Peer teaching among nursing students in the clinical area: effects on student learning

How does training format and clinical education model impact fidelity and confidence in a speech-language pathology rotation?

Clinical education rotations typically involve an initial training phase followed by supervised clinical practice. However, little research has explored the separate contributions of each component to the development of student confidence and treatment fidelity. The dual purpose of this study was to compare the impact of clinical training format (synchronous vs. asynchronous) and education model (traditional vs. collaborative) on student confidence and treatment fidelity. Thirty-six speech-language pathology graduate students completed this two-phase study during a one-term clinical rotation. Phase 1 investigated the impact of training condition (synchronous, asynchronous guided, asynchronous unguided) on student confidence and treatment fidelity. Phase 2 explored the impact of education model (traditional vs. collaborative) on student confidence and treatment fidelity. Treatment fidelity was measured at the conclusion of Phases 1 and 2. Students rated their confidence at six-time points throughout the study. Our results indicate that training condition did not differentially impact student confidence or treatment fidelity; however, education model did: students in the collaborative education model reported increased confidence compared to students in the traditional education model. Students in the collaborative education model also trended towards having higher treatment fidelity than students in the traditional education model. These results demonstrate that pre-clinical trainings can be effective in several different formats provided they cover the discrete skills needed for the clinical rotation. While preliminary, our results further suggest that students may benefit from working with peers during their clinical rotations.

Effectiveness of peer teaching in health professions education: A systematic review and meta-analysis

BACKGROUND

The reform in health professions education requires the focus to shift from fact memorization to exploring, analyzing, assimilating, and synthesizing information to promote active and collaborative learning. Peer teaching is one of the educational strategies.

AIMS

This review aimed to explore and synthesize quantitative evidence to determine the overall effect of peer teaching in enhancing students' theoretical knowledge and practical skills (e.g., procedural skills and resuscitation) in health professions education.

METHODS

PubMed, ScienceDirect, CINAHL, ERIC, ProQuest, reference lists of relevant studies, and reviews were searched till November 2021. Results were pooled using random-effects meta-analysis or narrative synthesis.

RESULTS

A total of 44 RCTs were included. This review showed a significant effect of peer teaching on procedural skills improvement and a comparable effect on theoretical knowledge and resuscitation skills acquisition compared to the conventional teaching method. Near-peer teaching seemed to be the most effective method for skill improvement. Subgroup analysis showed no significant differences between peer teaching and conventional teaching groups (e.g., expert/faculty teaching, self-study or lectures).

CONCLUSIONS

Peer teaching seems to be a promising teaching and learning strategy in health professions education, positively affecting theoretical knowledge and procedural skills. Future research should explore the effect of peer teaching in developing countries to provide a comprehensive picture of peer teaching.

"We know what they're struggling with": student peer mentors' embodied perceptions of teaching in a health professional education mentorship program

This paper reports on a study of student peer mentorship in the context of nursing education in a higher education program in Canada. The study used an embodied hermeneutic phenomenological methodology to investigate student peer mentors' perceptions of teaching during peer mentorship. The data were collected over one calendar year (2019) and involved analysis of 10 participants' interview data and their 'body maps,' produced in response to guided questions. Through the data analysis a core theme of 'commitment to mentee growth' was identified, along with seven interrelated themes: sharing responsibility for learning, moderating stress, mediating power relations, navigating unknown processes, valuing creative approaches, offering generous acceptance, and facilitating confidence. Student peer mentorship has the potential to contribute to health professions education in a number of unique ways including through embodied attunement, trusting intersubjective relations, and dialogic education. This study is innovative in its purposeful design and aim to investigate both cognitive and embodied perceptions of student peer mentors. The findings point to the promise of student peer mentorship for advancing health sciences education. Implications for peer mentorship program development in health professions education are discussed.

SIESTA: a quick interprofessional learning activity fostering collaboration and communication between paediatric nursing trainees and medical students

BACKGROUND

Interprofessional education has emerged as a key concept in education of health professionals over the last 20 years. Positive effects of interprofessional education have been shown, but it has proved to be more time-consuming than traditional teaching methods. We therefore developed a 30-minute interprofessional learning activity, using peer-teaching methods. We were interested in effects on and ways of interprofessional learning, including conditions and resources that make it successful despite limited time.

METHODS

Speed InterprofESsional Peer Teaching PaediAtric (SIESTA) was developed in the context of an interprofessional training ward. 20 paediatric nursing trainees and 20 medical students were enrolled in the study. Two students from each profession participated in a total of four SIESTA sessions each, supervised by registered paediatric nurses and paediatricians. We used a mixed-methods approach of quantitative and qualitative data (questionnaires, semi-guided focus group interviews) to evaluate self-perceived interprofessional competencies, interprofessional learning gains and ways of interprofessional learning.

