This may demonstrate that

peer-assisted learning activities can be utilised in paired student placements without reducing access to other learning activities. It may have indicated that students in peer-assisted learning were able to use their ‘downtime’ (ie, time when, in the traditional approach, they may have been waiting for their clinical educator to direct their learning) to complete the designated peer-assisted learning tasks. The rigid structure of the formal peer-assisted learning activities may have contributed to the dissatisfaction with the model, a notion that is supported by the clinical educators citing a preference for a ‘flexible peer-assisted learning’ model in the future. To ensure Galunisertib consistency in the research protocol, the formal elements of the peer-assisted learning MLN0128 molecular weight model were prescribed and did not vary throughout the placement. Principles of learning dictate that an effective teaching strategy involves a progression of increasingly complex tasks as knowledge and skill increase.29 Although it was theoretically possible to increase complexity of the task within the prescribed activities, this may have been difficult for clinical educators and students to execute, given that it was their first experience with the

tools. If paired student placement models are utilised in clinical education, it may be important to consider incorporating flexibility in the type and number of peer-assisted learning activities facilitated each week, although the results of the trial may have been different if this approach had been tested. The time allocated to familiarise students with the tools and expectations of the peer-assisted learning model in this study

may have been insufficient, which may have contributed to students’ relative dissatisfaction with the formal tools and the model Cell press itself. Students’ willingness to engage in a different learning culture to traditional, teacher-led practices can affect their engagement with peer-assisted learning19 and has been recognised as being important to clinical educators.30 To help address this, it may be of benefit to introduce the various tools in the pre-clinical period, and to invest time in orientating learners about the evidence of both the short-term and long-term benefits of working with and learning with peers.9, 10, 11, 12, 13, 14, 16, 17, 19 and 31 It is also possible that some elements of the peer-assisted learning model may have greater acceptability to students than others, and this will be the focus of ongoing investigations. The project was conducted in one health service with one group of clinical educators, which limits generalisability. Clinical educator participants were volunteers and therefore a self-selecting group. Issues may have been missed that related specifically to clinical educators who did not volunteer.