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Abstract Background Peer-assisted learning (PAL) has been widely implemented for many years worldwide. To further enhance the understanding of available data, a scoping review of systematic reviews was conducted to synthesize existing evidence on the effectiveness of PAL in health professional education, aiming to provide more comprehensive outcomes. Methods Nine databases were systematically searched. The review process was guided by the five-stage scoping review framework proposed by Arksey and O’Malley. The JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses was used to assess the methodological quality. The results were narratively synthesized and reported following the Context, Input, Process, and Product (CIPP) evaluation model. Results 24 systematic reviews (including nine meta-analyses) were included. The majority of these reviews were synthesized using narrative analysis. The application of PAL in health professional education was developed. In the context of evaluation, support for the theory, problem-based drivers, and the need to develop teaching and assessment skills for students were the main reasons for the development of PAL. Inputs for PAL predominantly centered on tutor recruitment and tutor training. Common activities within the PAL process encompassed peer teaching, peer tutoring, peer feedback, peer simulation, peer discussion, peer-led debriefing, peer supervision, and curriculum design. Outcomes of PAL were categorized across peer tutees, peer tutors, health professional educators, and challenges of PAL. Conclusions Despite certain challenges, the reciprocal benefits of PAL for peer tutees and tutors are evident. It is recommended that relevant institutions should consider incorporating PAL into the curriculum for health professional students. Future research should aim to develop a more rigorous framework to determine the short- and long-term effects, cost-effectiveness, and generalizability of PAL in health professional education.

Abstract Background As ultrasound is one of the most utilized imaging procedures in clinical practice in Germany, its integration into undergraduate medical education is imperative. Thereby, the limited availability of qualified instructors is a major challenge. Peer tutors, who are trained to instruct their peers collaboratively, could resolve staff constraints. This systematic review explores the literature on peer teaching in undergraduate ultrasound education, aiming to provide an overview of methodologies, outcomes, and peer teacher training concepts. Methods Following the PRISMA guidelines, a systematic literature review was conducted on the subject of peer teaching in undergraduate ultrasound education. Using PubMed and Google Scholar as databases, studies in English or German involving training concepts for peer teachers in undergraduate ultrasound education, published up to November 21, 2023, were included. Data extraction of original studies followed the PICOS schema with special respect to didactic concepts of peer tutor training programs and the effectiveness of peer teachers compared to faculty instructors. A modified version of the Newcastle–Ottawa Scale (NOS) was used to assess the quality of included studies. Results Finally, the search resulted in 20 relevant original studies, including 16 studies exploring peer teacher training concepts. Predominantly, peer teachers studied in their 4th year of medical school and on average one year further compared to their students. Peer teacher training was integrated into curricula by course-based concepts (93.8%) and internships (50.0%). Didactic modalities varied, encompassing laboratory rotations including the scanning of patients, the scanning of fellow students, lectures, and didactic training. The median training duration was about ten days. Of six comparative studies, five found peer-assisted learning to be comparably effective and one even better than faculty-led courses. Conclusion Despite the growing amount of literature underlining the effectiveness and wide application of peer teaching in ultrasound education, training concepts stay heterogenous without a standardized system for training and qualifying peer teachers. Developing comprehensive guidelines for peer tutor education could increase acceptance and recognition of peer-assisted learning and ensure minimum training standards.

Abstract Introduction/Background Peer-led teaching sessions (PLTS) supplement conventional medical education, allowing students to share knowledge effectively. PLTS have shown significant academic benefits for student instructors. However, the impact on attendees, especially concerning NBME-style examinations, remains underexplored. Methods This study analyzed de-identified data from 67 first-year medical students at Kirk Kerkorian School of Medicine, divided into PLTS attendees (study group) and non-attendees (control group) based on session participation. Data were collected before two NBME examinations, with attendees defined as those attending at least five Peer-led teaching sessions. Academic performance was measured using NBME Customized Assessment Services (CAS) exam scores. Statistical analyses, including p-tests, chi-square, and t-tests, assessed differences in performance and potential biases based on MCAT scores, first-generation status, and socioeconomic background. Results The study group initially had 26 students, and the control group had 31 students. Post-first examination, the study group adjusted to 22 students, and the control group to 35 students. MCAT scores and demographics showed no significant differences between groups. The first examination revealed a significant higher score in PLTS attendees’ scores (4.28% increase, p = 0.036), indicating a positive impact of PLTS on basic science knowledge. The second examination on organ systems physiology showed no significant difference (p = 0.722). Discussion PLTS effectively enhance foundational science understanding but may be less impactful for advanced topics. The diminishing effect may result from increased use of diverse study resources and adaptation to medical school. Future research should explore long-term benefits, optimal implementation strategies, and the impact of instructor quality and engagement. Therefore, the overall conclusion is that PLTS positively influence NBME-style exam performance in early medical education, but benefits decrease over time.

Abstract Background Peer tutorials are widely used in medical and health professions education. Some evidence suggests that peer tutorials can have positive effects for student peer tutors and tutees alike. To promote these positive effects, peer tutors are often prepared for their tasks. However, detailed information about this preparation is missing in the literature. The present study thus examines from the tutors’ perspective how peer tutor preparation is conducted, both in interprofessional and uniprofessional contexts, and how this preparation affects peer relations. Methods A qualitative design was used for the study. For data gathering, three online focus group discussions were conducted with student peer tutors from uniprofessional and interprofessional settings who had a background in health professions. Data were analysed inductively via thematic analysis. Results A total of 19 individuals participated in three focus group discussions (n = 6/n = 6/n = 7). From the participants’ perspective, preparation measures were heterogenous. Of a wide range of different measures, some were perceived as more helpful, others as less helpful. In analysing the data, three relevant themes came up which were dereived from the peer tutors’ perspective: roles, eye level, and (self-)trust. All three themes were found to be closely related and appeared to have a direct influence on peer relations. This influence on the learning/teaching process was either positive or negative depending on the respondents’ experiences. Conclusion From the peer tutors’ perspective, the preparation they received affected their relationships with their peers in a variety of ways, influenced by the context and the peer tutors’ needs. This finding should be taken into account when planning and implementing future preparatory activities. In addition, further pedagogical considerations and discussions about preparatory activities for peer tutors and their potential impact on social and cognitive congruence are needed.

Abstract Background Work-integrated learning (WIL) is a core aspect of allied health education. WIL placements typically focus on developing clinical skills, with broader conceptions of work readiness a secondary consideration. Near-peer mentoring (NPM), where senior students mentor junior students, is one WIL placement model that holds promise for developing students’ work readiness, along with additional benefits for educators and service users. While there is emerging evidence of the benefits of NPM in allied health, a more comprehensive understanding of the design and outcomes of NPM WIL placements for allied health students, their educators and service users is needed. Methods A systematic search of seven electronic databases (CINAHL, ERIC, ProQuest Education, Medline, PsychInfo, EMBASE and Scopus) from 2003 to 2022 was conducted with 4195 records reviewed. Included studies reported on near-peer mentoring between at least one of the identified 11 allied health professionals providing services to real people (i.e. not simulation). Data extracted included pedagogical approaches, type of service model and relationship of peers to each other and educator, objectives for implementing the NPM, and effects for students. Quality appraisal was undertaken using the Standards for Reporting of Qualitative Research (SRQR). Results Fourteen studies met the inclusion criteria. The majority were North American in origin, from the disciplines of pharmacy, physiotherapy, psychology and occupational therapy, and used a range of research designs. Four types of placement design were observed from incidental co-location of students and observing outcomes through to deliberate preparation of students and/or educators for their roles in a NPM placement. Outcomes for junior students included lowered anxiety leading to increased confidence and motivation to learn and thus enhanced clinical skills. Senior student outcomes included development of educator skills, increased confidence, and enhanced professional reasoning. Service users and educators also benefited from NPM; however, evidence was sparse in these areas. Conclusion The evidence supports near-peer mentoring as a valuable WIL model to support work readiness, and several general pedagogical designs are evident. Future research should design NPM WIL with a greater integration of educational theory and evaluate outcomes beyond satisfaction and self-reported experiences.

Abstract Introduction In response to the COVID-19 crisis, this study aimed to introduce a new virtual teaching model for anatomy education that combines Peer-Assisted Learning (PAL) and flipped classrooms, aligning with constructivist principles. Method The Flipped Peer Assisted (FPA) method was implemented in a virtual neuroanatomy course for second-year medical students at Birjand University of Medical Sciences via a descriptive study. The method involved small groups of PAL, with peer learning serving as educational assistants and the teacher acting as a facilitator. Educational content was uploaded to the university’s learning management system (LMS). The opinion of medical students regarding the teaching method were evaluated using a 15-item questionnaire on a five-point Likert scale. Results A total of 210 students participated in the instruction using the FPA method. The analysis of students’ scores revealed an average score of 26.75 ± 3.67 on the 30-point test. According to student feedback, this teaching method effectively motivated students to study, enhanced teamwork and communication skills, transformed their perspective on the anatomy course, provided opportunities for formative assessment and feedback, and demonstrated the teacher’s dedication to education. Conclusion The FPA model demonstrates its effectiveness in transforming traditional classroom teaching and fostering teaching and learning in virtual environments, particularly during pandemics like COVID-19. This model holds promise for enhancing anatomy education in challenging circumstances.

