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

7. Tomorrow’s 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

9. 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 1&2 students)

11. 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

12. 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

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

14. ‘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 consultantsin 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

17. 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

18. What makes a good clinical skills teacher?

19. The Twelve Roles of the Teacher (Harden et al 2002) Facilitator Role model Assessor Information provider Planner Resource developer

20. 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)

21. 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

22. 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 is…that’s 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’

26. 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”.

27. 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

28. 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

29. 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’

30. 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

32. 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. Tomorrow’s 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

34. 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