The Role of Peer Instruction in Health Professions Education

by Whitley Tassin, MBS, PharmD, PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center

Instructors are always looking for methods to improve student participation and engage learners in the classroom. Multiple methods have been proposed including pop quizzes, audience response systems, small group discussion, group work, case vignettes, and more. But what is the evidence to support these methods and what are the best methods to engage learners? In recent years, peer instruction has gained increasing support and has become widely used in undergraduate education in an effort to not only engage students but, most importantly, improve learning.¹ Multiple methods of peer instruction have been developed and there are subtle differences between each of these methods.  Table 1 below describes the different peer instruction methods.

Table 1: Types of Peer Instruction¹

Term	Definition
Peer Teaching	Learners with similar levels of expertise and from comparable social groups (but who are not professional teachers) assist each other to learn and learn by teaching
Peer Modeling	The teacher provides (or points out) a competent exemplar(s) by a learner(s) in the group with the purpose that others will emulate these examples
Peer Education	Learners share information and talk about attitudes or behaviors with the goal of educating people, clarifying general life problems, and identifying solutions
Peer Monitoring	Learners observing and checking to determine if their partners/peers are engaged in appropriate and effective processes for learning and studying
Peer Assessment	Learners provide feedback or score/grade (or both) their peers’ performance based on a set criteria

 

While these tactics have been employed across various disciplines, few have been studied in pharmacy education. However, the literature consistently points to the positive impact that peer instruction has had on improving learning outcomes.

One study at Cedarville University looked at the effect of peer instruction in a self-care course within a Doctor of Pharmacy program.² Peer instruction was employed for seven topics: constipation and anorectal disorders; nausea, vomiting, and diarrhea; allergies; cough and cold; fungal and wounds; ophthalmic, otic, and oral; and dermatitis and sun care. Students were asked to prepare for each topic before class in anticipation of a “quiz” given on each topic. They were paired with a peer to discuss each topic after the quiz. If the average was above 70%, this indicated that most students had a good understanding of the concept, and discussion was not needed. When a score fell below 30%, this indicated that most students did understand of the topic, and the instructor provided additional instruction about the concept. If the score was between 30% and 70%, students would then engage in a discussion about their answers.  Students were instructed to justify their answers to their peers. Following this brief period of peer instruction, the questions were again presented to the class and scored. Results showed that scores improved significantly for each topic when peer instruction was implemented. In addition, students were asked to voluntarily complete a survey about their opinions and experiences with peer instruction. More than 80% of students responded to the survey and the results suggested that students felt very positive about peer instruction. Students reported that defending their thoughts was beneficial and that peer instruction reduced the awkwardness and “embarrassment” of approaching a professor with a question. They also reported that they enjoyed discussing concepts with their classmates and that they would like to see this technique used more frequently and in other courses.

Another study at the University of California San Francisco looked at the effectiveness of peer instruction in a pharmacology course taught by pharmacy students to physical therapy students.³ Physical therapy students were instructed to review pre-recorded lectures prior to attending class and take quizzes on the material. Under the mentorship of a faculty member, all lectures, quizzes, cases, and final assessments were developed by pharmacy students. In-class sessions consisted of working in small groups and then presenting what was discussed to the larger group. Pharmacy students served as teaching assistants and were present to answer questions and facilitate discussion. When surveyed at the end of the course, physical therapy students reported that they felt that learning about other healthcare professions from someone outside of their discipline was beneficial and it increased their comfort interacting with other members of the healthcare team. This demonstrates that peer instruction improves student’s learning and can also be a potential tool to increase interprofessional interaction.

What are some best practices that faculty should follow if they wish to use peer instruction in their classes? A recently published scoping review sought to determine the best methods for peer instruction, identify barriers to implementation, and student perceptions of peer instruction in pharmacy education.¹ The results suggested there was a positive impact on learning and feedback from students was positive regardless of what type of peer instruction was used. Using both quantitative and qualitative survey methods, students in the included studies reported that participating in peer instruction would likely result in a higher grade and they are open to using this learning method more often. Students also reported that peer instruction challenged them to think critically, defend answer choices, and discuss aspects of the topic they might not have otherwise considered.^1,2

While peer instruction has several potential benefits, faculty should be aware of the potential barriers when implementing this teaching strategy. It is important to train peers instructors and reviewers. If the peer instructor doesn’t have a good understanding of the topic, this can lead to misinformation and would obviously negatively impact student learning. In addition, when peer assessment is used, the students giving feedback must have very clear guidelines or rubrics that should be used when delivering feedback. Peer reviewers should receive training not only on the appropriate use of the rubric but also on how to effectively deliver constructive feedback. Thus, students who are actively teaching or leading any portion of peer instruction must receive proper training in order for the program to succeed.¹  This requires the teacher to spend an adequate amount of time and energy developing train-the-trainer materials.

Overall, the results of numerous studies demonstrate that peer instruction can have many beneficial effects. Implementing peer instruction throughout the curriculum can increase student engagement, improve learning outcomes, and build important critical thinking skills.

References

1. Aburahma M, Mohamed H. Peer Teaching as an Educational Tool in Pharmacy Schools; Fruitful or Futile. Currents in Pharmacy Teaching and Learning [Internet]. 2017; 9(6): 1170-1179.
2. Straw A, Wicker E, Harper N. Effect of Peer Instruction Pedagogy on Concept Mastery in a First Professional Year Pharmacy Self-Care Course. Currents in Pharmacy Teaching and Learning [Internet]. 2021; 13(3): 273-278.
3. Hsia S, Tran D, Beechinor R, et al. Interprofessional Peer Teaching: The Value of a Pharmacy Student-led Pharmacology Course for Physical Therapy Students. Currents in Pharmacy Teaching and Learning [Internet]. 2020; 12(10): 1252-1257.