ORIGINAL ARTICLE

Peer Assisted Versus Expert Assisted Learning:

A Comparison of Effectiveness in Terms of Academic Scores
Iram Manzoor

ABSTRACT
Objective: To compare the effectiveness of peer assisted learning versus expert assisted learning in terms of academic
scores.
Study Design: Cross over-randomized control trial followed by a cross-sectional survey.
Place and Duration of Study: Fatima Memorial Hospital, College of Medicine and Dentistry, Lahore, during January to
October 2012.
Methodology: This study was conducted on 4th year MBBS students. The students were randomly divided in two groups
by lottery method following their roll numbers. The groups A and B were dealt with Peer Assisted Learning (PAL) and
Expert Assisted Learning (EAL) respectively. Effectiveness of both methods of learning was calculated on the basis of
academic scores obtained in MCQ tests. One best answer type of MCQs were used and their construct validity was
checked by other senior faculty members. After crossover of groups and altered teaching strategy, academic scores were
compared again within the group and the comparable group. Student's views about this technique were measured by
Likert's scale. P-values were obtained by applying independent and paired t-tests and considered statistically significant
at ≥ 0.05.
Results: There were 70 students of 4th year MBBS which included 24 (34.3%) males and 46 (65.7%) females. The
Crohnbach's alpha value of these MCQs was 0.64. Scores of MCQ test were compared by applying independent t-test
and p-value obtained was 0.971; after cross over p-value was 0.468 which was not significant between the results
obtained by two learning strategies. Twenty five students (46.3%) said that PAL is an effective technique. Thirty eight
(70.4%) students found it easy to communicate with a peer. For incorporation of PAL in curriculum of community medicine,
24 (44.4%) students voted in its favour.
Conclusion: Peer assisted learning has proved of equivalent efficacy in terms of students score in MCQs test as expert
assisted learning.

Key Words: Expert assisted learning. Peer assisted learning. Academic scores. Student's views.

INTRODUCTION alternate between the roles of peer teacher and peer

Recent trends in medical education include a shift from
the traditional, didactic, lecture-oriented approach to a
more student-driven, problem-based approach to
learning.1 The boundaries of knowledge are no longer
restricted to textbooks and lectures. The student of
today has access to journals, Internet resources,
educational videos, online conferencing and much
more.2 Team based learning, problem based learning,
peer assisted learning and online learning is few of the
popular options for acquisition of knowledge.1
Peer Assisted Learning (PAL) has been defined as "the
development of knowledge and skill through active help
and support among status equals or matched
companions".3 Peer teaching in medical schools often
occurs as reciprocal peer teaching, in which students
Department of Community Medicine, Fatima Memorial
Hospital, College of Medicine and Dentistry Shadman,
Lahore.
Correspondence: Prof. Dr. Iram Manzoor, 118-H, Wapda Town,
Lahore.
E-mail: iramdr123@yahoo.co.in
Received: February 15, 2013; Accepted: August 12, 2014.
learner.4
The benefits of Peer Assisted Learning (PAL) are well
established with positive effects on examination scores,
student satisfaction and reported personal and
professional development.3 A study was conducted in
first year undergraduate students in which 82% of the
students said that PAL helped them get a clearer
understanding of course direction and expectations.4
Peer assisted learning has been used in many medical
schools as a support to Expert Assisted Learning (EAL)
because of the shortage of faculty members.5 Recent
trends in medical education in Pakistan also include a
shift from the traditional to a more student based
approach.
The effectiveness of peer assisted learning has been
reported by many studies but only few references is
available in Pakistani context.2,5,6
PAL is perceived as rewarding in terms of fostering
higher order thinking, effective teaching skills and in
improving self efficacy among learners. Local
comparison of effectiveness in peer assisted learning
and expert assisted learning will help us to give

Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (11): 825-829 825
Iram Manzoor

evidence in incorporating peer assisted learning in 0.05. Confidentiality of the students was ensured by
Pakistani medical schools. This will also help faculty keeping questionnaires anonymous and fictitious roll
members to utilize the strengths of students to enhance numbers were allocated for compilation of data. IRB
their learning opportunities as well as provide evidence clearance was taken before starting the project.
to medical educationists that PAL can be incorporated in
local setup. RESULTS
The objective of this study was to compare the This study was conducted on 70 students of 4th year
effectiveness of peer assisted learning and expert MBBS in Fatima Memorial Hospital, College of Medicine
assisted learning in terms of academic scores obtained and Dentistry. Amongst these 24 (34.3%) were males
after MCQ test in a private undergraduate medical and 46 (65.7%) were females. The mean age of this
college of Lahore. group was 22.05 ± 0.652 years with a variance of 0.426
years. These 70 students were randomly divided into
METHODOLOGY two groups. Group A had 34 (48.6%) and group B had 36
(51.4%) students. Group A had a subject expert assisted
This study was conducted in 4th year MBBS students of
and group B had peer assisted learning session in the
Fatima Memorial Hospital, College of Medicine and
subject of Community Medicine. They were assessed
Dentistry, Lahore, during January to October 2012. It
through one best answer type of MCQs. The reliability
was a cross-over, randomized control trial to collect
coefficient of these MCQ scores was calculated by using
quantitative scientific evidence of effectiveness of two
Crohnbach's Alpha which was 0.64. It was observed that
strategies in terms of numbers gained in MCQs by
mean scores of group A and B were 42.65 ± 16.75 and
students. Considering ethical issues in educational
42.50 ± 16.79 respectively. There was no statistically
intervention, sampling was avoided and whole class was
significant difference in p-values of independent t-test.
included in the study. Informed consent of the students
Then the groups were crossed over and group A had
was taken prior to conducting the study. The class of 4th
peer assisted learning and group B had expert assisted
year MBBS was divided into two groups (A and B)
learning and the MCQ test was conducted. It was
randomly by using lottery method. An expert faculty
observed that mean score of group A which had peer
member (professor) delivered a lecture to group A and a
assisted learning was 41.47 ± 16.72 and group B which
peer tutee delivered lecture to group B. This peer tutee
had expert assisted learning was 44.44 ± 17.31. There
was selected on the basis of best academic record and
was no significant difference found in p-values after
willingness to act as tutee. The student selected to
application of independent t-test (Table I).
implement Pal was oriented thoroughly with this strategy
and initial training was given to him to impart lecture. For analyzing the difference in the same group after two
Prevention of chronic diseases was the topic and two techniques of learning, the results of group A and group
different diseases were dealt in two sessions. The topics B were compared to their own performance with two
of lectures were of same difficulty. Both groups were interventions. It was observed that there was no
assessed about their knowledge of the subject with statistically significant difference between the marks
MCQ test. MCQs used were of one best answer type obtained by two techniques. The mean score of group A
and they were based to measure all three levels of was 42.65 ± 16.75 with expert assisted learning and
cognition including recall, understanding and problem
Table I: Comparison of MCQ scores after peer and expert assisted
solving. Three subject specialists vetted these MCQs to learning.
validate their construct. The total number of MCQs used Group Number of Mean score Standard p-value
was 20. students x deviation
n
In the next session, there was a crossover of batches A. Expert 34 (48.6%) 42.65 16.75 0.971
and then they were exposed to alternate intervention. B. Peer 36 (51.4%) 42.50 16.79
Group B had an expert tutee and group A had peer tutee After cross over
and they were again exposed to the MCQ test and their A. Peer 34 (48.6%) 41.47 16.72 0.468
marks of MCQ test were compared. The reliability B. Expert 36 (51.4%) 44.44 17.31
coefficient of these MCQ scores was calculated by using
Crohnbach's Alpha which was 0.64. Students views Table II: Comparison of MCQ scores of each group after application
about peer assisted learning were gathered by using a of paired sample t-test.
questionnaire with a Likert scale on the preformed Group Number of Mean score Mean p-value
questionnaire. students
n
x difference

