Online Peer Teaching in Medical School during a Pandemic Period:

A Reflection

Lehashenee Thirukumar, Lim Li Siew, Law Hian Hui, Narendra Pamidi and Amudha Kadirvelu

Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia

Keywords: Peer Teaching, Online Learning, Medical Students.

Abstract: Peer-teaching has been rapidly adopted throughout higher education institutions, including medical schools,

to provide students with a diverse learning environment and to enhance academic development. Peer assisted

study session (PASS) is a peer-teaching program implemented in Monash University Malaysia and was

conducted virtually during the COVID-19 pandemic. Perspectives from the viewpoint of peer tutors during

the pandemic period are presented in this paper. Throughout the year, peer tutors were confronted with the

unique challenges of teaching virtually. Various factors which contribute to changes in the dynamics of group-

based discussions in online classes are discussed. On online platforms, students are graced with more privacy

and freedom, a double-edged sword that can translate into reduced student engagement. Nonetheless, the

practical skills acquired by adapting to the abrupt switch from on-campus to online peer-teaching can be

employed in our future practice as health professionals.

1 INTRODUCTION

Learning is a never-ending process. This is especially

relevant in the medical field where many ground-

breaking discoveries are made annually. Medical

practitioners are hence tasked with not only

maintaining updated knowledge but also

communicating it to patients and junior colleagues

with clarity. The essence of a successful doctor-

patient relationship lies in how well the doctor

ensures a patient understands their health condition

and management. This is reflected in the numerous

studies published on the significance of effective

doctor-patient communication in achieving positive

patient health outcomes (Stewart, 1995). As future

healthcare workers, honing our communication skills

is an integral part of our learning process. Peer

teaching is one method by which medical students

can acquire these relevant professional skills.

Peer teaching involves students teaching other

students in small groups regarding a subject or

discipline of interest (Mohd Shafiaai et al., 2020).

Usually, the peer tutor has prior knowledge or

experience on the subject whereas the tutee is a

novice in the field (Harrison et al., 2019). Peer

teaching is often provided by senior students to

relatively junior students in university settings. The

peer teaching sessions complement formal classes by

providing students with an additional opportunity to

receive clarification on complex topics with seniors

who have recently overcome similar hurdles.

In medical school, new knowledge is built upon

previously laid foundations and students are expected

to absorb and digest an extensive amount of new

information each day. Peer teaching is an efficient

way to assist students with their learning in different

and friendly contexts.

Peer Assisted Study Sessions (PASS) in Monash

University Malaysia is an academic mentoring

program of guided study groups. The sessions are

facilitated by senior/experienced students who are

carefully selected by faculty members. PASS sessions

are conducted weekly for a minimum of one hour

where Year 1 medical students are allocated into ten

groups, each led by two Year 2 peer tutors.

Prior to the COVID-19 pandemic, the PASS

program was conducted face-to-face in designated

classrooms. In 2020, the program was delivered via

an online platform as the country went into lockdown

and the physical classroom environment was not

accessible. Online delivery allowed students to

continue their learning unhindered by their location.

The online sessions were conducted using Zoom.

Thirukumar, L., Siew, L., Hui, L., Pamidi, N. and Kadirvelu, A.

Online Peer Teaching in Medical School during a Pandemic Period: A Reﬂection.

DOI: 10.5220/0010473604910496

In Proceedings of the 13th International Conference on Computer Supported Education (CSEDU 2021) - Volume 1, pages 491-496

ISBN: 978-989-758-502-9

491

2 PEER-TEACHING: PHYSICAL

VS. VIRTUAL ENVIRONMENTS

Apart from the mode of delivery of the PASS session,

the framework of the PASS program was generally

unaffected by the pandemic situation. In Monash

University Malaysia, the selection of peer tutors is

made based on enthusiasm to teach, communication

skills and academic excellence. The selected students

then undergo training prior to the initiation of the

PASS sessions.

Each week, the PASS leaders generate practice

questions and scenarios to be discussed with the

tutees during the session. The questions are

specifically designed to facilitate discussions and

understanding of core concepts. The topics are

selected based on tutees’ requests and are typically on

the content covered during the week or specific

challenging domains. This allows the Year 1 students

to consolidate the scope of learning in recent lectures

whilst assessing their knowledge. The tutees receive

said questions several days before each session to

allow for their attempt and reflection on areas they are

struggling with.

