Peer-assisted learning: filling the gaps in basic science education for preclinical medical students

Attendance of Near-Peer Tutoring Sessions Improves Academic Performance of First-Year Medical Students

Introduction

Many medical schools have implemented near-peer tutoring (NPT) programs based on the substantial benefits of these programs to both tutors and tutees. This study correlated the frequency of attending weekly NPT sessions to students' academic performance, and also compared performance of high and low attending students.

Methods

Twenty-one weekly NPT sessions were delivered by fourth-year (M4) students to first-year (M1) students. Attendance was recorded, and accordingly students were divided into three groups, high (15-21 sessions), moderate (7-14 sessions), and low (0-6 sessions) attendance groups. Pearson product-moment correlation coefficient was computed to assess the relationship between students' frequency of attendance and their overall performance on overall basic medical sciences at the end of M1 year and M2 mid-year NBME® CBSE. Students' performance was also analyzed using ANCOVA and Bonferroni post hoc test to compare differences between the three attendance groups.

Results

An increase in number of attended NPT weekly sessions corresponds with an increase in students' performance on overall M1 basic sciences weighted average (r(196) = .240, p ≤ 0.001) and the M2 mid-year NBME® CBSE (r(196) = .325, p ≤ 0.001). High attending students performed significantly higher than low attending students on overall M1 weighted average of basic science courses (F(2, 192) = 8.518, p < .001) and M2 mid-year NBME® CBSE (F(2, 192) = 15.494, p < .001).

Conclusion

Attending NPT weekly sessions is a valuable experience that is associated with an improvement in M1 medical students' academic performance. However, low performing students tend to miss attending NPT weekly sessions.

Teaching Medical Students How to Teach: A Scoping Review

PHENOMENON

Teaching medical students how to teach is a growing and essential focus of medical education, which has given rise to student teaching programs. Educating medical students on how to teach can improve their own learning and lay the foundation for a professional identity rooted in teaching. Still, medical student-as-teacher (MSAT) programs face numerous obstacles including time constraints, prioritizing curriculum, and determining effective evaluation techniques. The purpose of this scoping review is to map the current landscape of the literature on medical school initiatives designed to train students to teach to describe why medical student teaching programs are started; the benefits and barriers; who teaches them; what content is taught; and how content is delivered. With this new map, the authors aimed to facilitate the growth of new programs and provide a shared knowledge of practices derived from existing programs.

APPROACH

The authors conducted a scoping review, guided by Arksey and O'Malley's framework, to map the literature of MSAT training programs. Six databases were searched using combinations of keywords and controlled vocabulary terms. Data were charted in duplicate using a collaboratively designed data charting tool. This review builds on the Marton et al. review and includes articles published from 2014 to 2020.

FINDINGS

Of the 1,644 manuscripts identified, the full-text of 57 were reviewed, and ultimately 27 were included. Articles included empirical research, synthetic reviews, opinion pieces, and a descriptive study. Analysis focused on modalities for teaching medical students how to teach; content to teach medical students about teaching; benefits and barriers to starting teaching programs; and the value of teaching programs for medical students.

INSIGHTS

The rapid growth of MSAT programs suggests that this curricular offering is of great interest to the field. Literature shows an increase in evaluative efforts among programs, benefits for students beyond learning to teach, and evidence of effective engagement in medical students' designing and implementing programs.

Near-Peer Learning During the Surgical Clerkship: A Way to Facilitate Learning After a 15-Month Preclinical Curriculum

OBJECTIVES

To investigate the performance and perspectives of third-year medical students (MS3s) participating in near-peer learning (NPL) sessions during their core surgical clerkship following a 15-month preclerkship curriculum.

DESIGN

An evaluation study of 7 NPL sessions developed and implemented by fourth-year medical students (MS4s) held from March 2019 to February 2020. MS4s taught 1-2 sessions per rotation that included test taking strategies, illness script development, radiology review, case-based multiple-choice questions, and rapid review. Participants completed a questionnaire with 11 seven-point Likert and open-ended questions after each session. Analyses included quantitative comparison of shelf score averages between NPL participants and nonparticipants and qualitative content analysis for open-ended questions.

SETTING

Surgical clerkship at the University of California, San Francisco.

PARTICIPANTS

Forty-eight (32%) MS3s participated, with an average attendance of 10 students per rotation. Thirty-three (69%) participants completed the questionnaire.

RESULTS

MS3s enjoyed the session (6.9 ± 0.4), improved their knowledge (6.8 ± 0.5), and felt more prepared for the surgery shelf examination (6.5 ± 0.6). MS4 leaders found that MS3s always wanted radiology review, and their interest in test taking strategies and illness script development declined across the clerkship year. Participants had lower shelf exam scores compared to nonparticipants (68.1 vs 71.4, respectively; p = 0.04, ES = 0.03). Shelf exam scores increased over time in both cohorts. Each group had 2 shelf exam failures. Qualitative analysis suggests that MS3s appreciated the NPL's tailored approach and exam demystification, with a desire for increased NPL integration into the clerkship.

