DESCRIPTIVE ARTICLE

Near-Peer Teaching in Anatomy: An Approach forDeeper Learning

Darrell J. R. Evans,* Tracy CuffeBrighton and Sussex Medical School, Sussex University, Brighton, United Kingdom

Peer teaching has been recognized as a valuable and effective approach for learning andhas been incorporated into medical, dental, and healthcare courses using a variety ofapproaches. The success of peer teaching is thought to be related to the ability of peertutors and tutees to communicate more effectively, thereby improving the learning envi-ronment. Near-peer teaching involves more experienced students acting as tutors who areideally placed to pass on their knowledge and experience. The advantage of usingnear-peer teachers is the opportunity for the teacher to reinforce and expand their ownlearning and develop essential teaching skills. This study describes the design and imple-mentation of a program for fourth year medical students to teach anatomy to first- andsecond-year medical students and evaluates the perceptions of the near-peer teachers onthe usefulness of the program, particularly in relation to their own learning. Feedbackfrom participants suggests that the program fulfills its aims of providing an effective envi-ronment for developing deeper learning in anatomy through teaching. Participants recog-nize that the program also equips them with more advanced teaching skills that will berequired as they move nearer toward taking on supervisory and teaching duties. The pro-gram has also provided the school with an additional valuable and appropriate resourcefor teaching anatomy to first- and second-year students, who themselves view the inclu-sion of near-peer teachers as a positive element in their learning. Anat Sci Educ 2:227–233,

2009. © 2009 American Association of Anatomists.

Key words: gross anatomy; undergraduate medical education; collaborative learning;communication skills; anatomical knowledge; dissection; peer teaching

INTRODUCTION

The use of peer teaching has been an integral part of humanlearning for centuries and in its most literal sense involves par-ticipants that are all of a similar age or level of learning. Thesuccess of peer teaching is thought to be connected to the abil-ity of peer tutors and tutees to communicate more effectivelyand, therefore, improve the learning environment (Allen andBoraks, 1978). Peer teaching has been used in a variety of gui-ses including peer-assisted learning, team-based learning (TBL)and reciprocal peer teaching, and in many different areas ofhealth education and the biosciences (Krych et al., 2005; Tariq,

2005; Gill et al., 2006; Secomb, 2007; Evans and Canavan,2008; Shankar and Roopa, 2009). Within anatomy, peer teach-ing has been widely recognized as a valuable approach forlearning and has been effectively incorporated into medical,dental, and healthcare curricula (Nnodim, 1997; Bruecknerand MacPherson, 2004; Youdas et al., 2008). The manner ofpeer teaching has varied extensively and has included one-to-one teacher-tutee interactions, group peer teaching, problem-based learning, or even peer-developed learning materials(Walker-Bartnick et al., 1984; Lake, 1999; Krych et al., 2005;Nieder et al., 2005; Youdas et al., 2008). While many of theseexamples have involved students in the same year of training orin immediately adjacent years and therefore meet the definitionof peer teaching, other activities which include alternate formsof tutor-led teaching where direct peers are not involved havealso been regarded as peer teaching. In these cases, tutoringinvolves experienced students at more advanced stages of theirtraining acting as tutors and hence the term of near-peer teach-ing is more appropriate. The educational concept of near-peerteaching is different to that of peer teaching as the underlyingprinciples involved differ. While peer teachers are usually of asimilar age or level of learning and therefore relatively inexper-

*Correspondence to: Dr. Darrell J. R. Evans, Brighton and SussexMedical School, Sussex University, Falmer, Brighton BN1 9PX,United Kingdom. E-mail: d.evans@bsms.ac.uk

Received 16 July 2009; Revised 28 August 2009; Accepted 28 August2009.

