1 Background

Peer tutoring is a learning strategy where students take on the responsibility for teaching and evaluating their peers. Peer tutors can include learners at the same level or a peer more advanced in their training and is an effective teaching strategy in health science professions [5, 6, 41] for cognitive development and improving educational learning outcomes [25, 41]. Additionally, student satisfaction with this type of learning strategy is generally high [25].

Peer tutoring is a different learning experience than traditional teaching modules, with unique advantages [32]. Tutors have recently learned material and can better align teaching to the tutees’ level of understanding [18]. Additionally, they are able to create a more relaxed learning environment than the traditional classroom with less anxiety for the learner [32]. Peer tutoring also provides reciprocal benefits for tutors in knowledge and performance [7, 10, 13, 20, 26,31,28, 30]. Finally, peer tutoring offers economic benefits to programs and students, when using peer tutors as lower cost alternatives to faculty or adjunct faculty [5, 9, 31] and often at a lower teacher to learner ratio [32].

Medical education has well-established peer tutoring models. In a survey of United States medical schools, 76% of respondents reported they used some form of peer tutoring in their programs [29]. However, the method is not well described for rehabilitation sciences curriculums [6] and established programs may not be based on an understanding of the theories and research of peer tutoring.

The development of any learning program should be made with an understanding of the available literature. Our team aims to develop a robust peer-tutoring program in a rehabilitation science curriculum, informed by the available literature. To understand the depth and breadth of the limited literature available, the scoping review methodology was chosen. The aim of this review is to describe how peer tutoring is used in rehabilitation sciences curriculums and describe the outcomes of these programs. The objectives of this review are.

  1. 1.

    Describe how peer tutoring programs are implemented in rehabilitation science curriculums

  2. 2.

    Describe the outcomes of peer tutoring programs in rehabilitation science curriculums.

2 Methods

The study protocol was based on the Arksey and O’Malley [2] scoping review framework modified by Levac et al. [16] and consisted of a five-step process: (1) framing the research question, (2) searching and obtaining studies, (3) study selection per criteria, (4) charting the data, and (5) summarizing, synthesizing, and reporting results. The databases searched were PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC) and Scopus. The search strategy was executed in August of 2021 and again in August 2022. Full study protocol and search strategy are available online (OSF Peer tutoring in rehabilitation sciences curriculums: A scoping review protocol).

The study selection criteria included the English language, peer-reviewed articles that report outcomes of a peer-tutoring program for students enrolled in occupational therapy, physical therapy, speech therapy and or athletic training programs. There was no limit on age of the publication. Studies were excluded if the intervention was primarily mentorship, which was defined as a process and relationship that is long term and built on shared experiences. Mentors are individuals who build deep relationships to provide guidance, advanced learning and development [14].

Search results were loaded into Rayyan for the selection process [22]. Graduate occupational therapy students (CF, HM) performed screening for study inclusion after training by faculty (AB). Quality checks were performed, and faculty reviewed any disagreements in study selection to make final determination. Two independent reviewers completed data extraction. Teams included one occupational therapy student and one faculty member (AB, LK, RS). In the event of disagreement, conflicts were reviewed by an additional faculty member. Data were extracted into a table into Microsoft Excel (Microsoft Inc.). The following data was extracted from the full text articles: author, publication date, country of study, degrees, program set up including course topic, faculty or student led, intensity of tutoring offered, integration into course work, tutor characteristics such as selection criteria and trainings and outcomes of the program.

3 Results

The database searches resulted in 1409 studies and 16 studies met the inclusion criteria for the review. The study selection process is reported in the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) for Scoping reviews format [33] (Fig. 1). Table 1 provides an overview of the included studies. The overwhelming majority of research studies were conducted at universities the United States of America (n = 13). England (n = 1), Brazil (n = 1) and Belgium (n = 1) were also represented. The research methodology is of lower levels with most work using a one group pre-post design (n = 7). Only three studies used a two-group design, with one running a randomized control trial and the other two using a quasi-experimental design.

