator role; learning from peers; and time and effort expended. Perceived benefits included learning in depth through scenario writing, improved knowledge retention, understanding the patient's perspective and learning to give feedback through debriefing.

Conclusion

PAL in SBE is feasible and was perceived positively by students. Perceived benefits appear to be greater for the peer teachers than for peer learners.

Perception of medical students about courses based on peer-assisted learning in five Peruvian universities

Objectives

Peer-assisted learning (PAL) is a supportive strategy in medical education. In Peru, this method has been implemented by few universities. However, there are no consistent studies evaluating their acceptability by medical students. The objective of this study was to evaluate the perception of medical students about PAL in five Peruvian universities.

Results

A total of 79 medical students were included in the study. The mean age was 20.1 ± 1.9 years, 54% were female, and 87% were in the first 4 years of study. Most of the students were satisfied with classes and peer teachers. Similarly, most of the students agreed with the interest in developing teaching skills. It was also observed that 97% of students approved to implement PAL in medical education programs.

Qualitative analysis of cognitive and social congruence in peer-assisted learning - The perspectives of medical students, student tutors and lecturers

BACKGROUND

The teaching of students by peers, so-called peer-assisted learning, is effective based on cognitive and social congruence among students and student tutors. This study aims to investigate cognitive and social congruence by analysing the perspectives of students, student tutors and lecturers in order to receive a better understanding of these concepts and to improve the teaching in tutorials as well as the relationship among students and student tutors.

METHODS

Cognitive and social congruence were assessed by conducting semi-structured interviews. An interview guide about teaching and relationship in tutorials was based on previous findings of Schmidt & Moust (1995) and Lockspeiser et al. (2008). The interviews were analysed inductively by using qualitative content analysis.

RESULTS

Twenty-nine participants were interviewed. The following categories were found for cognitive congruence: knowledge base, high expertise by student tutors, same language and effective knowledge transfer. Social congruence was represented by relaxed learning atmosphere, sharing social roles, empathic and supportive behaviour of student tutors, sharing experiences, understanding difficulties and enjoying tutorial.

CONCLUSION

Cognitive and social congruence may be displayed on the practical behavioural level. Trust in student tutor could be found in both concepts on different levels. The qualitative results provide a deeper insight by indicating that the student tutors may play a 'mediator' role for the relationship between students and lectures.

Peer-Developed Modules on Basic Biostatistics and Evidence-Based Medicine Principles for Undergraduate Medical Education

Introduction

Evidence-based medicine (EBM) is pivotal in shaping patient care, yet it is challenging to incorporate into undergraduate medical education (UME) due to a lack of dedicated resources within the preclinical curriculum. To address this challenge, we used a peer-led approach to explain difficult concepts through language that students can understand at their shared level of understanding.

Methods

Four second-year medical students trained in EBM over 18 months by facilitating monthly journal clubs, ultimately leading to their involvement as peer-instructors. With input from a faculty expert, peer-instructors designed integrative PowerPoint modules and interactive problem sets on basic biostatistics and EBM principles. Assessment included formative quizzes with multiple attempts to achieve at least 80% to demonstrate mastery of core learning objectives. Afterwards, students were invited to provide feedback using a 5-point Likert scale survey.

Results

Of second-year students who participated, all 151 demonstrated 80% competency on each quiz. Eighty-seven (58%) students completed the survey on which, 77% agreed/strongly agreed that their level of understanding of EBM improved after the peer-led sessions, 76% agreed/strongly agreed that the sessions were more conducive to learning compared to traditional lectures, and 94% agreed/strongly agreed that the material covered was relevant to the USMLE Step 1.

Discussion

This peer-led approach has been rated as effective by learners, improving their ability to critically appraise and apply clinical evidence. To promote integration of EBM into UME, we have prepared modules, problem sets, quizzes, and an outline of the problem-solving sessions for universal adoption.

