systematic review of peer teaching and learning in clinical education

DOI: 10.1111/J.1365-2702.2007.01954.X
Corpus ID: 12219841

A systematic review of peer teaching and learning in clinical education.

Jacinta Secomb
Published in Journal of Clinical Nursing 1 March 2008
Education, Medicine

497 Citations

The value of peer learning in undergraduate nursing education: a systematic review, how are we assessing near-peer teaching in undergraduate health professional education a systematic review., advances in medical education and practice dovepress medical students-as-teachers: a systematic review of peer-assisted teaching during medical school, near-peer teaching in undergraduate nurse education: an integrative review., an integrated literature review of undergraduate peer teaching in allied health professions, examining the use of peer led education in patient safety training : a scoping review, facilitators and barriers in application of peer learning in clinical education according to nursing students, a peer learning intervention for nursing students in clinical practice education: a quasi-experimental study., exploration of the effects of peer teaching of research on students in an undergraduate nursing programme.

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Does peer-assisted learning improve academic performance? A scoping review.

26 references, peer teaching among nursing students in the clinical area: effects on student learning., peer learning in clinical education., enhancing clinical competence using a collaborative clinical education model., physiotherapy students’ perceptions of an innovative approach to clinical practice orientation, the 2:1 clinical placement model, peer mentorship in clinical education: outcomes of a pilot programme for first year students., a quasi-experimental study of the differences in performance and clinical reasoning using individual learning versus reciprocal peer coaching, using peer groups in nursing education, the 2:1 clinical placement model: review, facilitating peer group teaching within nurse education., related papers.

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A systematic review of peer teaching and learning in clinical education.

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Improving the quality of nursing students' clinical placements in nursing homes: an evaluation study., collaborative learning using nursing student dyads in the clinical setting: experiences and perceptions of students and patients, nursing preceptors' experiences of two clinical education models., crossing professional barriers with peer-assisted learning: undergraduate midwifery students teaching undergraduate paramedic students., peer teaching among nursing students in the clinical area: effects on student learning, enhancing service productivity in acute care inpatient settings using a collaborative clinical education model, a quasi-experimental study of the differences in performance and clinical reasoning using individual learning versus reciprocal peer coaching, peer mentorship in clinical education: outcomes of a pilot programme for first year students, a model for peer tutoring in the medical school setting., related papers (5), the effectiveness of peer tutoring in further and higher education: a typology and review of the literature, understanding the experience of being taught by peers: the value of social and cognitive congruence., dimensions and psychology of peer teaching in medical education., student teaching: views of student near-peer teachers and learners, peer-assisted learning: a novel approach to clinical skills learning for medical students..

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Peer teaching and learning in clinical education: A systematic review of the literature Paperback – December 9, 2010

Print length 160 pages
Language English
Publication date December 9, 2010
Dimensions 5.91 x 0.37 x 8.66 inches
ISBN-10 3838355172
ISBN-13 978-3838355177
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Product details

Publisher ‏ : ‎ LAP LAMBERT Academic Publishing (December 9, 2010)
Language ‏ : ‎ English
Paperback ‏ : ‎ 160 pages
ISBN-10 ‏ : ‎ 3838355172
ISBN-13 ‏ : ‎ 978-3838355177
Item Weight ‏ : ‎ 8.6 ounces
Dimensions ‏ : ‎ 5.91 x 0.37 x 8.66 inches

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Implementing Peer Learning in Clinical Education: A Framework to Address Challenges In the "Real World"

Affiliations.

1 a Centre for Research in Assessment and Digital Learning , Deakin University , Geelong , Victoria , Australia.
2 b Faculty of Medicine , Nursing and Health Sciences, Monash University , Melbourne , Victoria , Australia.
3 c School of Medicine , University of Tasmania , Hobart , Tasmania , Australia.
4 d Allied Health Research Unit , Monash Health , Melbourne , Victoria , Australia.
PMID: 27997224
DOI: 10.1080/10401334.2016.1247000

Phenomenon: Peer learning has many benefits and can assist students in gaining the educational skills required in future years when they become teachers themselves. Peer learning may be particularly useful in clinical learning environments, where students report feeling marginalized, overwhelmed, and unsupported. Educational interventions often fail in the workplace environment, as they are often conceived in the "ideal" rather than the complex, messy real world. This work sought to explore barriers and facilitators to implementing peer learning activities in a clinical curriculum.

Approach: Previous peer learning research results and a matrix of empirically derived peer learning activities were presented to local clinical education experts to generate discussion around the realities of implementing such activities. Potential barriers and limitations of and strategies for implementing peer learning in clinical education were the focus of the individual interviews.

Findings: Thematic analysis of the data identified three key considerations for real-world implementation of peer learning: culture, epistemic authority, and the primacy of patient-centered care. Strategies for peer learning implementation were also developed from themes within the data, focusing on developing a culture of safety in which peer learning could be undertaken, engaging both educators and students, and establishing expectations for the use of peer learning. Insights: This study identified considerations and strategies for the implementation of peer learning activities, which took into account both educator and student roles. Reported challenges were reflective of those identified within the literature. The resultant framework may aid others in anticipating implementation challenges. Further work is required to test the framework's application in other contexts and its effect on learner outcomes.

Keywords: Peer learning; challenges in clinical education; qualitative research.

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Open access
Published: 02 September 2024

Empathy ability and influencing factors among pediatric residents in China: a mixed-methods study

Pingping Li 1 na1 ,
Ling Weng 2 na1 &
Lu Dong 1

BMC Medical Education volume 24 , Article number: 955 ( 2024 ) Cite this article

Metrics details

Empathy is one of the fundamental factors enhancing the therapeutic effects of physician–patient relationships, but there has been no relevant research in China on the pediatric resident physicians’ capacity for empathy or the influencing factors.

A mixed-methods study was undertaken. The student version of the Jefferson Scale of Empathy was used to assess 181 postgraduate residents at Shanghai Children’s Medical Center and Shanghai Children’s Hospital. Differences in empathy ability among pediatric resident physicians of different genders and specialties were analyzed using independent sample t-tests and Mann–Whitney U tests. A one-way analysis of variance was used to analyze the differences in empathy ability at different educational levels and years of medical residency training. Seven third-year postgraduate pediatric residents from Shanghai Children’s Medical Center participated in semi-structured interviews exploring the influencing factors. We analyzed the interview transcripts using thematic analysis.

The scale was completed by 154 pediatric residents. No statistically significant differences in empathy were found between educational level, postgraduate year, gender, or specialty. The factors influencing empathy in doctor–patient communication included the person who accompanied the child to see the doctor, how the children cooperated with doctors for medical treatment, the volume of pediatric outpatient and emergency visits, and the physician’s ability to withstand pressure. All interviewed resident physicians regarded learning empathy as important but rarely spent extra time learning it.

Conclusions

The evaluation results of resident physicians on changes in empathy after improving clinical abilities vary according to their understanding of empathy, and the work environment has an important impact on pediatricians’ empathy ability. Their empathy score is relatively low, and this requires exploration and intervention.