Published online 15 September 2009 in Wiley InterScience (www.interscience.wiley.com). DOI 10.1002/ase.110

© 2009 American Association of Anatomists

Anatomical Sciences Education SEPTEMBER/OCTOBER 2009 Anat Sci Educ 2:227–233 (2009)

ienced, near-peer teachers are in a position to more easily passon their knowledge and experience (near-peer teachers wouldtypically be 2–5 years ahead in their learning). In addition,near-peer teachers have an unrivalled opportunity to reinforceand expand their own learning and usually have increasedmotivation as teaching opportunities are often chosen ratherthan being part of a curriculum (Josephson and Whelan, 2002;Bulte et al., 2007). In the healthcare environment, near-peerteachers are able to use the tutor experience as a relevant edu-cational tool as they move nearer toward taking on supervisoryroles (Haist et al., 1997). In anatomy, near-peer teaching iswidely used (Houwink et al., 2004) and is probably best exem-plified by the anatomy demonstrators who are used extensivelyacross medical schools in the United Kingdom (UK) and else-where to help the faculty staff direct student learning withinthe anatomy laboratory. Demonstrators are usually junior doc-tors within the early postgraduate training years and who, ingeneral, intend to follow careers within surgery or radiology.Similar approaches have been used in the United States withupper classmen and residents taking the role as demonstrator(Lee et al., 1999). The use of demonstrators in anatomy hasbeen seen as a successful approach for both student learning anddemonstrator learning and development and probably reflectsthe fact that it encompasses many of the attributes of peer teach-ing as well as incorporating such characteristics as mentorshipand role modeling. Unfortunately, there has been a reduction inthe availability of these clinical trainees due to reform of thepostgraduate training programs in the UK (Fraher, 2007), whichtogether with the reported deficit in experienced anatomy fac-ulty (Malamed and Seiden, 1995; Monkhouse, 1996; McKeownet al., 2003; McCuskey et al., 2005) has meant that there is a rel-ative lack of suitable teachers to inspire and develop the knowl-edge of students in anatomy. This is particularly unfortunategiven the recent resurgence in the demand for effective anatomi-cal teaching and communication of anatomical information(Evans, 2008; Pawlina and Drake, 2008). Despite this, the utili-zation of demonstrators is still widely seen as one of the primaryand favored methods of anatomical tutoring and, therefore, theidentification of additional demonstrator resources has beeninvestigated by a number of schools.

At Brighton and Sussex Medical School (BSMS) in the UK,this issue has been tackled by developing a formalized near-peer teaching program in anatomy where fourth year studentsare given the opportunity to act as ‘‘junior’’ demonstrators andteach first- and second-year students in the anatomy labora-tory. Offering such a program provides an ideal environmentfor medical students to develop their teaching skills as recom-mended by the General Medical Council (GMC, 2003) whichgoverns all medical courses in the UK. Anatomy within the 5-year undergraduate medical program at BSMS is delivered asan integrated element within the system-based modules in yearsone and two and within year four clinical rotations (Evans andWatt, 2005). The dominant mode of learning for anatomy isstudent-led dissection with accompanying lectures, tutorials,and living anatomy sessions including imaging. Like many UKmedical schools, BSMS uses a team of traditional demonstra-tors as well as anatomy faculty within the dissecting room;however, students are urged to make their own ‘‘journey of dis-covery’’ during the dissection sessions and we use an informalTBL approach. Working in groups of eight, students lead thedissection process using specially designed worksheets andwith the guidance of staff. Students are encouraged to teacheach other through demonstration and the inclusion of check-lists in the worksheets provides an opportunity for peer-led

assessment of the knowledge and understanding gained in thesession. These checklists are then used by demonstrators andfaculty to ensure learning outcomes have been achieved. Inaddition, each worksheet contains a series of applicable ques-tions designed to make students think about the relevance ofthe anatomical region they are studying. These questions arefor students to explore and answers are not directly givenwithin the session. Instead students are encouraged to discoverpossible answers after the session, with the formal answersreleased at a later date. While achievement in anatomy isdescribed as above average (compared to other disciplines) forthe majority of the students as exemplified by analysis of theresults of summative module assessments, it has been necessaryto ensure that this knowledge and understanding is not just su-perficial with deeper learning the goal. Deeper learning isencouraged where possible through the chosen teaching meth-ods, the extensive formative assessments we have developedonline, and by bringing students back to the dissecting room inthe fourth-year when taking rotations such as ENT and ortho-pedics to refresh and develop relevant anatomy (Evans andWatt, 2005). However, it was recognized that the creation of anear-peer teaching program would provide some students withadditional opportunities to re-enforce understanding of anat-omy, as well as equipping them with educational training anddeveloping their career competitiveness. This study describesthe design and implementation of the near-peer teaching pro-gram and evaluates the near-peer teacher perceptions of theusefulness of the program, particularly to their own learning.