RESULTS

Questionnaires were obtained from all participants (n = 40) and n = 26 took part in the group interviews. Participants from both professions reported an increase in self-perceived understanding of interprofessional roles and tasks. Communication and cooperation emerged as important aspects. The workplace-based nature of SIESTA promoted interprofessional learning, while peer teaching fostered a safe learning environment. Regarding time constraints participants suggested thorough preparation and structuring by facilitators as a solution.

CONCLUSIONS

Our short interprofessional peer teaching activity showed promising results. Participants reported enhanced interprofessional competencies and provided suggestions for successful learning in limited time. Further studies should include an objective assessment of the interprofessional learning progress. The SIESTA concept can be easily adapted to other medical fields, providing interprofessional learning opportunities for many more health care professionals to come.

Peer-Assisted Learning With Simulation for Examination and Transition Success

This article reports how one pilot project explored prelicensure baccalaureate nursing students' perceptions of peer-assisted learning combined with simulation-based education to prepare for and enhance readiness for programmatic exit and national examinations. A convergent parallel mixed-methods study design was used to address the research questions. A nonprobability convenience purposive sample of 17 prelicensure baccalaureate nursing students enrolled in a programmatic synthesis course participated. Findings demonstrate how prelicensure nursing students, despite experiencing varied levels of anxiety, are ready to engage in peer-assisted learning strategies that incorporate simulation-based education to gain additional preparation for both programmatic and licensure examinations. In an era where hospitals are onboarding newly licensed nurses with simulation, hospital educators and specialists in the health care industry can look to the literature on anxiety and teaching preferences to determine opportunities to integrate peer learning and simulation within transition into practice programs. [J Contin Educ Nurs. 2019;50(3):115-120.].

A systematic review of qualitative studies exploring peer learning experiences of undergraduate nursing students

BACKGROUND

Peer learning experiences have been reported in previous qualitative studies, however individual findings could limit practical leverage due to small sample size. Thus it is necessary to integrate invaluable findings from various qualitative studies to consider appropriateness and acceptability of peer learning in professional nurse education.

OBJECTIVE

To identify and synthesize qualitative evidence of peer learning experiences of undergraduate nursing students so as to understand their perceptions on peer learning experiences.

DESIGN

A qualitative systematic review was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement.

DATA SOURCES

Database searching was conducted on electronic databases such as Cumulative Index to Nursing and Allied Health Literature (CINAHL), Science Direct, and MEDLINE that published from 2007 to 2017.

REVIEW METHODS

Qualitative studies were appraised using the Critical Appraisal Skills Programme (CASP). Thematic analysis was used to analyse the data using line by line coding, organising coding into descriptive themes, and interpreting further to generate new insights.

RESULTS

Six studies were included in this review. The most common themes identified were integrated into two new insights including personal development and professional development.

CONCLUSION

This review has revealed that peer learning experiences contribute to the learning process of undergraduate nursing students in preparing them to become professional nurses through personal development and professional development.

Peer Teaching in High-Fidelity Simulation: Participant Experiences and Reflections

Peer teaching provides students with opportunities to experience the educator role and increase self-confidence and problem-solving skills. To address the shortage of meaningful leadership experiences for senior baccalaureate nursing students, faculty implemented an alternative leadership experience involving senior students taking on the role of peer teachers in the high-fidelity simulation (HFS) laboratory. We conducted focus groups to assess peer teachers and learners' experiences and used thematic analysis to examine and interpret the data. Findings included the intersection of learning, HFS, clinical experience, and teaching; the benefits of practicing teaching in a safe environment; how empathy enhanced understanding of the continuum of expertise; and power differentials experienced by peer teachers and learners.

Effectiveness of various innovative learning methods in health science classrooms: a meta-analysis

This study reports the results of a meta-analysis of the available literature on the effectiveness of various forms of innovative small-group learning methods on student achievement in undergraduate college health science classrooms. The results of the analysis revealed that most of the primary studies supported the effectiveness of the small-group learning methods in improving students' academic achievement with an overall weighted average effect-size of 0.59 in standard deviation units favoring small-group learning methods. The subgroup analysis showed that the various forms of innovative and reform-based small-group learning interventions appeared to be significantly more effective for students in higher levels of college classes (sophomore, junior, and senior levels), students in other countries (non-U.S.) worldwide, students in groups of four or less, and students who choose their own group. The random-effects meta-regression results revealed that the effect sizes were influenced significantly by the instructional duration of the primary studies. This means that studies with longer hours of instruction yielded higher effect sizes and on average every 1 h increase in instruction, the predicted increase in effect size was 0.009 standard deviation units, which is considered as a small effect. These results may help health science and nursing educators by providing guidance in identifying the conditions under which various forms of innovative small-group learning pedagogies are collectively more effective than the traditional lecture-based teaching instruction.