Beyond the self: The role of co-regulation in medical students' self-regulated learning

CONTEXT

Medical students are expected to self-regulate their learning within complex and unpredictable clinical learning environments. Research increasingly focuses on the effects of social interactions on the development of self-regulation in workplace settings, a notion embodied within the concept of co-regulated learning (CRL). Creating workplace learning environments that effectively foster lifelong self-regulated learning (SRL) requires a deeper understanding of the relationship between CRL and SRL. The aim of this study was therefore to explore medical students' perceptions of CRL in clinical clerkships and its perceived impact on the development of their SRL.

METHODS

We conducted semi-structured interviews with 11 purposively sampled medical students enrolled in clinical clerkships at one undergraduate competency-based medical school. Data collection and analysis were conducted iteratively, informed by principles of constructivist grounded theory. Data analysis followed stages of open, axial and selective coding, which enabled us to conceptualise how co-regulation influences the development of students' self-regulation.

RESULTS

Data revealed three interrelated shifts in CRL and SRL as students progressed through clerkships. First, students' CRL shifted from a focus on peers to co-regulation with clinician role models. Second, self-regulated behaviour shifted from being externally driven to being internally driven. Last, self-regulation shifted from a task-oriented approach towards a more comprehensive approach focusing on professional competence and identity formation. Students indicated that if they felt able to confidently and proactively self-regulate their learning, the threshold for engaging others in meaningful CRL seemed to be lowered, enhancing further development of SRL skills.

CONCLUSIONS

Findings from the current study emphasise the notion that SRL and its development are grounded in CRL in clinical settings. To optimally support the development of students' SRL, we need to focus on facilitating and organising learners' engagement in CRL from the start of the medical curriculum.

Stimulating Intrinsic Motivation in Millennial Students: A New Generation, a New Approach

There has been a fundamental change in health care pedagogy to address the demands and challenges posed by the present generation of millennial students. There is also a growing recognition of the role of intrinsic motivation as a catalyst in a positive learning experience. The term intrinsic motivation refers to energizing behavior that comes from within an individual and develops due to an inherent interest in the activity at hand. However, stimulating intrinsic motivation in the present generation of millennial health care students is a daunting task, considering their diverse and disparate nature. In addition, the inherent generational differences between educators and students, and an increasing emphasis on technological tools have resulted in a dichotomy in the educational environment leading to the development of a greater incidence of burnouts among students. Hence, numerous innovative techniques have been introduced in health care education to enhance the levels of intrinsic motivation in these students. Unfortunately, most of these approaches have only been moderately successful due to their limited ability to address the unique educational expectations of millennial students. The cumulative evidence suggests that specific approaches to stimulate intrinsic motivation should aim at nurturing the learning efforts of students, bridging the generational barriers between educators and students, and ameliorating the stress associated with health care education. Hence, the specific aim of this narrative review is to suggest empirically proven curricular strategies and institutional reforms to enhance intrinsic motivation in health care students belonging to the Millennial Generation.

Applying Educational Theory and Best Practices to Solve Common Challenges of Simulation-based Procedural Training in Emergency Medicine

OBJECTIVES

Procedural competency is an essential prerequisite for the independent practice of emergency medicine. Multiple studies demonstrate that simulation-based procedural training (SBPT) is an effective method for acquiring and maintaining procedural competency and preferred over traditional paradigms ("see one, do one, teach one"). Although newer paradigms informing SBPT have emerged, educators often face circumstances that challenge and undermine their implementation. The goal of this paper is to identify and report on best practices and theory-supported solutions to some of these challenges as derived using a process of expert consensus building and reviews of the existing literature on SBPT.

METHODS

The Society for Academic Emergency Medicine (SAEM) Simulation Academy SBPT Workgroup convened approximately 8 months prior to the 2019 SAEM Annual Meeting to perform a review of the literature and participate in a consensus-building process to identify solutions (in the form of best practices and educational theory) to these challenges faced by educators engaging in SBPT.

