Thirteen peer teachers (9 female, 4 male) agreed to participate. Three of them stopped being a peer teacher after 1 year. The other 10 peer teachers were tracked for 2 years. In total we gathered 47 interviews (34 face-to-face interviews and 13 mailings) (Table 3).
Table 2 illustrates the most relevant codes generated through our analyses addressing a variety of aspects concerning PAL. During analysis we built ‘themes’ to understand how peer teachers experienced their PAL period. These themes are presented in a mind map in Fig. 3. The 4 themes identified were 1) change in motivation 2) self-efficacy in clinical and teaching skills, 3) becoming a role model and 4) developing maturity by integrating the CanMEDS roles [14].
In the following section, we indicated the occurrence of different CanMEDS roles using the previously mentioned abbreviations (background), f.e. results based on interview data referring to the role of the Medical Expert is indicated (ME).
Changing motivation from personal benefit to helping others
There were different reasons for each peer teacher to enroll in the program (Tables 3 and 4). Most peer teachers applied for the program to develop certain skills (as speaking in front of a group or learning to teach). Some students were inspired by the previous peer teachers and wanted to offer the students the same chances of practicing skills they had experienced (S).
During the interviews several peer teachers indicated that their motivation had changed over time. One peer teacher admitted having started the program for his own development, but he felt so satisfied by the positive responses of the students that teaching others became his new motive (S). Another peer teacher enjoyed the way his teaching skills developed and learned that every doctor needs these skills in their professional life (P). It enhanced his motivation. Illustrating quotes are displayed in Table 5.
More self-efficacy in clinical and teaching skills
Peer teachers developed confidence in their clinical and teaching skills. This was built through the affirmation that they received from staff members, students, and fellow peer teachers. Peer teachers also learned through the questions that students asked them, especially when they were challenged to really think about their subject matter. If the student did not understand it, this made them realize that there can be different views and they learned to use a different perspective in their teaching (S). Some peer teachers indicated that they maybe didn’t improve their skills, but above all they felt more confident in their skills through the program. They also demonstrated their self-confidence to (simulated) patients during consultation practice lessons. This is an important step in building the doctor-patient relationship, even more so during ’embarrassing’ examinations, such as a gynecological exam (CR).
The peer teachers reported to take more initiative because of their increased self-confidence in clinical skills during electives (e.g., requesting to suture wounds on patients). Furthermore, peer teachers learned to become calmer during stressful situations. Here, they mainly referred to the stressful OSCE exam. An Illustrating quote is displayed in Table 6.
Becoming a role model for their peers
Peer teachers were becoming a role model for their students and each other as they developed their clinical and teaching skills and inspired others. Peer teachers felt responsible for effectively teaching skills. In doing so, they encountered their own shortcomings and learned to deal with them (P). Unanimously, they indicated that they had no problems consulting a colleague or a present teacher (CL). They learned that it is normal to occasionally feel insecure and to not know something (P). Even as a future doctor, this can occur. After all, you cannot know everything, they answered firmly. An Illustrating quote is displayed in Table 7.
Developing maturity
We defined mature students as students who have more life experiences outside the standard curriculum. During the interviews the peer teachers provided insight into how they developed maturity by integrating the different CanMEDS roles.
The practice sessions always started with a short plenary session. Peer teachers stepped out of their comfort zone (P) by speaking in front of a group (S) together with their peers (CL) which stimulated them to reflect on their communications skills (CR) afterwards. Doing this simple act, 4 different CanMEDS roles were addressed.
Peer teachers rehearsed the skills of their topic very regularly. As a result, they developed a routine (ME). Some even called it an ‘automaticity’. This approach gave them a sense of clarity, allowing them to fully focus on the patient’s history (CR) and enhancing their clinical diagnostic reasoning skills (ME).
The peer teachers worked in small groups of 3 to 6 peer teachers per topic and were all responsible for the content of the practice session. This taught them how to function in a team (CL, P). They reflected on their own strengths and weaknesses as team members and thought about how they aimed to function in a team the next year during their internship (CL).
Based on the peer teachers’ experiences PAL seemed to stimulate the process of ‘learning to obtain good grades in exams’, to ‘learning to be a good doctor’. The tipping point was situated at the transition from Bachelor to Master. They realized that the purpose of learning for an examination was not to perform it on a simulation patient, but rather to understand the underlying cause of the patient’s symptoms (ME, HA). They occasionally felt a bit uncomfortable when students from lower academic years were primarily concerned with acquiring skills for upcoming exams rather than prioritizing their development as future doctors.
As a result, they derived enjoyment when they were asked to assist in training professionals, f.e. a workshop suturing for sailors. They then experienced how the questions asked were very focused on what was happening in practice.
By working on the same material each time, the peer teachers expressed noticing how they made the material their own and developed even their own style. Illustrating quotes are displayed in Table 8.
Longitudinal perspective
Although the analysis is based on the data of all participants, we now present 4 cases to better illustrate the influence of being a peer teacher on medical students’ personal and professional development over time. Each quote used in this section is contextualized within the specific timeframe of the peer teachers’ academic journey, denoting their respective semesters in Master 1 (semester 1 and 2) and Master 2 (semester 3 and 4).
Peer teacher 3: “It is sometimes difficult for me to speak in front of a large group.”
This peer teacher not only learned to present to a group, but also experienced that she is allowed to make mistakes. She has learned to step out of her comfort zone and to find her place in a team (P, CL).
By doing this regularly, they developed confidence. Even when unexpected situations arise, such as when fellow peer teachers were absent, and they had to deal with the class on their own (P). Illustrating quotes are displayed in Table 9.
Peer teacher 12: “It’s about humans.”
This student made it very clear how she slowly grew into her role as a future doctor and how important it was for her that the previous peer teachers acted as role models.
The previous generation of peer teachers acted as mentors for the current peer teachers, providing an example of the desired characteristics of an effective peer teacher. Illustrating quotes are displayed in Table 10.
Peer teacher 10: “I find it amazing how much confidence that students have in us.”
This student learned to reflect on his own learning and experiences to take more initiative.
Unlike many other peer teachers, he revealed himself to be a rather nonchalant student who planned everything at the last minute.
As the sessions progressed and he further developed into his role as a peer teacher, he reflected on his preparation. He recognized that he was no longer solely responsible for his own teaching, but that he now had the responsibility of teaching others.
He literally said how his motivation shifted from personal benefits towards benefiting others and how amazed he was by the confidence students had in the peer teachers. He was becoming a role model himself. Illustrating quotes are displayed in Table 11.
Peer teacher 8: “Teaching isn’t really for me.”
This peer teacher saw in his peers a clear role model who helped him grow into a better teacher. Throughout the interviews his teaching skills and his self-confidence as a teacher grew.
For most peer teachers, it was a conscious decision to sign up for PAL. In the case of Peer teacher 8, we saw a different story. He responded to a call launched because peer teachers were still needed for a particular topic. Given his hobby as an ambulance driver, he knew he had enough expertise, but did not see himself as a ‘teacher’ at all. Hoping to grow and develop, he became a peer teacher. Throughout the interviews he provided feedback on how he observed fellow peer teachers during practice sessions (their teaching style, how they improve students) and he followed these examples to further develop his own teaching skills (P). Illustrating quotes are displayed in Table 12.