EXPERIMENTAL PROCEDURES

Program Design and Development

The near-peer teaching program was developed in the firstinstance to enhance opportunities for fourth year students (intheir penultimate year of medical school) to try to developdeeper learning of anatomy and provide educational training.An additional objective was to increase numbers of demon-strators to teach first- and second-year undergraduate medicalstudents. In terms of specific outcomes, it was hoped that bythe end of the program cycle, near-peer (NP) teachers wouldhave:

� Gained an enhanced understanding of anatomy in specificregions and systems of the body;

� Gained significant exposure to the theory and practice ofteaching;

� Further developed oral communication skills;� Recognized the importance of the near-peer teaching expe-rience to both tutor and tutee and its relevance to futurecareer development.

For the tutees it was hoped that they would have:

� Gained from the interaction with students at a differentlevel of learning and therefore provide an enhanced learn-ing environment;

� Gained from an increased number of demonstrators actingas guides and tutors in the anatomy laboratory.

Invitations were sent to all medical students toward theend of their third year of undergraduate study asking them toexpress an interest in joining the near-peer teaching program.

228 Evans and Cuffe

Students were informed that this was a voluntary experienceand one that should not compete with their own timetabledactivities. Interested students were subsequently invited toattend a training and selection session organized by the anat-omy faculty. Short presentations were given on aspects ofmedical education with an emphasis on ‘‘becoming an effec-tive teacher,’’ the UK anatomy regulatory system (Human Tis-sue Act, 2004) and details of the selection procedure. Thenext stage of the training was designed to give all participantsan example of teaching practice within the anatomy labora-tory and remind them of the style of teaching that underpinsanatomy at BSMS (Evans and Watt, 2005). Each member ofanatomy faculty led small groups for a 20-minute cadavericdemonstration. Finally, trainees were given an opportunity toillustrate their own teaching skills, anatomical knowledge,and general ability to interact with students by presenting ashort practical demonstration on an element of thoracic anat-omy using cadaveric specimens to a member of experiencedanatomy faculty and a group of fellow trainees. All traineeswere given prior warning of what area would be covered andadvised that they should attempt to deliver at the level of afirst-year undergraduate medical student with level descrip-tors provided.

The selection process was semi-structured and one thatinvolved experienced anatomy faculty judging the ability ofstudents based on four criteria: (1) anatomical knowledge dem-onstrated, (2) enthusiasm shown, (3) ability to provide clarityand achieve the necessary level, and (4) ability to fit within theteam dynamic. These criteria were used by the anatomy facultyto shortlist candidates. The merits of each shortlisted candidatewere discussed by all faculty in relation to the original criteriaand a decision was made on the final selection. It was decidednot to use previous summative assessment success in anatomyas a selection criterion so as not to disadvantage or discourageany candidate. On subsequent evaluation, selected candidateswere shown to be those who had performed above average oraverage in anatomically related assessments in the first twoyears of the course. All students completing the initial trainingsession were provided with attendance certificates for theircareer development portfolios.

Following the training session, all selected NP teacherswere provided with a timetable of available teaching sessionswithin first- and second-year modules and asked to highlighttheir availability. Each was subsequently assigned to up tothree dissection sessions for each of six modules, with two tothree teachers selected for each session. NP teachers wereprovided with detailed tutor notes (containing details of thedissection to be carried out by the students and answers topredicted questions) at the start of each module to preparethem for each teaching session. In addition, they were able toarrange visits to the Anatomy Laboratory before each sessionto prepare with prosected cadaveric material. On the day ofeach session, NP teachers were given a final training sessionby the lead faculty on the available prosections; a reminderof any specific points of note regarding the forthcoming dis-section; and an opportunity to pose any questions or seekclarification. During each session, the lead faculty memberinformally observed each NP teacher and senior demonstra-tors and faculty were available to help when any difficultiesarose or the NP teacher was unable to answer a student ques-tion (students were advised not to step outside their limits ofknowledge). At the end of each session, an informal debrief-ing was held to assess how the session had gone and to makeany necessary changes to subsequent sessions.

