Laura K. Molgaard1 and Emma K. Read2
1College of Veterinary Medicine, University of Minnesota, USA
2Faculty of Veterinary Medicine, University of Calgary, Canada
Peer-assisted learning (PAL) has been shown to be a valuable strategy in health sciences education, and while it is not yet widely adopted or described in veterinary medical education, there are many possible benefits that could be explored. PAL has been defined as “people from similar social groupings who are not professional teachers helping each other to learn and learning themselves by teaching” (Topping, 1996, p. 322). This chapter will focus on uses of PAL identified to date and attempt to define relevant terminology for the veterinary education context. It will also outline the potential benefits of implementing PAL, explore considerations for both tutors and tutees, and describe several applications of PAL that may be particularly relevant to veterinary medical education.
Group work and cooperative learning differ from PAL. Group work and cooperative learning are about peers working together on faculty-designed interactions. With PAL, the emphasis is on peer teaching and peer direction (Ross and Cameron, 2007). For the purposes of this chapter, group and cooperative learning will not be considered under the working definition of PAL.
Peer tutors are often tasked with “helping others to learn,” but this does not fully encompass the role they may play. Peers can play a role in teaching new material, helping to revise previously acquired knowledge, producing learning resources, mentoring study or life skills, and assessing progress related to learning (Ross and Cameron, 2007).
Confusion exists regarding terminology commonly employed in the literature, with many authors using the same term to describe a variety of activities or roles. In peer-assisted learning the peer teacher may be from the same year of study as the learners (peer) or from a more advanced year (near-peer), although this distinction is not clearly articulated in many references. The peer teacher is often referred to as the tutor and is responsible for assisting in the teaching of, mentoring of, or assessment of the tutee. The tutor has less content knowledge, less formal teacher training, and less authority than the formal course instructors (Damon, 1989). The tutee is the one being assisted. The term “learner” is sometimes used to describe the tutee, but because all students are learners, and in fact some PAL programs are designed with the primary goal of the tutor learning to teach, this term might best be avoided in the context of PAL.
Definitions relating to PAL are summarized in Box 8.2.
In a 2007 Association for Medical Education in Europe (AMEE) guide, Ross and Cameron (2007) articulated a planning and implementation framework for PAL with 23 questions organized into 7 categories to help guide an institution through the process of creating and implementing a PAL program. We have consolidated and adapted this framework to include background and objectives, a discussion of roles and responsibilities of participants, and a description of published outcomes and best practices.
Background to and Objectives of PAL
Programs may have a variety of reasons for considering the implementation of PAL. Educational institutions ranging from primary schools to those offering undergraduate, graduate, and professional programs have created PAL programs to serve a variety of needs, many of which are relevant to veterinary education. Objectives of these programs include support of individual students through social support, remedial support, or additional opportunities to practice new technical skills. While PAL cannot replace the role or expertise of the faculty instructor, it can provide another mechanism for students to have basic or common questions answered in a setting that may be considered more comfortable and less intimidating (Micari, 2006). Peer tutors and peer learners have “cognitive congruence” with the peer tutee, meaning that in many cases they are better able to understand and answer the questions that a tutee poses. This often relates to their use of simpler language for explanation and to their ability to more readily identify problem areas that are making learning challenging for the tutee (Lockspeiser et al., 2008).
In addition to benefit to the individual student, peer support can provide benefit to the institution through decreased attrition (Higgins, 2004). An institution may also choose to offer PAL to alleviate the teaching burden or address limited resources (Ten and Durning, 2007). This can be critical when the cohort is large and the institutional resources, particularly the budget, are limited. It has been especially useful in the area of clinical skills teaching and learning when demand for repeated practice exceeds the staff resources available. It should be noted that programs using PAL to alleviate resource limitations have been criticized by some commentators for ethical concerns regarding possibly disadvantaging students with what might be perceived as lower-quality education (Ross and Cameron, 2007).
