RESEARCH

 

Designating selected roles and responsibilities for effective same-year/ level peer-assisted learning for foundation provision in health sciences education in South Africa

 

 

R Slabbert

PhD; Department of Clinical Sciences, Faculty of Health and Environmental Sciences, Central University of Technology Free State, Bloemfontein, South Africa

Correspondence

 

 

---

ABSTRACT

BACKGROUND. The implementation of same-year/level peer-assisted learning (SPAL) offers potential pedagogical benefits for participants' academic and skills development. However, there is limited descriptive literature on the strategic designation of roles and responsibilities needed to ensure effective SPAL implementation. Additionally, no studies addressing this in South African (SA) higher education institutions (HEIs) offering foundation provision (FP) in health sciences education (HSE) were found.
OBJECTIVES. To establish the strategic designation of selected roles and responsibilities concerning SPAL implementation, validated by experts in support of effectively achieving the strategy's implementation objectives for FP in HSE at SA HEIs.
METHODS. A four-round qualitative Delphi survey was conducted with 12 purposively sampled experts in higher education and health professions education (HPE). Open and axial coding of narrative feedback were applied to develop statements, which were endorsed when 75% of the experts reached consensus.
RESULTS. Ten statements were endorsed. Although the participating experts assigned general responsibility for the overall administration, tutor identification and training to both faculty and academic support centres, unique sub-delegations were identified for each entity. The reflection, reporting and evaluation functions concerning the effectiveness of SPAL were validated in a primarily decentralised manner by the Delphi panel.
CONCLUSION. The strategic designation of roles and responsibilities for SPAL implementation was recommended to support the strategy's objectives and promote the 'access to success' aim of FP in HSE at SA HEIs.

Keywords: same-year/level peer-assisted learning, extended curriculum programmes, foundation provision, teaching and learning strategy, roles, responsibilities.

---

 

 

The implementation of same-year/level peer-assisted learning (SPAL) in medical curricula is substantiated by the potential pedagogical benefits for participants' academic and skills development within the same study cohort.^[1-3] SPAL promotes active reciprocal learning among students on the so-called same 'wavelength', a practice recognised worldwide.^[2,3] With a strong focus on self-directed learning, SPAL aims to create a safe and accessible environment for students to identify and address one another's educational needs.^[1,3]

Based on the confirmed educational benefits of SPAL, this teaching and learning strategy seems applicable for foundation provision (FP) in health sciences education (HSE), where student support for 'access to success' is warranted.^[4,5] Previously disadvantaged students placed on extended curriculum programmes (ECPs) should receive the necessary support through an FP curriculum employing teaching and learning strategies that are sensitive and responsive to their educational needs, and thus focused on promoting the successful completion of their studies.^[5]

Despite the well-reported pedagogical advantages of SPAL implementation in medical curricula, current literature lacks descriptions of key implementation elements, complicating its replication and adaptation in other contexts.^[1] For example, further clarification is needed on strategically designating functions, such as tutor selection, training and evaluation practices to specific human resources to effectively achieve the objectives of the strategy.^[1,6] A literature search revealed similar evidence in the South African (SA) HSE context. Only one university of technology (UoT) reported on SPAL's academic and developmental benefits for ECPs in HSE but did not clarify its strategic implementation. The designation of SPAL implementation roles, responsibilities and evaluation practices of the effectiveness of the strategy were absent in other SA studies.^[7]

Building on the limited SA works in the UoT context and addressing the identified gaps in the broader SA literature, the research aimed to establish expert validation on the strategic designation of selected roles and responsibilities concerning SPAL implementation for FP in HSE to support effective achievement of the strategy's implementation objectives.

 

Methods

A qualitative Delhi survey was selected as the mode of inquiry for this study. An initial questionnaire was developed based on existing scholarly work and findings from earlier phases of the larger investigation, following the qualitative Delphi methodology described by Sekayi and Kennedy.^[8]

Study sample

Purposive sampling was applied in the identification of 12 known SA experts in the field of HE and health professions education (HPE). The panellists were recruited from member networks, such as the special interest groups (SIGs) of the South African Association of Health Educationalists (SAAHE), the Foundation Collaborative Learning Community (FCLC) and the Higher Education Learning and Teaching Association of Southern Africa (HELTASA). The inclusion criteria were as follows:

• Academic staff members with at least 3 years of teaching experience in ECPs in HSE

• Academic support staff in HE involved in curricula development for ECPs in HSE

• Heads of department managing HPE or ECPs in HSE.

Procedure

Delphi panel members were informed about the four envisaged rounds of qualitative surveying. Each round's questionnaire was distributed electronically and returned to facilitate data collection. Supporting documentation explaining the data analysis of the previous round's narrative input accompanied each questionnaire. This study was completed after the circulation of the final endorsed statements in round 4.