Program Evaluation

During the final module of the academic year, feedback wascollected from all NP teachers through an anonymous 5-pointLikert questionnaire. NP teachers were asked to assess thestandard of the training and selection procedure, the value ofthe ongoing training and preparation received and the effectof the program on improving their deeper knowledge of anat-omy, enhancing their oral communication skills and develop-ing their teaching skills. In addition, participants were askedabout their perception of how the program had affected theircareer development plan. A definition of deeper learning wasgiven to participants. In addition to numerical scoring, NPteachers were also asked a number of open-ended questionsto solicit comment on the positive and negative aspects of theprogram and where improvements could be made. Open-ended responses were categorized into common themes.While the focus of evaluation was directed toward the per-ceptions of the NP teachers, students (tutees) were also infor-mally asked to comment upon the value of having the fourthyear NP teachers present in the dissection sessions in additionto the more ‘‘traditional’’ demonstrator.

RESULTS

Participation

Initial interest shown by fourth year students to participate inthe near-peer anatomy teaching program was in excess ofwhat had been anticipated. A total of 65 expressions of inter-est from a cohort of 135 students were received. The initialintention was to select a team of eight NP teachers, however,given the interest it was agreed to expand this to 12 teachers.Thirty-four students were able to attend the training andselection event, which was held toward the end of a day toencourage attendance of those particularly committed towanting to become an NP teacher. The standard of studentteaching in the practical demonstration segment of the train-ing event was high when marked against the selection crite-ria. The final team of 12 NP teachers was chosen after collec-tive discussion of each of the shortlisted candidates and inrelation to the selection criteria. All students attending andcompleting the training event received their certificates at theend of the session and successful students were informed sub-sequently. Selected NP teachers were able to partake in aminimum of five to six sessions during the course of the aca-demic year and the program achieved a zero drop-out rate,although one student chose not to complete the training/selec-tion event. All NP teachers were provided with an additionalcertificate of program completion for their career develop-ment portfolios.

Teaching Sessions

Two or three NP teachers were assigned to each dissectionsession within the six first- and second-year modules in whichanatomy appears. Before each session, NP teachers were pro-vided with detailed tutor notes and given ongoing trainingand guidance. During the teaching sessions, NP teachers wereinitially encouraged to shadow faculty and senior demonstra-tors before gaining ‘‘independence’’ and NP teachers felt thatthis helped with confidence building. The faculty leads foreach session informally observed interactions between NPteachers and the students and were on hand in case of diffi-

Anatomical Sciences Education SEPTEMBER/OCTOBER 2009 229

culty or where a teacher was unsure of the answer to a par-ticular student enquiry. Most NP teachers were found to becompetent in their teaching skills as observed by anatomyfaculty and in many cases were able to demonstrate therequired level of knowledge and understanding of both func-tional and clinically related anatomy as defined by the learn-ing outcomes. Some NP teachers had to be guided on particu-lar areas of anatomy during the session and some asked fac-ulty for particular help at different stages. The end of sessiondebriefing did not highlight specific problem areas and wasused to clarify any points of anatomical confusion and alsoto prepare for subsequent sessions.

Program Evaluation

Figure 1 shows the mean scores achieved for various aspectsof the NP teaching program as identified by the NP teachersthrough an end of program questionnaire (return rate 5100%). In the case of the training and selection event, andthe subsequent training/preparation sessions, NP teachersscored the program 4.5 and 4.6, respectively. All NP teachersexpressed the view that the program had significantlyenhanced their knowledge and understanding of anatomy,scoring a maximum 5.0 and were convinced that the programhad enabled them to develop effective teaching skills (score of4.9). NP teachers also viewed their general oral communica-tion skills to have improved from interactions with the first-and second-year students scoring 4.7. Finally, most NP teach-ers recognized that the program has contributed significantlyto their overall career development plan (score of 4.6).

