Peer assisted learning and assessment

1
Peer assisted learning and assessment

• Dr Deborah Gill
• Senior Lecturer in Medical Education
• Academic Centre for Medical Education
• Royal Free and University College Medical School

2
Aims of the workshop

• Outline the range of activities that can be
  classified as peer assisted learning and
  assessment
• Identify the drives that are encouraging the
  adoption of peer assisted learning in education
  for the health professions
• Outline the range of peer tutoring initiatives
  taking place at the Royal Free University
  College Medical School
• Provide you with an opportunity to reflect on how
  peer assisted learning and assessment could be
  introduced in your own setting

3
What is PAL?

• People from similar social groupings who are
  not professional teachers helping each other to
  learn, and learning themselves, by teaching.
  Topping 1996

4
What is PAL?

• Co-operative learning with a collaborative
  approach
• syndicate groups and group projects
• groups tackle tasks, problems, activities or
  projects. Includes discussion groups and problem
  based learning
• peer assessment and peer monitoring
• Includes supplemental instruction, peer support
  groups
• peer tutoring
• Including same year fixed role, reciprocal, and
  cross year
•        

5
Why PAL ?

• PAL has been shown to be effective for tutor and
  tutee alike in non-medical and medical settings.
• several hundred institutions deploy this method
  of teaching and that well-constructed and
  well-supported peer tutoring schemes have shown
  to be successful in a wide range of educational
  settings. Topping 1996
• Providing opportunities for students to teach
  each other may be one of the most important
  services a teacher can render Whitman 1988

6
What is driving the development of PAL in
healthcare settings?

• Tomorrow's Doctors
• Teaching and Learning strategy in higher
  education
• The large body of empirical evidence of the
  efficacy of peer assisted learning
• Changes to the teaching and learning environment

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Tomorrows Doctors Teaching skills

• Be able to demonstrate appropriate teaching
  skills
• Be willing to teach colleagues and to develop
  their own teaching skills
• Be familiar with a range of teaching and learning
  techniques
• Understand the principles of education as applied
  to medicine

8
Working Together Learning Together (DOH 2001)

• Ensure the NHS builds on good practice in
  learning and development
• working more proactively with partners
• Maintaining and extending careers

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Opportunities for medical students at RFUCMS

• Student Selected Components (SSCs) in years 1, 2
  5
• Interprofessional teaching and learning SSCs
• Peer led assessments
• Buddy system
• Reverse mentoring scheme
• The Professional Development Spine

10
Student Selected Components in cross year peer
tutoring

• Peer tutors from year 5
• 4 weeks attachments to the Academic Centre for
  Medical Education
• all peer tutors attend a TIPS course and
  supplementary learning for teaching sessions
• teaching on the Introductory Course in Clinical
  Method (year 3 students)
• teaching in the Professional Development Spine
• (year 12 students)

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SSCs in interprofessional peer tutoring

• Year 5 medical students act as tutors
• Tutees experienced nurses
• Medical students teach assess clinical
  examination skills in one module of the
  Developing the Nurse Practitioner Course at
  Middlesex University

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SSCs in medical teaching

• Year 2 medical students
• Extended TIPS course
• Learn new clinical skills and teach other
  participants
• Anticipated that they may be likely to take on
  PAL roles in the future

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Peer assessment

• End of the introductory course in clinical method
  (a peer led module)
• End of surgery firm
• Nurse practitioner OSCE
• Drug projects

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Buddy system

• Buddies from years 2 3
• Voluntary scheme
• 2 buddies attached to each PDS group
• Meet PDS group formally and informally
• Linked to house system

15
Reverse mentoring scheme

• 16 first year medical students train to become
  personal trainers in IT skills
• Offer four hours of one to one tuition to SpRs
  and consultants in the Enhancing consultants IT
  skills programme

16
The Professional Development Spine

• Small group work
• group projects and presentations
• revision guide
• Training in evaluating teaching
• one hour session on day 1 of the professional
  development spine course where small groups
  explore
• what constitutes good and bad teaching
• what sort of feedback if helpful to encourage
  change
• the rules of constructive feedback

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Features of PAL activities at RFUCMS

• PALS on SSCs attend a TIPS course
• Learning for teaching sessions
• Peer tutoring method adopted (fixed roles)
• Peer tutors work with small groups of learners
  using simulated patients or volunteers
• PAL tutors have regular observation and feedback

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What makes a good clinical skills teacher?
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The Twelve Roles of the Teacher (Harden et al
2002)
Facilitator
Role model
Assessor
Information provider
Planner
Resource developer
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What are the roles of a clinical skills teacher?

