Why Peer-to-Peer Learning Sticks

In a typical lecture class, only 40% of learners are actively paying attention.¹ 70% of learners retain what they hear in the first 10 minutes of a lecture, and only 20% of learners retain what they hear during the last 10 minutes.² For educators, this can be disheartening. For nursing programs, this poses a serious problem. Learners who need to graduate with life-saving skills and knowledge may not recall a large portion of the material.

“While we teach, we learn,” said the Roman philosopher Seneca. For thousands of years, education has continued to come back to this axiom. The success that educators have had by assigning learners to teach others is known as the Protégé Effect. And, in the context of using simulation to become competent in performing clinical tasks, it presents an ideal opportunity to take an old-school learning method and make it new-school today.

During peer-to-peer learning, the assigned teacher, the protégé, experiences a far greater motivation to learn, meaning that students generally make a greater effort to learn for those that they will teach than they do for themselves.³ And, there are benefits for the non-protégé as well. Learning becomes a social endeavor, as all students involved will engage with one another to collaboratively construct their understanding of material.⁴

In nursing schools, where there is an almost unanimous burden to do more with less, peer-to-peer learning has been an emerging trend. Peer-to-peer learning, sometimes referred to as peer teaching or peer mentoring, involves learners in a similar situation learning from and with each other through their interactions. In this article, we highlight how this educational approach can help you to more effectively train new nurses.

In the United States, the average student to faculty member ratio in colleges and universities is 16:1.⁵ Within nursing programs, the number of students is often higher. The limited number of one-on-one or small group interactions to develop skills can negatively impact learners. And, acknowledging the significant time commitment and cognitive overload, nursing students are less likely to volunteer their free time for extra skills practice.

Peer-to-peer learning can help to satisfy the needs of learners for simulated skills training. One study showed that students who used peer-led deliberate practice saw increased confidence and support in performing psychomotor skills.⁶ Another study suggested that performance scores for those who learned through peer teaching will be significantly better than those trained by assistant teaching staff in traditional clinical sessions.⁷ Both findings point to peer-to-peer learning as a method of improving learner outcomes.

If your organization is battling low faculty and staff numbers, peer-to-peer learning might be an alternative method that can help. As part of this method, instructors and simulation experts play the role of facilitator, setting expectations, assigning teams, and overseeing the learner interactions. However, it is the learners (specifically, the protégés) who lead the skills development session, observe other learners, and provide detailed feedback and guidance throughout a scenario.

It’s often stated that millennials are glued to their phones – and a recent survey found that this is true! 39% of millennials (born between 1981 and 1996) admit that they interact more with their smartphones than they do with their significant others, parents, friends, or co-workers.⁸ In an age of increasing screen time, learners may experience less face-to-face time with other learners and their instructors. The time for discussion and group exercises can be limited and learners can begin to feel isolated in their studies. 

Peer-to-peer learning can provide the personal engagement that millennials want. Research findings show benefits of peer partnerships that support the transition from university to nursing practice, including preparing students to be mentors in the clinical setting and reducing student anxieties.⁹ Experts also believe that peer-to-peer learning provides a sense of belonging that can help learners cope with academic stress. Learners will often turn to their peers for advice and guidance, particularly when they are exposed to new concepts. And, such socialization has been proven to strengthen the learning process.¹⁰

In addition to the psychological benefits, learners see cognitive improvement with peer-to-peer learning. One study found that peer learning among nursing students led to an increase in clinical accuracy and a decrease in practical mistakes.¹¹ Because peer-to-peer learning holds learners accountable for their own performance as well as another learner’s, their engagement is high. Learners feel an increased level of commitment to the subject matter at hand.

With peer-to-peer learning, there is no question whether your learner is dedicated to clinical excellence. He or she can repeat a skill or scenario time and time again, returning to weak areas in their training, until they perform a task perfectly.

Today, many universities are seeking supplemental approaches to the traditional classroom. The reasons vary from budget cuts, high student populations, and increasing demands on staff.¹² A primary benefit of simulation boasted by experts is a high return on investment (ROI). As a reminder, it’s not just high-fidelity simulation that can build ROI – skills training offers an opportunity as well.

Peer-to-peer learning can result in a time-savings. By enabling learners to assess each other’s skills performance – rather than relying on one sole instructor – multiple trainings can occur simultaneously without sacrificing quality. In fact, nursing students who have practiced using peer learning techniques agreed that the feedback they received from their peers is more helpful than feedback from their clinical instructor.¹³

In addition, peer-to-peer learning can offer a cost-savings in resources. The cost of high-fidelity simulators and the staffing to run them can be quite high, which is why it’s often more beneficial to separately introduce skills training first. Using peer-to-peer learning, learners can acquire their foundational skills and knowledge. This can help you better time an investment in full-scale simulation until it's truly necessary. 

There is also ROI involved for learners. One study demonstrated that peer learning helped to develop professional skills, such as feedback techniques, leadership qualities, and autonomy in learning.¹⁴ Learners invest greatly in their education, and it can reflect very positively on an organization if they believe their experience was positive and gave them ROI.

Budget limitations are a reality for many nursing programs today but, fortunately, ROI can come in many forms. In the realm of simulation, peer-to-peer learning can provide ample opportunity for ROI with little risk.

The U.S. Bureau of Labor projects a demand for 1.1 million new nurses by 2022, when the aging population will require 575,000 newly created positions in addition to replacements for the 550,000 nurses expected to retire.¹⁵ As this severe nursing shortage approaches, nursing schools are unable to accept qualified applicants because of their lack of resources.¹⁶ As they struggle to expand their faculty and class sizes, there are simply not enough new graduates to replenish the workforce.

Peer-to-peer learning is one way for your organization to approach the challenge that lays ahead. While it is not intended to replace traditional classroom learning or high-fidelity simulation, it offers a supplemental and highly-valuable training opportunity. Your faculty can maximize their scarce time while learners (and their future patients) reap the benefits of repeated and safe skills practice.