Document Type : Original Article
Authors
- . Laura Brunelli 1
- . Annarita Tullio 2
- . Giuseppe Perri 3
- . Lucia Lesa 4
- . Lucrezia Grillone 5
- . Giulio Menegazzi 6
- . Corrado Pipan 7
- . Francesca Valent 2
- . Silvio Brusaferro 8
- . Maria Parpinel 8
1 Department of Medicine, University of Udine, Accreditation and Quality Unit, Central Friuli University Integrated Trust
2 Hygiene and Clinical Epidemiology Unit, Central Friuli University Integrated Trust
3 Department of Medicine, University of Udine,
4 Medical Directorate, Central Friuli University Integrated Trust
5 Department of Medicine, University of Udine Medical Directorate, Central Friuli University Integrated Trust
6 HTA Unit, Regional Trust for Healthcare Coordination, Udine, Italy
7 Department of Medicine, University of Udine Hygiene and Clinical Epidemiology Unit, Central Friuli University Integrated Trust
8 Department of Medicine, University of Udine
Abstract
CONTEXT: Health promotion (HP) and clinical risk management (CRM) topics are seldom discussed
during medical school lessons. Peer‑assisted learning (PAL) has long occurred informally in medical
education, and interest in this method has recently grown, as it is considered a valuable technique
for both tutors and tutees.
AIMS: The aim was to evaluate the impact of HP and CRM PAL intervention on medical
students’ (tutees) knowledge level.
SETTINGS AND DESIGN: A PAL intervention has been implemented at Udine University medical
school during 2017. It was composed of lectures and practical activities conducted by ten near‑peer
tutors.
METHODS: The effectiveness has been evaluated by giving tutees: (1) a knowledge multiple‑choice
questionnaire, before and after the intervention; (2) a satisfaction questionnaire; and evaluating (3)
tutees’ group assignments.
STATISTICAL ANALYSIS USED: We performed descriptive analysis; then McNemar, Wilcoxon
signed rank, Wilcoxon Mann–Whitney, and t‑tests were applied.
RESULTS: The number of students addressed by PAL intervention was 62. Difference in total
correct answers among pre‑ and post‑intervention questionnaires showed a statistically significant
improvement (P < 0.0001), both when analyzing it globally and by area (HP/CRM). Students’
satisfaction for CRM was greater than for HP area (P = 0.0041).
CONCLUSIONS: This educational intervention based on PAL showed its effectiveness producing
a statistically significant improvement in students’ knowledge. Our findings confirm that PAL could
be a feasible method for HP and CRM topics.
Keywords
higher education: A typology and review of the literature. High
Educ 1996;32:321‑45.
2. Bulte C, Betts A, Garner K, Durning S. Student teaching:
Views of student near‑peer teachers and learners. Med Teach
2007;29:583‑90.
3. Ross MT, Cameron HS. Peer assisted learning: a planning and
implementation framework: AMEE Guide no. 30. Med Teach
2007;29:527‑45.
4. Nestel D, Kidd J. Peer assisted learning in patient‑centred
interviewing: The impact on student tutors. Med Teach
2005;27:439‑44.
5. Rashid MS, Sobowale O, Gore D. A near‑peer teaching program
designed, developed and delivered exclusively by recent
medical graduates for final year medical students sitting the final
objective structured clinical examination (OSCE). BMC Med Educ
2011;11:11.
6. Pelloux S, Grégoire A, Kirmizigul P, Maillot S, Bui‑Xuan B,
Llorca G, et al. Peripheral venous catheter insertion simulation
training: A randomized controlled trial comparing performance
after instructor‑led teaching versus peer‑assisted learning.
Anaesth Crit Care Pain Med 2017;36:397‑402.
7. Preece R, Dickinson EC, Sherif M, Ibrahim Y, Ninan AS,
Aildasani L, et al. Peer‑assisted teaching of basic surgical skills.
Med Educ Online 2015;20:27579.
8. Saleh M, Sinha Y, Weinberg D. Using peer‑assisted learning to
teach basic surgical skills: medical students’ experiences. Med
Educ Online 2013;18:21065.
9. Tang TS, Hernandez EJ, Adams BS. Learning by teaching:
A peer‑teaching model for diversity training in medical school.
Teach Learn Med 2004;16:60‑3.
10. Knobe M, Münker R, Sellei RM, Holschen M, Mooij SC,
Schmidt‑Rohlfing B, et al. Peer teaching: A randomised controlled
trial using student‑teachers to teach musculoskeletal ultrasound.