CONCLUSION

Students participating in NPL were satisfied with the sessions. Participants may have been students who struggled as indicated by shelf exam scores and appreciated the support. The shift in preferred topics across the blocks reflects the students' development during clerkships. Near-peer teachers should adjust sessions over time to fit students' evolving needs.

Student Perception of Case-based Teaching by Near-Peers and Faculty during the Internal Medicine Clerkship: A Noninferiority Study

INTRODUCTION

Third-year medical students traditionally receive their didactic or small group teaching sessions from clinical faculty during clerkship rotations. Near-peer teaching is increasingly recognized as an acceptable method for teaching, however most near-peer teaching takes place during the pre-clinical curriculum. We sought to determine if fourth year medical students were noninferior to faculty in facilitating small group discussions during clerkship rotations.

METHODS

Seventy-five third-year medical students participated in a small group session focused on rheumatologic diseases during their internal medicine clerkship rotation. Students were taught by fourth-year medical students who self-selected to participate as near-peer teachers at 1 clinical site (near-peers, N = 36) and by clinical faculty at another site (N = 39). At the end of the session, third-year medical students completed a survey evaluating teacher performance and effectiveness.

RESULTS

There was no significant difference between the 2 groups on each of the 17 survey items assessing teacher performance, the total teaching performance score, and the teaching effectiveness rating (all P-values >.05). A mean between-group difference of 2% in favor of the near-peers indicated noninferiority of the near-peer teachers compared with faculty teachers on the total teaching performance score. An absolute difference of 14% in favor of the near-peers indicated noninferiority of the near-peer teachers compared with faculty teachers on the teaching effectiveness score. Near-peer teachers reported several benefits, including improving their own medical knowledge and skills as a future educator.

DISCUSSION

Our data supports the noninferiority of the perceived performance and effectiveness of near-peer teachers compared to faculty teachers in the clerkship setting. Adding near-peer teachers to the clerkship setting is feasible and can be beneficial to all stakeholders.

Implementing Change in Neuroanatomy Education: Organization, Evolution, and Assessment of a Near-Peer Teaching Program in an Undergraduate Medical School in Greece

In light of the current shifts in medical education from traditional lectures to more active teaching modalities, a peer-teaching program was introduced to a compulsory, second-year neuroanatomy course. A cross-sectional survey of 527 medical students in the six-year medical program of the National and Kapodistrian University of Athens was administered. The primary aim of the survey, which was distributed to second- through sixth-year medical students, who had completed the neuroanatomy course, was to assess student perception of peer teachers (PTs). Across the five years assessed, students increasingly acknowledged the contribution of PTs to their learning (P < 0.001). Attributes of PTs (e.g., contribution to learning, motivation, effective usage of material, and team environment) were significantly related to the student's opinion of the importance of laboratory activities (P < 0.001). Students who received "average" final grades scored the importance of laboratory exercises, and by inference PTs, significantly lower than students who received "excellent" final grades (P < 0.05). The amount of training that PTs had received was also significantly related to student perceptions of a PT's contribution. Better trained PTs were associated with significantly higher scores regarding learning, motivation, and positive environment compared to less trained PTs (P < 0.05). The results of the present study show that peer-teaching was well received by students attending the neuroanatomy course. While the results express the evolution of the program across the years, the findings also show that learners believed that PTs and the laboratory program contributed significantly to their understanding of neuroanatomy.

Determining the effectiveness of peer-assisted learning in medical education: A systematic review and meta-analysis

OBJECTIVE

Despite the popularity of peer-assisted learning (PAL), existing literature has not shown enough evidence that can validate its impact on students' active learning. This meta-analysis aims to quantitatively analyse the effectiveness of PAL in medical education.

METHODS

We searched selected databases using the Medical Subject Headings (MeSH) terms 'peer-assisted', 'learning', 'active learning', 'teaching strategy', 'peer mentoring', and 'peer instructions' for full-text English language studies with a pre-post design. Following a systematic protocol, we selected 11 articles for final analysis. A meta-analysis was done using Review Manager (RevMan) 5.3 from Cochrane Training and the final output was presented by a forest plot.

RESULTS

The results showed a significant effectiveness of PAL; notably, there was a standardised mean difference of 1.26 with a confidence interval of 0.58-1.94. The Cochran's Q test showed a 5% level of significance as measured by Chi2 = 449.46. Besides, the results of the I2 test were significant (98%); moreover, a z value of 3.65 validated the effectiveness of PAL.

CONCLUSION

This research has shown that PAL can be used as a valuable learning tool in the medical field. Educational interventions in curricula for incorporating PAL strategies can potentially enhance the learning experience of the medical students.

