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Peer Assisted Versus Expert Assisted Learning:

A Comparison of Effectiveness in Terms of Academic Scores
Iram Manzoor

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

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Peer assisted versus expert assisted learning

Table III: Responses of students about PAL session. Peer assessment and feed back has provided an
Responses Frequency Percentage opportunity of positive and constructive criticism
PAL is an effective teaching strategy regarding communication skills, professionalism, clinical
Yes 25 46.3% problem solving skills and clinical performance in
No 27 50.0% different medical schools.8
Don't know 2 3.7%
Peer mentoring is a supportive relationship between two
students of differing academic or experience levels
Are you satisfied with content
coverage in PAL
Yes 16 29.6% within the professional program which focuses more on
No 33 61.1% emotional support and encouragement, rather than on
Don't know 5 9.3% peer teaching and learning.7 Peer leaders supervise
PAL gives safer environment as their colleagues and can provide clinical supervision by
compared to EAL taking correct decisions.8
Yes 27 50.0%
The results of this study have shown that there was no
No 24 44.4%
Don't know 3 5.6%
significant difference in the marks obtained by students
It is easy to communicate with peer
by two learning strategies. Many studies in comparison
as compared to expert to that have shown that PAL has a positive effect in
Yes 38 70.4% terms of examination scores.4
No 13 24.1%
Some other studies have shown the evidence that in
Don't know 3 5.6%
PAL group, students with similar knowledge, values and
41.47 ± 16.72 with peer assisted learning. When the backgrounds, can limit learning opportunities for other
scores of group B were compared it was observed that
mean score with expert assisted learning was 44.44 ± The results of this study have also shown that there is no
17.31 and with peer assisted learning 42.50 ± 16.79. significant difference in learning of the individual groups
Application of paired sample t-test showed no significant after PAL and expert assisted learning. When p-value
difference in scores after the application of two was obtained for each group after two learning
techniques (Table II). strategies, it was 0.794 and 0.554 for group-A and
group-B respectively. It has been documented that peer
The students were asked to share their views about peer assisted learning is not only beneficial for tutee but it
assisted learning sessions in comparison to expert also plays a key role in cognitive development,
assisted learning. Out of 70 students, 54 agreed to communication skills and improvement of self esteem of
participate with a response rate of 77.14% and their tutor as well.10
responses were assessed on Likert's scale of 1 - 3. It
was observed that 25 (46.3%) students agreed that Peer While gathering the responses of students about peer
Assisted Learning (PAL) is an effective teaching assisted learning, multiple responses were obtained. It
strategy. Out of 54 students, only 16 (29.6%) were was observed that (25) 46.3% of the students believed
satisfied with coverage of course content in PAL that PAL is an effective teaching strategy. Worldwide
sessions. Fifty percent participants agreed that PAL acceptance of students for peer assisted learning is very
gives a safer environment of learning as compared to high. A study published showed that 82% of tutees
expert assisted learning. Out of 54 respondents, 38 considered the peer teaching model to be sufficient, and
(70.4%) strongly agreed that it was easy to a mere 1% expressed the wish for skills training to be
communicate with a peer in lecture as compared to provided by faculty staff only.11 PAL is used in many
medical schools of United Kingdom and it plays an
subject expert (Table III).
important role in robust process for assuring the quality
When the students were asked about incorporation of of teaching in future teachers and consultants.12
peer assisted learning session in Curriculum of 4th year
This study found that 16 (29.6%) students were satisfied
MBBS in subject of Community Medicine, 24 (44.4%)
with content coverage and 33 (61.1%) were not
responded in favour while 30 (55.6%) responded
satisfied. It has been documented that peer assisted
against it. When it was asked what are students’
learning has certain disadvantages. Sometimes the peer
recommendation about PAL incorporation in the routine
tutees are not well conversant with the topic and do not
session, 9 out of 24, which constituted 37.5%,
have full depth of knowledge; in that case, further
responded that there should be sessions of PAL on
confusions can be created for tutee.13 In some cases of
monthly basis.
peer assisted learning, peer pressure, embarrassment
and inappropriate behaviour has also been reported.10
DISCUSSION This research shows that students feel much safer in
Many different types of peer assisted learning have been environment with peer assisted learning and they feel
identified which include peer teaching, peer assessment that it is much easier to communicate with peers as
and feedback, peer mentoring and peer leadership.7 compared to experts.

Journal of the College of Physicians and Surgeons Pakistan 2014, Vol. 24 (11): 825-829 827
Iram Manzoor

Research has shown that peer-teaching in under- PAL has been embraced by medical educationalists for
graduate medical programs is comparable to conven- many years in the United States of America which has
tional teaching when utilized in selected contexts.14 shown high examination scores, lowered subjective
Some of the studies have shown a greater impact of distress and enhanced course satisfaction among
peer assisted learning and near peer learning when students of this system.4 Some of the developing
imparted as a revision course after the core course countries are also trying to experience the peer assisted
taught by teachers.15,16 learning in their local set up and the most recent
In this study, 27 students (50%) said that PAL provides example is of Sri Lanka, where Kuppi classes are
safer environment as compared to EAL. It has been arranged to promote peer assisted learning. Despite
proven by many studies that in comparison to teacher many advantages it recommends that administration
led lessons, peer assisted learning provides much safer may need to consider different aspects in planning and
environment for interactive learning.17 A study was developing future peer assisted learning activities.12
conducted in fifth-year medical undergraduates, who This indicates the need of PAL associated activities to be
had completed their communication skills modular
incorporated in Pakistani medical schools as well. There
training and attended a preparatory workshop, facilitated
is limited scientific evidence available regarding peer
a role-play session for their second-year colleagues, it
assisted learning in Pakistan. Although informally peer
was observed that both tutor and tutee were relaxed and
teaching, mentoring and leadership are present in
comfortable during the session and developed an
environment of confidence and trust which served as an different forms which are mainly student driven. The
ideal atmosphere for learning.4 Another study aimed to need of hour is to incorporate these peer assisted
evaluate the implementation of a same-year Peer- learning in growing medical college's curriculum where
Assisted Learning (PAL) scheme, showed that the lack of teaching staff is a strong indication to promote
majority of students agreed that PAL helped with social such activities. It should be clearly kept in mind that
aspects of learning but not contributed to improved study these PAL activities need proper administrative and
skills or assignment preparation.18 training support to get the maximum benefits. Faculty
should be trained to become familiar with PAL and
The documented qualitative benefits of peer-teaching
should change stance towards the continuously
strategies in the setting of health professional education
changing trends of medical education and help us in
has shown enhancement of cognitive, psychomotor and
incorporating new teaching methodologies.
affective domains of tutor and tutee both.19
When the students were asked about incorporation of A large group used during PAL and EAL is one of my
peer assisted learning in curriculum of community limitations as it is recommended that PAL is more
medicine, 24 (44.4%) favoured it. effective in small groups. Such studies should be
repeated at different medical colleges before making
Out of these (24) 44.4%, the students who wanted to PAL a part of curriculum.
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 Peer assisted learning has proved of equivalent efficacy
in terms of student's scores in MCQs test as expert
For implementation of peer assisted learning in
assisted learning. Many students favour its application in
institutions a 24 questions framework have been
regular teaching practices so PAL can be used as
designed by Ross which gives a clear picture for
organization and implementation of this program.21 PAL supporting technique in delivery of the curriculum in
is attaining significant importance in medical education undergraduate level.
where the restrictions on resources have forced
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