Fig. 1
figure 1

Study Selection Flow Chart

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Table 1 Study Characteristics
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3.1 Program structure

Tutoring program design varied (Table 2). Near peer (n = 12) and reciprocal teaching (n = 4) were the only peer tutoring models identified. Near peer is when students with more training provide tutoring to students in the earlier stages of the curriculum. Reciprocal tutoring is when peers of equal training each take responsibility for teaching different content. Programming was almost always in groups with one report using both group and 1:1 based on the preference of the tutee. Interprofessional education was well represented in peer tutoring programs (n = 7) with tutee/tutors coming from different academic programs. The most common areas taught by tutors was anatomy (n = 6) followed by clinical assessments (n = 3).

Table 2 Program Structures
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Tutoring program content was developed by faculty (n = 7) and by a combination of faculty and student tutors (n = 6). In only two reports did the student tutor have full responsibility for developing the content. Reporting of the frequency of tutoring activities varied throughout the included studies. Reciprocal teaching models described the interactions as course modules that ranged from 1–5 modules in the course. Near peer teaching was most often reported in terms of hours (n = 8 studies; range 0.5–19.5 hours) and number of tutoring sessions (n = 1–13). The most common format was one-two times per week (n = 5).

3.2 Tutor characteristics

Tutors were most often enrolled in physical therapy programs (n = 8), followed by occupational therapy (n = 4), speech language pathology (n = 2) and audiology (n = 2). Other degrees represented included athletic training, nutrition, medicine psychology, physical education, and teaching/education (Table 1).

Most programs had multiple criteria for selecting tutors. The most common selection method was through faculty recommendation (n = 8) followed by academic achievement (n = 5), competency assessment (n = 3), a commitment or interest in the program/topic area (n = 2) and interview (n = 1). Academic achievement was assessed by either total GPA and/or grade achieved in the course the tutors would be providing near peer tutoring in, however only 3 articles reported the specific grades needed. Faculty recommendations were not well described with only three articles articulating the criteria for recommendation that included oral and communication skills (n = 2) and faculty report of academic achievement or skills (n = 2) (Table 2).

Nine reports described some type of training provided to the peer tutor that included training or support on teaching strategies (n = 6), content specific training (4) and written materials (n = 2) (Table 2).

3.3 Tutee characteristics

Similar to the tutors, the tutees were most often enrolled in physical therapy programs (n = 7), followed by speech language pathology (n = 4), occupational therapy (n = 3), medicine (n = 2), and athletic training (n = 1). Other degrees include nutrition, psychology, physical education, exercise science and teaching/education (Table 1). Seven programs required students to participate in tutoring while participation was voluntary for eight programs. Criteria for tutees to access the services were most often enrollment in the educational program or within a specific course. Only one program reported requirement of an application and GPA consideration (Table 2).

3.4 Outcomes

Outcomes for both tutors and tutees were described in the literature (Table 3). All studies described tutee outcomes and 12 studies reported on outcomes for the tutors. The most common method of reporting outcomes for tutees (n = 12) and tutors (n = 8) were surveys. Objectives measures of tutee outcomes were less common (n = 5). One report evaluated the tutees achievement of a skill, two reported on grades in specific course and two on progression in a program. The only objective measure of tutor academic benefit was by Youdas et al. [40] who reported academic achievement for tutors in similar content areas to describe the potential benefit of being a peer tutor.

Table 3 Outcomes
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4 Discussion

This review aimed to describe the use of peer tutoring in rehabilitations science curriculums. The results demonstrate that peer tutoring is utilized in AT, OT, PT and SLP curriculums, however the evidence is limited in both number of studies and methodological rigor.

