Tomorrow's Doctors and Nurses: Peer assisted learning

The Efficacy of Frontline Near-Peer Teaching in a Modern Medical Curriculum

Within medical education a reduction in curriculum time for subjects, such as anatomy puts pressure on educators to ensure the same learning outcomes are conveyed in less time. This has the potential to impact negatively on student experience. Near-peer teaching (NPT) is often praised as an effective revision tool, but its use as a frontline teaching resource remains unreported. The study explores the potential for NPT to promote delivery of learning outcomes and maximize student experience within a neuroanatomy module for second year medical students. The study occurred in three educational settings, (1) frontline NPT of cranial nerves, (2) revision session NPT of cranial nerves, and (3) NPT alongside faculty staff in laboratory-based neuroanatomy practical exercises. For the first and second components, knowledge was measured using a pre- and post-session test and student perception was ascertained with a questionnaire. For the third component, student perception was assessed with an end-of-module survey. The results show that overall, NPT was well received by learners. A significant knowledge gain was seen between the pre- and post-session test of the frontline NPT session. The study presents evidence in favor of using NPTs to supplement the delivery of learning outcomes in a time and resource constrained curriculum. In particular, for the effective delivery of frontline material. Anat Sci Educ 0: 1-9. © 2018 American Association of Anatomists.

Peer Tutoring for Anatomy Workshops in Cambodia

Historical loss of staff and teaching resources in Cambodia has resulted in significant challenges to anatomy education. Small group anatomy teaching opportunities are limited. A visit to Cambodia by a teaching team from the University of Melbourne in 2010 demonstrated it was possible to implement well-resourced anatomy workshops for this purpose. However, continuation of the workshop program was inhibited by the limited number of local teaching staff. In 2015, another team from the University of Melbourne returned to Cambodia to implement anatomy workshops that incorporated peer tutoring. The objective was to improve teacher-to-student ratios and to demonstrate that interactive anatomy workshops could be delivered successfully despite low staff numbers. The anatomy workshops were attended by 404 students of Medicine, Dentistry, Nursing, and Midwifery at the University of Puthisastra. Medical students were invited to act as peer tutors for nursing students. A five-point Likert scale questionnaire was used to determine student satisfaction with both the workshops and peer tutoring. The overwhelming majority were positive about the workshops and keen for them to continue. Almost all medical students who acted as peer tutors agreed or strongly agreed that this role increased their anatomical knowledge (98%) and confidence (94%). Most nursing students agreed or strongly agreed with statements that they would like peer tutoring to continue (94%) and that they would like to be peer tutors themselves (88%). This report demonstrates that peer tutoring could be an effective tool in educational settings where poor staff-to-student ratios limit delivery of interactive workshops.

The National Undergraduate Neuroanatomy Competition: Lessons Learned from Partnering with Students to Innovate Undergraduate Neuroanatomy Education

Undergraduates often perceive neuroscience to be a challenging discipline. As the scope of neuroscience continues to expand, it is important to provide undergraduates with sufficient opportunities to develop their knowledge and skills with the aim of encouraging the future generation of basic and clinical neuroscientists. Through our experience of developing the National Undergraduate Neuroanatomy Competition (NUNC), we have accrued an extensive volume of performance data and subjective insight into the delivery of undergraduate neuroanatomy education, which has the potential to inform how to better engage students within this field. More broadly, our group has implemented a technology enhanced learning platform alongside a peer-assisted teaching program. These achieve the dual purpose of compensating for the reduction in dedicated neuroanatomy teaching hours and encouraging undergraduates to develop an interest in the neurosciences. Here, we consider how improving the learning experience at an undergraduate level encourages further engagement in the neurosciences and the importance of this within the wider neuroscience community.

Peers versus professional training of basic life support in Syria: a randomized controlled trial

BACKGROUND

Peer training has been identified as a useful tool for delivering undergraduate training in basic life support (BLS) which is fundamental as an initial response in cases of emergency. This study aimed to (1) Evaluate the efficacy of peer-led model in basic life support training among medical students in their first three years of study, compared to professional-led training and (2) To assess the efficacy of the course program and students' satisfaction of peer-led training.

