의학교육에서 동료교수법(Peer teaching)을 사용해야 할 열두가지 이유

Peer teaching in medical education: twelve reasons to move from theory to practice

OLLE TEN CATE1 & STEVEN DURNING2

1Center for Research and Development of Education at UMC Utrecht, the Netherlands, 2Uniformed Services University of the Health Sciences, USA

Abstract

목적 : 얼마나 Peer teaching(동료교수, PT)이 자주 이용되는지, 그리고 그 이유

Objective: To provide an estimation of how often peer teaching is applied in medical education, based on reports in the literature and to summarize reasons that support the use of this form of teaching.

방법 : 2006년의 문헌을 살펴보고 카테고리별 분류

Method: We surveyed the 2006 medical education literature and categorised reports of peer teaching according to educational distance between students teaching and students taught, group size, and level of formality of the teaching. Subsequently, we analysed the rationales for applying peer teaching.

결과 : 12개의 서로 다른 이유들을 찾아내었음

Results: Most reports were published abstracts in either Medical Education’s annual feature ‘Really Good Stuff’ or the AMEE’s annual conference proceedings. We identified twelve distinct reasons to apply peer teaching, including ‘alleviating faculty teaching burden’, ‘providing role models for junior students’, ‘enhancing intrinsic motivation’ and ‘preparing physicians for their future role as educators’.

결론 : 자주 사용되는 방법이긴 하나 논문으로까지 나오지는 않는다. near-peer teaching이 효과적이며, 견습생(apprentice)와 장인(master)의 사이 단계인 journeyman이라는 비유가 의학교육의 연속체에서 중요하고 가치있지만 아직 잘 활용되고 있지는 않은 것이라 할 수 있다.

Discussion: Peer teaching appears to be practiced often, but many peer teaching reports do not become full length journal articles. We conclude that specifically ‘near-peer teaching’ appears beneficial for student teachers and learners as well as for the organisation. The analogy of the ‘journeyman’, as intermediate between ‘apprentice’ and ‘master’, with both learning and teaching tasks, is a valuable but yet under-recognized source of education in the medical education continuum.

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Ten Cate와 Durning은 peer teaching에 대한 광범위한 프레임워크(틀)를 제시했는데, 이 틀은 Peer teaching의 세 가지 독특한 특징을 바탕으로 한다 - 교사와 학생간의 거리, 격식, 학습그룹 크기

In Ten Cate and Durning (this issue) we provided a framework for approaching the broad concept of peer teaching. This framework is based on theory and addresses three distinct features of the peer teaching encounter: the educational distance between teacher and learner, the formality of the setting, and the learner group size.

의학교육에서 peer teaching에 대한 최근 묘사

Recent descriptions of peer teaching in medical education

2006년의 문헌을 살펴봄

A comprehensive review is beyond the scope of this paper and other authors have reviewed this topic well (Ten Cate et al. 1984; Whitman 1988; Topping 1996; Falchikov 2001). To acquire a more recent impression, we reviewed the 2006 medical education literature

다음의 저널에 2006년에 발간된 모든 논문을 살펴보았다. 

We explored the full contents of all 2006 issues of Medical Teacher, Medical Education, Academic Medicine, Teaching and Learning in Medicine, Education for Health, Advances in Health Sciences Education, The Clinical Teacher, BMC-Medical Education, Medical Education Online and the abstracts of the 2006 conference of the Association for Medical Education in Europe (AMEE). We found no reports in Teaching and Learning in Medicine, Education for Health, The Clinical Teacher, Medical Teacher and Academic Medicine in 2006.

peer teaching은 journal article까지는 잘 나오지는 않는다. 그 이유가 잘 알려져 있지는 않다.

It appears that peer teaching is practiced enough to produce a substantial number of abstracts, but does not often lead to peer-reviewed journal articles; the reasons for this are not known.

• Educational distance
• Formality of the educational setting
• Learner group size
• Terminology used
• Reasons cited

Peer teaching의 Rationale.

Rationales for the practice of peer teaching

교육에 대한 교수들의 부담 경감

To alleviate teaching pressure for faculty

4학년 학생이 교수들의 강의를 대체한다고 학습의 질이 떨어지진 않는다.

Tolsgaard et al. and Burke et al. (both in this issue), provide empirical support for the idea that replacing faculty teachers with senior medical students does not compromise the learning of the students taught, a conclusion that was previously drawn by Haist et al. (1998).