Med Educ 2010;44:148‑55.
11. English R, Brookes ST, Avery K, Blazeby JM, Ben‑Shlomo Y. The
effectiveness and reliability of peer‑marking in first‑year medical
students. Med Educ 2006;40:965‑72.
12. Engels D, Kraus E, Obirei B, Dethleffsen K. Peer teaching beyond
the formal medical curriculum. Adv Physiol Educ 2018;42:439‑48.
13. Rees EL, Quinn PJ, Davies B, Fotheringham V. How does peer
teaching compare to faculty teaching? A systematic review and
meta‑analysis. Med Teach 2016;38:829‑37.
14. Burgess A, McGregor D, Mellis C. Medical students as peer tutors:
A systematic review. BMC Med Educ 2014;14:115.
15. Ten Cate O, Durning S. Peer teaching in medical education:
Twelve reasons to move from theory to practice. Med Teach
2007;29:591‑9.
16. Ottawa Charter for Health Promotion; 1986. Available from:
http://www.euro.who.int/en/publications/policy‑documents/
ottawa‑charter‑for‑health‑promotion‑1986. [Last accessed on 2017
Mar 18].
17. Makary MA, Daniel M. Medical error‑the third leading cause of
death in the US. BMJ 2016;353:i2139.
18. The principles of quality assurance. WHO Working Group. Qual
Assur Health Care 1989;1:79‑95.
19. Scally G, Donaldson LJ. The NHS’s 50 anniversary. Clinical
governance and the drive for quality improvement in the new
NHS in England. BMJ 1998;317:61‑5.
20. Rubin JD, Sobal J, Moran MT. Health promotion beliefs and
practices of fourth‑year medical students. Am J Prev Med
1990;6:106‑11.
21. International Patient Safety Goals. Joint Commission International.
Available from: https://www.jointcommissioninternational.org/improve/international‑patient‑safety‑goals/. [Last accessed on
2020 Jan 27].
22. Clark‑Carter D. Quartiles. Wiley StatsRef: Statistics Reference
Online. Chichester, UK: John Wiley and Sons, Ltd.; 2014.
23. R: The R Project for Statistical Computing. Available from:
https://www.r‑project.org/. [Last accessed on 2020 Jan 27].
24. Ten Cate O, Durning S. Dimensions and psychology of peer
teaching in medical education. Med Teach 2007;29:546‑52.
25. Herrmann‑Werner A, Gramer R, Erschens R, Nikendei C,
Wosnik A, Griewatz J, et al. Peer‑assisted learning (PAL) in
undergraduate medical education: An overview. Z Evid Fortbild
Qual Gesundhwes 2017;121:74‑81.
26. Widyahening IS, Findyartini A, Ranakusuma RW, Dewiasty E,
Harimurti K. Evaluation of the role of near‑peer teaching in critical
appraisal skills learning: A randomized crossover trial. Int J Med
Educ 2019;10:9‑15.
27. Tamachi S, Giles JA, Dornan T, Hill EJ. You understand that whole
big situation they’re in: Interpretative phenomenological analysis
of peer‑assisted learning. BMC Med Educ 2018;18:197.
28. Sevenhuysen S, Farlie MK, Keating JL, Haines TP, Molloy E.
Physiotherapy students and clinical educators perceive several
ways in which incorporating peer‑assisted learning could
improve clinical placements: A qualitative study. J Physiother
2015;61:87‑92.
29. Khalid H, Shahid S, Punjabi N, Sahdev N. An integrated 2‑year
clinical skills peer tutoring scheme in a UK‑based medical school:
Perceptions of tutees and peer tutors. Adv Med Educ Pract
2018;9:423‑32.
30. Carr SE, Brand G, Wei L, Wright H, Nicol P, Metcalfe H, et al.
Helping someone with a skill sharpens it in your own mind:
A mixed method study exploring health professions students
experiences of Peer Assisted Learning (PAL). BMC Med Educ
2016;16:48.
31. Khaw C, Raw L. The outcomes and acceptability of near‑peer
teaching among medical students in clinical skills. Int J Med Educ
2016;7:188‑94.
32. Burgess A, McGregor D. Peer teacher training for health
professional students: A systematic review of formal programs.
BMC Med Educ 2018;18:263.
33. To Err is Human. Washington, DC.: National Academies Press;
2000. Available from: http://www.nap.edu/catalog/9728. [Last
accessed on 2020 Jan 27].
)