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Background: Peer-assisted learning (PAL) is used throughout all levels of healthcare education. Lack of formalised agreement on different PAL programmes may confuse the literature. Given the increasing interest in PAL as an education philosophy, the terms need clarification. The aim of this review is to 1) describe different PAL programmes, 2) clarify the terminology surrounding PAL, and 3) propose a simple pragmatic way of defining PAL programmes based on their design. Methods: A review of current PAL programmes within the healthcare setting was conducted. Each programme was scrutinised based on two aspects: the relationship between student and teacher, and the student to teacher ratio. The studies were then shown to fit exclusively into the novel proposed classification. Results: The 34 programmes found, demonstrate a wide variety in terms used. We established six terms, which exclusively applied to the programmes. The relationship between student and teacher was categorised as peer-to-peer or near-peer. The student to teacher ratio suited three groupings, named intuitively 'Mentoring' (1:1 or 1:2), 'Tutoring' (1:3-10), and 'Didactic' (1:>10). From this, six novel terms - all under the heading of PAL - are suggested: 'Peer Mentoring', 'Peer Tutoring', 'Peer Didactic', 'Near-Peer Mentoring', 'Near-Peer Tutoring', and 'Near-Peer Didactic'. Conclusions: We suggest herein a simple pragmatic terminology to overcome ambiguous terminology. Academically, clear terms will allow effective and efficient research, ensuring furthering of the educational philosophy.
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RESEARCH ARTICLE
Peer-assisted learning: time for nomenclature
clarification
Alexander Olaussen
1,2,3
*, Priya Reddy
1
, Susan Irvine
1
and Brett Williams
1
1
Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne,
Australia;
2
Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia;
3
National Trauma
Research Institute, The Alfred Hospital, Melbourne, Australia
Background: Peer-assisted learning (PAL) is used throughout all levels of healthcare education. Lack of
formalised agreement on different PAL programmes may confuse the literature. Given the increasing interest
in PAL as an education philosophy, the terms need clarification. The aim of this review is to 1) describe
different PAL programmes, 2) clarify the terminology surrounding PAL, and 3) propose a simple pragmatic
way of defining PAL programmes based on their design.
Methods: A review of current PAL programmes within the healthcare setting was conducted. Each
programme was scrutinised based on two aspects: the relationship between student and teacher, and the
student to teacher ratio. The studies were then shown to fit exclusively into the novel proposed classification.
Results: The 34 programmes found, demonstrate a wide variety in terms used. We established six terms, which
exclusively applied to the programmes. The relationship between student and teacher was categorised as
peer-to-peer or near-peer. The student to teacher ratio suited three groupings, named intuitively ‘Mentoring’
(1:1 or 1:2), ‘Tutoring’ (1:310), and ‘Didactic’ (1:10). From this, six novel terms all under the heading of
PAL are suggested: ‘Peer Mentoring’, ‘Peer Tutoring’, ‘Peer Didactic’, ‘Near-Peer Mentoring’, ‘Near-Peer
Tutoring’, and ‘Near-Peer Didactic’.
Conclusions: We suggest herein a simple pragmatic terminology to overcome ambiguous terminology.
Academically, clear terms will allow effective and efficient research, ensuring furthering of the educational
philosophy.
Keywords: PAL ;peer-assisted learning;near-peer;mentor;tutoring;didactic;near-peer teacher
*Correspondence to: Alexander Olaussen, Department of Community Emergency Health & Paramedic
Practice, Monash University Peninsula Campus, PO Box 527, McMahons Road, Frankston, Victoria 3199,
Australia, Email: alexander.olaussen@monash.edu
Received: 12 January 2016; Revised: 17 June 2016; Accepted: 19 June 2016; Published: 12 July 2016
Peer-assisted learning (PAL) as an educational
method has been around since Socrates and Plato
began questioning one another’s ideas in small
groups (1). In recent times, PAL has gained increasing
attention across many different healthcare disciplines
and educational sectors (1). Naturally following such is
a growing body of evidence to determine its usefulness.
The benefits of PAL has been well-described by Topping
et al. (1) and clearly pertain to all stakeholders (i.e., the
universities, the peer-teacher, and the peer-learner) (13).
There appears to be a climate of readiness to formally
incorporate PAL into different areas of healthcare studies.
PAL has one philosophy: students learning from stu-
dents (4). Two different relationships between the students
and some variations in the arrangement of PAL pro-
grammes have carved out the different methods described
to date. Given the simple and common root that all PAL
programmes stem from, the extensively varying terminol-
ogies used is peculiar. Several mismatched terms exist
throughout the literature. Examples of these include, but
are not limited to: peer-led teaching, peer-led training, peer-
tutoring, peer-teaching, collaborative learning, collaborative
tutoring, cooperative learning, supplementary instruction,
tutor-less group, peer supported learning, shared learning,
co-teaching, co-tutoring, student partnership, facilitated
peer mentoring, and similar variations of near-peer or
cross year. The most commonly used term peer-assisted
learning is arguably just an umbrella term encompassing
all PAL programmes, and as such this term is non-
descriptive (1).
PAL has been extensively researched in the pedagogy
(5) and seems to carry less confusion about the terminol-
ogy than in andragogy. This may be because adult
learners are more heterogeneous than the young, as well
Medical Education Online
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Citation: Med Educ Online 2016, 21: 30974 - http://dx.doi.org/10.3402/meo.v21.30974
(page number not for citation purpose)
as the environment in which they learn differs. The
variance also appears in the preferred learning methods
and the personal motivation (6). Adult learners’ ‘richest
resources for learning reside in the adult learners
themselves’ (6) (p. 45). Focus on experience-based tech-
niques, including PAL, is therefore beneficial.
Terms need to be consistent for a number of reasons.
