Peer-assisted learning: time for nomenclature clarification

Figures & data

Table 1 An overview of different PAL programs, their method and used terminology, presented sequentially based on the novel terminology

Proposed terminology and the corresponding teacher-to-student ratio	Study title (reference)	Method	Suggested name by the study
Peer-to-peer
Peer Mentoring (1 to 1–2)	Relationship between retention and peer tutoring for at-risk students (12)	26 ‘at-risk’ nursing students were randomised to a PAL or control group. 20 were given peer tutors (who had a higher academic score than the learner) in a one to one fashion.	‘Peer tutoring’
	Clay modelling for pelvic anatomy review for third-year medical and physician assistant students (13)	23 third year medical students taught one another female anatomy after listening to a lecture and seeing a demonstration.	‘Peer learning (peer learner and peer teachers)’
	Learning in the simulated setting: a comparison of expert-, peer-, and computer-assisted learning (14)	60 medical students were randomised to three groups. All were given a brief lecture. The peer group was split into groups of two where they taught each other while the other group consisted of computer-assisted learning.	‘PAL’
	Peer assisted learning in surgical skills laboratory training: a pilot study (15)	Residents taught each other with and without guidelines then provided feedback to each other on the skills practiced.	‘Peer feedback’ and ‘peer teaching’ was referred to as PAL
Peer Tutoring (1 to 3–10)	A controlled trial of peer-teaching in practical gross anatomy (16)	160 second year medical students, 80 of which were controls. Half the group would dissect then they would teach the next group then retire to study while the second group dissected. The second group then showed the first group.	‘Peer teaching’
	A comparison of learning outcomes and attitudes in student- versus faculty-led problem-based learning: an experimental study (17)	Second year medical students were assigned a peer within groups of 10 to facilitate tutorials.	‘Peer facilitator’
	Student-led tutorials in problem-based learning: educational outcomes and students’ perceptions (18)	Third year medical students taught each other in groups of 8–10.	‘Student led tutorials’
	Involvement in teaching improves learning in medical students: a randomized cross-over study (19)	135 first year medical students rotated the role of tutor and tutee in small groups with two tutors per group.	‘Peer educators’
	Knowledge transfer of spinal manipulation skills by student-teachers: a randomised controlled trial (20)	292 third and fourth year medical students were taught in groups of 6–12 by fellow peers (who received brief teaching course).	‘Student teachers’
	Peer teaching: a randomised controlled trial using student-teachers to teach musculoskeletal ultrasound (21)	151 students, 75 of which were taught by nine student teachers of the same year.	‘Student teachers’
Peer Didactic (1 to > 10)	Peer assisted versus expert assisted learning: a comparison of effectiveness in terms of academic scores (22)	70 fourth year medical students where one group (35 students) was given a lecture by a peer who had the highest academic score.	‘Reciprocal peer teaching’
Near-Peer
Near-Peer Mentoring (1 to 1–2)	Reducing student anxiety by using clinical peer mentoring with beginning nursing students (23)	30 ‘freshmen’ nursing students were paired with individual ‘sophomore’-level medical-surgical peer mentors.	‘Peer mentoring’
Near-Peer Tutoring (1 to 3–10)	Can near-peer medical students effectively teach a new curriculum in physical examination? (24)	83 third year medical students were taught in groups by nine 4th/5th years.	‘Near peer teaching’
	Peer assisted learning in patient-centred interviewing: the impact on student tutors (25)	Two third year medical students taught groups of six first year medical students.	‘Student tutors’
	Student teachers can be as good as associate professors in teaching clinical skills (26)	Medical students in year two and above taught first year medical students in groups of 5–6.	‘Student teachers’
	Formal peer-teaching in medical school improves academic performance: the MUSC supplemental instructor program (27)	Medical students from upper levels taught junior students in groups of 4–6.	‘Supplemental instructors’
	Peer tutoring and student outcomes in a problem-based course (28)	Medical students who had completed a particular course two semesters prior taught current students in groups of 4–8.	‘Peer tutors’
