Copy igh © ISRG Publishe s. All igh s Rese ed.
DOI: 10.5281/zenodo.17707876
10
Abs ac
Backg ound:
Pee -Assis ed Lea ning (PAL) has become a aluable pedagogical ool in medical educa ion, emphasizing ac i e
pa icipa ion, eamwo k, and e lec ion. Despi e i s in eg a ion in o mode n cu icula, he dynamics o PAL du ing clinical
placemen s emain unde explo ed in many con ex s, especially in Asian medical schools.
Aim: This s udy explo ed unde g adua e medical s uden s’ expe iences o pee lea ning du ing hei clinical placemen s in he
Depa men o Medicine a a mili a y medical ins i u ion.
Me hods:
A desc ip i e c oss-sec ional s udy was conduc ed in 2016 among 166 unde g adua e medical s uden s (Thi d Yea ,
Final Pa I, and Final Pa II) unde aking clinical placemen s. Da a we e collec ed using a s uc u ed p o o ma adminis e ed
a e in o med consen . Responses we e anonymized and analyzed quan i a i ely and quali a i ely o explo e pe cep ions, bene i s,
and ba ie s o PAL.
Resul s:
Specialis s we e pe cei ed as he mos signi ican sou ce o lea ning (57.8%), while pee s anked hi d (12.7%). Pee
lea ning occu ed mos equen ly in eaching hospi al wa ds (80.2%) and p ima ily in ol ed obse ing his o y- aking and
physical examina ions (49.4%). S uden s engaged in PAL a leas once weekly. Re lec ion oppo uni ies (28.9%) we e he p ima y
mo i a o o pa icipa ion, whe eas he isk o s ained iendships (32.5%) eme ged as a majo ba ie . S uden s alued pa ien
in o ma ion sha ing and cons uc i e pee eedback as en iching hei lea ning p ocess.
ISRG PUBLISHERS
Abb e ia ed Key Ti le: ISRG J Clinic.Medici.Medica.Res.
ISSN: 3048-8850 (Online)
Jou nal homepage: h ps://is gpublishe s.com/cmm /
Volume – II, Issue - VI (No embe -Decembe ) 2025
F equency: Bimon hly
Unde g adua e Medical S uden s’ Expe iences o Pee -Assis ed Lea ning (PAL)
Du ing Clinical Placemen in he Depa men o Medicine
Myin Thein Naing1*, Thu ein Win1, Tun Tun Naing1, Nyan Sin Tun1, Ye Phyo Aung1, Nwe Nwe Win2 &
Ma la Than1
1 De ence Se ices Medical Academy, Myanma
2 No. (2) Mili a y Hospi al (500-Bedded), Myanma
| Recei ed: 17.11.2025 | Accep ed: 22.11.2025 | Published: 25.11.2025
*Co esponding au ho : Myin Thein Naing
De ence Se ices Medical Academy, Myanma
Copy igh © ISRG Publishe s. All igh s Rese ed.
DOI: 10.5281/zenodo.17707876
11
Conclusion:
Al hough PAL was pe cei ed as less signi ican compa ed o acul y-led eaching, i played a aluable supplemen a y
ole in os e ing e lec ion and eedback du ing clinical placemen s. S uc u ed aining in pee eaching, assessmen , and eedback
is essen ial o maximize PAL’s po en ial and o e come in e pe sonal challenges. Fu u e cu icula designs should in eg a e o mal
PAL sessions o op imize lea ning ou comes and p epa e s uden s o collabo a i e p ac ice.
Keywo ds: Pee -Assis ed Lea ning, Unde g adua e Medical Educa ion, Clinical Placemen s, Re lec ion, Medical S uden s
In oduc ion
The ans o ma ion o medical educa ion o e he pas wo decades
has been cha ac e ized by a shi om adi ional didac ic eaching
o mo e s uden -cen e ed, ac i e lea ning app oaches. Among
hese, Pee -Assis ed Lea ning (PAL) has gained signi ican ac ion
as bo h an ins uc ional and de elopmen al s a egy in
unde g adua e medical cu icula wo ldwide (Secomb, 2020). PAL
b oadly e e s o si ua ions in which s uden s o simila academic
s anding engage in eaching and lea ning ac i i ies wi h each o he ,
ei he o mally o in o mally (Topping, 2018). This p ocess
le e ages he concep s o cogni i e cong uence and social
cong uence, whe e lea ne s bene i om explana ions by pee s
who a e close o hei own le el o unde s anding (Ten Ca e &
Du ning, 2020).