Peer Review reports

There has been a long-standing tension in the physician–patient relationship in pediatric clinics in China [ 1 ]. There are complex reasons for this, but research has found that 80% of doctor–patient disputes result from poor communication, often due to a lack of empathy during interactions [ 2 , 3 ]. The current medical literature defines empathy as the ability to understand the patient’s perspective and feelings, as well as sharing and acting on this understanding during interpersonal interactions [ 4 ]. Studies show that empathy is linked with enhanced patient satisfaction and treatment compliance [ 5 ]. High levels of empathy in healthcare professionals are connected to positive clinical prognoses for patients by reducing mental stress, improving self-awareness, and reducing anxiety and depression [ 6 , 7 ].

Residency training is mandatory for doctors to qualify to practice independently [ 8 ]. In China, standardized residency training began nationwide in 2013; seven government ministries jointly issued the policy document, “Guidance on the Establishment of a Standardized Residency Training System” [ 9 ]. All clinicians, including pediatricians, are required to undergo three-year residency training after graduating from medical school. During these three years, residents study in different departments.

The Chinese Medical Doctor Association recommends six core competencies for medical residents based on the content and standards for standardized residency training (2022 version): professionalism, clinical professionalism, managing patients, communication, teaching, and learning. While professionalism necessarily involves knowledge and skill, the unique characteristic of medical professionalism is empathy [ 10 ], a capacity that is also strongly related to communication. Thus, cultivating empathy is important for medical residents.

The student version of the Jefferson Scale of Empathy (JSE-S) was specifically developed as a self-report scale for the assessment of empathy in medical students [ 11 , 12 ]. Some studies have reported a decline in empathy among medical students [ 13 , 14 , 15 ], while some have noted that students in their final year scored higher for empathy than did first-year medical students [ 16 , 17 ] and others have reported little change in empathy scores across the years [ 18 ]. However, there is little comparable research for China.

Some studies have shown that the work environment can affect the development of empathy [ 19 ], and pediatric departments recorded a high incidence of doctor–patient disputes [ 20 ]. According to the 2019 National Medical Injury Liability Dispute Case Big Data Report, pediatrics is a high-risk area for doctor–patient disputes.

Therefore, this study aimed to analyze whether there are differences in the ability to empathize among pediatric resident physicians of different grades and whether the pediatric medical environment affects that ability. A mixed-methods approach was used: We assessed empathy scores using the JSE-S and then conducted a semi-structured survey to discuss the influencing factors.

Study design

Quantitative and qualitative methodologies were used to analyze empathy and influencing factors among pediatric residents, incorporating a survey for the quantitative analysis and interviews for the qualitative assessment.

Quantitative methodology

Data collection: survey.

In July 2023, all residents of the Shanghai Children’s Medical Center, affiliated with Shanghai Jiao Tong University School of Medicine, and the Children’s Hospital affiliated with Shanghai Jiao Tong University School of Medicine, were surveyed using an anonymous online questionnaire. Informed consent was obtained from all participants. The survey was available online for one week, and after three days, the residents were sent reminders via WeChat by staff members from the two hospitals.

The JSE-S was used in this study [ 21 ] The scale consists of 20 items, measured using a seven-point Likert scale ranging from 1 = completely disagree to 7 = completely agree but with items 1, 3, 6, 7, 8, 11, 12, 14, 18, and 19 reverse scored. The total score of the scale comprises the total score for all items, with higher scores indicating higher levels of empathy. The scale is subdivided into three dimensions: perspective-taking, compassionate care, and standing in the patient’s shoes [ 12 , 21 ]. The maximum score on the JSE is 140, and the minimum score is 20. Other data collected as part of the JSE survey included sex and years of medical resident training, specialty, and education.

Data analysis

Independent samples t-tests were performed to assess differences in mean JSE scores between sexes. The Mann–Whitney U test was used to compare the differences in mean JSE scores between specialties. A one-way analysis of variance (ANOVA) was performed to compare the differences between the different years of medical residency training and different levels of education. All analyses were performed using the IBM SPSS Statistics Version 25.0. The data are presented as mean ± standard deviation (SD) unless otherwise stated.

Qualitative methods

Data collection: interviews.

As the third-year postgraduate (PGY3) pediatric residents who entered standardized training for pediatric resident physicians in 2020 had completed their training, in August 2023, PGY3 pediatric residents at the Shanghai Children’s Medical Center were asked to participate in the interviews. Seven consented to participate (Table 1 ).

Two researchers (LPP and WL) conducted individual face-to-face semi-structured interviews. The interviews lasted 50–70 min (60-minute average) and were audio recorded and transcribed verbatim by a professional service. The interview guide (Table 2 ) included three aspects: work environment, residents’ standardized training, and open questions. The open-ended questions explored the most memorable cases of smooth and unsmooth communication with patients.

During the interviews, the research followed the guidelines of the interview outline and interviewees’ actual situations. The order and method of questioning were adjusted according to the context and the value of the questions. The language used by the interviewees was accepted without judgment, and no inducements or interventions were made. To protect the privacy of the respondents, their names have been replaced by numbers.

In accordance with a constructivist approach, the analyses tapped into the sense that the participants made of their experiences of communicating with patients. Inductive thematic analysis [ 22 ] was used to identify themes. The interviews were audio recorded and transcribed verbatim by a professional service (iFLYTEK). WL and LPP read and reread transcripts for immersion and familiarization. Two authors (WL and LPP) iteratively coded the data deemed relevant to the current study using Nvivo14 [ 23 ]. Disagreements were discussed with another author (DL). The next step was to group related codes into potential themes. Subsequently, three authors (LPP, WL, and DL) jointly reviewed the themes to ensure that the codes in each theme were coherent and that the codes in different themes could be clearly distinguished.

Quantitative research results

Study population characteristics.

In total, 154 residents responded to the survey, a response rate of 85.1% (154/181). The participating pediatric residents included 60 (39.0%) residents from postgraduate year 1 (PGY1), 48 (31.1%) from postgraduate year 2 (PGY2), and 46 (29.9%) from PGY3. A total of 111 participants (72.1%) were women, and 43 (27.9%) were men. A total of 112 (72.7%) participants were pediatric residents, and 42 (27.3%) were pediatric surgery residents. There were 63 (40.9%) undergraduate residents, 69 (44.8%) master’s residents, and 22 (14.3%) doctoral degree residents in this study. The mean JSE-S score for the overall study population was 81.41 ± 5.43.

Based on the independent samples t-test and Mann–Whitney test, we found no differences in pediatrics’ sex (t = 0.878, p = 0.381) or specialty (z=-0.981, p = 0.327).

The education levels of different residents were not significantly different (f = 1.455, p = 0.237) (Table 3 ).

