Peer observation of student-led teaching

Abstract

Introduction

The use of near-peer teaching in medical schools is increasing internationally. Peer observation of teaching (POT) is a useful and effective method for enhancing teaching experiences and quality, but its use among student peer teachers is not well documented. The aim of the study was to explore medical student perceptions on the value and limitations of POT.

Methods

Ten medical students were trained as observers. Using a previously developed model, they observed 27 teaching sessions led by other students (observees), with a pre- and post-observation meeting. Observers and observees completed a survey and group interview to explore their experiences. Descriptive analysis of survey data and thematic analysis of qualitative data were conducted.

Results

Observees found feedback valuable in learning about, reflecting on, and increasing confidence in teaching practice. They felt comfortable receiving feedback and reported positively about the observers in terms of: expertise, relatability, non-intimidating presence, and awareness of the target audience. Observers reported learning more about good teaching practice. While most observers found it enjoyable, several found some aspects of giving feedback uncomfortable. Most found it difficult to establish a satisfactory dynamic, citing lack of credibility and difficulty in eliminating hierarchies. Pre-existing friendships were reported by observers as both helping and hindering the dynamic.

Discussion

Both observers and observees gained from the experience of POT. However, observers lacked confidence in their credibility. Further work should address how best to implement POT into the curriculum to improve teaching practice in medical students. Further training or coaching could be considered to overcome observers’ concerns.

Practice points

• Consider coaching observers to address concerns of credibility.

• Consider collaborating with experienced staff to ensure evaluation is robust.

• To support sustainability, consider facilitation of experienced observers training those more junior in POT.

• Following initial training, observers could be given the chance to shadow an observer, do an observation and debrief with a trainer.

Keywords:

• Assessment
• feedback
• teaching and learning
• collaborative/peer-to-peer

Introduction

There is growing recognition of the benefits of medical students’ active participation in their education beyond the 'student as learner’ role (Meeuwissen and Whittingham 2020), such as being a peer tutor. While research has explored peer teaching (Burgess 2014; Bowyer and Shaw 2021) and the training offered to students to support their teaching (Burgess 2020), less attention has been given to peer observation of teaching (POT) as a process to enhance students’ teaching. POT, involving a peer observing a teaching session and offering feedback, can enhance standards of teaching, encourage self-reflection, and increase confidence in giving and receiving feedback among medical educators (Sullivan 2012; Mookherjee 2014; Caygill 2017). The benefits of its use among undergraduate peer medical educators is less clear (Rees 2015; Caygill 2017). Extant research has indicated the feasibility of a student POT programme (Rees 2015), but the benefits of POT for both observers and observees remain unclear.

This paper reports findings from a POT programme piloted among medical students at the University of Edinburgh in 2020–2021. We explore medical students’ experiences observing and being observed and the programme’s impact on their teaching practice. The findings provide novel insights that can inform further development of POT programmes for undergraduate medical students.

Methods

Setting up the programme

Using social media and email, we recruited 27 students to be observed (observees) and five senior students with teaching experience (observers). As 5th year students, the authors (EW, AP, SP, and LC) recruited students to be observed and to be observers (alongside the authors). Observers received workshop training from a medical education lecturer on: conducting observations, feedback models, common feedback mistakes and using a standardised pro forma (Supplementary File). This was based on previously published literature (Bell 2002; Rees 2015), which emphasised the use of a collaborative approach (Gosling 2013).

Observers and observees met to agree the goals of the observation, and afterwards for feedback. All observed teaching sessions and meetings were online via Zoom.

Evaluating the programme

After their sessions, observers (excluding authors) and observees were asked to complete a short survey on: training, the experience of giving/receiving feedback, self/perceived expertise, and benefits and challenges of POT (Suplementary Appendices A and B). Preliminary responses from the surveys informed the planning of discussion topics for five group interviews (one with observers and four with observees; guides in Supplementary Appendices C and D).

A thematic analysis of the survey text responses and interview data was conducted; an iterative, reflexive process, moving from coding to the development of final themes (Braun and Clarke 2006). While the authors were not participants in the survey or interviews, a reflexive approach was adopted to ensure awareness of any impact on analysis of their dual position as peer observer and researcher.

Results

All observees (n = 27) and observers (n = 5) were students in years 4–6 and all completed the survey and group interview. Observees reported a range of teaching experience; observers self-identified as experienced teachers. Core themes are outlined below; illustrative quotes are given in the Supplementary Table.

Observees

Experience of being observed

Not daunting

Observees reported enjoying the process. Several reported it was made more comfortable by the relatability of the observer.

Anxiety

Some observees acknowledged anxiousness when they were: aware of being observed, in the ‘spotlight’, or out of their ‘comfort zone’.

Familiarity

Some observees found having a familiar face helped them relax; others reported concerns including: observers giving kinder feedback to maintain positive relationships, and previous conflicts creating tension.

Faculty vs. peer

Credibility

Several more junior observees felt the observers’ experience and knowledge surpassed their own. Others felt that the observer had a similar level of expertise, but were able to provide an alternative perspective and present new ideas.

Benefit of peer knowledge

Participants noted different benefits from peer feedback compared to experienced teaching staff; they felt peers were able to give a unique perspective, such as teaching methods that resonate with students, due to their proximity to the target audience.