The first questionnaire enabled an open-ended brainstorming exercise where participants were prompted to recommend the strategic designation of selected SPAL implementation roles and responsibilities that, in their expert view, would ensure the effective achievement of the implementation objectives of the strategy for ECPs in HSE. These roles and responsibilities included the overall administration of SPAL, the identification, recruitment, appointment and training of SPAL tutors, the evaluation and monitoring of SPAL activities and reporting on SPAL implementation. Panel members were required to substantiate the respective designations of these roles and responsibilities they viewed as central to effectively achieving SPAL implementation objectives. Data analysis of the individual narrative input received after the first round's questionnaire entailed the use of open and axial coding to identify categories that informed the generation of statements to be presented in the second questionnaire. Individual responses and analysis thereof were disseminated to all participants in a separate supporting document. This list of statements represented a composite group response of panel members to each of the prompts included in the first questionnaire.

For round 2 of the qualitative Delphi survey, panel members were requested to critique the list of statements by applying modifications they considered necessary for depicting a more representative statement of their expert opinion, as expressed in the open-ended brainstorming round. While maintaining the nuances of the initial statements' meanings, the researcher studied all modifications and developed a list of refined statements presented in the third and endorsement rounds of the survey.

The endorsement process followed in round 3 of the Delphi survey allowed participants to designate each refined statement on a three-point Likert scale containing response options labelled 'Strongly endorsed', 'Endorsed' and 'Not endorsed'. Members were requested to perform the endorsement process for each statement presented, even if some participants had not suggested modifications to all statements in the previous round. To promote the reliability of data collection in this round's questionnaire, standardised meanings for each rating point on the Likert scale were provided to the panel members. A priori consensus level of 75% agreement among members was established to determine the endorsement outcome for each statement. All endorsed statements were regarded as findings of the study. The fourth and final round signalled the conclusion of the qualitative Delphi survey, and the final list of endorsed statements was distributed to all participants.

Ethical considerations

The Health Sciences Research Ethics Committee (HSREC) of the University of the Free State approved the study (UFS-HSD2021/1908-0003). The invitations to participants were accompanied by an information document detailing the confidential treatment of members' personal information and the voluntary participation and withdrawal from the study by any member at any time. All invited members consented to participate in the study before any data were collected.

 

Results

During the first and second rounds of the Delphi survey, two participants withdrew from the study. The remaining participants were informed about these anonymised withdrawals and how the consensus level agreement among the smaller number of participants would subsequently be influenced and calculated.

The first questionnaire was returned by 11 participants. This round's findings informed the generation of 10 composite statements relating to prompts on the strategic designation of the roles and responsibilities included in SPAL implementation. Table 1 summarises the process followed for the generation of all the composite statements and statements generated for the first two prompts of the brainstorming round. The remaining eight composite statements generated for the other two prompts are listed in Table 2.

The modifications received from 10 participants after round 2 were incorporated into the revised and final statements presented for endorsement in round 3. All remaining participants complied with the endorsement request in round 3, and all 10 statements were endorsed. Table 3 shows the results of the third questionnaire's findings on the endorsement of the statements. The endorsement results were distributed to all remaining participants in round 4 and signalled the conclusion of the study.

 

Discussion

Coordination of peer-assisted learning (PAL) in HSE is often centralised, though there are also contextualised, faculty-led programmes available.^[6] Experts participating in the current study endorsed an approach to administering SPAL implementation for FP in HSE that designates academic support centres to complement a mainly faculty focused role. Substantiating this finding requires the acknowledgement of SPAL having a stronger focus on addressing the academic needs of students than offering support in wider educational domains, such as social and pastoral matters.^[9-11] Therefore, administering discipline-specific elements of SPAL potentially requires module experts as the designated primary overseer of SPAL and personnel from academic support centres complementary to this coordination role.^[6,12,13] Effective SPAL involves a trusted administrator, and the vulnerability of students in ECPs additionally warrants a decentralised administration framework that would be more sensitive and responsive to these marginalised students' educational needs.^[5,12,13] This reasoning was also noted in experts' views as reflected by the endorsement of faculty staff to be responsible for identifying suitable tutors, while academic support centres are mandated with the management of the processes involved. This finding is relatable to a confirmed notion that a more primary faculty-led teaching and learning strategy better accommodates students' involvement in the organisation and development processes and thus confirms the suitability of SPAL for FP in HSE.^[6,14]

