RESEARCH REPORT

Perceptions of First-Year Medical Students towards Learning

Anatomy Using Cadaveric Specimens through Peer Teaching
Andee Agius,1* Neville Calleja,2,3 Christian Camenzuli,4,5 Roberta Sultana,6 Richard Pullicino,7
Christian Zammit,5 Jean Calleja Agius,5 Cristoforo Pomara5,8
1
Faculty of Medicine and Surgery, University of Malta, Msida, Malta
2
Directorate for Health Information and Research, Ministry of Health, Valletta, Malta
3
Department of Public Health, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
4
Department of Surgery, Faculty of Medicine and Surgery, University of Malta, Tal-Qroqq, Malta
5
Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
6
Department of Occupational Therapy, Saint Vincent de Paul Long-Term Care Facility, Luqa, Malta
7
The Walton Centre, National Health Service Foundation Trust, Liverpool, United Kingdom
8
Section of Forensic Pathology, Department of Clinical and Experimental Medicine, University of Foggia,
Foggia, Italy

During the last decade, global interest in the multiple benefits of formal peer teaching
has increased. This study aimed to explore the perceptions of first-year medical students
towards the use of peer teaching to learn anatomy using cadaveric specimens. A descrip-
tive, cross-sectional, retrospective survey was carried out. Data were collected using an
online questionnaire which was administered to all medical students who were in their
second year of their medical school curriculum and who had participated in sessions
taught by their peers during their first year. Peer teaching was perceived as an effective
method of learning anatomy by more than half of the participants. Analysis of mean
responses revealed that the peer teachers created a positive, non-intimidating learning
environment. Overall, participants gave positive feedback on their peer teachers. Six cate-
gories emerged from the responses given by participants as to why they would or would
not recommend peer teaching. Ways of improvement as suggested by the respondents
were also reported. Variables found to be significantly associated with the perceived ben-
efits of the peer teaching program included sex differences, educational level and recom-
mendations for peer teaching. This study brings to light the merits and demerits of peer
teaching as viewed through the eyes of the peer learners. Peer teaching provides a sound
platform for teaching and learning anatomy. Further discussions at higher levels are
encouraged in order to explore the feasibility of introducing formal peer teaching in the
medical curriculum. Anat Sci Educ 00: 000–000. V
C 2017 American Association of Anatomists.

Key words: gross anatomy education; medical education; undergraduate education; peer
teaching; peer assisted learning; medical students; anatomy pedagogy; cadaver dissection

INTRODUCTION
*Correspondence to: Ms. Andee Agius, Faculty of Medicine and During the last decade, there has been an increased global
Surgery, University of Malta, 212, St. Catherine Street, Qormi
QRM2208, Malta. E-mail: [email protected] interest in the multiple benefits of formal peer teaching (Evans
Additional Supporting Information can be found in the online version
and Cuffe, 2009; Burgess et al., 2014). The philosophical
of this article. underpinning of peer teaching is that student helps other stu-
Received 12 April 2017; Revised 22 August 2017; Accepted 17 dents learn and in doing so learn in the process (Lockspeiser
October 2017. et al., 2008).
Published online 00 Month 2017 in Wiley Online Library In the past, peer teachers have been referred to as
(wileyonlinelibrary.com). DOI 10.1002/ase.1751 “surrogate” teachers as they were considered a substitute for
the teacher or tutor whose main purpose was to transfer
C 2017 American Association of Anatomists
V knowledge (Topping, 1996). It was considered an effective

Anatomical Sciences Education MONTH 2017 Anat Sci Educ 00:00–00 (2017)
way to transmit knowledge from the “better able” to the been found to be beneficial both for the peer teacher and the
“less capable” students. This definition of peer teaching has peer learner (Krych et al., 2005).
changed throughout the years and peer teaching is no longer Benefits attributed to peer teaching include an increase in
seen as the role of the more gifted students but more as knowledge, understanding and retention of the material pre-
“people from similar social groupings who are not profes- sented, improvement in study habits, more positive attitudes
sional teachers helping each other to learn and learning them- toward the subject, gains in psychological well-being, and
selves by teaching” (Topping, 1996). This implies that the independent self-learning (Lockspeiser et al., 2008; Bruno
peer teachers have the same level of knowledge and experi- et al., 2016; Hanson et al., 2016). Furthermore, being a peer
ence as their fellow students within the same educational teacher has added beneficial outcomes with regard to
cohort and academic year. This is different from “near-peer” improved teaching skills, increased confidence, enhancement
teaching or “cooperative learning,” terms mentioned by in communication skills, and improvement in examination
Whitman (1988), which involves students who are at a more performance (Wong et al., 2007; Lachman et al., 2013).
advanced level in their education teaching other students Research also showed that students who adopt the role of a
(Houwink et al., 2004; Duran et al., 2012, Erie et al., 2013; teacher are more likely to acquire leadership skills that will
Hall et al., 2014). Unfortunately, sometimes these two com- be found useful once they graduate (Weyrich et al., 2008).
monly cited terms “peer-teaching” and “near peer teaching” Apart from facilitating the transition of knowledge, peer
are used interchangeably. Results from a systematic review teaching is a catalyst in bridging the gap from being a student
revealed that 12 out of the 19 included studies focused on to becoming a doctor (Lockspeiser et al., 2008). Adequate
“near peer” teaching (Burgess et al., 2014), indicating that training and continuous supervision from the lecturer is para-
there is a paucity of published data on “peer teaching.” The mount for peer teaching to be successful (Weyrich et al.,
systematic review by Burgess et al. (2014) included studies 2008). Findings from a meta-analysis on students’ outcomes
which focused on both undergraduate and graduate entry on peer teaching versus faculty teaching reported no statisti-
medical education. cal difference in outcomes between students taught by their
Throughout the years, peer teaching has been integrated peers or by faculty members. The authors outlined that when
into a number of medical and allied health courses (Brueckner peer teaching complements faculty teaching, peer teachers are
and MacPherson, 2004; Youdas et al., 2008; Iqbal, 2016; provided with better opportunities to enhance their knowl-
Seenan et al., 2016) and has been identified as an enriching edge and teaching skills (Rees et al., 2016). Findings from a
and effective method for learning (Evans and Cuffe, 2009; retrospective comparative study on summative examination
Bene and Bergus, 2014). Implementation of peer teaching in results of peer teachers and peer learners found that the peer
anatomy using cadaveric specimen has been gaining popularity teachers performed statistically significantly better than peer
(Han et al., 2015; Manyama et al., 2016). Although the merits learners in the practical anatomy spotting test of the subject
of peer teaching are widely known, this method of teaching is material they had taught when compared to all other anat-
still not implemented as a compulsory module in many pro- omy spotting examinations. The authors underlined that
grams of studies and participation in peer teaching remains on although peer teaching is a reciprocal process, it appears to
a voluntary basis (Burgess et al., 2014). Boud (2001) described benefit anatomy peer teachers more than peer learners
the concept of peer teaching as two-way, reciprocal learning (Stabile and Agius, 2017).
that involved the sharing of ideas, knowledge and experience In spite of the time-consumption involved in organizing a
such that both the peer teacher and the peer learner benefit peer teaching program, Ten Cate and Durning (2007) pointed
from the experience. In 2010, a survey conducted in the United out that from the academic point of view, peer teaching may
ease the faculty teaching burden as it facilitates the growing
States highlighted that 99 out of 130 medical schools provided
number of medical students. Similar views were expressed by
medical students with some form of peer teaching whilst fol-
Yu et al. (2011) stating that this method helps ingrain the
lowing the medical program. Additionally, 57 of the above
values of teaching within medical students, which will help
mentioned schools provided a formal medical student-as-
them fulfill their teaching roles in their career as a doctor. In
teachers program (mSAT) to facilitate and guide them in their
fact, the word “doctor” is derived from Latin “docere”
teaching roles (Soriano et al., 2010).
which means to teach. In view of the above, the benefits of
The intrinsic values of verbalization and questioning were
peer teaching are reported to be threefold: to the peer
highlighted as the core components of peer teaching
teacher, the peer learner and the academic body of the univer-
(Topping, 1996). The strong collaboration between the sity. The General Medical Council in United Kingdom stated
learner and the peer teacher is the result of both the that during undergraduate and postgraduate education, all
“cognitive” and “social” congruence between both parties doctors should gain basic skills in teaching and learning
(Lockspeiser et al., 2008). Cognitive congruence refers to the (GMC, 2011). Despite this, undergraduate students are sel-
same level of knowledge and experience that is shared by the dom given the opportunity to teach (Jackson and Evans,
peer teacher and the peer learner. Therefore, peer teachers 2012).
are in a better position than faculty staff to understand Notwithstanding the evidence showing the described bene-
exactly what the students are going through at that point in fits attributed to peer teaching, other published studies have
time as they are experiencing the same struggles and chal- challenged these findings (Ashdown et al., 2013; Rees et al.,
lenges. Social congruence refers to the similar social status of 2016). The extent of the benefits that peer teaching offers
the peer teacher and the peer learner as ultimately both of remains a subject of debate.
them are still students. Therefore, peer teachers are likely to In an effort to address the upsurge of undergraduate medi-
be less authoritarian in their teaching style and student learn- cal students in the Anatomy Department at the University of
ers feel more comfortable in their presence (Schmidt and Malta, peer teaching using cadaveric specimens was intro-
Moust, 1995; Ten Cate and Durning, 2007; Yu et al., 2011; duced in the Musculoskeletal and Integumentary System
Rees et al., 2016). Consequently, this method of teaching has module. The conception of this study emerged following the