The NP teacher ‘‘open-ended’’ comments reflected much ofthe statistical feedback with teachers citing the program assuccessful and highly beneficial to their development. Open-ended responses were categorized into common themes withpositive comments grouped into four themes: deeper learning,teaching skills, career development, and enjoyment. Areas forimprovement were divided into three themes: session num-bers, feedback, and training (Table 1). Most NP teachersmade comments on how the program had provided an oppor-tunity to revise and develop their anatomical knowledge andunderstanding with one NP teacher remarking ‘‘I cannotbelieve how far I’ve come since year one and how my anat-omy has improved.’’ Many also expressed the benefit fromthe experience of teaching less experienced colleagues. Therewere fewer responses given in the ‘‘areas for improvement’’but the most prominent of these reflected the usefulness ofthe program with NP teachers requesting further teaching ses-sions. Some NP teachers would like to receive increased feed-back on performance and further training.

First- and Second-Year Observations

Although not formally requested, students receiving teachingfrom NP teachers were encouraged to comment on the valueof having the fourth years present in the dissection sessions.A number of students mentioned the NP teachers in end-of-module questionnaires and in all cases these were of a posi-tive nature with students noting that they were impressed bythe level of knowledge of the NP teachers and found little dif-ference to that of more senior demonstrators. They also com-mented that they had benefited from the increased numbersof demonstrators in the Anatomy Laboratory. Students’ oralcomments made to faculty mirrored those of the results fromquestionnaires with some students remarking that they feltmore comfortable asking NP teachers for help in view oftheir near-peer status and that the level of knowledge dissemi-nated was appropriate. In contrast, several students com-mented independently that some of the NP teachers did notknow the answers to all their questions and were unable tohelp fully with the dissection element.

DISCUSSION

Despite recommendations from the General Medical Council(GMC, 2003) that all medical students should be trained asteachers, formalized opportunities within most UK medicalcurricula for developing teaching skills appears to be limited(Pasquinelli and Greenberg, 2008) with most teaching experi-ence gained informally, usually within a clinical setting andwithout any training or feedback. This is particularly unfortu-nate for those students entering the later phases of theircourses where they will soon be appointed in teaching or su-pervisory roles (Hasit et al., 1997). Indeed one of the keyactivities of a doctor is teaching, whether this is directed atteaching skills or knowledge to colleagues or explaining a di-agnosis or care plan to a patient (Bulte et al., 2007). Enablingstudents at this stage of their studies to engage in some aspectof teaching encourages deeper learning of the subject areawith opportunities to teach being an opportunity to ‘‘learntwice’’ (Annis, 1983) or an alternative strategy for learning(Topping, 1996; Youdas et al., 2008). As most students havelittle or no previous teaching experience, incorporation ofteaching possibilities will hopefully help to re-enforce positive

Figure 1.

All selected NP teachers were asked to fill in formal questionnaires at the endof the program. As a part of the feedback, NP teachers were requested to givenumerical scores (5-point Likert scoring where 1 5 highly negative, 5 5 highlypositive) to specified aspects of the program and its outcomes. Key: training—standard of training and selection event; preparation—usefulness of ongoingsession training and preparation; knowledge—improvement in knowledge andunderstanding of anatomy; teaching—development of teaching skills; communi-cation—improvement in oral communication skills; career—contribution toindividual career development plan. n 5 12 respondents, which equals aresponse rate of 100%.

230 Evans and Cuffe

attitudes toward teaching, prepare students for continued andindependent self-learning, and direct their communicationskills toward effective transfer of understanding to patientsand colleagues. Some medical schools have developed activ-ities to promote teaching experience with peer teaching beingrecognized as one particular technique and used to train less-experienced colleagues in areas such as clinical examinationskills (Gill et al., 2006; Buckley and Zamora, 2007; Evansand Canavan, 2008). This study examined the implementa-tion of a near-peer teaching program in anatomy where moreexperienced medical students acted as NP teachers to first-and second-year medical students. Analysis focused on thesubsequent perceptions of the NP teachers as to the effective-

ness of such a method for encouraging their deeper under-standing of anatomy and advancing their teaching skills.

