Keywords peer teaching - learning media - student-centered - self-directed learning
Introduction
Peer teaching is a well-acknowledged method to facilitate teaching and learning among
medical students as it provides them with a platform to interact with each other and
learn in a collaborative manner.[1 ] Peer teaching gives medical students a chance to teach their peers (student-centered),
and in the process learn the art to simplify complex concepts and even deliver constructive
feedback to them about their learning.[1 ]
[2 ] At the same time, it provides students with a supportive and enabling learning environment,
wherein students participate in the learning process actively and thus accounts for
better retention of knowledge and attainment of intended learning outcomes.[2 ]
[3 ] Further, peer teaching has the potential to bring about an overall improvement in
the quality of medical education delivered to students as it augments the learning
experiences among medical students.[1 ]
[2 ]
[3 ] The learning pyramid suggests that once we teach others (peer teaching), the average
retention rate is 90% which is much more than any other form of learning.[4 ] Moreover, peer teaching also supports the learning theories of behaviorism (wherein
depending on the peer teaching, other students acquire knowledge or skills—change
in behavior), constructivism (peers build upon the knowledge that students already
have), etc.
Peer teaching has been employed in heterogeneous settings (such as small group discussions,
clinical teaching, problem-based learning, etc.) by different researchers and the
studies have given encouraging results in terms of better acquisition of knowledge
and performance in assessments.[1 ]
[3 ]
[5 ]
[6 ]
[7 ] In peer teaching, the general fear associated with committing a mistake in a teacher-student
setting is significantly reduced.[4 ]
[5 ] In other words, they feel comfortable and safe to learn from their peers without
being afraid of worrying about the consequences, if they commit a mistake.[4 ]
[5 ] Another advantage of peer teaching is that it can neutralize the challenge of a
shortage of learning resources (viz., through encouraging students to make use of
existing resources like sharing of textbooks, notes, and online collaborative tools;
knowledge sharing and broader dissemination of information; creation of supplementary
materials by the peer teachers that can enhance the learning experience for everyone;
etc.), and at the same time give them an opportunity to enhance their communication
skills.[3 ]
[4 ]
[5 ] This entire process is not only useful for the students but even for the teachers
as they gain insights on different ways a topic can be taught, especially keeping
in mind how the students of the current generation learn.[6 ]
[7 ]
Considering the fact that medical education is complex, wherein students are expected
to learn multiple competencies, learning media occupy a crucial place as they aid
the students to acquire the intended learning competencies expected of a medical graduate.[8 ] The need of the hour is to employ a combination of learning media that will neutralize
the monotony linked with conventional media and will give students a chance to actively
engage, promote better retention, and stay motivated in the learning process.[8 ] Further, learning media also has the potential to bridge the gap that exists between
theoretical concepts and practical relevance and thus provide better understanding
to the students.
This calls for the need that we must employ appropriate and combination of learning
media (viz., videos, simulation, chart, PowerPoint, etc.), that not only meets the
need of students with different learning styles, but act as an effective tool to acquire
critical thinking, problem-solving, and practical skills.[8 ]
[9 ] Thus, keeping the wide range of merits that have been attributed to peer teaching
that enables student-centered learning and the scope of learning media in enhancing
the learning experiences among medical students, the current study had been planned
with objectives to assess the merits and effectiveness of peer teaching in small groups
through the employment of different learning media.
Materials and Methods
Study design and study settings : This was a cross-sectional descriptive study conducted among a group of 34 students
from the third professional year in the department of community medicine in a tertiary
medical college as a part of a small group teaching session. The selected topic for
peer teaching was “Epidemiology of Hypertension.” These students are a part of the
undergraduate medical training course which is of 5.5 years' duration, including 1
year of internship. The 4.5 years of the course is divided into first, second, third
professional year—part I, and third professional year—part II, and each year had specific
number of subjects that a student must clear in summative assessment. Community medicine
is a subject that is taught to students right from the first professional year, but
its summative assessment finally happens at the end of the third professional year—part
I.
Sampling method : Purposive sampling was employed in the study, wherein we selectively those third
professional year medical students who were posted in the department during the period
of study.
Inclusion and exclusion criteria : All students posted in the department for the small group session were included.
Only those students who were absent during the session were excluded from the study.