Data was analyzed through Statistical Package for A. Peer 34 41.47 -1.176 0.794
Social Sciences (SPSS) version 17. Mean scores of A. Expert 42.65
MCQ tests were compared by application of t-test and B. Peer 36 42.50 -1.944 0.554

p-value of significance was fixed at equal to or below B. Expert 44.44

826 Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (11): 825-829
Peer assisted versus expert assisted learning
Table III: Responses of students about PAL session.
Responses Frequency
PAL is an effective teaching strategy
Yes 25
No 27
Don't know 2 3.7%
Are you satisfied with content
coverage in PAL
Yes 16
No 33
Don't know 5 9.3%
PAL gives safer environment as
compared to EAL
Yes 27
No 24
Don't know 3 5.6%
It is easy to communicate with peer
as compared to expert
Yes 38
No 13
Don't know 3 5.6%
41.47 ± 16.72 with peer assisted learning. When the
scores of group B were compared it was observed that
mean score with expert assisted learning was 44.44 ±
17.31 and with peer assisted learning 42.50 ± 16.79.
Application of paired sample t-test showed no significant
difference in scores after the application of two
techniques (Table II).
The students were asked to share their views about peer
assisted learning sessions in comparison to expert
assisted learning. Out of 70 students, 54 agreed to
participate with a response rate of 77.14% and their
responses were assessed on Likert's scale of 1 - 3. It
was observed that 25 (46.3%) students agreed that Peer
Assisted Learning (PAL) is an effective teaching
strategy. Out of 54 students, only 16 (29.6%) were
satisfied with coverage of course content in PAL
sessions. Fifty percent participants agreed that PAL
gives a safer environment of learning as compared to
expert assisted learning. Out of 54 respondents, 38
(70.4%) strongly agreed that it was easy to
communicate with a peer in lecture as compared to
subject expert (Table III).
When the students were asked about incorporation of
peer assisted learning session in Curriculum of 4th year
MBBS in subject of Community Medicine, 24 (44.4%)
responded in favour while 30 (55.6%) responded
against it. When it was asked what are students’
recommendation about PAL incorporation in the routine
session, 9 out of 24, which constituted 37.5%,
responded that there should be sessions of PAL on
monthly basis.
DISCUSSION
Many different types of peer assisted learning have been
identified which include peer teaching, peer assessment
and feedback, peer mentoring and peer leadership.7
Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (11): 825-829
Peer assessment and feed back has provided an
Percentage opportunity of positive and constructive criticism
regarding communication skills, professionalism, clinical
46.3% problem solving skills and clinical performance in
50.0% different medical schools.8
Peer mentoring is a supportive relationship between two
students of differing academic or experience levels
29.6% within the professional program which focuses more on
61.1% emotional support and encouragement, rather than on
peer teaching and learning.7 Peer leaders supervise
their colleagues and can provide clinical supervision by
taking correct decisions.8
50.0%
The results of this study have shown that there was no
44.4%
significant difference in the marks obtained by students
by two learning strategies. Many studies in comparison
to that have shown that PAL has a positive effect in
70.4% terms of examination scores.4
24.1%
Some other studies have shown the evidence that in
PAL group, students with similar knowledge, values and
backgrounds, can limit learning opportunities for other
students.9
The results of this study have also shown that there is no
significant difference in learning of the individual groups
after PAL and expert assisted learning. When p-value
was obtained for each group after two learning
strategies, it was 0.794 and 0.554 for group-A and
group-B respectively. It has been documented that peer
assisted learning is not only beneficial for tutee but it
also plays a key role in cognitive development,
communication skills and improvement of self esteem of
tutor as well.10
While gathering the responses of students about peer
assisted learning, multiple responses were obtained. It
was observed that (25) 46.3% of the students believed
that PAL is an effective teaching strategy. Worldwide
acceptance of students for peer assisted learning is very
high. A study published showed that 82% of tutees
considered the peer teaching model to be sufficient, and
a mere 1% expressed the wish for skills training to be
provided by faculty staff only.11 PAL is used in many
medical schools of United Kingdom and it plays an
important role in robust process for assuring the quality
