Impact of a pre-clinical skills course with Peer Assisted Learning (PAL) on preparedness and confidence levels of medical students in Africa

  • Cheryl Snyder MA, DO, San Diego Christian College
  • Rose Chisenga MB ChB, University of Zambia


Background: Many benefits of pre-clinical medical skills training have been documented in more technologically advanced nations, and in the past decade, these courses have been introduced to developing countries. Curriculum that can prepare and build confidence in medical students must be cost effective, evidence-based and culturally sensitive in places where there are severe resource limitations.  In 2013, an initial pre-clinical skills course without assessments was introduced to medical students in Zambia. Later that year, a more developed course was launched to a second cohort integrating Peer Assisted Learning (PAL) and assessments. These trainers were prepared in advance with instruction in standardized skills, learning theory, effective feedback techniques and use of rubrics to insure good inter-rater reliability in teaching and assessments.

Methods: A quantitative study surveyed 108 students utilizing convenience sampling and a written questionnaire. Data collected compared preparedness and confidence in performing clinical skills of the intervention cohorts with the control group (medical students who preceded pre-clinical skills training).

Results: Preparedness responses increased from 36.1% of the students in the control group to 90.9% in the intervention group who had been exposed to the PAL course with assessments (p value <0.001). Student confidence levels in history taking, physical exam skills, procedures and the application of critical thinking skills diagnostically also showed improvement from 11.5-29.5% range in the control group to 77.3-86.4% range in the PAL cohort (p value <0.001).

Conclusions:Exposure to pre-clinical training program especially utilizing PAL with assesments had a positive impact on the sense of preparedness and confidence levels for medical students beginning their clinical training years at the University of Zambia.  Integration of PAP influenced academic development, clinical procedural standardization, appropriate curriculum additions, transitional support and program sustainability. PAL may have beneficial application extending to basic science lab instruction in resource limited environments. Recommendation for future research would be integration of qualitative triangulation and reduction of variables in confidence data reporting. 

Author Biographies

Cheryl Snyder, MA, DO, San Diego Christian College

MA, DO, Associate professor at San Diego Christian College and Chair of the science department

Rose Chisenga, MB ChB, University of Zambia
Rose Chisenga is a Junior Resident Medical Officer currently doing her internship at the University Teaching Hospital in Zambia.She received her Bachelor of Medicine and Bachelor of Surgery degrees from the University of Zambia, School of Medicine.She is interested in teaching and carrying out research that can help improve the standard of health care in developing countries like Zambia.She hopes to get specialized training in infectious diseases.  
How to Cite
SNYDER, Cheryl; CHISENGA, Rose. Impact of a pre-clinical skills course with Peer Assisted Learning (PAL) on preparedness and confidence levels of medical students in Africa. Christian Journal for Global Health, [S.l.], v. 4, n. 1, p. 3-12, mar. 2017. ISSN 2167-2415. Available at: <>. Date accessed: 24 june 2018. doi:


PAL;Africa; clinical skills; confidence levels