Summary: Dr Maria Blanco (Tufts University School of Medicine) reflects on the experience of implementing peer learning. Description: Given that the medical profession today demands the perpetual education of students, peers, and patients, the field endorses teaching as a necessary skill for trainees and physicians. Indeed, the literature on peer teaching and learning states that senior peers are familiar with the educational program and have closer training experiences to junior peers than expert faculty members, which facilitates junior peers’ approachability and identification, and thus learning (Naqi, 2014). Tolsgaard et al. (2007) conducted an experimental, randomized, controlled study comparing the training of student teachers and associate professors with relation to participant learning outcome and satisfaction with the teaching. They concluded that trained student teachers can be just as good as associate professors in teaching clinical skills.

Other benefits of peer learning supported by research include: the development of interpersonal and communication skills (Naqi, 2014); increased student confidence in clinical practice (Secomb, 2007); improvement of cognitive and clinical skills (Secomb, 2007); promotion of higher-order thinking, teaching skills and self-efficacy (Naqi, 2014); friendly learning environment and conceptual clarity (Naqi, 2014). Research also indicated increased motivation for learning with better learner engagement, and improved group discipline as a result of peer teaching and learning (Tolsgaard et al., 2007). Glynn et al. (2006) reported positive effects on examination scores, student satisfaction and personal and professional development.

Nevertheless, this research also highlights challenges associated with peer learning, such as proper content coverage and transfer of correct knowledge to avoid misconceptions (Naqi, 2014), learning style or personality incompatibility (Secomb, 2007), reduced time with clinical instructors (Secomb, 2007), and quality of peer teaching (Glynn et al., 2006). To overcome such challenges, scholars recommend training peer teachers to improve effectiveness and having faculty take responsibility for the instructional intervention. It is also suggested that student-learners be prepared and gradually introduced to the use of peer learning to foster active participation and commitment.

At our medical school, we designed and launched a developmental Student-As-Teacher (SAT) program for all of our students, beginning with the class of 2016 (Blanco et al., 2014). One of the requirements of our SAT program is participation in a SAT field teaching experience (of the student’s choosing), which may be completed at any time throughout medical school. Thus, many of our SAT field teaching opportunities include cross-year peer teaching and learning. For example, fourth-year students may serve as facilitators in our Problem-Based Learning (PBL) first-year course, and second-year students may serve as co-leaders in the Orientation in Mindfulness for Patient and Student Support (COMPASS) first-year program. Peer-teachers are trained and supervised by faculty members.

Through a mixed-methods study conducted to examine the reliability and strength of student evaluation of PBL facilitators teaching and the type of student feedback provided (comparing two evaluation modes—anonymous online and face-to-face), we also found that students consistently gave fourth-year medical student-facilitators higher ratings. We attributed this to an advanced-medical student to a junior-medical student coaching effect (Blanco et al., 2010).

Students must be in good academic standing in order to teach junior peers. Still, from my daily interactions with junior students, I notice that some prefer to work on their own while arguing that they find this individualistic approach to learning more efficient. They are also concerned that not all of the students truly engage in and contribute to peer learning in groups. Thus, I agree that we should also prepare student-learners for peer learning to help them see the value of it for their professional development. At our school, our students learn how to learn from each other in our PBL first-year course. I also believe our SAT program conveys the value of peer learning. In addition, we suggest faculty members require student attendance at small group sessions to reinforce the value of peer teaching and learning for student professional development. After all, healthcare is a crucial team effort, so, peer learning is fundamentally suited to the practice of medicine today. Furthermore, our assessment approaches should also reinforce the value of peer learning to better align instructional methods, assessment approaches, and educational values - thus promoting meaningful learning.

In peer learning, learners at similar or differing levels teach and learn from each other; in other words, “reciprocity is key!” (Naqui, 2014). This notion is pedagogically rooted in Piaget and Perry, who advocated for social interaction and collaboration as essential components of knowledge construction (Secomb, 2007). I truly enjoy and feel rewarded witnessing students solving a patient care problem together. They all look equally invested in the task at hand, and thirsty for finding the most appropriate answers to treat “their” patient. They challenge each other's ideas and accept their mistakes while pushing their comfort zones and showing respect for each other’s thoughts in a safe and friendly environment.

With the current emphasis on “collective competence” (Lingard, in Pluta et al., 2013) and the social foundation of cognition, collaborative learning has become a critical teaching and learning approach. However, as Pluta et al. (2013), warns, “activities successfully promote collaborative learning and associated learning outcomes when they encourage interactivity, such as shared elaboration and explanation” (S10). Peer teaching and learning has the potential to nurture and support collaborative learning if we direct learners to promote “substantial dialogue and co-construction of ideas” (S9) while teaching and learning from each other, as I witness during our student’s patient care problem-solving discussions.

Educators must then engage in collaborative research and sharing of best practices in peer teaching and learning in order to help learners make the most of this promising educational method. So, let’s go for it!

References

Blanco MA, Maderer A, Oriel A, Epstein SK. How we launched a developmental student-as-teacher (SAT) program for all medical students. Medical Teacher. 2014;36(5):385-9. doi: 10.3109/0142159X.2014.886770. Epub 2014 Feb 14.

Blanco MA, Maderer A, Aarons R, Sung Y-C, Epstein S. “Walking on Eggshells”: PBL Facilitators’ and Students’ Perceptions of Student Face-to-Face Feedback on Teaching. Accepted for Poster Presentation at the 2010 AAMC Annual Meeting - RIME Conference. Washington, DC, November 8, 2010.

Glynn LG, MacFarlane A, Kelly M, Cantillon P, Murphy AW. Helping each other to learn – a process evaluation of peer assisted learning. BMC Medical Education. 2006; 6:18doi:10.1186/1472-6920-6-18. Available from: http://www.biomedcentral.com/1472-6920/6/18

Naqi SA. Peer Assisted Learning as a Formal Instructional Tool. Journal of the College of Physicians and Surgeons Pakistan. 2014; 24 (3): 169-172 169.

Pluta W, Richards B, Mutnik A. PBL and Beyond: Trends in Collaborative Learning. Teaching and Learning in Medicine. 2013;25 Suppl 1:S9-16. doi: 10.1080/10401334.2013.842917

Secomb J. A systematic review of peer teaching and learning in clinical education. Journal of Clinical Nursing. 2008;17(6):703-16. Epub 2007 Nov 30.

Tolsgaard M, Gustafsson A, Rasmussen M, Hoiby P, Muller C, Ringsted C. Student teachers can be as good as associate professors in teaching clinical skills. Medical Teacher. 2007; 29:553-7.