Medical Students' Use of Peer Assisted Learning on Clinical Placements


  • Joanna Tai
  • Elizabeth Molloy
  • Terry Haines
  • Ben Canny


Student as teacher


HeatlhPEER (Health Professions Education and Educational Research)
Monash University


Peer Assisted Learning (PAL) may be useful in building graduates’ life-long ‘non-technical skills’, such as communication, teamwork, time-management and self-direction (1).PAL also confers benefits in its potential time efficiency for both staff and students as compared to traditional placement structures (2). Studies of PAL in clinical placements have largely focussed on assessment (3,4). Little is known about formal (structured) or informal PAL in medical students’ clinical placements.

Summary of Work

Monash University runs a hybrid PBL-lecture, five-year undergraduate and four year graduate entry medical program in Australia. PAL activities are incorporated into the pre-clinical years; there are fewer formal PAL structures on clinical placements.  In 2012, students in their first clinical year were asked to complete an online survey, which collected information on their PAL usage, and perceptions of PAL utility, advantages and disadvantages.

Summary of Results

54 students responded from metropolitan, rural and international (Malaysia) sites.  The most useful activity for students’ learning needs was being taught by a peer, and the least useful was giving feedback to a peer (Table 1). The most frequent activity reported was discussing a case with a peer; the least was having a skill demonstrated.



Table 1. PAL activities, ranked in order from most useful to least useful
How useful was this activity for your learning needs? * Male % Female % Total % Average weekly
I was taught by a peer about a topic 89 86 87 2.96
I taught a peer about a topic 83 85 86 2.24
I was observed by a peer performing a history/examination 71 93 85 2.43
I received feedback from a peer on my performance/knowledge 69 88 81 1.83
I discussed a case wtih a peer 82 74 77 3.65
A peer discussed a case with me 75 74 74 3.37
A peer demonstrated a skill to me 64 77 72 1.11
I observed a peer performing a history/examination 53 80 70 3.31
I demonstrated a skill to a peer 57 76 69 1.26
I gave feedback to a peer on their performance/knowledge 53 59 57 2.15
TOTAL 70 79 87 24.31



*Responses were measured on a scale of 1 = not at all useful to 5 = extremely useful, with no intermediary descriptors used for points 2, 3 and 4. In the above table, responses greater than 3 were pooled.


Figure 1. Reasons for participation in PAL activities

Figure 1. Reasons for participation in PAL activities

PAL was largely self-initiated as opposed to educator prompted or peer prompted (Figure 1). A proportion was undertaken in informal settings such as the student common room, outside the hospital, in the cafeteria and on the wards (Figure 2).

Figure 2. Locations of PAL activities

Figure 2. Locations of PAL activities

There was high agreement that PAL allowed students to measure their progress against peers (78%), improved teaching skills (74%) and increased understanding (72%). Forty-one percent of students felt uncomfortable giving their peers feedback, and 41% reported that they did not trust their own judgement on their peers’ knowledge or performance.

Figure 3. Percentage of students who agreed or strongly agreed with PAL statemetns

Figure 3. Percentage of students who agreed or strongly agreed with PAL statements


PAL may contribute not only to content learning, but also the development of non-technical skills such as self-directed learning and teamwork. This study demonstrated that a proportion of PAL on clinical placements occurs in informal, non-structured settings. Exposure to formalised, facilitated PAL in pre-clinical years may orientate learners to PAL’s purpose and benefits.  Further investigation of how PAL is enacted in the clinical environment is required. 

Take-home Messages
  • Students voluntarily use PAL on clinical placements: this occurs mainly in informal settings
  • Students report feeling challenged by making judgements about the quality of a peer's performance and communicating this in the form of verbal feedback
  • PAL benefits could be enhanced through:
    • orienting learners to PAL methods and outcomes
    • providing learners and educators with frameworks for supporting PAL

  1. Lincoln MA, McAllister L. Peer learning in clinical education. Medical Teacher. 1993;15(I):17–25.
  2. Ladyshewsky RK. Enhancing service productivity in acute care inpatient settings using a collaborative clinical education model. Physical therapy. 1995 Jun;75(6):503–10.
  3. Levine R, Kelly P, Karakoc T. Peer evaluation in a clinical clerkship: Students’ attitudes, experiences, and correlations with traditional assessments. Academic Psychiatry. 2007;31(1):19–24.
  4. Kovach R a, Resch DS, Verhulst SJ. Peer assessment of professionalism: a five-year experience in medical clerkship. Journal of general internal medicine. 2009 Jun;24(6):742–6.
Summary of Work
Summary of Results
Take-home Messages
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