|Year : 2015 | Volume
| Issue : 2 | Page : 145-147
Ongoing faculty development for peer tutors: A widely neglected need
Gihan Jayasinghe1, Rebecca Jayasinghe2, Dason E Evans3
1 Core Surgical Trainee, Tunbridge Wells Hospital, Tonbridge Road, Pembury, Tunbridge Wells, Kent TN2 4QJ, United Kingdom
2 Core Medical Trainee Darent Valley Hospital, Dartford, Kent DA2 8DA, United Kingdom
3 Senior Lecturer in Medical Education, St. George's, University of London, Cranmer Terrace, London SW17 0RE, United Kingdom
|Date of Web Publication||21-Nov-2015|
Department of Trauma and Orthopaedics, Tunbridge Wells Hospital, Tonbridge Road, Pembury, Tunbridge Wells, Kent TN2 4QJ
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Jayasinghe G, Jayasinghe R, Evans DE. Ongoing faculty development for peer tutors: A widely neglected need. Educ Health 2015;28:145-7
Peer-assisted learning (PAL) is increasingly utilised in medical education, as it is one way to attain the small group sizes essential for learning in resource-intensive settings, such as teaching clinical skills. Examples described in the literature include clinical examination,, procedural  and communication skills.
With this growing popularity it would seem appropriate for faculties to not only provide initial training but also engage in continuing development of peer tutors, known as faculty development, and it is the aim of this article to explore the rationale behind this premise.
Various advantages associated with PAL have been described. Tutees report being more comfortable clarifying their understanding and practicing new skills with peer instructors than with faculty. Peer tutors also sometimes know the current curriculum better and can incorporate their own contemporary clinical experiences into their teaching. Several studies have shown no significant difference in OSCE results for students taught by peers versus expert tutors.,, Student tutors report improvement in their own clinical skills and increased self-confidence, demonstrating a reciprocity of learning. For the institution, PAL can be a cost-effective method of teaching,, particularly important in resource-poor settings. This growing body of literature provides strong support for the use of PAL within medical education and underlies the trend towards more institutions implementing this teaching method.
Although the success of PAL schemes depends on adequate training for tutors, the literature identifies differences in how peer tutors are trained across institutions. Some institutions report that they select tutors based on academic merit and provide no additional training.,, Others describe training courses for new peer tutors, from half-a-day to two days in duration, to introduce basic teaching strategies, learning theories,, technical teaching skills  and training in receiving feedback. Some institutions provide five-week Special Study Modules (SSM) in medical education, upon completion of which students are able to teach clinical skills to their peers. These SSMs tend to cover the content of the training courses described above, with the additional requirement of a reflective dissertation.,, The review of videotapes, role-plays and the provision of training manuals for peer tutors have also featured in some PAL training schemes.. One London medical school provides extensive clinical skills teaching throughout the early years of the medical curriculum, principally delivered by a bank of peer tutors. These tutors are selected through a rigorous short listing process, and they undergo a one-day training session with subsequent supervision and evaluation.
The documented differences across institutions in how peer tutors are trained, make it difficult to know that all PAL schemes provide quality education to students. The literature does highlight one uniform need across institutions: A lack of attention to the ongoing training of existing peer tutors even though faculty development is accepted as a cornerstone of medical education. Wilkerson and Irby state that: "Academic vitality is dependent upon faculty members' interest and expertise; faculty development has a critical role to play in promoting academic excellence and innovation".
Studies provide substantial evidence supporting the rationale for ongoing faculty development workshops. School teachers attending workshops have reported an increase in motivation, enthusiasm and self-awareness in their teaching., Workshops result in faculty's greater knowledge of how best to deliver clinical teaching and plan curriculum,, as well as how to deal with problem learners. Both self-reports and observed changes after staff development interventions have demonstrated an increased use of interactive techniques to engage learners, implementation of learner-centred teaching behaviours (e.g., formulating objectives), and an increased ability to construct a positive learning climate and provide positive feedback. These reported gains in both knowledge and skills translate to improved student ratings of the learner experience and teaching behaviours, with the greatest improvement among tutors with the previously lowest ratings.
Given the wealth of literature supporting faculty development programmes beyond initial training, it is concerning that peer tutors do not have the same access to it as other educators. Programmes for ongoing development would be expected to enhance peer-tutors' teaching ability, which will ultimately yield a more positive educational experience for their learners.
To compare the published literature with current practice, we performed a national survey of UK medical schools in 2011. Telephone interviews were conducted with the head of the clinical skills department at each faculty to investigate the use of PAL in teaching clinical skills and the training the tutors received. Of the 31 medical schools in the UK, 26 heads of clinical skills were reached and provided data towards the study, as summarised in [Figure 1]. We learned that 11 medical schools using PAL to teach clinical skills within the core curriculum provided initial training courses ranging from one evening to two days, with five of these universities also offering 4- to 5-week SSMs in medical education. The content of introductory training sessions and SSMs are similar to that described within the literature, as summarised previously in this report. One institution using PAL to teach cardiopulmonary resuscitation sent their student-tutors to external courses. Only two institutions described any ongoing development for their tutors. One reported sending peer tutors on a compulsory introductory Teaching Improvement Project System (TIPS) course  with the opportunity for further teaching courses. The second university invited their peer tutors to attend optional faculty education forums also attended by professional teaching staff. From this survey we can conclude that although over one-third of institutions in the UK make use of PAL to deliver clinical skills teaching, the provision of continuing faculty development to these peer tutors is as insufficient in practice as it is in the literature.
|Figure 1: Consort diagram illustrating results of telephone survey of heads of clinical skills in UK medical schools|
Click here to view
To start filling this void, researchers need to identify the specific difficulties peer tutors face and the most effective methods to address them. To begin this dialogue within our own school, we held informal discussions with current peer tutors. The principal difficulties they identified were teaching unfamiliar skills and maintaining group attentiveness when delivering topics perceived as 'less interesting'. The groups suggested methods to overcome these and other challenges that included developing a handbook detailing course objectives, clinical skills and techniques for personal development, as well as maintaining a teaching portfolio. These peer tutors also endorsed ongoing observation, feedback and evaluation for new tutors throughout their training. Interestingly, this mirrored the literature on faculty development for qualified teaching staff, such as school teachers.,,, However, the limits of applying this literature to medical peer tutors must be recognised, as there are clear differences between the teaching objectives, environments within which peer tutors and school teachers work, their tutee populations and teaching resources they have available. Also most of the current literature highlighting difficulties within small group teaching relates to areas other than clinical skills., These important factors point out the need for targeted research to guide the design of purpose-built faculty development programmes for peer tutors within medical education.
| Acknowledgments|| |
The authors would like to thank Dr. Deborah Horton for ideas and valuable input throughout the project. The authors would also like to thank the clinical skills team at St George's for their ongoing advice, feedback and helping to orchestrate the NGTs and Questionnaires. Lastly, the authors would like to thank all the participants who gave up their valuable time to help provide data for the study. Mr. Gihan Jayasinghe had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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