그 외에도 장점이 많다.

But even without these scaffolds, peer teaching may provide surprisingly beneficial effects (Tolsgaard et al. this issue).

학생의 인지수준에 맞는 교육 제공

To offer education to students on their own cognitive level

인지적 일치 가설(cognitive congruence hypothesis) : 지식 수준이 비슷한 경우 교육이 더 효과적이다.(지적 '거리(distance)'가 먼 경우보다 효과적이다.

The cognitive congruence hypothesis argues that a teacher with a knowledge base that is similar (i.e. congruent) to the learner’s is a more effective teacher than an expert in the field who has a dissimilar knowledge base, i.e. who is cognitively incongruent, or has a large ‘cognitive distance’ (Cornwall 1979; Lockspeiser et al. 2006).

학생간 지식의 거리가 멀지 않을 때, 비형식적인 교육일 때 'collaborative'혹은 'cooperative' 이라고 한다. 이 경우 학습에 있어서 장점은 조금 덜하다. 

When there is no cognitive distance and when the teaching task is not explicit but informal, we rather speak of collaborative or cooperative learning among students than peer teaching. Here, the relative benefit in terms of learning is less obvious. When the objective is to acquire independent, personal clinical skill, mere collaborative learning may not be more effective than individual study.

편안하고 안전한 교육환경

To create a comfortable and safe educational environment

교육 환경이 중요함

The educational environment or learning climate is appears to be important for optimizing learning and is one of the principal topics addressed in faculty development programs (Skeff et al. 1997).

동료가 학습자에게 덜 위협적이고 의학교육에서 받는 스트레스를 잘 이해할 수 있음.

Peers and near-peers however may be in even a better position to do this as they are potentially seen as less threatening by learners and often have a rich understanding of the stresses of the medical school curriculum, according to the so-called social congruence theory (Lockspeiser et al. 2006).

교육의 성과가 더 나을 뿐만 아니라, 스트레스는 낮다.

Topping (1996) cites authors who found not only better achievement in reciprocal one-to-one peer tutoring arrangements, compared to traditionally taught groups but also significantly reduced stress indicators.

학생들을 사회화시키고 롤모델을 보여줌

To socialize students in medical school and provide role models

의과대학 1학년을 시작하며 사회적으로 소외되거나 사회화 문제가 있을 수 있음. 'student counselling peer'원칙, 'helper therapy'원칙.

Specifically in the first year of medical school, the transition from secondary education or college may create alienation and problems of socialization. The ‘students counselling peers’ principle has been described as beneficial for both the student being counselled as well as the student counsellor, according to the ‘helper therapy principle’ (Whitman 1988).

뛰어난 학생들은 롤모델이 될 수도 있고, peer modelling이라고 함. hidden curriculum의 한 종류

More advanced students can also serve as powerful role models Topping (2001) has called this ‘peer modelling’. The so-called ‘hidden curriculum’ encompasses all those unwritten rules that students should follow to survive or excel the curriculum; peer modelling may play an important role in this phenomenon.

학습방법 뿐만 아니라 동기부여가 됨

To offer students an alternative motivation as well as another method for studying

어떤 부분을 가르치게 된 학생은 그 부분에 관심을 가지게 되고, 단순히 '두 번 배우는' 것이 아니라 더 지식의 유지가 더 강화된다.

Students who are tasked to teach or train others in a domain that interests them and that is relevant for their career, do not only ‘learn twice’; the literature suggests that they learn in a different way, which possibly adds to a longer and more solid retention of knowledge.

비록 예전에 공부한 것과 같더라도 가르치는 역할을 한 학생은 그것을 준비하면서 더 동기부여가 된다. 학습의 강력한 유도(driving)

One of the salient experiences with the student teaching rotation as described in this issue (Ten Cate 2007) is that students who taught were highly motivated to thoroughly prepare for the teaching, even though they studied the same content material themselves some years before. Apparently the teaching task evoked this motivation. Teaching can, next to assessment, clearly serve a powerful drive for learning.

4학년 학생이 2학년 학생에게 사회문화적 다양성을 가르치는 것이 그 이슈에 대한 지식을 높여주는데, 학습을 유도할 뿐만 아니라 가르치는 학생의 지식을 의미있는 방향으로 증대시킨다. 