The endorsement of a two-fold SPAL tutor training programme highlights the importance of a strategic approach to effectively empower tutors for FP in HSE. Marginalised students often feel overwhelmed when adapting to university life, particularly owing to demanding course material.^[4,5,12,15] While SPAL activities predominantly focus on students' academic and skills development, related literature suggests that tutor preparation should be based on the fundamental principles of PAL. This training should encompass both module-specific and broader tutoring principles, irrespective of the implementation format.^[3,6,12] Furthermore, it is not unreasonable to argue that conceptualised training offered continuously by module experts will ensure that they, as the primary overseer of SPAL, stay sensitive to ever-changing student needs.^[4,6,13] This strategic approach, in addition to training programmes that involve student self-reflection practices, will also promote responsiveness to tutors' training demands in support of both the aim of FP and the focus of the strategy.^[2,4-6]

Five statements were endorsed concerning the strategic delegation of functions related to evaluating and monitoring the effectiveness of SPAL. Delphi panel members recommended module experts take the lead in operationally and continuously assessing the effectiveness of SPAL. Participants strategically delegated academic support centres as supplementary entities in this function, viewing them as responsible for safeguarding the integrity of related institutional policies and procedures. This finding supported the argument of some authors proclaiming that the evaluation of SPAL requires a collegial approach between all the strategic partners involved. ^[16] However, authorising faculty staff as the main leaders in the evaluation process will enable them to better understand the educational needs of FP students, thereby promoting the applicability of such a teaching and learning strategy for vulnerable student cohorts.^[4,6,15]

Experts emphasised that feedback for reflection and quality assurance practices are important strategic elements in evaluating the effectiveness of SPAL.^[17] Participants assigned these roles and responsibilities in a decentralised manner to faculty staff, ensuring that these elements are accommodated in their SPAL implementation frameworks. Similar to other research findings, student feedback practices play an important role in tutor development, which in turn strengthens the effectiveness of the teaching and learning strategy.^[2,17] Tutor contemplation practices also enhance the quality of teaching and learning within the strategy where information is responsively transformed into knowledge.^[2] The critical evaluation of the strategy's effectiveness, and thus applicability for FP in HSE, would be optimised through reflection practices that would assist faculties with evaluating how well ECP student needs and suggestions are accommodated in preparing them for the successful completion of their studies.^[5]

The study participants believed that the faculty reporting on the effectiveness of a SPAL strategy should be inclusive of both qualitative and quantitative data. Some researchers argue that relying solely on quantitative measures to assess the effectiveness and quality assurance of SPAL does not provide a comprehensive view of the strategy's impact.^[18] Educational indicators should also be qualitatively investigated and preferably triangulated with the known quantitative effects of the strategy to highlight the full potential for student development.^[1,18] This finding echoes the confirmed lack of such qualitative investigations in the literature. Consequently, the author asserts that well-structured quality assurance systems reporting on triangulated data are good starting points for accumulating reliable data to address such identified research needs.

Limitations

The study focused on the strategic designation of selected roles and responsibilities for SPAL implementation, an area identified in the literature as needing further investigation. Consequently, other applicable roles and responsibilities might have been excluded. The withdrawal of two study experts could also have limited the substantiation of the established strategic designation of the included roles and responsibilities in this study. Furthermore, the study was based on available literature found only in the SA UoT context. However, despite these possible limitations, the researcher is optimistic about the degree of transferability of the study's results to other HE institutions.

 

Conclusion

The study provided expertly validated recommendations for the strategic designation of certain roles and responsibilities concerning SPAL implementation for ECPs in HSE. These recommendations aim at promoting the achievement of the strategy's objectives in support of providing 'access to success' to FP students in HSE. The paper also addresses a lack of descriptive literature on the strategic designation of human resources involved in the selection and training of tutors and practices for evaluating the effectiveness of SPAL. Describing expertly validated recommendations on these implementation elements was done to possibly enhance the replication of SPAL implementation in other contexts. However, the author recommends that further realist review studies be conducted to identify the differential effects of these validated endorsements when implemented in different HSE contexts and circumstances.

Declaration. This article is based on research conducted in fulfilment of RS's PhD degree.

Acknowledgements. The author gratefully acknowledges the Delphi panel members for their participation in the study, and Dr Daleen Struwig for the technical and editorial preparation of this paper.

Author contributions. RS is the sole contributor to the paper.

Funding. Funding was received through the University Capacity Development Grant (UCDG) from the Department of Higher Education (DHET).

Data availability statement. The datasets generated and analysed during the current study are available from the corresponding author upon reasonable request.

Conflicts of interest. None.