Perceptions from Athletic Training Students Involved in an Intentional Peer-Assisted Learning Pedagogy

Context: Peer-assisted learning (PAL) has been shown to benefit students across educational levels. Current research has investigated perceptions of PAL, postgraduate impact, as well as prevalence. This study investigated athletic training students' perceptions of an intentional PAL pedagogy on both the peer-student and peer-tutor. In this study, the peer-tutors had training prior to implementation.

Objective: To explore athletic training students' perceptions of an intentional PAL pedagogy.

Design: Qualitative study using a phenomenological approach.

Setting: Focus group interviews with professional undergraduate athletic training students.

Patients or Other Participants: Eleven athletic training students from 1 accredited athletic training program volunteered for this study. Five students (4 females, 1 male) serving as peer-tutors and 6 (5 females, 1 male) peer-students participated in focus group interviews in spring term 2015. The peer-tutors completed training prior to tutoring the peer-students.

Main Outcome Measure(s): Focus group interviews were conducted with a structured interview protocol. The peer-student and peer-tutor groups were asked separate questions. Interview data were analyzed inductively to uncover dominant themes, first by organizing the data, then summarizing into codes, and finally interpreting. Credibility was secured through member checking, triangulation, and investigator triangulation.

Results: Themes indicated that both peer-students and peer-tutors perceived that, through PAL, they collaborated, built relationships, gained confidence, were exposed to varied techniques, and the PAL pedagogy served as a way to review and practice, which changed their clinical educational experiences. Peer-tutors developed skills in leadership and teaching through their PAL experience.

Conclusions: Evidence demonstrated that PAL created a learning environment in the student's clinical educational experiences that involved collaboration, relationships, confidence building, and more time for review and practice.

Undergraduate nursing students' perceptions of the effectiveness of clinical teaching behaviours in Malaysia: A cross-sectional, correlational survey

BACKGROUND

Clinical teachers are a critical determinant of the quality of nursing students' clinical learning experiences. Understanding students' perceptions of clinical teachers' behaviours can provide the basis for recommendations that will help improve the quality of clinical education in clinical settings by developing better clinical teachers.

OBJECTIVES

To understand clinical teaching behaviours and their influence on students' learning from the perspective of undergraduate nursing students.

DESIGN

A cross-sectional, correlational survey.

SETTING

A nursing faculty in Kuantan, Pahang, Malaysia.

PARTICIPANTS

A sample of 120/154 (78%) students from Year 2-Year 4 were recruited according to set criteria.

METHODS

A self-administered questionnaire was employed to collect demographic data, and students' perceptions of clinical teaching behaviours and their impact on learning using the Nursing Clinical Teaching Effectiveness Inventory (NCTEI).

RESULTS

Year 3 and 4 students perceived faculty clinical teaching behaviours positively. There was a significant association between clinical teaching behaviours and their influence on students' clinical learning. Teachers' competence rated as the most significant influential factor, while teachers' personality rated as least influential.

CONCLUSION

Participants were able to identify the attributes of good clinical teachers and which attributes had the most influence on their learning. Overall, they perceived their teachers as providing good clinical teaching resulting in good clinical learning. Novice clinical teachers and nursing students can use this positive association between teaching behaviours and quality of clinical learning as a guide to clinical teaching and learning.

Student midwives and paramedic students' experiences of shared learning in pre-hospital childbirth

AIM

To explore the experiences of midwifery and paramedic students undertaking interprofessional learning.

METHOD

A one day interprofessional learning workshop incorporating peer assisted learning for undergraduate pre-registration midwifery and paramedic students was developed based on collaborative practice theory and simulation based learning. Twenty-five student midwives and thirty-one paramedic students participated in one of two identical workshops conducted over separate days. Videoed focus group sessions were held following the workshop sessions in order to obtain qualitative data around student experience. Qualitative data analysis software (ATLAS.ti) was used to collate the transcriptions from the focus group sessions and the video recordings were scrutinised. Thematic analysis was adopted.

RESULTS

Four main themes were identified around the understanding of each other's roles and responsibilities, the value of interprofessional learning, organisation and future learning. Students appeared to benefit from a variety of learning opportunities including interprofessional learning and peer assisted learning through the adoption of both formal and informal teaching methods, including simulation based learning. A positive regard for each other's profession including professional practice, professional governing bodies, professional codes and scope of practice was apparent. Students expressed a desire to undertake similar workshops with other professional students.

CONCLUSION

Interprofessional learning workshops were found to be a positive experience for the students involved. Consideration needs to be given to developing interprofessional learning with other student groups aligned with midwifery at appropriate times in relation to stage of education.

Near-peer-assisted learning (NPAL) in undergraduate medical students and their perception of having medical interns as their near peer teacher

INTRODUCTION

A near-peer-assisted learning term (NPAL) is "a trainee one or more years senior to another trainee". The current study is aiming to determine the pattern of NPAL activities, to compare its effect on student's course achievement score and to determine the perception of students regarding having near-peer clinical teaching from their fellow medical interns.