2 Agius et al.
introduction of peer teaching within the Department of Anat- that took place in the second semester of the first year of the
omy and due to inconsistencies found in the literature on this Medicine and Surgery course. In the beginning of the second
subject. The aim of the study was to explore the perceptions semester, one of the professors of anatomy introduced the con-
of first-year medical students towards learning anatomy with cept of peer teaching and gave the students an overview of
the use of cadaveric specimens through peer teaching. In what peer teaching involved. Students who showed an interest
order to fulfill this aim, the following objectives were set out: to be peer teachers were encouraged to enroll. While 47 stu-
to identify peer learners’ perceptions towards the use peer dents applied, only 12 peer teachers were required for the
teaching to learn anatomy with cadaveric specimens and to course. The final peer teachers were chosen by simple random
determine the factors associated with the perceived benefits sampling using the lottery method (Elfil and Negida, 2017). In
of the peer teaching program. this way, all those who applied had an equal chance of being
chosen. A systematic review on the effectiveness and impact of
peer-teaching on objective learning outcomes of medical stu-
Teaching of Anatomy in Malta dents underlined that 10 out of 19 articles included studies
that adopted a randomized sampling technique. Most of the
Medical students at the University of Malta follow a 5-year
participants in the respective studies were self-selected volun-
curriculum, which includes two preclinical years and three
teers (Yu et al., 2011). The professor of the course then guided
clinical years. The program includes 50 compulsory study
the peer teachers to study a specific area of the body. For this
units, which make up 60 European Credit Systems (ECTS) to
study, the leg and foot were chosen as the topic. Peer teachers
be covered annually, as per the Bologna Process (Crosier
were then given time to study the theory, familiarize them-
et al., 2015). One ECTS is equivalent to seven contact hours.
selves with the cadaveric specimens in the dissection hall, and
During the preclinical years, the students learn anatomy by
to practice presenting the information to their peers. The pro-
regions, for example, musculoskeletal system (MDS 1008).
fessor of anatomy supervised the whole process and assisted
Each system is a year-long study unit in the first year and car-
the students with the dissections. After 6 weeks of practicing,
ries 10 ECTS, which entails around 70 hours of teaching in
peer teachers gave two video dissections to the whole class.
the form of 30% lectures and seminars, 30% dissection prac-
These videos were prepared by the peer teachers together with
tical sessions, and 40% small group teaching in the form of
the professor of anatomy. Each peer teacher was responsible
clinical sessions and critical thinking skills, apart from indi- for giving a maximum of four prosection sessions. During
vidual study. In critical thinking sessions, clinical cases are these sessions, students were taught in small groups and the
discussed and students are given the opportunity to reflect, peer teachers (two in each session) went over the specimens
analyze, and create a management plan. prepared in the video dissection. This helped to reinforce the
learning and give more individual attention. This method of
MATERIALS AND METHODS teaching was standardized across all groups of students.
This study took the form of a descriptive, cross-sectional, ret-
rospective survey. A cross-sectional survey was chosen given Research Instrument
the intention to explore the perceptions of medical students
toward learning anatomy through peer teaching at a specific An online self-administered questionnaire was used to collect
point in time. Data were collected retrospectively in order to data (see Supplementary material: Survey). Online question-
explore the perceptions of students after they participated in naires were chosen since apart from being convenient for the
peer teacher sessions. The study was approved by the Univer- population under study, they provide a feasible economical
way for distribution and eliminate interviewer bias (Hasson
sity of Malta Research Ethics Committee.
et al., 2015). Since no validated questionnaire was found that
addressed the research objectives, the questionnaire was
Participants devised by the researcher and research supervisor after an
extensive literature review was carried out. The questionnaire
All second-year medical students who took part in peer was divided into six sections with a total of 17 questions. It
teaching during their first year in the course were invited to consisted mainly of closed-ended questions with five open-
participate. A total of 147 students were eligible to partici- ended questions. Open-ended questions were included in
pate. Students who acted as peer teachers in the same year, order to gather a clearer idea of the respondents’ perceptions
students who were repeating their second year and students (Polit and Beck, 2017). Section A consisted of four questions
who participated in the pilot phase of this study were that focused on the demographic characteristics of the partic-
excluded. ipants. Section B focused on the methods that students found
to be effective in learning anatomy. Section C examined the
extent to which peer teaching affected the students’ learning.
Course Outline on Which the Survey Was
Section D targeted gathering information on the students’
Based views on the peer teachers. Section E explored the views of
In previous years, near-peer teaching involving second-year stu- the peer learners on the applicability of peer teaching to other
dents teaching first-year students took place in the Department modules whereas Section F, the final section, focused on the
of Anatomy at the University of Malta. However, this was the participants’ recommendations for peer teaching.
first time that peer teaching, which specifically included first-
year students teaching first-year students, was introduced
Validity of the Questionnaire
among medical students as one of the novel approaches to
learn anatomy. This method of teaching was introduced in one The questionnaire was tested for face and content validity.
of the modules (musculoskeletal and integumentary system) Face validity was established by regular consultation with the