Tang et al. (2004) showed how the teaching of sociocultural diversity issues in medicine to second year students, as an educational method, enhanced the knowledge of fourth year peer teachers on these issues. Not only is teaching a drive for learning, it appears to add to the teacher’s knowledge in a meaningful way. This could be through re-learning and further organizing knowledge or it may be that teaching evokes different knowledge acquisition and retention which may act synergistically to learning the material.

학생의 내적 동기 강화

To enhance intrinsic motivation in students

가르쳐야 되는 상황은 '외적 동기'처럼 보일 수 있으나, '내적 동기'도 강화시킨다. Self determination theory에 따르면 교사의 위치에 있는 학생이 단순히 학생의 역할만 하는 학생보다 더 내적 동기가 빨리 강해진다.

The obligation to teach can be viewed as an extrinsic motivator, but teaching may also enhance intrinsic motivation. Self determination theory predicts that students in a teacher role will more quickly develop intrinsic motivation to study material then when they just act in a regular student role (Ryan & Deci 2000). This may be due to the fact that the conditions for feelings of competence, autonomy and relatedness are more optimized when assuming the role of the teacher on a topic area as opposed to being a more passive learn

의사의 한 역할인 교육자로서의 준비과정

To prepare physicians for their future role as educators

'의사는 교육자가 되어야 한다'라는 점차 확대되고 있는 컨센서스에 대한 것. 

A very different argument for peer teaching is the growing consensus among the medical education community that doctors need to be educators. Dandavino et al. have elaborated this argument in a paper in this issue. Several recent competency frameworks for future physicians stipulate the role of the physician as educator (Frank et al. 1996; Bleker et al. 2004). 

The need to prepare physicians for this future role has led to...

• initiatives to train students and residents in teaching skills (Edwards et al. 2002; Busari et al. 2006; Haber et al. 2006), 
• provide teaching rotations for residents (Borleffs et al. 2002) and educational fellowships (Searle et al. 2006), 
• and make medical students qualify for teaching tasks (Evans et al. 2007; Ten Cate this issue).

동료에게 피드백 주는 것에 대한 연습

To practice peer feedback as part of multi source feedback

MSF는 직무기반 medical competence의 평가에 있어서 점차 늘어나고 있는 접근법이다. 이 때 정보원중 하나는 동료들에 의한 평가이고, 이를 위해서 학생들은 서로를 평가할 수 있는 능력을 키워야 한다.

Multi source feedback (MSF) is an increasingly popular approach to the assessment of work-based medical competence in trainees and physicians (Epstein 2007). One of the sources of information for feedback and appraisal in MSF is the peer. To fulfil this objective, students should be trained to assess each other. 

Peer assessment is often not considered a easy task (Arnold et al.), and its validity is questioned (English et al. 2006; Lurie et al. 2006) (동료에 대한 평가가 너무 후함.)as students tend to rate their peers too highly (Tyler 2006). Essential is the difference between summative assessment and formative feedback. The latter appears to be much suitable to be executed by peers (Dannefer et al. 2005; Lockyer & Clyman in press). Peer assessment is not the topic of the papers in this theme issue, but the literature shows that it is increasingly practised (Arnold et al. 2005, 2007).

리더십 스킬과 자신감 훈련

To train leadership skills and confidence

리더십은 다음에 필요하다.

The role of the teacher is not merely one of knowledge transmission. 

Leadership is necessary to...

organise teaching, 

to guide and facilitate a group, 

to make decisions about what courses of action are needed during a classroom session and 

to prioritise the subject matter being taught. 

Students, who are experienced in acting as a peer teacher, specifically when distance, formality and group size are large, will likely also develop leadership skills that may be useful in other situations that an academic graduate will be expected to handle.

교육을 중요한 임무로 받아들이는 문화 형성

To modify the academic medical culture toward embracing education as a core task of health care

선진국에서 교육이 중시되지 않는 것은 단순히 재정적 문제뿐은 아니다. 

One problem regarding current medical training in western countries is the undervalued importance as well as the relative paucity of resources available for academic medical education (Cooke et al. 2006). This is not only a matter of finances; a culture that fosters educational leadership and acknowledges the importance of a profession to adequately transmit its knowledge, skills, habits and professional codes of conduct to future generations requires an attitude that is not just focused on the here an now of managed care.