	Advanced Cardiac Resuscitation Evaluation (ACRE): a randomised single-blind controlled trial of peer-led vs. expert-led advanced resuscitation training (29)	One sixth year medical student taught cardiac resuscitation to nine fifth year medical student.	‘Peer instructors’ & ‘Peer led training’
	Are fourth-year medical students effective teachers of the physical examination to first-year medical students? (30)	Nine fourth year medical students taught first year medical students in groups of four.	‘Student preceptor’
	Peer-assisted learning from three perspectives: student, tutor and co-ordinator (2)	Small group sessions with 12 students per two peer tutors. Peer tutors were generally one year senior. Consultants reviewed the teaching and learning material. Peer tutors received training in the relevant skills.	‘Peer tutors’ within a PAL framework
	Impact of peer teaching on nursing students: perceptions of learning environment, self-efficacy and knowledge (31)	179 first year nursing students were taught by 51 third year students.	‘Peer teaching’
	Peer-assisted learning in the acquisition of clinical skills: a supplementary approach to musculoskeletal system training (32)	Four fourth year medical students trained 28 second year students with 218 control students.	They called it ‘PAL’ but referred to the near peers as ‘student trainers’
	Undergraduate rheumatology: can peer-assisted learning by medical students deliver equivalent training to that provided by specialist staff? (33)	12 senior medical students trained 45 second	‘Student trainers for PAL’ year students.
	Randomized surgical training for medical students: resident versus peer-led teaching (34)	60 third year medical students taught by fourth years in groups of 4–5.	‘PAL’
	Peer-led resuscitation training for healthcare students: a randomised controlled study (35)	122 first year medical, dental, nursing and physiotherapy students taught by second years in groups of 10–12 with two peers (of 1 year higher) per group.	‘Student instructors’ in ‘peer led’ training
	Near-peer teaching in anatomy: an approach for deeper learning (36)	12 fourth year medical students ran dissection classes for first and second year students (no specific number was stated but it is noted that the entire first and	‘Near peer teachers’ abbreviation used ‘NP’ Students were called ‘tutees’
		second year class was involved in this programme). 2–3 ‘near-peer teachers’ were assigned to each small group.
	Peer-assisted versus faculty staff-led skills laboratory training: a randomised controlled trial (37)	89 third year medical students divided into three groups of controls (28), PAL (run by fourth and fifth years) (29), and staff taught (26).	‘Cross year’ PAL
Near-Peer Didactic (1 to >10)	A vertical study programme for medical students: peer-assisted learning in practice (38)	Fifth year medical students provided five sets of 2 h case based lectures in groups of 10–15 medical students from years one to four.	‘PAL facilitators’
	Effects of peer-assisted training during the neurology clerkship: a randomized controlled study (39)	Six medical students who had completed a neurological clerkship the semester prior taught 66 medical students currently undertaking their clerkship.	‘Peer tutoring’
	A multi-level assessment of a program to teach medical students to teach (40)	28 fourth year medical students taught 117 second year medical students.	‘Student teachers’
	The role of students as teachers: four years’ experience of a large-scale, peer-led programme (41)	Eight medical students within their clinical phase taught 358 junior medical students in their pre-clinical phase.	‘Peer led teaching’ and the learners were referred to as ‘tutees’
	Peer-assisted learning: a novel approach to clinical skills learning for medical students (42)	Three year 4–5 students taught 86 year 1–2 students: one near-peer to 23 students, 1 to 29 students, and 1 to 34 students.	‘Trainer and Trainee’
	Clinical skills education: outcomes of relationships between junior medical students, senior peers and simulated patients (43)	125 second year medical students were trained by 11 sixth year students.	‘Cross year PAL’
	A three-day anatomy revision course taught by senior peers effectively prepares junior students for their national anatomy exam (44)	105 second year medical students taught by four fourth year students in a lecture setting.	‘Course tutors’
	Peer-assisted teaching: an interventional study (45)	One third year paramedic student taught 12 first year paramedic students with the presence of a paid sessional staff member.	‘Peer teaching’