METHODS

A total of 189 third year medical students participated in the study. The study questionnaire contains three sections. The first is the focus group section, self-administered questions and lastly quality control section. Trained staff helped in conducting the data collection.

RESULTS

Clinical teaching with mentoring was experienced by 116 students (61.4%) from their assigned interns in the early clinical experience course. The results of the study showed higher course achievement grades for students who experienced mentoring with clinical teaching compared to those students who experienced mentoring only, but it did not reach statistical significance. The study also found that most medical students acknowledged and agree that their near peers medical interns could provide unique input in helping them mastering clinical and communication skills competencies, the average percent for the seven opinion questions of the response agree combined with strongly agree was 62%.

CONCLUSION

In conclusion, third year medical students recognize the unique and important role of near peer teaching in under graduate medical education and its importance for their professional development. NPAL strategy should be encouraged and used in other medical schools. The benefits of NPAL to peer teacher and in late clinical medical years needed to be investigated in future studies.

Impact of peer teaching on nursing students: perceptions of learning environment, self-efficacy, and knowledge

BACKGROUND

Peer teaching has been shown to enhance student learning and levels of self efficacy.

OBJECTIVES

The purpose of the current study was to examine the impact of peer-teaching learning experiences on nursing students in roles of tutee and tutor in a clinical lab environment.

SETTINGS

This study was conducted over a three-semester period at a South Central University that provides baccalaureate nursing education.

PARTICIPANTS

Over three semesters, 179 first year nursing students and 51 third year nursing students participated in the study.

METHODS

This mixed methods study, through concurrent use of a quantitative intervention design and qualitative survey data, examined differences during three semesters in perceptions of a clinical lab experience, self-efficacy beliefs, and clinical knowledge for two groups: those who received peer teaching-learning in addition to faculty instruction (intervention group) and those who received faculty instruction only (control group). Additionally, peer teachers' perceptions of the peer teaching learning experience were examined.

RESULTS

Results indicated positive response from the peer tutors with no statistically significant differences for knowledge acquisition and self-efficacy beliefs between the tutee intervention and control groups. In contrast to previous research, students receiving peer tutoring in conjunction with faculty instruction were statistically more anxious about performing lab skills with their peer tutor than with their instructors. Additionally, some students found instructors' feedback moderately more helpful than their peers and increased gains in knowledge and responsibility for preparation and practice with instructors than with peer tutors.

CONCLUSIONS

The findings in this study differ from previous research in that the use of peer tutors did not decrease anxiety in first year students, and no differences were found between the intervention and control groups related to self efficacy or cognitive improvement. These findings may indicate the need to better prepare peer tutors, and research should be conducted using more complex skills.

The clinical teaching preference questionnaire (CTPQ): an exploratory factor analysis

BACKGROUND

Peer assisted learning is growing internationally as a beneficial pedagogical strategy in health care and tertiary education. Therefore having instruments such as the Clinical Teaching Preference Questionnaire (CTPQ) with strong measurement properties to use in educational research is vital.

OBJECTIVES

To investigate the factor structure of the CTPQ when completed by a group of respondents from a large Australian university.

METHODS

Data from the CTPQ completed by first year undergraduate nurses were analysed with a factor analysis using a Principal Axis Factoring (PAF) with Oblique Oblimin rotation.

FINDINGS

A total of (n=265) first year undergraduate nursing students participated in the study. The vast majority of the participants were female 89% (n=236) and aged between 17 and 21 years of age 74% (n=197). Factor analysis of the 10 items revealed two factors with eigenvalues above 1, accounting for 68.3% of the total variance. Items with loadings greater than ± .30, with the factor in question, were used to characterise the factor solutions.

CONCLUSIONS

Findings from the exploratory factor analysis provide preliminary results that the CTPQ has adequate construct validity and reliability. This offers those involved in peer-assisted teaching and learning with a practical and usable instrument.

Crossing professional barriers with peer-assisted learning: undergraduate midwifery students teaching undergraduate paramedic students

BACKGROUND

Peer assisted learning (PAL) has been shown in undergraduate programmes to be as effective as learning from instructors. PAL is a shared experience between two learners often with one being more senior to the other but usually both are studying within the same discipline. Interprofessional education occurs when two or more professionals learn with, from and about each other. Benefits of PAL in an interprofessional context have not been previously explored. As part of a final year education unit, midwifery students at Monash University developed workshops for second year undergraduate paramedic students. The workshops focused on care required during and after the birth of the baby.

AIM

To investigate the benefits of an interprofessional PAL for both midwifery and paramedic students.