Data collection : The entire session was facilitated by a single faculty to provide guidance to the
students whenever they are in doubt and also to streamline the entire peer teaching
session. At the beginning of the session, a pretest consisting of 10 multiple-choice
questions (MCQs), each carrying 1 mark, was conducted on “Epidemiology of Hypertension”
using Google Form. The MCQs were of the single best type with four options and tested
recall and understanding levels as per Bloom's taxonomy of the cognitive domain. All
these questions were designed after a thorough brainstorming session in the department,
and subsequently it was pilot-tested among a representative group of students. Further,
based on the feedback obtained, the questions were modified and this validated set
of MCQs were used for both pretest and posttest. Subsequently, the facilitator explained
the objectives of the small group teaching session and all 34 students were divided
randomly into 5 groups by asking them to call out from 1 to 5, and subsequently, all
similar numbers were grouped together (each group comprising of 6–7 members each).
Further, the lottery method was used to allocate the topic as well as the learning
media to each of the groups by inviting one representative from each of the groups
(as mentioned in [Table 1 ]).
Table 1
Group-wise allocation of topic and learning media
Group
Allocated topic
Allocated learning media
1
Distribution and magnitude of hypertension, and tracking of blood pressure
Video
2
Risk factors and rule of halves
PowerPoint presentation
3
Prevention of hypertension
White board
4
National Programme for Prevention and Control of Cardiovascular Disease, Cancer, Diabetes,
and Stroke
Chalk-and-talk
5
Five levels of prevention
Chart
Each group was provided with a time of 45 minutes to discuss the topic and then present
their discussion findings in the large group using the allocated learning media. Moreover,
students were given instructions to sit in the form of a circle and discuss their
plan of action and execution. They were also asked to identify leaders and presenters
from the group and even define the role of each member in the group. Students were
given the freedom to refer to any learning resource (viz., textbook, government documents,
World Health Organization web site, etc.) for the allotted subtopic and at the end
of the discussion, make a presentation to the entire class within 5 minutes.
At the time of the presentation by one group, other groups were asked to ask questions/clarifications
and also provide constructive feedback on what was done well and the areas wherein
the group could have done better. Subsequently, the best group was decided based on
multivoting, wherein each student was given an opportunity to vote three times in
favor of the group which they liked the most (except their own group). This voting
was done keeping in mind variables like teamwork (representation from each member
of the group), presentation skills (such as clarity of presentation, logical flow,
etc.), overall outcome (like quality of video, clarity of chart/whiteboard/blackboard,
adherence to standard rules in making PowerPoint, etc.), and the ability to respond
to the questions of peers from other groups.
Upon the completion of the session, a posttest was administered to the students using
the same 10 MCQs and the results were compared with the pretest. At the end of the
session, students were asked to provide feedback about the peer teaching session and
using a Google feedback form, which was designed to obtain sociodemographic details,
feedback on attributes of the session on a Likert scale of 1 to 5 (strongly disagree
to strongly agree), feedback on the facilitator, and two open-ended questions (viz.,
mention any three things that you liked in today's peer teaching session, and mention
areas that needs to be improved in the future).
The Kirkpatrick Level 1 (reaction) was assessed by obtaining the immediate reactions
of the students to the session like what they liked, what needs to be improved, and
feedback of session attributes. This eventually provided insights about the utility/merits
of the peer teaching session. For the Kirkpatrick Level 2 (learning), we carried out
a comparison between the score of pretest and posttest, and this gave insights about
the extent of learning after the session. In other words, this comparison provided
inference about the effectiveness of the peer teaching session.
Study variables : Feedback from students about the role of the facilitator in stimulating interest
in the topic, provision of adequate opportunity to participate in group activity and
discussion, topic coverage, time utilization, adherence to session objectives, merits
of peer teaching, areas that need to be improved, etc.
Statistical analysis : Data entry was done in Microsoft Excel sheet and analysis was done using SPSS version
16. Descriptive statistics were used to represent the data in the form of mean, standard
deviation, frequency, and percentages. Paired t -test was used to compare the performance of the students in pretest and posttest
at p level < 0.05. Open-ended answers were grouped into categories (similar kinds of responses
are grouped together and presented in the form of cumulative numbers and percentages).
Ethical considerations : Written informed consent was obtained from the study participants before the conduct
of the study. Students were given reassurance that performance in the assigned task
will not have any impact on their academic performance and the entire exercise is
being done to encourage learning and as a part of formative assessment.
Results
This innovative session of peer teaching on the different subtopics related to epidemiology
of hypertension were undertaken as a part of a 3-hour small group discussion session.