Feedback value

Timing

The immediacy of the post-session debrief reduced anxiety. Its timing also meant the session was fresh in the minds of the observees, helping to facilitate collaborative reflection.

Format

Observees found the focus on teaching skills to be a valued area in which they rarely receive feedback. The structured, detailed written feedback was identified as beneficial.

Quality and impact of the programme

Observees identified the personalised nature of the feedback, and its focus on teaching style, as a primary advantage of the POT programme.

Observers

Experience observing

Beneficial

Observers also found the process to be enjoyable and worthwhile. Refinement of their own teaching skills and practice in feedback provision were identified as most valuable.

Uncomfortable

Some found the experience of providing feedback to peers uneasy, and reflected on feelings of self-doubt and concerns about being condescending.

Familiarity

Some individuals felt familiarity between the observer and the observee made the process more comfortable, while others believed that familiarity meant feedback was less critical.

Faculty vs. peer

Credibility

Observers were concerned their feedback was not as valuable as teaching staff’s and that the observees weighted their opinion too highly.

Hierarchy

Observers felt uneasy that peer observation created a sense of hierarchy, and it was difficult to avoid adopting a more instructional tone in the feedback.

Discussion

A POT programme with medical students was trialled. Observees found the feedback helpful: many commented that they had never received such bespoke teaching feedback. Observers found providing feedback useful for self-reflection of their practice, and reported a synergistic learning environment allowing mutual exchange of ideas, aided by the collaborative feedback approach (Gosling 2013).

Nevertheless, observers reported lacking confidence in observing compared to perceived ‘expert’ staff; a form of ‘imposter syndrome’ (Feenstra 2020). This concern was not echoed by observees, who found the peer feedback relatable and at the right level. This is reinforced by literature on cognitive and social congruence in peer assisted learning (Lockspeiser 2008). This dichotomy has been reported with teaching staff, where observees found the feedback more reliable and valid than the observers (Kohut 2007). Ackerman et al. discuss the ‘expert’ role as a flexible one: staff can be experts when assessing content, while students can be experts in assessing delivery (Ackerman 2009). In contrast, another study comparing staff versus peer feedback reported that most students preferred feedback from a staff member but felt peer feedback provided a distinct addition (Burgess and Mellis 2015). This may indicate a benefit to receiving feedback from various people with different perspectives. Indeed, feedback from multiple novices has been reported to be more valuable than from one expert (Cho and MacArthur 2010). The use of multiple student and staff observers may therefore allow for enhanced feedback.

Strengths and limitations

This study is among the first in implementing and evaluating a POT programme in undergraduate medical students, with studies elsewhere mainly focusing on staff (Kohut 2007; Sullivan 2012). Building on a similar programme developed by Rees et al. (Rees 2015; Eastwood 2023), this study provides a deeper understanding of the experiences of peer observers/observees, emphasising the potential benefits of and issues with POT.

Unlike previously reported POT programmes, this pilot took place online due to the pandemic. While the differences between online and face-to-face teaching were not explicitly discussed with participants beforehand, multiple participants mentioned their preference of an online platform as the presence of an observer was less noticeable. Increased authenticity during online POT due to reduced learner awareness of observers has been discussed by Bennett and Barp (2008). Other noted benefits of online POT include increased flexibility and accessibility that transcends geographical boundaries and allows for increased diversity in observers (Bennett and Santy 2009).

Unfortunately, as this was a pilot, it was not possible to evaluate the sustainability and impact of the programme over time.

Further work

Informed by the insights gained from this pilot, next steps in further developing the programme include:

1. Co-developing with students a coaching programme integrated into a POT scheme to address observers’ concerns about perceived lack of credibility.

2. Developing and evaluating the sustainability of a larger programme, with changes such as experienced observers training those more junior in POT to facilitate this.

3. Considering faculty involvement to ensure quality of feedback and offer more experienced perspectives.

To support the sustainability of the scheme, we ran a POT training workshop for current students (the authors having now graduated) and made the resources accessible to student peer teaching societies. We are also advising a group of students who are developing a research project to build on this pilot scheme.

Author contributions

All authors contributed to the conception and design of the work, the acquisition, analysis and interpretation of data, and the drafting and revising of the work.

Ethics statement

Ethical approval was gained from the University of Edinburgh MVM Medical Education Research Ethics Committee on 10/11/2020 (reference 2020/35). All participants consented to having anonymised data used for research (Supplementary Appendix E).

Acknowledgements

We thank our observers: Alex Clark, Liam Lee, Jay Park, Aleksandra Poziemska, and James Sheppard. We thank Dr Eliot Rees for his support including delivering observer training.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Ed Whittaker

Ed Whittaker, MBChB, NHS Greater Glasgow & Clyde, UK. Edinburgh Medical School, University of Edinburgh, UK.

Anushka Pathak

Anushka Pathak, MBChB, NHS Lothian, UK. Edinburgh Medical School, University of Edinburgh, UK.

Simran Piya

Simran Piya, MBChB, NHS Greater Glasgow & Clyde, UK. Edinburgh Medical School, University of Edinburgh, UK.

Louisa Cary

Louisa Cary, MBChB, NHS Northumbria, UK. Edinburgh Medical School, University of Edinburgh, UK.

Jeni Harden

Jeni Harden, PhD, Usher Institute, University of Edinburgh, UK.