METHODS

Data for this project were obtained by both quantitative and qualitative methods. Questionnaires were distributed to both cohorts of students to explore experiences of peer teaching and learning. Results were analysed using Statistical Package for Social Sciences (SPSS). Focus groups were conducted separately with both cohorts of students and transcripts analysed using a thematic approach.

FINDINGS

Response rates from the midwifery and paramedic students were 64.9% and 44.0% respectively. The majority of students regardless of discipline enjoyed the interprofessional activity and wanted more opportunities in their curricula. After initial anxieties about teaching into another discipline, 97.3 (n = 36) of midwifery students thought the experience was worthwhile and personally rewarding. Of the paramedic students, 76.9% (n = 60) reported enjoying the interaction. The focus groups supported and added to the quantitative findings. Both midwifery and paramedic students had a new-found respect and understanding for each other's disciplines. Midwifery students were unaware of the limited knowledge paramedics had around childbirth. Paramedic students admired the depth of knowledge displayed by the midwifery students.

IMPLICATIONS

This study indicates both educational and professional benefits for undergraduate students from different disciplines having shared PAL activities.

Collaborative Learning Using Nursing Student Dyads in the Clinical Setting

Formal pairing of student nurses to work collaboratively on one patient assignment is a strategy for improving the quality and efficiency of clinical instruction while better utilizing the limited resources at clinical agencies. The aim of this qualitative study was to explore the student nurse and patient experiences of collaborative learning when peer dyads are used in clinical nursing education. Interviews were conducted with 11 students and 9 patients. Students described the process of collaborative learning as information sharing, cross-checking when making clinical decisions, and group processing when assessing the outcomes of nursing interventions. Positive outcomes reported by students and patients included reduced student anxiety, increased confidence and task efficiency. Students’ primary concern was reduced opportunity to perform hands-on skills which had to be negotiated within each dyad. Meeting the present and future challenges of educating nurses will require innovative models of clinical instruction such as collaborative learning using student peer dyads.

An undergraduate critical-care seminar: an innovative design for learning in the classroom

There is a need for more innovative learning designs in nursing education. For optimal learning to occur, students need to take a more active part in their education. This article describes one institution's effort to design a critical-care seminar class in a baccalaureate program. Students presented content in small groups on a predetermined topic.

Peer-led training and assessment in basic life support for healthcare students: synthesis of literature review and fifteen years practical experience

BACKGROUND

In 1995, the University of Birmingham, UK, School of Medicine and Dentistry replaced lecture-based basic life support (BLS) teaching with a peer-led, practical programme. We present our 15-yr experience of peer-led healthcare undergraduate training and examination with a literature review.

METHODS

A literature review of healthcare undergraduate peer-led practical skills teaching was performed though Pubmed. The development of the Birmingham course is described, from its inception in 1995-2011. Training methods include peer-led training and assessment by senior students who complete an European Resuscitation Council-endorsed instructor course. Student assessors additionally undergo training in assessment and communication skills. The course has been developed by parallel research evaluation and peer-reviewed publication. Course administration is by an experienced student committee with senior clinician support. Anonymous feedback from the most recent courses and the current annual pass rates are reported.

RESULTS

The literature review identified 369 publications of which 28 met our criteria for inclusion. Largely descriptive, these are highly positive about peer involvement in practical skills teaching using similar, albeit smaller, courses to that described below. Currently approximately 600 first year healthcare undergraduates complete the Birmingham course; participant numbers increase annually. Successful completion is mandatory for students to proceed to the second year of studies. First attempt pass rate is 86%, and close to 100% (565/566 students, 99.8%) following re-assessment the same day. 97% of participants enjoyed the course, 99% preferred peer-tutors to clinicians, 99% perceived teaching quality as "good" or "excellent", and felt they had sufficient practice. Course organisation was rated "good" or "excellent" by 91%. Each year 3-4 student projects have been published or presented internationally. The annual cost of providing the course is currently £15,594.70 (Eur 18,410), or approximately £26 (Eur 30) per student.

CONCLUSIONS

This large scale, peer-led BLS course demonstrates that such programmes can have excellent outcomes with outstanding participant satisfaction. Peer-tutors and assessors are competent, more available and less costly than clinical staff. Student instructors develop skills in teaching, assessment and appraisal, organisation and research. Sustainability is possible given succession-planning and consistent leadership.

Longitudinal evaluation of the impact of placement development teams on student support in clinical practice

AIMS

To investigate the impact of a new structure for supporting healthcare students and mentors in practice placements (Placement Development Teams).

INTRODUCTION

The English Model National Partnership Agreement for healthcare education required Strategic Health Authorities, Higher Education Institutions and National Health Service Trusts to redesign strategies for student support. Placement Development Teams are one English University's response to this.