PAL’s ad an ages ex end beyond con en mas e y. I os e s sel -
di ec ed lea ning, communica ion skills, e alua i e judgmen , and
he abili y o unc ion e ec i ely wi hin a eam—a ibu es c i ical
o compe en medical p ac i ione s (Agius e al., 2021). PAL also
encou ages e lec i e p ac ice and p o ides a psychologically sa e
en i onmen whe e s uden s can ask ques ions and make mis akes
wi hou ea o o mal e alua ion (Abdel Meguid & Collins, 2021).
Wi hin clinical educa ion, PAL plays a pa icula ly impo an ole.
Medical s uden s o en ace challenges in b idging heo e ical
knowledge wi h clinical p ac ice. Pee lea ning can ease his
ansi ion, allowing lea ne s o obse e, p ac ice, and ecei e
eedback in eal-wo ld con ex s (Tai e al., 2021). By obse ing
pee s conduc his o y- aking o examina ions, s uden s ein o ce
hei unde s anding and de elop con idence. Mo eo e , he
ecip oci y o eaching and lea ning among pee s’ nu u es
accoun abili y and deepens comp ehension (He mann-We ne e
al., 2017).
Howe e , despi e hese ad an ages, PAL is no wi hou challenges.
P e ious s udies ha e highligh ed issues such as a iabili y in
eaching quali y, insu icien aining in pee eaching, and
conce ns abou he accu acy o in o ma ion sha ed among pee s
(Khallou i e al., 2022). Addi ionally, in e pe sonal dynamics can
complica e PAL, wi h some s uden s epo ing discom o in
c i iquing o being c i iqued by iends (Mille e al., 2019).
The con ex in which PAL occu s signi ican ly in luences i s
e ec i eness. Mos o he li e a u e o igina es om Wes e n
ins i u ions, whe e PAL has been sys ema ically inco po a ed in o
cu icula. By con as , in many Asian medical schools, including
Myanma , PAL o en a ises in o mally du ing wa d o a ions,
u o ials, and g oup discussions a he han h ough s uc u ed
p og ams (Naing e al., 2016). This gap unde sco es he impo ance
o con ex -speci ic esea ch o unde s and how s uden s pe cei e
and engage in PAL.
The cu en s udy sough o explo e he expe iences o
unde g adua e medical s uden s ega ding pee lea ning du ing
clinical placemen s in he Depa men o Medicine a he De ence
Se ices Medical Academy. By examining s uden s’ pe spec i es,
equency o engagemen , pe cei ed bene i s, and ba ie s, his
esea ch con ibu es o he b oade discou se on PAL in clinical
educa ion. Unde s anding hese expe iences can in o m cu iculum
design, highligh ing a eas whe e s uc u ed pee lea ning
in e en ions could enhance clinical aining ou comes.
Aim o he s udy: To explo e unde g adua e medical s uden s’
expe iences o pee lea ning du ing clinical placemen s in he
Depa men o Medicine, wi h a ocus on pe cei ed bene i s,
ba ie s, and implica ions o medical educa ion.
Li e a u e Re iew
Theo e ical Founda ions o Pee -Assis ed Lea ning: Pee -Assis ed
Lea ning (PAL) is g ounded in se e al educa ional heo ies.
Vygo sky’s concep o he Zone o P oximal De elopmen (ZPD)
posi s ha lea ne s bene i mos when guided by someone jus
sligh ly mo e ad anced in knowledge o skill (Vygo sky, 1978).
PAL aligns wi h his idea, as pee s o en sha e a close cogni i e
and social backg ound compa ed o acul y, os e ing a ela able
and suppo i e lea ning en i onmen .
Global Adop ion o PAL in Medical Educa ion: PAL has become
inc easingly p ominen in medical schools wo ldwide. In he UK, i
has been ins i u ionalized h ough nea -pee eaching p og ams,
whe e senio s uden s u o junio s in ana omy, clinical skills, and
exam p epa a ion (Danda ino e al., 2007). Simila ly, No h
Ame ican medical schools inco po a e PAL wi hin p oblem-based
lea ning (PBL) g oups and clinical cle kships, enhancing eamwo k
and e lec i e lea ning (So iano e al., 2010).
