피어티칭이 교수의 수업에 비하면 어떠한가? 체계적 고찰과 메타분석 (Med Teach, 2016)

피어티칭이 교수의 수업에 비하면 어떠한가? 체계적 고찰과 메타분석 (Med Teach, 2016)

How does peer teaching compare to faculty teaching? A systematic review and meta-analysis*

ELIOT L. REES, PATRICK J. QUINN, BENJAMIN DAVIES & VICTORIA FOTHERINGHAM

Keele University, UK

도입

Introduction

학부 의학 교육에서 학생들의 학습을 촉진하는 데 사용되는 방법은 매우 중요합니다. 피어티칭은 그 방법중 하나로, 피어 - 보조 학습 또는 near peer 교육이라고도 불리며, 최근 수십 년 동안 교육에 잘 포함되었습니다 (Ten Cate & Durning 2007b). "한 학생이 한 명 이상의 동료 학생들을 가르치는 교육 협약 (Ten Cate & Durning 2007a)"으로 정의 된 동료 교육은 교사 (Nestell & Kidd 2005)와 학생 (Graham)이 배운 새로운 지식과 기술에 대한 기회를 제공합니다 et al., 2008).

The methods used to facilitate students’ learning in undergraduate medical education are of great importance. One such method, peer teaching, also referred to as peer-assisted learning or near-peer teaching, has become well embedded in education in recent decades (Ten Cate & Durning 2007b). Defined as ‘an educational arrangement in which one student teaches one or more fellow students’ (Ten Cate & Durning 2007a), peer teaching offers opportunities for new knowledge and skills to be learned by both tutor (Nestell & Kidd 2005) and student (Graham et al. 2008).

피어티칭의 핵심 교습은 인지적, 사회적 합치이다 (Lockspeiser et al., 2008). 

• 인지적 합치는 지성과 사고 처리에서 튜터와 학생의 유사성입니다. 피어티칭에서 학습자와 교사는 모두 교육적으로 유사한 수준에 있으며, 교수 주도의 교육에 비해 인지적 합치가 더 커집니다. 이를 통해 동료 교사는 학습자가 더 잘 이해할 수있는 방식으로 복잡하고 어려운 주제를 더 잘 설명할 수 있습니다 (Lockspeiser 외. 2008). 이는 피어튜터 학생들도 최근에 동일한 자료를 학습했기 때문이며, 초보자가 보다 수용적인 방식으로 개념을 표현할 수 있다.

• Key to peer teaching is the elements of cognitive and social congruence (Lockspeiser et al. 2008). Cognitive congruence is the similarity of tutor and student in intellect and thought-processing. Within peer teaching, both learners and teachers are of a similar level educationally leading to greater cognitive congruence compared to faculty-led teaching. This allows peer teachers to express often complex and intimidating topics in ways, which learners are better able to understand (Lockspeiser et al. 2008). This is also assisted by the fact that peer teachers will themselves have recently covered the same material and may be able to express the concepts in a manner to which novices are more receptive.

• 동등하게, 동료 학습자와 동료 교사는 동일하거나 유사한 사회적 지위를 가질 것으로 예상됩니다. 이 사회적 합치의 결과로, 동료 교사들은 사회 및 학업 생활에 대한 높은 이해를 바탕으로, 학습자의 필요와 우려에 대해 더 많이 이해하는 것처럼 보입니다 (Schmidt & Moust 1995).

• Equally, peer learners and peer teachers are expected to be of the same or a similar social standing. As a result of this social congruence, peer teachers seem to express more of an understanding of their learner’s needs and concerns, by way of an increased understanding of their social and academic lives (Schmidt & Moust 1995).

문헌에 의하면 의대생은 피어티칭를 받아들이는 경향이 있다고합니다. 연구에 따르면 피어 학습자는 

• 더 나은 학습 환경과 분위기 (Kassab 외 2005), 

• 시험 관련 스트레스 해소 (Kommalage & Thabrew 2011) 

• 동료들이 커리큘럼 교육에 도움이 되는 보조 도구가 됨 (Naeger et al., 2013). 

피어 교육이 널리 받아 들여지면 교과 과정 내에서 귀중한 자산이됩니다.

The literature suggests that medical students tend to be receptive to peer teaching. Studies have found that peer learners report: 

• a better learning environment and atmosphere (Kassab et al. 2005), 

• relief of exam-related stress (Kommalage & Thabrew 2011) and 

• find their colleagues to be a helpful adjunct to the curriculum teaching (Naeger et al. 2013). 