Abstract Aim The transition from medical students to competent physicians requires comprehensive training during residency programs. In China, resident students typically undergo 2- or 3-year training programs. While they learn from patient interactions under the guidance of experienced doctors, integrating theoretical knowledge from textbooks into practical cases remains a challenge. This study aimed to explore the impact of medical interns acting as peer-students on the knowledge mastery of resident students. Method The participants of this study consisted of resident students specializing in respiratory medicine at the Second Affiliated Hospital of Zhejiang University, School of Medicine. Resident students were given the opportunity to volunteer as peer-teachers for medical interns in the respiratory department. Those who chose to instruct interns were automatically placed into the test group, while those who opted not to partake in intern instruction formed the control group. In their role as peer-teachers, resident students assumed the responsibility of guiding interns in patient management throughout the entire continuum, spanning from initial engagement to discharge, a commitment that extended over a minimum period of 2 weeks. The resident students' academic performance was evaluated through a departmental examination consisting of 50 multiple-choice questions, which was administered upon completing their rotation. Statistical analysis was performed to assess the impact of peer-teaching on the resident students’ performance. Results Between January 2023 and June 2023, a total of 158 resident students completed their rotation in the respiratory department. Among them, 40 resident students willingly took on the responsibility of instructing medical interns, while 118 resident students did not participate in intern teaching. With a "one-to-one" teaching policy in place, the overall satisfaction rate of the interns was an impressive 95.35%. Pre-rotation test scores for the test group averaged 81.66 ± 8.325 (Mean ± SD) and the control group averaged 81.66 ± 8.002, without significance. The departmental examination scores of the test group averaged 85.60 ± 7.886, while the control group scored an average of 82.25 ± 8.292, with a statistically significant difference (p = 0.027). Conclusion In conclusion, our study underscores the positive influence of peer-teaching on the knowledge mastery of resident students.

Introduction: Ultrasound diagnostics is an important examination method in everyday clinical practice, but student education is often inadequate for acquiring sufficient basic skills. Individual universities have therefore started integrating (extra)curricular training concepts into medical education. This study aimed to evaluate sustainable skills development through participation in peer-assisted ultrasound courses. Methods: From 2017, students in the clinical part of medical school could opt for extracurricular peer-assisted ultrasound courses. Depending on the format (10-week course/2-day compact course) these comprised 20 teaching units focusing on abdominal and emergency ultrasonography. Students attending compulsory workshops at the start of their practical year were enrolled in this study, allowing for a comparison between the study group (attended ultrasound course) and the control group (did not attend ultrasound course). Competency from two out of four practical exams (subjects: “aorta”, “gallbladder”, “kidney” and “lung”) was measured, and a theory test on the same subject areas (“pathology recognition”) was administered. Additional questions concerned biographical data, subjective competency assessment (7-point Likert scale), and “attitude to ultrasound training in the curriculum”. Results: Analysis included 302 participants in total. Ultrasound courses had been attended on average 2.5 years earlier (10-week course) and 12 months earlier (2-day compact course), respectively. The study group (n = 141) achieved significantly better results than the control group (n = 161) in the long-term follow-up. This applies both to practical exams (p < 0.01) and theory tests (p < 0.01). After course attendance, participants reported a significantly higher subjective assessment of theoretical (p < 0.01) and practical (p < 0.01) ultrasound skills. Conclusions: Peer-assisted ultrasound courses can sustainably increase both theoretical and practical competency of medical students. This highlights the potential and need for standardised implementation of ultrasound courses in the medical education curriculum.

Peer-assisted learning (PAL) encompasses the active acquisition of knowledge and skills among students in similar social settings where teaching one another enables reciprocal learning. Sameyear/ level PAL (SPAL) is applied in theoretical and clinical teaching across medical disciplines worldwide and is regarded as a teaching and learning strategy promoting self-directed learning. However, it is unclear if SPAL is supporting the academic progress and skills development of students placed on extended curriculum programmes (ECP) in health sciences education (HSE) effectively. This paper focuses on ECP tutors and tutees’ experiences of SPAL on their academic, personal and professional development. Six qualitative, semi-structured group interviews were conducted with 41 ECP students (14 tutors and 27 tutees) after they had participated in SPAL sessions. Findings indicate that SPAL supports ECP students not only academically, but also improves graduate attributes and leadership development, and promotes adapting to higher education through the establishment of communities of learning. Embedding structured SPAL sessions into ECPs in HSE was found to be central to the success of this teaching and learning strategy.

Introduction: Peer-assisted learning (PAL) is a student-centered active learning process which provides a flexible approach for students to prepare and organize their learning prospectus and gives opportunity for collaboration among peers. Aims: The purpose of this study was to assess the effectiveness and impact of online PAL session in enhancing the knowledge of breast cancer and breast self-examination (BSE) among medical students. Settings and Design: This was a cross-sectional, quasi-experimental study done using mixed-method design. Subjects and Methods: Online PAL session was conducted for premedical and preclinical students by the peer tutors for 93 medical students in March 2020. Knowledge of breast cancer and BSE was compared with the pretest and posttest scores. Feedback survey from tutees, tutors, and faculties was taken to evaluate conduct and satisfaction of the workshop for improvements in future. Statistical Analysis Used: Data were analyzed using SPSS 22. Descriptive data were presented as frequency and percentage. Continuous data were presented as mean and standard deviation. Paired sample t-test was applied for statistical significance of pretest and posttest data. Results: Significant improvements were observed in the posttest scores of knowledge on breast cancer and BSE. The mean satisfaction score was high among the tutees, tutors, and faculties, indicating that PAL session had significant impact on students. Conclusions: PAL sessions can be a dynamic tool to create a safe and successful learning environment for students to learn on sensitive health issues such as breast cancer and BSE.

Abstract Background Peer-assisted learning represents a favoured method of teaching in universities. The COVID-19 pandemic has necessitated transferring medical education to digital formats, and subsequently, the question has arisen of whether online tutorials might be effective. This study, thus, investigated the efficacy of online tutorials in a communication course by assessing the interaction, verbal communication, and nonverbal communication of tutors and students. Methods Second-year medical students were invited to participate in this longitudinal quantitative study. Validated and self-developed questionnaires (e.g., Jefferson Empathy Scale) including 39 questions (rated on a 7- or 5-point Likert scale) were used to assess the different variables including interaction, verbal and nonverbal communication and students’ learning success. Results Out of 165 medical students, 128 took part in the study. The students as well as tutors reported that they found each other likeable (Mstudents = 4.60±0.71; Mtutors = 4.38±0.53; p > .05). Learning success increased throughout the communication course (Cohen’s d = 0.36–0.74). The nonverbal and verbal communication in the simulated patient (SP) encounter was also rated as high by all three groups (Mnonverbal = 3.90±0.83; Mverbal = 4.88±0.35). Conclusions Interaction as well as nonverbal and verbal communication occurred in the online format, indicating that online tutorials can be effective. The implementation of SPs increases the efficiency of synchronous online learning as it enhances the simulation of a real patient–physician encounter. Thus, online tutorials are a valuable amendment to medical education.

Abstract Background Clinical skill training (CST) is indispensable for first-year surgical residents. It can usually be carried out through video-based flipped learning (FL) within a web-based learning environment. However, we found that residents lack the process of reflection, blindly imitating results in losing interest and passion for learning in the traditional teaching pattern. The teaching method of "spot the difference" (SDTM), which is based on the fundamentals of the popular game of "spot the difference," is designed to improve students' participation and reflective learning during skill training. This study aimed to evaluate this novel educational model's short-term and long-term effectiveness for surgical residents in China. Methods First-year residents who required a three-month rotation in the head and neck surgery department were recruited to participate in a series of CSTs. They were randomized into SDTM and traditional FL (control) groups. Clinical skill performance was assessed with validated clinical skill scoring criteria. Evaluations were conducted by comparing the scores that contain departmental rotation skill examinations and the first China medical licensing examination (CMLE) performance on practical skills. In addition, two-way subjective evaluations were also implemented as a reference for the training results. Training effects were assessed using t tests, Mann–Whitney–Wilcoxon tests, chi-square tests, and Cohen’ s effect size (d). The Cohen’ s d value was considered to be small (0.8). Results The SDTM group was significantly superior to the control group in terms of after-department skill examination (t=2.179, p0.8). There were no significant differences between the two groups on clinical competence (t=0.819, p=0.415, d=0.18), the first-time pass rate for CMLE (χ2 =1.663, p=0.197, d=0.29), and short-term operational skills improvement (t=1.747, p=0.084, d=0.39). Conclusions SDTM may be an effective method for enhancing residents' clinical skills, and the effect is significant both short- and long-term. The improvement effect seemed to be more significant in the peer-involved SDTM than training alone. However, despite positive objective results, SDTM still risks student learning burnout. Trial registration ISRCTN registry, ISRCTN10598469 , 02/04/2022，retrospectively registered.