Peer Tutoring in Preclinical Medical Education: A Review of the Literature

Peer-assisted learning (PAL) is an educational method where students teach their peers. PAL has been increasingly integrated into medical education in various formats including near-peer tutoring (NPT), reciprocal-peer tutoring (RPT), and peer-to-peer tutoring. This review adds to current literature by focusing exclusively on outcomes from PAL peer tutoring programs implemented in conjunction with basic science courses in medical education. Although the programs differ in size, duration, course, resource availability, and method of evaluation and thus can be difficult to compare, PAL programs overall demonstrate benefits for both tutors and tutees and merit further investigation into optimal methods of implementation.

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.

Using integrated problem- and lecture-based learning teaching modes for imaging diagnosis education

BACKGROUND

There are two parts included in traditional imaging diagnosis teaching: theoretical lessons and experimental lessons. Most of the time, the experimental lesson is a review of the theoretical lesson. The teacher is the centre of the course and students are passive learners. Thus, in this study we included the patient problem of the imaging centre in our imaging diagnosis education. The traditional theoretical lessen was used to discuss prior knowledge, the discussion and analysis of patient problems was arranged under class, and the experimental lesson was used to synthesize and test the newly acquired information. The aim of this study is to determine whether or not integration of problem- and lecture-based learning teaching modes in imaging diagnosis education was associated with a good teaching effect. Forty-six of sixty students (76.7%) like integrated problem- and lecture-based learning teaching mode and 53 of 60 students (88.3%) think that integrated problem- and lecture-based learning teaching mode can make their ability of self-study be improved.

METHODS

Sixty students participated in a prospective study with a two-phase cross-over design. All of the students were divided into 2 groups of 30 each. In the first term, the first group participated in an integration of the problem- and lecture-based learning teaching mode, whereas students in the second group underwent the lecture-based learning teaching mode alone. During the second term, the teaching modes were exchanged between the two groups. A close-exam and survey were used to evaluate the teaching effect, and the data were analysed means of analysis of variance with a two-phase cross-over design and a χ² test with a 2-tailed α of 0.05.

RESULTS

There was a statistically significant difference in the test scores between the integration of the problem- and lecture-based learning teaching mode and the lecture-based learning teaching mode alone (P < 0.05). The integration of problem- and lecture-based learning teaching mode was well-appraised.

CONCLUSION

Integration of the problem- and lecture-based learning teaching modes in teaching imaging diagnosis education resulted in a good teaching effect.

A large-scale peer teaching programme - acceptance and benefit

INTRODUCTION

The involvement of students in the embodiment of university teaching through peer-assisted learning formats is commonly applied. Publications on this topic exclusively focus on strictly defined situations within the curriculum and selected target groups. This study, in contrast, presents and evaluates a large-scale structured and quality-assured peer teaching programme, which offers diverse and targeted courses throughout the preclinical part of the medical curriculum.

METHODS

The large-scale peer teaching programme consists of subject specific and interdisciplinary tutorials that address all scientific, physiological and anatomic subjects of the preclinical curriculum as well as tutorials with contents exceeding the formal curriculum. In the study year 2013/14 a total of 1,420 lessons were offered as part of the programme. Paper-based evaluations were conducted over the full range of courses. Acceptance and benefit of this peer teaching programme were evaluated in a retrospective study covering the period 2012 to 2014. Usage of tutorials by students who commenced their studies in 2012/13 (n=959) was analysed from 2012 till 2014. Based on the results of 13 first assessments in the preclinical subjects anatomy, biochemistry and physiology, the students were assigned to one of five groups. These groups were compared according to participation in the tutorials. To investigate the benefit of tutorials of the peer teaching programme, the results of biochemistry re-assessments of participants and non-participants of tutorials in the years 2012 till 2014 (n=188, 172 and 204, respectively) were compared using Kolmogorov-Smirnov- and Chi-square tests as well as the effect size Cohen's d.

RESULTS

Almost 70 % of the students attended the voluntary additional programme during their preclinical studies. The students participating in the tutorials had achieved different levels of proficiency in first assessments. The acceptance of different kinds of tutorials appears to correlate with their performance in first assessments. 94% of the students participating in tutorials offered in the study year 2013/14 rated the tutorials as "excellent" or "good". An objective benefit has been shown by a significant increase in re-assessment scores with an effect size between the medium and large magnitudes for participants of tutorials compared to non-participants in the years 2012, 2013 and 2014. In addition, significantly higher pass rates of re-assessments could be observed.

CONCLUSION

Acceptance, utilisation and benefit of the assessed peer teaching programme are high. Beyond the support of students, a contribution to the individualisation of studies and teaching is made. Further studies are necessary to investigate possible influences of large-scale peer teaching programmes, for example on the reduction of study length and drop-off rates, as well as additional effects on academic achievements.