The widespread acceptability of peer teaching makes it a virtuous asset within a curriculum.

피어티칭의 또 다른 역할은 '미래의 의사들'에게 조기에 자신의 교수법을 연습 할 수있는 기회를 제공하는 것입니다. 가르침은 임상의의 일에서 필수적인 부분으로서, 의사는 환자와 동료 모두에게 지식을 효과적으로 전달할 수 있어야 한다. 실제로 영국의 종합 의료 협의회 (General Medical Council) 'Good Medical Practice'가이드는 교육 분야에서의 역량의 중요성을 강조합니다 (General Medical Council 2013).

Another role of peer teaching is to offer ‘tomorrow’s doctors’ the opportunity to practice their teaching skills at an early stage in their careers. As teaching is an integral part of a clinician’s job, it is vital that they are effective at imparting knowledge upon both patients and colleagues. Indeed, in the UK the General Medical Council’s guide to ‘Good Medical Practice’ stresses the importance of competence in the art of teaching (General Medical Council 2013).

Methods

질문

Review question

How are the knowledge and skills outcomes of undergraduate medical students taught by peers different to those taught by faculty?

검색 전략

Search strategy

Selection criteria

The criteria for inclusion in this systematic review were as follows:

• 집단   Population: Undergraduate medical students.

• 개입   Intervention: Peer teaching.

• 비교   Comparison: Faculty teaching.

• 성과   Outcomes: Knowledge or skills outcomes measured through objective assessment.

• 연구 설계   Study design: Comparative.

스크리닝

Screening and selection of studies

파일럿 연구

Pilot study

자료 추출

Data extraction

연구 퀄리티 평가

Assessment of methodological quality

The methodological quality of included studies was rated using the Medical Education Research Study Quality Instrument (MERSQI) (Reed et al. 2007). The MERSQI is a validated tool consisting of 10 items in six domains: 

• study design, 

• sampling, 

• type of data, 

• validity of evaluation instrument, 

• data analysis and 

• outcomes.

편향 평가

Assessment of risk of bias

Risk of bias of included studies was determined using the Cochrane collaboration risk of bias assessment tool (Higgins & Green 2011). A judgement of ‘low risk of bias’, ‘unclear risk of bias’ or ‘high risk of bias’ has been given for each source of bias for each study accompanied by supporting statements. The sources of bias considered were 

• 무작위 순서 생성 random sequence generation (selection bias), 

• 할당 은폐 allocation concealment (selection bias), 

• 참가자와 연구자 블라인딩 blinding of participant and personnel (performance bias), 

• 성과 평가의 블라인딩 blinding of outcome assessment (detection bias) and 

• 불완전한 성과자료 incomplete outcome data (attrition bias).

자료 통합

Data synthesis

결과

Results

검색 결과

Search results

Figure 1 illustrates the flowchart of included papers.

방법론적 퀄리티

Methodological quality

The mean (SD, range) MERSQI score for included studies was 13.25 (0.65, 12.5–15.5) of 18 (Table 1).

편향 위험

Risk of bias

The risk of bias and justification for individual studies is detailed in Table 2, the overall risk of bias for included studies is illustrated in Figure 2.

연구 결과 요약

Summary of included papers

Methods, population, intervention and comparator, outcomes, and findings for each included study are detailed in Table 3.

지식

Knowledge

Only one study reported a significant difference between peer-taught and faculty-taught students’ knowledge; favouring peer-teaching. The pooled effect favours peer-teaching, but does not reach significance [standardised mean difference(SMD) = 0.07, p = 0.32] (Figure 3). 

스킬

Skills

For skills outcomes, again only one study reported significantly different outcomes between peer-taught and faculty-taught students (again in favour of peer-teaching). The pooled effect favoured peer teaching but again failed to reach significance(SMD = 0.11, p = 0.24) (Figure 4).

고찰

Discussion

포함 된 논문에 학생들의 결과에 차이가 없다고해서 모든 학생들이 학부 의학 커리큘럼의 주제를 가르치는 데 교수만큼 효과적 일 수 있다고 제안하지는 않습니다. 포함 된 연구 중 8 가지 (80 %)는 신체 검사 또는 의사 소통 기술에 대한 교육을 조사한 반면, 2 가지 연구 만이 기초 또는 임상 과학을 연구했습니다. 학생들이 의사 소통, 임상 및 절차 기술을 가르칠 때에는 효과가 비슷할지 모르지만 기본 또는 임상 과학 교육에 더 많은 전문 지식이 필요할 수도 있습니다.