Empathy competencies of pediatric residents with different pediatric standardized training years

The empathetic recognition mean JSE-S score was 81.41 ± 5.43. Compared to PGY1 (81.33 ± 4.45) and PGY2 (80.75 ± 4.08), PGY3 had a high JSE-S score (82.2 ± 7.48), but there were no significant differences between different years of medical residency training (f = 0.839, p = 0.434) (Table 4 ).

In the perspective-taking scale, the mean JSE-S score was 54.66 ± 6.70, and the one-way ANOVA revealed significant differences between PGYs (f = 3.51, p = 0.032). There were significant differences between PGYs for three items: “Physicians’ understanding of the emotional status of their patients, and that of their families is an important component of the physician–patient relationship” (f = 4.391, p = 0.014); “Physicians should try to stand in their patients’ shoes when providing care to them” (f = 4.697, p = 0.010); and “I believe that empathy is an important therapeutic factor in medical treatment” (f = 250.996, p = 0.000).

The mean JSE-S score on the compassionate care scale was 20.76 ± 5.97. PYG1, PYG2, and PYG3 scored 22.42 ± 4.48, 19.42 ± 6.17, and 20.00 ± 7.00, respectively, indicating significant differences between them (f = 4.053, p = 0.019). Significant differences were found for years of pediatric residency training for “Physicians should not allow themselves to be influenced by strong personal bonds between their patients (f = 40.158, p = 0.000) and their family members” and “I do not enjoy reading non-medical literature or the arts.” (f = 37.236, p = 0.000).

The standing in the patient’s shoes dimension of the JSE-S showed no significant differences between the PGYs.

Qualitative research results

The influence of pediatric visiting environment on physicians’ empathy ability.

Because children are unable to express their discomfort or illness well, they should be accompanied by parents or grandparents when attending hospital. Doctors, therefore, have to communicate with the parents or grandparents, and their circumstances, including their education level, familiarity with the child, physical health status, communication and understanding skills, and attitude toward doctors, can affect empathy between doctors and patients.

Compared to adult hospitals , the empathy ability of doctors in children’s hospitals may be slightly reduced because we are dealing with parents , not patients themselves , and many of them are brought for treatment by elderly people. Elderly people do not understand the child’s disease or may have difficulty hearing clearly , which can greatly affect communication , let alone empathy. (P1, M) Some elderly people may regard their children’s condition unnecessarily seriously , resulting in us not being able to understand the symptoms of the child properly. (P2, F) Parents tend to have a good understanding of the child’s condition. If grandparents with a low education or if other relatives bring them over , the process of consultation may not be very smooth. (P3, F) The child might be brought over on the first day of treatment by their parents but subsequently by older relatives. Because the child is still running a fever for two or three days , they will be very anxious. When they communicate this to us , their attitude is often poor. (P4, M) If an elderly person brings a child to see a doctor , I often ask the elderly person to call the parents on the spot so I can listen to them. It is better this way. (P7, M)

Some resident physicians said that the language of the patients’ parents significantly impacted their ability to empathize:

Because I am not from Shanghai and grandparents who accompany their children may speak the local dialect , we are unable to communicate. This is challenging for me and many colleagues because most of us cannot understand the Shanghai dialect. (P2, F)

The child’s upbringing and willingness to cooperate with treatment were also identified as important:

Some parents may spoil their children , some children start acting spoiled as soon as they arrive at the clinic , and some even make a scene , which can interfere with the medical treatment. (P2, F)

The volume of pediatric outpatient and emergency visits and the self-regulation ability of physicians facing strong workloads can also affect communication and empathy between doctors and patients:

Outpatient hours may limit our communication with patients. Generally , you need to finish one within 5–10 min. Otherwise , the patient’s visit may be too long , and you may not be able to see all registered patients before leaving work. For example , last summer , our two doctors saw an average of around 130–150 patients a day , while I saw an average of 80–90 patients per day. That was during the pandemic last year , and there will definitely be more this year. (P7, M) The doctor is very tired and has a large number of patients. If the patients are in a hurry , you need to see them within a short period. If our resident physician’s self-regulation ability is not good , it will affect communication. (P5, M)

Standardized training for resident physicians to cultivate empathy skills

The three resident physicians interviewed believed that in their first year of participating in standardized resident training, they felt more empathy for patients due to their lack of clinical knowledge. By contrast, after three years of clinical practice and improvements in their clinical knowledge, they viewed the patient’s condition more rationally and from a medical perspective.

Because you have learned systematic knowledge about diseases , you know what the likely outcome will be objectively. Consequently , your empathy regarding the intermediate treatment process and patients may decrease , and you have to think about the treatment from a doctor’s professional perspective. (P2, F) When I first entered standardized training for resident physicians , I lacked clinical experience and was not familiar with the treatment process for many diseases. When I encountered critically ill patients , I felt that they were so pitiful. After three years of training , however , these diseases have become more familiar. I know the treatment processes for each disease and feel that empathy has decreased. (P3, F)

The two residents felt that empathy followed a curved path. Residents who have just entered clinical practice have relatively high empathy. However, as their clinical abilities and understanding of diseases increase, coupled with the busy workload of clinical work, their empathy decreases. However, empathy may improve after becoming a physician.

When I went to the outpatient clinic with my supervisor , I felt that my supervisor , who was already a chief physician , had reached a very high level of empathy. I think his empathy ability was much stronger than mine; that is , regardless of the patient’s attitude , he could think from the patient’s perspective. As a resident physician , I still cannot reach the level of empathy that my supervisor possesses. Perhaps I need to acquire some experience in my career to reach the level of empathy that my supervisor possesses , but the process may be a bit complex. (P2, F) As a physician , I think that empathy is a curved process , initially high , but as your clinical abilities improve and work experience increases , empathy may decrease. The attending physician is very busy , and at some point , the value of empathy may be underestimated , but it increases again with age. Perhaps at a certain point or stage , you suddenly feel it is important , and you become very focused on the ability to empathize. (P3, F)

Two interviewees believed that after three years of standardized training for resident physicians, their empathy skills had improved. Three years ago, they only thought about the disease. Today, they are able to think from the perspective of the patient and stand in their shoes.

For example , parents who come to the surgical emergency department are very anxious. As a physician , I can understand their feelings. Some common diseases that you have seen before have a likely trajectory. Although you are also anxious about their diseases , you know how to treat different disease symptoms and have the ability to handle them. I know why parents are anxious , and I can think from their perspective. (P4, F) As you gain an understanding of diseases and as your own abilities and clinical experience improve , your feelings toward the patient change. Because I know how a disease like Mycoplasma pneumonia , for example , develops , when I was in PGY1 , I felt that the child’s cough was very severe , which made the parents very anxious. At the time , I was also quite anxious. Now , however , I know that the course of this disease is long. If parents are very anxious , I will explain this disease to them and comfort them. I have had more contact with patients , and I will consider the problem more from their perspective. (P6, F)

Cultivating residents’ empathy ability during standardized resident training

Self-study: The residents believed it important to learn theories relevant to doctor–patient communication and empathy. The interviews revealed that most of them improved their communication skills in clinical practice, and a few residents spent time studying how to communicate with patients. Only one student bought a book about communication, and one student paid attention to the ability to communicate with patients because they had to take an exam on doctor–patient communication.