During the PASS session, the peer tutors impart

study skills and how to approach challenging topics

or concepts. Some tutees also utilise the PASS

sessions to seek advice on other aspects of medical

school. For example, peer tutors can relay their

experiences of managing the transition from college

to medical school, coping with the demanding

workload, and juggling extracurricular activities.

2.1 What Works Well in Online

Environments

During on-campus learning, the PASS sessions were

timetabled each week and designated classrooms

allowed for conducive delivery and achievement of

objectives of the sessions. However, finding one hour

in a busy timetable weekly and booking venues for 10

groups was a major challenge for the management

staff and students as they needed to accommodate the

varying arrangements each week. Since the PASS

sessions were normally tightly scheduled between

normal lessons, students needed to rush to arrive at

the designated classrooms on time. Students were

often late and resulted in a notable portion of the one-

hour sessions being wasted. In contrast, online PASS

sessions permit flexible scheduling. The sessions on

Zoom are a mere click away and require no prior

booking of venues. Moreover, with online platforms,

attendance can be taken immediately and requires

little effort from tutors and tutees alike. This is more

efficient than physical classes, where tutees are

required to take turns signing an attendance sheet.

Thus, online learning environments can make

administrative tasks simpler and more organised.

At times, tutees may be unprepared or unable to

attend the PASS sessions. Zoom has the advantage of

a built-in screen recording functionality, enabling

tutees to watch the sessions at a more suitable time

and pace. Similarly, students who may struggle to

grasp certain topics will benefit from this as they can

re-watch their tutor’s explanations (Kemp & Grieve,

2014). This contrasts with physical classes, where

absent students can only rely on their fellow tutee’s

notes.

Furthermore, online classes can accommodate

various students’ personality types better than

physical sessions. During on-campus learning,

extroverted tutees typically dominate the discussions

while other students are too shy to openly seek

clarification. With online sessions, shy tutees have the

option of privately sending questions to their PASS

leaders and can remain anonymous. Kemp and Grieve

(2014) concur that online sessions create a more

private and less socially pressured learning

atmosphere. Therefore, a wider range of learners can

contribute to these virtual discussions.

2.2 Challenges of Peer Teaching

Through On-Screen Interaction

The sense of privacy and anonymity that online

platforms offer to tutees can create drawbacks for

tutors. Most tutees preferred to disable their

microphones and cameras throughout the sessions

and remained silent when tutors posed questions. As

such, tutors noted an overall less favourable student

engagement as compared to face-to-face classes

despite the voluntary participation of tutees in the

PASS sessions. Such observations were also made in

another medical school where online peer teaching

was conducted (Roberts et al., 2020).

The freedom that online classes provide, in

conjunction with the lack of accountability, invites

distractions into tutees’ learning environments. The

feeling of isolation may also contribute to behaviours

such as using social media and playing computer

games during classes (Dumford & Miller, 2018).

Alternatively, in traditional learning environments,

students may endeavour to remain focused as they are

constantly under observation.

The absence of visual cues may also induce

boredom and discourage interactivity among tutees

(Qiu & McDougall, 2013). If tutees are unable to

CSEDU 2021 - 13th International Conference on Computer Supported Education

492

observe the reactions of their peers, they would be

unaware if others are struggling with similar topics.

This may then discourage tutees from asking

questions to clarify doubts on behalf of their group.

Consequently, the online sessions were more one-

sided as the PASS leaders were often unable to

stimulate discussions and had to resort to only giving

explanations as though in a lecture. Additionally,

without cameras turned on, tutors were unable to

observe body language and facial expressions to

gauge whether the sessions were appropriately paced.

This is unlike physical classes where tutors can pick

up on tutees’ non-verbal cues to verify their

understanding of answers (Dumford & Miller, 2018).

At times, PASS leaders experienced poor network

connectivity, resulting in increased latency or

complete disconnections from Zoom meetings. These

interruptions impaired efficiency as both parties

needed to wait for the tutor’s internet to stabilise

before resuming the session. Likewise, distortions in

audio at unfortunate moments sometimes resulted in

misunderstandings and incited confusion among

tutees.

3 THE ART OF FEEDBACK

Learning to give and receive constructive feedback is

an essential element of personal development. In

medical school, students are urged to provide

feedback to peers as it encourages reflection and

critical thinking (Lerchenfeldt et al., 2019). It can also

promote a growth mindset and help the other party

improve by giving non-judgemental and clear

recommendations.

