A study of medical students' peer learning on clinical placements: What they have taught themselves to do

Peer assisted learning (PAL) is implemented in many undergraduate medical programs, largely in classroom-based learning. There is relatively less knowledge about the use of PAL in clinical education environments. This study explores how PAL is experienced and perceived by Year 3 medical students who are new to the clinical environment. Students across urban/metropolitan sites, rural sites, and an international site (Malaysia) were invited to participate in a cross-sectional survey; 54 of a potential 415 students responded. We found that students are already using PAL on their clinical placements and can see its value. PAL not only occurs in structured events within the curriculum, such as Problem Based Learning (PBL) or bedside tutorials, but also in unstructured and student-prompted ways, such as debriefing cases at lunch time, observation of practice on the ward, and self-selected study groups outside clinical placement. These PAL activities in the clinical environment are yet to be mapped within the literature. Importantly, contrary to previous studies, PAL was not reported to increase competition amongst students and a drive for social acceptance was not reported to hinder honest peer-to-peer feedback. Despite the "organic" episodes of PAL on clinical placements, students reported that they needed more PAL education and training. Students are reticent to judge their peers' performance, not because of social pressures, but due to a lack of confidence in knowing performance targets. Observational research is suggested as a way to further explore these trends and to inform development of helpful PAL strategies for learners.