Perceived teaching quality between near-peer and academic tutors in an osteopathic practical skills class

Abstract

Background

Near-peer teaching (NPT) has been reported in a number of teaching programs across different health professions. The utilisation of near-peer teaching in a teaching program has been demonstrated as beneficial for the student, the near-peer tutor and the teaching institution. The literature reports that students evaluate near-peer teaching as comparable to faculty teaching. The use of near-peers with academic tutors in the same classroom and utilising near-peer teaching for an extended period is unreported in osteopathy and limited in the broader literature.

Objective

This study aimed to investigate the quality ratings of the academic tutors and near-peer tutors teaching in the same classroom, over a semester.

Design

Questionnaire-based study using the Practical Class Teaching Questionnaire (PCTQ).

Setting

Osteopathic practical skills laboratory.

Methods

The PCTQ is a 9-item teaching quality tool developed for this study. Students were asked to rate the academic tutors (ATs) and near-peer tutors with the PCTQ at week 5 and week 12 of a 12-week semester. Descriptive and inferential statistics were used to investigate differences between the tutor types and differences between administration times.

Participants

Students in the first year of the osteopathy program at Victoria University.

Results

Statistically significant differences in mean ratings (p < 0.05) between tutor types were noted at week 5. These differences had largely been ameliorated by week 12. There is a strong relationship between the total PCTQ and a global rating of teaching quality.

Conclusions

Teaching quality of near-peer tutors and ATs is comparable at the end of a 12-week teaching period in a first year osteopathic practical skills subject. Although the mean near-peer tutors ratings were lower than the ATs at week 5, with increasing experience and confidence of the near-peer tutors these differences largely resolved by week 12. NPT should be considered for osteopathic practical skills subjects in the early years of the training program.

Introduction

The ever-changing educational environment necessitates academics to review and develop curricula as part of their roles. Academics and program administrators design teaching programs to respond to a host of factors ranging from epistemological considerations and policy changes to staffing and enrolment numbers. One such review of a unit in the osteopathy program at Victoria University led to the implementation of near-peer teaching (NPT) to resolve the key drivers of instituting a learner-centred approach, adapting to changing student demand and learner and staffing profiles whilst improving the quality of learning for the learners, the teaching experience for facilitators and instituting evidence-based teaching practice.

Peer-assisted learning (PAL) refers to a learning process that occurs between people from a similar group who are not experts or teachers in the area. It may therefore include both peers and near-peers in the learning process and as such there is some overlap in the terminology associated with peer learning and teaching.¹ Peer teaching (PT) is defined as a student teaching or working with a student at the same academic level.¹ It has also been referred to as collaborative teaching.² Bulte et al.¹ defined a near peer teacher as “… a trainee of one or more years senior to another trainee on the same level of medical education training” (p. 583). Thus near peer teaching (NPT) is teaching of students by students who are one or more years further along the program. One key difference between PT and NPT is that, in NPT, there is no competition for academic grades or achievement between the near-peer and learner.³

Literature relating to PAL has been published in a number of health professions, although NPT is not widely used within the core curriculum of health profession programs.⁴ The only mention in the osteopathic education literature relates to teaching of anatomy.⁵ Nevertheless both PT and NPT have been employed in health professional teaching programs like nursing, medicine and physiotherapy and in areas such as anatomy,3, 6 problem-based learning,⁷ prescribing,⁸ and clinical skills.9, 10 Where NPT has been employed, a number of benefits to the near-peer tutors and learners, have been demonstrated.

The literature on NPT is universally positive about its effect on the near-peer tutor. Near-peer tutors have reported positive developments in their knowledge base, understanding of subject content, and communication skills.11, 12, 13, 14, 15 Improvements in communication skill have also been reported to translate to a peer tutors' own patient consultations in PAL,15, 16 and it is likely a similar result could be anticipated with NPT. As would be expected NPT is also a practical and authentic method by which a student can develop their own teaching skills,14, 17 an outcome deemed important by Bulte et al.¹ Further, NPT can also enlighten the near-peer tutors to the challenges and satisfaction associated with teaching “… which may make them more broad-minded (p. 414).”¹⁵ Development of teaching skill, along with helping students to learn, has been reported as strong reasons for students to become near-peer tutors,1, 11 and potentially helps in their developing role as health professionals.1, 18, 19

The impact of NPT on the learner has also been investigated with the literature indicating a positive outcome on a learner.¹⁹ Ross & Cameron¹ suggest that near-peer tutors provide “a qualitatively different educational experience (p. 532)”⁴ that may support meaningfulness, motivation and individual feedback. Given that the academic level of the near-peer tutors is only a small jump from that of the learner, this may provide a motivating effect on learning and development.4, 12, 20 Near-peer tutors have been reported to create a positive learning climate,1, 21 increased confidence with clinical skill application,9, 22 improved OSCE (Objective Structured Clinical Examination) performance,²³ and to serve as role-models for learners.2, 14, 24

When comparing near-peer tutors to academic teachers there is reported to be little difference in teaching quality between these two groups7, 10, 11, 19, 20, 25, 26 with numerous authors demonstrating no difference in the outcome of learner results on assessments.20, 22, 27, 28

The educational theories relevant to PAL, as described by ten Cate and Durning,2, 29 can also be applied to the use of NPT. ten Cate and Durning¹ discuss the idea of a “…journeyman” (p. 597) or a person midway on the journey from novice to master who is developing skills whilst practising and teaching those who have not travelled as far along the educational path. These journeymen share a closer congruence, both socially and cognitively, with the learners and congruence has been put forward as the theoretical basis of NPT.1, 18, 30 Social congruence applies to NPT insofar as the learner and near-peer tutor are of a similar social standing within their community of practice, and just having the learners interacting with the near-peer tutors increases the value of such an educational approach.³⁰ Jackson and Evans³¹ report there is no optimum distance between the learner and near-peer tutor, however, ten Cate and Durning²⁹ and Hall et al.⁶ suggest that once a student qualifies as a health professional, they can no longer be considered a near-peer. Cognitive congruence refers to the learner and near-peer tutor sharing a similar knowledge base and therefore, the near-peer tutor may be able to better explain concepts at a similar level to the learner.30, 32 More recently ten Cate et al.³³ have proposed that self-determination theory can account for much of the ‘intrinsic’ motivation for peer teaching. Students participating as peer or near-peer teachers may see it as a way of developing themselves as a professional and gain expertise, without needing to be ‘rewarded’ through grades or financially.

NPT is not issue free. Making any change to NPT solely for financial reasons (i.e. near-peer tutors being cheaper to employ than academic faculty) is potentially unethical, unless comparability with faculty-led teaching can be demonstrated⁴ and teaching quality maintained or improved. The lack of experience as an educator and clinician can make it a challenge for the near-peer tutor to engage the learners or provide job-related reinforcement of the practical application of the subject content. There is also the potential for a learner to not respect the near-peer tutor as the near-peer tutor is also a student.¹ The lack of experience has also been reported to be a key reason for resistance to the introduction of near-peer programs.³⁴ Another reason may be that neither a peer or near-peer tutor is a content expert or experienced educator.1, 4 Whilst there are challenges, the educational theories and current research suggests that the benefits to implementing near-peer teaching outweigh these challenges. The current paper reports on the implementation of NPT in an osteopathic practical skills class. Given the importance of feedback from learners,⁴ and perhaps more so with the introduction of a change to the teaching program, the paper presents data from the learner evaluations of teaching that involved both academic and near-peer tutors.