The power of peers: Design-based research on stimulating peer-assisted learning for enhancing the clinical-reasoning...

Peer-assisted learning (PAL) is widely used in undergraduate medical education, and collaborative learning is gaining momentum. Unfortunately, literature shows that students utilise their peers less during undergraduate clerkships, a phase when PAL is known to be particularly useful to students and their clinical-reasoning learning process. For this reason, we investigated the following question: How can we design a workplace for undergraduate students that fosters PAL with regard to enhancing their clinical-reasoning learning practice?

We used a design-based research (DBR) methodology, involving iterative development to address a complex educational issue. Between September 2022 and October 2023, stakeholders participated in four work conferences (WCs). The final output consists of design principles for a workplace to encourage PAL for the enhancement of the clinical-reasoning learning practice for undergraduate students, as well as an evaluated 2-month pilot intervention, 'paired consultation', that aligns with these design principles. This study is conducted in the Netherlands.

A total of 101 individuals participated in this study. In the WCs, design principles were continuously discussed, while an intervention was developed under the guidance of the research group. Discussion topics included reciprocal vulnerability, culture, autonomy, flexibility, ownership, psychological safety, competition and the role of supervisors. Overall, the pilot was considered a success by all involved and small adjustments were made throughout. Students mentioned that observing peers supported their clinical-reasoning learning process. Supervisors expressed growing enthusiasm for PAL.

To ensure successful interventions based on the design principles, three topics deserve attention: (1) Students must share responsibility for learning with peers, (2) supervisors must contribute to the evolution towards a collaborative learning environment and (3) a community of learners within a community of practice can enhance the collaborative learning practice. Further research should focus on guiding the workplace in this transition towards collaborative learning.