METHODS

A randomized controlled trial with blinded assessors was conducted on 72 medical students from the pre-clinical years (1st to 3rd years in Syria) at Syrian Private University. Students were randomly assigned to peer-led or to professional-led training group for one-day-course of basic life support skills. Sixty-four students who underwent checklist based assessment using objective structured clinical examination design (OSCE) (practical assessment of BLS skills) and answered BLS knowledge checkpoint-questionnaire were included in the analysis.

RESULTS

There was no statistically significant difference between the two groups in delivering BLS skills to medical students in practical (P = 0.850) and BLS knowledge questionnaire outcomes (P = 0.900). Both groups showed statistically significant improvement from pre- to post-course assessment with significant statistical difference in both practical skills and theoretical knowledge (P-Value < 0.001). Students were satisfied with the peer model of training.

CONCLUSION

Peer-led training of basic life support for medical students was beneficial and it provided a quality of education which was as effective as training conducted by professionals. This method is applicable and desirable especially in poor-resource countries and in crisis situation.

The near-peer tutoring programme: embracing the 'doctors-to-teach' philosophy--a comparison of the effects of participation between the senior and junior near-peer tutors

BACKGROUND

While there is an increasing pool of literature documenting the benefits of near-peer tutoring programme, little is known about the benefits for junior and senior peer tutors. Knowledge of the peer tutors' perceived benefits at different levels of seniority will aid in the development of a near-peer tutoring programme that will better fulfil both curricula and personal aspirations of near-peer tutors. We, therefore, investigated the perceived benefits of participation in a near-peer tutoring programme for junior as well as senior near-peer tutors.

METHODS

Pre- and post-participation questionnaires were distributed to near-peer tutors after their clinical skills teaching sessions with Phase I undergraduate medical students. The Peer Tutor Assessment Instrument questionnaires were distributed to the 1) students, and to the 2) near-peer tutors (junior and senior) after each teaching and learning session for self-evaluation.

RESULTS

The senior near-peer tutors felt that their participation in the programme had enhanced their skills (p=0.03). As a whole, the near-peer tutors were more motivated (Pre 5.32±0.46; Post 5.47±0.50; p=0.210) to participate in future teaching sessions but did not expect that having teaching experiences would make teaching as their major career path in the future (Pre 4.63±1.07; Post 4.54±0.98; p=0.701). The senior near-peer tutors were evaluated significantly higher by the students (p=0.0001). Students' evaluations of near-peer tutors on the domain of critical analysis was higher than self-evaluations (p=0.003).

CONCLUSIONS

Generally, the near-peer tutors perceived that they have benefited most in their skills enhancement and these near-peer tutors were scored highly by the students. However, senior near-peer tutors do not perceive that the programme has a lasting impact on their choice of career path.

Peer-assisted learning--beyond teaching: How can medical students contribute to the undergraduate curriculum?

INTRODUCTION

Peer-assisted learning (PAL) has become increasingly popular over recent years with many medical schools now formally incorporating peer-teaching programs into the curriculum. PAL has a sound evidence base with benefit to both peer-teacher and peer-learner. Aside from in teaching delivery, empowering students to develop education in its broadest sense has been much less extensively documented.

CASE STUDIES

Five case studies with supportive evaluation evidence illustrate the success of a broad range of peer-led projects in the undergraduate medical curriculum, particularly where these have been embedded into formal teaching practices.

DISCUSSION

These case studies identify five domains of teaching and support of learning where PAL works well: teaching and learning, resource development, peer-assessment, education research and evaluation and mentoring and support. Each case offers ways of engaging students in each domain.

CONCLUSIONS

Medical students can contribute significantly to the design and delivery of the undergraduate medical program above and beyond the simple delivery of peer-assisted "teaching". In particular, they are in a prime position to develop resources and conduct research and evaluation within the program. Their participation in all stages enables them to feel involved in course development and education of their peers and ultimately leads to an increase in student satisfaction.