MATERIALS AND METHODOLOGY

This study was phase 2 of a longitudinal qualitative evaluation of Placement Development Teams. Data were collected after establishment of Placement Development Teams, and compared and contrasted with those collected prior to their implementation. Telephone interviews were conducted with key educational stakeholders in Trusts and Strategic Health Authorities. Focus groups were conducted with third year non-medical healthcare students and first year paramedics working in 16 NHS Trusts in the south west peninsula of England.

RESULTS

Pre-Placement Development Teams, themes from the students' data were: Supportive and unsupportive behaviour of staff; Mentor allocation; Placement allocation; Benefits of students to the placement area and Perceived control over the learning experience. Post-Placement Development Teams, the themes were Communication; Supportive and unsupportive behaviour of staff; The effect of peers on the placement experience; Knowledge and perceptions of the work of the PDTs. Form the staff data, pre-Placement Development Teams the themes were: Vision for improving student support. Post-Placement Development Teams themes from the staff data were how they provided a central point of contact for student and mentor support; and how they supported students and mentors.

CONCLUSION

Support of students and mentors is particularly important following the introduction of The English Model National Partnership Agreement for healthcare education. Placement Development Teams can facilitate partnership working between higher education institutions and placement providers for student support.

Medical students as teachers: how preclinical teaching opportunities can create an early awareness of the role of physician as teacher

BACKGROUND

As future physicians, questions about when medical students realize they will have to teach remain under-explored.

AIM

To understand when students serving in pre-clinical teaching roles make the connection between teaching and being a physician.

METHODS

Medical students involved in a peer instruction program included: (1) archived first-year student interview candidate data (n = 60/150); (2) focus groups of first-year students selected as instructors (n = 16/60); and (3) focus groups of second-year students (n = 16/24) who taught for the program. A modified extended-term mixed-method research design involved data from the pre-hire interviews and post-hire focus group.

RESULTS

Prior to teaching, none of the first year interviewees made an explicit connection between teaching and being a physician. The new instructors selected to teach minimally made a connection and only after prompting. The majority of the experienced instructors did make the connection; however, and did so spontaneously.

CONCLUSION

It was only after they taught medicine-related material that students saw the benefits of teaching as a way of preparing for becoming a physician and not merely as a way to review or help their peers.

A step ahead: teaching undergraduate students to be peer teachers

Nurses have a responsibility to share knowledge with others. However, many are reluctant to undertake teaching, feeling unprepared for the responsibility. With this in mind, a semester-long compulsory core unit was designed and implemented in 2009 to equip final year students with knowledge and skills to enable facilitation of teaching and learning in practice. As part of the summative assessment, third (final) year students taught vital signs in first year skills laboratories. To evaluate the strategy, the Peer Teaching Experience Questionnaire (adapted from Iwasiw and Goldenberg, 1993) was administered to third year students and Clinical Teaching Preference Questionnaire (Iwasiw and Goldenberg, 1993) to first years. Focus groups were conducted with third year volunteers to explore issues in greater detail. One hundred and five (75%) third year and 112 (52%) first year students completed questionnaires. In addition, 11 third year students participated in a focus group. Overall, third year students reported increased confidence in their knowledge and teaching abilities, reflected on their own learning and found the experience rewarding, acquiring skills they considered would be helpful in graduate years. Many suggested there should be more opportunities for such types of learning and interaction. First year students reported feeling comfortable learning skills with senior peers, as well as being able to learn from their experiences. Overall, both groups recognised strongly that teaching was part of nurses' roles.

A systematic review of peer teaching and learning in clinical education

AIMS AND OBJECTIVES

The purpose of this review is to provide a framework for peer teaching and learning in the clinical education of undergraduate health science students in clinical practice settings and make clear the positive and negative aspects of this teaching and learning strategy.

BACKGROUND

The practice of using peers incidentally or purposefully in the clinical education of apprentice or undergraduate health science students is a well-established tradition and commonly practiced, but lacks definition in its implementation.

METHOD

The author conducted a search of health science and educational electronic databases using the terms peer, clinical education and undergraduate. The set limitations were publications after 1980 (2005 inclusive), English language and research papers. Selection of studies occurred: based on participant, intervention, research method and learning outcomes, following a rigorous critical and quality appraisal with a purposefully developed tool. The results have been both tabled and collated in a narrative summary.

RESULTS

Twelve articles met the inclusion criteria, representing five countries and four health science disciplines. This review reported mostly positive outcomes on the effectiveness of peer teaching and learning; it can increase student's confidence in clinical practice and improve learning in the psychomotor and cognitive domains. Negative aspects were also identified; these include poor student learning if personalities or learning styles are not compatible and students spending less individualized time with the clinical instructor.

CONCLUSIONS

Peer teaching and learning is an effective educational intervention for health science students on clinical placements. Preclinical education of students congruent with the academic timetable increases student educational outcomes from peer teaching and learning. Strategies are required prior to clinical placement to accommodate incompatible students or poor student learning.