Abstract Introduction Peer-assisted learning programs have been focused on providing students with competencies to deliver lectures and facilitate workshops, whereas involvement of students as co-developers of educational programmes has been relatively under-described in the literature. Likewise, the use of students as facilitators in simulation-based training and debriefing is also scarce. In this paper, we describe how medical students were co-developers of a novel course on patient safety and how they were trained as student facilitators to conduct simulation-based training and debriefing, as well as workshops. Methods Medical students co-developed a course in patient safety consisting of three simulation-based scenarios and three workshops. The students were educated in relevant patient safety topics. They were trained to become student facilitators to conduct workshops, simulations and debriefings at a patient safety course for medical students. A questionnaire was developed to evaluate the course participants´ perception of the learning objectives and the student facilitators following the latest course in 2020. In addition, semi-structured interviews with the student facilitators were conducted to explore their perceptions of being part of the course. Results A total of 92% of the course participants completed the evaluation of the course. The majority of the course participants found that the student facilitators created a safe learning environment and had the necessary skills to teach. The learning objectives for the course were found to be useful. A total of 10 interviews with the student facilitators were conducted. We found that the student facilitators were motivated to teach in the course, as a way of improving their teamwork, leadership qualities and communication skills, as well as their resume. Some of the student facilitators mentioned that they were able to create a safe learning environment, whereas others mentioned a feeling of inadequacy for their teacher role. In addition to developing their teaching skills, they mentioned that they developed their medical expertise, alongside their communication-, collaboration-, leadership- and professional skills. Conclusion This study illustrates how medical students were involved in the co-development, delivery and implementation of a course in patient safety. The evaluation of the course shows that student facilitators succeeded in creating a safe learning environment. The interviews of the student facilitators reveal their various motivations for teaching, in addition to different perceptions of their experience as a student facilitator. Some expressed a positive feeling of being able to establish a safe learning environment, whilst others expressed a feeling of inadequacy when facilitating peers. In addition, the student facilitators indicated that they developed themselves both professionally and personally.

This study focuses on undergraduate student paraprofessionals who facilitated peer study groups for academically challenging college courses. A grounded qualitative research study of these student facilitators at an institution identified their professional identity development in unexpected ways that went against written policies for teacher attitudes and behaviors. Rather than perceiving themselves as peer study group facilitators following a narrow job description, many of them referred to themselves as teachers and acted accordingly, breaking the boundaries of behavior established by the study group program administrator. This article unmasks this professional identity emergence, postulates the mechanism for this choice, presents a model to explain it, and makes recommendations for talking openly about this identity and the subsequent behaviors that occurred as a result by the facilitators and the implications for the PAL program.

Anatomy and physiology courses have been identified as a major barrier to the persistence and graduation of undergraduate students seeking careers in the health professions. This break in the health profession’s educational pipeline may have implications for perpetuating racial/ethnic educational attainment disparities that further health disparities through a lack of representation in healthcare providers. Although Supplemental Instruction (SI) is a well-developed, evidence-based program for improving student success, it has traditionally been used primarily in lecture-based courses. In addition, much of the literature on peer-assisted learning in anatomy and physiology focuses on medical school students. Therefore, it is difficult to extrapolate the effectiveness of SI on freshman and sophomore undergraduate students in a laboratory-based course. Here, we describe the expansion of our SI program, in conjunction with a complete curricular redesign, to address student success in an undergraduate gateway anatomy and physiology laboratory. Students who participated in the SI laboratory sessions held outside of instructor-led class time were significantly more likely to be high performers in the course, and there were no students who participated in SI sessions who earned a final course grade below a C. In addition, students expressed high satisfaction with the SI program and indicated that SI leaders provided both content and emotional support. In conclusion, SI is a valuable program to address student success in a laboratory-based course, particularly when integrated thoughtfully and intentionally with other evidence-based best practices in curriculum.

Supplemental Instruction is an evidence-based academic support program which improves the success of higher education undergraduate students who participate in the program, including students from historically underrepresented populations. Sessions are led by near-peer leaders who have previously successfully completed the course. While the impacts of leading SI programs have previously been demonstrated, there is little research on the specific impacts on historically underrepresented student leaders at Hispanic-Serving Institutions (HSIs). Our study aims to elucidate the impact of leading SI on our diverse population of SI leaders at the largest private HSI in New York State. Data were collected from SI leaders on their reflective perceptions about their experiences as SI leaders through both surveys and focus groups. Our data demonstrate that our diverse SI leaders feel positively about their experiences in the SI program with a focus on three areas of perceived self-improvement: confidence, communication and community. These areas of perceived self-improvement are particularly important as they may lead to higher retention and graduation rates.

Objective: To investigate the impact of peer-assisted learning (PAL) in chest tube insertion education on surgical residents. Methods: This study is a quasi-experimental study conducted on thirty general surgeon residents enrolled in the PAL program. They were divided into two learner groups (A and B) based on the period of residency start. Group A and B had six and one months of general surgery residency experience, respectively. All participants received adequate training for chest tube insertion by a recently graduated general surgeon. Chest tubes insertion skill was assessed using the tool for assessing chest tube insertion competency (TACTIC) test. Results: Post-TACTIC test score was significantly higher (p=0.001) than Pre-TACTIC test score in both groups. However, a comparison of mean Pre-TACTIC test scores and mean Post-TACTIC test scores between group A and group B showed that PAL effectiveness in group A was significantly higher (p=0.001) than group B. Conclusion: There was a positive relationship between the PAL program and the improvement of chest tube insertion technical skills in surgical residents. Based on our findings and similar studies, it can be concluded that the PAL program can increase the chest tube insertion skill of surgical residents.

Abstract Background Peer-led tutorials are widely used in medical education to promote practical skills acquisition and support faculty staff. Typically, student tutors are custom trained for this specific task. We investigated whether opening up an existing medical tutor qualification program to other degree programs is successful in terms of acceptance among students, acquisition of tutor-specific and interprofessional competencies, and which factors contribute to success or failure. Methods We developed a two-day tutor qualification program and conducted it annually from 2016 to 2020 with medical and other healthcare students. At the end of each course, we administered a written survey in which the participants rated the following items: their attitudes towards interprofessional learning (using the UWE-IP-D Interprofessional Learning Scale), the interprofessional learning setting, the teaching approach, and their competency acquisition (each on a five-point Likert scale; 1 = strongly agree, 5 = strongly disagree). Furthermore, we assessed participants’ qualitative feedback in free-text fields and performed inductive content analyses. Results The study participation rate was high (response rate 97%; medical students: n = 75; healthcare students: n = 22). Participants stated high levels of competency acquisition (total M = 1.59, individual items’ M’s ranging from 1.20 to 2.05) and even higher satisfaction with the teaching approach (total M = 1.28, individual items’ M’s ranging from 1.43 to 1.05). Overall satisfaction with the training was M = 1.22; SD = 0.58. No significant differences in ratings were found between the student groups. The qualitative results showed that students appreciated the interprofessional setting and experienced it as enriching. The most positive feedback was found in didactics/teaching methods on role-plays and group work; most suggestions for improvement were found in the area of structure and organisation on breaks and time management. Conclusions Opening up an existing medical tutor qualification program to other student groups can be seen as fruitful to teach not only tutor-related aspects but also interprofessional competencies. The results demonstrate the importance of detailed planning that considers group composition and contextual conditions and provides interactive teaching methods to promote interprofessional experiences. This study offers important information about prerequisites and methodological implementation that could be important for the interprofessional redesign of existing training programs.

Abstract Background Peer-assisted learning is a method of active learning that is gaining traction throughout higher education. In the medical curriculum, peer-assisted learning has been the subject of independent studies collecting various types of data. However, an overall analysis of those studies providing objective measurements of the influence of peer-assisted learning could be particularly useful for teachers and students alike in a knowledge-heavy curriculum such as medicine. In this study we set out to analyse the efficacy of peer-assisted learning on medical students’ learning of clinical knowledge and skills that is assessed through some objective examination, and thereby define whether such approaches have a reproducible benefit for inclusion in the medical curriculum. Methods Databases including Pubmed, Embase and Science Direct were searched for relevant studies containing randomized controlled trials (RCTs) of peer-assisted learning published before July 29th ,2020. A meta-analysis was performed by using RevMan 5.3 software. Results Thirteen studies involving 2,003 medical students were analyzed for clinical knowledge and skills gains that included some objective measurement of learning. The results of this meta-analysis indicated that considering all these studies together, peer-assisted learning leads to improvements in clinical knowledge and skills learning for medical students compared with traditional teacher-led passive learning. One study was found likely to be a source of significant heterogeneity, and when this was removed from the meta-analysis, the pooled effect was no longer statistically significant. Conclusions Peer-assisted learning can be an effective method of learning applied to medical student education. Active learning through peer-assisted learning should be seen as complementary to teacher-led approaches. Two of the individual studies on peer-assisted learning show a statistically significant benefit on examination performance compared to the other studies considered, that either show negligible benefits or at worst no detriment in learning. This highlights the need for more high-quality and focused randomized control trials to identify those critical parameters that lead to improved student learning using such approaches.

