| Abstract|| |
Context: Peer-assisted teaching and learning (PTL) is being experimented in different medical universities worldwide. It is a learner-centered approach involving students through active learning strategies. Aims: To study the student perception of PTL in methods such as group-led seminars and fishbowls, in classroom through various interactive activities; compare and find out the student acceptability and efficacy of each of these methods in learning conceptual topics such as various types of anemia. Subjects and Methods: Medical students of second-year professional course were subjected to PTL in classroom during allotted teaching hours for 10 successive sessions using group-led modified seminars, fishbowls, and different formality-level interactive activities such as street plays, prop sessions, quiz sessions, to make them understand the clinical features and presentation of different types of anemia through understanding of etio-pathogenesis. To ascertain the aspects that influenced learning, focus group discussions were conducted in small groups consisting of 14 students and one facilitator in each group. Qualitative thematic analysis was performed on transcripts of the audio recordings by authors. Results: The emerging themes from qualitative analysis of transcripts were pertaining to teacher, student, and organization. We found motivation, interest, and involvement of peer teacher, student behavior and collaboration, contact time between students and facilitator, preparation time, coherence with other curricular activities, group size and composition, suitability of topic for the kind of activity, and availability of material for preparation as few sub-aspects affecting learning. Conclusion: For PTL to be effective, adequate transfer of knowledge through good peer teacher involvement, learner receptiveness, and adequate contact time is needed. Proper preparation with suitability of topics for the type of activity, alignment of seminars with other activities, and course coherence are prerequisites for the same.
Keywords: Aspects, interactive, peer-led seminars, peer teaching and learning, qualitative study, small group
|How to cite this article:|
Grover S, Sood N, Chaudhary A. Student perception of peer teaching and learning in pathology: A qualitative analysis of modified seminars, fishbowls, and interactive classroom activities. Indian J Pathol Microbiol 2018;61:537-44
|How to cite this URL:|
Grover S, Sood N, Chaudhary A. Student perception of peer teaching and learning in pathology: A qualitative analysis of modified seminars, fishbowls, and interactive classroom activities. Indian J Pathol Microbiol [serial online] 2018 [cited 2019 Jan 24];61:537-44. Available from: http://www.ijpmonline.org/text.asp?2018/61/4/537/242971
| Introduction|| |
The medical universities all over the world are adopting learner-centered methodology, shifting from individual learning to group learning in which students themselves take the responsibility of learning and recognize the learning gaps and deficits., Peer-assisted teaching and learning (PTL) is such a methodology based on student involvement. Classroom-based PTL can be in the form of seminars, fishbowls, and interactive activities. In seminars, students teach their peers in classrooms. For small group activities, students are divided into small groups of <8 to perform an assigned task. In fishbowl, a small group discusses a topic which is observed by larger group of audience., The group tasks may be followed by a plenary session where the facilitator summarizes the points discussed in group tasks.
Students here learn through participation, improve their teaching, coordination, and managerial skills., The effective reciprocal feedback from pears is essential for effective PTL assessment. It creates a culture of teamwork, encourages cooperative learning, and increases learner motivation.
Anemia is a conceptual topic as different types of anemia have different etio-pathogenesis, clinical presentations, investigations, and treatment. To understand and assimilate such conceptual topics in pathology at undergraduate level, a lot of effort and commitment from the students as well as teachers are required.
We designed this PTL-based study to compare and find out the student acceptability and efficacy of methods such as group-led seminars and fishbowls aided by interactive activities conducted in classroom in learning such conceptual topics. We also aimed to study the aspects affecting quality of PTL in classroom using these methods.
| Subjects and Methods|| |
This pilot interventional study was conducted with M.B.B.S undergraduates in a North Indian Medical College of good repute which is known for its research activities. The administration is promoting student education and welfare-related activities with the help of committed faculty. But still the usual method of teaching in many subjects in our college includes didactic lectures. Interactive teaching and learning (TL) involves only 5–10% of study time. We designed this study to promote PTL as a TL tool.
After adequately informing about the details and obtaining informed consent, 70 students of M.B.B.S. second-year professional course were enrolled for PTL activities to be conducted in usual college timings during the ten allotted hours for teaching anemia over a period of 4 weeks. Permission was obtained from the research committee and ethics committee to conduct this study.
