Peer learning is a term that has many interpretations and includes a wide variety of learning approaches. It has no universally agreed definition, nor is there a standard method to its delivery. All at once, it is an approach, a communication channel, a method, a philosophy and a strategy (UNAIDS, 1999). A variety of descriptors include co-learning, cooperative learning, peer tutoring, peer-led instruction, peer-mediated instruction, peer evaluation, peer coaching and reciprocal learning.
For these Guidelines, peer learning fits into the following two categories:
1. Cooperative learning: Peers learn alongside one another (i.e., reciprocal learning).
2. Peer-led learning: Peers play a facilitator role (referred to as peer facilitators) and share their knowledge and experience with others.
A peer is defined as someone from a “like-group” who shares some (or all) of the following characteristics: gender, age, cultural background, religion, or socioeconomic circumstances. Peer learning is often used with youth or other specific audiences who may not recognise themselves (or their values and experiences) in a traditional facilitator. The familiarity of a peer can create new opportunities to share knowledge or change behaviour because the relationship is often based on trust and openness. It is especially beneficial to reach audiences who may be underserved by traditional forms of education (British Red Cross, 2015).
Guidelines
Good practice points
- Peer-led learning or cooperative learning may be used to develop first aid knowledge, skills and attitudes. The best practice is to select the approach most suited to the context and audience.
- Peer-led learning or cooperative learning may encourage individuals to share their first aid experiences which may benefit the learning of others. When a peer shares insight or experience, they bring valuable authenticity to support the learning (e.g., in conflict contexts or working with vulnerable people).
- Although peers bring value to the learning experience, they should not be considered a substitution for professional facilitators.
- Where peers are encouraged to provide some form of facilitation (peer-led learning), they should not be viewed as interchangeable with professional educators or trainers. The peer relationship should enrich the learning experience and benefit both the learner and facilitator.
Chain of survival behaviours
The value of this method is when a peer can offer something new to other learners. Their knowledge may be more readily accepted because they are seen as “the same”, compared to a professional facilitator who may be viewed as an outsider or someone with different experiences. The knowledge and skills peers may provide include:
- strategies they used when preparing for an emergency (prevent and prepare)
- indicators that alerted them to an emergency (early recognition)
- improvised materials they used to provide care (first aid steps)
- useful resources in the community that provide assistance (access help)
- actions they did to support themselves or others during or after an event (self-recovery).
Education considerations
We have mainly examined how to use this method to develop knowledge and skills. Peer learning is less commonly examined as a method to impact learners’ attitudes and values, such as the willingness to act. Still, this strategy does provide the opportunity to influence these aspects of learning.
Context considerations
- While cooperative learning typically requires few resources to develop (human and financial), developing people to become effective peer facilitators can take time and effort, and care should be taken to do this sensitively.
- A broad range of communities can use cooperative and peer-led learning because they are not dependent on internet access or the availability of digital devices.
- Peer learning is inclusive, scalable to any programme size, has a much shorter training time and provides freedom from the traditional classroom setting. As such, it may be useful to reach communities underserved by conventional training. It could also be an affordable format for Refresh and retraining sessions (Wik et al., 1995).
- Educators facilitating peer-led learning and cooperative learning need to bear cultural, gender and religious sensitivities in mind.
Learner considerations
- Peer learning seems to take place most often when working with youth (ages 10–25) in schools with large groups of learners who share common elements and have peers who can take on a facilitator role.
- Either cooperative or peer-led learning can be used with a variety of audiences where the influence of likeness is valued. Some examples include:
> young children (pre-school and elementary ages)
> ageing populations
> those with a specific shared influence (new parents, grandparents/caregivers, homeless persons, those struggling with substance abuse, etc)
> those living in similar conditions (rural, remote, conflict, etc).
Facilitation tips
- Remember that peer learning has different requirements than traditional, facilitator-led learning. Find the approach where the peer relationship provides a vehicle for learning (e.g., sharing experiences through storytelling).
- Engage peer facilitators in programme development to ensure that they connect with the content, approach and audience.
- Carefully consider who you select to be peer facilitators. Typically, we choose someone we know, which influences the facilitation process as well as how we provide and discuss feedback (Iserbyt et al., 2009).
- For cooperative learning, support peer-based relationships as this may encourage learners to share the knowledge, skills and attitudes gained during a session with other peer groups (e.g., family, friends or colleagues).