Introduction: There is a paucity of research on conducting written formative assessment with constructive feedback for theory paper writing for postgraduates of Community Medicine in India. The concept of “Written Formative assessments with Peer-Assisted Learning Program” was implemented to improve the first 2 levels of Miller's Pyramid and assess its impact on the summative assessment. Materials and Methods: The program was conducted for 2 batches of postgraduate students in the Community Medicine enrolled for the academic session of 2016–2019 and 2017–2020. The written formative assessment was conducted every Saturday for 1 h from August to March month in 2018 and 2019. After each test, answer papers were evaluated by the peer and faculty from the department. Written and oral feedback was given by the peer. After IEC approval, we planned to assess the program's effect on level 1 and level 2 Kirkpatrick's framework. The data were analyzed using SPSS statistical package version 24 (SPSS Inc., Chicago, IL, USA). P < 0.05 was considered statistically significant. Results: Total 23 formative written assessments were conducted per year. The proportions of knowledge, comprehension, and analytical type of questions asked were 47%, 32%, and 21%, respectively. The mean attendance rate was 76.28% ±16.4%. There was no statistically significant difference in the average percentage of marks in formative (weekly test) and summative assessment (university final examination). There was a statistically significant positive co-relation of projected mean marks and summative assessment marks with the co-efficient of the determination being 22.6%. There was overall positive feedback of the formative and peer-assisted learning (PAL) from post graduate students. Conclusions: Written Formative Assessment with PAL program is one of the effective programs for postgraduate students to gain confidence in writing and presentation skills and to score higher in theory examination.

Introduction Patient-physician interviewing skills are crucial in health service delivery. It is necessary for effective care and treatment that the physician initiates the interview with the patient, takes anamnesis, collects the required information, and ends the consultation. Different methods are used to improve patient-physician interview skills before encountering actual patients. In the absence of simulated patients, peer simulation is an alternative method for carrying out the training. This study aims to show whether patient-physician interview skills training can be implemented using peer simulation in the absence of the simulated patient.Methods This is a descriptive quantitative study. This research was conducted in six stages: identification of the research problem and determination of the research question, development of data collection tools, planning, acting, evaluation, and monitoring. The data were collected via the patient-physician interview videos of the students. The research team performed descriptive analysis on quantitative data and thematic analysis on qualitative data.Results Fifty students participated in the study. When performing peer-assisted simulation applications in the absence of simulated patients, the success rate in patient-physician interviews and peer-simulated patient roles was over 88%. Although the students were less satisfied with playing the peer-simulated patient role, the satisfaction towards the application was between 77.33% and 98%.Discussion and Conclusion In patient-physician interviews, the peer-simulated patient method is an effective learning approach. There may be difficulties finding suitable simulated patients, training them, budgeting to cover the costs, planning, organizing the interviews, and solving potential issues during interviews. Our study offers an affordable solution for students to earn patient-physician interview skills in faculties facing difficulties with providing simulated patients for training.

The concept of peer-assisted learning (PAL) has been implemented at many medical faculties. Due to the Covid-19 pandemic, parts of the medical education experience transitioned to digital formats. However, little is known about PAL and online student tutorials. PAL is effective due to cognitive and social congruence. This study aims to investigate these concepts in an online student tutorial on taking a patient’s medical history. This longitudinal study took place in a preclinical communication course on how to take a patient’s medical history. In an online student tutorial, the students learned how to take a patient’s psychosocial medical history. Using standardised questionnaires, cognitive and social congruence were assessed. T-tests of independent samples were performed for data comparison. The participants included 128 second-year medical students and 5 student tutors. Cognitive congruence (Mstudent = 4.19 ± 0.56; Mstudenttutor = 4.04 ± 0.57) and social congruence (MStudent = 4.25 ± 0.56; MStudenttutor = 4.06 ± 0.57) were high for both students and student tutors in the online setting. In comparison to the face-to-face group, students in the online setting considered the student tutors to be significantly (p

Current evidence indicates that undergraduate medical students display deficits in musculoskeletal physical examination skills (MPES). While various instructional methods are recommended for teaching clinical skills, effective methods for teaching MPES have not been established. This study compared the effectiveness of a multimodal teaching approach incorporating video-based learning, interactive small-group teaching, hands-on practicing, peer-assisted learning, formative assessment, and constructive feedback with traditional bedside teaching in developing undergraduate orthopedic MPES. Participants were 151 fifth-year medical students divided into two groups. One group received multimodal teaching, and the other received traditional bedside teaching. In both groups, the participants learned how to physically examine the knee and shoulder. The primary outcome was objective structured clinical examination (OSCE) scores, while the secondary outcomes included teaching sessions’ total durations, facilitator’s demonstration time, participants’ practice time, and proportion of students with passing checklist scores and global ratings-based assessments for the two teaching approaches. The multimodal teaching group had significantly higher OSCE scores (checklist scores, global ratings, and passing rates; p = 0.02, 0.02, 0.01, respectively) than the comparison group. Individual OSCE component assessments showed significant improvements in the special musculoskeletal physical examination test. The overall duration and amount of participants’ hands-on time were significantly longer for the multimodal than for the traditional bedside teaching group (p = 0.01 and 0.01, respectively), and the facilitator’s demonstration time was significantly shorter (p = 0.01). The multimodal learner-centered teaching approach evaluated in this study was effective for teaching MPES. It appeared to maximize learner engagement through enhancing interactions and providing increased time to engage in hands-on practice. This teaching approach improved MPES levels, maximized teaching efficiency for scenarios with limited instruction time and resources, and enhanced competency of undergraduate medical students in performing special musculoskeletal physical examinations compared to traditional bedside teaching.

Background Peripheral venous catheterization (PVC) and blood sampling (BS) represent some of the first basic techniques that a medical student learns when starting clinical practice. As they are invasive maneuvers, there is a level of self-doubt that can be overcome through practice in a simulated setting. Peer-assisted medical simulation learning is an innovative educational technique that allows students to gain confidence in conducting clinical maneuvers in a safe environment. Simulation based learning focuses on trial and error, participants being able to approach the technique multiple times, without the risk of hurting a real patient. Additionally, the fact that the workshop is conducted by fellow students, creates a more comfortable learning setting. Aim of study Our aim is to determine the effectiveness of medical simulation in learning to perform PVC and BS and in increasing the level of confidence of the participants. Materials and methods Our study was conducted at the Department of Medical Simulation of the Center for Innovation and e-Health (CIeH), part of the University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania, between March and December 2021. During this period, 2186 first year students took part in a peer-conducted simulation workshop, conducted by undergraduate medical students in all years of studies, who had previously undergone extensive training and evaluation. The aim of the workshop was to learn the basics in PVC and BS in a controlled environment. Through a questionnaire, we collected data regarding knowledge acquisition and auto-evaluation of the students’ skill and knowledge prior and after the training on a five-point scale. At the beginning of the questionnaire we obtained informed consent from the study participants. Results The response rate to the questionnaire was 66,10%. The participants obtained an average score of 60%. There were few participants that did not acquire enough information in order to answer correctly to the questionnaire. 80% of the respondents answered accurately on 2 out of 3 questions. We observed a 48,35% increase in the confidence level of participants regarding clinical knowledge and skill acquisition after the workshop. Prior to the workshop, only 10% of participants self-evaluated with a score of 4 or 5, compared to 85% of respondents after the workshop. Conclusions The medical simulation training led to a significant rise in students’ confidence and a high impact on the development of skill and knowledge. Through our basic workshops we want to familiarize the participants with the clinical environment, additional knowledge and skills being acquired once throughout their studies. The workshop's objective of increasing participants’ comfort regarding basic clinical techniques, such as blood sampling and peripheral venous catheterization, was accomplished. The outcome of the study enables us to adapt the curriculum and testing procedures to better meet the needs of the participants.

