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Table 1 Challenges of online PAL in clinical skill training

From: Challenges of peer assisted learning in online clinical skills training of ophthalmology module

# Theme Sub-theme Representative quotes Solutions
1 Infrastructure • Network connection
• Scheduling
• Timing/duration of sessions
“Internet connection is a big issue all the time.”
“I feel that time for the session was too short to learn clinical skills by a big batch of students.”
Improve network connection
More PAL sessions can be added
Timing of the PAL sessions can be increased for student’s practice
2 Psychological issues • Behavioral
• Personality
• Distrust on peer tutor
• Skill deficit (use of gadgets)
“I found poor motivation to start work and learn coz of no direct contact with the teacher.”
“I felt little confused whether I am getting right skill or not while learning clinical skills from my class fellow.”
“I think that our tutor needed more training because in the question-answer session he could not give satisfactory answers to my question.”
Motivational discussion sessions with the tutor sum-up sessions by the physician (tutor) himself
More meticulous training sessions for the peer tutors
3 Learning environment • Professionalism
• Acceptability
(culture of safety)
“I do not feel myself in a professional environment that’s why get distracted most of the time.” Meticulous questioning on different steps of clinical skill by the tutor
4 Interaction deficit • Patient
• Physician
“No direct contact with the patient.”
“Honestly, I prefer live and personal interaction with the doctor and watching and learning from her directly in clinics especially in clinical subjects like ophthalmology. It is impossible to compare it with attending clinics or rotations.”
Videos of actual performance of tutor on his patients
Add multiple videos of the skill performances
In-camera skill performance by the physician
5 Learning preferences • Desire for supervision
• Desire for training
“I prefer the session to be conducted by the doctor as we gain experience from the doctor which of course more skilled and well versed.”
“No hands-on experience which I think is very important in learning clinical skills.”
Videos of the actual performance of tutor on his patients
6 feedback on performance   “Feedback on performance, I missed it. Due to lack of practice, I feel that I can still make many mistakes while performing this clinical skill and nobody would correct me or would be there to give me feedback on my performance (whether I am right or wrong).” Feedback session by the tutor himself at the end of each session