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ORIGINAL ARTICLE
Year : 2018  |  Volume : 11  |  Issue : 2  |  Page : 108-114  

Peer-assisted learning: A boon in disguise


1 Department of Physiology, Army College of Medical Sciences, New Delhi, India
2 Department of Sports Medicine, Armed Forces Medical College, Pune, Maharashtra, India

Date of Web Publication18-May-2018

Correspondence Address:
Ritu Sharma
A 303, Meerabai CGHS, Plot No. 10, Sector 5, Dwarka, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/MJDRDYPU.MJDRDYPU_172_17

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  Abstract 


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.

Keywords: Peer-assisted learning, pre- and post-activity scores, questionnaire, symposium, tutorial


How to cite this article:
Gupta RR, Sharma R, Datta K. Peer-assisted learning: A boon in disguise. Med J DY Patil Vidyapeeth 2018;11:108-14

How to cite this URL:
Gupta RR, Sharma R, Datta K. Peer-assisted learning: A boon in disguise. Med J DY Patil Vidyapeeth [serial online] 2018 [cited 2019 Aug 25];11:108-14. Available from: http://www.mjdrdypv.org/text.asp?2018/11/2/108/232644




  Introduction Top


The rise in international interest in peer-assisted learning (PAL) is a result of a global increase in medical students and limited teaching resources.[1],[2] There is a requirement that teaching methods be suitably innovated to not only offset this deficiency but also to inculcate student-participative approach. This is presumed to motivate students, make them more inquisitive, more interested in the class, enhance their attention span, and learn by doing. This is also expected to help students retain the lesson better, be fearless in asking questions and accept their shortcomings without being admonished.[3]

There is a huge gap in the demand and supply of medical professionals in India. While the community reels under severe deficiency of doctors, medical colleges, and teachers, there is a requirement that the teaching methods be suitably improved and adapted to inculcate a more student participative approach. This is also expected to help the students retain the lesson better, be fearless in asking questions and accept their shortcomings without being admonished. The increased effectivity of communication of the peer learning process is thus expected in better learning ensuring resource efficiency.

In view of the presumed benefits, a retrospective study was undertaken to compare PAL with traditional teacher-assisted learning. The study aimed to ascertain if these activities help students in active learning and better retention which was assessed by comparing preactivity and postactivity scores. Critical analysis of the results can give us an idea about incorporating such kind of learning activities in the future also as an active learning tool.


  Materials and Methods Top


The study was conducted by the Department of Physiology in a medical college in North India. The study is a retrospective analysis of two teaching activities. The activities involved a peer-assisted symposium, and a teacher-assisted tutorial.

It was conducted from March to June 2015. All the students present in the class were included in this study. Both the topics covered under the activities were from “must know areas” of physiology. The topics were covered during regular didactic lectures earlier.

The institutional ethical committee approval was obtained.

The activities conducted were as follows:

  1. Peer-assisted symposium – A symposium on glomerular filtration rate (GFR) was conducted for eighty-three students. This group is referred as “experimental group.” The topic of the symposium had been taught by a faculty in a regular didactic lecture. The students were conveyed verbally, and a notice was also displayed on departmental notice board to prepare for the topic in advance for this activity. The topic was divided into six subtopics, and six randomly selected speaker students of the same batch were asked to prepare these subtopics with a faculty moderator. 1st student spoke on introduction, normal value, and significance, 2nd on determinants, 3rd and 4th students discussed the regulation, 5th student discussed the measurement of GFR, and 6th on applied aspects. Six speakers were considered as peer teachers. Each peer teacher from this group was asked to speak for about 10 min on his/her topic, thus the total duration of activity was 1 h. Thus, there were six peer-teachers who conducted symposium for eighty-three students. For this symposium, a set of eight questions related to the topic was prepared by all faculty members beforehand [Appendix 1]. On the day of symposium, the experimental group students were first asked to fill the questionnaire to obtain a presymposium score. After which, the symposium was conducted in the presence of faculty members who monitored the activity. At the end of the symposium, the students were asked to fill the same questionnaire again to obtain a postsymposium score. The change in knowledge, understanding, and retention of the topic was evaluated from pre- and post-symposium questionnaire scores
  2. Teacher-assisted tutorial class – A tutorial class on a topic from sensory system was conducted by two faculty members. Fifty-four students were present that day to attend tutorial. The group is referred as “control group.” The topic of tutorial had been taught by a faculty in a regular didactic lecture. The topics discussed during the tutorial were receptors, their properties, and ascending tracts. The duration for this activity was 1 h. The students were conveyed to prepare for the topic in advance for this activity. For this tutorial, a set of twelve questions [Appendix 2] from the topic was prepared by all faculty members beforehand. On the day of tutorial, all the students were first asked to fill the questionnaire to obtain a pretutorial score. After which, the tutorial was conducted by faculty members. At the end of the tutorial, the students were asked to fill the same questionnaire again to obtain a posttutorial score. The change in knowledge, improvement in understanding, and retention of the topic was evaluated from pre- and post-tutorial scores.