Background: Community health workers (CHWs) act as a bridge between community and clinical care in caring for HIV patients. This study aimed to evaluate the effectiveness of peer education in improving HIV knowledge, attitude, and perception of CHWs in Babol, Iran in 2019. Methods: This was a quasi-experimental study conducted among CHWs in the health centers of Babol, Iran. The city was divided into two areas of the North and the South according to the geographical map. Then, based on the list of the health centers in each of the areas, one health center was randomly selected and assigned to either the experimental or the control group. Results: Following peer education, all study variables including knowledge score, attitude, and perception about HIV-related issues significantly improved in the experimental group compared to the pre-intervention phase (P=0.002, P=0.02, and P=0.00 respectively). The most significant change was in misconception score with a approximately large effect size (0.78), presenting an increase of 95.53% from 15 to 29.33 after the intervention, while attitude and knowledge respectively presented 85.04% and 81.07% increase with a smaller effect size of 0.57 and 0.52. Conclusion: In the study peer education proved to be an effective strategy in improving the knowledge, attitudes, and perception of CHWs concerning HIV/AIDS. Therefore, the peer-to-peer training model can fill a critical gap in the training of CHW based on the idea that not only do the CHWs themselves need to enhance their knowledge of related topics but they also need to train others. In turn, this will result in providing cost-effective health promotion and prevention services in a more culturally appropriate manner.

Abstract Background Online communication has taken over in the last 2 years due to the frequent lockdowns because of the COVID-19 pandemic. Overburdened physicians in this pandemic are struggling to get enough time to teach clinical skills online to the students. Also, due to student’s safety issues, the students cannot fully attend the clinics. Therefore, in this scenario, online PAL (Peer Assisted Learning) sessions for clinical skill teaching and learning can be an effective alternative for undergraduate medical students. The academic limitations caused by the COVID-19 related lockdown however can have a pleasurable outcome if certain challenges, related to online PAL, are overcome. Therefore, the present study aims to identify the challenges of Peer Assisted Learning (PAL) sessions during online clinical skills training in the Ophthalmology module of undergraduate medical students. Methods This qualitative exploratory study, utilizing online focus group discussions to explore the challenges of online PAL in training and learning of clinical skills were carried at the Ophthalmology department of Batterjee Medical College, Jeddah; Saudi Arabia. A purposive convenient sampling technique was used to collect data. Data were transcribed and analyzed using thematic analysis. Results The study identified six themes that were further divided into smaller subthemes. The subthemes derived from the collected data were organized under the following major themes; infrastructure, learning environment, psychological problems, interaction deficit, learning desires, and desire for feedback on performance. The major challenge reported by the medical student during online PAL sessions was infrastructure in terms of network connection, scheduling, and timing of the session. The unprofessional learning environment, psychological problems in terms of behavioral issues and personality changes, interaction deficit with peers, tutor, and patient, learning desires, and desire for feedback on performance were the other important challenges faced by the students. Conclusion The challenges explored by our study can be used by the medical educators to incorporate online PAL as an effective, efficient, and alternative teaching and learning modality in the curriculum especially in compromised circumstances like the current COVID-19 pandemic.

Introduction: Peer-assisted learning (PAL) is a teaching method that develops new knowledge and skills through active learning support from peers. Objectives: To assess the impact of PAL in medical education, by collecting quantitative data that explore its effectiveness. To evaluate students’ perception of and satisfaction with PAL. Methods: A 5-point Likert scale survey was developed for students participating in the PAL program either as tutors or learners. Data were compared and statistically analyzed according to gender, GPA, and year of study. Moreover, follow up of peer tutors and peer learner’s achievement was done through comparing their grades with those that not shared in PAL and with their GPA of previous year. Results: Statistical analysis of questionnaire data revealed that medical students regarded voluntary peer-teaching similarly to faculty teaching and have a generally positive perception of PAL. Most of the respondents reported that they benefited both professionally and personally from PAL activities. They recommended expanding the role of PAL and officially incorporating PAL sessions into the curriculum. Students’ achievement was significantly increased for those who acted as peer learners and peer tutors. Conclusions: Using PAL in conjunction with other teaching and learning methods provides additional value by fostering cooperation and social interaction among medical students and further prepares them for their future role as medical science educators. Additional research into the impact of PAL on academic achievement, both short- and long-term learning outcomes, in medical programs is warranted.

Muna Aljahany,1 Haifaa Malaekah,2 Hayat Alzahrani,1 Fatimah Alhamadah,3 Wireen Leila Dator4 1Clinical Sciences Department, Faculty of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia; 2Department of Surgery, Dr.Sulaiman Alhabib Hospital, Altakhasussi, Riyadh, Saudi Arabia; 3Department of Surgery, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia; 4Faculty of Nursing, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi ArabiaCorrespondence: Haifaa MalaekahPrincess Nourah Bint Abdulrahman University, Airport Road, Riyadh, 11564, Saudi ArabiaTel +966118238711Email h_malaika@hotmail.comObjective: Since 2010, simulation-based learning has become increasingly popular as a well-recognized method of learning used by medical undergraduates in clinical settings. However, the relatively new concept of simulation-based peer-assisted learning has not yet been widely accepted, so it has not been well documented. Therefore, this study evaluated the perceived advantages of simulation-based peer-assisted learning among health professions students and interns and their acceptance of this new concept of learning from a student-instructor.Methods: This was a pilot study conducted with 11 students in various health profession fields at Princess Nourah bint Abdulrahman University (PNU). The students were given a comprehensive lecture on simulation scenario development and were assigned to four separate interdisciplinary teams for a practical session on simulation scenario writing. Then, they each completed a questionnaire seeking their opinion concerning their experience and concept understanding.Results: The results confirmed the advantages of interprofessional simulation-based peer-assisted learning as it helped in understanding the process as perceived by the study participants. All students expressed their willingness and enthusiasm to use simulation as a technique for peer-assisted learning.Conclusion: The study affirms the importance of developing student teachers’ teaching skills at an institutional level. The future implementation of simulation-based peer-assisted learning is dependent on the students’ awareness of the concept. By exploring a new dimension of medical education, the student teachers could expand their horizon of exposure to holistic case management and interactive learning and equip themselves with practical communication skills to excel in a real-world setting.Keywords: peer-assisted learning, simulation-based learning, student teachers, interprofessional education, teaching skills

Abdulkarim A Jawhari,1 Maha A Safhi,1 Mawadah M Magadmi,1 Rajwa H Alobaidi,1 Khaled M Alghamdi,1 Reem N Basyouni,1 Omar M Saggaf,1 Murad A Yasawy,2 Rania M Magadmi3 1Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; 2Faculty of Medicine, Ibn Sina College, Jeddah, Saudi Arabia; 3Department of Pharmacology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Abdulkarim A JawhariFaculty of Medicine, King Abdulaziz University, Jeddah, 23212, Saudi ArabiaTel +966559977079Email Kremjohari@gmail.comPurpose: Research methodology is an essential part of evidence-based medicine. Many educational programs include clinical research methodology within their curriculum. Moreover, students’ preferences for learning methods are different than before, as they now prefer alternative methods, such as peer teaching. Peer-assisted learning enhances students’ tutoring skills. Thus, the current study aimed to evaluate the effect of peer teaching on enhancing clinical research skills.Participants and Methods: Peer-assisted learning was evaluated during a four-week online research methodology course designed for medical students at King Abdulaziz University. A total of 121 students’ and 38 tutors’ attitudes and perceptions of peer teaching were evaluated using a self-administered questionnaire. The effectiveness of peer teaching was assessed using pre- and post-course knowledge tests. Chi-square was used to assess the association of qualitative data, and Mann–Whitney U-test and Wilcoxon rank test were used as nonparametric tests for the variables that were not normally distributed.Results: The post-course knowledge score was significantly higher than the pre-test score. Students had a positive perception of peer-assisted learning. Over 90% of the students preferred peer-assisted learning to traditional teaching. Similarly, the tutors had significantly positive perceptions of peer-assisted teaching. Younger students who had higher post-test mean knowledge scores had a good perception of peer teaching.Conclusion: The current study demonstrates students’ and tutors’ positive perceptions of peer-assisted learning as well as the effectiveness of peer learning. Medical schools should pay more attention to students and prepare them for peer-teacher roles.Keywords: peer-assisted learning, medicine, clinical, methodology, education

The study of medicine poses an immense burden on the medical students to become competent in all the core competencies. Medical students understand the learning requirements of their peers and thus senior students or peers can significantly help to achieve learning outcomes. Peer-assisted learning has been implemented in both undergraduate and postgraduate courses in clinical as well as classroom settings. It is quite beneficial as it makes the learning process interactive, more focused, and conducted in a relaxed atmosphere. It also reinforces points that require more attention.