Fig. 1 Categories of PAL and the novel terms.

Higgins B. Relationship between retention and peer tutoring for at-risk students. J Nurs Educ. 2004; 43: 319.

 PubMed Web of Science ®Google Scholar

Patel J, Rosentsveyg J, Gabbur N, Marquez S. Clay modeling for pelvic anatomy review for third-year medical and physician assistant students. Obstet Gynecol. 2014; 123: 19S–20S.

 Web of Science ®Google Scholar

Walsh CM, Rose DN, Dubrowski A, Linq SC, Grierson LE, Backstein D, etal. Learning in the simulated setting: a comparison of expert-, peer-, and computer-assisted learning. Acad Med. 2011; 86(10 Suppl): S12–16.

 Web of Science ®Google Scholar

Beard JH, O'Sullivan P, Palmer BJ, Qiu M, Kim EH. Peer assisted learning in surgical skills laboratory training: a pilot study. Med Teach. 2012; 34: 957–9.

 PubMed Web of Science ®Google Scholar

Nnodim JO. A controlled trial of peer-teaching in practical gross anatomy. Clin Anat. 1997; 10: 112–17.

 PubMed Web of Science ®Google Scholar

Steele DJ, Medder JD, Turner P. A comparison of learning outcomes and attitudes in student-versus faculty-led problem-based learning: an experimental study. Med Educ. 2000; 34: 23–9.

 PubMed Web of Science ®Google Scholar

Kassab S, Abu-Hijleh MF, Al-Shboul Q, Hamdy H. Student-led tutorials in problem-based learning: educational outcomes and students’ perceptions. Med Teach. 2005; 27: 521–6.

 PubMed Web of Science ®Google Scholar

Peets AD, Coderre S, Wright B, Jenkins D, Burak K, Leskosky S, etal. Involvement in teaching improves learning in medical students: a randomized cross-over study. BMC Med Educ. 2009; 9: 55.

 PubMed Web of Science ®Google Scholar

Knobe M, Holschen M, Mooij SC, Sellei RM, Munker R, Antony P, etal. Knowledge transfer of spinal manipulation skills by student-teachers: a randomised controlled trial. Eur Spine J. 2012; 21: 992–8.

 PubMed Web of Science ®Google Scholar

Knobe M, Munker R, Sellei RM, Holschen M, Mooij SC, Schmidt-Rohlfing B, etal. Peer teaching: a randomised controlled trial using student-teachers to teach musculoskeletal ultrasound. Med Educ. 2010; 44: 148–55.

 PubMed Web of Science ®Google Scholar

Manzoor I. Peer assisted versus expert assisted learning: a comparison of effectiveness in terms of academic scores. J Coll Physicians Surg Pak. 2014; 24: 825–9.

 Web of Science ®Google Scholar

Sprengel AD, Job L. Reducing student anxiety by using clinical peer mentoring with beginning nursing students. Nurse Educ. 2004; 29: 246–50.

 PubMedGoogle Scholar

Blank WA, Blankenfeld H, Vogelmann R, Linde K, Schneider A. Can near-peer medical students effectively teach a new curriculum in physical examination?. BMC Med Educ. 2013; 13: 165.

 PubMed Web of Science ®Google Scholar

Nestel D, Kidd J. Peer assisted learning in patient-centred interviewing: the impact on student tutors. Med Teach. 2005; 27: 439–44.

 PubMed Web of Science ®Google Scholar

Tolsgaard MG, Gustafsson A, Rasmussen MB, Hoiby P, Muller CG, Ringsted C. Student teachers can be as good as associate professors in teaching clinical skills. Med Teach. 2007; 29: 553–7.

 PubMed Web of Science ®Google Scholar

Wong JG, Waldrep TD, Smith TG. Formal peer-teaching in medical school improves academic performance: the MUSC supplemental instructor program. Teach Learn Med. 2007; 19: 216–20.

 PubMed Web of Science ®Google Scholar

Sobral D. Peer tutoring and student outcomes in a problem-based course. Med Educ. 1994; 28: 284–9.

 PubMed Web of Science ®Google Scholar

Hughes TC, Jiwaji Z, Lally K, Lloyd-Lavery A, Lota A, Dale A, etal. Advanced Cardiac Resuscitation Evaluation (ACRE): a randomised single-blind controlled trial of peer-led vs. expert-led advanced resuscitation training. Scand J Trauma Resusc Emerg Med. 2010; 18: 3.