Students were divided into ten small groups of seven students each. In the introductory session, student groups were allotted different activities for various types of anemia, each activity with a different formality level and different performing method [Table 1]. The peer-teacher groups were told to prepare their activity and each group presented it in different peer teaching sessions in classroom to rest of students. The peer-teachers were thus expected to learn by performing, while peer-learners were expected to learn through observing. The time and day of classroom activities were kept such to provide adequate time for the activities which needed preparation.
|Table 1: Various activities allotted to the individual student groups for discussing different type of anemia|
Click here to view
The students took separate roles in planning, preparing, and performing the different peer activities. Different students were assigned the roles such as group leader, script writer, and director in activities such as play and prop. Similarly, in multiple-choice questionnaire (MCQ) activities and quiz activities, the peer group divided the work of designing MCQ and quiz questions among themselves. Students who were good at holding the stage acted as quiz masters. In most of the activities, students were given adequate time to prepare and perform. However, in the prop activity, peer-teachers were told to read in advance and the props such as chalks, dusters, stoles, benches, small cardboard boxes, were given at the time of classroom session and students given 15 min to prepare the activity and present in front of the rest of students. Thus, it required onsite coordination and group dynamics. After each activity the highlights of the activities were presented by one of the peer-teachers in a plenary session. Using only one method or activity for entire ten sessions was avoided to prevent monotony and loss of interest by students in the course.
Five, second-year pathology residents acted as facilitators for two groups each and helped students in preparing the activities. In most of the activities, except for those which were performed extempore, the content of activity and extent of participation were analyzed before the activity by the facilitators. They were either present during final rehearsal or asked students to show them their final materials, notes, and presentations before the session was conducted. To explore student perceptions about the aspects affecting PTL in these activities, focus group sessions were conducted in five groups of 14 each and answers to semi-constructed and open-ended questions were sought by facilitators. While questioning, the residents swapped groups to prevent bias and one facilitator interviewed two groups at one time because of time constraints. The discussion was audio-recorded and the important points were summarized to the participating students for verification.
The audio recordings were transcribed. The transcripts are shown in [Table 2]a. Content analysis as described by Krippendorf was used for making replicable and valid inferences from data to their context., A coding system was developed in order to use content analysis. All transcripts were individually read by first and second author separately. Both the authors made notes of their first impressions of each relevant quote by students. The first impressions were converted into codes. Labels for the codes were used to construct initial coding scheme. The discrepancies between coding schemes were reconciled through discussion between first and second author. The codes were then consolidated for emerging themes. Qualitative thematic analysis was performed on the themes and aspects which emerged. The method of analysis of transcript is presented in [Table 2]b.
| Results|| |
The participant comments were categorized into themes. Three basic themes emerged, and seven major aspects and many sub-aspects were finally clustered into these themes [Table 3]. Student perception and their analysis is as follows.
|Table 3: Aspects and sub-aspects affecting learning in peer led seminars and interactive activities that emerged in focus group discussions|
Click here to view
Peer-teacher and performer group characteristics
Students appreciated those peer-teacher groups who could encourage learner involvement, participation, and active thinking irrespective of the activity assigned to the peer-teacher group. The peer-teachers taking the ownership and responsibility of the task allotted to them were appreciated the most. Even in low formality level activity, the students recommended the peer-teachers to have control over the dynamics of the class and activity. They liked those teachers who were able to elicit answers from the audiences in plenary sessions. Students disliked the peer-teachers who could not ascertain a level of formality in the sessions.
Students enjoyed PTL seminars as performers as well as learners. They appreciated their involvement in different activities as active participants, group coordinators, planners, actors, script writers for play or prop session, prop designers for explaining pathogenesis, quiz masters, MCQ developers, and above all as peer teachers for their own batch mates. Students had good expectations from themselves as well as their colleagues to work as a team, integrate their knowledge with the tasks allotted to them, generate good seminar notes, formulate good MCQ and quiz questions, and thus ultimately teach their peers as better as they can. They also acted as good critics, with a healthy discussion on the case-based studies.
Student motivation was the best part of PTL. Motivation was variable for different sessions depending on the type of activity, topic under discussion, timing of seminar, preparation time allotted to them, and the number of group members present during the activity.
Type of activity
Students liked the activities which could stimulate student interaction, interpersonal communication, creativity, and public speaking by overcoming hesitation. These included play, prop, quiz, and class discussions. They liked the idea of using chalk, duster, bench, dustbins, stoles, etc. as prop and as a study tool and learn pathology of iron deficiency anemia using that.