A total of 34 students, including 21 (61.8%) girls and 13 (38.2%) boys, with a mean
age of 22 ± 1.3 years participated in the peer teaching session using five different
learning media. While carrying out the Kirkpatrick Level 1 evaluation of the session
using a 5-point Likert scale, it was quite encouraging to note that almost 90% of
the respondents positively rated the domains of the role of the facilitator in stimulating
interest in the topic, provision of adequate opportunity to participate in a group
activity, and overall encouraging experience in the teaching-learning process ([Fig. 1 ]). There was a mean average increase of 1.7 marks on comparing the scores of the
posttest with the pretest and the reported difference was statistically significant
(Kirkpatrick Level 2).
Fig. 1 Feedback on attributes of the session.
Group 1 (7 members) was assigned to the task of preparing a video to explain the “distribution
and magnitude of hypertension and tracking of blood pressure” ([Fig. 2 ]). The group came out with a 90-second video, wherein all members were assigned different
roles and the video was appreciated by everyone owing to the clear message that was
delivered and that it was made in a very short period of time. Group 2 consisting
of 7 members was asked to make a PowerPoint presentation on the topic “Risk Factors
and Rule of Halves,” and then make the presentation to the large group ([Fig. 2 ]). Based on the constructive feedback that was given to the group, it was highlighted
that all team members could have been involved in the presentation, as only three
of them made the presentation.
Fig. 2 Activity by group 1 and group 2.
Group 3 comprising of 6 students was given the task to present about the “prevention
of hypertension” to the large group using a white board ([Fig. 3 ]). The group received positive feedback from other groups, but the members were not
able to answer about quaternary prevention and its need in public health. A total
of 7 students was allocated to group 4, which was assigned the task to elaborate on
the “National Programme for Prevention and Control of Cardiovascular Disease, Cancer,
Diabetes, and Stroke” using chalk-and-talk as the learning media ([Fig. 3 ]). The overall content prepared by the group members was appreciated by all other
groups, nevertheless as a constructive suggestion, it was emphasized that all members
should be engaged in the presentation (as only one student presented the entire topic).
Fig. 3 Activity by group 3 and group 4.
Group 5 was allocated the task to present “Five Levels of Prevention” using a chart
as the learning media ([Fig. 4 ]). The overall outcome was colorful and attractive, but some of the members from
other groups mentioned that the details in the chart were not visible. For the benefit
of the undergraduate students, after the presentation of each group, the pros and
cons of different learning media were discussed by the facilitator to help them make
an informed choice in their future assignments. Finally, to decide the winner among
all the groups, multivoting was done ([Fig. 5 ]).
Fig. 4 Activity by group 5.
Fig. 5 Multivoting to decide the best group.
[Table 2 ] depicts the areas which the students liked about peer teaching and the most frequently
cited options were joyful learning 24 (66.7%), peer teaching 23 (63.9%), group discussion
23 (63.9%), and do's and don'ts about learning media 22 (61.1%), respectively. With
reference to constructive suggestions for improvement in the peer teaching session,
7 (19.4%) students of the sessions suggested more time for preparation while 11 (30.5%)
students asked for similar sessions in the future to augment their learning.
Table 2
Feedback on positive things in the peer teaching session
Parameters
Number[a ] (%)
Interactive session
19 (52.8)
Equal opportunity was given to all students
11 (30.5)
Understanding and learning about the topic was made easier
16 (44.4)
Group discussion
23 (63.9)
Involvement of all students
18 (50)
Feedback from other teams
15 (41.7)
Informative and resourceful
19 (52.8)
Joyful and fun-filled learning
24 (66.7)
Innovative approach to teach a dry topic
17 (47.2)
Teamwork and cooperation
17 (47.2)
Time management
9 (25)
Encouragement of creativity
7 (19.4)
Interesting to learn from batch mates (peer-teaching)
23 (63.9)
Improvement in communication
11 (30.5)
Do's and Don'ts about learning media
22 (61.1)
In-depth coverage of topics
19 (52.8)
a Responses obtained were not mutually exclusive.
Discussion
The peer teaching session was conducted for third professional year students to cover
a topic on the epidemiology of hypertension using five different learning media. On
a similar note, the findings of a study done with an intention to identify the preference
of medical students for peer teaching, 62.5% of the third professional year students
opted for small group teaching.[10 ] The current study was first of its kind as it involved the employment of five different
readily available learning media to promote collaboration among team members and also
to ensure an in-depth understanding of the topic. A total of 34 students, including
21 girls and 13 boys actively participated in the session to represent subtopics allocated
to their groups. The findings of a study done on peer teaching involving 33 students
in the United States revealed that students got multiple opportunities to enhance
their professional growth.[5 ]
In our study, 24 (66.7%) participants mentioned that the peer teaching session was
joyful and fun-filled. This could be because we conducted the session in the form
of a competition, wherein it was announced that the best performing group will be
felicitated. This accounted for a sense of competition among groups and all of them
ensured that their group presentation remains innovative and different from the usual.
