2. 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”
3. 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.
4. 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
5. 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
6. Why do reflections?
re ectere –fl bend back
Development of ‘expertise’ – requires more than just
knowledge
Inform future actions
Reflection = deeper learning, new knowledge integrated
with existing knowledge and skills
8. Reflections
Gibbs’ Cycle:
7. Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Educational
Unit, Oxford Polytechnic.
9. 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
10. Venepuncture – simple?
Performed many times in practice
Practiced twice in SDL area beforehand
Feelings: nerves!
Evaluation
Ran the session with another PAL – confidence+++
“rollercoaster of experiences, emotions and thoughts”
Inspiring experience
Identity -> medical educator?
Chris: the first teaching session…
11. 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
12. New skill session – C21 curriculum
= difficult to prepare thoroughly for (cf. venepuncture)
Feelings: more confident, some apprehension -> new skill
Evaluation
Confidence building – ability to facilitate an ‘unknown’
session
Ability to answer (and not answer) questions from students
Chris: C21: drug
calculations/discovery tasks
13. 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
14. 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”
15. 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
16. 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
18. 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.
Notes de l'éditeur
Similar social groupings – helping each other. Not about a hierarchy / teacher-student power relationship
PAL – since late 1980s (students as educators + solution to limited resources & staffing)
PAL in communication skills - Glynn et al (5th years running role-play sessions for 2nd years)
“positive effects on examination scores, student satisfaction and personal and professional development”
First described within the field of clinical skills teaching in 2007
90% of trainees (learners) rated PAL highly;
86% of students wished to become trainers.
79% of students perceived that PAL training could improve examination skills
Pilot programme ran in 2011/12 at Cardiff University was immediately successful with students, PALs and faculty staff.
GMC advocate the role of students as teachers and educators in Tomorrow’s doctors
Rated highly – Field, Lau et al (Cardiff) and repeated elsewhere
“reciprocity” – no hierarchy / power imbalance
PAL tutors – approachable, understanding, know what its like to be in their shoes, students ask a lot about OSCEs etc
Tutors gain competence as teachers – gain confidence in teaching small groups and explaining new tasks
Outcomes ? – no difference in examination results
Many definitions
“a generic term for those intellectual and affective activities in which individuals engage to explore their experiences”
“active, persistent and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it”
Reflection has key role in Kolb’s experiential learning cycle. Kolb cycle does not expand on reflection, but attempts to locate it in a sequence of activities. Vital for activities process of learning. Spiral – cycle can be repeated many times.
Metacognitive process, ie – ‘thinking about thinking’
I <3 reflection
Deep learning, imform future development as medical educators, lifelong skill for healthcare professionals – reflective practitioners
Highlight of med ed degree
Chris reflection 1
Nerves settled rapidly as had already seen this session run twice with the 2nd years – once shadowing and once doing. Able to answer students’ questions, as had learnt a lot from previous 5th years PALs / other tutors.
One student asked the nurse practitioner in quite a sarcastic and arrogant tone whether in reality people did actually wash their hands and bother to keep everything so clean on the wards – shocking from a first year
The other really struggled to follow any of the instructions even though being shown one by one – assembling equipment / drawing up meds / giving injection
Not yet assessing clinical performance skills in these first years, only teaching them the correct methods to achieve clinical competence (Newble 1992). Thought it may also be helpful to look at professionalism. Finn et al (2010) – can be switched on – indeed unlikely the first case that he would have posed the same questioned to a consultant or nurse on the wards. In relation to Lave & Wenger’s situated learning heory – perhaps first year students do not feel any central participation and therefore cannot conceptualise the importance of achieving competent and professional behaviour in the clinical skills lab. Must note this is the minority of students (but the ones that get all the attention in the debrief!
Consider by role as a PAL and how the students see my role, especially the 1st years. Can be quite hard to balance being a peer and a friend with the role of a respected tutor – ideal is to achieve both of course.
Chris reflection 2
First time teaching this skill – did not know if there would be a particular way to teach it (like injections); fear of not getting blood during demonstration. Watched 1st and demonstrated for 2nd group. Luckily had a nurse practitioner and 2 5th year PALs there so felt very well supported. Sometimes feel guilty that I am less experienced than other tutors and that perhaps students would learn better from them.
Can be difficult to support students who need more guidance one-on-one without singling them out from the rest of the group.
Vygotsky’s theory of the zone of proximal development, sometimes referred to as scaffolding claims that with support, for example from more experienced peers, students can master concepts and skills that they would not have been able to understand in isolation. For me, this underlines the value of PAL tutoring and peer mentoring.
Scaffolding – idea of supporting them so that in the end they can do it themselves was a helpful way to conceptualise how I can support students one-on-one, and what the purpose of that is.
Chris and Camille – add from reflections
Add to this?
Add ?
Look how scholarly we are with all these references. Anstey would be proud.