Firstly, programme implementation is facilitated chiefly by
clear terminology, communication, and intent. Secondly, for
research purposes building an evidence-based foundation is
more achievable. The uncertainty and incongruence around
the terms weakens and confuses the research starting point.
Thirdly, communication across institutions and disciplines is
eased through accurate and consistent terms.
Attempts to clarify the terminology exist. Ladyshewsky (7)
outlined different PAL methods and suggested groupings
based on common ‘indices’. Ten Cate and Durning (8)
designed a framework distinguishing between three elements.
Ladyshewsky (7) argues there are two common indices
that can describe all methods of implementing PAL
namely, 1) equality (e.g., to which extent learners take
direction from each other) and 2) mutuality (e.g., in
relation to the learners’ discourse). Although this may be
theoretically sound, its applicability is limited by the non-
practical definitions. Moreover, a single PAL programme
may be difficult to define within the suggested category,
as the indices are not quantifiable as well as overlapping.
Ten Cate and Durning (8) on the other hand distinguish
PAL programmes based on three believed core compo-
nents: 1) education distance, 2) group size, and 3) formality.
The distance is undoubtedly a key factor to consider
and should differentiate between peers and near-peers.
Further, the size of the group is also important as it has
practical implications for the educational providers and
correlates with students’ preferences and learning (9).
There is limited evidence around the impact formality
has on the PAL outcomes. Furthermore, this is difficult
to include in nomenclature given the spectrum formal
involvement lies on and its vast variation amongst dif-
ferent education institutions.
Despite these clarifying attempts, inconsistencies con-
tinue to exist throughout the literature. This may be be-
cause the suggested components are difficult to define. We
therefore aim to 1) describe the different methods in which
PAL programmes have been incorporated to date, 2) clarify
the terminology surrounding PAL, and 3) propose a
simple pragmatic way of defining PAL programmes.
Methods
We searched five databases (PubMed, Cinahl, Medline,
Proquest, and Embase) and two grey literature websites
(www.greylit.org and www.tripdatabase.com), in a scop-
ing review manner for articles of relevance (10). The
articles were narrowed down based on the key concepts of
describing the implementation of a PAL programme and
pertaining to the healthcare education. We included
studies describing different forms of PAL in order to
i) show the wide and varied approach PAL can take, and
ii) to ensure that our suggested novel terms would be
applicable to all methods of PAL practice.
We derived the new terms from a consensus process
stemming from the different PAL methodologies within
the literature. In accordance with previous nomenclature
clarification attempts within other fields, we desired to
keep well-established acronyms where possible, whilst
also clarifying any confusion through making the novel
terms more accurate in their description (11).
Results
We describe 34 different approaches to PAL. From the
findings, a clear disparity in nomenclature was deter-
mined, further highlighting the importance of formalising
the terminology around PAL. The 34 programmes
reviewed are listed in Table 1. Their methods and used
terminology are tabulated.
Given the wide variety, we propose a new pragmatic
indexing approach, which is based on unambiguous
components. Based on components commonly used to
describe the programmes, we propose the new classifica-
tion relates to the relationship between the students and
the ratio of students to student-facilitators (Fig. 1).
Discussion
The umbrella term: PAL
PAL is the umbrella term and encompasses all pro-
grammes in which students learn from students, and does
not specifyany more than that. There seems to be confusion
in the literature between PAL as an umbrella term and
peer-to-peer learning. Peer-to-peer is the appropriate
name when the students are peers; as opposed to near-
peers. Considering that both students (i.e., the teacher and
the one being taught) are learning and benefitting (3, 4)
may alleviate the confusion. Thus, the term peer-learner
should not solely describe the student which it often does
but rather describe both the teacher and student. We do
not wish to alter this terminology because the acronym
PAL is widely known and utilised.
Relationship between students: peer or near-peer
We consider peer and near-peer the first key separation
because cognitive congruence is a vital component of
learning (8).
Our proposed classification therefore immediately begs
the question what is a peer? Is a peer merely someone at
the same academic year level, or is it more appropriate to
distinguish based on ability? Whilst disagreement on this
question flourishes in the literature, Ladyshewsky (7) and
King (46) concludes that without pairing students’ status
and ability, the programme becomes simply tutoring, not
Alexander Olaussen et al.
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Tabl e 1. An overview of different PAL programs, their method and used terminology, presented sequentially based on the novel
terminology
Proposed
terminology and
the corresponding
teacher-to-student
ratio Study title (reference) Method
Suggested name
by the study
Peer-to-peer
Peer Mentoring
(1 to 12)
Relationship between retention and peer
tutoring for at-risk students (12)
26 ‘at-risk’ nursing students were randomised
to a PAL or control group. 20 were given peer
tutors (who had a higher academic score than
the learner) in a one to one fashion.
‘Peer tutoring’
Clay modelling for pelvic anatomy review for
third-year medical and physician assistant
students (13)
23 third year medical students taught one
another female anatomy after listening to a
lecture and seeing a demonstration.
‘Peer learning (peer
learner and peer
teachers)’
Learning in the simulated setting: a comparison
of expert-, peer-, and computer-assisted
learning (14)
60 medical students were randomised to three
groups. All were given a brief lecture. The peer
group was split into groups of two where they
taught each other while the other group
consisted of computer-assisted learning.
‘PAL
Peer assisted learning in surgical skills
laboratory training: a pilot study (15)
Residents taught each other with and
without guidelines then provided feedback
to each other on the skills practiced.
‘Peer feedback’ and
‘peer teaching’ was
referred to as PAL
Peer Tutoring
(1 to 310)
A controlled trial of peer-teaching in practical
gross anatomy (16)
160 second year medical students, 80 of
which were controls. Half the group would
dissect then they would teach the next
group then retire to study while the second
group dissected. The second group then
showed the first group.