Anatomical Sciences Education MONTH 2017 3

research team and discussion with a number of medical stu- completed, to submit their replies. Students were explained
dents. Content validity was ensured by carrying out an exten- that the submitted questionnaire implied their consent to par-
sive literature review and in depth discussions with experts in ticipate in this study.
the field (the main supervisor, who is a professor of anatomy, In the beginning of the questionnaire, three eligible ques-
and other senior academic members of the Department of tions were devised by the researcher in order to ensure that
Anatomy at the University of Malta) who inspected the ques- students who participated in the pilot phase of the study
tionnaire and ensured that it fulfills the aim and objectives of and peer teachers or medical students who were repeating
the study. their second year of the course were automatically directed
out of the questionnaire. In this way, the questionnaire was
only made available to students who participated in sessions
Reliability Testing of the Research Instrument taught by their peers. Participants were required to fill in
the questionnaire once. The online questionnaire took
A group of 20 students who participated in sessions given by
approximately ten to fifteen minutes to complete. To over-
peer teachers were recruited. The same questionnaire was
come the low response rate attributed with online question-
administered twice to the same cohort of students three
naires (Polit and Beck, 2017) two reminders were sent via
weeks apart. The participants were asked to write the same
e-mail two weeks apart in order to encourage the partici-
“pen name” on both questionnaires. This was explained on
pants to complete the questionnaire. If after the second
the participants’ information sheet. In addition to safeguard-
reminder, participants did not respond no further reminders
ing the respondents’ anonymity, this allowed the researcher were sent.
to compare each participant’s responses generated from both
questionnaires. Test–retest reliability was assessed using the
Cronbach’s a and the Kendall’s tau B. Data Analysis and Presentation
The Cronbach’s a test showed no significant difference
between the responses given in each questionnaire with all All data were exported to the Statistical Package for Social
responses scoring more than >0.6. The Kendall’s tau B test Sciences (SPSS), version 22 (IBM Corp., Armonk, NY).
also showed a good level of association between the two Data were analyzed using descriptive and inferential statis-
questionnaires except for statement C14 “I did not feel the tics depending on the variables being tested. Graphs and
tables were used to present the findings. Additionally, sig-
need to attend the lectures given by the peer teachers,” which
nificance tests were completed to test for relationships
had a low correlation coefficient. After discussion with the
among variables. Tests of significance used included the
research team, this statement was amended to “I did not feel
Mann–Whitney U test and the Spearman rank correlation.
the need to attend the sessions given by the peer teachers.”
A P-value of less than 0.05 was considered statistically sig-
By changing the word from “lectures” to “sessions” potential
nificant. Content analysis was used to analyze the open-
misunderstandings were avoided. For this statement, the
ended questions systematically. To capture the participants’
researcher was referring to both the video dissection lectures
own views, three open-ended questions (D6, D7, and D8)
and the dissection sessions given by the peer teachers. The
were included in the questionnaire. Content analysis was
results obtained from the abovementioned test illustrated that
tailored to group words from the participant responses into
the questionnaire satisfied the test–retest criteria and was reli- a small number of categories selected due to their theoreti-
able (Polit and Beck, 2017). cal value (Bryman, 2012). The responses generated from the
three open-ended questions were reviewed carefully to
Pilot Study and Modifications reveal common categories. This was followed by the devel-
opment of sub-categories for the different emerging catego-
A pilot study was carried out among 10 medical students ries. Each response was allocated to at least one coding
who did not form part of the final sample. After analyzing category. This was done using an Excel worksheet (Micro-
the results of the pilot study, and based on feedback given soft Corp., Redmond, WA), in which the responses were
by students during the pilot study the following minor inserted under one column and the categories were inserted
change was made: Section D, question D1 originally con- in the next column. Patterns and trends in the responses
sisted of seven questions where respondents had to select were identified and documented. This was followed by sub-
one answer from a Likert scale (1 representing strongly dis- coding. The analysis was recorded using descriptive text
agree and 5 representing strongly agree). The questions including direct accounts from the respondents (Krippen-
were changed to statements in order to facilitate better dorff, 2013; Neuendorf, 2017).
understanding.
RESULTS
Data Collection Participants’ Characteristics
An e-mail was sent with a participant information sheet and From the 147 eligible students, a total of 122 medical stu-
link to the questionnaire which directed them to the internet dents completed the questionnaire yielding a response rate of
based survey tool. In order to ensure anonymity, the ques- 83%. Almost equal number of males (47.5%, n 5 58) and
tionnaires were sent via e-mail by the Faculty Officer who females (52.5%, n 5 64) participated in this study. The par-
acted as a gatekeeper. In this way, the researcher was not ticipants (peer learners) were between the ages of 18 and
able to identify the participants in any way. In the participant 30 years with a mean age of 20.5 6 3.55 years. The majority
information sheet, the purpose of the study was explained. If were within the age group of 18 and 22 years (73.0%,
they accepted to participate, students were asked to fill in the n 5 89) with only one participant (0.82%) being in the
questionnaire by clicking on the link given and once 28–32 age group. The highest level of education completed

4 Agius et al.
by the majority of participants was post-secondary education Table 1.
(71.3%, n 5 87). Thirty-five participants (28.7%) stated that
they had completed either an undergraduate or a postgradu- Methods of learning anatomy
ate degree.
Methods of learning Percentage of Number of
anatomy participants participants (n)
Previous Peer Teaching Experience Discussion of 87.4 97
clinical cases
The majority of the respondents (91.7%, n 5 111) stated
that this was their first experience of being taught by their Dissection sessions 84.7 94
peers. Only 10 students (8.3%) stated that this was not carried out in groups
their first experience of being taught by peer teachers. Six
of the latter were students who had obtained a previous Use of textbooks 83.4 93
degree. All six students reported that peer teaching was
practiced as part of their tertiary education. The other four Use of dissection 77.5 86
room specimens
students claimed to have experienced peer teaching during
their post-secondary school years. This study aimed to Use of videos 76.6 85
explore the perceptions of first-year medical students
toward learning anatomy through peer teaching by the use Video dissection 61.3 68
of cadaveric specimens therefore the 10 students who had
previous experience of peer teaching were excluded from Peer teaching 60.4 67
further analysis. This was done in order to avoid any bias
Attending lectures 39.6 44
due to any preconceived ideas carried over from previous
experiences. Material provided 31.5 35
by lecturer