- Plan time for tactile learning (connecting and applying previous learning) as this seems to be equal, if not more valuable, than the method of instruction itself. For skills that combine knowledge with physical actions (e.g., CPR), ensure that there is time to apply and practice the learning.
Facilitation tools
- A cooperative learning approach is most successful when learners are well suited to work and construct meaning together. They likely have similar backgrounds and life experiences to draw from and can mutually help each other. With this type of peer learning, pairs will take directions from a facilitator then work together to execute them. This approach applies to all of the domains within the Chain of survival behaviours. For example, the facilitator provides instruction on how to perform a skill then peers coach each other on how to do it (first aid steps). Peers may also work together to brainstorm how to prepare for a variety of emergencies (prevent and prepare) or develop a case study together based on a shared experience (applicable to all domains).
- Feedback between peers has added value compared to a feedback device because it is more personalised. Peers can also provide continuous feedback in conversation, whereas a machine is much more standardised (Iserbyt et al., 2009).
- Some elements of peer learning could also happen in an online format, see Online learning for children.
Limitations
- Programme designers need to ensure that peer facilitators are supported to provide a successful learning experience. Support should extend beyond the initial orientation to motivate and ensure continuous consistency and connection.
Scientific foundation
The reviews for this topic looked at how peer learning impacts learners, and the person in need of care, compared to other educational methods or no education at all. When examined as a learning strategy, we sought to explore evidence to compare peer learning to other methods, rather than consider its potential as a more impactful method (Iserbyt et al., 2009).
Peer-led learning
In a study prepared by Beck et al. (2015), a group of middle school students was trained by their peers in Basic Life Support. The study investigated whether student-led learning was as effective as that led by a professional facilitator (defined as having higher medical education and more instructional experience). The peer facilitators prepared ahead of time before facilitating the session. Using a standardised checklist, two independent evaluators conducted a practical evaluation that determined the key indicators of success.
Results were comparable with 40.3 per cent of students successful in peer-led learning versus 41 per cent successful in professional-led learning. While the groups had similar results, there was concern over the selection of the peer educators, often characterised as strong students who were focused and capable. The authors were unsure how the profile of the selected peers impacted the learning outcomes as they did not consider how the peer facilitators, other students or the relationship between the two would influence the study.
Lester et al. (1997) considered the impact of peer tutoring on resuscitation training. Peer tutoring can be a valuable instructional method in first aid education. It can lead to increased engaged time (time spent actively contributing), provide a mechanism to correct errors at the time of practice and create better opportunities for support and encouragement. During the study, six teachers and 11 students trained as CPR instructors and then taught two groups of course participants. The first group trained by a teacher only included 106 participants, while 137 were trained by a teacher (for knowledge components) and a peer facilitator (for practical components).
Indicators of success for both courses included a ten-point multiple-choice test, a peer assessment of practical skills, an assessment by either the teacher or peer facilitator and an attitude assessment. There was no significant difference between the multiple-choice test and practical skill assessment for either method. However, boys in the second group (instructed by a teacher and peer) showed less willingness to resuscitate in an emergency than girls from either group (P<0.01). Those with previous knowledge of resuscitation techniques performed better during the skill assessment than students new to CPR (P<0.025).
The study flagged concern over the peer facilitators’ ability to assess one another accurately. As unskilled assessors, they may have been more likely to mark an action as correct that would not have been passed by a more experienced person. As a solution, a member of the research team assessed a sample of students to ensure a fair assessment process.
Wik et al. (1994) considered a peer-training model for CPR instruction among Norwegian factory workers. The intervention group was in Norway, and the control group was in the United States. For the intervention, the project followed a group of employees who were trained in CPR (referred to as “tier 1”) and then shared their knowledge with co-workers (“tier 2”) and then family members and associates at home (“tier 3”) using a trickle-down teaching approach. This approach was desirable to the trained group because it allowed for flexibility in terms of pace and method. It was also motivating to help one’s family. The study included 1,303 trained individuals: 41 people in tier 1, 311 employees in tier 2 and 873 people at home in tier 3. The study invited people from all tiers back to the factory to demonstrate their skills on feedback manikins within three weeks of training. The primary interest was to assess the capabilities of the tier 3 learners who were taught by people not explicitly trained as facilitators. The performance from those in tier 3 did not vary significantly from those in the control group who were tested directly after attending a facilitator-led CPR session and did not receive any peer training. However, because the intervention group was in Norway and the control group in the United States, the study cautioned that the different locations might have influenced the results of the study.