RELEVANCE TO CLINICAL PRACTICE

The findings from this systematic review, although not statistically significant, do have pragmatic implications for clinical practice. It can increase clinical placement opportunities for undergraduate health students, assist clinical staff with workload pressures and increase clinician time with clients, while further developing students' knowledge, skills and attitudes.

Peer assisted learning: a planning and implementation framework: AMEE Guide no. 30

Much has been written about the benefits and applications of Peer Assisted Learning (PAL) in the literature. Curriculum developers increasingly consider PAL as a vehicle to help undergraduate healthcare students learn to teach; an outcome which has received more attention in the UK since the General Medical Council stated in Tomorrow's Doctors that medical graduates must 'Be able to demonstrate appropriate teaching skills'. This guide is primarily designed to assist curriculum developers, course organisers and educational researchers develop and implement their own PAL initiatives. It is structured around a PAL planning framework consisting of 24 questions. The questions are grouped in threes, around eight themes. Each question is discussed with reference to the PAL literature and other related subjects, and is exemplified by responses from a recent PAL project developed at The University of Edinburgh. Working through the 24 questions, particularly with discussion in a small planning group, will enable readers to efficiently develop their ideas for PAL into comprehensive and practical project plans cognisant of current educational theory, existing PAL literature and the local context. The framework is particularly suitable for those who want to develop healthcare undergraduate PAL initiatives yet have little or no experience of PAL, as it provides an introduction to the relevant literature field and a step-by-step process for the design and implementation of such projects. It will also be of interest to those with experience of PAL and those seeking a structured framework for planning non-PAL curriculum developments in undergraduate healthcare curricula.

Patterns of Peer Tutoring in Nursing

Peer tutoring in higher education is an effective strategy for promoting academic gains. Within nursing, peer tutoring has been used in the clinical setting, but little information is available regarding its use across the nursing curriculum. A peer tutoring program was created at a regional Appalachian university to meet the needs of students with poor academic backgrounds and multiple risk factors for failure. As the program naturally evolved, students moved beyond the time-honored one-on-one model. Many tutoring patterns developed including dyad, small group, large group, skill based, assignment based, and question based. Qualitative evaluation data from the program revealed that each pattern required different tutor skills, involved varied tutor-tutoree relationships, focused on different outcomes, and had certain advantages and disadvantages. All tutoring patterns contributed to improved academic skills and performance.

Small group learning in medical education: a second look at the Springer, Stanne, and Donovan meta-analysis

All in all, the evidence is not convincing. Only four of the nine randomized studies used the conventional small-group learning paradigm and qualify as studies of small-group learning, which are relevant to medical education. The results of one of the four are impossible to interpret because of the involvement of the investigator in teaching and test construction. The three remaining studies showed no effect, a negative effect, and a positive effect, respectively. The nonrandomized studies failed to establish the comparability of the groups. The evidence does not support the authors' call for "more widespread implementation of small-group learning in undergraduate SMET". Small-group learning has not been shown to support the acquisition of content any better [or worse] than large-group learning. In medical education, small-groups are employed in large part to develop team work skills, communication skills, and peer- and self-assessment skills. But these outcomes are not addressed in this meta-analysis. More seriously, our rereading of these studies raises general concerns about meta-analysis in education, which have important implications for evidence-based medical education. The meta-analysis under discussion at first appeared to be just the kind needed to guide an evidence-based educational enterprise. However, a closer look revealed both what is lacking in the meta-analysis and some of the ways educational research and reporting need to be changed if anything like evidence-based education is ever to become a reality. At the least, study design must be clearly described. In addition, if the design is nonrandomized, the groups should be described in sufficient detail to allow a meaningful interpretation of the role of preexisting differences on the outcome measures. (This is why we limited our discussion here to the randomized studies.) Also, effect-size measures should be reported for all comparisons that bear on the impact of the intervention, including preexisting differences. Reporting significance is not enough. This shows only whether sampling error can be ruled out (with a low probability of error, p < .05) as a possible explanation of the connection between the intervention and the outcome. The effect can still be trivial and the comparisons confounded. In addition, descriptions of the actual educational interventions employed need to be more comprehensive and precise. For the most part, the papers would have been strengthened by providing more information for replicating the studies and for deciding which should be included in a given meta-analysis. Perhaps most seriously, our rereading of these studies makes us wonder about the possibility of meaningfully synthesizing the results of educational studies, given their idiosyncrasies and their many extraneous, uncontrolled factors. The conclusions from most educational studies, then--whether randomized or not--must be highly qualified, with explicit warnings about preexisting differences and other confounding factors that plausibly account for the study results. However, these narrative qualifications do nothing to adjust the effect-size measures, which are typically pooled or synthesized across studies--confounds and all. The idiosyncrasies of the studies seem to preclude a blanket qualification that can be applied conceptually across the collection of studies to arrive at a sound conclusion from the synthesis. In brief, the meta-analysis considered here does not support the application of small-group learning in medical education and it raises questions about meta-analysis in education with implications for evidence-based education.

