What is peer-assisted learning (PAL)?
Peer-Assisted Learning (PAL) has roots in educational research dating back to 1993 when it was developed to enhance learning through collaboration. The idea was simple but powerful: students learn better when they learn together. By harnessing the benefits of peer tutoring, PAL aimed to support diverse learning needs and improve educational outcomes.
One of the key figures in this movement was Fuchs, whose work focused on making education more inclusive and effective. The approach recognised that learning is not just about absorbing information from an expert—it’s also about the social aspects of learning, where students teach, support, and challenge each other in ways that traditional teaching alone may not achieve.
From its early days, PAL has grown into a well-established educational strategy that is widely used in medicine and healthcare training. But why is it so effective? It comes down to how we process and retain information when we engage in active discussions, explain concepts to others, and receive feedback from our peers. The interactive nature of PAL makes learning more engaging, reinforcing knowledge in a meaningful and memorable way.
What are the benefits of Peer-Assisted Learning (PAL)?
PAL offers many benefits, making it a valuable tool in education, particularly in healthcare training.
- Better academic performance – Learning alongside peers fosters collaboration, helping students grasp complex concepts more effectively.
- Stronger knowledge retention and clinical skills – Teaching and discussing topics with others reinforces understanding and improves practical application.
- Higher engagement – Students are more actively involved in learning when participating in discussions and peer-led sessions.
- Encourages self-directed learning – This is a game-changer. When students take the lead in their education, they develop autonomy and confidence—skills that will serve them well throughout their careers.
- Creates a supportive, nonjudgmental environment—Learning from peers can feel less intimidating than traditional teaching methods, making it easier to ask questions and clarify uncertainties.
- Prepares students for future teaching roles – In healthcare, teaching is a core responsibility. PAL helps students develop the skills they’ll need when they, in turn, become educators for the next generation of learners.
What makes PAL effective?
The Master Adaptive Learner (MAL) model, introduced around 2017, set a new benchmark for clinical expertise. Rather than focusing solely on efficiency and technical competence, the MAL model emphasises the development of adaptive experts—clinicians who can navigate the complexities of modern healthcare with both efficiency and innovation.
One of the key strengths of the MAL approach is its ability to optimise learning transfer. In other words, it ensures that today’s knowledge and skills remain relevant and applicable to new and evolving clinical challenges. This adaptability is crucial in a fast-changing healthcare environment, where guidelines, treatments, and technologies are constantly advancing.
When applied over time, the MAL model fosters key traits in clinicians, including adaptability, reflexivity, curiosity, and a continuously deepening understanding of medicine. By encouraging these habits, the model supports lifelong learning and the ability to navigate the ever-evolving challenges of healthcare.
Following the Master Adaptive Learner (MAL) model, a trainee in the emergency department can reflect on a trauma case using a structured four-stage process:
- Planning – Before the case, the trainee collaborates with their supervisor to set specific learning goals, such as improving rapid assessment skills or refining their approach to traumatic brain injury management. This phase ensures a clear focus on what they aim to learn.
- Learning – During the case, the trainee actively participates in patient assessment and management, applying their knowledge in real time while making critical decisions under supervision. This hands-on experience reinforces emergency protocols and sharpens clinical reasoning under pressure.
- Assessing—After the case, the trainee participates in a debrief, reflecting on their performance and identifying areas for growth. Supervisors provide feedback, highlighting strengths and pinpointing areas for improvement—whether that’s refining decision-making speed or enhancing team communication.
- Adjusting – With this feedback, the trainee adapts their approach for future cases. They might practise rapid assessments in simulations or explore further resources on trauma care. This step ensures ongoing growth, helping them become more confident and adaptable in high-pressure situations.
By cycling through this process, trainees develop the skills and mindset needed to improve and adapt continually—a crucial trait for any emergency clinician.
Why is peer-assisted learning important in the ED?
Trainees in emergency departments operate under intense pressure, where the need for rapid, accurate decisions can be overwhelming. The fast pace, high stakes, and emotional weight of managing life-threatening situations can lead to stress, anxiety, and mental blocks, all of which can impact performance.
The key to overcoming these challenges lies in developing critical thinking skills. By refining their ability to assess and respond effectively in high-pressure scenarios, trainees can boost confidence, reduce anxiety, and improve decision-making—ultimately leading to better patient care. Various teaching methods have been explored to support this, but how we approach learning in the emergency department could be just as crucial as the skills themselves.