Methods of Learning Anatomy Imaging material 20.7 23

“Discussion of clinical cases” (87.4%), “dissection sessions Total number of participants (n) 5 111.
(in groups)” (84.7%), and “use of textbooks” (83.4%) were
the three methods found most effective to learn anatomy by
peer learners. The two least effective methods mentioned Views on the Peer Teachers by the Peer
included “use of imaging material” (20.7%) and “material Learners
provided by lecturer e.g. dissection sheets” (31.5%). More
Overall, all participants gave positive feedback to the state-
than half of the participants (60.4%) perceived “peer
ments given (Table 2). Peer learners were confident that peer
teaching” as an effective method to learn anatomy. The teachers were well prepared for the session.
results are presented in Table 1. Moreover, students were also
given the option to specify any other method/s not mentioned
in the list which they found effective to learn anatomy. These Table 2.
included; drawing and coloring structures, studying from an
Mean and standard deviation of the responses given by the
atlas, use of 3D computer-generated anatomical models,
participants on their views of peer teachers
online quizzes, flash cards, listening to audio recordings, and
studying with a friend. Statement Mean (6SD)

The peer teachers were well prepared 4.18 (61.002)

for the session
Learning through Peer Teaching
Overall, analysis of mean responses showed that peer teach- The training sessions were interesting 3.83 (60.986)
ing as delivered during the study created “a positive, non-
Enough time was allocated for the sessions 3.83 (60.984)
intimidating learning environment.” Peer learners felt that
they “could communicate freely with the peer teachers” and When questions were asked they were 3.72 (60.942)
“felt more comfortable.” From the results, it is evident that appropriately answered
students did not feel “threatened” by peer teaching and that
they did not “feel anxious.” Moreover, they felt that they Most of the peer teachers explained 3.87 (60.851)
“benefited from the experience” and students “felt the need the topic clearly
to attend the sessions given by the peer teachers.” The mean
Most of the peer teachers were confident 3.83 (60.877)
responses to the statement “I was worried that the students
would give us incorrect information” showed that students I felt well prepared for the examination 3.59 (61.011)
did in fact have confidence in the answers given by the peer on the topic taught by the peer teachers
teachers. Moreover, the average response to this statement
was not strongly negative therefore some students still felt Each statement was provided with a Likert scale ranging from 1
that they could not rely solely on the peer teachers’ (representing strongly disagree) to 5 (representing strongly
responses. agree); total number of participants (n) 5 109.

Anatomical Sciences Education MONTH 2017 5

Table 3.
Reasons given by the peer learners on why they recommend or why they do not recommend peer teaching

Categories Number of responsesa Descriptions

Participants’ opinions on why they recommend peer teaching

Empowerment and opportunity to 67 Easier to ask questions and a less stressful environment
enhance learning Less intimidating than the lecturer
If learned by someone at your level, than it is doable

Unique methods to facilitate and 46 Sharing mnemonics makes it easier

assimilate learning Approaching anatomy from people who have the
same need as the student

Appreciating innovative ways of 28 Accessible for queries

learning and its effects Helps you to think outside the box
Reinforces knowledge by collaboration

Participants’ opinions on why they do not recommend peer teaching

Strong preference to the Lecturers know what they are talking about not just
lecturer-based approach 12 memorising from a book
Students might miss things whilst the lecturer would not
Lecturers possess valuable skills gained through years of
experience and qualifications

Limited quality of knowledge by some 5 Inefficient educatory system if the quality of the peer
of the peer teachers teachers is not uniform
Not all peer teachers had a sound knowledge base and
some were too shy to convey it

Patronizing approach adopted by 4 Some peer teachers were arrogant, big headed and rude
some of the peer teachers Superior attitude of the peer teachers found to be intimidating

a
Each participant could give more than one response; total number of responses (n) 5 162.

Views on the Peer Teaching Program by the respondents were asked their opinion on why they recom-
Peer Learners mend peer teaching or why they do not. Respondents could
give more than one opinion therefore quotes presented in
Peer learners were asked whether peer teaching could be the table given do not correspond to the number of respond-
used for other subjects apart from anatomy. Slightly more ents who answered this question. Ninety-three participants
than half (58%) stated that they did not think that peer (76%) highlighted that they would recommend peer teach-
teaching could be used for other subjects apart from anat- ing to other students. The responses generated from this
omy. Those who stated that peer teaching is applicable for question were grouped under three main categories. The
other subjects apart from anatomy (42%) were then asked most common reason mentioned by participants on why
for which subject/s they thought peer teaching is applicable. they recommend peer teaching to other students was
Peer learners indicated that peer teaching apart from anat- “empowerment and opportunity to enhance learning,” fol-
omy is mostly applicable to physiology, histology, and radi- lowed by “unique methods to facilitate and assimilate
ology. Ethics, biochemistry, genetics, and pharmacology learning” and “appreciating innovative ways of learning
were not viewed by peer learners as subjects that were and its effect.”
applicable to be learned through peer teaching. “Dissection” Sixteen participants (13%) indicated that they would not
was the only practical session that peer learners believed the recommend peer teaching to other students. The responses
peer teaching method was applicable to. “Critical thinking given by the participants were grouped under three main cat-
sessions,” “clinical skills,” and “histology” were not viewed egories with the “strong preference to the lecturer-based
as practical sessions that could be learned through peer approach” being the most mentioned reason followed by
teaching. “limited quality of knowledge by some of the peer teachers”
and “patronizing approach adopted by some of the peer
teachers.” Table 3 represents reasons given by the peer learn-
Recommendation of Peer Teaching to Other ers on why they recommend or why they do not recommend
Students peer teaching.
Participants were asked to state their views of how peer
The majority of peer learners (85%) were in favor of peer teaching could be improved. Forty-five participants (36.9%)
teaching and they highlighted that they would recommend answered this question. Participants could give more than
peer teaching to other first-year medical students. The one view. The responses given were grouped under four

6 Agius et al.
Table 4.
Participants’ views on how peer teaching could be improved

Categories Number of responsesa Descriptions

Ameliorating peer teaching 19 Better preparation and more time to

through better training consolidate skills and increase
confidence during teaching
More guidance to instil passion and
creativity for teaching

More chance of participation by all students 11 If more students had the chance to be peer
teachers the number of sessions would
have increased allowing more room for
repetition

Improving peer teachers’ approach 8 Peer teachers should remember that they
are still students themselves

Importance of lecturer’s input throughout 7 To ensure transference of correct informa-

peer teaching session tion lecturer’s presence should be more
thorough

a
Each participant could give more than one response; total number of responses (n) 5 45.

