Rethinking How to Introduce the Learning Sciences: a Near-Peer Approach

Abstract

To address the problem of students cramming for examinations using short-term memorization, we developed an interactive session for first-year medical students in which a near-peer discussed evidence-based learning strategies and how to apply them to specific curricular activities to promote long-term retention and deep understanding. Immediate and delayed post-survey data suggested this new session promoted adoption of evidence-based learning strategies and was well-received by students.

Background

Tasked with learning extensive new knowledge, many students must adapt their approach to studying in medical school to promote durable retention and application of knowledge. To facilitate this learning, our first-year curriculum previously included a lecture by faculty introducing students to evidence-based learning strategies from the learning sciences. A student focus group revealed that our faculty-led approach of disproving “myths” about learning (such as discouraging the use of cramming) was ineffective and led students to feel defensive about their prior learning strategies, such as highlighting texts or studying isolated topics just before an exam. Students also emphasized the need to move away from abstract theory and instead provide concrete examples of effective study strategies that they could apply within their curriculum.

Activity

To make evidence-based learning strategies more accessible, we revised our approach to teaching the learning sciences by developing an interactive session led by a near-peer. Peer-assisted learning, well established in medical education, is broadly defined as learning facilitated by a near-peer at the same or a level above the learner. Near-peer learning succeeds because of cognitive congruence, or the similarity of recent learning experience and training level. Medical students have highlighted near-peers’ ability to better understand their learning difficulties as a strength of near-peer teaching [1]. We found no reports on near-peer teaching related to the learning sciences.

A second-year medical student familiar with evidence-based learning strategies through review of the literature and discussions with an education scientist at the institution designed and facilitated the session. This optional 50-min-long interactive session for all first-year medical students occurred in their first month of classes. Drawing from a review of the effectiveness of various learning techniques, the session included the following five evidence-based learning science strategies: interleaving, distributed practice, retrieval practice, elaboration, and dual coding [2].

The session began with a brief interactive discussion about the unique challenges of learning during medical school, such as the high volume of content. During this discussion, students shared aloud with their peers seated nearby the challenges they had noticed within their first few weeks of medical school, and what seemed different about learning in medical school compared to prior educational experiences. Some students then shared with the entire class key points from their discussion. Next, the near-peer discussed the five evidence-based learning science strategies. Because the near-peer teacher was familiar with the students’ requirements, she provided specific examples of how to apply each learning strategy to their own coursework. For example, in the discussion of interleaving and distributed practice, she used the course calendar to map out a hypothetical detailed study plan that spaced out her studying for the upcoming exam. When discussing retrieval practice, the near-peer encouraged students to first attempt their weekly required formative quizzes without looking at notes. During the discussion of elaboration, the near-peer suggested that students take the time to compare and contrast different patient cases that are presented in class, in order to understand the similarities and differences among various pathologies covered in class. And lastly, when discussing dual coding, the near-peer showcased pictures of a classmate’s notes from a physiology course, in which the classmate had drawn and labeled her own diagrams in order to synthesize the material. To promote commitment to change, the session included multiple breakouts where students discussed specific techniques they planned to try within the next week. Though the session was optional, the majority of students attended. The near-peer purposely chose supportive language to avoid phrases that students previously interpreted as punitive.

To evaluate the curriculum, we distributed an immediate 9-item post-survey within an hour after the session ended and required that it be returned within 2 days. We then administered a delayed post-survey 8 weeks later to all students who attended the session. This delayed post-survey was returned within 1 week of its administration. Questions included 23 items with one open-ended question.

Results and Discussion

Overall response rate to the immediate post-survey was 63.4% (97/153). Immediate and delayed post-survey data suggested this new session promoted the adoption of evidence-based learning strategies and were well-received by students. Importantly, 89.7% (87/97) of respondents endorsed learning a new evidence-based learning strategy from this session and 88.6% (86/97) reported being “quite likely” or “extremely likely” to try a new learning strategy based on this session (Table 1). In the delayed post-survey, all respondents endorsed using a new learning strategy since the session, with interleaving being the most frequently endorsed (15/22) (Table 2). When asked to describe what changes students made to their studying methods as a result of this session, one wrote: “I used distributed practice over the course of this block by recapping information every few days to consistently reinforce material.” Another student demonstrated a shift toward interleaving, stating that they “purposefully and deliberately time short bursts of studying for different topics instead of one topic studying for longer time periods.” Survey data also showed that upon entering medical school, students found that long-term retention and deep understanding became greater priorities than before, supporting the importance of teaching evidence-based learning techniques early in the curriculum. An additional key lesson was that having a near-peer as the primary facilitator for teaching the learning sciences was instrumental; 85.6% (83/97) of respondents to the immediate post-survey reported that it was “quite important” or “essential” to have a near-peer lead this session. After a previous attempt to integrate the learning sciences into our formal curriculum, we found that a near-peer facilitator, avoidance of a corrective tone, and direct applications to the medical school curriculum through examples contribute to the success of this educational intervention.