MCQ seminars and quizzes were appreciated for enhancing in-depth understanding of various type of hemolytic anemia; for presenters due to efforts involved in preparing it, as well as for peer learners by putting entire class in competitive mode and hence enhance retention of topic. Although black-board seminars required extra effort for remembering everything and preparing notes before presentation by peer-teacher group, still many learners preferred it because of the natural pauses by the peer-teacher that allowed learners to make notes and easily follow the lecture content, while others preferred PowerPoint seminar because of audio–visual effects, images, and easy availability of soft copy of PowerPoint as class notes.
Few students discouraged play for taking away focus from the main topic, and few others found using prop as difficult and useless idea. Even quizzes were told as learning aids of quick ones who could use their mind fast and respond. Few of the learners asked for case discussion on real patients in wards than simulating in classrooms.
Seminar planning and execution methodology
Students recommended to reduce group size to less than four instead of seven for a healthy group interaction. They advocated about adequate time for preparation of activities. They emphasized on distributing equal tasks to all group members so that there is a shared responsibility and a few members are not overburdened. Students recommended that a small MCQ session be there before every subsequent day seminar to revise previous day concepts. Students requested the plenary session after PTL sessions to be brief but sufficient to highlight the important points of that session. However, the seminar facilitators admitted that providing adequate time for seminar preparations as per student expectations as well as in-class time for MCQ sessions and plenary sessions after every activity was little difficult to manage within the stipulated time allotted for that session.
Suitability of topic for the type of activity
Students appreciated the use of specific interactive activity to understand different topics, i.e., the play activity for understanding patient presentation, examination and signs elicitation, prop activity for understanding pathophysiology, quiz session to understand the intricacies, and differences of various type of hemolytic anemia. Quiz and MCQ sessions stimulated them to read and study on their own, which further helped them understand it during classroom question–answer session.
Students felt that groups function well only when there is a strict deadline and compulsion of day and time. Because there were some low formality level activities, students felt that not all participants were taking it seriously enough and needed some warnings, punishments, or rewards to complete the tasks on time and help in keeping group properly functional. The sessions such as quiz in which all the students had equal responsibility were appreciated for better group functioning.
“In quiz all the students study as anyone can be asked a question and there is a good discussion. In play its fun as roles given to students are subsequent and all the participants have dialogues.”
Preparation was considered the most important parameter that affected TL experience. According to students the outcome was affected significantly by time allotted for preparation, access to preparation materials, classrooms, and even internet facilities after college hours. Student factors affecting preparation were their motivation and interest, fear of consequences of not preparing as well as curricular and extracurricular activities going on in other departments. Access to well-structured preparatory materials and guidance from technical experts on preparation of PowerPoint presentations were asked. Similarly, students asked for help from college administration to fund the designing of better props which could be used for future batches. Even acknowledgement of student's effort and addition of remarks in the Curriculum Vitae or recommendations from principal or faculty would encourage for better preparation.
Schedule and seminar timing
Students suggested that when an experimental module is going on in one subject, effective use of timing becomes very important. The class tests and assessment going on in other subjects be minimized for that period or all subjects of that professional course should adopt the same methodology. And even appropriate sequence of lectures should be paid attention to. They preferred PTL activity to be scheduled in morning hours or after a boring didactic lecture of other subject. During the peer presentation it was emphasized to keep adequate time for discussions and explanations.
| Discussion|| |
In this study we attempted to find out student perceptions about PTL in peer-led seminars, fishbowls, and interactive activities, and hence qualitatively analyze the emerging aspects. The major aspects that our analysis revealed were: seminar-teacher and peer-teacher characteristics, student characteristics, preparation-related aspects, group functioning, seminar methodology, seminar schedule, activity characteristics, and dynamics [Table 3].
We found that the major aspects and sub-aspects influencing learning in peer-led seminars and interactive activities are in congruence with findings by previous authors on small group seminar learning.,,,,, Sprujit et al. in their two separate studies explored students' perceptions and teachers perceptions of aspects affecting seminar learning., Sprujit, similar to our study, also highlighted that factors which influence learning are student factors, methodology, course schedule, group interaction and composition, interaction within the group, and the alignment of the educational methods.