RESULTS AND ANALYSIS

Thirteen distinct educational challenges to SBPT emerged from the expert group's primary literature reviews and consensus-building processes. Three domains emerged upon further analysis of the 13 challenges: learner, educator, and curriculum. Six challenges within the "learner" domain were selected for comprehensive discussion in this paper, as they were deemed representative of the most common and most significant threats to ideal SBPT. Each of the six challenges aligns with one of the following themes: 1) maximizing active learning, 2) maintaining learner engagement, 3) embracing learner diversity, 4) optimizing cognitive load, 5) promoting mindfulness and reflection, and 6) emphasizing deliberate practice for mastery learning. Over 20 "special treatments" for mitigating the impact of the 13 challenges were derived from the secondary literature search and consensus-building process prior to and during the preconference workshop; 11 of these that best address the six learner-centered challenges are explored, including implications for educators involved in SBPT.

CONCLUSIONS/IMPLICATIONS FOR EDUCATORS

We propose multiple consensus-generated solutions (in the form of best practices and applied educational theory) that we believe are suitable and well aligned to overcome commonly encountered learner-centered challenges and threats to optimal SBPT.

Radiography students' perceptions of Peer assisted learning

INTRODUCTION

Peer Assisted Learning (PAL) is collaborative learning in which students from the same or different academic levels learn from each other. It is meant to support the regular teaching and learning process. Learning in PAL can be explained by constructive social learning theories and has many advantages such as, students' perception of it and the ease of discussion between peers. This study aims to measure students' perception of PAL in the context of radiography education.

METHODS

A PAL programme was implemented in one module taught to second year radiography students. A questionnaire was then distributed to the participating students (n = 28) to measure their perception of PAL; the questionnaire consisted of 13 questions with a Likert scale of 5 (1 = strongly disagree to 5 = strongly agree). The results were analysed using SPSS to calculate the percentages, means, standard deviations, and factorial analysis.

RESULTS

Twenty-six students responded to the questionnaire (92.8%). The range of agreement in all questionnaire items ranged from 79.9% to 92.3%. The factor analysis revealed two main factors affecting students' acceptability. PAL enriched students' learning experience and helped them in preparation for exams.

CONCLUSION

The use of PAL is highly acceptable by students in context of radiography education.

IMPLICATIONS FOR PRACTICE

More studies are necessary to confirm the best methods of using PAL. These may involve both students and educators, and pre- and post-methods.

Cognitive and social congruence in peer-assisted learning - A scoping review

This scoping review presents an overview of cognitive and social congruence in peer assisted learning (PAL), as the positive effects of PAL have been shown to rely on these critical factors. The scoping review followed the guidelines of the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. Databases were systematically searched for articles that focus on PAL and cognitive and social congruence. Participants of the studies included were medical, health science, polytechnic, law and paramedic students. Studies that assessed cognitive and social congruence by questionnaires with a 5-point Likert scale were regarded for meta-analytic pooling. Sixteen of 786 identified articles were included in the review, whereof 9 studies were considered for meta-analytic pooling. The meta-analytic pooling showed that tutees tend to see their student tutors as cognitively (M_weighted = 3.84; range of M_weighted= 2.69–4.56) and socially congruent (M_weighted = 3.95; range of M_weighted = 2.33–4.57). Further, characteristics of student tutors are summarized. This scoping review presents an overview and operationalization of cognitive and social congruence in PAL. Based on the presented meta-analytic pooling, cognitive and social congruence were found to represent relevant key factors in the PAL context. Thus, this theoretical background should be acknowledged as a core concept for tutorials within the medical curriculum.

Effect of Peer Assisted Learning (PAL) education on knowledge, attitude and behavior related to prevention and control of diabetes

Objectives

The present study aimed to compare the effect of Peer Assisted Learning (PAL) method and routine lecture on knowledge, attitudes, and behaviors of participants in the prevention of diabetes.