of teaching in future teachers and consultants.12
This study found that 16 (29.6%) students were satisfied
with content coverage and 33 (61.1%) were not
satisfied. It has been documented that peer assisted
learning has certain disadvantages. Sometimes the peer
tutees are not well conversant with the topic and do not
have full depth of knowledge; in that case, further
confusions can be created for tutee.13 In some cases of
peer assisted learning, peer pressure, embarrassment
and inappropriate behaviour has also been reported.10
This research shows that students feel much safer in
environment with peer assisted learning and they feel
that it is much easier to communicate with peers as
compared to experts.
827
Iram Manzoor
Research has shown that peer-teaching in under-
graduate medical programs is comparable to conven-
tional teaching when utilized in selected contexts.14
Some of the studies have shown a greater impact of
peer assisted learning and near peer learning when
imparted as a revision course after the core course
taught by teachers.15,16
In this study, 27 students (50%) said that PAL provides
safer environment as compared to EAL. It has been
proven by many studies that in comparison to teacher
led lessons, peer assisted learning provides much safer
environment for interactive learning.17 A study was
conducted in fifth-year medical undergraduates, who
had completed their communication skills modular
training and attended a preparatory workshop, facilitated
a role-play session for their second-year colleagues, it
was observed that both tutor and tutee were relaxed and
comfortable during the session and developed an
environment of confidence and trust which served as an
ideal atmosphere for learning.4 Another study aimed to
evaluate the implementation of a same-year Peer-
Assisted Learning (PAL) scheme, showed that the
majority of students agreed that PAL helped with social
aspects of learning but not contributed to improved study
skills or assignment preparation.18
The documented qualitative benefits of peer-teaching
strategies in the setting of health professional education
has shown enhancement of cognitive, psychomotor and
affective domains of tutor and tutee both.19
When the students were asked about incorporation of
peer assisted learning in curriculum of community
medicine, 24 (44.4%) favoured it.
Out of these (24) 44.4%, the students who wanted to
incorporate it on monthly basis were (9) 38%. Peer
assisted learning can be intentionally planned and
incorporated in timetables by faculty members, but
sometimes incidentally by the students themselves.20
For implementation of peer assisted learning in
institutions a 24 questions framework have been
designed by Ross which gives a clear picture for
organization and implementation of this program.21 PAL
is attaining significant importance in medical education
where the restrictions on resources have forced
teachers to create new educational environments which
can be delivered at a lower cost.19 By and large,
healthcare and academic staffs are enthusiastic about
teaching, but are often limited by resources and staff
numbers.19 Peer assisted learning may result in cost
saving and can address curricular outcomes as well.10
PAL is increasingly being used in medical education. To
increase the effectiveness of peer assisted learning in
medical schools, some important aspects which cover
organizational issues, tutor selection, training of the
tutor, and running and evaluating the sessions is
essential.22 The authors gave special emphasis on tutor
selection and his training for this research.
828 Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (11): 825-829
PAL has been embraced by medical educationalists for
many years in the United States of America which has
shown high examination scores, lowered subjective
distress and enhanced course satisfaction among
students of this system.4 Some of the developing
countries are also trying to experience the peer assisted
learning in their local set up and the most recent
example is of Sri Lanka, where Kuppi classes are
arranged to promote peer assisted learning. Despite
many advantages it recommends that administration
may need to consider different aspects in planning and
developing future peer assisted learning activities.12
This indicates the need of PAL associated activities to be
incorporated in Pakistani medical schools as well. There
is limited scientific evidence available regarding peer
assisted learning in Pakistan. Although informally peer
teaching, mentoring and leadership are present in
different forms which are mainly student driven. The
need of hour is to incorporate these peer assisted
learning in growing medical college's curriculum where