The resources needed to create and manage a PAL program must be considered, including recruitment and training of tutors, design of interactions, development of materials, scheduling of sessions, oversight of peer tutors, and assessment of outcomes (Topping, 1996). Stakeholders, including faculty, need to be involved early in order to obtain buy-in and minimize political resistance (Ross and Cameron, 2007). Faculty may worry that students who require additional support through PAL are not capable of meeting the requirements of a rigorous program or that PAL encourages grade inflation (Widmar, 1994). If peer tutors are perceived as a replacement for instructors, students may be skeptical about the knowledge and skill of the peer tutors, and faculty may be suspicious of administrative motives in using students to replace faculty effort (Smith, 2013). The quality and variability of the tutoring may also be a concern that needs to be mitigated by training and evaluation (Topping, 1996). Clear guidelines must be created to delineate when peers will be used to support instruction. In the case of peer tutoring for academic support, faculty and students alike need to understand the role of the peer tutor as a facilitator, not as replacement for the instructor. Students who look to the peer tutor for quick-fix learning or as a mechanism simply to increase grades will not benefit from the potential benefits of deeper learning and social support (Smith, 2013).
In a review of the literature, there are four main purposes for which one may wish to consider PAL in a veterinary institution: academic support, skill development, development of teaching skills, and assessment. The following sections will include some uses of PAL at veterinary schools that have not been described in the published literature previously, although most have been discussed at educational meetings. These interactions have come to light following an informal survey of Association of American Veterinary Medical Colleges (AAVMC) veterinary colleges, and are presented here as some examples of how peer programs may be useful in meeting current educational challenges.
PAL to Provide Academic Support
A common objective for PAL programs in undergraduate and health science programs is to provide additional study support to learners or mentoring in case of remediation or gaps in preparation for high-stakes assessments. Additionally, support may be required for specific courses in a curriculum with a high volume of difficult-to-master material, and relatively high failure rates (Hurley et al., 2003). The structure of a PAL academic support tutor program may be one-to-one, in which a student, typically a near-peer from a more senior class, acts in a fixed role (Topping, 1996). An alternative structure is small-group tutoring, where a tutor works with a small group or multiple small groups to provide remedial content support as well as more effective approaches to studying or understanding the content. The rigors of a veterinary curriculum invariably put demands on learners and stretch their ability to cope with the tremendous volume and complexity of content they are expected to learn. While little has been published in veterinary medical education about PAL as it is defined in this chapter, with the peer tutor acting in a fixed role to support the learning of another student or students, in an informal survey of veterinary colleges (unpublished) the most commonly reported use of PAL was for near-peer tutor programs to support struggling learners. Most colleges did not provide training to tutors beyond a brief orientation. Supervision was also similarly variable. An example of a near-peer tutor program is provided in Box 8.3.
PAL to Support Skills Development
Using peers to support anatomical, professional, and clinical skills training and assessment is intuitively beneficial because this sort of teaching does not always lend itself well to the efficiency of one teacher working with a large classroom filled with students. The dominant mode of learning in anatomy is student-led dissection with accompanying lectures, and living anatomy demonstrations using imaging and animals (Evans and Cuffe, 2009). The University of Glasgow medical school was one of the first institutions to use near-peers to teach clinical examination to junior veterinary students (Field et al., 2007). Clinical skills training courses have recently seen an increased emphasis in many curricula as part of the focus on outcomes-based programming. Many of these programs incorporate peer tutors to help with teaching, learning, and assessing clinical skills, including a novel use of peers to teach rectal palpation skills with the Haptic Cow simulator at the Royal Veterinary College in London, UK (Kinnison et al., 2009). PAL was combined with an automated self-teaching version of this computerized simulator and role-playing exercises were used to improve tutee communication skills. There was an emphasis on the preparation and support of tutors.
Examples of using PAL to enhance anatomical training exist in both the medical and veterinary medical literature. Near-peer programs have been employed in medical schools to allow upperclassmen to gain teaching experience and a deeper understanding of the material, while enhancing the student–teacher ratio in labs and providing educational materials aimed at highlighting some of the challenges in retaining large volumes of material (Evans and Cuffe, 2009). With the advent of outcomes-based programs in medical and veterinary schools, some educators have highlighted concerns about the reduction in contact hours for teaching anatomical principles (Hall et al., 2013). This shift in ideology was partly instituted to create more time to develop non-technical competencies (also referred to as SKAs or Skills Knowledge Aptitudes and Attitudes; Brown and Silverman, 1999; Lloyd et al., 2004) that provide essential social and professional skills that will benefit students in becoming well-rounded professionals on graduation (Hall et al., 2013), but some educators insist that this additional training has compromised time spent on core content knowledge. Educators at the Royal Veterinary College in London developed a novel anatomy training system with four defined roles for students in a reciprocal PAL exercise, and reported enhancements in learning, pre-class preparation efforts, and use of available resources (Hall et al., 2013). Examples of PAL in veterinary skills training are provided in Box 8.4.