Repo ed Bene i s o PAL: E idence consis en ly shows ha PAL
p o ides mul iple academic and pe sonal bene i s. S uden s ac ing
as pee eache s consolida e hei knowledge, de elop con idence,
and acqui e eaching skills, which a e inc easingly ecognized as
co e compe encies o medical g adua es (Secomb, 2020). Fo
lea ne s, PAL p omo es ac i e pa icipa ion, educes anxie y, and
os e s collabo a i e p oblem-sol ing (Agius e al., 2021).
Challenges and Ba ie s o PAL: Despi e hese ad an ages, se e al
challenges pe sis . S uden s may ques ion he c edibili y o pee
eaching, especially when compa ed o ins uc ion om
expe ienced clinicians (Mille e al., 2019). The s ain on
iendships caused by c i ical eedback o pe cei ed compe i ion
has also been no ed (Ross & Came on, 2019). Fu he mo e,
wi hou o mal aining, pee s may p o ide inaccu a e o
incomple e eedback, po en ially ein o cing misconcep ions
(Khallou i e al., 2022).
PAL in Clinical Placemen s: The clinical en i onmen o e s
unique oppo uni ies and challenges o PAL. On hospi al wa ds,
s uden s o en obse e each o he ’s pa ien in e ac ions, sha e
no es, and exchange ips o examina ions. This in o mal PAL
supplemen s o mal bedside eaching. A s udy in Ge many ound
Copy igh © ISRG Publishe s. All igh s Rese ed.
DOI: 10.5281/zenodo.17707876
12
ha clinical PAL enhanced eamwo k and boos ed s uden s’
con idence in pa ien ca e (He mann-We ne e al., 2017).
Howe e , clinical p essu es, limi ed ime, and inconsis en
oppo uni ies o s uc u ed pee in e ac .
Gaps in Cu en Resea ch: While PAL has been ex ensi ely
s udied in Wes e n con ex s, li e a u e om Asian medical schools
emains limi ed. Many exis ing s udies ely on o mal PAL
in e en ions, such as pee - u o ing p og ams, whe eas in o mal
pee lea ning du ing clinical placemen s is unde explo ed.
Fu he mo e, li le a en ion has been gi en o he emo ional and
ela ional dimensions o PAL, pa icula ly he balance be ween
cons uc i e eedback and main aining pee ela ionships.
Me hodology
S udy Design: This esea ch employed a desc ip i e c oss-sec ional
design o in es iga e unde g adua e medical s uden s’ expe iences
o pee lea ning du ing hei clinical placemen s in he Depa men
o Medicine. A c oss-sec ional app oach was chosen as i allowed
o he collec ion o da a a a single poin in ime, p o iding an
o e iew o s uden pe cep ions and beha io s ela ed o PAL.
S udy Se ing and Pa icipan s: The s udy was conduc ed a he
De ence Se ices Medical Academy (DSMA), Myanma , du ing
he 2016 academic yea . The Depa men o Medicine was selec ed
as he se ing because i ep esen s a co e clinical o a ion whe e
s uden s a e ac i ely in ol ed in pa ien ca e and pee in e ac ion.
A o al o 166 medical s uden s pa icipa ed in he s udy, spanning
h ee coho s: Thi d-yea s uden s, Final Pa I s uden s, and Final
Pa II s uden s. Pa icipa ion was olun a y, and s uden s we e
in o med.
Da a Collec ion Tool: A s uc u ed p o o ma (ques ionnai e) was
used o collec da a. The p o o ma was de eloped a e e iewing
ele an li e a u e and ailo ed o he local clinical con ex . I
included bo h closed-ended and open-ended ques ions designed o
assess: sou ces o lea ning du ing clinical placemen s, equency
and se ing o pee lea ning ac i i ies, ypes o ac i i ies conduc ed,
mo i a ing ac o s o engaging in PAL, and pe cei ed ba ie s o
PAL.
P ocedu e: The pu pose o he s udy and ins uc ions o
comple ing he p o o ma we e explained o pa icipan s. The
ques ionnai es we e illed ou anonymously o educe esponse bias
and encou age hones epo ing. Da a collec ion occu ed du ing
clinical placemen s, ensu ing s uden s e lec ed on hei immedia e
expe iences.
