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.