 

References

1. Hernández Coliñir J, Molina Gallardo L, González Morales D, Ibáñez Sanhueza C, Jerez Yañez OJ. Characteristics and impacts of peer assisted learning in university studies in health science: A systematic review. Rev Clin Esp (Barc) 2022;222(1):44-53. https://doi.org/10.1016/j.rceng.2021.02.006        [ Links ]

2. Bugaj T, Blohm M, Schmid C, et al. Peer-assisted learning (PAL): Skills lab tutors' experiences and motivation. BMC Med Educ 2019;19(1):353. https://doi.org/10.1186/s12909-019-1760-2        [ Links ]

3. Burgess A, van Diggele C, Robers C, Mellis C. Planning peer assisted learning in clinical schools. BMC Med Educ 2020;20(2):453. https://doi.org/10.1186/s12909-020-02289-w        [ Links ]

4. Scott I. Access, success and curriculum. In: Dhunpath R, Vithal R, eds. Alternative Access to higher education. Pinelands: Pearson 2014:26-50.         [ Links ]

5. Garraway J, Bozalek V. Theoretical frameworks and the extended curriculum programme. Alternation 2019;26(2):8-35. https://doi.org/10.29086/2519-5476/2019/v26n2a2        [ Links ]

6. Herrmann-Werner A, Gramer R, Erschens R, et al. Peer-assisted learning (PAL) in undergraduate medical education: An overview. J Evid Based Med Healthc 2017;121:74-81. https://doi.org/10.1016/j.zefq.2017.01.001        [ Links ]

7. Slabbert R, du Plessis J. Quality assurance of peer-assisted learning by measuring academic performance of health sciences extended curriculum students. Perspect Educ 2021;39(2):95-112. https://doi.org/10.18820/2519593X/pie.v39.i2.8        [ Links ]

8. Sekayi D, Kennedy A. Qualitative Delphi method: A four round process with a worked example. Qual Rep 2017;22(10):2577-2763. https://doi.org/10.46743/2160-3715/2017.2974        [ Links ]

9. Meertens R. Utilisation of a peer assisted learning scheme in an undergraduate diagnostic radiography module. Radiography 2016;22(1):e69-e74. https://doi.org/10.1016/j.radi.2015.08.004        [ Links ]

10. Blohm M, Lauter J, Branchereau S, et al. "Peer-assisted learning" (PAL) in the skills-lab - An inventory at the medical faculties of the Federal Republic of Germany. GMS Z Med Ausbild 2015;32(1):10. https://doi.org/10.3205/zma000952        [ Links ]

11. Weyrich P, Schrauth M, Kraus B, et al. Undergraduate technical skills training guided by student tutors - analysis of tutors' attitudes, tutees' acceptance and learning progress in an innovative teaching model. BMC Med Educ 2008;8(1):18. https://doi.org/10.1186/1472-6920-8-18        [ Links ]

12. Burgess A, Dornan T, Clarke AJ, et al. Peer tutoring in a medical school: Perceptions of tutors and tutees. BMC Med Educ 2016;16:85. https://doi.org/10.1186/s12909-016-0589-1        [ Links ]

13. Capstick S. Benefits and shortcomings of peer assisted learning (PAL) in higher education: An appraisal by students. 2004 https://www.bournemouth.ac.uk/sites/default/files/asset/document/stuart-capstick.pdf (accessed 14 November 2023).         [ Links ]

14. Wadoodi A, Crosby JR. Twelve tips for peer-assisted learning: A classic concept revisited. Med Teach 2002;24:241-244. https://doi.org/10.1080/01421590220134060        [ Links ]

15. Tai JHM, Canny BJ, Haines TP, Molloy EK. Implementing peer learning in clinical education: A framework to address challenges in the 'real world. Teach Learn Med 2017;29(2):162-172. https://doi.org/10.1080/10401334.2016.1247000        [ Links ]

16. Lindeman BM, Lipsett PA. Evaluation and feedback. In: Thomas PA, Kern DE, Hughes MT, Chen BY, eds. Curriculum development for medical education: A six-step approach. Baltimore, MA: Johns Hopkins University Press, 2016:121-167.         [ Links ]

17. Balilah M, Babgi M, Alnemari W, et al. A proposed framework to develop, describe and evaluate peer-assisted learning programmes. Adv Med Educ Pract 2020;11:1005-1013. https://doi.org/10.2147/AMEP.S282582        [ Links ]

18. Guraya SY, Adballa ME. Determining the effectiveness of peer-assisted learning in medical education: A systematic review and meta-analysis. J Taibah Univ Med Sci 2020;15(3):177-184. https://doi.org/10.1016/j.jtumed.2020.05.002        [ Links ]

 

 

Correspondence:
R Slabbert
sslabbert@cut.ac.za

Received 15 November 2023
Accepted 6 June 2024