Results

The results showed that one month after the intervention and the implementation of the educational program, the mean scores of the two groups in terms of knowledge, attitude, and behavior increased significantly.

Electronic supplementary material

The online version of this article (10.1186/s13104-019-4261-9) contains supplementary material, which is available to authorized users.

Face yourself! - learning progress and shame in different approaches of video feedback: a comparative study

BACKGROUND

Feedback is a crucial part of medical education and with on-going digitalisation, video feedback has been increasingly in use. Potentially shameful physician-patient-interactions might particularly benefit from it, allowing a meta-perspective view of ones own performance from a distance. We thus wanted to explore different approaches on how to deliver specifically video feedback by investigating the following hypotheses: 1. Is the physical presence of a person delivering the feedback more desired, and associated with improved learning outcomes compared to using a checklist? 2. Are different approaches of video feedback associated with different levels of shame in students with a simple checklist likely to be perceived as least and receiving feedback in front of a group of fellow students being perceived as most embarrassing?

METHODS

Second-year medical students had to manage a consultation with a simulated patient. Students received structured video feedback according to one randomly assigned approach: checklist (CL), group (G), student tutor (ST), or teacher (T). Shame (ESS, TOSCA, subjective rating) and effectiveness (subjective ratings, remembered feedback points) were measured. T-tests for dependent samples and ANOVAs were used for statistical analysis.

RESULTS

n = 64 students could be included. Video feedback was in hindsight rated significantly less shameful than before. Subjectively, there was no significant difference between the four approaches regarding effectiveness or the potential to arise shame. Objective learning success showed CL to be significantly less effective than the other approaches; additionally, T showed a trend towards being more effective than G or ST.

CONCLUSIONS

There was no superior approach as such. But CL could be shown to be less effective than G, ST and T. Feelings of shame were higher before watching one's video feedback than in hindsight. There was no significant difference regarding the different approaches. It does not seem to make any differences as to who is delivering the video feedback as long as it is a real person. This opens possibilities to adapt curricula to local standards, preferences, and resource limitations. Further studies should investigate, whether the present results can be reproduced when also assessing external evaluation and long-term effects.

Consultant led peer assisted learning model

BACKGROUND

Undergraduate medical students frequently report inadequate basic surgical skills such as suturing and knot tying. In recent years, peer assisted learning (PAL) has proven to be an effective method of teaching basic surgical skills. The consistency of the teaching and the quality of the content may be questionable in these workshops. This study aimed to develop a consultant led peer assisted learning model (CL-PAL) to facilitate the quality-controlled delivery of basic suturing skills in undergraduate medical education.

METHODS

A video on basic suturing techniques was developed with the assistance of an experienced plastic and reconstructive surgeon. Sixty students were recruited and allocated to four workshops across 2 days. Each student was provided with a pre and post workshop form to self-assess their confidence levels with different suturing techniques and theories of suturing. Three PAL facilitators rotated through student stations to address any concerns and to improve the learning experience.

RESULTS

From the post-workshop assessment, students expressed increased confidence in handling surgical instruments, suturing and understanding sharp safety. Following this workshop, 90% of the students reported that they were more likely to attend self-directed learning sessions to maintain their acquired skills. Workshop providers also had an opportunity to develop teaching skills such as communication and the demonstration of suturing skills.

CONCLUSION

CL-PAL uses technology aided resources created by an experienced surgeon to facilitate the delivery of high quality basic surgical teaching. This model is not only applicable to basic skills training but can also be developed for applications in other specialties. In recent years, peer-assisted learning (PAL) has proven to be an effective method of teaching basic surgical skills.

Instructor-led vs. peer-led debriefing in preoperative care simulation using standardized patients

BACKGROUND

Debriefing involves the active participation of learners to identify and close gaps in knowledge and skills. Varied debriefing methods are used in simulation, but no empirical studies have examined the effectiveness of peer-led debriefing in simulation using standardized patients. The purpose of this study was to compare the effects of two debriefing methods (instructor-led vs. peer-led) on nursing skills, knowledge, self-confidence, and quality of debriefing among undergraduate nursing students in South Korea.