‘Peer teaching’
A comparisonof learning outcomes and attitudes
in student- versus faculty-led problem-based
learning: an experimental study (17)
Second year medical students were
assigned a peer within groups of 10 to
facilitate tutorials.
‘Peer facilitator’
Student-led tutorials in problem-based
learning: educational outcomes and students’
perceptions (18)
Third year medical students taught
each other in groups of 810.
‘Student led tutorials’
Involvement in teaching improves learning in
medical students: a randomized cross-over
study (19)
135 first year medical students rotated the
role of tutor and tutee in small groups with
two tutors per group.
‘Peer educators’
Knowledge transfer of spinal manipulation skills
by student-teachers: a randomised controlled
trial (20)
292 third and fourth year medical students
were taught in groups of 612 by fellow
peers (who received brief teaching course).
‘Student teachers’
Peer teaching: a randomised controlled trial
using student-teachers to teach
musculoskeletal ultrasound (21)
151 students, 75 of which were taught by
nine student teachers of the same year.
‘Student teachers’
Peer Didactic
(1 to 10)
Peer assisted versus expert assisted learning:
a comparison of effectiveness in terms of
academic scores (22)
70 fourth year medical students where one
group (35 students) was given a lecture by a
peer who had the highest academic score.
‘Reciprocal peer
teaching’
Near-Peer
Near-Peer
Mentoring
(1 to 12)
Reducing student anxiety by using clinical peer
mentoring with beginning nursing students (23)
30 ‘freshmen’ nursing students were paired
with individual ‘sophomore’-level medical-
surgical peer mentors.
‘Peer mentoring’
Peer-assisted learning
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Tab le 1 (Continued )
Proposed
terminology and
the corresponding
teacher-to-student
ratio Study title (reference) Method
Suggested name
by the study
Near-Peer
Tutoring
(1 to 310)
Can near-peer medical students effectively
teach a new curriculum in physical
examination? (24)
83 third year medical students were taught
in groups by nine 4th/5th years.
‘Near peer teaching’
Peer assisted learning in patient-centred
interviewing: the impact on student tutors (25)
Two third year medical students taught
groups of six first year medical students.
‘Student tutors’
Student teachers can be as good as associate
professors in teaching clinical skills (26)
Medical students in year two and above taught
first year medical students in groups of 56.
‘Student teachers’
Formal peer-teaching in medical school
improves academic performance: the MUSC
supplemental instructor program (27)
Medical students from upper levels taught
junior students in groups of 46.
‘Supplemental
instructors’
Peer tutoring and student outcomes in a
problem-based course (28)
Medical students who had completed a
particular course two semesters prior
taught current students in groups of 48.
‘Peer tutors’
Advanced Cardiac Resuscitation Evaluation
(ACRE): a randomised single-blind controlled
trial of peer-led vs. expert-led advanced
resuscitation training (29)
One sixth year medical student taught
cardiac resuscitation to nine fifth year
medical student.
‘Peer instructors’ &
‘Peer led training’
Are fourth-year medical students effective
teachers of the physical examination to first-
year medical students? (30)
Nine fourth year medical students taught
first year medical students in groups of four.
‘Student preceptor’
Peer-assisted learning from three perspectives:
student, tutor and co-ordinator (2)
Small group sessions with 12 students per
two peer tutors. Peer tutors were generally
one year senior. Consultants reviewed the
teaching and learning material. Peer tutors
received training in the relevant skills.
‘Peer tutors’ within a
PAL framework
Impact of peer teaching on nursing students:
perceptions of learning environment,
self-efficacy and knowledge (31)
179 first year nursing students were taught
by 51 third year students.
‘Peer teaching’
Peer-assisted learning in the acquisition of
clinical skills: a supplementary approach to
musculoskeletal system training (32)
Four fourth year medical students trained
28 second year students with 218 control
students.
They called it ‘PAL
but referred to the
near peers as
‘student trainers’
Undergraduate rheumatology: can peer-assisted
learning by medical students deliver equivalent
training to that provided by specialist staff? (33)
12 senior medical students trained 45
second
‘Student trainers for
PAL’ year students.
Randomized surgical training for medical
students: resident versus peer-led teaching (34)
60 third year medical students taught by
fourth years in groups of 45.
‘PAL
Peer-led resuscitation training for healthcare
students: a randomised controlled study (35)
122 first year medical, dental, nursing and
physiotherapy students taught by second
years in groups of 1012 with two peers (of
1 year higher) per group.
‘Student instructors’
in ‘peer led’ training
Near-peer teaching in anatomy: an approach
for deeper learning (36)
12 fourth year medical students ran
dissection classes for first and second year
students (no specific number was stated
but it is noted that the entire first and
‘Near peer teachers’
abbreviation used
‘NP’ Students were
called ‘tutees’
Alexander Olaussen et al.
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peer-tutoring. The role of the faculty will be in facilitating
and monitoring the relationship between their students.
The definition of a near-peer is generally clearer, and
consists of two participants that are at least one academic
year apart. However, exceptions exist. For instance, when
PAL is used within interdisciplinary programmes, (47)
students may have different abilities although being at the
same academic year level. We suggest that cases of inter-
disciplinary PAL programmes should be referred to as near-
peers when they are at the same acedemic year level.
Ratio of students: mentoring, tutoring, or didactic
In concordance with Ten Cate and Durning (8), we also
consider the number of students in the group crucial. This
correlates with students’ preferences (9), therebyaffecting the
likelihood of engagement and implicitly learning. Ten Cate
and Durning (8) split the size of the PAL group into only two
groups (i.e., 1 to B3 students, and 1 to ]3 students). Given
the varying dynamic of different group size, this distinction
may be too blunt. We therefore propose a three-way split
which is more consistent with traditional academic structur-
ing, namely mentoring, tutoring, and didactic.
