Peer Assisted Learning in Sophomore Anatomy & Physiology II Laboratory: an Ultrahybrid Design

1. Peer Assisted Learning in Sophomore Anatomy & Physiology II Laboratory: an Ultrahybrid Design George A. Steer PhD Michael L. Slaughter MS Kimberly Whiter MS Chase Poulsen PhD Elliot Carhart PhD

2. Peer Assisted Learning in Sophomore Anatomy & Physiology II Laboratory: an Ultrahybrid Design • Discussion • Personal experience(s) with peer tutors? • Successes • Problems • Courses • Sciences vs. Humanities

3. IntroductionOur Considerations • Anatomy & Physiology • Required by essentially all programs of study • Lack of success in sequence of scheduled program delays full progression for one year • AS programs - freshman course • Interprofessional Education • Institutional and Organizational commitment • Virginia Tech Carilion School of Medicine and Jefferson College of Health Sciences – Physician Assistant & MS Nursing

4. IntroductionReal Attachment • All undergraduate students will be working in teams after graduation • IPE team building courses – upper level courses @ JCHS • Introduces interprofessional team care at earliest stages of academic development • Makes the lab tangible – somebody does this every day • Why do I care • Get through Dr. Steer’s lab so I can move on

5. Introduction National perspective • Student success in undergraduate A&P is a focus of many institutions - nationally • Foundational course for all health professions • Attrition rates are as high as 40-70% in basic science courses despite increasing SAT scores and admission GPA • Two methods to improve student success in A&P are • required or voluntary recitation sections • Peer Assisted Learning (PAL)

6. Introduction Peer Assisted Learning • Student acceptance, recommendation and benefit from PAL has been empirically established across math and some science disciplines • PAL is characterized by three different methods; • a) “same-level equal status” students of the same class with equal knowledge • b) “same-level unequal status” students of the same cohort but with unequal expertise and/or training - higher performers in the course and, • c) “cross-level“ students of higher academic level, upperclassmen, tutor students of lower academic ranking, underclassmen. Previously taken the course and performed well.

7. Same Level Equal & Unequal Status • No improvement in lecture examination performance in gross anatomy • Requires significant faculty time for preparation of the student tutor – ensure consistent information delivery • Students described concern over the inadequate teaching performance of the tutor • Undergraduate human A&P student concerns • miscommunication, delivery of erroneous information and inability to stay on task

8. Cross Level Peer Tutors • Physician and nurse practitioner programs in the UK have positive outcomes and views of clinical training activities • Still requires significant time for faculty preparation of the tutors

9. Hybrid Cross Level Peer Tutor • We created a variation of Cross Level Tutors using students from several health care professional programs • Students from various health professional programs assist in the anatomy and physiology II laboratories • Peer tutors have displayed competency in laboratory exercises within their professional programs – technical experts in the exercise • Eliminates the vast majority of faculty time investment for tutor preparation

10. Hybrid Cross Level Peer Tutor • This study piloted a hybrid PAL activity where educators and students from various health professions programs delivered and assisted in A&P II lab exercises • The educator and student tutors delivered discipline-specific information during four standard laboratory exercises

11. Hybrid Cross Level Peer Tutor • Tutors participate in laboratory activities where they are the discipline specific expert • Medical Laboratory Science • Blood typing, blood cell differentiation and urinalysis • Emergency Medical Science • Blood pressure, ECG • Respiratory Therapy • Breathing & Respiratory Volumes

12. Goals • Promote the institutional philosophy of interprofessional education activities while utilizing current resources to improve the student learning experience • Assess students’ recognition of the direct applicability of the laboratory activity to healthcare practice and the professional who performs the procedure • Assess the students’ perspective on the benefit of PAL to understanding the principles of the exercise

14. Methods • Three A&P II laboratory sections participated in the study; • a control group (n1= 24) with a professor to student ratio of 1 to 12-20 received standard content delivery • an intervention group PAL (n2 = 17)that had a tutor to student ratio of 1:4 plus 2 faculty members. • The PAL group had a faculty member and five student tutors from either the Medical Laboratory Science, Respiratory Therapy or Emergency Services programs