The most common course content addressed were foundational sciences (n = 7). The large portion devoted to the single area of anatomy (n = 6) may reflect program need to support students in course work they find most challenging [19, 39]. However, peer tutoring was also used to teach skills directly related to clinical practice including clinical assessments (n = 3), cultural competency (n = 2) and evaluation and treatment in a pro bono clinic (n = 1). These studies demonstrate the potential for peer tutoring in courses beyond foundational content to develop professional and clinical skills, as reported in medical education [1, 9, 34].

An anticipated outcome of any tutoring program is knowledge or skill acquisition; however, this was only assessed in six reports. Studies included in this review relied heavily on the perceptions and self-reported outcomes of the tutees. This limited evidence on effectiveness is consistent with a systematic review of peer tutoring in health professional education which also found limited work to objectively evaluate outcomes of peer tutoring [6]. Further work is needed to ensure resources expended into programs yield the desired results for tutees.

In addition to exploring the outcome of students receiving tutoring, 75% of the included studies explored the impact for the tutors. Although less commonly investigated [37], tutors do benefit from participation, perhaps even more than their tutees [4, 9, 31, 32]. In this review, self-reported positive outcomes by tutees included increased confidence, personal growth, and overall satisfaction with the experience. Only one study reported on academic outcomes of the tutors with most tutors achieving greater than class means on course assessments of similar content areas [40].

In addition to the academic and self-perceived growth, acting as a peer tutor may have additional benefits. Teaching is a fundamental skill of healthcare professional. Explaining complex concepts as part of client education is a necessary clinical skill [8]. Developing the communication skills to effectively communicate these complex ideas requires practice and participating in tutoring may provide these additional opportunities [21]. Tutors must also use essential professional behaviors [32] that typically are not required until clinical education [15].

However, it is important to acknowledge that peer tutors report challenges. These included insufficient support by academic staff [3], the large amount of time and dedication needed, learning how to teach, and expectation of them to have the same level of knowledge as the professors [7]. Any peer tutoring program should develop resources and processes to support the tutors through the challenges that are unique to the peer tutoring role. In this review, nine articles included training and support for the tutors, however in-depth descriptions were not available.

5 Conclusion

The included studies largely reported positive outcomes of their peer tutoring program. A major limitation of the scoping review process is that it does not having a grading criteria scale similar to a systematic review allowing for comment on the methods. Additional limitations are related to the inclusion criteria to only include English language studies. The works presented were overwhelming from the United States which may suggest a bias. A research librarian was consulted in the development and execution of the search strategy to minimize this bias.

Peer tutoring is used in rehabilitation science curriculums to improve learning in didactic and clinical course work. Peer tutoring is most often described in physical therapy programs for foundational science course work. This scoping review provides a summary of how peer tutoring has been used in rehabilitation sciences curriculums and can be used to inform future work in this area in both development and evaluation of peer tutoring programs.

Future research should capture objective outcomes such as impact on academic performance and retention rates. Additionally, evaluating the short-term benefits of being a tutor and the longer-term outcomes of peer tutors’ professional trajectories are fruitful areas of study. Finally, peer tutoring should be evaluated for course work beyond foundation level courses and in all the rehabilitation science disciplines.

5.1 Educational implications

This review highlights the limited publications around peer tutoring in rehabilitation sciences curriculums. The included articles not only demonstrated variability in the outcomes reported, but also in the depth of information on the program structures. Many publications did not report on relevant aspects of their tutoring program such as tutor qualifications, program outcomes and tutor training. Faculty recommendation was a common criteria for tutor selection (n = 8) however depth into criteria for recommendation was often missing and tutor training requirements were only described in nine of the reviewed articles. The limited information on the tutoring programs creates a challenge for educators to replicate the described programs. Our team aims to implement a peer tutoring program that is grounded in the literature. Based on the results of this review, key aspects of the program will include tutor training, performance based assessments of academic outcomes of peer tutoring participation as well as performance based assessment of tutor outcomes. This review highlights the need for well designed evaluation of peer tutoring to not only report on the success but also to ensure successful programs can be replicated at other institutions.