In our study students wanted peer teacher to be enthusiastic, creative, and have good interpersonal skills. The peer-teachers who took ownership of tasks and activities allotted to them were appreciated the most. As highlighted by few students, maintenance of formality level by peer-teacher groups and all learners was required, which lacked a little in activities such as street plays and prop activity, but it did not affect learning much as per student feedback. The difficult tasks for seminar facilitators and teacher were to maintain coordination and effective communication in low formality level activity as well as overlook or sort out the manifest differences in thinking process and execution of ideas by the peer-teacher groups. Thus, it required lot of efforts of facilitators to achieve the desired learning gain. Ideally group division should be done after accurately examining and analyzing student's level of knowledge, interest, coordination, and communication skills through direct personal interviews. But as highlighted by Sprujit et al., availability of seminar facilitator's or teacher's individual time was a big constraint in organizing these interviews. Sprujit et al. and McCrorie pointed out that for small group teachings to be effective the teachers should promote thinking and problem-solving, encouraged interaction, keep the group focused at the task, deal effectively with group dynamics, allow learners to take ownership of their learning and make the process enjoyable in a nonthreatening relaxed environment., Like Sprujit et al. we also recommend for pedagogical training of seminar teachers and facilitators and also participation of students in such training sessions for effective PTL.
In our study, performance by peer-teacher groups got maximum enthusiastic response in MCQ session and quiz session as audience involvement and group interaction was taken care of and the audience was kept focused at the task at hand. The important highlights of peer-led seminars and fishbowls in our study were reduced resistance between peer-teacher and learner groups while still maintaining the group dynamics. Chou et al. and Menzes and Premnath also highlighted the importance of safer learning environment, while learning with peers than while learning from experts as the relative lack of status and hierarchy lowers the stakes of engaging in practice and performing in front of others.,
The involvement of students in activities and maintenance of interest was good because different kind of activity was allotted to each different peer-teacher group, thus avoiding monotony. However, the type of activity influenced the involvement of students as stated by Greenstock et. al. Some students just wanted to see their peers perform without themselves participating actively. We felt that such students needed strict action or counseling. Coping up with such student required lot of inputs and time of facilitators as they had departmental and hospital duties also. Edmund and Brown stated that effectiveness of any method of small group learning depends on skills and motivation of teachers. They concluded that findings of studies of small group learning cannot be generalized as it is extremely difficult to control all the variables in experimental studies of small group learning.
The concept of peer-led experiential learning is supported by sociocultural learning theory, which can explain how participation and interaction with peers helps students create knowledge, comprehend the task required of them, and gain information about their own performance in comparison to the required standard.
We found various sub-aspects to learner students such as distinct roles students played during planning and execution, student behavior, motivation and involvement, their creativity, interpersonal communication, interaction and coordination, and time management skills, which affect learning gain. Similarly, Edmond and Brown, Dennick et al. in their study on small group learning and Sprujit et al. on seminar learning also advocated on students' motivation, thorough preparation, active participation, collaboration with other students, good learning style, and good time management as prerequisites for deeper learning.,,
Students in our study wanted the activities to be allotted to small groups of four or five for better preparation, coordination, stability of group, healthy group dynamics, and performance. Dennick and Spencer and Sprujit et al. also emphasized on adequate group size, composition, stability, setting ground rules, and anticipating group problems for an effective small group interaction., According to Edmund and Brown, 6–8 is an ideal size for better learning, development of discussion skills, exploration of attitudes, and sharing. But we feel that dividing students in further smaller groups would have meant more number of individual activities and hence more total course time and contact time per day or per week, which would have increased monotony and required more time of the facilitators and teacher.
As recommended by Edmunds, students in our study also suggested plenary sessions after group activities to be brief with just few comments on the task discussed by the peer-teacher group to avoid the plenary discussions becoming boring and repetitive.
Our findings about aspects of preparation, schedule, and seminar timing are in congruence with Sprujit et al. who advocated on high-quality structured preparation material with adequate time for preparation, adequate contact time, adequate seminar time, appropriate sequencing of seminar with a coherent schedule, and curriculum mapping as important prerequisites for seminar learning., Harden also emphasized on effective integrated curriculum with curriculum mapping. As Sprujit et al. highlighted, there are logistic barriers to seminar schedule, coherence, curriculum mapping, availability of seminar teachers and facilitators, availability of space and rooms for small group activities, preparation materials, resources, and especially time constraints for both facilitators and students. We would still recommend special consideration to all these issues for making these newer educational methods, such as PTL, a norm and increasing their acceptability in the modern medical curriculum. Even pedagogical training of teachers and creating a new educational culture in medical colleges and universities is the need of the hour by motivating students and rewarding teachers for their role in such activities.