Cooperative learning
Charlier et al. (2016) considered how training a large section of the population over time might impact the rate of bystander CPR and survival after cardiac arrest (occurring outside of a hospital). The study assumed that those trained are more likely to take action than those who are not. The participants were master candidates in the field of education.
The study used peer-assisted learning as a base and built a model where participants would work together to maximise their learning. Participants were assigned a small section of content and were taught by either an expert or a learning tool. Next, they got into partners and shared what they learned with one another, working together to master the whole content. This type of peer-led learning allowed students to draw from a high level of personal understanding that they used to coach one another. Both the intervention and the control group started with an instructor-led phase.
While the intervention group broke off into pairs to work together, the control group filled the excess time by practising bandaging. The key indicators of success were linked to a practical evaluation. The results showed that the peer-assisted learning approach was as effective as the instructor-led approach in meeting the European Resuscitation Council’s 2010 guidelines for CPR quality.
Iserbyt et al. (2009) considered how peer evaluation within a reciprocal learning approach might increase CPR quality. For this study, students were split into two groups and then paired off. Students worked together in a defined doer-and-helper relationship, switching roles every five minutes after completing a set of standardised task cards. In the intervention group, the helper evaluated the doer’s performance one minute before switching roles. Both groups took a retention test two weeks after training. While both groups showed relevant acquired learning, the addition of peer evaluation resulted in significantly more students from the intervention group performing all Basic Life Support items in the correct order, compared to the control group. No other significant differences were found following the intervention or two weeks later. This study has shown that students can learn without an instructor when using reciprocal learning and that a peer evaluation strengthens the learning. The doer learns by doing, the helper learns by observing, analysing and giving performance-related feedback. Through cooperation, the peers were able to co-construct knowledge through observation, feedback, reason and discussion of the task.
Knowledge gaps
Peer learning would benefit from further exploration with regards to how it can support first aid education. First aid programme designers are encouraged to consider research projects that could contribute to the current evidence base. This evidence would be used for future guideline revisions, specifically to consider peer learning’s positive impact on learning outcomes.
Aspects that are unclear and would benefit from further investigation are included below:
- The impact of peer learning within interventions that result in certification compared to how it affects interventions with no certification.
- The impact of peer learning on audiences other than youth or students (e.g., groups affected by opioid poisoning or using reciprocal learning with older adults or within families).
References
Beck, S., Issleib, M., Daubmann, A., & Zöllner, C. (2015). Peer education for BLS-training in schools? Results of a randomized-controlled, non inferiority trial. Resuscitation, 94, 85–90.
DOI: 10.1016/j.resuscitation.2015.06.026
British Red Cross (2015). Literature review: Peer education. [Unpublished manuscript]. Education Department.
Charlier, N., Stock, L. V. D., & Iserbyt, P. (2016). Peer-assisted learning in cardiopulmonary resuscitation: The jigsaw model. The Journal of Emergency Medicine, 50(1), 67–73.
DOI: 10.1016/j.jemermed.2015.04.002
Iserbyt, P., Elen, J., & Behets, D. (2009). Peer evaluation in reciprocal learning with task cards for acquiring Basic Life Support (BLS). Resuscitation, 80(12), 1394–1398.
DOI: 10.1016/j.resuscitation.2009.07.006
Lester, C., Donnelly, P., & Weston, C. (1997). Is peer tutoring beneficial in the context of school resuscitation training? Health Education Research, 12(3), 347–354.
DOI: 10.1093/her/12.3.347
UNAIDS (1999). Peer education and HIV/AIDS: Concepts, uses and challenges.
https://www.unaids.org/sites/default/files/media_asset/jc291-peereduc_en_0.pdf
Wik, L., Brennan, R. T., & Braslow, A. (1995). A peer-training model for instruction of basic cardiac life support. Resuscitation, 29(2), 119–128.
https://www.researchgate.net/profile/Robert_Brennan2/publication/15539020_A_peer-training_model_for_instruction_of_basic_cardiac_life_support/links/59e97b5fa6fdccfe7fec4575/A-peer-training-model-for-instruction-of-basic-cardiac-life-support.pdf
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