Statistical analysis

Pre- and post-test scores were analyzed using the t-test. Mann–Whitney U-test was also carried out to ascertain as to which activity; PAL or teacher-assisted learning resulted in better understanding of the topic.


  Results Top


For experimental group, the number of correct answers was evaluated before and after peer-assisted symposium as pre- and post-test scores. Eighty-three students had participated. The scores are summarized in [Table 1].
Table 1: Peer-assisted symposium: Pre- and post-activity scores of experimental group (n=83)

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Similarly, pre- and post-tutorial scores were evaluated for control group. The scores of fifty-four participant students are summarized in [Table 2].
Table 2: Teacher-assisted tutorial: Pre- and post-activity scores of control group (n=54)

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In both the cases, i.e., in experimental and the control groups, the postactivity score was found to have been significantly improved (P < 0.001), which reflects comparable improvement in understanding and retention of the topic in both kinds of activities.

Which activity showed better improvement?

It is evident from the above results that both activities, i.e., the experimental and control group showed improvement in the performance of the students. It will, however, be interesting to evaluate, as to which activity resulted in more improvement in understanding and retention of the topic. Mann–Whitney U-test was carried out to ascertain this. Results are summarized in [Table 3].
Table 3: Comparison of difference in scores (pre- and post-test) between two groups

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It was seen that the Group 2, i.e., the control group registered a better improvement than the experimental group in performance as far as the pretest and the posttest scores were concerned. This was found to be statistically significant at P < 0.001.


  Discussion Top


PAL can be defined as people from similar social groupings, who are not professional teachers, helping each other to learn and learning themselves by teaching. The peer teachers are neither content nor teaching experts.[4]

PAL has become a common feature over recent years in medical education. Peer teachers because of their proximity to the learner, they understand the difficult aspect of the topic. Moreover, the learners are in near to the peer teachers; this allows learners to freely express their difficulties more comfortably and in relaxed manner.[5]

A nonrandomized, interventional study, with mixed methods design was conducted by Srivastava et al. on similar lines. In that study, the “cases” were exposed to peer teaching whereas “controls” underwent tutorials for four consecutive classes by teachers. Quantitative evaluation was done through pre-/post-test score analysis. It was found that the average pre and posttest score was statistically significant within cases (P = 0.01) and controls (P = 0.023). The same result is found in our study also as both experimental and control groups showed statistically significant improvement in the postactivity scores; P < 0.001.[6]

Another study was conducted by Han et al., for anatomy dissection course in 2015. The study divided the students into two groups: one was experimental group (n = 134) who dissected a cadaver while guided by peer tutors who had prepared for the dissection in advance, and a control group (n = 71) dissected a cadaver after the introduction by a faculty through prosection. Self-assessment scores regarding the learning objectives related to the upper limbs were significantly higher in experimental group than in control group. In addition, experimental group received significantly higher academic scores than did a control group.

The study concluded that the students in PAL perceived themselves as having a better understanding of course content and achieved better academic results. Students who served as tutors were better able to acquire knowledge by teaching, and tutees were encouraged to actively participate rather than act as bystanders. This study also suggested that the institutions should offer programs that help students understand the meaning of PAL, to learn how to become effective tutors.

When the above study was compared with our study, it was observed that in both the cases i.e., in experimental and the control group, the postactivity score was found to be significantly improved (P < 0.001), which reflects comparable understanding and retention of the topic in both kinds of activities.

There was, however, a difference between the results of the study by Han et al. and the current study. A significant difference in Han et al. in the improvement in the performance of students (as manifested by the test scores) between the experimental group taught by the students and the control group taught by the teachers.[7] The current study showed better result in teacher-guided tutorial than peer-guided symposium (P < 0.001).

Another study conducted at King George's Medical University, Lucknow, India, by pediatric department where three PAL sessions, one per week, each on specific topic, were conducted using small group discussion methodology for 9th semester MBBS students. The study involved a faculty contact with student leader and 4–6 peer learners. A pretest using multiple-choice questions (MCQs) was conducted followed by the distribution of learning objectives and list of resource material. The students were asked to prepare for the topic. PAL session was conducted after 72 h; followed by posttest MCQs. This PAL session also had focus group discussion on students' experiences.