자원이 제한적인 환경에서 의료 훈련 프로그램을 지속시키기 위해서

To sustain medical training programmes in severely resource-constrained settings

In most developed countries, the provision of resources for education is under pressure and peer teaching may help to alleviate some of this pressure, as was mentioned above. However, in some developing countries, the mere existence of medical education is threatened by the accumulation of societal problems. In an excellent overview, Burch (2007) discusses how South Africa’s recent combination of economic decline, a sharp increase in disease burden, a substantial emigration of medical graduates from a country with already one of the world’s lowest healthcare workers to population ratio, seriously threatens the capacity to train sufficient doctors. One recent regulation issued in this country is to spend one compulsory postgraduate year in public health care before registration as a doctor is possible

역량바탕프로그램의 졸업후 교육에서 감독책임(supervision responsibility) 강화

To offer supervision responsibility to trainees in competency-based postgraduate programmes

역량바탕교육과정에서 수련의 outcome이 중요함.

In competency-based curricula, specifically in postgraduate medical training, the outcome of training – i.e. the competence of the specialists – is considered more important than the input of the training – i.e. the training circumstances (Long 2000; Carracio et al. 2002; Ten Cate 2005; ACGME 2007).

이러한 상황에서 레지던트들은 동료 레지던트에 대한 supervision responsibility가 있다.

It has been suggested that in competency-based training, residents may be formally awarded supervision responsibilities for fellow residents, once they have mastered the required competency-level in predetermined areas, ahead of others (Ten Cate & Scheele 2007). This supervision includes being a clinical teacher and role model.

The natural interaction of learningand teaching in medical education

오랜 기간 의학은 '전문가-초심자' 관계로 전수되어왔다. 많은 세대가 개인지도를 해주는 길드 구조에서 전문직으로 키워졌으며, 이러한 길드 구조는 초심자-중간자-마스터의 단계를 이룬다. 점차 독립하게 되는 것이다. 이 중 가장 흥미로운 단계는 'journeyman'이다.

In history, medicine has long been practiced and learned in apprentice–expert arrangements. Many generations have acquired competence in our profession by joining the guild structure of personal guidance. A typical guild structure shows three levels of expertise: apprentice, journeyman and master; phases that reflect growth toward independence. Perhaps the most interesting phase is that of the journeyman, the midskilled craftsman who has completed the apprenticeship.

journeypersons는 가르치는 역할을 자주 하게 되지는 않지만, 마스터가 되기 위해 연마하는 단계를 더 밟아야 하고, journeyperson이 가르치는 역할을 맡음으로서 더 마스터에 가까워질 수 있다.

Journeypersons were often entitled to teach, but still had to develop their own skills further to become a master; indeed it is believed that having the journeyperson teach contributed to the development of mastery.

Collins는 apprenticeship을 교육에 대입해서 'cognitive apprenticeship'이라 불렀다.

Collins et al. (1989) reintroduced the apprenticeship concept in education, and called it ‘cognitive apprenticeship’. But the intermediate stage, the journeyman, seems to have vanished. Following Collins et al. (1989) ‘cognitive journeymanship’ could very well serve as a logical concept in long educational tracks, such as the medical education continuum.

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Med Teach. 2007 Sep;29(6):591-9.

Peer teaching in medical education: twelve reasons to move from theory to practice.

Ten Cate O1, Durning S.

Author information

Abstract

OBJECTIVE:

To provide an estimation of how often peer teaching is applied in medical education, based on reports in the literature and to summarizereasons that support the use of this form of teaching.

METHOD:

We surveyed the 2006 medical education literature and categorised reports of peer teaching according to educational distance between students teaching and students taught, group size, and level of formality of the teaching. Subsequently, we analysed the rationales for applying peerteaching.

RESULTS:

Most reports were published abstracts in either Medical Education's annual feature 'Really Good Stuff' or the AMEE's annual conference proceedings. We identified twelve distinct reasons to apply peer teaching, including 'alleviating faculty teaching burden', 'providing role models for junior students', 'enhancing intrinsic motivation' and 'preparing physicians for their future role as educators'.

DISCUSSION:

Peer teaching appears to be practiced often, but many peer teaching reports do not become full length journal articles. We conclude that specifically 'near-peer teaching' appears beneficial for student teachers and learners as well as for the organisation. The analogy of the 'journeyman', as intermediate between 'apprentice' and 'master', with both learning and teaching tasks, is a valuable but yet under-recognized source of education in the medical education continuum.

PMID:

 

17922354

 

[PubMed - indexed for MEDLINE]