Clinical education: a challenging component of undergraduate nursing education

Clinical education is an essential part of every undergraduate nursing curriculum. The main benefits are that it allows students to put theory into practice and experience the realities of the practice-based nursing profession. Limitations include the unstable nature of the clinical area as a learning environment and the challenges this produces with students' assessments. This article reviews the literature and concludes there is room for significant improvement in the area of clinical education and numerous strategies can be implemented to do so.

Assessment of the use of problem-orientated, small-group discussion for learning of a fixed prosthodontic, simulation laboratory course

AIM

To evaluate a simulation laboratory course that used student-centred small-group problem-orientated discussion activities as the main medium of instruction.

METHODS

A structured questionnaire using a six-point Likert scale with 30 statements relating to a fixed prosthodontics course was distributed to 4th-year and 5th-year students who had completed the course.

RESULTS

A 93% response rate was achieved for both years with a mean score for the 4th-year being 94.2 (+/- 13.7) and the 5th-year 107.5 (+/-16.9). The differences between the scores of both years are highly significant (P = 0.0006) indicating that the 5th-year were more favourable about the course and learning approach used. Consistency and reliability of the questionnaire was judged reliable according to Cronbach's alpha (4th-year = 0.7, 5th-year = 0.83). Many aspects of the small-group student-centred activities were highly valued by students however, students expressed a preference for learning and interacting with teachers than colleagues.

CONCLUSION

Small-group student-centred learning activities were reported as creating an active, safe learning environment with beneficial opportunities for peer-peer interaction such as questioning, teaching and learning from students. However, students expressed a preference for teacher-centred information dissemination and activities. An understanding of the rationale of student dependence to teacher-centred learning may allow improved modifications in a student-centred learning environment.

Experiential Learning of Clinical Skills by Beginning Nursing Students: "Coaching" Project by Fourth-Year Student Interns

To fulfill the requirements for the internship program, fourth-year academic nursing students participated in a leadership program and became coaches for novice students who were beginning their first clinical rotations in the hospital. The concept of coaching is recognized in theory, research, and clinical education as an educational tool, which provides mutual benefits for the coachee and the coach. The project lasted 12 weeks, 2 clinical days per week. The coaches served as a source of support and knowledge and assisted in problem solving for the beginning students. As nurse educators who oversaw the project, the authors summarized the program as it was developed and implemented at the Assaf HaRofeh School of Nursing including problems, revisions, and final conclusions and discussion.

Perceived Benefits of Peer Leadership as Described by Junior Baccalaureate Nursing Students

Nursing students often do not get the chance to practice the skills they need as nurses prior to graduation. Many of the required skills are difficult to teach using traditional classroom or clinical teaching methods. Peer leadership is one teaching method that may provide alternative learning opportunities for enhancing these professional nursing skills, and it encompasses the notions of peer teaching and peer supervision simultaneously. The purpose of this study was to describe what junior baccalaureate nursing students perceived as the benefits of a peer leadership experience, using Loving's Competence Validation Model as the theoretical framework. Twelve junior nursing students participated during their adult medical-surgical rotation and completed self-evaluations following the peer leadership experience. From analysis of these self-evaluations, responses were categorized into five perceived benefits: practice in prioritizing, enhancement of critical thinking skills, enhancement of technical skills, realization of peers as resources, and development of management skills.

Peer mentorship in clinical education: outcomes of a pilot programme for first year students

Identifying effective strategies for promoting learning in the clinical setting continues to pose challenges for nurse educators. The aim of the present paper is to examine the potential that peer mentorship may have in helping nursing students to improve clinical learning outcomes. An example of a peer mentorship programme for nursing students undertaking their first clinical practicum is described, and preliminary findings from an evaluation of this pilot programme are presented. The results suggest that peer mentorship may be of some benefit to students, particularly in relation to reducing anxiety and improving confidence with clinical practice experiences, and is therefore a strategy which is worthy of further investigation.

Key influences on the professional socialisation and practice of students undertaking different pre-registration nurse education programmes in the United Kingdom

A principal aim of pre-registration nurse education programmes is the process of effective socialisation of students into the professional role. Key influences on the professional socialisation and practice of students undertaking such programmes were explored using a semi-structured interview approach (N = 99). This work formed part of a major comparative study of outcomes of pre-registration nurse education programmes in the United Kingdom. Analysis revealed differences between the programmes regarding positive influences of the respective courses; therapeutic influences of the practice environment; modelling performance on exemplars of high quality practice; and the identification of teachers within the educational setting and nurses in practice as key persons. This study has confirmed that the positive influence of the education programmes and the practice environment as well as high quality role models from both education and practice establishments are critical to the professional socialisation of student nurses.