categories. The highest category mentioned was Age was not found to be significantly associated with any of
“ameliorating peer teaching through better training.” This the variables.
was followed by “more chance of participation by all Educational level. The Mann–Whitney U test was used to
students,” “improving peer teachers’ approach,” and test for differences between being an undergraduate or a
“importance of lecturer’s input throughout the peer teaching postgraduate (having a first degree) with the perceived bene-
sessions.” Table 4 presents these four categories together with fits of the peer teaching program. The null hypothesis for this
direct quotes from the participants. analysis was that there is no significant difference in the way
peer teaching affects students’ learning related to if they are
an undergraduate or postgraduate. The alternative hypothesis
Factors Associated with the Perceived Benefits was that being postgraduate altered a student’s learning
of the Peer Teaching Program by Peer through peer teaching. A significant difference was found in
Learners two of the 14 statements: “it was easier for me to ask ques-
Sex differences. The Mann–Whitney U test was used to tions” (P 5 0.026) and “I would have preferred if the tradi-
explore how peer teaching differed in its effect on partici- tional lecturer-based approach was adopted” (P 5 0.03),
pants’ learning depending on the sex of participants. The null which shows that those who were postgraduates found it eas-
hypothesis for this analysis is that there is no significant dif- ier to ask questions however they preferred if the traditional
ference in the effect of peer teaching on a participant’s learn- lecturer-based approach was used (Fig. 2).
ing related to the sex of participant. The alternative Recommendation of peer teaching by the peer
hypothesis was that participants’ sex affected students’ learn- learners. Since the data were deemed to be nonparametric,
ing through peer teaching. the Mann–Whitney U test was used to test for differences in
Sex differences were found to significantly influence a num- the way peer teaching affected students’ learning between the
ber of statements. When compared to males, females were “less students who did and did not recommend peer teaching. The
threatened,” “felt less anxious,” “felt comfortable,” felt that null hypothesis for this analysis was that there is no signifi-
they “could communicate better with their peer teachers,” and cant difference in the way peer teaching affected peer stu-
the “peer teachers created a positive non-intimidating learning dents’ learning between the students who did and did not
environment.” Moreover, another two statements that were recommend peer teaching. The alternative hypothesis was
found to be significantly different when comparing the males that there is a significant difference in the way peer teaching
with the females included: “I did not benefit from this experi- affected students’ learning between the students who did and
ence” and “I did not feel the need to attend the lectures given did not recommend peer teaching. A number of variables
by the peer teacher.” These two statements were significantly were found to be significantly different (Fig. 3). The only two
associated with males (Fig. 1). statements that were not found to be significantly different
Age of participants. The Spearman rank correlation was included “I felt anxious” and “I was worried that I would
used to test for associations in the way peer teaching affected not know the answers and embarrass myself in front of my
students’ learning depending on a participant’s age. This sta- peers.”
tistical test was utilized due to non-parametric data. The null
hypothesis for this analysis was that there is no association in DISCUSSION
the way peer teaching affects students’ learning depending on
a participant’s age. The alternative hypothesis was that the The number of medical students enrolling in each first-year
age of a participant affected their learning with peer teaching. class in the University of Malta has increased drastically from

Anatomical Sciences Education MONTH 2017 7

Figure 1.
Effects of participant sexual differences on the perceived benefits of the peer teaching program. Each statement was provided with a Likert scale ranging from 1
(representing strongly disagree) to 5 (representing strongly agree). The mean Likert scores and their standard deviations are represented in red (males) and blue
(female) bars.

75 students for the academic year 2006/2007 to 151 students Though they showed a level of interest in peer teaching, they
in 2016/2017. In an attempt to address this large influx of were less likely to recommend such method of learning. This
undergraduate medical students in the Anatomy department is consistent with results reported by Field et al. (2007). In
at the University of Malta, peer teaching using cadaveric their study, they reported that learners with a previous degree
specimens was introduced in the Musculoskeletal and Integu- were hesitant about peer teaching when compared with
mentary System module. This study adds to the body of undergraduate students.
knowledge on peer teaching by showing that peer teaching Reduced levels of anxiety among students who partici-
has a positive influence on peer learners and offers a deeper pated in peer teaching sessions were reported by McKenna
approach to learning. Overall, peer teaching was found to and French (2011). Similarly, in the present study, female par-
facilitate a conducive and socially-supportive environment for ticipants revealed that they were open and comfortable when
learning since the majority of the participants remarked that interacting with peer teachers. Additionally, they felt “less
such methods promoted mutual respect, communication, threated” and “less anxious” during the sessions taught by
cooperation, and interaction throughout the sessions. More the peer teachers. These views were not expressed by the
importantly most of the peer learners elucidated that they male participants. Compared to their female counterparts,
were undaunted to discuss challenging issues and were able males felt that they benefited less from peer teaching and did
to actively engage in the sessions. These results support previ- not feel the need to engage in sessions taught by the peer
ous research showing that peer learners perceive peer teach- teachers. These results do not support previous findings
ing using cadaveric specimens as a positive and effective reported by Field et al. (2007) as in their study no significant
way of learning (Krych et al., 2005; Correa et al., 2009; difference in responses from male and female participants
Manyama et al., 2016). was found. The latter study was carried out in Glasgow.
Sex differences, educational level, and recommendations Such differences could be due to cultural differences between
for peer teaching were found to be significantly associated Northern and Southern European countries.
with the perceived benefits of the peer teaching program. Among other methods of learning anatomy, peer teaching
When comparing the perceived benefits of the peer teaching was perceived by more than half of the peer learners as an
program among undergraduates and postgraduates, postgrad- effective method to learn anatomy. However, “discussion of
uate peer learners found it easier to ask questions however clinical cases,” “dissection sessions carried out in groups,”
they preferred the traditional lecturer-based approach. and “use of textbooks” were the three most mentioned

8 Agius et al.
Figure 2.
Effects of participant level of education (undergraduate vs postgraduate) on the perceived benefits of the peer teaching program. Each statement was provided with
a Likert scale ranging from 1 (representing strongly disagree) to 5 (representing strongly agree). The mean Likert scores and their standard deviations are repre-
sented in red (postgraduate) and blue (undergraduate) bars.