When I was admitted for training , there was a medical teacher talking about doctor–patient disputes , which was quite scary at the time. I bought relevant books but did not read them. (P1, M) I have not bought any books related to doctor–patient communication , but I think in clinical practice , it is necessary to participate more in the conversation process with superiors , listen more to their conversations , listen more to how they communicate with patients , and then try to learn how to better communicate with patients on my own. (P2, F) This year’s standardized training and graduation assessment for resident physicians added an assessment of doctor–patient communication. I have paid attention to this knowledge , but I have not delved into it. (P3, F)

Training course: It is necessary to set courses to cultivate residents’ empathy ability, such as theoretical training courses, case-sharing groups, and scenario simulations.

I think it’s necessary to set courses for residents to teach us how to communicate , how to express the appropriate level of empathy to patients , etc. (P1, M) I think theoretical teaching in this area is possible , but it cannot be a single output of this teaching mode. Instead , we could hold some doctor–patient communication and sharing meetings , where residents or specialists could share their cases in clinical work and learn from each other . (P3, F) Maybe establish some scenario simulation courses for training. (P5, M)

Sharing the most memorable cases during resident training

Due to the fact that resident physicians undergo rotational training in different clinical departments over 3 years, clinical departments, patient situations, work environments, and severity of diseases may vary. By conducting interviews with resident physicians during the training period, the factors that affect the empathy ability of resident physicians can be further explored by allowing them to profoundly impact the departments where communication with patients is not smooth or smooth. The results are shown in Table 5 .

Clinical empathy and number of years of standardized training

Some studies have shown that empathy scores are associated with ratings of clinical competence [ 24 ]. From the results of the questionnaire survey, the JSE-S scores of PGY1, PGY2, and PGY3 showed no significant differences. From the interview results, seven respondents compared the changes in their empathy skills between the beginning and completion of the standardized resident physician training. Five pediatric resident physicians believed that their empathy skills had decreased with the improvement in their medical skills, while two resident physicians believed that their empathy skills improved after receiving standardized resident physician training. The results of the interviews seem to confirm the results of the questionnaire survey that different physicians have different understandings of the relationship between the improvement of clinical abilities and empathy. These two perspectives may be due to different perspectives on empathy. A resident physician who believes that empathy decreases may believe that the physician’s empathy toward patients is more about the patient’s illness. As their medical abilities improve, they can treat the patient’s illness and believe that it will eventually be cured, so the need for empathy decreases. Some studies have reported that doctors who sympathize with their patients share their suffering, which could lead to emotional fatigue and a lack of objectivity [ 25 ]. However, one resident physician believed empathy had improved by progressing from learning about diseases from books during their medical student stage to the realities of clinical practice, seeing the impact of diseases on patients, families, and even society.

Clinical empathy and the pediatric work environment

Doctor–patient communication in pediatrics is more complex and difficult than when treating adults, meaning that pediatricians bear higher risks. The probability of medical disputes in pediatrics is much higher than in other departments; pediatricians are often insulted and even physically threatened [ 26 ]. Physician empathy is at the heart of doctor–patient communication and significantly influences patient outcomes [ 27 ]. This study explored the factors that influence empathy between pediatricians and patients. In patient terms, the level of cooperation from the child and the characteristics of the person accompanying the child are factors. As for the doctors, they can be confronted with pressure and the need to communicate effectively in the face of high outpatient volumes, which can affect their expressions of empathy, a finding similar to that of previous studies [ 28 , 29 ].

Further analysis of direct doctor–patient communication and empathy among pediatric resident physicians in different rotating departments showed that communication between doctors and patients was seen to be smoother in the Rheumatology and Immunology, General Surgery, and Special Diagnosis Departments, while difficulties were encountered in Outpatients and Emergency, Hematology and Oncology, Surgical Oncology, and Cardiology. The reasons may be complex, but four principal issues can be identified. First, the duration of communication between doctors and patients and the environment of medical treatment; in the Special Diagnosis Department, for example, patients are able to communicate and interact with doctors for a long time, and the medical environment is very good, whereas Outpatients and Emergency see a rapid turnover and high workload. Second, the level of familiarity between patients and physicians can play a role. In Rheumatology and Immunology Departments, for example, there are often patients with chronic diseases who have been hospitalized for a long time; doctors and patients are very familiar with each other, and some studies have shown empathy is easier to generate when closer interpersonal relationships develop [ 30 ]. Third, different teaching methods may have an impact. Better training on the wards can make residents feel more confident in communicating with patients, whereas Outpatients and Emergency can require residents to face patients alone, generating anxiety or even burnout [ 31 ]. Fourth, disease severity can play a role. In some departments, such as Hematology and Oncology, patients may not have a high hope of recovery but may have high expectations of the treatment. This may not only put a lot of pressure on doctors but also make it difficult to communicate effectively with patients; research has indicated that there is still a gap between the actual and expected disclosure of “bad news” about cancer among healthcare workers, patients, and family members, leading to various disclosure dilemmas [ 32 ].

Clinical empathy across different settings

The mean empathy levels found in this study (81.41 ± 5.43) are lower than those reported [ 33 ] in most similar studies around the world. Similar lower JSE scores have been seen in undergraduate medical students in China; the average JSE score among medical students from Sun Yat-sen University was 84 [ 34 ]. This finding is concerning. The shortage of pediatricians, [ 35 ] low wages, [ 36 ] severe occupational burnout, [ 37 ] and the influence of Asian parental culture [ 38 ] may partly explain our findings. Further investigations are required to determine the factors associated with such low scores so that steps can be taken to address the situation.

Cultivating empathy among pediatric residents

Our research shows that resident physicians believe that empathy is important, even though their self-rated empathy scores are less than ideal. Interventions to further investigate the teaching and learning of empathy were discussed [ 39 ]. Many training courses have proven to be beneficial in enhancing the empathy skills of resident physicians. The teaching innovation “How to act-in-role” has been shown to be effective not only in increasing medical students’ self-reported empathy but also in their competence in consultation skills [ 40 ]. The addition of narrative medicine-based education in standardized training improved empathy and may have improved the professional knowledge of residents [ 41 , 42 ] The use of Balint group activities [ 43 ] with residents has shown significant improvements in empathy across all dimensions. Medical schools should design appropriate training courses and implement interventions at all stages (from the admission process to curricula to residency) and levels (explicit and implicit curricula) depending on the empathy levels of their resident physicians.

Our findings suggest that, based on the different understandings of empathy among resident physicians, the clinical empathy level of pediatric resident physicians is not closely related to an improvement in clinical abilities. Rather, the working environment of pediatricians significantly impacts their empathy ability. Empathy is lower among pediatric residents in China when compared to their European counterparts, and further research into the underlying factors associated with such low scores is necessary to plan interventions to cultivate empathy among pediatric residents.