 PubMed Web of Science ®Google Scholar

Haist SA, Wilson JF, Fosson SE, Brigham NL. Are fourth-year medical students effective teachers of the physical examination to first-year medical students?. J Gen Intern Med. 1997; 12: 177–81.

 PubMed Web of Science ®Google Scholar

Hill E, Liuzzi F, Giles J. Peer-assisted learning from three perspectives: student, tutor and co-ordinator. Clin Teach. 2010; 7: 244–6.

 PubMedGoogle Scholar

Brannagan KB, Dellinger A, Thomas J, Mitchell D, Lewis-Trabeaux S, Dupre S. Impact of peer teaching on nursing students: perceptions of learning environment, self-efficacy, and knowledge. Nurse Educ Today. 2013; 33: 1440–7.

 Web of Science ®Google Scholar

Burke J, Fayaz S, Graham K, Matthew R, Field M. Peer-assisted learning in the acquisition of clinical skills: a supplementary approach to musculoskeletal system training. Med Teach. 2007; 29: 577–82.

 PubMed Web of Science ®Google Scholar

Graham K, Burke JM, Field M. Undergraduate rheumatology: can peer-assisted learning by medical students deliver equivalent training to that provided by specialist staff?. Rheumatology. 2008; 47: 652–5.

 PubMed Web of Science ®Google Scholar

Graziano SC. Randomized surgical training for medical students: resident versus peer-led teaching. Am J Obstet Gynecol. 2011; 204: 542.e1–4.

 Web of Science ®Google Scholar

Perkins GD, Hulme J, Bion JF. Peer-led resuscitation training for healthcare students: a randomised controlled study. Intensive Care Med. 2002; 28: 698–700.

 PubMed Web of Science ®Google Scholar

Evans DJ, Cuffe T. Near-peer teaching in anatomy: an approach for deeper learning. Anat Sci Educ. 2009; 2: 227–33.

 PubMed Web of Science ®Google Scholar

Weyrich P, Celebi N, Schrauth M, Möltner A, Lammerding-Köppel M, Nikendei C. Peer-assisted versus faculty staff-led skills laboratory training: a randomised controlled trial. Med Educ. 2009; 43: 113–20.

 PubMed Web of Science ®Google Scholar

Kam JK, Tai J, Mitchell RD, Halley E, Vance S. A vertical study programme for medical students: peer-assisted learning in practice. Med Teach. 2013; 35: e943–5.

 PubMed Web of Science ®Google Scholar

Heckmann JG, Dutsch M, Rauch C, Lang C, Weih M, Schwab S. Effects of peer-assisted training during the neurology clerkship: a randomized controlled study. Eur J Neurol. 2008; 15: 1365–70.

 PubMed Web of Science ®Google Scholar

Blatt B, Greenberg L. A multi-level assessment of a program to teach medical students to teach. Adv Health Sci Educ Theory Pract. 2007; 12: 7–18.

 PubMed Web of Science ®Google Scholar

Batchelder AJ, Rodrigues CM, Lin LY, Hickey PM, Johnson C, Elias JE. The role of students as teachers: four years’ experience of a large-scale, peer-led programme. Med Teach. 2010; 32: 547–51.

 PubMed Web of Science ®Google Scholar

Field M, Burke JM, McAllister D, Lloyd DM. Peer-assisted learning: a novel approach to clinical skills learning for medical students. Med Educ. 2007; 41: 411–18.

 PubMed Web of Science ®Google Scholar

Hudson JN, Tonkin AL. Clinical skills education: outcomes of relationships between junior medical students, senior peers and simulated patients. Med Educ. 2008; 42: 901–8.

 PubMed Web of Science ®Google Scholar

Rengier F, Rauch PJ, Partovi S, Kirsch J, Nawrotzki R. A three-day anatomy revision course taught by senior peers effectively prepares junior students for their national anatomy exam. Ann Anat. 2010; 192: 396–9.

 PubMed Web of Science ®Google Scholar

Williams B, Olaussen A, Peterson EL. Peer-assisted teaching: an interventional study. Nurse Educ Pract. 2015; 15: 293–8.

 Web of Science ®Google Scholar