lack of teaching staff is a strong indication to promote
such activities. It should be clearly kept in mind that
these PAL activities need proper administrative and
training support to get the maximum benefits. Faculty
should be trained to become familiar with PAL and
should change stance towards the continuously
changing trends of medical education and help us in
incorporating new teaching methodologies.
A large group used during PAL and EAL is one of my
limitations as it is recommended that PAL is more
effective in small groups. Such studies should be
repeated at different medical colleges before making
PAL a part of curriculum.
CONCLUSION
Peer assisted learning has proved of equivalent efficacy
in terms of student's scores in MCQs test as expert
assisted learning. Many students favour its application in
regular teaching practices so PAL can be used as
supporting technique in delivery of the curriculum in
undergraduate level.
REFERENCES
1. Kwan CY. What is problem-based learning (PBL)? It is magic,
myth and mindset. Center Develop Teach Learn Brief 2000;
3:1-2.
2. Yawar A, Shah SS. Faculty and student survey: methods of
imparting knowledge suitable for undergraduate medical
students. Pakistan J Med Res 2003; 42:245-9.
3. Glynn LG, MacFarlane A, Kelly M, Cantillon P, Murphy AW.
Helping each other to learn: a process evaluation of peer
assisted learning. BMC Med Educ 2006; 6:18.
4. Academic support. Peer assisted learning. Benefits to the
participants [Internet]. www.pal.bournemouth.ac.uk/benefits_
participants.html
Peer assisted versus expert assisted learning
5. Arnold L, Shue CK, Kritt B, Ginsburg S, Stern DT. Medical
students views on peer assessment of professionalism. J Gen
Intern Med 2005; 20:819-24.
6. Wadoodi A, Crosby JR. Twelve tips for peer assisted learning:
a classical concept revisited. Med Teach 2002; 24:241-4.
7. ROSS MT, Cameron HS. Peer assisted learning: a planning
and implementation framework: AMEE Guide no. 30. Med Teach
2007; 29:527-45.
8. Glass N, Walter R. An experience of peer mentoring with
student nurses: enhancement of personal and professional
growth. J Nurs Educ 2000; 39:155-60.
9. Burke J, Fayaz S, Graham K, Matthew R, Field M. Peer-
assisted learning in the acquisition of clinical skills: a
supplementary approach to musculoskeletal system training.
Med Teach 2007; 29:577-82.
10. Heckmann JG, Dütsch M, Rauch C, Lang C, Weih M, Schwab
S. Effects of peer-assisted training during the neurology
clerkship: a randomized controlled study. Eur J Neurol 2008;
15:1365-70.
11. Dickson JM, Harrington R, Carter MJ. Teaching clinical
examination using peer assisted learning amongst graduate
entry students. Clin Teach 2011; 8:8-12.
12. Kommalage M, Thabrew H. Student-led peer-assisted
learning: The Kuppi experience at the medical school of the
University of Ruhuna in Sri Lanka. Educ Health 2011; 24:1-13.
13. Wadoodi A, Crosby JR. Twelve tips for peer assisted learning:
a classic concept revisited. Med Teach 2002; 24:241-4.
14. Batchelder AJ, Rodrigues CM, Lin LY, Hickey PM, Johnson C,
Elias JE. The role of students as teachers: four years'
Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (11): 825-829
experience of a large-scale, peer-led programme. Med Teach
2010; 32:547-51.
15. Rengier F, Julian Rauch P, Partovi S, Kirsch J, Nawrotzki R.
A three-day anatomy revision course taught by senior peers
effectively prepares junior students for their national anatomy
exam. Ann Anat 2010; 192:396-9.
16. Mensch JM, Ennis CD. Pedagogic strategies perceived to
enhance student learning in athletic training education. J Athl
Train 2002; 37:S199-S207.
17. Hammond JA, Bithell CP, Jones L, Bidgood P. A first year
experience of students- directed peer assisted learning. Active
Learn Higher Educ 2010; 11:201-12.
18. Nestel D, Kidd J. Peer tutoring in patient-centred interviewing
skills: experience of a project for first-year students. Med
Teach 2003; 25:398-403.
19. Yu T, Wilson NC, Singh PP, Lemanu DP, Hawken SJ, Hill AG.
Medical students as teachers: a systematic review of peer
assisted teaching during medical school. Adv Med Educ Pract
2011; 2:157-72.
20. Henning JM, Eiedner TG, Marty MC. Peer assisted learning in
clinical education: literature review. Athl Train Educ J 2008;
3:84-90.
21. Busari JO. How residents perceive their teaching role in the
clinical setting. Med Teach 2002; 24:57-61.
22. Weyrich P, Schrauth M, Kraus B, Hebermehl D, Netzhammer
N, Zipfel S, et al. Undergraduate technical skills training guided
by students tutors: analysis of tutor's attitudes, tutees
acceptance and learning progress in an innovative teaching
model. BMC Med Edu 2008; 9:8-18.
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