Table 1.

Responses from 97 first-year medical students to a survey immediately after a session on learning strategies

Question	Mean (SD)
Now that you are in medical school, when selecting a study strategy, how important are the following? *
Efficiency of studying (mean, SD)	4.69 (0.50)
Ability to perform well on a test (mean, SD)	4.07 (0.90)
Memorization of facts (mean, SD)	3.70 (0.90)
Conceptual understanding (mean, SD)	4.72 (0.54)
Long-term retention (mean, SD)	4.84 (0.44)
Deep understanding (mean, SD)	4.71 (0.56)
In this lecture, did you learn an evidence-based study strategy that you had NOT been using already? (N (%) answering yes)	87 (89.7)
How likely are you to try one of the evidence-based learning strategies presented in this lecture?**	4.36 (0.79)
How important is it to you as a student that these study strategies were taught by a peer teacher that has taken this course?*	4.03 (0.87)

*1 not important, 2 slightly important, 3 moderately important, 4 quite important, 5 essential

**1 not at all likely, 2 slightly likely, 3 moderately likely, 4 quite likely, 5 extremely likely

Table 2.

Responses from 22 first-year medical students to a survey 8 weeks after a session on learning strategies

Question	Mean (SD)
So far in medical school, how often have you used the study strategies listed below? *
Cramming in the hours or days prior to a test	2.45 (1.18)
Highlighting text	3.05 (1.20)
Re-reading text	3.19 (1.03)
Studying one subject at a time during a study session	3.18 (1.01)
Now that you are in medical school, when selecting a study strategy, how important are the following?**
Efficiency of studying	4.72 (0.55)
Ability to perform well on a test	4.05 (0.80)
Memorization of facts	3.55 (0.96)
Conceptual understanding	4.77 (0.43)
Long-term retention	4.18 (0.66)
Deep understanding	4.09 (0.87)
Did you try out a new learning strategy because of this lecture? Select all that apply. (N (%) answering yes)	22 (100)
Interleaving (alternating between topics while studying)	15 (68.2)
Retrieval practice (recalling information from long-term memory)	14 (63.6)
Distributed practice (spacing out study sessions over an extended period of time—the opposite of cramming)	13 (59.1)
Dual coding (combining words and visuals)	10 (45.5)
How often are you using one of the 5 learning strategies presented in this lecture?*
Interleaving (alternating between topics while studying)	3.54 (1.01)
Retrieval practice (recalling information from long-term memory)	3.77 (0.87)
Distributed practice (spacing out study sessions over an extended period of time—the opposite of cramming)	3.91 (0.87)
Elaboration (explaining a concept in your own words, and thinking about how it relates to concepts you have already learned)	3.95 (0.79)
Dual coding (combining words and visuals)	2.91 (1.15)
How important is it that these study strategies were taught by one of your peers (a second or third-year med student who has gone through your curriculum), rather than a faculty member?**	3.45 (1.1)

*1 almost never, 2 once in a while, 3 sometimes, 4 often, 5 almost always

**1 not important, 2 slightly important, 3 moderately important, 4 quite important, 5 essential

Authors’ Contributions

AR contributed to the conception, design, and implementation of this curriculum, as well as data collection and analysis and writing the drafts and final version of this manuscript. SW contributed to the conception, design, and implementation of this curriculum, as well as securing institutional review board (IRB) approval, and contributing to the drafts of this manuscript. CB contributed to the conception and design of the original session described in this manuscript, upon which our new session was based. CB also gave input on data analysis and contributed to drafts of this manuscript. KEH contributed to the design of this session and drafting of this manuscript, including providing important intellectual content. All authors approved the final manuscript for publication.

Funding

No funding was sought or provided for this curriculum development project and study.

Data Availability

Not applicable.

Compliance with Ethical Standards

Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.