Chris JefferiesCamille Kostov

Medical Education (BSc)

What is Peer-Assisted Learning (PAL)?

“people from similar social groupings who are not professional teachers helping each other to learn and learning themselves by teaching” (Topping 1996)

1. Topping, K. 1996. The Effectiveness of Peer Tutoring in Further and Higher Education: A Typology and Review of the Literature. Higher Education 32(3), pp. 321-345.

…as opposed to “more able students helping less able students to learn in co-operative working pairs or small groups carefully organised by a teacher”

Background to PAL

PAL has been used as a teaching method since the 1980s2

PAL in communication skills (Glynn et al 2006) 3

“positive effects on examination scores, student satisfaction and personal and professional development”

A PAL programme was launched at Cardiff University in 20114

First described as being used in clinical skills training by Field et al. in 2007. It was popular with student tutors and learners.

Why use PAL?

Developing students’ skills as a teachers and educators is encouraged by the GMC5.

Rated highly by PAL tutors and peers2

“reciprocity” of experience is unique & valued6

Learners value being taught by other students, who are approachable and understanding4

Tutors develop new competencies and gain confidence as teachers4

Students taught by PAL tutors or experienced clinicians have been shown to perform the same in examinations6

What is reflection?“metacognitive process that creates a greater

understanding of both the self and the situation so that future actions can be informed by this

understanding”7

Experiential learning cycle (Kolb)

Experience alone is not sufficient for learning to take place.

Reflection is vital for active process of learning8

Why do reflections?

reflectere – bend back

Development of ‘expertise’ – requires more than just knowledge

Inform future actions

Reflection = deeper learning, new knowledge integrated with existing knowledge and skills

Our Journey…

Reflections Gibbs’ Cycle:

7. Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Educational Unit, Oxford Polytechnic.

What skills have we taught?

Venepuncture and blood cultures

Arterial blood gas

IV cannulation and fluids

Suturing

Safe injections and drug calculations

Male and female catheterisation

Vital signs monitoring

Histories and examinations – C21 curriculum

Venepuncture – simple?Performed many times in practicePracticed twice in SDL area beforehand

Feelings: nerves!

EvaluationRan the session with another PAL – confidence++

+“rollercoaster of experiences, emotions and

thoughts” Inspiring experience Identity -> medical educator?

Chris: the first teaching session…

Camille: Issues of Competence (3rd teaching session)

Teaching safe Injections to first years Nerves settled rapidly –

familiar territory.Surprised by the behaviour of some

students.

2 students:-one questioned the necessity of asepsis

-one struggling to follow any of the steps

Assessing competence difficult; differs from ‘clinical performance’

(Newble 1992). Professionalism can be “switched on” (Finn et al 2010)

Consider my role as a PAL: peer vs (/ and) tutor

Wider context helps understand the

behaviour of students. Our role to support them in the

clinical skills lab

New skill session – C21 curriculum= difficult to prepare thoroughly for (cf.

venepuncture)

Feelings: more confident, some apprehension -> new skill

EvaluationConfidence building – ability to facilitate an

‘unknown’ sessionAbility to answer (and not answer) questions from

students

Chris: C21: drug calculations/discovery tasks

Camille: Supporting students (ZPD)

Venepuncture and blood culture (first

time) Fear of not succeeding at taking blood during demonstration; less

experienced than other tutors (guilt)

Session went well!

Sometimes can be difficult to support students without singling them out

Vygotsky’s Zone of Proximal Development (scaffolding) –

students can achieve more with support from peers12

Continue to gain confidence in

teaching

Scaffolding – consider how to

support students one-on-one

What did we learn from our reflections?

How to reflect

Identifying areas for improving as PAL tutors

Knowledge of our own abilities and confidence as educators – “yes, I can do this”This is sometimes not immediately apparent! Only

on reflection do you realize/process - “that session went really well”

What did we gain from being PAL tutors?

How to teach

Opportunity to apply what we have learnt during the BSc

Gaining confidence as medical educators

Learning from clinical skills tutors and other PALs

Refreshing our own clinical skills knowledge

Becoming a part of the team / community of practice

Poster prize at C21 showcase conference

What’s next?

Continue to be PAL tutors (hopefully!)

Find other areas where we can get involved with teaching, e.g. anatomy

Encourage other students to become PAL tutors

Continue to use reflections in our teaching and learning

Thank you for inviting us to be PAL

tutors

References

1. Topping, K. 1996. The Effectiveness of Peer Tutoring in Further and Higher Education: A Typology and Review of the Literature. Higher Education 32(3), pp. 321-345.

2. Field, M., Burke, J., McAllister, D. and Lloyd, D. 2007. Peer-assisted learning: a novel approach to clinical skills learning for medical students. Medical Education 41, pp. 411-418.

3. Glynn, L., MacFarlance, A., Kelley, M., Cantillon, P. and Murphy, A. 2006. Helping each other to learn – a process evaluation of peer assisted learning. BMC Medical Education 6(18)

4. Lau, D., Williams, SE., Chiu, E., Grant, A. and Sweetland, H. 2012. Peer-assisted learning in clinical procedural skills – a pilot initiative. [Poster].

5. GMC. 2009. Tomorrow’s Doctor’s. London.6. Haist, S., Wilson, J., Fosson, N. nd Brigham, N. 1997. Are fourth-year medical students effective teachers of

the physical examination to first-year medical students?. Journal of General Internal Medicine 12(3), pp. 177-81

7. Sandars, J. 2009. The use of reflection in medical education: AMEE Guide No. 44. Medical Education 31, pp 685-695.

8. Kolb DA. 1984. Experiential learning: Experience as the source of learning and development. New Jersey: Prentice Hall.

9. Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Educational Unit, Oxford Polytechnic.

10. Newble, D. 1992. Assessing clinical competence at the undergraduate level. Medical Education 26, pp. 504-11.

11. Finn, G., Garner, J. and Sawdon, M. 2010. ‘You’re judged all the time!’ Students’ views on professionalism: a multicentre study. Medical Education 44(8), pp. 814-25.

12. HEAN, S., CRADDOCK, D., & HAMMICK, M (2012). Theoretical insights into interprofessional education: AMEE Guide No. 62. Medical Teacher, AMEE Guide No 62, 34: , e78-e101.