That there is no difference in students’ outcomes in the included papers does not suggest that all students would be as effective as staff at teaching any topic in the undergraduate medical curriculum. Eight (80%) of the included studies investigated teaching of physical examination or communication skills, while only two studies researched basic or clinical sciences. It may be that students are equally effective at teaching communication, clinical and procedural skills, but that basic or clinical sciences teaching might require even greater expertise. 

그럼에도 불구하고,이 메타 분석은 학생 동료들이 교수로서 이러한 특정 주제를 가르치는 데 효과적임을 보여줍니다. 피어티칭의 수용 가능성(Kassab 외 2005), 피어티칭(Nassell & Kidd 2005)의 교육적 이득, 학부 학생에게 교육 역량 개발의 필요성(General Medical Council 2009, 2013)등을 고려할 때, 우리는 학생들이 동료들에게 가르침을 전하는 것이 적절하다고 제안합니다.

Nevertheless, this meta-analysis demonstrates that student peers are as effective at teaching these certain topics as faculty. Considering the reported acceptability to the peers they teach (Kassab et al. 2005), the educational benefit to the peer tutors (Nestell & Kidd 2005), and the necessity for undergraduate students to develop competency in teaching (General Medical Council 2009, 2013), we suggest that it is appropriate for students to deliver teaching to their peers.

피어티칭이 의과 대학 내에서 어떻게 구현되고 모니터되는지는 주어진 학교 내에서 피어 교육의 목표에 달려 있습니다. 예를 들면 피어티칭이 교수 및 자원에 대한 부담을 줄이기 위해서인지, 온전히 피어튜터의 교육 역량 개발만을 위한 것인지 등이다. Nestel과 Kidd는 자원 부족으로 의사 소통 기술 교사의 교원을 대체 할 동료 교사를 사용한다고보고합니다 (Nestel & Kidd 2003). 이 peer teacher들은 교사 연수 워크샵에 참석하고, 교육 세션에 대한 보수를 받았습니다.

how peer teaching is implemented and monitored within medical schools will depend on the aim of peer teaching within a given school, whether to alleviate pressure on faculty and resources, or purely for the educational development of the peer tutors. Nestel and Kidd report using peer teachers to replace faculty in communication skills training due to a shortage in resources (Nestel & Kidd 2003). These peer teachers attended a teachertraining workshop and received remuneration for the sessions they delivered.

다른 학교에서는, 학생들이 교수 교습의 보조 도구adjunct로서 교과외 교육을 제공합니다 (Naeger 외, 2013). 교수의 수업에 더하여 피어티칭을 활용하는 것은 교수 수업만 있는 것보다 낫고, 동료 교사에게도 교육적 혜택을 줄 것입니다.

In other schools, students deliver extracurricular teaching as an adjunct to faculty teaching (Naeger et al. 2013). Peer teaching in addition to faculty teaching is likely to be better than faculty teaching alone, and will still offer the educational benefit to the peer teachers.

피어 교육이 학교 커리큘럼의 일부이든 supplementary하든 관계없이, 피어 교사는 이론 및 방법을 가르치는 데 필요한 몇 가지 형식의 교육을 받아야합니다.

Regardless of whether peer-teaching form part of a school’s curriculum or is supplementary, it seems sensible that peer tutors should receive some forms of instruction on teaching theory and methods.

최근의 문헌리뷰에서 학생의 교수법 개발을 위한 3대 선도 사업으로 [피어티칭 프로그램, 교육 워크샵, 지역 사회 봉사 활동 프로그램]이 확인되었다 (Marton 외 2015).

A recent review identified peerteaching programmes, teaching workshops and community outreach programmes as the three leading initiatives for developing students’ teaching skills (Marton et al. 2015).

각 연구에서 학생들은 자발적으로 참여했다. 교육에 관심이있는 학생에게 참여할 수있는 기회가 주어지는 것이 적절하지만, 모든 학생에게 teaching 역할을 기대해야하는지, 아니면 학생의 선택으로 남아 있어야하는지에 대한 질문이 제기됩니다. 일부 교육 기관에서는 이전 학업 성과 (Sobral 2002) 또는 개인 인터뷰 (Weyrich 외 2008)에 근거하여 피어튜터가 될 학생을 선발합니다.