This study was conducted on a small number of participants of only one MBBS professional batch of a single medical college for brief period. Many more students of other batches, colleges, and universities need to be exposed to such large-level studies to obtain a full impact of PTL. The responses may not be representative of the opinions of all the students, as not all students were equally involved in focus group discussions nor all the students individually prepared and performed all the activities. Individual interviews may have generated better responses, which was not possible due to time constraints. The comments are also context-dependent, so it is not clear to what extent the findings are transferable to other settings.
Our results highlight the areas for further research in peer-teaching seminars, such as seminar methodology, seminar schedule, activity dynamics, course coherence, and sequencing of the different educational methods. We recommend further research in these aspects of seminar learning to enhance learning gain in these peer-led seminars and fishbowls.
| Conclusion|| |
The several aspects influencing peer TL in our study are like those affecting seminar learning. These are peer-teacher involvement and ownership of task, learner receptiveness and motivation, adequate preparation time and contact time, proper group composition, group functioning and adequate interaction, alignment of course activities, suitable topics for each activity, good seminar methodology, schedule coherent with other curricular and cocurricular activities, and above all a nonthreatening learning climate.
We are grateful to Dr. Sonia Singh, Associate Professor, Department of Anatomy, Dayanand Medical College and Hospital for her help in preparing and formatting the manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Wolff M, Wagner MJ, Poznanski S, Schiller J, Santen S. Not another boring lecture: Engaging learners with active learning techniques. J Emerg Med 2015;48:85-93.
de Jong Z, van Nies JAB, Peters SWM, Vink S, Dekker FW, Scherpbier AJJA. Interactive seminars or small group tutorials in preclinical medical education: Results of a randomized controlled trial. BMC Med Educ 2010;10:79.
McCrorie P. Teaching and leading small groups. In: Swanwick T, editor. Understanding Medical Education: Evidence, Theory and Practice. Oxford: Wiley-Blackwell; 2010. p. 124-38.
Edmunds S, Brown G. Effective small group learning: AMEE guide no. 48. Med Teach 2010; 32:715-26.
Burges A, Nestel D. Facilitating the development of professional identity through peer assisted learning in medical education. Adv Med Educ Pract 2014;5;403-6.
Burgess A, Clark T, Chapman R, Mellis C. Senior medical students as peer examiners in an OSCE. Med Teach 2013;35:58-62.
Asghar A. Reciprocal peer coaching and its use as a formative assessment strategy for first-year students. Assess Eval High Educ 2010;35:403-17.
Krippendorff K. “Content Analysis: An Instruction to Its Methodology.” London: Sage Publications; 1980.
Hsieh H, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277-88.
Spruijt A, Jaarsma A, Wolfhagen H, van Beukelen P, Scherpbier A. Students' perceptions of aspects affecting seminar learning. Med Teach 2012;34:129-35.
Spruijt A, Wolfhagen I, Bok H, Schuurmans E, Scherpbier A, van Beukelen P, et al
. Teachers' perceptions of aspects affecting seminar learning: A qualitative study. BMC Med Educ 2013;13:22.
Jaarsma ADC, de Grave WS, Muijtjens AMM, Scherpbier AJJA, van Beukelen P. Perceptions of learning as a function of seminar group factors. Med Educ 2008;42:1178-84.
Dennick RG, Spencer J. Teaching and learning in small groups. In: Dornan T, Mann K, Scherpbier AJJA, Spencer J, editors. Medical Education Theory and Practice. 1st
edition. Edinburgh: Elsevier Ltd; 2011. p. 131-56.
Spruijt A, Leppink J, Wolfhagen I, Bok H, Mainhard T, Scherpbier A, et al
. Factors influencing seminar learning and academic achievement. J Vet Med Educ 2015;42:259-70.
Chou CL, Johnston CB, Singh B, Garber JD, Kaplan E, Lee K, et al
. A “safe space” for learning and reflection: One school's design for continuity with a peer group across clinical clerkships. Acad Med 2011;86:1560-5.
Menezes S de, Premnath D. Near-peer education: A novel teaching program. Int J Med Educ 2016;7:160-7.
Greenstock L, Molloy E, Fiddes P, Fraser C, Brooks P. Medical students' interprofessional experiences in a rehabilitation and palliative care placement. J Interprof Care 2013;27:537-9.
Yardley S, Teunissen PW, Dornan T. Experiential learning: AMEE Guide No. 63. Med Teach 2012;34:e102-15.
Harden RM. AMEE Guide No. 21: Curriculum mapping: A tool for transparent and authentic teaching and learning. Med Teach 2001;23:123-37.
Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]