Da a Analysis: Quan i a i e da a we e coded and analyzed
desc ip i ely using pe cen ages and equencies. Resul s we e
p esen ed in abula and g aphical o ma s o cla i y. Quali a i e
commen s om open-ended ques ions we e e iewed hema ically
o p o ide addi ional insigh in o s uden s’ pe cep ions o PAL.
E hical Conside a ions: E hical app o al was ob ained om he
ins i u ional e iew boa d o he De ence Se ices Medical
Academy. Pa icipa ion was olun a y, and in o med consen was
secu ed om all esponden s. Anonymi y and con iden iali y we e
main ained h oughou he s udy.
Limi a ions o he Me hodology: This s udy elied on sel - epo ed
da a, which may be in luenced by ecall bias o social desi abili y
bias. Addi ionally, he pa icipan s had no been o mally ained in
pee lea ning echniques, which may ha e limi ed he dep h o hei
expe iences. Despi e hese limi a ions, he s udy p o ides aluable
insigh s in o he in o mal dynamics o PAL du ing clinical
placemen s in Myanma .
Resul s
A o al o 166 unde g adua e medical s uden s comple ed he s udy
ques ionnai e. The indings a e summa ized below.
Sou ces o Lea ning: S uden s iden i ied mul iple sou ces o
lea ning du ing clinical placemen s. Specialis s we e pe cei ed as
he mos impo an sou ce (57.8%), ollowed by pa ien s (18.7%).
Pee s anked hi d a 12.7%, highligh ing ha while PAL was
alued, i emained seconda y o acul y-led eaching.
Table 1. Sou ces o lea ning
Sou ce o Lea ning
Pe cen age (%)
Specialis s ( acul y)
57.8
Pa ien s
18.7
Pee s (PAL)
12.7
Books/lec u e no es
6.4
O he s
4.4
Se ing and F equency o PAL: The majo i y o PAL ac i i ies
occu ed in he wa ds o eaching hospi als (80.2%), ollowed by
u o ial ooms and ou pa ien clinics. Mos s uden s epo ed
engaging in PAL a leas once pe week, wi h some doing so mo e
equen ly du ing case-based g oup wo k.
Figu e 1. F equency o Pee -Assis ed Lea ning
Types o Ac i i ies: S uden s epo ed a ange o pee lea ning
ac i i ies. The mos common we e obse ing his o y- aking and
physical examina ion (49.4%), ollowed by discussion o pa ien
cases, sha ing lec u e no es, and in o mal bedside eaching.
Table 2. Ac i i y o Lea ning
Ac i i y
Pe cen age (%)
His o y- aking/physical examina ion
49.4
Case discussions
28.3
Sha ing lec u e no es/ esou ces
14.5
Pee eedback (in o mal)
7.8
Mo i a o s and Ba ie s: Re lec ion oppo uni ies we e ci ed as he
p ima y mo i a o (28.9%) o engaging in PAL. Con e sely, he
mos signi ican ba ie was s ain on iendships (32.5%), wi h
some s uden s exp essing discom o in c i iquing pee s o being
c i iqued.
12%
26%
42%
20%
Daily
2–3 imes/week
Once/week
Less han
once/week
Copy igh © ISRG Publishe s. All igh s Rese ed.
DOI: 10.5281/zenodo.17707876
13
Figu e 2. F equency Dis ibu ion in Mo i a o s o PAL
Figu e 3. F equency Dis ibu ion in Ba ie s o PAL
Discussion
This s udy explo ed unde g adua e medical s uden s’ expe iences
o pee lea ning du ing clinical placemen s in he Depa men o
Medicine. The esul s demons a e ha while PAL was no he
p ima y mode o lea ning, i p o ided aluable oppo uni ies o
e lec ion, eedback, and skill ein o cemen .
PAL as a Supplemen a y Lea ning Sou ce: The inding ha
specialis s we e he mos signi ican lea ning sou ce (57.8%) aligns
wi h p e ious s udies emphasizing he cen al ole o acul y in
medical educa ion (Khallou i e al., 2022). Howe e , pee s
accoun ed o 12.7% o lea ning, unde sco ing hei ole as a
supplemen a y, ye meaning ul, educa ional esou ce. This e lec s
global ends whe e PAL is ecognized no as a eplacemen o
acul y-led ins uc ion bu as a complemen a y s a egy (Secomb,
2020).
