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Peer Assisted Learning in Sophomore Anatomy & Physiology II

Laboratory: an Ultrahybrid Design

George A. Steer PhDMichael L. Slaughter MS

Kimberly Whiter MSChase Poulsen PhDElliot Carhart PhD

Peer Assisted Learning in Sophomore Anatomy & Physiology II Laboratory: an

Ultrahybrid Design• Discussion

• Personal experience(s) with peer tutors?• Successes• Problems• Courses

• Sciences vs. Humanities

IntroductionOur Considerations

• Anatomy & Physiology • Required by essentially all programs of study• Lack of success in sequence of scheduled program delays full

progression for one year• AS programs - freshman course

• Interprofessional Education• Institutional and Organizational commitment • Virginia Tech Carilion School of Medicine and Jefferson College

of Health Sciences – Physician Assistant & MS Nursing

• All undergraduate students will be working in teams after graduation • IPE team building courses – upper level courses @ JCHS

• Introduces interprofessional team care at earliest stages of academic development

• Makes the lab tangible – somebody does this every day• Why do I care• Get through Dr. Steer’s lab so I can move on

IntroductionReal Attachment

IntroductionNational perspective

• Student success in undergraduate A&P is a focus of many institutions - nationally• Foundational course for all health professions

• Attrition rates are as high as 40-70% in basic science courses despite increasing SAT scores and admission GPA

• Two methods to improve student success in A&P are • required or voluntary recitation sections • Peer Assisted Learning (PAL)

IntroductionPeer Assisted Learning

• Student acceptance, recommendation and benefit from PAL has been empirically established across math and some science disciplines

• PAL is characterized by three different methods; • a) “same-level equal status” students of the same class with equal

knowledge• b) “same-level unequal status” students of the same cohort but

with unequal expertise and/or training - higher performers in the course and,

• c) “cross-level“ students of higher academic level, upperclassmen, tutor students of lower academic ranking, underclassmen. Previously taken the course and performed well.

Same Level Equal & Unequal Status

• No improvement in lecture examination performance in gross anatomy

• Requires significant faculty time for preparation of the student tutor – ensure consistent information delivery

• Students described concern over the inadequate teaching performance of the tutor

• Undergraduate human A&P student concerns• miscommunication, delivery of erroneous information and

inability to stay on task

Cross Level Peer Tutors

• Physician and nurse practitioner programs in the UK have positive outcomes and views of clinical training activities

• Still requires significant time for faculty preparation of the tutors

Hybrid Cross Level Peer Tutor

• We created a variation of Cross Level Tutors using students from several health care professional programs

• Students from various health professional programs assist in the anatomy and physiology II laboratories

• Peer tutors have displayed competency in laboratory exercises within their professional programs – technical experts in the exercise• Eliminates the vast majority of faculty time investment for

tutor preparation

• This study piloted a hybrid PAL activity where educators and students from various health professions programs delivered and assisted in A&P II lab exercises

• The educator and student tutors delivered discipline-specific information during four standard laboratory exercises


• Tutors participate in laboratory activities where they are the discipline specific expert• Medical Laboratory Science

• Blood typing, blood cell differentiation and urinalysis• Emergency Medical Science

• Blood pressure, ECG• Respiratory Therapy

• Breathing & Respiratory Volumes


Goals

• Promote the institutional philosophy of interprofessional education activities while utilizing current resources to improve the student learning experience

• Assess students’ recognition of the direct applicability of

the laboratory activity to healthcare practice and the professional who performs the procedure

• Assess the students’ perspective on the benefit of PAL to understanding the principles of the exercise

Methods

• Three A&P II laboratory sections participated in the study; • a control group (n1= 24) with a professor to student ratio of 1 to

12-20 received standard content delivery

• an intervention group PAL (n2 = 17) that had a tutor to student ratio of 1:4 plus 2 faculty members. • The PAL group had a faculty member and five student tutors

from either the Medical Laboratory Science, Respiratory Therapy or Emergency Services programs

Methods

• At the end of each laboratory session both groups completed a seven question survey (6 pt Likert), to assess students’ perception of the laboratory activities

• Survey was developed by an expert panel using a consensus approach

Please indicate your agreement or disagreement with each of the following statements using the following scale - circle your answer below each statement

Strongly Disagree; Disagree, Somewhat Disagree; Somewhat Agree; Agree and Strongly Agree

1. This lab exercise was beneficial to my understanding of the material.

2. I received an appropriate amount of individualized attention to learn the material during this lab exercise.

3. I do not understand how the content of this lab exercise is applied to “real life” health care situations.

4. I am able to recognize which health professions utilize the content of this lab exercise within their scope of practice.

5. The content of this lab exercise did not reinforce the knowledge covered in lecture.

6. The content covered in this lab exercise is relevant to my future clinical practice.

7. I believe the Pre-Laboratory assignments were useful for understanding and comprehension of the material.

Results• Independent-sample t-test s indicate a significant

difference between groups within Survey Question (SQ)1,2, and 7. See Fig. 1. These included: • (1) “This lab exercise was beneficial to my understanding of the

material”• (2) “I received an appropriate amount of individualized attention to

learn the material during this lab exercise”• (7) “Rate the pre-laboratory assignments with respect to the

usefulness for understanding the material”

• Students approached a significant difference in recognizing which profession performed the procedure (p=.071) and its application to their future clinical practice (p=.095).

4.4

4.6

4.8

5

5.2

5.4

5.6

5.8

SQ1 (p=.037) SQ2 (p=.028) SQ7 (p=.017)

PAL Control

Fig 1.

Faculty Comments• Preparing labs required planning time with the

professional students, but proved to be a great student learning experience

• The Medical Laboratory Science labs required some theory delivery, to A&P student prior to performance of activity, which was provided by the faculty with the aid of professional students

• PAL activity greatly increased interactions within the groups of students. Students from different plans of study conversed in a focused manner to deliver the contents of their activity.

Discussion

• We were able to design a program which: • Dramatically reduced the instructor to student ratio

• Upgrades 2 laboratory sessions from “paper” to hands on; lung volumes and ECG and expand others.

• Assess the students’ perspectives of key components of their educational experience

• Incorporates interprofessional education and awareness and clinical application of laboratory exercises into the earliest stages of the students’ pre-professional academic development.

• Obstacles• Scheduling and availability of faculty and students

• JCHS not possible• Cost, although minimal for this study, would be increased if all

sections were included. Larger institution a real consideration

• Limitations of the study• Population (age, academic development) , class size, and

location• Survey question #5 - actual lecture and lab coordination – too late

• Assumptions • equality of professor(s), students, and content - to enable group

comparisons.

Discussion

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RoutledgeFalmer; 2001. • Bently BS, Hill RV. Objective and subjective assessment of reciprocal peer teaching

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• Hughes K. Peer-assisted learning strategies in human anatomy and physiology. Am Biol Teach. 2011 Mar;73(3):144-147.

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