Limitations

One important weakness of this study is that it was based in one medical school with two specialized children’s hospitals; the limited sample size of the investigation and interviews may mean that the study is not representative of pediatric residents in China. Moreover, the cross-sectional survey precluded us from identifying a causal relationship; thus, a prospective longitudinal study with a larger sample size of pediatric residents is warranted.

Data availability

The questionnaire data that support the findings of this study are available in the Baidu Netdisk repository, https://pan.baidu.com/s/1hRjCKuIVVry79HwTzxB_bA with the primary accession code e9hp.The interview datasets analysed during the current study are not publicly available due to privacy concerns but are available from the corresponding author upon reasonable request.

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Acknowledgements

This work was financed by Postgraduate Medical Education Project in 2022 (BYH20220412); The 2022 Science and Technology Innovation Project (Humanities and Social Sciences) Project of Shanghai Jiao Tong University School of Medicine (WK2217); Fujian Medical University Education Reform Project: Application Research on the Intelligent Teaching Platform for Clinical Teachers under the Background of “New Medical Science” (J22021).

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Pingping Li and Ling Weng contributed equally to this work and should be considered co-first authors.

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Department of Pediatric Clinical Medicine School, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200127, China

Pingping Li & Lu Dong

Department of Science and Education, Fujian Maternity and Child Health Hospital, Fujian, 350000, China

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L.P.P. conceptualized the idea of this study. L.P.P. and W.L. contributed to design of the project and survey preparation and dissemination. L.P.P. contributed to investigate. D.L. contributed to writing-review and agreed to be accountable for all aspects of the work. All authors reviewed the manuscript.

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Correspondence to Lu Dong .

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Ethical approval for this study was obtained from the institutional research ethics committee of Shanghai Children’s Medical Center Affiliated to Shanghai Jiao Tong University School of Medicine(NO: SCMCTRB-K2023147-1). All participants received written explanations about the study in advance and signed a written consent form to participate.

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Li, P., Weng, L. & Dong, L. Empathy ability and influencing factors among pediatric residents in China: a mixed-methods study. BMC Med Educ 24 , 955 (2024). https://doi.org/10.1186/s12909-024-05858-5

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Exploring nursing students’ experience of peer learning in clinical practice

Maryam ravanipour.

Department of Nursing, School of Nursing and Midwifery, and The Persian Gulf Tropical Medicine Research Center, Bushehr, Iran

Masoud Bahreini

1 Department of Nursing, School of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, Iran

Masoumeh Ravanipour

2 Department of Environmental Health, School of Health, Bushehr University of Medical Sciences, Bushehr, Iran

Background:

Peer learning is an educational process wherein someone of the same age or level of experience level interacts with other students interested in the same topic. There is limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of this study was to explore nursing students’ experiences of peer learning in clinical practice.

Materials and Methods:

A qualitative content analysis was conducted. Focus groups were used to find the students’ experiences about peerlearning. Twenty-eight baccalaureate nursing students at Bushehr University of Medical Sciences were selected purposively, and were arranged in four groups of seven students each. The focus group interviews were conducted using a semi-structured interview schedule. All interviews were tape-recorded, transcribed verbatim, and analyzed using conventional content analysis method.

The analysis identified four themes: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice. Gained advantages and perceived disadvantages created paradoxical dualism, and peer exploitation resulted from peer selection and peer training.

Conclusion:

Nursing students reported general satisfaction concerning peer learning due to much more in-depth learning with little stress than conventional learning methods. Peer learning is a useful method for nursing students for practicing educational leadership and learning the clinical skills before they get a job.

INTRODUCTION

With explosive increase in knowledge, new technologies, and rapid changes in pattern of diseases, there is concern that nursing students are not provided with enough opportunities to learn required clinical skills.[ 1 ] To meet this concern, finding effective strategies to improve students’ learning, especially clinical learning, always has been considered by nursing professions. Shift in teacher-centered paradigm to student-centered paradigm and replacing the traditional and passive strategies such as mentoring by active strategies such as peer learning are counterparts in the same direction.[ 2 , 3 ]

Although some benefits have been identified in mentoring students by clinical trainers, such as encouragement, advice, and feedback, the importance of balancing among clinical role, educational role, and scientific preparation has caused many difficulties in mentorship programs.[ 3 , 4 , 5 , 6 ] On the other hand, sharing knowledge with others teaching skills has been recognized for registered nurses as core competency. However, peer learning as a strategy in which a group of students involve in the learning process and training the other students is increasingly considered in other disciplines of medicine. Unfortunately, evidences indicate that in nursing education, there is less attention given to peer learning over recent years.[ 7 ]

A peer is a student of the same age, group, academic level, or experience level.[ 8 ] The Oxford Dictionary (2009) defines a “peer” as someone of the same age or someone who was attending the same university. The term “peer” can also refer to people who have equivalent skills of different experiences.[ 9 ] Peer learning is also described as a two-way reciprocal learning activity which includes sharing knowledge, ideas, and experiences in a way that has some benefits for both groups of peer and student.[ 10 ]

As a benefit of peer learning, it seems necessary to appreciate friendship in clinical learning environments among nursing students. In other words, more flexibility with students at clinical learning environments in interacting with their peers, whom they trust as friends, can facilitate earlier integration into the students’ community and, hence, enable peer learning for support.[ 5 ] In spite of these benefits, unfortunately, there is limited evidence indicating use of peer learning in clinical education in developing countries like Iran.

A review of studies has shown the use of peer learning method in nursing education. Results of most of these studies that have been designed as a quantitative approach indicate that peer learning encourages interaction, facilitates engagement with learning, and increases personal development.[ 11 , 12 ] At Monash University in Australia, McLelland et al. , investigated the benefits of an interprofessional peer-assisted learning for both midwifery and paramedic students. Results revealed that students enjoy peer learning activities and interaction. Also, both groups had a newly found respect and understanding for each other's disciplines.[ 13 ] Besides, another study confirmed the existence of peer effects in a learning process, showing a partner motivational effect even before the actual cooperation took place.[ 14 ] Students can be sensitively encouraged to share their views on participating in peer learning programs, which may well provide important insights into the benefits and challenges presented by student support initiatives as well as offer an outlook onto some important interactional processes influencing learners’ educational journeys.[ 15 ] It should be noted that there are some controversies regarding the outcomes of peer learning applicabilities. For example, Brannagan et al. , conducted a study evaluating the impact of peer learning on nursing students’ perception of learning environment, self-efficacy, and knowledge. Overall, findings differed from previous studies in that the use of peer teaching–learning did not decrease anxiety in the first year students, and, concerning self-efficacy and knowledge acquisition, no differences were found between the two groups receiving either peer tutoring (intervention group) or faculty instruction only (control group).[ 16 ]

In Iran, limited studies have been conducted on nursing students’ peer learning.[ 17 , 18 , 19 ] Hemat et al. , assessed the effect of conducting training programs for high school students on the performance of the peers with asthma.[ 18 ] Ravanipour et al. investigated the facilitators and barriers in the application of such a method in clinical settings.[ 19 ] Dehghani et al. examined the impact of peer educational program on the anxiety of multiple sclerosis (MS) patients. Results indicated that peer group educational program reduced anxiety in patients suffering from MS.[ 20 ] Regarding the mentioned controversies and due to the shortage of studies in the peer learning realm, and based on the results of some studies on the peer experiences and peer learning/teaching processes,[ 21 , 22 ] this study aimed to explore nursing students’ experiences of peer learning in clinical practice.