methods perceived by participants to be effective when learn- computer generated anatomical models using anatomical
ing anatomy, whereas “use of imaging material” and applications” was also mentioned by the participants. In fact,
“material provided by lecturer example dissection sheets” multimedia based learning packages including computer soft-
were among the least preferred methods perceived by partici- ware were found to be a motivating and effective means to
pants to learn anatomy. This supports previous research by augment the study of anatomy (Turney, 2007; Sugand et al.,
Besag et al. (1976), Nnodim (1988), and Smith and Mathias 2010). Therefore, it is evident that students tend to prefer
(2010) who reported that studying from textbooks and pri- some methods of learning over others. Considering that each
vate study were the two most common ways in which stu- method has its advantages and disadvantages, ideally an
dents obtained their anatomical knowledge. Moreover, other eclectic approach should be adopted to maximize the learning
methods that were found by students to be important to outcomes.
learn anatomy included: use of human cadavers, mock exam- Overall, students were very satisfied with the level of peer
ination, online material, group learning, familiarization with teaching exhibited by the peer teachers. Indeed, the majority
the anatomical language and natural variation, and clinical- of peer learners highly recommended peer teaching to other
based teaching (Smith and Mathias, 2010). Chapman and students. The responses given by the participants reflected
colleagues in their study to evaluate medical students’ percep- positive feedback on the peer teachers. These findings imply
tions of various teaching methods showed that dissection fol- that this method of learning was well accepted by the stu-
lowed by prosection was the most preferred method chosen dents and was found to be a useful method to facilitate the
by the students to learn anatomy (Chapman et al., 2013). learning of anatomy. The results of this study support previ-
Similarly, Azer and Eizenberg (2017) and Yammine (2014) ous results reported by Krych et al. (2005), Bruke et al.
emphasized the importance of dissection for the studying of (2007), and Lockspeiser et al. (2008). Although in the latter
anatomy. First-year students chose “dissection” as the pre- two studies “near-peer teaching” was adopted, the peer learn-
ferred approach for learning anatomy whereas second-year ers shared similar views. In the present study, only a minority
students chose “textbooks” followed by “dissection” as their of participants expressed negative views regarding peer teach-
preferred findings. While in the present study the use of text- ing. Through their comments, some of the students explained
books and dissection were both given importance by the peer that they preferred being taught by their lecturers rather than
learners during the first year of the medical course, it would their peers due to lack of experience of the latter. Moreover,
be interesting to explore whether students maintained their participants expressed the importance of having the lecturer
preference throughout the subsequent year. “Use of 3D present throughout the session in order to ensure that the

Anatomical Sciences Education MONTH 2017 9

Figure 3.
Perceived benefits of the peer teaching program by peer learners on whether or not they recommend peer teaching. Each statement was provided with a Likert scale
ranging from 1 (representing strongly disagree) to 5 (representing strongly agree). The mean Likert scores and their standard deviations are represented in red (not
recommending peer teaching) and blue (recommending peer teaching) bars.

correct information is given by the peer teachers. These find- A number of studies have reported the applicability of
ings echo those of Weyrich et al. (2008) who accentuated the peer teaching for other subjects including teaching of
importance of sufficient training and supervision of the peer “clinical skills” (Weyrich et al., 2008; Mutwali and Hassan,
teachers. In line with this, Bulte et al. (2007) reported that 2013). Additionally, near peer teaching was also found bene-
peer teachers acknowledged lack of experience as one of the ficial in challenging subjects such respiratory, cardiac and
weaknesses of peer teaching. Peer teachers disclosed that they blood physiology (Jackson and Evans, 2012). In the present
found it rather challenging to be firm with the peer learners study, less than half of participants stated that peer teaching
due to the informal setup. They expressed their concern that could be applied to other subjects namely physiology and his-
such setup prevented peer learners from regarding what they tology. Students did not feel that subjects such as ethics, bio-
said seriously. Kooloos et al. (2016) underlined that higher chemistry, genetics, and pharmacology could be learned
levels of in-class formality during peer teaching sessions aug- through peer teaching. With regard to the practical sessions,
mented satisfaction and participation of students. there was a consensus by the majority of students that peer
An interesting category which emerged was “improving teaching should be adopted for “dissection” sessions. Such
peer teachers’ approach.” Some of the students underlined findings should be interpreted with caution as the peer learn-
that they felt that peer teachers adopted a patronizing atti- ers participating in this study were only exposed to peer
tude and felt superior over their peer learners. Such an teaching with regards to the teaching of anatomy in dissec-
approach goes against the fundamental principles of peer tion sessions. This might have affected their responses to the
learning. This behavior should be avoided at all costs as it is questions in this section. Results generated from the present
likely to result in a negative impact on the peer learners’ study revealed that peer teaching was well received by the
experiences and hinder learning. Additionally, the findings peer learners. In view of this, the applicability of peer teach-
underline the need to explore whether such behaviors were ing to other subjects and other disciplines apart from the
influenced by how peer teachers were taught. It also sheds medical field should be explored further.
light on the importance of introducing workshops to amelio- Results of this study brought to light the merits of includ-
rate competency in communication, presentation skills, ing this method of teaching in the curricula. It is envisaged
respectful behavior and teamwork. The scope for such work- that the results of this study will encourage discussions at
shops is to instill a more positive and constructive way to higher levels in order to explore the feasibility of introducing
learning. formal peer teaching in the medical curricula, both locally