Most of the time, our choice of educational methods is driven by the need to build competencies, clarify complex concepts, or help trainees pass exams. But what if a simple shift in how we teach could significantly improve patient outcomes? What if the key to saving more lives in emergency medicine isn’t just better technology, but a stronger culture of learning and collaboration?
How can we use peer-assisted learning?
Point-of-Care Teaching
Point-of-care teaching is a hands-on educational approach that takes place directly at the bedside or within the clinical environment. It allows trainees to bridge the gap between theory and practice, applying their knowledge in real time while guided by experienced clinicians. This method emphasises learning through experience, with the added benefit of immediate feedback, helping trainees refine their skills and decision-making.
Point-of-care teaching offers several key benefits for medical trainees. Linking theory with practice enhances learning and improves knowledge retention. The opportunity for immediate feedback allows trainees to refine their skills and decision-making in real time, fostering continuous improvement. This approach strengthens patient-centred care by integrating clinical reasoning with direct patient interaction. Additionally, it promotes the development of critical thinking and adaptability—essential skills for navigating the complexities of clinical practice.
Bite-Sized Teaching
Bite-sized teaching delivers educational content in short, focused segments, making learning more efficient and engaging. By using concise lessons, quick case discussions, flashcards, or mobile apps, educators can help trainees build knowledge and skills without overwhelming them. This method is especially valuable in fast-paced environments like emergency departments, where time is limited but learning remains essential.
One of its biggest advantages is time efficiency—short sessions fit seamlessly into busy schedules without disrupting workflow. By emphasising key points, bite-sized teaching also improves retention, making it easier for trainees to recall and apply information when it matters most. Its flexibility allows teaching to take place during shift changes or brief pauses in patient care, maximising learning opportunities. Additionally, it enables targeted learning, focusing on specific skills or knowledge gaps to ensure a more personalised and effective educational experience.
Visual Thinking Strategies for the Critical Eye
Visual Thinking Strategies (VTS) is an innovative teaching method that uses art to strengthen critical thinking, communication, and observational skills through guided discussions. In the emergency department, this approach can be adapted using medical images, encouraging trainees to analyse X-rays, CT scans, or clinical photographs in a structured way. By exploring these images together, they may identify subtle fractures, unusual injury patterns, or early signs of pathology that might otherwise be overlooked.
The facilitator plays a key role, guiding the discussion with open-ended questions like, “What does this fracture pattern suggest about the mechanism of injury?” or “How might this change our treatment approach?” This encourages trainees to justify their observations with evidence, sparking debate and deeper clinical reasoning.
VTS offers several benefits in emergency medicine. It sharpens observational skills, helping trainees pick up critical details in patient assessments. Engaging with visual information this way also strengthens critical thinking, as they practise forming and defending evidence-based conclusions. The process enhances communication skills by encouraging clear articulation of thoughts and active listening. Finally, by discussing different interpretations, trainees develop empathy, gaining insight into the varied perspectives and experiences of their patients.
Take-home message
Effective education and training in healthcare rely on collaboration and a commitment to developing critical thinking in our trainees. As educators, our role extends beyond teaching facts—we are shaping future clinicians who can think independently, adapt to challenges, and lead with insight.
By embracing the mindset of “learn to learn and learn to teach,” we create a culture of continuous growth and shared knowledge. Encouraging trainees to take ownership of their learning and pass on their expertise strengthens not only their development but also the future of healthcare as a whole.
References
Fuchs, D., Fuchs, L. S., Mathes, P. G., & Simmons, D. C. (1997). Peer-Assisted Learning Strategies: Making Classrooms More Responsive to Diversity. American Educational Research Journal, 34(1), 174-206. https://doi.org/10.3102/00028312034001174
Cutrer WB, Miller B, Pusic MV, Mejicano G, Mangrulkar RS, Gruppen LD, Hawkins RE, Skochelak SE, Moore DE Jr. Fostering the Development of Master Adaptive Learners: A Conceptual Model to Guide Skill Acquisition in Medical Education. Acad Med. 2017 Jan;92(1):70-75. doi: 10.1097/ACM.0000000000001323. PMID: 27532867.