We define a programme as a mentor programme if the
teacher to student’s ratio is 1:1 or 1:2 (i.e., a microenviron-
ment). Mentoring involves positive role modelling and
reinforcement, supplemented by counselling, often used
for disadvantaged groups (3). PAL by mentoring is bene-
ficial in that it provides a more intimate setting where
students are more inclined to ask questions and express
Tab le 1 (Continued )
Proposed
terminology and
the corresponding
teacher-to-student
ratio Study title (reference) Method
Suggested name
by the study
second year class was involved in this
programme). 23 ‘near-peer teachers’ were
assigned to each small group.
Peer-assisted versus faculty staff-led skills
laboratory training: a randomised controlled
trial (37)
89 third year medical students divided into
three grou ps of controls (28), PAL (run b y fourth
and fifth years) (29), and staff taught (26).
‘Cross year’ PAL
Near-Peer
Didactic
(1 to 10)
A vertical study programme for medical
students: peer-assisted learning in practice (38)
Fifth year medical students provided five sets
of 2 h case based lectures in groups of 1015
medical students from years one to four.
‘PAL facilitators’
Effects of peer-assisted training during the
neurology clerkship: a randomized controlled
study (39)
Six medical students who had completed a
neurological clerkship the semester prior
taught 66 medical students currently
undertaking their clerkship.
‘Peer tutoring’
A multi-level assessment of a program to teach
medical students to teach (40)
28 fourth year medical students taught 117
second year medical students.
‘Student teachers’
The role of students as teachers: four years’
experience of a large-scale, peer-led
programme (41)
Eight medical students within their clinical
phase taught 358 junior medical students in
their pre-clinical phase.
‘Peer led teaching’
and the learners were
referred to as ‘tutees’
Peer-assisted learning: a novel approach to
clinical skills learning for medical students (42)
Three year 45 students taught 86 year 1 2
students: one near-peer to 23 students, 1 to
29 students, and 1 to 34 students.
‘Trainer and Trainee’
Clinical skills education: outcomes of
relationships between junior medical students,
senior peers and simulated patients (43)
125 second year medical students were
trained by 11 sixth year students.
‘Cross year PAL
A three-day anatomy revision course taught by
senior peers effectively prepares junior
students for their national anatomy exam (44)
105 second year medical students taught
by four fourth year students in a lecture
setting.
‘Course tutors’
Peer-assisted teaching: an interventional study
(45)
One third year paramedic student taught 12
first year paramedic students with the
presence of a paid sessional staff member.
‘Peer teaching’
Peer-assisted learning
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uncertainties. Furthermore, the likelihood of student in-
volvement in the process and direct monitoring of student
progress by the teacher can be easily facilitated. The obvious
drawback of PAL mentoring lies in resource demand.
Finding compatible pairs is a challenge for the institution.
We define a tutorial as a setting where there is one
teacher to between 3 and 10 students. Tutoring is often
highly focused on curricula content and is characterised by
the assignment of specific roles (i.e., tutor and tutee), most
often with clear guidance around the structure (3). The
benefits of peer-tutoring are i) less resource demanding, ii)
increased possibility for the university to follow up their
peer-teachers, and iii) raised and diversified collaboration
given the larger group and the inherent broader range of
views and perceptions. However, this also leads to the
possible drawback that quiet students may remain quiet
and unnoticed, thereby limiting the utility of such a PAL
programme for those students.
We define a programme as didactic if the teacher to
student’s ratio is in excess of 1:10. Among the vast array
of learning methods and styles, although less common in
PAL, is a class delivered lecture format. This one
directional method is beneficial in that it uses minimal
resources and teaches the peer-teacher to both prepare
and present in front of a large group. However, limited
possibilities for feedback, participation, and student
interaction are considerable drawbacks to this method.
Based on the above-described components, every PAL
programme will fall, mutually exclusively, under any of six
categories. Figure 1 outlines these categories and illustrate
their corresponding suggested names.
Conclusion
We have herein tabulated the main variations in PAL
programmes and proposed a novel nomenclature classifi-
cation. We are not classifying previous authors and their
terminology as wrong, nor do we wish to correct them. We
merely encourage future research in this field to be more
consistent with its terminology. This will better enable the
formal integration of PAL into educational programmes.
To overcome the shortcomings of previous attempts
at clarifying the terminology, we have proposed a clear,
intuitive, and unambiguous nomenclature in which pro-
grammes mutually exclusively belong to just one term.
To broaden the platform of research around PAL and to
allow easy integration across institutions, consistent terms
and definitions are necessary. We urge consistent use of the
PAL terms based on the suggested groupings offered in
this paper. Expansion of the MeSH (Medical Subject
Headings) terms is necessary. It may be anticipated that
new terminology introduction may be inconvenient at
first, and it is unlikely that a consensus will be reached
quickly; however, we believe the long-term benefits uni-
form terminology has on research and education outweigh
this hindrance.
Conflicts of interest and funding
The authors report no conflicts of interest. The authors
alone are responsible for the content and writing of the
paper.
Disclaimers
The views expressed in this article are those of the authors.
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Alexander Olaussen et al.
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... Built upon "personalised and enduring mutually beneficial relationships between an experienced clinician, junior clinicians and/or undergraduates and the host organization" [8], novice mentoring, which is the dominant mentoring approach in PM has been especially compromised by COVID-19 restrictions [9][10][11] including the re-deployment of mentors to the 'frontlines' and restrictions on in-person meetings [12]. These limitations have compromised mentoring support [13] and raised the risk of inadequate oversight [14] of mentoring relationships and assessments of progress, potentiating the danger of ethical, legal and professional lapses in mentoring (henceforth ethical issues in mentoring) [15]. ...