10 Agius et al.
and abroad. Skills acquired through peer teaching will even- CHRISTIAN CAMENZULI, M.D., M.Sc. Adv.Surg.Pract.
tually serve to facilitate the transition from a student to a (Cardiff), M.R.C.S.Ed., F.R.C.S.Ed., F.E.B.S., is an assistant
doctor. visiting lecturer in the Department of Surgery, Faculty of
Medicine and Surgery at the University of Malta, Tal-Qroqq,
Malta, and a trainee in general surgery at the Mater Dei Hos-
Strengths and Limitations of the Study pital in Msida, Malta. He is currently enrolled in graduate
This is the first Maltese study carried out to explore the per- (Ph.D.) program in the Department of Anatomy at University
ceptions of first-year medical students toward learning anat- of Malta, Msida, Malta.
omy using cadaveric specimens through peer teaching. A ROBERTA SULTANA, B.Sc. Health Sci. (Melit), P.G.Dip.
rigorous approach was adopted throughout the whole (Geriatrics and Gerontology) (Melit), is a senior allied health
research process. Moreover, this study had a very good care professional currently working at Saint Vincent de Paul
response rate (83%) meaning that the results generated Long-Term Care Facility in Luqa, Malta.
reflect the perceptions of the population under study. RICHARD PULLICINO, M.D., M.Sc. (Health Informat-
One of the limitations of this study is that no validated ics), M.R.C.P. (U.K.), E.D.i.R., F.R.C.R., is an interventional
research tool was found that addressed the proposed research neuroradiology fellow at The Walton Centre NHS Founda-
objectives. In view of this limitation, the questionnaire had to tion Trust, Liverpool, United Kingdom.
be devised by the researcher together with the research super- CHRISTIAN ZAMMIT, M.D., M.Sc., is an assistant lec-
visor after an extensive literature review was carried out. turer in the Department of Anatomy at the University of
Moreover, to combat such limitation the devised question- Malta, Msida, Malta. He teaches head and neck anatomy
naire was tested for face validity, content validity and reli- and neuroanatomy to second-year medical students.
ability. Another limitation was that since data had to be JEAN CALLEJA-AGIUS, M.D., M.R.C.O.G., M.R.C.P.I.,
collected retrospectively, it was subjected to recall bias since M.Sc. Clin. Embryol. (Leeds), Ph.D. (London), is an associate
data collected relied on the participants’ ability to remember professor of anatomy and Head of the Department of Anat-
certain details. However, this limitation could not be elimi- omy, Faculty of Medicine and Surgery at University of Malta,
nated due to the nature of this study. Though every effort Tal-Qroqq, Malta. She teaches anatomy and embryology to
was made to avoid researcher’s bias, the participants were first- and second-year medical students, as well as postgradu-
aware that the researcher was one of the peer teachers. ate Masters students.
Knowing this, the participants may have tried to answer in a CRISOFORO POMARA, M.D., Ph.D., is an associate
way that might please the researcher. In order to combat this professor of anatomy in the Department of Anatomy, Faculty
limitation, the researcher had no contact with the partici- of Medicine and Surgery, University of Malta, Msida, Malta,
pants and the survey was sent via e-mail by the administra- and a professor of forensic pathology in the Section of Foren-
tive faculty officer who acted as a gatekeeper. Although sic Pathology, Department of Clinical and Experimental Med-
online questionnaires may yield a lower response rate when icine at University of Foggia, Foggia, Italy. He is also the
compared to other methods of data collection, participants author of more than 90 scientific publications and co-author
are not pressurized to respond in any way (Cook et al., 2000; of the Forensic Autopsy: A Handbook and Atlas.
Nulty, 2008). Regardless of these unavoidable limitations the
LITERATURE CITED
study objectives have been duly answered.
Ashdown L, Lewis E, Hincke M, Jalali A. 2013. Learning anatomy: Can dis-
section and peer-mediated teaching offer added benefits over prosection alone?
CONCLUSION ISRN Anat 2013:873825.
Azer SA, Eizenberg N. 2017. Do we need dissection in an integrated problem-
based learning medical course? Perceptions of first-and second-year students.
Peer teaching provided an overall positive experience to the
Surg Radiol Anat 29:173–180.
cohort studied. It offers the possibility of improving educa- Bene KL, Bergus G. 2014. When learners become teachers: A review of peer
tional outcomes while at the same time mitigating the ever teaching in medical student education. Fam Med 46:783–787.
increasing demands on faculties. Therefore, when integrated Besag F, Blake A, Cartwright P, Griffiths P, Zeitlin S, Long D, Bowker M,
with other teaching modalities, peer teaching can offer a via- Longmore M, Huang CL, Venning M, et al. 1976. On the learning and teach-
ing of anatomy: A contribution by students. J Anat 121:641–642.
ble resource to the quest of excellence in teaching anatomy. Boud D. 2001. Introduction: Making the move to peer learning. In: Boud D,
Cohen R, Sampson J (Editors). Peer Learning in Higher Education: Learning
from and with Each Other. 1st Ed. Abingdon, Oxon, UK: Kogan Page Limited.
NOTES ON CONTRIBUTORS p 1–20.
Brueckner JK, MacPherson BR. 2004. Benefits from peer teaching in the dental
ANDEE AGIUS, B.Sc. (Health Sci.) (Melit), M.Sc. Public gross anatomy laboratory. Eur J Dent Educ 8:72–77.
Health Med. (Melit), M.Clin. Res. (University of Newcastle), Bruke J, Fayaz S, Graham K, Matthew R, Field N. 2007. Peer-assisted learning
is a senior midwife and is currently a fifth-year medical stu- in the acquisition of clinical skills: A supplementary approach to musculoskele-
tal system training. Med Teach 29:577–582.
dent at the Faculty of Medicine and Surgery at the University
Bruno PA, Love Green JK, Illerbrun SL, Holness DA, Illerbrun SJ, Haus KA,
of Malta, Msida, Malta. Her research interest is in medical Poirier SM, Sveinson KL. 2016. Students helping students: Evaluating a pilot
education. program of peer teaching for an undergraduate course in human anatomy.
NEVILLE CALLEJA, M.D., Ph.D., F.F.P.H., is a medical Anat Sci Educ 9:132–142.
Bryman A. 2012. Content analysis. In: Bryman A. Social Research Methods.
statistician and a public health specialist at the Department 4th Ed. New York, NY: Oxford University Press, Inc. p 288–309.
of Public Health, Faculty of Medicine and Surgery at the Bulte C, Betts A, Garner K, Durning S. 2007. Student teaching: View of stu-
University of Malta, Msida, Malta. He is also Director for dent near-peer teachers and learners. Med Teach 29:583–590.
Health Information and Research for the Ministry of Health. Burgess A, McGregor D, Mellis C. 2014. Medical students as peer tutors: A
systematic review. BMC Med Educ 14:115.
He is involved in the teaching of medical statistics, epidemiol-
Chapman SJ, Hakeem AR, Marangoni G, Prasad KR. 2013. Anatomy in medi-
ogy, and health information to medical and health care cal education: Perceptions of undergraduate medical students. Ann Anat 195:
students. 409–414.