Clinical PAL Ac i i ies: The p edominance o PAL in wa d
se ings (80.2%) highligh s he impo ance o clinical en i onmen s
as e ile g ounds o pee collabo a ion. Obse ing his o y- aking
and physical examina ion (49.4%) as he mos common ac i i y
mi o s indings om He mann-We ne e al. (2017). Such
ac i i ies a e consis en wi h Vygo sky’s ZPD amewo k, as
s uden s sca old hei lea ning by obse ing pee s pe o m asks
jus beyond hei own capabili y.
Re lec ion and Feedback: Re lec ion was a key mo i a o o PAL,
epo ed by 28.9% o s uden s. This aligns wi h Tai e al. (2021),
who emphasized he e lec i e na u e o PAL in os e ing
e alua i e judgmen and sel -awa eness. Pee eedback was also
alued, hough inconsis en ly p ac iced. Wi hou o mal aining,
he quali y o pee eedback may be limi ed, educing i s
educa ional po en ial.
Ba ie s o PAL: A signi ican ba ie iden i ied was he s ain on
iendships (32.5%), consis en wi h s udies no ing in e pe sonal
challenges o PAL (Mille e al., 2019). S uden s epo ed
eluc ance o c i ique pee s due o ea o o ending hem. This
unde sco es he need o explici aining in eedback deli e y and
p o essionalism. O he ba ie s, such as lack o aining and ime
cons ain s, e lec sys emic challenges. S uc u ed PAL ini ia i es
wi h acul y o e sigh could mi iga e hese issues.
Implica ions o Cu iculum De elopmen : The indings sugges
ha PAL in Myanma emains in o mal and s uden -d i en,
limi ing i s po en ial impac . Fo malizing PAL h ough s uc u ed
pee eaching, pee assessmen wo kshops, and acul y-guided
sessions could enhance i s e ec i eness. Embedding PAL wi hin
compe ency-based amewo ks may also ensu e i suppo s
domains like eamwo k, communica ion, and p o essionalism.
Compa ison wi h In e na ional Li e a u e: These indings align
wi h global li e a u e bu also highligh con ex ual di e ences.
Wes e n ins i u ions o en epo highe engagemen wi h PAL due
o o maliza ion, whe eas in Myanma , PAL is supplemen a y and
in o mal. None heless, he e lec i e and collabo a i e bene i s
emain uni e sal.
Limi a ions and Fu u e Resea ch: This s udy’s limi a ions include
eliance on sel - epo ed da a and lack o quali a i e dep h. Fu u e
esea ch should adop mixed me hods and e alua e s uc u ed PAL
in e en ions in local con ex s.
Conclusion
This s udy explo ed unde g adua e medical s uden s’ expe iences
o pee lea ning du ing clinical placemen s in he Depa men o
Medicine a he De ence Se ices Medical Academy. Al hough
specialis s we e he p ima y sou ce o lea ning, pee s played a
meaning ul supplemen a y ole, pa icula ly in os e ing e lec ion,
eedback, and skill ein o cemen .
The indings highligh ha PAL mos equen ly occu ed in wa d
se ings, ocusing on his o y- aking and physical examina ion.
Re lec ion was he mos alued ou come, while in e pe sonal
challenges, pa icula ly s ained iendships, we e he mos
signi ican ba ie . These esul s unde sco e he dual po en ial o
PAL as a aluable educa ional ool when s uc u ed e ec i ely, bu
one ha can also pose challenges i le in o mal and unsuppo ed.
PAL holds signi ican p omise o en iching unde g adua e
medical educa ion in Myanma and beyond. By o malizing and
suppo ing pee lea ning wi hin clinical cu icula, medical schools
can enhance e lec i e p ac ice, eamwo k, and p o essional
g ow h, ul ima ely p epa ing s uden s o collabo a i e, pa ien -
cen e ed heal hca e.
Recommenda ions
1. In oduce s uc u ed PAL aining wi hin he cu iculum,
ocusing on eaching, assessmen , and eedback skills.
2. No malize cons uc i e pee eedback by in eg a ing i
in o clinical eaching sessions.