Do peer-tutors perform better in examinations? An analysis of medical school final examination results

CONTEXT

Peer-assisted learning (PAL) is recognised as an effective learning tool and its benefits are well documented in a range of educational settings. Learners find it enjoyable and their performances in assessments are comparable with those of students taught by faculty tutors. In addition, PAL tutors themselves report the development of improved clinical skills and confidence through tutoring. However, whether tutoring leads to actual improvement in performance has not been fully investigated.

OBJECTIVES

As high-achieving students are already en route to succeeding in final examinations, we wanted to examine whether participation in a peer-tutoring programme in itself leads to better final-year examination performance.

METHODS

We conducted a retrospective analysis of results on final-year written and clinical examinations at University College London Medical School during 2010-2012. Z-scores were calculated and the performances of PAL tutors and students who were not PAL tutors were compared using analysis of covariance (ancova). Year 4 examination results were used as indicators of previous academic attainment.

RESULTS

Of the 1050 students who attempted the final examination, 172 were PAL tutors in the final year. Students who acted as PAL tutors outperformed students who did not in all examination components by 1-3%. Z-scores differed by approximately 0.2 and this was statistically significant, although the significance of this difference diminished when controlling for Year 4 results. Students who acted as PAL tutors who had scored in the top quartile in Year 4 examinations scored significantly better in a long-station objective structured clinical examination (LSO).

CONCLUSIONS

Although students who acted as PAL tutors performed better than students who did not in final-year examinations, this difference was small and attributable to the students' background academic abilities. High-achieving students appear to be self-selecting as peer-tutors and their enhanced performance in LSOs may reflect their inherent academic abilities. Although peer-tutoring in itself did not lead to enhanced examination performance, further studies are required as many factors, such as the proximity of examinations and previous tutoring, can potentially affect the relationship between peer-tutoring experience and examination performance.

Development of a supported self-directed learning approach for anatomy education

The ability to deliver sufficient core anatomical knowledge and understanding to medical students with limited time and resources remains a major challenge for anatomy educators. Here, we report the results of switching from a primarily didactic method of teaching to supported self-directed learning for students studying anatomy as part of undergraduate medicine at the University of Edinburgh. The supported self-directed approach we have developed makes use of an integrated range of resources, including formal lectures and practical sessions (incorporating gross anatomy specimens, medical imaging technologies, anatomical models, clinical scenarios, and surface anatomy workstations). In practical sessions, students are provided with a custom-made workbook that guides them through each session, with academic staff, postgraduate tutors, and near-peer teaching assistants present to deal with misunderstandings and explain more complicated topics. This approach retains many of the best attributes of didactic teaching but blends them with the advantages associated with self-directed learning approaches. The switch to supported self-directed learning-initially introduced in 2005-resulted in a significant improvement in anatomy examination scores over the subsequent period of five years, manifesting as an increase in the average anatomy practical spot examination mark, less students failing to obtain the pass mark and more students passing with distinction. We conclude that the introduction of supported self-directed learning improved students' engagement, leading to deeper learning and better understanding and knowledge of anatomy.

Near-peer teaching in anatomy: an approach for deeper learning

Peer teaching has been recognized as a valuable and effective approach for learning and has been incorporated into medical, dental, and healthcare courses using a variety of approaches. The success of peer teaching is thought to be related to the ability of peer tutors and tutees to communicate more effectively, thereby improving the learning environment. Near-peer teaching involves more experienced students acting as tutors who are ideally placed to pass on their knowledge and experience. The advantage of using near-peer teachers is the opportunity for the teacher to reinforce and expand their own learning and develop essential teaching skills. This study describes the design and implementation of a program for fourth year medical students to teach anatomy to first- and second-year medical students and evaluates the perceptions of the near-peer teachers on the usefulness of the program, particularly in relation to their own learning. Feedback from participants suggests that the program fulfills its aims of providing an effective environment for developing deeper learning in anatomy through teaching. Participants recognize that the program also equips them with more advanced teaching skills that will be required as they move nearer toward taking on supervisory and teaching duties. The program has also provided the school with an additional valuable and appropriate resource for teaching anatomy to first- and second-year students, who themselves view the inclusion of near-peer teachers as a positive element in their learning.