15. Methods • At the end of each laboratory session both groups completed a seven question survey (6 pt Likert), to assess students’ perception of the laboratory activities • Survey was developed by an expert panel using a consensus approach

16. Please indicate your agreement or disagreement with each of the following statements using the following scale - circle your answer below each statement Strongly Disagree; Disagree, Somewhat Disagree; Somewhat Agree; Agree and Strongly Agree This lab exercise was beneficial to my understanding of the material. I received an appropriate amount of individualized attention to learn the material during this lab exercise. I do not understand how the content of this lab exercise is applied to “real life” health care situations. I am able to recognize which health professions utilize the content of this lab exercise within their scope of practice. The content of this lab exercise did not reinforce the knowledge covered in lecture. The content covered in this lab exercise is relevant to my future clinical practice. I believe the Pre-Laboratory assignments were useful for understanding and comprehension of the material.

17. Results • Independent-sample t-test s indicate a significant difference between groups within Survey Question (SQ)1,2, and 7. See Fig. 1. These included: • (1) “This lab exercise was beneficial to my understanding of the material” • (2) “I received an appropriate amount of individualized attention to learn the material during this lab exercise” • (7) “Rate the pre-laboratory assignments with respect to the usefulness for understanding the material” • Students approached a significant difference in recognizing which profession performed the procedure (p=.071) and its application to their future clinical practice (p=.095).

18. Fig 1.

19. Preparing labs required planning time with the professional students, but proved to be a great student learning experience The Medical Laboratory Science labs required some theory delivery, to A&P student prior to performance of activity, which was provided by the faculty with the aid of professional students PAL activity greatly increased interactions within the groups of students. Students from different plans of study conversed in a focused manner to deliver the contents of their activity. Faculty Comments

20. Discussion • We were able to design a program which: • Dramatically reduced the instructor to student ratio • Upgrades 2 laboratory sessions from “paper” to hands on; lung volumes and ECG and expand others. • Assess the students’ perspectives of key components of their educational experience • Incorporates interprofessional education and awareness and clinical application of laboratory exercises into the earliest stages of the students’ pre-professional academic development.

21. Discussion • Obstacles • Scheduling and availability of faculty and students • JCHS not possible • Cost, although minimal for this study, would be increased if all sections were included. Larger institution a real consideration • Limitations of the study • Population (age, academic development) , class size, and location • Survey question #5 - actual lecture and lab coordination – too late • Assumptions • equality of professor(s), students, and content - to enable group comparisons.

22. References • Tenney A, Houck B. Peer led team learning in introductory biology and chemistry courses: A parallel approach. J Math Sci: Collab Expl. 2003;6:11-20 • Crouch CH, Mazur E. Peer Instruction: Ten years of experience and results. Am J Phys. 2001 Sept;69(9):970-979. • Falchikov N. Learning together. Peer tutoring in higher education. London: RoutledgeFalmer; 2001. • Bently BS, Hill RV. Objective and subjective assessment of reciprocal peer teaching in medical gross anatomy laboratory. Anat Sci Educ. 2009 July/Aug;2:143-149. • Krych AJ, March CN, Bryan RE, Peake BJ, Pawlina W, Carmichael SW. Reciprocal peer teaching: Students teaching students in the gross anatomy laboratory. Clin Anat. 2005;18:296-301. • Hughes K. Peer-assisted learning strategies in human anatomy and physiology. Am Biol Teach. 2011 Mar;73(3):144-147. • Gill D, Parker C, Spooner M, Thomas M, Ambrose K, Richardson J. Tomorrow’s doctors and nurses: Peer assisted learning. Clin Teach. 2006;3(1):13-18. • Saunders C, Smith A, Watson H, Nimmo A, Morrison M, Fawcett T, Tocher J, Ross M. The experience of interdisciplinary peer-assisted learning (PAL). Clin Teach. 2012;9:398-402.