MATERIALS AND METHODS

To explore the nursing students’ experiences of peer learning, a study was conducted with a qualitative research design in 2010. The emphasis of the investigation on the concept of peer learning within the real life context of nursing students in clinical practice was best facilitated using a qualitative research approach, conventional content analysis. Qualitative content analysis is a research methodology and a reasonable tool to describe the quality of a phenomenon.[ 23 ]

Through purposeful and criterion-based sampling, 28 senior BSc nursing students were selected and assigned to four focus-group discussions. Under the supervision of one of the researchers, participants had passed pediatric and neonatal field practices as a peer learning method of field training (just for medication and IV therapy). To ensure that correct information would be given by the peers, on the first day of their training programs, all the students were provided with enough opportunities to practice the mentioned skills (medication and IV therapy) and learn from the lecturer's demonstration. The next day, the peer volunteers carried out some selected nursing cares under supervision, and on the third day, they acted as peer to help others.

In order to collect data, a focus group was used. In nursing researches, a focus group involves a number of people (often with common experiences or characteristics) interviewed by a researcher for the purpose of eliciting ideas, thoughts, and perceptions about a specific topic or certain issues linked to an area of interest.[ 24 , 25 ]

Focus group interviews were undertaken with each group after finishing their field training at the end of their semesterand after the students’ grades had been given.

An expert convener led the focus groups to ensure that all members could participate freely. An interview guide of semi-structured questions was used to elicit data. The research questions focused on how the nursing students’ experiences of peer learning were compared to usual learning. What aspects of peer learning made the experience either positive or negative for the nursing students? There were some other questions based on their answers. The convener introduced theoutline of processes and aims to the focus groups. Thereafter, participants were encouraged to express their opinions, and were provided with sufficient time to do so. In total, four focus group interviews were conducted, with seven participants in each. A research assistant was present throughout to help with organization, audio-recording, and to write field notes. Data on demographic characteristics, including age, sex, and marital status, were extracted and recorded.

Following the focus group discussion, the interviews were transcribed verbatim. Based on the students’ explanations and condensing the codes that emerged, saturation in the categories had been seemingly achieved.

The principles of qualitative data analysis are similar to those of other non-structured or semi-structured interviews. The analysis stages include the following: Finding meaning, condensing, abstracting, identifying content that addresses a specific topic in an interview, and identifying emerging codes, categories, and themes.[ 26 ] Audio-taped recordings of the focus group interviews were transcribed verbatim, and the transcripts were read and reread by the investigators. Notes were made on the thematic and conceptual categories emerging from the transcripts and on the reasons why the categories emerged. Transcripts were then re-examined independently, pursuing the themes and concepts, resulting in the emergence of several subthemes and themes. At each stage of the analysis process, groupings and subsequent themes of the two researchers were compared and contrasted and then independently reviewed by the other one. The researchers discussed the differences and deviations in detail till consensus was reached; all relevant data were then categorizedby consensus. Codes were used when presenting participants’ quotes. By extracting the essence of ideas and using labels, the interviewers’ coded paragraphs and sentences were put into the margin of the transcript. By reducing thesecodes into larger categories, themes were formed.

To increase the trustworthiness and rigor, the researchers devoted time to collect the information and data. We used effective communication principles with the participants in this study, returned the coded information to them, and checked the accuracy of the interviews by using all our colleagues’ supplementary opinions to ensure that the interview responses were well understood. We also checked the research findings as peer reviews to increase the credibility and confirmability of the research.[ 24 ]

The Research Ethics Committee of Bushehr University of Medical Sciences approved this study for the participants’ protection. The students were both talked and written to concerning their information about the study. We ensured them about the confidentiality and anonymity that was maintained by using codes. They were informed about their rights to withdraw from the study at any time with no consequences.

The participants had a mean (SD) age of 22 (1.47) years; majority of the participants were females (91.4%) and single. Out of the focus group analysis, four major themes were obtained: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice[ Table 1 ].

Nursing students’ experiences in peer learning

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Paradoxical dualism

A dual sense of peer learning experience referred to the acquired advantages and perceived disadvantages applied to the nursing students. Thus, peer learning caused an increase in self-confidence, accuracy, and skill in the students’ performance and a decrease in stress and practical mistakes. While dependency on others in performing the activities reduces the opportunity to display individual capabilities, from the students’ viewpoints, restricted learning ways or making mistakes were the disadvantages of this method. It also seemed these two dual senses rooted from two dimensions: The educational environment and the amount of workload.

Acquired advantages

From the students’ viewpoint, the advantages of peer learning were better learning with no stress and reduced anxiety in making mistakes. They were largely due to mentors judging the students’ practical and scientific disabilities. One of the students said, “When the peer was our classmate, our stress got less; it was easier to talk about our problems to him/her than to the teacher. The teacher could criticize us why we hadn’t learned such cases yet. Naturally answering our friends was much easier.” The student's comment on accuracy of the work and self-confidence had two aspects: Increasing the accuracy of the work and reducing the mistakes. It consequently increased the confidence due to the work done. But if the students did such things alone, they could increase their accuracy in order to avoid mistakes. Besides, the confidence would increase due to the work done independently.

Perceived disadvantages

The students explained that if peer learning was the only teaching method at clinical settings, there would not be any chance for them to show their capabilities. They added they could get more dependent on the peers if they did not find any opportunity to do the cares independently. Moreover, if the peer is not exposed to independent learning, he/she may acquire the ideas in wrong or limited ways, thus not being able to solve the problems. Another student said, “Although peer can be useful for better group working, this method brings about dependency, especially if one student is weak and the other peer does the duty for him/her; this is not suitable for their future, for they need to do it independently.” According to the students, these two dual senses rooted from two dimensions: The educational environment and the amount of workload in the educational environment. Despite passing various hospital wards, it was their first time being a pediatric and infant trainee. From their point of view, due to the high sensitivity of nursing care, this type of work required very high precision. The feeling of not having an opportunity to compensate for the mistakes and being very novice for some cares caused high stresses; thus, they automatically referred to their peer groups for consultation and collaboration to get more support and precision in their cares. Due to the stress and high sensitivity, if any of their peers was weak in performing the duties, they tended not to become his/her peer. One of the students said, “We are dealing with infants and children; therefore, we have to be careful about the quantity of their body liquid and calculating the volume of serum and the number of drops, because unlike the adult's wards, we don’t have any opportunity to compensate the mistake. Andthat's the very reason of our high stress. And if I know that the person who is going to be my peer has done too many mistakes, I try not to be his/her peer anymore.” They stressed that for better learning, staff nurses should be in a protective role instead of being as a source of stress for students.