... The motivation for most host organizations in supporting CNEP and IPT is to improve patient care and safety [98][99][100] by structuring mentoring programs and establishing guidelines, codes of conduct and standards of practice [101][102][103][104][105][106]. A consistent set of guidelines serve to confine mentoring practices within acceptable standards as mentoring programs try to accommodate to the individual goals [107][108][109], abilities [109,110] and needs of mentors' and mentees' [13,108,111,112], and to nurture a personalized, mentee-centric, non-judgmental, confidential and trusting environment [113][114][115]. ...
... This combined approach appears equipped to provide timely, personalized, accessible, and holistic support to mentees while ensuring effective policing of compliance to established Codes of Practice and agreed goals, expectations, timelines, and roles and responsibilities of stakeholders. The data here also suggests that a combined CNEP-IPT mentoring program would facilitate effective adaptations to mentoring support amid changing stakeholder related circumstances [13,108,111,112], goals [107][108][109] and availabilities [109,110]. ...
Article
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Introduction The redeployment of mentors and restrictions on in-person face-to-face mentoring meetings during the COVID-19 pandemic has compromised mentoring efforts in Palliative Medicine (PM). Seeking to address these gaps, we evaluate the notion of a combined novice, peer-, near-peer and e-mentoring (CNEP) and interprofessional team-based mentoring (IPT) program. Methods A Systematic Evidence Based Approach (SEBA) guided systematic scoping review was carried out to study accounts of CNEP and IPT from articles published between 1st January 2000 and 28th February 2021. To enhance trustworthiness, concurrent thematic and content analysis of articles identified from structured database search using terms relating to interprofessional, virtual and peer or near-peer mentoring in medical education were employed to bring together the key elements within included articles. Results Fifteen thousand one hundred twenty one abstracts were reviewed, 557 full text articles were evaluated, and 92 articles were included. Four themes and categories were identified and combined using the SEBA’s Jigsaw and Funnelling Process to reveal 4 domains - characteristics, mentoring stages, assessment methods, and host organizations. These domains suggest that CNEP’s structured virtual and near-peer mentoring process complement IPT’s accessible and non-hierarchical approach under the oversight of the host organizations to create a robust mentoring program. Conclusion This systematic scoping review forwards an evidence-based framework to guide a CNEP-IPT program. At the same time, more research into the training and assessment methods of mentors, near peers and mentees, the dynamics of mentoring interactions and the longitudinal support of the mentoring relationships and programs should be carried out.
... Peer tutoring has been utilized at several academic centers and in numerous programs around the globe [3][4][5][6][7][8][9][10][11][12]. As defined by the article by Shenoy and Petersen [15] and the article by Olaussen A et al. [16], the program proposed for use here would be a near-peer tutoring (NPT) endeavor, in which, for our study in particular, senior medical students removed from having taken the courses would act as near-peer tutors for students. The rationale for using this method is social benefit [15], psychological benefit [18], and increased student access to individuals who have recently learned the same material. ...
... Such a program has had success at a number of different institutions as listed and described by Shenoy and Petersen [15] in their literature review. The implementation of this particular option for students is to ensure that individual students are able to access a near-to-peer mentor which will help reduce anxiety [18], improve connectivity within the institution [15,16], and improve learning the material for those in the courses [17]. Other social benefits can include the creation of long-lasting bonds with the individuals receiving tutoring, increased retention of the material by both parties, the subjective feeling of a more supportive environment, and, finally, practice in teaching for those providing tutoring [15]. ...
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The purpose of this study was to demonstrate the desire and need for peer-to-peer tutoring programs at Division 1 Dell Medical School at the University of Texas. Materials and Methods. Two sets of surveys were created and sent to students at the Dell Medical School, University of Texas, USA. One survey asking about the need or desire to engage with a peer tutor was sent to first-year students, and another one asking about the desire to provide these services to underclassmen as a potential leadership course option was sent to third-year students. Results. For the first-year student survey, 52.9% of respondents disagreed or strongly disagreed of being aware of near-peer tutoring and 70.5% of respondents either agreed or strongly agreed that it would be an option utilized by students. For the third-year student survey, 75% of students either disagreed or felt neutral in being aware of near-peer tutoring as an option to serve underclassmen, whereas 65% of upperclassmen either agreed or strongly agreed that if near-peer tutoring had been offered, they would have chosen this leadership course option in the effort to teach their underclassmen peers. Conclusions. Numerous studies have demonstrated peer-to-peer tutorial options to be of high utility to students in the medical education space. This particular paper obtained results demonstrating students’ desire to engage in peer tutoring voluntarily for their own course success goals and upperclassmen’s desire to participate as near-peer tutors for the benefit of underclassmen.
... It is an umbrella term encompassing all PAL programs. [12] As per Miller's Pyramid, four levels of competencies are "Knows," "Knows how," "Shows how," and "Does." [13] The first two competencies can be assessed by multiple-choice questions, short answered questions, or long answered questions while the latter two competencies can be assessed by objective structured practical/clinical examination and other performance-based assessments tools. ...
... It was near peer since peer was one academic level higher than the postgraduate students and tutoring type since the ratio of peer to students was <10. [12] In our study, the peer was the one who joined the department to complete the bond. By involving the peer, it solved the dual purpose. ...
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Introduction: There is a paucity of research on conducting written formative assessment with constructive feedback for theory paper writing for postgraduates of Community Medicine in India. The concept of "Written Formative assessments with Peer-Assisted Learning Program" was implemented to improve the first 2 levels of Miller's Pyramid and assess its impact on the summative assessment. Materials and methods: The program was conducted for 2 batches of postgraduate students in the Community Medicine enrolled for the academic session of 2016-2019 and 2017-2020. The written formative assessment was conducted every Saturday for 1 h from August to March month in 2018 and 2019. After each test, answer papers were evaluated by the peer and faculty from the department. Written and oral feedback was given by the peer. After IEC approval, we planned to assess the program's effect on level 1 and level 2 Kirkpatrick's framework. The data were analyzed using SPSS statistical package version 24 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered statistically significant. Results: Total 23 formative written assessments were conducted per year. The proportions of knowledge, comprehension, and analytical type of questions asked were 47%, 32%, and 21%, respectively. The mean attendance rate was 76.28% ±16.4%. There was no statistically significant difference in the average percentage of marks in formative (weekly test) and summative assessment (university final examination). There was a statistically significant positive co-relation of projected mean marks and summative assessment marks with the co-efficient of the determination being 22.6%. There was overall positive feedback of the formative and peer-assisted learning (PAL) from post graduate students. Conclusions: Written Formative Assessment with PAL program is one of the effective programs for postgraduate students to gain confidence in writing and presentation skills and to score higher in theory examination.
