The Interplay Of Learning Culture And Medical Students’ Perspectives Towards A Newly Implemented Near-peer Teaching Programme

Abstract

Background: Near-peer teaching (NPT) has gained recognition as an effective pedagogical tool in medical education, with abundant literature supporting its benefits. However, little is known regarding students’ attitudes and perceptions towards newly implemented NPT programmes, with limited studies exploring the learning culture in which NPT is established. The development of NPT initiatives may be enhanced by gaining insight into students’ learning culture – the shared beliefs, values and assumptions that constitute an institution’s learning environment – and its interaction with students’ perspectives towards NPT. Aim: The aim of this study was to explore how students’ learning culture intersects with their attitudes and perceptions towards a novel NPT programme, thereby evaluate the potential contributions of NPT to the enhancement of medical education. Methods: A qualitative study was conducted. Medical students in their second and fifth year from a single institution in Hong Kong, who participated in a new student-initiated NPT programme as peer learners (PLs) and peer teachers (PTs) respectively, were involved in the study. After the conclusion of the NPT programme, 9 PLs and 3 PTs were recruited via purposive sampling to participate in semi-structured interviews. Thematic analysis of the transcribed interviews was conducted by two independent researchers who identified and coded recurrent themes, which were later revised with differences resolved by consensus. Results: Three core themes were identified from the qualitative data in terms of aspects of students’ learning culture that influenced their experience of NPT: students’ (1) learning priorities, (2) self- and peer-evaluation as learners and teachers, and (3) perceived norms of interactions between students. PTs and PLs’ differential learning priorities, in terms of their orientation towards improving their examination performance versus clinical acumen, were significantly influenced by their learning contexts. This further impacted their appraisal of NPT’s academic value as primarily a tool for revision or for facilitating the preclinical-to-clinical transition. The propensity for students to evaluate themselves and their peers in terms of the perceived extent of one’s medical knowledge manifested as doubt in NPT’s pedagogical legitimacy compared to formal teaching delivered by lecturers and clinicians, perceived by students as more trustworthy knowledge-providers. Beyond academics, NPT was considered a potential social platform for enhancing inter-cohort interactions and support, among a competitive learning environment with inadequate psychosocial support systems for students who largely adopted an individualistic approach to learning. Conclusion: Students’ attitudes and perceptions of NPT cannot be untied from the learning culture within which NPT arises. This study highlights the ways in which the specific sociocultural context of an NPT programme directly informs its feasibility, efficacy and role within medical education. While NPT serves as a bridge between the preclinical and clinical years of medical schooling in both academic and interpersonal ways, its acceptability to students may be impacted by concerns surrounding its pedagogical legitimacy and quality. Further research is required to elucidate the extent to which learning culture influences students’ perceptions of NPT, both longitudinally and across broader sociocultural and disciplinary contexts.