title: Clinical skills education: outcomes of relationships between junior medical students, senior peers and simulated patients.
abstract: OBJECTIVE
  Peer-assisted learning (PAL) has been reported to have educational benefits in cross-year, small-group teaching in other contexts. Accordingly, we explored whether senior medical students are effective tutors for their junior peers in clinical skills education, and how the participants in the learning triad (tutors, learners and simulated patients [SPs]) perceive the learning environment created in PAL.
  
  
  METHODS
  Year 2 students were randomly allocated to one of two groups for skills training. Group 1 (n = 64) were tutored by volunteer Year 6 students, and Group 2 (n = 67) by paid doctors. The results of both groups in a clinical skills examination were compared using an independent samples t-test. Qualitative data, obtained from Year 2 students (n = 125) by written questionnaire and Year 6 students (n = 11) and SPs (n = 3) by focus group interviews, were analysed for themes.
  
  
  RESULTS
  Students receiving PAL did at least as well in the clinical skills examination as students with qualified tutors (difference in mean total score: 0.7 marks out of 112; 95% confidence interval--8 to 2.4). The PAL environment was perceived as 'comfortable' and fostered the development of confidence in all participants. Peer tutors created a more active learning environment than doctor tutors for both learners and SPs and reported personal benefits from teaching.
  
  
  CONCLUSIONS
  With appropriate support, volunteer Year 6 student tutors are as effective as graduate doctors for small-group structured tutorials in clinical skills. Educational relationships were forged between all participants in the learning triad.
authors.affiliation: Graduate School of Medicine, Faculty of Health and Behavioural Science, University of Wollongong, Wollongong, New South Wales, Australia. nickyh@uow.edu.au
authors.forename: J Nicky
authors.initials: JN
authors.lastname: Hudson
authors.forename: Anne L
authors.initials: AL
authors.lastname: Tonkin
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D002983:Clinical Competence / Q000592:standards*; D004504:Education, Medical, Undergraduate; D006801:Humans; D007400:Interprofessional Relations; D016544:Patient Simulation; D010379:Peer Group; D013337:Students, Medical / Q000523:psychology*