... Peer-assisted learning has been defined to include peer-to-peer or near-pear relationships. Near-peers are two participants who are at least one academic year apart [4]. The teaching relationship can take the form of mentoring (if 1-2 students are involved); tutoring (if 3-10 students are involved); or may be didactic (if more than 10 students are involved) [4]. ...
... Near-peers are two participants who are at least one academic year apart [4]. The teaching relationship can take the form of mentoring (if 1-2 students are involved); tutoring (if 3-10 students are involved); or may be didactic (if more than 10 students are involved) [4]. ...
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There is a need to increase oral health knowledge, attitudes and behaviors in children to improve oral health. This research involves peer-assisted learning to determine if high school students can influence rural middle school students' oral health. The study sample consisted of middle school students. After completing pre-test, they were assigned to receive 1) didactic peer-assisted learning with professionally supervised and educated high school students (members of an after-school pipeline program for science, technology, engineering, mathematics, and health science); or, 2) teacher provided handouts/activity sheets. Both groups then completed a post test. The results of the Mann-Whitney U Tests showed that brushing and flossing failed to reach significant improvements between the pre-test and post-test for the handouts/activity sheets group (brushing, P=0.391; flossing, P=0.459). There was improvement within that group for oral health knowledge (P<.001). Brushing, flossing and oral health knowledge failed to reach significant improvement between the pre-test and post-test for the peer-assisted learning group (brushing, P=0.760; flossing, P=0.707; oral health knowledge, P= 0.154). In terms of oral health knowledge, there was no difference between the scores of the two groups on the pre-test (P-value = 0.980) nor on the post-test (P-value= 0.237). Near-peer assisted learning for oral hygiene knowledge, attitudes, and behaviors had similar outcomes as teacher provided handouts and activity sheets in a middle school setting.
... Para melhor entendimento dessa metodologia, é fundamental compreender algumas expressões, como "peer mentoring" --mentoreamento por pares (por dois ou menos alunos por professor), "peer tutoring" --tutoria por pares (por três a dez alunos por professor) e ¨peer didactic¨ -pareamento didático (para mais de dez estudantes por professor) 3 Continua... ...
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Resumo: Introdução: A instrução entre pares baseia-se na aquisição de conhecimento e habilidade por meio de cooperação entre estudantes com status e habilidades semelhantes. Assim, faz-se necessário buscar na literatura evidências científicas sobre a utilização, a eficácia, as potencialidades e as fragilidades desse tipo de instrução no processo ensino-aprendizagem referente ao ensino superior na área da saúde. Objetivo: Este estudo teve como objetivo investigar na literatura as evidências científicas sobre a metodologia ativa instrução entre pares aplicadas no ensino superior na área da saúde. Método: Trata-se de uma pesquisa descritiva, do tipo revisão integrativa, que teve como pergunta norteadora: ¨Quais evidências científicas existem na literatura sobre a metodologia ativa instrução entre pares aplicadas no ensino superior na área da saúde?¨. Realizou-se a pesquisa no período de junho e julho de 2020 nas bases de dados LILACS, MEDLINE (PubMed) e SciELO. Resultado: Foram analisados 12 artigos. Os resultados apontam que a aprendizagem em pares é uma ferramenta de ensino eficaz que contribui para o processo ensino-aprendizagem, pois proporciona aos alunos (tutores e tutoreanos) a oportunidade de revisar os conhecimentos e as habilidades adquiridos e refletir sobre eles. A maioria dos estudos foi realizada com alunos da graduação em Medicina de diversos países. Conclusão: A instrução entre pares se apresenta como potencial significativo em desenvolver o processo de autorreflexão e autoconhecimento, em diferentes estágios da formação superior. Professores, estudantes e instituições podem se beneficiar da implementação sistematizada dessa metodologia para aprimorar a aquisição de conhecimento e intensificar as relações interpessoais e práticas colaborativas de ensino-aprendizagem.
... During medical school (a curriculum of 6 years (7 until 2018)) students at the University of Antwerp can apply for a voluntary (near-)peer teaching program in the Skills Lab during their 4th and/or 5th year, which means 1 or 2 years before starting their clinical internship but after obtaining their Bachelor's degree (Fig. 1). Our program follows the classification of Olaussen et al., in terms of near-peer and peer teaching 1 [10]. ...
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Background This study investigates the impact of Peer-Assisted Learning (PAL) in clinical skills on peer teachers’ academic scores and competencies; however, controversy remains on this topic, and concrete evidence on its impact lacking. Methods We performed a mixed methods study combining a retrospective cohort study with a modified Delphi survey. Peer teachers and Skills Lab faculty members participated in this study. A validated questionnaire, the CanMEDS Competency Based Inventory (CCBI), and group interviews were used to assess the outcomes of PAL. Our results were also triangulated with literature data. Results In 3 consecutive cohorts of medical students ( n = 311), 78 participated in PAL. Peer teachers obtained higher scores from the start of the study, at different timepoints in medical school, and on their final scores compared to all other students. Interestingly their progress followed the same path and magnitude as other well-performing students. However, based on our findings from a modified Delphi survey (CCBI interviews) and a literature review, we found further supporting evidence for a positive impact of PAL on the competencies of physical skills (medical expert), teamwork and leadership (collaborator), lifelong learning (scholar), and for admitting uncertainty/limits (professional) within the CanMEDS roles. Conclusions We conclude that higher achieving students are more likely to volunteer for a peer tutoring program; however this does not significantly augment their academic scores as compared to above well-performing non-teaching fellow students. Importantly, our modified Delphi survey indicated which CanMEDS roles were positively impacted by PAL: medical expert, collaborator, scholar and professional.