3. Encou age acul y acili a ion o PAL, ensu ing accu acy
o knowledge while p omo ing collabo a ion.
4. Expand esea ch on PAL in Asian and low- esou ce
con ex s.
29%
22%
19%
12%
18% Re lec ion
Feedback
Con idence-
building
Con enience
O he s
33%
26%
22%
19% S ained
iendships
Lack o aining
Time
cons ain s
Pe cei ed
ine iciency
Copy igh © ISRG Publishe s. All igh s Rese ed.
DOI: 10.5281/zenodo.17707876
14
Re e ences
1. Abdel Meguid, E., & Collins, M. (2021). S uden s’
pe cep ions o pee -assis ed lea ning in clinical skills: A
mixed me hods s udy. Medical Teache , 43(2), 141–148.
h ps://doi.o g/10.1080/0142159X.2020.1814820
2. Agius, A., Calleja, N., Camille i, F., & Sul ana, R.
(2021). Pe cep ions o pee -assis ed lea ning in
unde g adua e medical educa ion: A mixed-me hods
s udy. BMC Medical Educa ion, 21(1), 89.
h ps://doi.o g/10.1186/s12909-021-02534-5
3. Danda ino, M., Snell, L., & Wiseman, J. (2007). Why
medical s uden s should lea n how o each. Medical
Teache , 29(6), 558–565.
h ps://doi.o g/10.1080/01421590701477449
4. He mann-We ne , A., G ame , R., E schens, R.,
Nikendei, C., & Junne, F. (2017). Pee -assis ed lea ning
in unde g adua e medical educa ion: An o e iew.
Zei sch i ü E idenz, Fo bildung und Quali ä im
Gesundhei swesen, 123, 74–81.
h ps://doi.o g/10.1016/j.ze q.2017.05.017
5. Khallou i, A., Hamza, M., & Bennani, S. (2022).
E ec i eness o pee -assis ed lea ning in medical
educa ion: A sys ema ic e iew. Ad ances in Medical
Educa ion and P ac ice, 13, 65–74.
h ps://doi.o g/10.2147/AMEP.S340239
6. Mille , M. L., D’Angelo, J. D., & Lyons, J. L. (2019).
Ba ie s o pee -assis ed lea ning: A quali a i e s udy o
medical s uden s’ expe iences. Teaching and Lea ning in
Medicine, 31(3), 269–276.
h ps://doi.o g/10.1080/10401334.2018.1526744
7. Ross, M. T., & Came on, H. S. (2019). Pee assis ed
lea ning: A planning and implemen a ion amewo k.
AMSPAR Medical Jou nal o Educa ion and T aining,
11(2), 33–41.
8. Secomb, J. (2020). A sys ema ic e iew o pee eaching
and lea ning in clinical educa ion. Jou nal o Clinical
Nu sing, 29(17–18), 2931–2940.
h ps://doi.o g/10.1111/jocn.15263
9. Shah, N., Choudhu y, A., & Kuma , S. (2020). Pee -
assis ed lea ning in Sou h Asia: An in eg a i e e iew.
Sou h Eas Asian Jou nal o Medical Educa ion, 14(1),
42–51. h ps://doi.o g/10.4038/seajme. 14i1.240
10. So iano, R. P., Bla , B., Copli , L., CichoskiKelly, E.,
Kosowicz, L., Newman, L., G eenbe g, L. (2010).
Teaching medical s uden s how o each: A na ional
su ey o s uden s-as- eache s p og ams in U.S. medical
schools. Academic Medicine, 85(11), 1725–1731.
h ps://doi.o g/10.1097/ACM.0b013e3181 53273
11. Tai, J. H. M., Canny, B. J., Haines, T. P., & Molloy, E.
K. (2021). De eloping e alua i e judgemen h ough
pee lea ning: A scoping e iew. Medical Educa ion,
55(3), 279–290. h ps://doi.o g/10.1111/medu.14345
12. Ten Ca e, O., & Du ning, S. (2020). Pee eaching in
medical educa ion: Twel e ips o make i wo k. Medical
Teache , 42(2), 137–143.
h ps://doi.o g/10.1080/0142159X.2018.1554890
13. Vygo sky, L. S. (1978). Mind in socie y: The
de elopmen o highe psychological p ocesses. Ha a d
Uni e si y P ess.