The amount of workload, in the students’ viewpoint, was another factor affecting the gained advantages or perceived disadvantages. Another student said, “if the workload gets less, we can act and work more accurately and give more tips to one another.”

Peer exploitation

The students maintained that by selecting appropriate peers (based on their scientific capabilities and some individual characteristics which improve the learning process) and training the peers to do their roles correctly, teachers could exploit the best results from peer teaching and learning.

Peer selection

Scientific and individual features were the important factors in students who played the role of peers. Based on the experiences they had with their peers, students mentioned lots of factors that were important in the process of learning. Having enough experience, information, and patience in education helped them correct mistakes, create learning opportunities, and being responsible in true teaching. Among the scientific characteristics of the peers were having a role in monitoring performance and leadership mentoring to teach others. Having speech ability, transferring contents, and showing self-confidence were the individual characteristics of a peer.

One of the students said, “Speech ability is so important because someone may know the subject but can’t express what s/he knows. I had this experience myself with two peers who had different speech abilities.” Another one said, “The peer's role should be more supervisory than duty performance. One of the problems of my peer was that instead of giving me a chance to do the work, he tried to do all the activities by himself.”

Peer training

This subtheme pointed out to the importance of a lecturer's role in the field. This role, according to the students, has many different aspects. These aspects include teaching the features and characteristics of a peer to students, the supervisory role of the individual mentor in the learning process, teaching how to correct the peers’ mistakes, adopting active and capable peers in the first days of training, using reinforcement tools, proper warnings, and distinguishing the students with false high confidence and students with ingratiation and flattering manner. One of the students said, “In my opinion, the teacher must supervise the students’ activities to see whether the information they have conveyed is really correct or not.”

First learning efficacy

According to the participating students in this research, the value and importance of peer learning is regarding to provide a less stressful and more respectful learning environment. Because of the importance of independence in giving cares to the patients, most of the students advocated the early application of this teaching method in learning, after which the process of learning could be handled each student individually. Thus, they consider this learning method to be more effective during the early days of learning. Because of the students’ high collusion in giving high scores to each other, their inability to have a comprehensive approach, and their consideration of different aspects of the evaluation, they assumed that peer assessment roles were inefficient. They added that in the case of necessary assessment, it would be better that the peers give only a small percentage of the total evaluation score. The trainer bases both processes of education and training for the peers on predefined educational objectives.

One of the students said: “The teachers should assess the students individually. However, it would be better if the teachers make a comparative assessment of the students’ work with that of their peers; this is due to the fact that some students’ group work is better than their individual performance.”

Socialization practice

Most of the students mentioned this as teamwork learning which helped them identify their own and their peers’ characteristics much better. Moreover, there were some points showing the socialization process of students, i.e. students’ awareness of their negative characteristics and the ways to control or overcome them while working with others, respectful training, and preserving the peers’ characteristics, condemning jealousy or humiliating peer groups’ mistakes. One of the students said, “I believe we should train our peer students in a completely sympathetic friendly way to learn something, not teasing the peers for training them. Because if they were to know everything, why would they need to have peers?”

Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice have emerged from students’ experiences as concepts of peer learning. According to the participants, dual role of the environment, type of the work and peers in creating stress, or quite the opposite, maintaining a secure environment for students, brought about a kind of stress for them.

There are so many sources of stress in the hospital or social health environments, such as too much workload, insufficient staff to support practitioners, inadequate communication, secrecy, lack of trust, and so on.[ 27 ] The findings of a study reveal that peer practice learning undertaken in a safe controlled environment enhances the realism of the experience, and therefore, will increase the likelihood of students engaging in the learning process.[ 28 ]

The students of this study had pointed out some of the advantages of peers. One of the most positive outcomes due to the effectiveness of peer teaching and learning, according to some studies, was the students’ increasing confidence in clinical practice and improved learning in the psychomotor and cognitive domains.[ 29 , 30 ] Feedback from participants in near-peer teaching suggests that the program fulfills its aims of providing an effective environment for developing deeper learning.[ 8 ] The students who participated in peer learning clinical teaching strategy claimed it to be mutually supportive, cooperative, and collaborative, and also to have grown in both the diligence and precision with which they approached their own practice and in the personal confidence with which they made clinical and practice decisions.[ 31 ]

The students who participated in our study were completely relying on learning from their peers and had taken this seriously as they expected an educational role from their peers like from their own teachers.

One of the important points about role-playing is that students, after some self-consciousness about the role, quickly settle down to project their own character and values into the role.[ 27 ] It is the role play element of peer practice learning that also appears to provide some of the wider benefits highlighted in the study, such as increased empathy, improved communication skills, and enhanced decision-making ability.[ 28 ] The findings of another study reveal that the third year nursing students who play the role of peers for the first year students commented that the peer learning experience gave them an opportunity “to review their skills,” allowing them to “evaluate their knowledge base,” whereas the first year students focused on the personal attributes of the third year students, rather than their teaching ability, with comments such as “my third year student was a friendly partner who was very patient with me.”[ 29 ] In some cases, it is thought that there are links between confidence and learning, as students who are confident are allowed more access to patients.[ 5 ]

From the students’ point of view, this educational process had some disadvantages also such as lack of any chance for them to show their capabilities, acquiring the ideas in wrong or limited ways from peers, dependence on peers, and so on.

There can be some disadvantages in the form of competition, along with feelings of being misunderstood leading to hurt and making unhelpful comparisons with others in peer-assisted ways.[ 15 ] There are also many serious barriers to mentors that include difficulty of role modeling care work in the context of nursing roles which are increasingly concerned with more technical work.[ 4 ]

For peer exploitation, teachers could exploit the best results from peer teaching and learning. Despite expecting a mentor-like role from the peers, it did not diminish the role of the teachers. Moreover, it increases its importance and students expect their teachers to provide the background process of education of the peers. The students in our study pointed out to the need of clinical teacher for supervising the process of teaching by peers.

A systematic review of peer teaching and learning in clinical education suggested that the students evaluated their own learning and reported increased confidence in leadership roles when working with a peer.[ 30 ] It has also been emphasized that students adopting the peer mentor role get some benefits like leadership and teaching skills from peer teaching and learning experience.[ 31 ] Effective management of clinical skills learning and teaching in simulated environments is therefore crucial. Peer practice learning should only occur with a small number of students for one facilitator to enable the facilitators give the evident support required.[ 28 ] As a limitation and negative aspect, personality and learning style of students should be appropriate to peer learning. Also there is a risk that students spend less time with their instructor.[ 30 ]

Most of the students regarded this method to be effective in learning and spoke with resistance against the evaluation process done by peer assessment.