Questionnaire feedback demonstrates that the studentsundertaking the role of an NP teacher in anatomy at BSMSviewed the opportunity in a positive way and the programwas found to be a useful experience in developing their ana-tomical knowledge and understanding and their teachingskills. The program appeared to be a popular development asdemonstrated by initial expressions of interest being submit-ted by almost 50% of the student cohort and the subsequent25% who took part in the training and selection event. Inter-est was not restricted to those students with surgical or radio-logical career aspirations and most students commented that

Table 1.

Open-ended Questionnaire Responses Categorized into Common Themes

Category ThemeNumber ofcomments Selected comments

Positive

comments

Deeper learning 9 The program allowed me to refresh and

deepen my knowledge of anatomy through

teaching younger students.

I have greatly improved myanatomical knowledge.

It helped me clinically as anatomy is

fundamental and has definitely increased

my understanding.

Teaching skills 7 I am developing my basic teaching skills,

which can only be a positive for my future career.

As an aspiring surgeon, it has been

very useful to develop my teaching skills.

Reward from being able to help someone understand

anatomical principles and ideas.

Career

development

6 I feel this experience will

help me get into a career in surgery.

Experience on this program is a great

asset for early career development.

Enjoyment 4 Extremely enjoyable experience and nice

to interact with senior demonstrators.

I enjoyed this innovative experience.

Areas for

Improvement

Session numbers 5 The only issue is the small number

of sessions each student gets.

More sessions please.

Feedback 3 If possible it would be useful to receive more

detailed feedback from the students so we can see

where we need to improve.

It would be helpful to have increased feedback as I amkeen to develop my teaching style.

Training 2 Possibly more help with guiding the dissection as

I felt less confident taking the student through the

dissection.

Anatomical Sciences Education SEPTEMBER/OCTOBER 2009 231

the opportunity to both re-enforce their anatomy and developteaching skills (important for their future practice) were thekey drivers behind their participation. The program appearedto meet their expectations with NP teachers indicating thatthey had gained an improvement in their anatomical knowl-edge during the teaching preparation stage and most com-mented that the face-to-face teaching had resulted in themevolving a deeper understanding of anatomical principles andconcepts. Whether this perception of a deeper understandingwill be evident at a later stage when the NP teachers progressthrough later stages of their training is unclear. Therefore,future evaluation will be necessary. Many NP teachers recog-nized that the ability to teach is an essential aspect of theirfuture career and felt that the program has created an idealopportunity to develop some teaching skills. Although manyNP teachers expressed nervousness before each session andwondered whether they were adequately prepared, mostfound the experience to be rewarding.

First- and second-year student perceptions of the NPteachers were positive and feedback indicated that the stu-dents interacted equally well with NP teachers and the moreSenior Demonstrators. Students found the level of knowledgeof the NP teachers to be appropriate in almost all casesalthough two students commented independently that someof the NP teachers did not know the answers to all theirquestions. It is important that students recognize that teachersdo not always know the answer to every question and stu-dents should be encouraged to discover answers for them-selves. Incorporation of a series of questions within the work-sheet is aimed at making students think about the relevanceof the anatomical region they are studying, but the outcomesof the feedback demonstrates that further guidance on a self-directed learning route in anatomy might be required. It wasexpected that the NP teachers’ level of knowledge would beweaker than that of more experienced demonstrating staffand, therefore, it was not viewed negatively by the faculty ifNP teachers were unable to answer some questions posed tothem. NP teachers had been advised not to step outside theirlevel of knowledge and this, therefore, acted as an importantrepresentation by the NP teachers of the guidance given bythe General Medical Council for demonstrating good medicalpractice (GMC, 2003) and the need to recognize when toseek appropriate help. The class attainment in anatomy wassimilar to previous years’ averages suggesting that the inclu-sion of the NP teachers had not impacted negatively on stu-dent learning and may have had positive affects on some stu-dents particularly as some found they were more comfortableasking NP teachers for help. Peer and near-peer teachers havebeen recognized to be better in understanding particularlearning difficulties faced by other students because of theirmore recent exposure to and experience of the material beingstudied (Brueckner and MacPherson, 2004; Lockspeiser et al.,2008) and this may lead to a more effective learning environ-ment for some students and create cognitive congruence.