Anatomical Sciences Education MONTH 2017 11

Cook C, Heath F, Thompson RL. 2000. A meta-analysis of response rates in Manyama M, Stafford R, Mazyala E, Lukanima A, Magele N, Kidenya BR,
web or internet-based surveys. Educ Psychol Meas 60:821–836. Kimwaga E, Msuya S, Kauki J. 2016. Improving gross anatomy learning using
Correa R, Brugal Y, Valentın L, Perez J, Perez-Gum a J. 2009. Peer-teaching: reciprocal peer teaching. BMC Med Educ 16:95.
An effective learning experience? P R Health Sci J 28:83. McKenna L, French J. 2011. A step ahead: Teaching undergraduate students
Crosier D, Desurmont A, Horvath A, Kocanova D, Paquet MF, Parveva T, to be peer teachers. Nurse Educ Pract 11:141–145.
Racke C, Rauhvargers A, Riihel€ ainen J. 2015. The European Higher Education Mutwali IM, Hassan AN. 2013. Skills training of junior medical students: Can
Area in 2015: Bologna Process Implementation Report. 1st Ed. Brussels, peer teaching be the solution? Afr J Health Prof Educ 5:84–87.
Belgium: Education, Audiovisual and Culture Executive Agency. 304 p. URL: Neuendorf KA. 2017. The Content Analysis Guidebook. 2nd Ed. Thousand
http://eacea.ec.europa.eu/education/eurydice/documents/thematic_reports/182EN. Oaks, CA: SAGE Publications, Inc. 438 p.
pdf [accessed 21 September 2017].
Nnodim JO. 1988. Learning human anatomy: Student preferences of methods
Duran CE, Bahena EN, Rodrıguez Mde L, Baca GJ, Uresti AS, Elizondo- in a Nigerian medical school. Med Educ 22:412–417.
Oma~ na RE, L opez SG. 2012. Near-peer teaching in an anatomy course with a
low faculty-to-student ratio. Anat Sci Educ 5:171–176. Nulty DD. 2008. The adequacy of response rate to online and paper surveys:
What can be done? Assess Eval High Educ 33:301–314.
Elfil M, Negida A. 2017. Sampling methods in clinical research: An educa-
tional review. Emerg (Tehran) 5:e52. Polit DE, Beck CT. 2017. Nursing Research: Generating and Assessing
Evidence for Nursing Practice. 10th Ed. Philadelphia, PA: Wolters Kluwer
Erie AJ, Starkman SJ, Pawlina W, Lachman N. 2013. Developing medical stu- Health. 784 p.
dents as teachers: An anatomy-based student-as-teacher program with empha-
sis on core teaching competencies. Anat Sci Educ 6:385–392. Rees EL, Quinn PJ, Davies B, Fotheringham V. 2016. How does peer teaching
compare to faculty teaching? A systematic review and meta-analysis. Med
Evans DJ, Cuffe T. 2009. Near-peer teaching in anatomy: An approach for Teach 38:829–837.
deeper learning. Anat Sci Educ 2:227–233.
Schmidt HG, Moust JH. 1995. What makes a tutor effective? A structural
Field M, Burke JM, McAllister D, Lloyd DM. 2007. Peer-assisted learning: A novel equations modelling approach to learning in problem-based curricula. Acad
approach to clinical skills learning for medical students. Med Educ 41:411–418. Med 70:708–714.
General Medical Council (GMC). 2011. Developing Teachers and Trainers in Seenan C, Shanmugam S, Stewart J. 2016. Group peer teaching: A strategy for
Undergraduate Medical Education. Advice Supplementary to Tomorrow’s Doc-
building confidence in communication and teamwork skills in physical therapy
tors (2009). 1st Ed. London, UK: General Medical Council. 27 p. URL: http://
students. J Phys Ther Educ 30:40–49.
www.gmc-uk.org/Developing_teachers_and_trainers_in_undergraduate_medical_
education___guidance_0815.pdf_56440721.pdf [accessed 4 May 2017]. Smith SF, Mathias HS. 2010. Medical students’ approaches to learning anat-
omy: Students’ experiences and relations to the learning environment. Clin
Hall S, Stephens J, Andrade T, Davids J, Powell M, Border S. 2014. Percep-
Anat 23:106–114.
tions of junior doctors and undergraduate medical students as anatomy teach-
ers: Investigating distance along the near-peer teaching spectrum. Anat Sci Soriano RP, Blatt B, Coplit L, CichoskiKelly E, Kosowicz L, Newman L,
Educ 7:242–247. Pasquale SJ, Pretorius R, Rosen JM, Saks NS, et al. 2010. Teaching medical
students how to teach: A national survey of students-as-teachers programs in
Han ER, Chung EK, Nam KI. 2015. Peer-assisted learning in a gross anatomy
U.S. medical schools. Acad Med 85:1725–1731.
dissection course. PLOS One 10:e0142988.
Stabile I, Agius A. 2017. Peer teachers do better then peer learners in summa-
Hanson JM, Trolian TL, Paulsen MB, Pascarella ET. 2016. Evaluating the influ-
tive anatomy examinations. J Anat 230:181.
ence of peer learning on psychological well-being. Teach High Educ 21:191–206.
Sugand K, Abrahams P, Khurana A. 2010. The anatomy of anatomy: A review
Hasson F, McKenna H, Keeney S. 2015. Surveys. In: Gerrish K, Lathlean J
for its modernisation. Anat Sci Educ 3:83–93.
(Editors). The Research Process in Nursing. 7th Ed. Chichester, West Sussex,
UK: John Wiley & Sons, Ltd. p 255–266. Ten Cate O, Durning S. 2007. Peer teaching in medical education: Twelve
reasons to move from theory to practice. Med Teach 29:591–599.
Houwink AP, Kurup AN, Kollars JP, Kral Kollars CA, Carmichael SW,
Pawlina W. 2004. Help of third-year students decreases first-year medical Topping KJ. 1996. The effectiveness of peer tutoring in further and higher
students’ negative psychological reactions on the first day of gross anatomy education: A typology and review of the literature. High Educ 32:321–345.
dissection. Clin Anat 17:328–333. Turney BW. 2007. Anatomy in a modern medical curriculum. Ann R Coll Surg
Iqbal H. 2016. Anatomy” peer teaching” in medical school: A literature Engl 89:104–107.
review. MedEdPublish 5:6. Weyrich P, Schrauth M, Kraus B, Habermehl D, Netzhammer N, Zipfel S,
Jackson TA, Evans DJ. 2012. Can medical students teach? A near-peer-led J€
unger J, Riessen R, Nikendei C. 2008. Undergraduate technical skills training
teaching program for year 1 students. Adv Physiol Educ 36:192–196. guided by student tutors—Analysis of tutors’ attitudes, tutees’ acceptance and
Kooloos JG, Klaassen T, van Kuppeveld S, Bolhuis S, Vorstenbosch M. 2016. learning progress in an innovative teaching model. BMC Med Educ 8:18.
The effect of in-class formality during a peer-teaching activity on student’s Whitman NA. 1988. Peer Teaching: To Teach Is To Learn Twice. 1st Ed.
satisfaction, perceived participation and learning gain. Creativ Educ 7: Washington, DC: Association for the Study of Higher Education. 106 p.
1810–1819. Wong JG, Waldrep TD, Smith TG. 2007. Formal peer-teaching in medical
Krippendorff K. 2013. Content Analysis: An Introduction to its Methodology. school improves academic performance: The MUSC supplemental instructor
3rd Ed. Thousand Oaks, CA: SAGE Publications, Inc. 441 p. program. Teach Learn Med 19:216–220.
Krych AJ, March CN, Bryan RE, Peake BJ, Pawlina W, Carmichael SW. 2005. Yammine K. 2014. The current status of anatomy knowledge: Where are we
Reciprocal peer teaching: Students teaching students in the gross anatomy lab- now? Where do we need to go and how do we get there? Teach Learn Med
oratory. Clin Anat 18:296–301. 26:184–188.
Lachman N, Christensen KN, Pawlina W. 2013. Anatomy teaching assistants: Youdas JW, Hoffarth BL, Kohlwey SR, Kramer CM, Petro JL. 2008. Peer
Facilitating teaching skills for medical students through apprenticeship and teaching among physical therapy students during human gross anatomy:
mentoring. Med Teach 35:e919–e925. Perceptions of peer teachers and students. Anat Sci Educ 1:199–206.
Lockspeiser TM, O’Sullivan P, Teherani A, Muller J. 2008. Understanding the Yu TC, Wilson NC, Singh PP, Lemanu DP, Hawken SJ, Hill AG. 2011. Medi-
experience of being taught by peers: The value of social and cognitive congru- cal students-as-teachers: A systematic review of peer assisted teaching during
ence. Adv Health Sci Educ 13:361–372. medical school. Adv Med Educ Pract 2:157–172.

12 Agius et al.