... Peer-assisted learning (PAL), which is often referred to as peer learning, is a particular teaching-learning approach where students learn from their peers who are not qualified teachers or professionals (Ross and Cameron 2007). PAL implementation has been recorded as early as Plato's era and is still widely used in the current medical and health professions education (Olaussen et al. 2016). The unique attributes of PAL are 'social congruence' and 'cognitive congruence'. ...
Chapter
Medical and health professions education should give attention to faculty and student wellbeing and create a supportive curriculum and teaching–learning process to assure the achievement of competency and readiness of graduates. This chapter highlights that the students, faculty, patients, and other human enterprises are the center of the process. Relevant theories and practices on resilience, burnout, and wellbeing will be discussed comprehensively in the medical and health professions education context in general and in a hierarchical-collectivist cultural context. Resilience or perseverance is the ability of an individual to respond to stress healthily and adaptively so that people may ‘bounce back’ from challenging circumstances and even become more robust in the process. On the other hand, the failed adaptation will result in burnout. The balance between resilience support and burnout prevention is believed to promote wellbeing. The concept is highly relevant to the vision of creating future medical and health professionals and in any efforts involving current students and faculty. In addition to individual processes and development, resilience is influenced by the learning environment. The socialization process within the education milieu allows students and faculties to stay motivated in achieving their goals, prevent burnout and keep developing their personal and professional identity. Studies show that interventions on the individual without paying attention to the learning environment are not adequate. The keys to nurturing and humanistic learning environment which supports resilience are at the individual, interpersonal, and organization/system levels in which culture is embedded. This chapter will also describe that positive role-modeling and mentoring can create the expected learning environment in hierarchical and collectivist cultural context.
... Two or fewer students per-peer teacher refers to peer mentoring, while 3 to 10 students per-peer teacher refers to peer tutoring, and more than 10 students per-peer teacher refers to peer didactics. 8 This study used a peer-to-peer didactic approach. Due to a lack of resources, PAL programs were created to serve a growing number of students and provide cost-effective teaching strategies. ...
Article
Full-text available
Objectives: To compare the effectiveness of peer-assisted learning (PAL) and expert-assisted learning (EAL) in terms of knowledge gain in virtual chest x-ray (CXR) interpretations. The secondary objective was to assess students' satisfaction levels between both groups. Methods: In this randomized controlled trial, second-year medical students who met the inclusion criteria were randomly assigned to the PAL and EAL groups. The study was carried out from December 2020 to February 2021 at Umm Al-Qura University, Makkah, Saudi Arabia. The primary endpoint was the difference in the students' scores, which were determined by an independent reviewer. The secondary endpoint was students' satisfaction levels. Results: A total of 166 second year medical students were included. The standard deviation and mean age of the population were 19.73±0.66 (males: 79 [47.6%]; females: 87 [52.4%]). Participants were allocated equally into two groups (83 in each group). Student scores did not differ significantly between the two groups (p=0.507). Students in the PAL group thought the session was useful (p=0.01), kept on time (p=0.043), and the tutor facilitated their learning process (p=0.011). They also felt that online teaching was as effective as traditional teaching (p=0.03). There was no significant difference in satisfaction scores on the other aspects of the questionnaire. Conclusion: Peer-assisted learning has equivalent efficacy compared to EAL in a virtual setting. The Students in the PAL group had higher level of satisfaction.
Thesis
Hintergrund und Ziele Der Lehrbetrieb an Universitäten ist seit der Corona-Pandemie stark eingeschränkt, wovon unter anderem das Studium der Zahnmedizin sehr betroffen ist. Einerseits ist die praktische Ausbildung ein sehr wichtiger Bestandteil des Studiums, birgt jedoch durch Behandlungskurse ein hohes Infektionsrisiko. Andererseits geht auch die theoretische Ausbildung in Form von Vorlesungen in Präsenz geht mit einer potentiellen Infektion einher. Darüber hinaus gilt es neben den konventionellen Prüfungen wie MC-Klausuren neue Alternativen zu suchen, die zugleich effektiv und während der Pandemie und darüber hinaus anwendbar sind. Peer Assisted Learning (PAL) könnte so eine Lehrmethode sein und wurde in dieser Studie untersucht. PAL bedeutet einfach gesagt, dass Studierende von Studierenden lernen, wobei es jedoch zahlreiche Subformen gibt. Eine davon ist Peer Assessment, bei der Studierende ihre Kommilitonen bewerten und gegebenenfalls ein Feedback geben. Die Idee dahinter ist, dass somit ein Umfeld geschaffen wird, in der die lernenden und lehrenden Personen gleichgestellt sind und dadurch eine bessere Kommunikation möglich ist. Daraus erhofft man sich bessere Lernergebnisse, ein effektiveres Arbeiten und auch eine Entlastung des Lehrpersonals. Weitere Vorteile sind das Verbessern der Selbstreflexion, die Möglichkeit, PAL online durchführen zu können und ein intensiveres Beschäftigen mit den Lernthemen. Diese Studie zielt darauf ab, ob PAL eine bessere Lern- und Prüfungsmethode ist und wie die subjektiven Eindrücke der Studierenden sind. Material und Methoden In der dieser Arbeit zugrundeliegenden Studie wurde im Sommersemester 2020 in der Abteilung für Mund- Kiefer- und Gesichtschirurgie eine Prüfung durchgeführt, an der 267 Studierende aus dem sechsten bis