The positive response from the first set of NP teachers wasgenerally encouraging and suggested the program could servea role in the professional development and anatomical learn-ing of these individuals. While these first participantsappeared to enjoy the experience it must be recognized thatnot all future participants may feel the same and may have aless successful experience. Following the program they mayfeel less confident about their anatomical knowledge, moreself-conscious about their ability to convey information toothers and find the teaching element intimidating. A further

potential downside to the program would be if participantsviewed this as their only opportunity to refresh their anatomi-cal knowledge and not embark on continued self-directedlearning. The perceived ‘‘endorsement’’ of the NP teachershas led to the continuation of the program for a second yearand once again there has been a similar level of interest fromfourth-year students and the training and selection event hasbeen oversubscribed. The second iteration of the program hasprovided an opportunity for the ‘‘areas for improvement’’identified by some NP teachers to be looked at. Theseincluded the need for increased feedback opportunities,enhanced training, and additional teaching sessions. Whilethe standard of the NP teachers, as assessed by the faculty,was deemed to be of a competent level, a more formal peerobservation process has now been developed whereby the fac-ulty member in charge of each session will spend a short pe-riod of time with each NP teacher to assess directly theirinteractions with students and their level of relevant knowl-edge. Within the subsequent debriefing period, faculty canfeedback areas of good practice to the team and those aspectsthat need further development.

The Senior Demonstrators have taken responsibility forfurther training opportunities and will provide additional(voluntary) sessions for NP teachers to go through the teach-ing outcomes for each session and to explore prosected mate-rial in greater detail. The resident prosector will also be onhand to provide guidance on each dissection. However, theemphasis will remain on the NP teachers to direct their ownanatomical learning. In view of the desire to give an appro-priate number of fourth-year students the opportunity to actas NP teachers and given the first- and second-year class size,the presence of the senior demonstrators and the size of theanatomy laboratory, it has not been possible to improve onthe number of sessions available to each NP teacher. Each NPteacher, however, is able to take on between five to eight ses-sions depending on their availability. In the first iteration ofthe program, NP teachers took part in a number of sessions,most of which were unrelated to each other and were not se-quential. Emphasis has now been placed on NP teachers dem-onstrating in several successive sessions within a module toprovide continuity in their learning of a particular body sys-tem and to encourage them to use self-directed learning inthose areas which are not part of their teaching experience.There are additional opportunities being developed for theNP teachers in other undergraduate degree courses and wid-ening participation programs currently taught by the Anat-omy Department. While the main objective of the NP teach-ing program was to provide opportunities for more experi-enced students to interact with less-experienced students andto expand their own knowledge and establish some teachingproficiency, the program also provided an additional valuableand appropriate resource to BSMS for teaching anatomy.

CONCLUSION

In conclusion, this study demonstrates a way of incorporatingnear-peer teaching into medical curricula to provide opportu-nities for more experienced students to further develop theiranatomical knowledge and to advance their teaching skills.The development of a near-peer teaching program for fourth-year medical students has proved to be a useful innovation atBSMS and has enabled students to be given hands-on teach-ing experience as they move nearer toward taking on the su-

232 Evans and Cuffe

pervisory and teaching duties that are a part of the doctor’srole. Feedback from participants suggests that the programfulfills its aim of providing a forum for encouraging deeperlearning in anatomy. However, only time will tell if deeperlearning has really been achieved and it will be necessary toassess the level of anatomical knowledge and understandingof NP teachers as they move through later stages of theirmedical training.

ACKNOWLEDGMENTS

The authors thank the near-peer teachers for their thoughtfulengagement during the evaluation process, Alison Bryson forhelping to develop the selection criteria, and Lisa Costick foradministering the training program and help during the sub-sequent evaluation. They are also grateful to some of our stu-dents for agreeing to appear in the cover image.

NOTES ON CONTRIBUTORS

DARRELL J. R. EVANS, B.Sc., Ph.D., F.H.E.A., M.I.B.M.S.,is a professor of anatomy and developmental tissue biology,Head of Anatomy and the Associate Dean at Brighton andSussex Medical School, Brighton, UK.

TRACY CUFFE, B.Sc., M.Sc., is a prosector in anatomyat Brighton and Sussex Medical School, Brighton, UK, andan education officer for the Institute of Anatomical Sciences.

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