Peer assessment is useful for assessing practical skills; but one of the problems with any kind of peer assessment is the potential for collusion among the students to raise the level of marks. One of the solutions to this problem is to use peer assessments as feedback rather than as final grading, to ensure honesty of the feedback.[ 27 ] Findings of a focus group discussion on nursing students’ experiences of formative assessments indicate that nursing students are not being prepared for the critical feedback associated with peer review and they may, therefore, be vulnerable to the process and outcome of peer review.[ 32 ]

In fact, the students had gained a kind of respect to the values and received new social roles.

The process by which an individual undergoes induction into these expected behaviors or roles is termed socialization. Secondary socialization begins as the child commences school, influenced not only by teachers but also by peers; occupational socialization involves induction into specific occupational roles after leaving school.[ 27 ] In a study about exploration of reflective groups, it was revealed that being able to reflect on real life experiences helped the students to recognize that others had similar experiences to their own and these “interconnected experiences” made them realize that they were not on their own.[ 33 ] Students involved in the peer mentorship programs might offer important illustrations of the critical aspects of pastoral and social support.[ 15 ] Another group of students explained their friendship and peer learning in clinical practice as valuable sources of information, which was the result of asking questions about the culture and convergence of each other, particularly when they found themselves alone or when their mentors were busy elsewhere.[ 5 ]

Finally, it seems students in our study were interested to change their clinical groups based on their changed friendship and the effects of group atmosphere and team work during their educational carrier. Similarly, in many nursing programs, it has resulted in changed membership of the learning communities in every semester, allowing students to work with different peers during each clinical rotation.[ 34 ]

CONCLUSIONS

This study sought to explore the common reasonable perceptions of peer learning typically designed to support better learning in clinical settings. There is some evidence that students’ learning is facilitated if peer learning in clinical settings can be followed, as it may improve in-depth learning with less stress, role satisfaction, and create a positive environment in which students can learn appropriate practices. Besides, the findings depict a general satisfaction among the participating students from peer learning in both direct learning outputs and indirect (hidden) learning outputs.

While role transition to advance practice is a key priority for the development of effective health care programs around the world, our findings support the nursing students’ role transition to educational leadership and teaching others, along with socialization.

Based on our findings, it seems this method of learning can be utilized in learning practical and laboratory techniques in fields such as biochemistry and microbiology, or in the operating room for students of different disciplines such as medical, nursing, environmental health, biology, etc. It suggests the teachers to determine the level and amount of support of peers required in clinical settings by the students, based on their year of education and level of excellence in practice, and then assess its outputs on the students’ level of learning. It seems this will help to facilitate a student-centered method of learning in clinical settings, especially for disabled students or with students with a learning difference.

ACKNOWLEDGMENT

We thank the students who participated in this study for sharing their life experiences with us and the Bushehr University of Medical Sciences for supporting the research financially.

Source of Support: Research Deputy at Bushehr University of Medical Sciences

Conflict of Interest: The author(s) declared no potential conflicts of interest with respect to the authorship and/or publication of this article

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Transforming High School Education with Digital Tools: A Systematic Review

This systematic review comprehensively examines the impact of digital tools on high school education, drawing from 23 peer-reviewed studies published between 2018 and 2023. The study explores a wide range of research methodologies, including randomized controlled trials, quasi-experimental designs, and experimental studies, to assess the effectiveness of digital technologies in enhancing education outcomes. The findings indicate that digital tools, particularly those integrated using the substitution augmentation modification and redefinition model, significantly improve student autonomy, engagement, and academic performance across diverse geographic and demographic contexts. However, the review also identifies challenges, such as the complexity of content, technological disparities, and the necessity for well-planned and context-sensitive implementation strategies. Furthermore, it highlights the importance of professional development for educators and the need for infrastructural support to ensure equitable access to technology. The study underscores the critical role of collaboration among educators, policymakers, and stakeholders to maximize the benefits of digital education. The review calls for ongoing research into innovative educational technologies and their long-term effects, and advocates for a strategic and well-supported approach to integrating these tools into high school settings.

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A systematic review of peer teaching and learning in clinical education
Preclinical education of students congruent with the academic timetable increases student educational outcomes from peer teaching and learning. Strategies are required prior to clinical placement to accommodate incompatible students or poor student learning. Relevance to clinical practice: The findings from this systematic review, although not ...
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A systematic review of peer teaching and learning in clinical education. Aims and objectives. The purpose of this review is to provide a framework for peer. teaching and learning in the clinical ...
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PDF A Systematic Review of Peer Learning in Clinical Education
Peer teaching and learning is an effective educational intervention for health science students on clinical placements. Preclinical education of students congruent with the academic timetable ...
A systematic review of peer teaching and learning in clinical education
Peer teaching and learning is an effective educational intervention for health science students on clinical placements. Preclinical education of students congruent with the academic timetable increases student educational outcomes from peer teaching and learning. Strategies are required prior to clinical placement to accommodate incompatible ...
Commentary on Secomb J (2008) A systematic review of peer teaching and
The search terms used to conduct the review (peer, clinical education and undergraduate) are narrow in emphasis and reinforce the notion that peer learning and teaching lacks definition. As a result the studies unearthed for review may lead the reader into thinking that peer learning is intentional and formalised, whereas in reality, there may ...
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A systematic review of evidence-based practices for clinical education
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Background: The reform in health professions education requires the focus to shift from fact memorization to exploring, analyzing, assimilating, and synthesizing information to promote active and collaborative learning. Peer teaching is one of the educational strategies. Aims: This review aimed to explore and synthesize quantitative evidence to determine the overall effect of peer teaching in ...
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and learning in clinical education. Journal of Clinical Nursing 17, 703-716 Deborah Roberts Peer teaching and learning are becoming increasingly impor-tant within nurse education, this is evidenced by the global nature of studies: hence this timely review of the literature. Secomb (2007) is correct in her assertion that peer teaching and ...
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Given this is the case, it is surprising how few large scale and comparative research studies have been conducted regarding practice placement models and peer learning. Although this systematic review was time limited (2010-2020) only 2892 students and 570 educators were involved in providing evidence in these results for certain.
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A systematic review of peer teaching and learning in clinical education.

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Empathy ability and influencing factors among pediatric residents in China: a mixed-methods study

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BMC Medical Education

Exploring nursing students’ experience of peer learning in clinical practice

Masoud Bahreini

Masoumeh Ravanipour

Background:

Materials and Methods:

Conclusion:

INTRODUCTION

MATERIALS AND METHODS

Paradoxical dualism

Acquired advantages

Perceived disadvantages

Peer exploitation

Peer selection

Peer training

First learning efficacy

Socialization practice

CONCLUSIONS

ACKNOWLEDGMENT

International Journal of Learning, Teaching and Educational Research

Transforming High School Education with Digital Tools: A Systematic Review

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