METHOD

A nonequivalent control group pretest-posttest design was used. Fifty-seven third-year nursing students were randomly assigned to instructor-led (n = 26) or peer-led (n = 31) debriefing groups after a simulation of preoperative care. Structured questions and areas for discussion guided debriefing in both groups. Self-administered questionnaires were used to collect data on students' knowledge and self-confidence in providing preoperative care. Faculty evaluated students' nursing skills during pre- and post-simulation practice. Students evaluated the quality of the debriefings.

RESULTS

Nursing skills for preoperative care (p < .001) and the quality of debriefing (p < .001) were statistically higher in the instructor-led group compared to the peer-led group. There were no statistically significant differences in knowledge (p = .445) and self-confidence (p = .686). Knowledge and self-confidence from pre-test to posttest were improved in both groups.

CONCLUSION

The instructor-led debriefing showed improved nursing skills and higher quality debriefing. However, peer-led debriefing led by a non-trained peer also rendered positive results. Thus, peer-led debriefing may be considered a useful strategy for improving nursing students' self-confidence.

Peer teaching beyond the formal medical curriculum

Peer-assisted learning (PAL) is nowadays commonly implemented in medical education. Mostly PAL is utilized to specifically support teaching within one subject or a specific curricular situation. Here, we present a large-scale peer teaching program that aims to address the individual student's learning needs. In addition, it provides a platform for students to participate in academic teaching. A retrospective data analysis was performed to reveal the program's development and acceptance. The program was implemented in 2008/09 with three tutorials conducted by 24 student tutors to support students preparing for reexaminations. Since then, the program has continuously grown. In 2015/16, 140 tutors conducted 52 tutorials, consisting of 2,750 lessons for 1,938 tutees. New tutorial categories were continuously introduced. In 2015/16, these encompassed tutorials that were held concomitantly to the formal curriculum, tutorials that exceeded the contents of the formal curriculum, tutorials for preparation for the state examination, and electives. Evaluations among the tutees revealed that 93.5% of the respondents rated the courses overall as "good" or "excellent" ( n = 13,489) in 2015/16. All elements of the peer teaching program are managed by one academic group. This encompasses the organization of tutorials, the quality management, and the qualification of tutors, including content-related supervision and didactic training. We conclude that the implementation of a large-scale peer teaching program can complement the formal curriculum. This might be beneficial for both tutors who can actively train their didactic and content-related competencies, and tutees who can autonomously consolidate and expand their knowledge.

Interactive peer-guided examination preparation course for second-year international full-time medical students: quantitative and qualitative evaluation

Background: It has been documented that international students face diverse challenges due to language and cultural barriers. International medical students suffer from personal distress, a lack of support and perform poorer than local fellow-students in clinical examinations. It has been documented that international medical students benefit from peer-led tutorials in their first year. We investigated the effectiveness of a tutorial offered for international medical students in their second year. Methods: A peer-guided examination preparation course with interactive elements for second year international medical students was designed, learning objectives were defined. Two evaluations were undertaken: In a quantitative assessment, students were asked to fill out five multiple-choice-questions at the beginning of every session of the tutorial (pre-test) as well as to participate in a post-test at the end of the semester in which all former multiple-choice-questions were re-used. Using a qualitative approach, participants were asked for their thoughts and comments in a semi-structured interview at the end of the semester. Results: International students (N=12) showed significantly better results in the post- than in the pre-test (t(11)=-8.48, p<.001, d=1.95). Within the interviews, international students (N=10) reported to have benefited from technical and didactic, as well as social learning experiences. The individual lectures students were asked to contribute were discussed controversially. Conclusion: Our peer-guided tutorial for second year international medical students is an effective and well accepted possibility to prepare these students for examinations.