Stress and stressors of medical student near-peer tutors during courses: a psychophysiological mixed methods study

Abstract

Background Structured peer-led tutorial courses are widespread and indispensable teaching methods that relieve teaching staff and contribute to the development of students’ competencies. Nevertheless, despite high general stress levels in medical students and associated increases in psychopathology, specific knowledge of peer tutors’ additional burdens is very limited. Methods Sixty student near-peer tutors from two structured peer-teaching programmes volunteered to participate. On multiple occasions in three different course sessions, we assessed tutors’ subjective stress, affective state, heart rate variability, and salivary cortisol. Additionally, tutors named everyday and course-specific stressors, which were evaluated by means of content analyses. Results The study participation rate was high (63% of all active tutors). The participating tutors are socially well adapted and resilient individuals. They report a variety of stressors such as time pressure, participant characteristics, teacher role demands, and study requirements, but nevertheless display only moderate psychological and physiological stress that decreases over sessions. Tutors’ negative affect in sessions is low; their positive affect is consistently high for senior as well as novice tutors. Tutors rate their courses’ quality as high and quickly recover after sessions. Conclusions Tutors successfully cope with teaching-associated and everyday life demands. The results corroborate the viability and success of current peer-teaching programmes from the tutors’ perspective. This study is the first to comprehensively quantify tutors’ stress and describe frequent stressors, thus contributing to the development of better peer teaching programmes and tutor qualification training. Electronic supplementary material The online version of this article (10.1186/s12909-019-1521-2) contains supplementary material, which is available to authorized users.

Peer-teaching at the University of Rwanda - a qualitative study based on self-determination theory

“…Several students autonomously identified repetitive practice as a means to overcome this anxiety. Peer-teaching in other settings has been documented to cause anxiety in the peer-teacher, which was also reported by our participants [12][13][14]. Though similar to previous studies, our participants reported that this decreased during the preparation.…”

“…Though similar to previous studies, our participants reported that this decreased during the preparation. It has also been reported in the literature that as more PAL activities are established in curricula that this learner anxiety reduces and that peer-teaching prepares students for future careers/roles as clinician-teachers and medical educators [ 12 , 14 ]. The anxiety experienced by students preparing for peer-teaching activities in the peer-teaching model needs to be addressed with adequate supervision, where available.…”

“…A further systematic review in 2016 specifically compared controlled studies of peerteaching with faculty delivered teaching in terms of knowledge and skill acquisition, and found that students taught by peers did not have significantly different outcomes to those taught by faculty and that peer-teaching should be supported [4]. Negative aspects of peerteaching include reduced student learning if personalities or learning styles are not compatible, students spending less individualized time with the clinical instructor and anxiety for the peer-teacher [11][12][13][14]. These challenges require careful consideration and may warrant bespoke responses in order to optimize the learning experience for students and a consideration of whether a more suitable educational activity is available.…”

An observation of the peer-assisted learning (PAL) method in the clinical teaching of vertigo/dizziness-related diseases for standardized residency training (SRT) students in China: a randomized, controlled, multicenter study

“…Therefore, we should draw attention to the increased risk of burnout if PAL is intended to be widely used in clinical teaching. Same concern was also raised by other researchers, Hundertmark et al comprehensively quantified tutors’ stress and described frequent stressors in the PAL [ 39 ], and Matthew et al proposed that support and feedback developed competence and confidence and reduced stress and anxiety [ 40 ].…”

The AaLplus near-peer teaching program in Family Medicine strengthens basic medical skills—A five-year retrospective study

“…Various studies show that tutors are able to convey skills and knowledge as effectively as faculty staff [22][23][24]. Further recognized benefits of using peers as teachers include cognitive, social, and economic benefits, as well as the acquisition of teaching, organizational, and interpersonal competencies for peer tutors themselves [20,[25][26][27][28]. In general, peer-teaching is well established in health professions, especially in nursing education [29,30].…”