zehnten Semester teilnahmen. Es wurden dafür fiktive Patientenfälle genutzt, zu denen die Studierenden zwischen fünf und acht Fragen, deren Schwierigkeit an das jeweilige Semester angepasst wurde, beantworten mussten. Danach bewertete jeder Studierende zwei durch Zufall bestimmte Kommilitonen und wurde ebenfalls von zwei Kommilitonen bewertet. Dabei hatten sie die Möglichkeit, zwischen einem und fünf Sternen zu verteilen und zusätzlich ein Feedback zu schreiben. Anschließend musste an einer Umfrage mit zwei Fragen bzw. fünf Aussagen teilgenommen werden, bei der die Studierenden zwischen „Besser“, „Gleich“ und „Schlechter“ bzw. „Ich stimme zu“, „Neutral“ und „Ich stimme nicht zu“ wählen konnten. Zusätzlich konnte ein Kommentar verfasst werden. Die Kommentare wurden anschließend anhand der Hauptaussagen nach Häufigkeit analysiert. Ergebnisse und Beobachtungen Insgesamt wurde der Lerneffekt von 77,9% der Studierenden als besser empfunden und 74,9% beschäftigten sich intensiver mit den Lerninhalten. Die meisten Studierenden gaben ebenso an, dass sie durch PAL ihr klinisches Denken und Feedbackfähigkeiten verbessern konnten. Die fehlende Anonymität wurde von 66,3% der Studierenden kritisiert. Die Kommentare bestätigten eine hohe Akzeptanz und das Verbessern von Soft Skills. Weiterhin wurde ein fiktiver Patient als praktisch empfunden. Schlussfolgerungen und Diskussion Die Gründe für einen möglichen besseren Lernerfolg sind die längere Beschäftigungszeit mit den Lernthemen, der Bewertungsprozess an sich und das individuelle Feedback, was jeder Studierende erhält. Weiterhin ist das Fördern des klinischen Denkens, ein wichtiger Bestandteil der medizinischen Tätigkeit, in dieser Studie durch das Prüfungsdesign und den fiktiven Patienten ermöglicht worden. Durch das Erhalten und Geben von Feedbacks kam es zu einem Austausch von fachlichen Informationen und aufgrund des fiktiven Patienten wurde eine klinische Situation simuliert. Die Kritik an der fehlenden Anonymität muss ernst genommen werden und es benötigt eine Lösung. Gründe für die einsehbaren Namen sind das Anregen von Gesprächen über die Lernthemen, das Bewusstwerden über die Verantwortung der eigenen Aussagen und ein Verhindern von zu harschem Bewerten. Diese Gründe könnten für ein besseres Verständnis den Studierenden erläutert werden, um so einen noch höheren Zuspruch zu erlangen. Insgesamt kann man dennoch eine hohe subjektive Akzeptanz bei den Studierenden feststellen. Es benötigt aber eine objektive und quantitative Messung über den tatsächlichen höheren Lernerfolg, z. B. im Vergleich zu Multiple-Choice-Prüfungen. Außerdem wäre eine Analyse, wie das Lehrpersonal PAL empfindet, interessant.
Chapter
Following the nature of student–teacher relationship in the hierarchical and collectivist culture, facilitating learning in this context brings its consequences. Few studies from this cultural context show that students from this cultural background perceive the small group discussion differently from the Western students. In this culture, teachers are seen as the ultimate rules, so small group discussion to formulate learning objectives may be puzzling, as the conclusion is the final words from the teachers. Therefore, health professional students anywhere in the world should be carefully trained to reflect on experiences and pieces of evidence and to learn from the lessons confidently. To be independent, self-regulated, and self-directed learners, students should begin to trust their reflections to plan further learning. Consequently, to stimulate reflection needs sufficient feedback, which means two-way dialogue between students and teachers. In this chapter, we emphasize on teacher training to start a constructive discussion and avoid misuse of social ‘power’. However, we understand that the majority of teachers that grew up in this cultural context have a lifetime experience of social-power. So, generation gap are potentially influencing their approaches in educating future health professionals. This chapter will discuss the endeavor of teachers in this cultural context in approaching student-centered learning.
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Objective: To compare the effectiveness of peer assisted learning versus expert assisted learning in terms of academic scores. Study Design: Cross over-randomized control trial followed by a cross-sectional survey. Place and Duration of Study: Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, during January to October 2012. Methodology: This study was conducted on 4th year MBBS students. The students were randomly divided in two groups by lottery method following their roll numbers. The groups A and B were dealt with Peer Assisted Learning (PAL) and Expert Assisted Learning (EAL) respectively. Effectiveness of both methods of learning was calculated on the basis of academic scores obtained in MCQ tests. One best answer type of MCQs were used and their construct validity was checked by other senior faculty members. After crossover of groups and altered teaching strategy, academic scores were compared again within the group and the comparable group. Student's views about this technique were measured by Likert's scale. P-values were obtained by applying independent and paired t-tests and considered statistically significant at ≥ 0.05. Results: There were 70 students of 4th year MBBS which included 24 (34.3%) males and 46 (65.7%) females. The Crohnbach's alpha value of these MCQs was 0.64. Scores of MCQ test were compared by applying independent t-test and p-value obtained was 0.971; after cross over p-value was 0.468 which was not significant between the results obtained by two learning strategies. Twenty five students (46.3%) said that PAL is an effective technique. Thirty eight (70.4%) students found it easy to communicate with a peer. For incorporation of PAL in curriculum of community medicine, 24 (44.4%) students voted in its favour. Conclusion: Peer assisted learning has proved of equivalent efficacy in terms of students score in MCQs test as expert assisted learning.
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