• Encourages active participation
• Emphasis on teaching of applied problem solving
• Integrates clinical medicine with basic science
• Close observation of students during practice
• Provides adequate opportunity for students to
  practice skills
• Provides good role model for interpersonal
  relationships with patients
• Teaching is patient orientated rather than
  disease orientated
• Demonstrates positive attitude towards teaching
• Canon Newble Handbook for
  Clinical Teachers (1983)
•  

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Evaluation

• Feedback from the learners
• Feedback from peer tutors
• reflective log diaries
• questionnaires
• focus groups discussions
• confidence ratings
• Measurement of improvement in clinical and
  teaching skills of tutors
• Opinion of faculty

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Evaluation outcomes - tutors

• Tutors reported gains in their
• Teaching skills
• Presentation skills
• Clinical skills
• Confidence
• Understanding of assessments
• Communication skills

23
Evaluation Outcomes -Tutors

• Self-ratings of perceived confidence and
  competence in clinical skills improved
• Performance in the after OSCE was better that
  in the before OSCE

24
Feedback from peer tutors teaching
This has been the most worthwhile thing I have
done in my entire medical course Students come
up to me in the bar and tell me how good the
course isthats a real feel good factor I
now know what it is I enjoy about medicine I
feel I have an advantage over my peers
25
Feedback from peer tutors clinical skills
I feel more prepared to be a PRHO My
clinical skills are up to scratch I feel I
have an advantage over my peers
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Feedback from a personal IT trainer I have
really enjoyed working as a personal IT trainer
on the ECITS course. I felt it helped to improve
both my communication skills and teaching skills.
Although reverse mentoring is a new concept for
many people, I felt that the SpR who I taught was
not fazed by a younger person teaching him and it
did not affect the teaching session.
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Evaluation outcomes - tutees

• Learner enthusiasm for PAL is overwhelmingly
  positive
• Learners suggest a wide range of other areas
  where PAL could be utilised
• Many tutees later become tutors

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Evaluation Outcomes -Tutees

• Learner enthusiasm for PAL is overwhelmingly
  positive
• 97 medical students
• 90 senior nurses
• Learners suggest a wide range of other areas
  where PAL could be utilised
• Many tutees later become tutors
• Tutees do as well as (and in some cases better)
  in assessments when taught by peer tutors

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Medical student learner feedback
PAL rocks! Great reassurance and a stress free
way to learn Senior students are more
approachable so it is easy to ask questions plus
they have only recently learnt about this
themselves so can empathise with us My senior
student was excellent. Confident, articulate and
clever
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Nurse learner feedback

• The peer tutors in my group were lovely, helpful
  honest. They made the session interesting ..our
  responses were used and respected
• They had so much interest and commitment to our
  cause I found them very supportive and
  encouraging
• They knew the subject and how to put it across.
  They also took into account our experience

31
Evaluation Outcomes -Faculty

• Initial scepticism those closely involved became
  champions
• Now approved and encouraged by education
  committee
• PAL seen as a way to deliver wide variety of
  teaching and learning support especially skills
  acquisition and small group work
• PAL allows more opportunities for hands on and
  more personal level of support
• PALS are flexible and reliable of teachers

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The Way Forward

• Additional SSCs
• pilot of peer teaching in anatomy 2005
• Other PAL clinical initiatives including other
  peer assessments
• Extending the scope of the buddy scheme for new
  students
• Reverse mentoring scheme to be expanded with
  funding from workforce confederation
• Syndicate group learning in finals revision
  course
• Expanding peer led ward teaching in the ICCM
• Further developing and evaluating early years
  SSCs
• Ensuring all students have basic training in
  teaching and assessment skills not just select
  few

33
Tomorrows Teachers?

• Peer tutors can develop effective skills in
  teaching and assessment
• They display many of the attributes of an
  effective clinical teacher
• Teaching skills helps them to develop better
  clinical skills themselves
• Teaching skills learnt as undergraduates will be
  useful for later teaching roles
• Strong school and GMC support for co-operative
  learning developments

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Could I utilise PAL?

• What PAL already exists?
• What PAL and peer assessment could be
  implemented?
• What are the benefits of developing and
  implementing PAL and peer assessment
• For tutors?
• For learners?
• For the institution?
• What are the potential barriers to implementing
  PAL and peer assessment?

35
Could I utilise PAL?

• Benefits include
• Gains for tutor and tutee alike
• Fosters cooperative learning
• Addresses GMC requirements
• Teaching pitched to the needs and level of the
  learners
• Learning for understanding for tutors
• More efficient use of learning time and
  resources

36
Could I utilise PAL?

• Barriers include
• Educational climate
• Resources for training and supporting PAL
• Quality assurance of teaching and assessment
• Payment