There is a fine line between constructive feedback

and criticism. During the PASS training program,

tutors were taught strategies to provide constructive

feedback, such as choosing the right words and using

the appropriate tone. When tutees navigate in a

different direction, PASS leaders give feedback and

guide them towards analysing the concept effectively.

Compared to simply providing them with the correct

answer, this feedback method additionally equips

tutees with the ability to arrive at the correct solutions

themselves. When especially difficult concepts arise,

tutors must attempt alternative ways of giving

feedback. In this case, having multiple tutors in each

group is useful as others may offer better approaches

towards understanding the subject.

In face-to-face sessions, the feedback provided is

mostly general. Immediate, personalised feedback is

hindered by time constraints and the physical

classroom environment among other students. The

online platform allowed for giving individual

feedback during the sessions using the Zoom private

chat box function.

At the end of each semester, the tutees were

prompted to provide feedback to their tutors

regarding possible improvements and the favourable

aspects of the PASS sessions. Generally, the Year 1

students were hesitant to provide feedback when

asked directly by the PASS leaders. Collecting or

receiving feedback was easier through an online

platform, as the tutees were more forthcoming when

responses were made anonymous through Google

Forms.

4 LESSONS LEARNT AS FUTURE

DOCTORS

While the primary purpose of the PASS program in

our university is to assist juniors to succeed in

challenging units, the peer tutors were also rewarded

with practical lessons learnt from the mentoring

experience. As medical students, certain skills

acquired from conducting these sessions can be

applied to our future practice as doctors.

4.1 Professionalism

To provide a respectful and safe learning

environment, it is paramount to establish and

maintain a professional relationship with fellow

tutors and junior students. Peer leaders communicated

using the university email address and provided

learning material through the university’s learning

management system. Consequently, the tutors

became familiar with formal communication and

were able to build rapport despite maintaining

professional boundaries. Since doctors often see

patients in their most vulnerable moments, it is

important to learn to provide support and guidance

without sacrificing these boundaries.

During the year, professionalism was also evident

in tutors when their relationship evolved from being

batchmates to colleagues. Teamwork was broadly

developed among tutors through their collective

efforts to produce practice questions for each session.

Due to the long list of topics that are covered each

week, the tutors delegated duties and cooperated to

ensure preparations were done efficiently. This is not

unlike working in a healthcare team, where

collaboration is required to successfully manage each

patient. As such, when disagreements arise, they were

Online Peer Teaching in Medical School during a Pandemic Period: A Reﬂection

493

settled diplomatically and without undermining

fellow tutors.

4.2 Life-long Learning

Medical school is where students are taught to

develop the thinking process and clinical reasoning of

a doctor. It is not where aspiring physicians learn

everything there is to know about practicing

medicine, seeing that advances in diagnostics or

management plans are shared in the community every

day. Accordingly, medicine is a career that demands

a life-long commitment to learning from its pursuers.

From studying to specialise further, to needing to

keep up with the latest clinical practice guidelines,

there is a ceaseless torrent of knowledge to be

acquired.

Before each PASS session, revision and further

reading must be done on the topics to be discussed

that week. This often requires employing resources

beyond lecture notes and textbooks, as tutors must

anticipate questions the tutees may ask and ensure

they are well-versed enough to provide clear

explanations. It may include topics tutors personally

dislike or may struggle in. To rehearse conveying

knowledge on such topics to tutees effectively, tutors

may need to think metacognitively to reconstruct their

comprehension of the material. One strategy is by

generating self-explanations, which is believed can

facilitate learning by prompting the identification of

defective mental models and their subsequent self-

repair (Chi, 2000). This departure from passive

learning will consequently make tutors better learners

themselves. Additionally, simply listening to the

explanations of fellow tutors may reveal alternative

means of understanding a topic.

Despite extensive preparations, tutees may

occasionally pose questions beyond their tutors’

knowledge or point out errors in explanations.

Humbling experiences as such are evidence that

learning opportunities are present at every moment.

