Peer-assisted learningfrom three perspectives:student, tutor andco-ordinatorElspeth Hill, Francesca Liuzzi and James Giles, School of Medicine, The University ofManchester, UK

SUMMARYBackground: Peer-assisted learn-ing (PAL) involves medicalstudents teaching other medicalstudents. Although the concept isnot new, formal PAL is a relativelynew development in medicaleducation.Context: PAL Manchester is apeer-assisted learning schemethat has run for over 6 years atSalford Royal NHS Foundation

Trust. It is a student-led schemethat teaches clinical skills tomedical students in years 3–5 ofthe Manchester curriculum. Thescheme comprises small groupsessions of 12 students and twopeer tutors.Innovation: Here, we presentthe experiences of PAL Man-chester from three perspectives:student (Francesca Liuzzi), peertutor (Elspeth Hill) and student

co-ordinator (James Giles).These accounts illustrate theroles within PAL Manchesterand the personal benefits thatmay be derived from such ascheme.Implications: Different roles formedical students can bedeveloped within a PAL scheme,presenting differentchallenges and benefits toparticipants.

Different rolescan be

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244 � Blackwell Publishing Ltd 2010. THE CLINICAL TEACHER 2010; 7: 244–246

INTRODUCTION

Peer-assisted learning (PAL) isthe concept of studentsteaching other students. This

has undoubtedly occurred infor-mally in medical education sincetime immemorial. Recently agreater interest in using peertutors in medical education hasdeveloped. Many models of PALare described in the literature.PAL Manchester is one suchscheme that has been running forover 6 years at Salford Royal NHSFoundation Trust. It is entirelystudent led and uses tutors drawnfrom clinical students to teachclinical skills to other students.PAL modules include peripheralvascular examination, neckexamination and fluid manage-ment. Scheme modules are smallgroup sessions with 12 studentsand two peer tutors, and peertutors are generally 1 year seniorto students in the medical course.Consultants from the relevantfield review the teaching andlearning material, and peer tutorsreceive training in the relevantskills to assure the quality of thesession content.

During the past 6 years thescheme has expanded, and withthis there has been the need tochange the organisational struc-ture. Here, we each reflect on thedifferent roles and experiences

that have emerged as a result ofthe scheme. Of course thesereflections are three personalopinions, and different peoplemay have differing experiencesand opinions of PAL in general,and of the Manchester scheme inparticular.

THE STUDENT’SPERSPECTIVE: FRANCESCALIUZZI

Before attending my first PALsession I was apprehensive for anumber of reasons: I was worriedthe students might give usincorrect information; that Iwould not know answers andembarrass myself in front of mypeers; and that the session wouldbe too basic and a waste of mytime. In fact, my worries weremisplaced and the session wasextremely useful.

Led by peers a year ahead ofus, the session was pitched atexactly the right level – I under-stood the content but stilllearned something new, despitehaving attended a previousconsultant-led session on thesame subject. The previoussession gave me the knowledge torecognise that the PAL teachingwas correct. It was also evidentthat a lot of preparation had goneinto the session: doctors hadcollaborated extensively with thestudents to design the learningmaterials. I now have a lot ofconfidence in the quality of PALsessions and the ability of peersto act as tutors.

One major advantage to stu-dent-led teaching was the oppor-tunity to discuss how the contentmay be presented to us in anobjective structured clinicalexamination (OSCE). When deliv-ered by consultants, teachingtends to relate to clinical practicealone, and sometimes the under-lying science is omitted and myunderstanding suffers. Effectiveclinical practice is the ultimategoal; however, an appreciation of

how the content relates to ourexaminations made it relevantto our stage of training, andtherefore easier to remember.

This particular session was onfluid balance, and emphasised thebackground physiology. One sug-gestion I would make about thePAL sessions is to include morepractical skills, such as cannula-tion. However, the session wasalready long enough, and includ-ing more material may be detri-mental. Overall the session was ofhigh quality and those deliveringit were keen and well informed.I look forward to my next sessionwith PAL.

THE STUDENT TUTOR’SPERSPECTIVE: ELSPETHHILL

My motivation to get involvedwith the PAL scheme stemmedfrom a combination of wanting toimprove my teaching and alsoreally benefitting from attendingthe PAL sessions when I was inthe third year. The tutors didn’tseem to be the world’s mostamazing medical students. It wasreassuring that they had pro-gressed to fourth year, and thatthey were willing to help me dothe same! I think they gave methe edge in my OSCEs, and Iwanted to do the same forstudents in the year below me.Although it takes up a lot of time,it is very satisfying when asession goes smoothly. I think mypresentation skills and teachingskills have improved.