Background: The aims of this study were to compare the outcomes of faculty led learning with peer assisted learning in acquiring procedural skills and to analyze perceptions on the learning experience of both groups so that feasibility of adopting peer teaching can be considered in the skills laboratory. Methods: Medical students from 4th semester were divided into two groups – A - Individual learners and B - peer tutored students. Group A was taught bladder catheterization by faculty. Six volunteers were chosen as peer teachers, trained by faculty to perform and teach the procedure. Each peer teacher was assessed for training skills. Five to six students were then assigned to each peer teacher. At the end of the study period, each student was assessed for skills acquired by objective structured practical examination. Feedback from students on perceptions of their learning experience was collected using validated feedback instrument. Results: Fifty-seven students excluding peer teachers were assessed–30 in Group A and 27 in Group B. Mean competency scores of Group B was higher than those of Group A (P < 0.012). Median scores of perceptions on overall skill development, teacher contribution, and student satisfaction were not different between the groups. Conclusion: This study has demonstrated that peer teaching can be an effective and feasible tool to teach basic procedural skills to students. Perceptions on the learning experiences of individual and peer led groups in the skills laboratory were not different emphasizing the acceptability of the peer tutor approach.

The learning process in higher nursing education develops student competences, such as applying standard precautions, in providing professional nursing care. To improve student knowledge and compliance related to standard precautions requires innovation from lecturers in providing appropriate learning methods. Peer-assisted learning (PAL) can enhance the active role of students and improve achievement. The PAL method involves senior students as peer teachers who help junior students. Using a questionnaire as an assessment instrument, this study aimed to determine the effectiveness of PAL on knowledge and compliance in the application of standard precautions in student nurses. This study design was quasi experimental with pre and post assessment and a control group design approach. This research was conducted at the D Hospital in Padang, Indonesia, a hospital where students practice. This study was conducted in June–September 2017 with a sample size of 45. Data analysis using paired t-test showed that the average values of the level of knowledge and skills of students in the application of standard precautions before and after PAL methods differed significantly in the intervention group (p= 0.001). In conclusion, PAL can be applied in the learning process of nursing students to increase student achievement. Abstrak Efektifitas Metode Peer-Assisted Learning terhadap Tingkat Pengetahuan dan Kepatuhan Mahasiswa dalam Penerapan Kewaspadaan Standar. Proses pembelajaran dalam pendidikan tinggi keperawatan mengembangkan kompetensi siswa, seperti menerapkan tindakan pencegahan standar, dalam memberikan asuhan keperawatan profesional. Untuk meningkatkan pengetahuan dan kepatuhan mahasiswa terkait kewaspadaan standar, dibutuhkan inovasi dari dosen dalam memberikan metode pembelajaran yang tepat. Peer-assisted learning (PAL) dapat mening-katkan peran aktif siswa dan meningkatkan prestasi. Metode PAL melibatkan mahasiswa senior sebagai peer-teacher yang membantu mahasiswa junior. Menggunakan kuesioner sebagai instrumen penilaian, penelitian ini bertujuan untuk menentukan efektivitas PAL pada pengetahuan dan kepatuhan dalam penerapan kewaspadaan standar pada maha-siswa keperawatan. Desain penelitian ini adalah quasi experiment dengan penilaian pre dan post dan pendekatan control group design. Penelitian ini dilakukan di Rumah Sakit D di Padang, Indonesia, sebuah rumah sakit tempat praktik mahasiswa. Penelitian ini dilakukan pada Juni–September 2017 dengan sampel 45. Analisis data menggunakan paired t-test menunjukkan bahwa nilai rerata tingkat pengetahuan dan keterampilan mahasiswa dalam penerapan kewaspadaan standar sebelum dan sesudah metode PAL berbeda secara signifikan pada kelompok intervensi (p= 0,001). Kesimpulan-nya, PAL dapat diterapkan dalam proses belajar siswa keperawatan untuk meningkatkan prestasi siswa. Kata kunci: kewaspadaan standar, mahasiswa keperawatan, peer-assisted learning

Abstract Background Peer-assisted learning is effective due to cognitive and social congruence. Cognitive congruence is created by sharing a similar knowledge base between students and student tutors. Social congruence is defined as having similar social roles. A questionnaire of these concepts was newly constructed, and this study explored the factor analysis of the instrument. Methods In a cross-sectional method design cognitive and social congruence were operationalised by exploratory and confirmatory factor analyses. Cognitive and social congruence were assessed by validated questionnaires and through self-developed items that were collected through semi-structured interviews.. The questionnaire consisted of 26 items that were rated on a five-point Likert scale, from 0 = I strongly disagree to 4 = I strongly agree. Results 676 medical students participated in the study. Exploratory factor analysis for students resulted in a two-factor solution with cognitive and social congruence as confirming factors. New findings showed that the items “non-judgmental learning atmosphere” and “informal communication” were associated to cognitive congruence, “effectiveness” and “comprehensible explanations” belonged to social congruence. Confirmatory factor analysis for student tutors confirmed the resulting two-factor solution. Conclusions As one of the largest investigation of cognitive and social congruence, this study investigated the underlying mechanisms of effective PAL using factor analysis. Cognitive congruence was created by sharing the same knowledge. Knowledge transfer might play a relevant role in cognitive congruence. Social congruence focused on the relationship between student tutors and students, which might impact the content level. Practical recommended actions (using the same language) could be implemented.

الملخص: أهداف البحث: على الرغم من شعبيتها، لم تُظهر الأدبيات ما يكفي من الأدلة التي يمكن أن تثبت صحة تأثير التعلم بمساعدة الأقران على التعلم الفعال للطلاب. يهدف هذا التحليل البعدي إلى التحليل الكمي لفاعلية التعلم بمساعدة الأقران في التعليم الطبي. طرق البحث: تم البحث في قواعد البيانات المختارة باستخدام مصطلحات الشبكة” مساعدة الأقران“ و”التعلم“ أو ”التعلم الفعال“ أو ”استراتيجيات التعلم“ أو ” توجيه الأقران“ أو ”تعليمات الأقران“ لإيجاد دراسات تشمل النص الكامل باللغة الإنجليزية مع معلومات قبل وبعد الدراسة. بعد بروتوكول منهجي، اخترنا ١١ مقالا للتحليل النهائي. وتم إجراء التحليل البعدي باستخدام برنامج المراجعة الإدارية ٥.٣ من مكتبة كوكرين، وتم عرض المخرجات النهائية على شكل مخطط غابي. النتائج: أظهرت النتائج فاعلية كبيرة للتعلم بمساعدة الأقران؛ فرق المتوسط المعياري ١.٢٦ مع فاصل ثقة ٠.٥٨ إلى ١.٩٤. أظهر اختبار كوكرين Q مستوى الأهمية ٥٪ كما تم قياسه بواسطة مربع كاي ٤٤٩.٤٦. إلى جانب ذلك، كانت نتائج اختبار I2 مهمة (٩٨٪). تتحقق قيمة Z بمقدار ٣.٦٥ من فاعلية التعلم بمساعدة الأقران. الاستنتاجات: أظهر هذا البحث أنه يمكن استخدام التعلم بمساعدة الأقران كأداة تعليمية قيمة في المجال الطبي. يمكن للتدخلات التعليمية في المناهج الدراسية وإدراجها في استرتيجيات التعلم بواسطة الأقران أن تعزز خبرة التعلم لطلاب الطب. Abstract: Objective: Despite the popularity of peer-assisted learning (PAL), existing literature has not shown enough evidence that can validate its impact on students' active learning. This meta-analysis aims to quantitatively analyse the effectiveness of PAL in medical education. Methods: We searched selected databases using the Medical Subject Headings (MeSH) terms ‘peer-assisted’, ‘learning’, ‘active learning’, ‘teaching strategy’, ‘peer mentoring’, and ‘peer instructions’ for full-text English language studies with a pre-post design. Following a systematic protocol, we selected 11 articles for final analysis. A meta-analysis was done using Review Manager (RevMan) 5.3 from Cochrane Training and the final output was presented by a forest plot. Results: The results showed a significant effectiveness of PAL; notably, there was a standardised mean difference of 1.26 with a confidence interval of 0.58–1.94. The Cochran's Q test showed a 5% level of significance as measured by Chi2 = 449.46. Besides, the results of the I2 test were significant (98%); moreover, a z value of 3.65 validated the effectiveness of PAL. Conclusion: This research has shown that PAL can be used as a valuable learning tool in the medical field. Educational interventions in curricula for incorporating PAL strategies can potentially enhance the learning experience of the medical students.