The result of this study showed that PAL was well accepted and improved learning was evident by 24.2% improvement in the posttest MCQ scores. The improvement in posttest score result which is similar to our study finding.

The study further suggested that PAL could be adopted for teaching selected topics across all subjects of MBBS course.[8]

A review on peer teaching in undergraduate medical programs by Yu et al. suggested that peer teaching is comparable to conventional teaching when utilized in selected contexts. Long-term effects of peer teaching during medical school remain poorly understood and future research should aim to address this. Although the results of this review article suggested that there are many perceived learning benefits for student tutors participating in PAL activities, no substantial evidence was found to conclude that participation as a peer tutor improves one's own examination performance.[3] Similarly, the mixed results observed by Burgess et al. regarding the accuracy of peer assessment and feedback warrants further research and investigation using objective measures.[1]

What could be the reason for improvement in posttest scores?

The current study shows improvement in understanding in both the activities.

The reasons could be as follows:

  1. In the experimental group (peer-assisted symposium), their own batch mates who conducted the symposium and this could have made the learning more interesting. Each speaker spoke only for 10 min on his/her topic that means every 10 min peer learners had a new speaker that might have added a novelty to the learning and better performance
  2. The control group which was a teacher-guided tutorial class in which a small group of students was taught by a teacher. This could have led them clear their doubts which otherwise in a large group discussion; the student would have hesitated to ask. They could have asked their doubts and queries without fear of being judged by fellow students
  3. The teacher-guided tutorial class showed better result than peer-guided symposium. The reason could be that the teacher has experience of teaching, with clear understanding and application of the topic, i.e., how to make the topic student-friendly whereas the students while acting as peer teachers try to memorize the topic, with less understanding and its application
  4. The postactivity scores in both the activities were collected immediately after the activity. This mainly involves short-term knowledge and memory which were retained by the students.


Limitations

  1. The study was carried out on pre-taught topics, as a revision class, and not on a fresh topic. PAL sessions may be conducted on a fresh topic with a faculty as a guide
  2. Different topics/systems were taught in two groups, i.e., the control and the experimental group, which limit the exact comparison of the two groups in terms of performance assessed through recall/retention in the pre- and post-study scores
  3. The interest in the subject of the students may be a confounding factor.



  Conclusions Top


It was concluded from the study that a statistically significant improvement was seen in the pre- and post-test scores of both the PAL and teacher-assisted learning groups. It was, however, also seen that the improvement in the teacher-assisted group was found to be significantly better than the peer-assisted group. It can, therefore, be interpreted that peer-assisted teaching in today's scenario where departments are limited by faculty number can be effectively employed for taking theory classes under the guidance of a teacher.

Acknowledgment

The authors sincerely thank Dr Rajul Kumar Gupta and Dr Puja Dudeja for guiding and helping us in statistical analysis and also for technical support.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Burgess A, McGregor D, Mellis C. Medical students as peer tutors: A systematic review. BMC Med Educ 2014;14:115.  Back to cited text no. 1
[PUBMED]    
2.
Topping KJ. The effectiveness of peer tutoring in further and higher education: A typology and review of the literature. Higher Educ 1996;32:321-45.  Back to cited text no. 2
    
3.
Yu TC, Wilson NC, Singh PP, Lemanu DP, Hawken SJ, Hill AG, et al. Medical students-as-teachers: A systematic review of peer-assisted teaching during medical school. Adv Med Educ Pract 2011;2:157-72.  Back to cited text no. 3
    
4.
Bennett D, O'Flynn S, Kelly M. Peer assisted learning in the clinical setting: An activity systems analysis. Adv Health Sci Educ Theory Pract 2015;20:595-610.  Back to cited text no. 4
    
5.
Glynn LG, MacFarlane A, Kelly M, Cantillon P, Murphy AW. Helping each other to learn – A process evaluation of peer assisted learning. BMC Med Educ 2006;6:18.  Back to cited text no. 5
[PUBMED]    
6.
Srivastava TK, Waghmare LS, Mishra VP, Rawekar AT, Quazi N, Jagzape AT, et al. Peer teaching to foster learning in physiology. J Clin Diagn Res 2015;9:JC01-6.  Back to cited text no. 6
    
7.
Han ER, Chung EK, Nam KI. Peer-assisted learning in a gross anatomy dissection course. PLoS One 2015;10:e0142988.  Back to cited text no. 7
[PUBMED]    
8.
Awasthi S, Yadav KK. Assessment of the acceptance and effectiveness of peer-assisted learning in pediatrics. Int J Appl Basic Med Res 2015;5:S3-6.  Back to cited text no. 8
[PUBMED]    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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