Within each of the studies included students volunteered to teach. While it is appropriate that those with an interest in teaching have an opportunity to engage, it raises the question of whether all students should be expected to teach or if it should remain optional. Some institutions select students to be peer tutors on the basis of previous academic performance (Sobral 2002) or performance in a personal interview (Weyrich et al. 2008).

강점과 한계

Strengths and limitations

발표된 문헌이 적음

As a review this study is limited by the availability of published literature.

미래 연구 영역

Areas for future research

피어티칭에 가장 적합한 학부 의료 커리큘럼 내의 주제는 무엇인가?

An area of interest for future study would be the topics within undergraduate medical curricula that are most appropriate for peer teaching.

그러나 교사에 대한 또래 교육의 이점이 입증 되었기 때문에 (Nestell & Kidd 2005), 성과가 저조한 학생들이이 과정에 참여하도록 장려하는 것이 효과적인 교육 전략 일 수 있습니다.

However, as advantages of peer teaching to the tutor have been demonstrated (Nestell & Kidd 2005), it is possible that it may be an effective educational strategy to encourage less well-performing students to engage with this process.

향후 토론을위한 마지막 주제는 퀄리티 보증입니다. 이 연구에 포함 된 여러 연구에서 교수진은 학습 계획 및 리소스를 검토하여 정확성을 보장 할 수 있었습니다. peer-taught session에서 고위 관리자 (super supervision)의 소개와 함께 한 단계 더 나아가는 것이 중요 할 수 있습니다. 이는 불안한 튜터에게 어려운 질문에 대한 안전망을 제공 할 수 있으며, 교육 기관이 적절한 교수법을 보장 해줄 수 있습니다. 그러나 이것(기관의 공식적 개입)은 피어 교수의 비공식성에서 오는 교육환경 측면의 특성을 disrupt함으로써 disadvantage가 될 수도 있다.

A final topic for future debate is that of quality assurance. Within many of the studies included in this article, faculty were able to review learning plans and resources in order to ensure their accuracy. It may be valuable to take this a step further, with the introduction of senior supervision in peer-taught sessions. This may provide an anxious tutor with a safety net for difficult questions, and allows the associated institution to ensure appropriate teaching practice. However, this risks disrupting the educational environment generated by the informal nature of peer teaching, and may therefore be disadvantageous.

Marton GE, McCullough B, Ramnanan CJ. 2015. A review of teaching skills development programmes for medical students. Med Educ 49: 149–160.

Ten Cate O, Durning S. 2007b. Peer teaching in medical education: Twelve reasons to move from theory to practice. Med Teach 29: 591–599.

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Med Teach. 2016 Aug;38(8):829-37. doi: 10.3109/0142159X.2015.1112888. Epub 2015 Nov 27.

How does peer teaching compare to faculty teaching? A systematic review and meta-analysis (.).

Rees EL1, Quinn PJ1, Davies B1, Fotheringham V1.

Author information

1

a Keele University , UK.

Abstract

PURPOSE:

In undergraduate medical education, peer-teaching has become an established and common method to enhance student learning. Evidence suggests that peer-teaching provides learning benefits for both learners and tutors. We aimed to describe the outcomes for medical students taught by peers through systematic review and meta-analysis of existing literature.

METHODS:

Seven databases were searched through 21 terms and their Boolean combinations. Studies reporting knowledge or skills outcomes of students taught by peers compared to those taught by faculty or qualified clinicians were included. Extracted data on students' knowledge and skills outcomes were synthesised through a random effects model meta-analysis.

RESULTS:

The search yielded 2292 studies. Five hundred and fifty-three duplicates and 1611 irrelevant articles were removed during title-screening. The abstracts of 128 papers were screened against the inclusion and exclusion criteria. Ten studies have been included in the review. Meta-analyses showed no significant difference in peer-teaching compared to faculty teaching for knowledge or skills outcomes, standardised mean differences were 0.07 (95% CI: -0.07, 0.21) and 0.11 (95% CI: -0.07, 1.29), respectively.

CONCLUSION:

Students taught by peers do not have significantly different outcomes to those taught by faculty. As the process of teachinghelps to develop both tutor knowledge and teaching skills, peer-teaching should be supported.

PMID:

 

26613398

 

DOI:

 

10.3109/0142159X.2015.1112888

[Indexed for MEDLINE]