Objective: This project report outlines the development and implementation of digital tutorials (“How to... train your skills goes digital!”) by peer tutors (TUTs) based on previously established in-person tutorials, as well as the subsequent combination of both approaches. The TUTs' objective, in spite of corona-related restrictions and strict hygiene requirements during the pandemic, was to provide fellow students with the opportunity to learn, practice and reflect on clinical-practical skills.Methodology: In a collaborative undertaking, the TUTs first analyzed the learning objectives of the in-person tutorials in order to be able to design content-matched digital tutorials without entirely abandoning the practical aspect. The Moodle learning management platform was selected as the appropriate tool for delivery of the relevant theoretical knowledge. Practical exercises are embedded in the digital tutorials during online meetings. The participants (PTs) create their own models in the sense of a home skills station based on instructions provided via Moodle. Acceptance was systematically documented via questionnaires.Results: The digital tutorials were well accepted by the PTs (n=64). Evaluation (response rate: 37.5%) outcomes were consistently positive. Both course implementation and the PTs' own progress were rated “good” to “very good”. Nevertheless, the PTs do not yet feel well-prepared to carry out the various activities practiced independently.In the winter semester of 2020/21, the in-person tutorials were also reintroduced in a combined format. The marked demand for the tutorials may indicate the PT preference for practice on the simulation center models.Conclusion: The systematic combination of digital and in-person tutorials using the flipped classroom approach would appear to make sense in the long run. The effectiveness and sustainability of this approach in comparison with in-person tutorials only should be further investigated.

Objective: This study aimed at assessing the effects of two verbal encouragement modalities on the different offensive and defensive performance indicators in handball small-sided games practiced in physical education settings. Methods: A total of 14 untrained secondary school male students, aged 17 to 18, took part in a three-session practical intervention. Students were divided into two teams of seven players (four field players, a goalkeeper, and two substitutes). During each experimental session, each team played one 8 min period under teacher verbal encouragement (TeacherEN) and another under peer verbal encouragement (PeerEN). All sessions were videotaped for later analysis using a specific grid focusing on the balls played, balls won, balls lost, shots on goal, goals scored, as well as the ball conservation index (BCI), and the defensive efficiency index (DEI). Results: The findings showed no significant differences in favor of TeacherEN in all the performance indicators that were measured, whereas significant differences in favor of PeerEN were observed in balls played and shots on goal. Conclusions: When implemented in handball small-sided games, peer verbal encouragement can produce greater positive effects than teacher verbal encouragement in terms of offensive performance.

Background: Previous research suggests that cardiac examination skills in undergraduate medical students frequently need improvement. There are different ways to enhance physical examination (PE) skills such as simulator-based training or peer-assisted learning (PAL). Aim: The aim of this study was to evaluate the effectiveness of a structured, simulator-assisted, peer-led training on cardiovascular PE.Methods: Participants were third-year medical students at Leipzig University Faculty of Medicine. Students were randomly assigned to an intervention group (IG) and a control group (CG). In addition to standard curricular training, IG received a peer-led, simulator-based training in cardiac PE. Participant performance in cardiac PE was assessed using a standardized checklist with a maximum of 25 points. Primary outcome was assessed via checklist point distribution.Results: 89 students were randomised to either CG (=43) or IG (=46) with 70 completing the study. Overall, IG students performed significantly better than CG students did (max. points: 25, ± in IG was 17±3, in CG 12±4,

Peer-assisted learning (PAL) is an innovative approach of learning where people from similar social groupings who are not professional teachers help each other to learn. This study was an experimental interventional comparative analysis conducted in the Department of Biochemistry and Department of Pediatrics, Karpagam faculty of medical sciences and research, Coimbatore. One hundred students were recruited in the study after getting informed consent. This study compared the effects of two educational methods: PAL and teaching by regular faculty members on 1st-year undergraduate medical students. Students' posttest marks in the PAL group were higher than the lecture group (12 ± 2.9 vs. 9.8 ± 3.5, P < 0.02). The majority (70%) of the students agreed that PAL is a better method of learning and develops teaching attitude. Most of the students strongly agreed that PAL provides friendly environment for learning (80%). PAL provides a relaxed environment for students to study and learn skills including leadership, presentation, and communication, all of which are very essential to practice modern medicine.

Abstract Background Peer-assisted learning (PAL) is a common teaching and learning method in medical education worldwide. In the setting of skills laboratories (skills labs), student tutors are often employed as an equivalent alternative to faculty teachers. However, to the best of our knowledge, there is a lack of qualitative studies which explore the reasons for the personal commitment of student tutors. The aim of our study was to examine how undergraduate students experienced and evaluated their roles as skills lab student tutors, what their motivation was, and whether social and cognitive congruence played a role in their teaching experiences. Methods We conducted in-depth, semi-structured interviews with student tutors who were currently teaching in a skills lab. After the interviews had been transcribed verbatim, two independent investigators performed a qualitative content analysis according to Mayring. Results In total, we conducted nine interviews with student tutors. Our results revealed that all student tutors showed great enthusiasm and motivation for their jobs as peer teachers. One of the main motivating factors for student tutors to teach in a skills lab was the possibility to simultaneously share and improve their knowledge and expertise. In general, the participants of our study had high aspirations for their teaching. They found it particularly important to be empathetic with the student learners. At the same time, they thought they would personally benefit from their teaching activities and develop a certain expertise as student tutors. Conclusions With the present study we are able to gain some insight into what motivates student tutors to teach in a skills lab and what kind of experiences they have. Our results provide an important input for the future training of highly qualified student tutors.

Abstract Background Simulation-based learning plays an important role in contemporary medical education, although there are problems providing tutors. Peer-assisted learning has begun being formally adopted in medical education. Although it is considered useful for simulation-based learning, its effectiveness remains unclear. This study was designed to compare the effect of simulation-based learning with that of traditional lectures conducted by postgraduate-year (PGY)-II residents on PGY-I residents. Methods This study was conducted at Okayama University Hospital over three years, for one week each year, before residents entered clinical practice. The study enrolled 76 PGY-I residents, who were randomized into two groups: simulation and lecture groups. PGY-II residents volunteered to conduct simulations and lectures. Knowledge evaluation was performed using pre- and post-tests, and self-evaluation of competence and behaviour-change and program evaluations were conducted using questionnaires. Results In both groups, knowledge test scores were found to improve significantly, and the score difference between pre- and post-tests in both the groups was not significant. Self-evaluation of competence and behaviour-change was found to be higher in the simulation group than the lecture group. The trainees in the simulation group valued the program and the PGY-II residents as teaching staff more than those in the lecture group. Conclusions The combination of simulation-based learning and peer-assisted learning led by PGY-II residents is potentially more effective in improving the postgraduate education of PGY-I residents than the combination of lecture and peer-assisted learning.

Peer-assisted learning (PAL) has numerous benefits in medical curricula. In the extended curriculum programme (ECP) at a university in South Africa, remedial interventions, such as same year/level PAL, were implemented to improve academic success. This article focuses on the measures to ensure the quality of PAL as an intervention for the academic under-preparedness of ECP students. After the midterm assessment results had been verified, the academically strongest ECP students were appointed as tutors (n=10) for the remainder of the student cohort (n=31). Structured, informal PAL activities were implemented as an academic intervention between consecutive assessments. Analysis of the pre- and post-intervention results showed a statistically significant difference for the whole study population as an increase of 6.1% was recorded in post-intervention results. Nine of the ten PAL groups showed an increase in the combined group results, the highest increase being 15.1%. Although the tutor group did not show a statistically significant difference between pre- and post-intervention results, 80% of the tutors experienced a positive effect on their academic progress by scoring higher post-intervention results. The results showed that same year/level PAL interventions can assist under-prepared ECP students to be academically successful with advantages for the tutors and tutees.

Introduction Medical students often lack training in advanced communication skills encompassing emotionally fraught situations and those in which an intense emotional response is expected. Such skills are required for clinical situations encountered during residency. We created and evaluated an advanced communication skills workshop (ACSW) using standardized patients for senior medical students. The workshop emphasized communication skills for four scenarios—strong emotion, goals of care, medical error, and palliative care assessment—and utilized formative peer assessment and feedback. Methods We created the four ACSW cases with case-specific communication behavior checklists and a common modified Master Interview Rating Scale in a Capstone Course for senior medical students. In groups of three, students rotated through three of four stations. Each student conducted one of the interviews while the other two completed the checklists and provided verbal feedback. We performed one-way analyses of variance on Likert responses and content analysis on open responses on a post-ACSW survey. Results Ninety-one students completed the ACSW and survey. Students assigned high value to all four ACSW student roles: interviewer, observer, feedback recipient, and feedback provider. Students rated the experience above average to excellent on nearly all survey items. Open-response themes included “liked the opportunity to give or receive peer feedback” (46%) and “found the checklists helpful” (45%). Discussion Feasible and well received by senior medical students, our ACSW offers an opportunity to practice and observe advanced communication skills and peer feedback. A peer-assisted, formative learning model, the ACSW efficiently addresses a key aspect of residency preparation.