Like most other careers, healthcare has a workplace

hierarchy. This serves as a reminder that even those

at the top of the hierarchy should be open to learning

from their subordinates; having inflated egos and

refusing to acknowledge one’s limits will only harm

patients down the line and can impede the

establishment of healthy doctor-patient relationships

(Huynh & Dicke-Bohmann, 2020). Likewise, when

tutees gain the ability and confidence to tactfully

point out mistakes that their tutors have made, they

begin to overcome the barrier that hierarchical

division can pose towards achieving honest

interprofessional communication (Thomson et al.,

2015). This positive trait is essential in the workplace

where doctors of varying seniority, nurses,

pharmacists, and mid-level practitioners are required

to collaborate to provide holistic patient care.

4.3 Virtual Communication Skills

Shifting the PASS program to an online platform

added dimension to the peer-teaching experience.

Learning communication skills is an essential aspect

of medical education. This is reflected by the

significant portion of clinical skills classes dedicated

to instilling appropriate and professional

communication skills. This relies on both verbal and

non-verbal cues, the latter of which may be distorted

with virtual meetings. For instance, after having

broken bad news, doctors may use physical touch to

comfort patients when words offer little solace.

Online interactions remove this crucial portion of

communication and require medical practitioners to

develop alternative methods to bridge this gap.

Online peer teaching highlights this issue. The

lack of visual cues from tutees demands more

advanced communication skills from tutors and

regular check-ins to ensure if the pacing of lessons is

appropriate. These virtual communication skills may

prove useful when interacting with patients in areas

with internet bandwidths that can only support audio

calls.

Explanations during PASS sessions in previous

years were mostly done verbally or by drawing on

whiteboards. These methods are nearly effortless and

require little, if any, preparations before the sessions.

However, online peer teaching requires different

implementations, as disruptions in internet

connections mid-explanation can lead to confusion

and frustration. Tutors needed to depart from the

norm of PASS sessions to minimise the impact of

minor connection issues, and explored the use of

videos, diagrams, and games (e.g., Kahoot!) to

maintain the efficiency of the sessions. Using more

engaging teaching methods can also help alleviate

boredom and rekindle the enthusiasm of tutees, hence

mitigating the negative impact virtual sessions have

on student participation.

5 CONCLUSIONS

The abrupt transition to online classes during the

COVID-19 pandemic necessitated flexibility from

educators and students alike. As peer tutors, we strove

to incorporate the positive examples our lecturers

displayed with virtual teaching with our own

CSEDU 2021 - 13th International Conference on Computer Supported Education

494

experiences as online learners to ensure the standard

of the PASS program was maintained or elevated.

The shift to an online platform certainly did not

provide tutors with a discounted peer-teaching

experience. Apart from the typical qualities required

from peer tutors such as confidence, time

management and pedagogical skills, the online

version of the PASS program also demanded

adaptability, digital literacy, and an open mind.

Consequently, peer teaching conducted in both online

and physical environments can equip medical

students with insights that reinforce the lessons learnt

in classrooms and enrich their journey in becoming

reliable, future-proof medical practitioners.

5.1 Limitations

This paper offers solely the viewpoints of the Year 2

PASS tutors who are comparing their experiences as

online tutors with their experiences as on-campus

tutees the previous year. The discussions also revolve

around the context of medical education during

preclinical years (Years 1 and 2), which involves

theoretical content and knowledge that can largely be

explained verbally. This contrasts with the clinical

years of medical school where learning is primarily

done in hospital settings and requires hands-on

approaches. Thus, the effectiveness of online peer-

teaching for medical students in their clinical years is

unclear.

5.2 Future Work

This paper presents collective experiences and

thoughts from the perspective of peer tutors.

Collecting feedback from tutees on their online peer-

led teaching experience would provide additional

information on the effectiveness of online peer-

teaching and their learning.

To obtain the quantitative evidence required to

make objective assessments regarding the benefits of

PASS, the results of the entire 2020 Year 1 cohort can

be analysed to evaluate the differences in academic

performance between those who attended the sessions

and those who did not. To ensure that the influence of

PASS on the tutees’ scores is being studied

independently from the effects of official lectures and

tutorials, the cohort’s results can be followed up to

Year 2, where there is no senior-led peer teaching

conducted. Additionally, to compare the

effectiveness of the online version of PASS with the

traditional on-campus sessions, the results of the Year

1 batch in 2020 can be compared with previous

batches.

These findings can be used to provide convincing

recommendations for the mode of delivery of PASS

sessions in medical school once the COVID-19

pandemic is over.

ACKNOWLEDGEMENTS

We thank all the peer learners, educators, and the

school for supporting the PASS program.

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