Undergraduate students as standardized patients to assess advanced practice nursing student competencies

Evaluating clinical skills of students in an online distance education program can be challenging because of the diverse location of students. The authors describe a unique and cost-efficient method of using standardized patients to evaluate these skills. The project involved undergraduate students representing standardized patients for graduate advanced practice nurse students.

Introducing peer-assisted learning into a veterinary curriculum: a trial with a simulator

Peer-assisted learning (PAL) was implemented in the context of delivering training with a simulator, the Haptic Cow. This project was undertaken as a way of increasing student access to the simulator and to investigate the possibility of using PAL more extensively in the curriculum. Peer tutors attended a workshop to learn basic teaching skills and were then trained to use the simulator. The tutors taught their peers the basic skills for bovine rectal palpation with the simulator. The PAL project was evaluated using questionnaires and a focus group to gather feedback from both tutors and learners. Sixteen peer tutors trained 99 fellow students with the simulator. Both tutors and learners thought that there were certain advantages in students, rather than veterinarians, delivering the training. Student tutors were less intimidating and could relate more closely to the difficulties of their peers. However, lack of knowledge was identified as a potential issue. Students reported certain benefits from their role as tutors, including improvements in communication skills, knowledge of the subject area, and confidence in performing bovine rectal palpation. Additionally, the skills developed, including learning to teach, were considered to be useful for their future careers as veterinarians. Tutors and learners supported the continued use of PAL both with the simulator and in other areas of the course. The trial of PAL proved a successful way of delivering simulator-based training and the project has provided a basis for the further use of PAL in our curriculum.

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.

Effects of participation in a cross year peer tutoring programme in clinical examination skills on volunteer tutors' skills and attitudes towards teachers and teaching

BACKGROUND

Development of students' teaching skills is increasingly recognised as an important component of UK undergraduate medical curricula and, in consequence, there is renewed interest in the potential benefits of cross-year peer tutoring. Whilst several studies have described the use of cross-year peer tutoring in undergraduate medical courses, its use in the clinical setting is less well reported, particularly the effects of peer tutoring on volunteer tutors' views of teachers and teaching. This study explored the effects of participation in a cross-year peer tutoring programme in clinical examination skills ('OSCE tutor') on volunteer tutors' own skills and on their attitudes towards teachers and teaching.

METHODS

Volunteer tutors were final year MBChB students who took part in the programme as part of a Student Selected Component (SSC). Tutees were year 3 MBChB students preparing for their end of year 'OSCE' examination. Pre and post participation questionnaires, including both Likert-type and open response questions, were used. Paired data was compared using the Wilcoxon signed-rank test. All tests were two-tailed with 5% significance level.

RESULTS

Tutors reflected their cohort in terms of gender but were drawn from among the more academically successful final year students. Most had previous teaching experience. They were influenced to participate in 'OSCE tutor' by a desire to improve their own teaching and associated generic skills and by contextual factors relating to the organisation or previous experience of the OSCE tutor programme. Issues relating to longer term career aspirations were less important. After the event, tutors felt that participation had enhanced their skills in various areas, including practical teaching skills, confidence in speaking to groups and communication skills; and that as a result of taking part, they were now more likely to undertake further teacher training and to make teaching a major part of their career. However, whilst a number of students reported that their views of teachers and teaching had changed as a result of participation, this did not translate into significant changes in responses to questions that explored their views of the roles and qualities required of a good clinical teacher.

CONCLUSION

Findings affirm the benefits to volunteer tutors of cross-year peer tutoring, particularly in terms of skills enhancement and reinforcement of positive attitudes towards future teaching responsibilities, and have implications for the design and organisation of such programmes.