Elizabeth Vacher, Paulina Bruessel UCL Medical School, London, WC1E 6DE, UKCorrespondence: Elizabeth Vacher Email Elizabeth.Vacher.14@ucl.ac.uk View the original paper by Dr Qian and colleagues

Peer learning is gaining momentum as an educational model suitable for university students. This study investigates the characteristics of the participation in peer-assisted learning groups (PALG) for students in Harbin-China, and compares them to their medical counterparts. The mode of peer-assisted learning interactions considered cuts across face-to-face and the use of four mediums of communication. The comparison was also extended to factors such as quality, conflict, cohesion, peer-influence, and leadership that is known to affect the learning interactions within such groups.Sixty percent (60%) of the peer-assisted learning interactions among the students take place via social media. The frequency of these learning interactions among peers is found to have a positive correlation with all the factors except for conflict (−0.040 p

Objective: Drastic restrictions were imposed due to the COVID-19 pandemic, especially relating to the practical training part of the undergraduate human and dental medical training. During emergency mode teaching in the summer semester of 2020, a pilot project on practical classroom teaching under COVID-19 conditions was undertaken the Skills Lab Dresden, the Interprofessional Medical Training Centre (MITZ). Students were able to continue learning basic communication and manual skills. This project report presents the adaptations needed for this teaching concept and discusses their feasibility as well as selected evaluation results of the trial run.Description of the project: In normal teaching, students rotate to complete training sessions in small groups. Teaching is provided in a peer-teaching format. An Inverted Classroom Model was implemented as a teaching concept during emergency operation with preparation through digital learning and classroom teaching. Organisational and teaching adjustments were carried out for the concept and to comply with containment regulations. The concept was evaluated by the students using a standardised online questionnaire.Results: 1012 students completed their training during emergency operation at the university. The containment regulations meant that there were a higher number of training sessions and a higher workload. Only one of the alternative dates provided had to be used for COVID-19-related reasons. Infection chains could be tracked. The majority of students found the communication of information via Moodle to be sufficient and did not experience any technical problems. An analysis of the students’ evaluation revealed a high level of overall satisfaction with the adapted teaching concept. Conclusion: The MITZ will once again use the concept in a modified form should there be renewed or continued emergency operation. The Inverted Classroom Model will also be established as an integral part of regular teaching. The findings may be of interest to other Skills Labs to develop concepts for emergency operation teaching to efficiently utilise site-specific resources.

Abstract Background Peer-assisted learning (PAL) increasingly features within medical school curricula. While there is evidence of its effectiveness, less is known about how it promotes learning. Cognitive and social congruence between peer-tutor and student have been described as important concepts underpinning teaching and learning in PAL. We employed interpretative phenomenological analysis for an in-depth exploration of how medical students experience PAL sessions. Methods We conducted the study at The University of Manchester within a near-peer scheme aimed at developing clinical skills within clinical clerkship students. We conducted individual interviews with three peer tutors and five students. We undertook interpretive phenomenological analysis of interview transcripts. We subsequently synthesised an account of the study participants’ lived experiences of PAL sessions from individual personal accounts to explore how medical students experience peer-assisted learning. This analysis was then used to complement and critique a priori educational theory regarding the mechanisms underlying PAL. Results Students experienced PAL sessions as a safe and egalitarian environment, which shaped the type and style of learning that took place. This was facilitated by close relationships with peer-tutors, with whom they shared a strong sense of camaraderie and shared purpose. Peer-tutors felt able to understand their students’ wider sociocultural context, which was the most important factor underpinning both the PAL environment and tutor-student relationship. Participants contrasted this relative safety, camaraderie and shared purpose of PAL with teaching led by more senior tutors in clinical settings. Conclusions This study provides a rich description of the important factors that characterise medical students’ experiences of PAL sessions. Participants felt a strong sense of support in PAL sessions that took into account their wider sociocultural context. Multiple factors interplayed to create a learning environment and tutor-student relationship that existed in contrast to teaching led by more senior, clinical tutors. The insight generated via IPA complemented existing theory and raised new lines of enquiry to better understand how the peer relationship fosters learning in PAL at medical school. We make recommendations to use insights from PAL for faculty and curriculum development.

Abstract Objective Physicians and medical students are generally poor-self assessors. Research suggests that this inaccuracy in self-assessment differs by gender among medical students whereby females underestimate their performance compared to their male counterparts. However, whether this gender difference in self-assessment is observable in low-stakes scenarios remains unclear. Our study’s objective was to determine whether self-assessment differed between male and female medical students when compared to peer-assessment in a low-stakes objective structured clinical examination. Results Thirty-three (15 males, 18 females) third-year students participated in a 5-station mock objective structured clinical examination. Trained fourth-year student examiners scored their performance on a 6-point Likert-type global rating scale. Examinees also scored themselves using the same scale. To examine gender differences in medical students’ self-assessment abilities, mean self-assessment global rating scores were compared with peer-assessment global rating scores using an independent samples t test. Overall, female students’ self-assessment scores were significantly lower compared to peer-assessment (p

Building effective and supportive communities of practice in an asynchronous environment can enable students to learn from each other at their own convenient times without the need to meeting for discussing concepts. In an undergraduate course with a large amount of content to learn, working collaboratively to answer practice exam questions can help encourage deeper learning and understanding. This project examined whether exam performance can be positively influenced by online collaboration during revision and suggests that the quality of an individual’s contribution has a direct effect on his/her subsequent exam performance. We compared two student cohorts’ exam marks from their previous 3 years of exams with how they performed in Year 4 after using PeerWise (an online repository of multiple-choice questions that are created, answered, rated and discussed by students). In addition, we looked at the quantity and quality of their contribution in PeerWise to evaluate how this affected their fourth year exam performance. We confirmed that exam performance is improved by authoring questions in PeerWise, but found it is further enhanced by replying to, and commenting on, others’ posts as well.

Context: The study was carried out to ascertain the effectiveness of peer-assisted learning (PAL) as compared to teacher-assisted learning. Aims: The aim of this study is to determine the efficacy of PAL for the first MBBS students. Settings and Design: A retrospective analytical study on medical education was conducted at a medical college in North India. Materials and Methods: The study had two activities. In the first, six students of the same batch were randomly selected to conduct a peer-guided symposium. A total of 83 students participated in this activity as experimental group. For the second activity, 54 students participated as a control group for a tutorial class conducted by two faculty members. In both activities, a questionnaire pertaining to the topic was given before and after the activity, and scores obtained were taken as pre- and post-activity scores, respectively. Change in performance, understanding, and knowledge was assessed. Statistical Analysis Used: Pre- and post-activity scores were compared using t-test. Mann–Whitney U-test was used to determine which activity was better. Results: Both activities showed a significant improvement in postactivity scores (P < 0.001) indicating that both activities are comparable and effective; however, improvement was better in teacher-assisted tutorial as compared to peer-assisted symposium (P < 0.001). Conclusions: Improvement in postactivity score of peer-assisted symposium showed that PAL may be implemented under the guidance of a teacher.

Arjun Menon, Rahul Menon, Vishnou MourougavelouFaculty of Medicine, Imperial College London, London, UKWe read with great interest the research by Shields et al,1 evaluating the most effective ways of teaching the clinical abdominal examination to medical students. As medical students ourselves, we too have noticed how variability in cohort size, teaching style, and levels of practice can affect competency when performing a clinical examination.At Imperial College, London, students are taught to perform examinations on real and simulated patients from an early stage. It is natural that students would like to examine real patients with clinical signs as without this experience early on in their medical career, it would put them at a disadvantage when they are required to recognize pathology. A randomized experiment found that what students valued most was the “authenticity” of real patient encounters.2 We do however acknowledge that simulated patients have their benefits, especially during the early learning stage. Furthermore, finding real patients who are willing to volunteer their time for the teaching of medical students can be challenging.1Another important factor to the successful teaching of the clinical examination is the size of the group. In a study of 48 medical students studying the musculoskeletal examination, it was found that through small-group interactive examination skills teaching, the students improved their skills immediately after the teaching but also maintained these acquired skills several months on.3 The controls on the other hand, who only carried out regular clerkship activities, such as hospital placements, were unable to improve their examination skills.3Authors' replyHelen M Shields,1 Nielsen Q Fernandez-Becker,2 Sarah N Flier,2 Byron P Vaughn,2 Melissa H Tukey,2 Stephen R Pelletier,3 Douglas A Horst21Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 2Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 3Center for Evaluation, Harvard Medical School, Boston, MA, USAWe are happy to respond to the excellent comments in the Letter to the Editor by Arjun Menon, Rahul Menon, and Vishnou Mourougavelou, medical students at Imperial College, London, regarding our recently published article entitled “Volunteer Patients and Small Groups Contribute to Abdominal Examination’s Success”.1We completely agree with Imperial College London’s routine practice of using “real patients” from the beginning of medical school for students to practice their physical examination skills. We would like to clarify and confirm that it is also our practice to use “real patients” for our Abdominal Examination Exercise. Our ability to recruit sufficient “real” volunteer patients each year for 43–46 small groups for the Abdominal Examination is the result of the popularity of this exercise with these patients.1 We have not had the difficulty in recruiting patients as noted by Bokken et al2 perhaps because all the patients came from the practices of the two Directors of the Abdominal Examination (HS and DH) who were committed to utilizing “real” patients.View the original article by Shields et al