My initial trepidation was nothaving sufficient knowledge, andbeing asked questions that werebeyond me. Being only a yearahead of the students in thetutorial meant I had misgivingsabout being on a high enoughacademic level to be a usefulteacher. I was really surprisedwhen I did my first session – thequestions students asked seemedquite basic, and easy for me toexplain the answer. Often consul-

I was worriedthe studentsmight give usincorrectinformation[and] that Iwould not knowanswers andembarrassmyself

� Blackwell Publishing Ltd 2010. THE CLINICAL TEACHER 2010; 7: 244–246 245

tants answer questions in a waythat isn’t always very relevant tome. I try to pitch the informationat the right level for third years –I know what they need to know topass the exams, and I also knowwhere they are up to in theircurriculum, so I can appreciatewhich areas they have alreadystudied.

I also realised it is absolutelyfine to admit that I don’t knowthe answer. In fact, when Idon’t, it often seems like arelief to the students, and theybring up other questions andtopics they don’t understand. Itcreates an informal environmentand can initiate a gooddiscussion.

On a personal level, I think Ihave gained a lot from being aPAL tutor. Not only do I enjoy thesessions, but it has been reallygood teaching experience. It hasalso been great to work in a groupwith my peers creating the ses-sion content, presentation slides,videos and teaching plan. It hastaken a lot of organisation andteamwork, especially recruitingdoctors and experts to help us,but has been rewarding. The mostchallenging aspect has beendeciding what to include, andidentifying the key knowledgeand skills relevant for that stage.I am a passionate advocate of thePAL scheme – I have gainedenormously from it both as a tutorand a learner. I would stronglyencourage others to get involvedin similar schemes, even in just aninformal manner.

THE STUDENTCO-ORDINATOR’SPERSPECTIVE – JAMESGILES

This year is my third year ofinvolvement with the PAL schemein Manchester, having previouslybeen a student and a peer tutor.With the continued expansion ofthe scheme, it became clear that aco-ordination role would be nec-essary to ensure communicationbetween different session teams,and to provide a focal contactwithin the scheme for the medicalschool.

PAL provided me with my firstexperience of chairing meetings. Ifound myself facilitating dia-logue on subjects such as expan-sion of the scheme, studentsatisfaction and quality assur-ance. It is vital to provide aforum where the three groupscan share ideas, experiencesand challenges together tobetter the scheme.

One of the major challengesfacing the scheme was selectingnew peer tutors. Last year overtwo-thirds of the year groupapplied to be a PAL tutor, whichwas brilliant, but overwhelming.We had a really skilled anddiverse group of students apply,many with a strong interestand background in teaching. Wehad to decide what qualities wewere really looking for in a peertutor, which led to some veryheated debate! We tried toassemble three teams with a

balance of skills to complementeach other. Fundamentally wewanted students who coulddemonstrate strong motivationand commitment, coupledwith enthusiasm for teaching.This was in part based onstudent feedback on previousPAL tutors.

Acting as medical school liai-son has also been important. Ihave been met with enthusiasmby the undergraduate team, whichhas been vital for our success. Itis more challenging than I firstthought to maintain open chan-nels of communication, so thatthe faculty members know whatwe’re up to.

Without the responsibilities ofteaching, I have also been able topursue an active programme ofresearch and audit within thescheme. I began to engage withthe published literature on thetopic, to see how we coulddevelop the scheme in view of theexperiences of other medicalschools. The medical educationresearchers helped me realise thatthe scheme could become thefocus of a programme of actionresearch.

CONCLUSIONS

Formal PAL is a relatively newdevelopment in medical educa-tion. Different roles for medicalstudents can be developed withina PAL scheme, each posing theirown challenges and benefits toparticipants.

Corresponding author’s contact details: Mr James Giles, Neurosciences Research Group, AV Hill Building, The University of Manchester, OxfordRoad, Manchester, M13 9PT, UK. E-mail: james.a.giles@student.manchester.ac.uk

Funding: None.

Conflict of interest: None.

Ethical approval: This paper does not describe research on human subjects and therefore ethical approval was not deemed necessary.

I try to pitchthe information

at the rightlevel. I know

what they needto know to passthe exams, andwhere they areup to in their

curriculum

246 � Blackwell Publishing Ltd 2010. THE CLINICAL TEACHER 2010; 7: 244–246