However, the findings from a study done among first year medical students from Turkey
revealed that the major benefit of peer teaching was in terms of improvement in the
confidence level of students.[4 ] This could be due to the fact that all first year students are very much new to
the stream of medicine and they do not have much experience in talking about medical
subjects, in contrast to our study, wherein participating students were from the third
professional year who already had in past experience for public speaking.
The present study clearly highlighted the utility of peer teaching as 23 (63.9%) students
reported that it was interesting to learn from their peers and the same number of
students also attributed their learning to the group discussion that happened in the
preliminary stage of the assignment. On a similar note, multiple other studies have
reported that peer teaching makes the entire learning more fruitful with better acquisition
of knowledge and improved retention among them.[1 ]
[2 ]
[3 ]
[4 ]
[5 ]
[6 ] This could be due to the active engagement of the students in the entire exercise,
which envisages a student-centered learning approach. Moreover, we cannot also rule
out the role of self-directed learning that happens between students once they were
given a topic and this would have surely helped them in their learning process.
The findings of a longitudinal study done at the University of Belgium reported that
students who participated in peer teaching activities had better academic performance
at different points of time during their undergraduate training when compared with
other students from the same cohort.[6 ] Similar kind of results were obtained in another study done at a medical university
in Germany that involved medical students from the first professional year.[11 ] Even in our study, there was an average increase of 1.7 marks and the obtained results
were found to be statistically significant. Moreover, we must note that in the study
done in Wardha in the department of physiology and even in the present study, the
importance of feedback was emphasized to augment learning as it aids the students
to understand their strengths and the areas where they need to improve upon.[7 ]
The findings of a study done in Ireland among first year anesthesia residents revealed
that the majority of the students opined that peer teaching plays a defining role
in improving communication skills.[12 ] Similarly, in our study, 11 (30.5%) students reported that peer teaching as a teaching
method is effective in augmenting communication skills. The impact on communication
skills could be due to the interactions which the students had in small groups while
they were preparing for the assignment, the interactions they had while they made
presentations to the large group, and the interactions reported while they gave feedback
to all other groups after their presentation. In other words, peer teaching followed
by feedback administration gave them multiple opportunities to improve their communication
skills.
The findings of a study done with the intention to explore the acceptability of peer
teaching as a teaching method at the University of New South Wales revealed that the
method was very much acceptable by the students.[13 ] At the same time, students found the method to be very effective and an approach
that could be implemented even in other settings.[13 ] Along similar lines, in the present study, it was reported that the peer teaching
session was interactive (19; 52.8%), gave equal opportunity to all students (11; 30.5%),
and that understanding and learning about the topic was made easier (16; 44.4%). All
these results indicate that during these sessions, the student gets multiple opportunities
to learn and retain the knowledge and become a better version of themselves.[13 ]
[14 ]
[15 ]
In the current study, medical students used only five learning media (viz., video,
PowerPoint presentation, white board, chalk-and-talk, and chart) to present the assigned
subtopic. However, in a study done in a medical college in Germany, among students
while reading pharmacology, a variety of learning media were used.[16 ] Similarly, the augmented reality tool was employed by students to enhance their
physical examination skills of pregnant women in Indonesia.[17 ] This could be primarily because of the fact that in our study, we restricted the
number of learning media to only five to make the entire process feasible and practical,
while that was not the case in other studies.[16 ]
[17 ]
The strength of the present study was that to ensure that small group discussion sessions
are more effective, we grouped students into further smaller groups to ensure better
collaboration between team members. Subsequently, in each group, we instructed members
to identify a leader and specify roles for each member and this was done to ensure
that all members are aware of their responsibilities and at the same time accountable.
Further, it was informed to all students that whenever one group is presenting, all
the other groups must ask questions and suggest areas where the group did well and
the areas where they could have done better. This was done with an intention to promote
collaborative learning and to ensure that students receive feedback from their peers
(more readily accepted than by teachers). The study had its share of limitations,
as it was done in only a single batch of students, that too, only for a single topic,
and thus study results cannot be generalized.
Conclusion
In conclusion, peer teaching is an important and valuable method of teaching and learning
in medical education, as it promotes active learning, ensures an in-depth understanding
of the topic, improves communication skills, and even brings about improvement in
the academic performance of the students. Based on the findings of the current study,
it was concluded that peer teaching using different learning media proved to be quite
effective in the improvement of knowledge about epidemiology of hypertension, the
pros and cons of different learning media, and encouraged creativity among students.
