Conference Contribution Details
Mandatory Fields
Bennett,D Kelly,M, O’Flynn,S
ASME Annual Scientific Meeting Brighton
Learning Together in The Clinical Setting - Peer Teaching at the Bedside - report for ASME small grant 2011
Brighton, UK
Invited Oral Presentation
Optional Fields


ASME Small Grant Award 2011

Learning Together in The Clinical Setting - Peer Teaching at the Bedside

Background and Purpose

Peer assisted learning (PAL) in undergraduate medical programs brings well established

benefits to student learning 1. It also aids the development of domain independent skills,

such as teamwork, communication, presentation skills, leadership and professional

behaviour2. PAL usually takes place in artificial settings. This study examined whether PAL

could enhance student learning in real-world complex clinical environments. The benefits,

feasibility and acceptability of PAL at the bedside were explored.


This is an explorative study of reciprocal PAL in the clinical setting in Year 3 medical

students (n=115) undertaking full time clinical hospital attachments across four sites.

Twenty six small groups of 4-5 students were formed for weekly PAL sessions. Each

student attended seven sessions. The “teacher” role was rotated and the teacher chose

the topic for the session based on a real case. Both quantitative and qualitative methods

were used to elicit student attitudes to and experience of PAL sessions. Feedback forms

with Likert scaled statements (scaled 1 to 6) and free text were returned by “teacher” and

students after each PAL session. Focus groups were held at the end of the intervention. At

one site the PAL sessions were held at the bedside. Patients were asked to complete

feedback forms after bedside sessions. Quantitative data was analysed in SPSS. Activity

systems analysis was used to analyse qualitative data.


Feedback forms were returned from 80% (n=146) of sessions by the “teacher”. For those

in student role 71.7% (n= 447) forms were returned. Quantitatively students and “teachers”

rated the PAL sessions positively, with no difference in the rating of the overall value of the

session, between bedside and non bedside groups. “Teachers’” perception of benefit to

students was significantly higher for the bedside sessions (p<0.05). Qualitative analysis

revealed that teaching at the bedside lead to a more professional approach from teacher

and students and was highly valued for practice of skills in an authentic setting and the

presence of clinical signs. However, students found the organisational aspect of bedside

teaching challenging. Patients (N=21, 66% response) rated the experience highly.

Qualitative findings will be presented using activity systems analysis3.

Discussion and Conclusions

PAL in the clinical setting, though challenging organisationally, did support learning.

However, introduction of PAL to the complex clinical learning environment was associated

with systemic contradictions and tensions and led to unintended consequences in student

activity. Quantitative analysis failed to capture these aspects and gave a false impression

of a universally positive outcome.


1. Peets A, Coderre S, Wright B, et al. Involvement in teaching improves learning in medical students: a randomized cross-over study.

BMC Medical Education 2009;9:55.

2. Cate OT, Durning S. Dimensions and psychology of peer teaching in medical education. Medical Teacher 2007;29:546-52.

3. Yamagata - Lynch LC. Activity Systems Analysis Methods. Understanding Complex Learning Environments. New York: Springer;