Sullivan et al.

BMC Medical Education 2012, 12:26

http://www.biomedcentral.com/1472-6920/12/26

RESEARCH ARTICLE Open Access

Peer observation of teaching as a faculty

development tool
Peter B Sullivan*, Alexandra Buckle, Gregg Nicky and Sarah H Atkinson

Abstract
Background: Peer observation of Teaching involves observers providing descriptive feedback to their peers on
learning and teaching practice as a means to improve quality of teaching. This study employed and assessed peer
observation as a constructive, developmental process for members of a Pediatric Teaching Faculty.
Methods: This study describes how peer observation was implemented as part of a teaching faculty development
program and how it was perceived by teachers. The PoT process was divided into 4 stages: pre-observation
meeting, observation, post-observation feedback and reflection. Particular care was taken to ensure that teachers
understood that the observation and feedback was a developmental and not an evaluative process. Twenty
teachers had their teaching peer observed by trained Faculty members and gave an e-mail ‘sound-bite’ of their
perceptions of the process. Teaching activities included lectures, problem-based learning, small group teaching,
case-based teaching and ward-based teaching sessions.
Results: Teachers were given detailed verbal and written feedback based on the observer’s and students’
observations. Teachers’ perceptions were that PoT was useful and relevant to their teaching practice. Teachers
valued receiving feedback and viewed PoT as an opportunity for insight and reflection. The process of PoT was
viewed as non-threatening and teachers thought that PoT enhanced the quality of their teaching, promoted
professional development and was critical for Faculty development.
Conclusions: This study demonstrated that PoT can be used in a constructive way to improve course content and
delivery, to support and encourage medical teachers, and to reinforce good teaching.
Keywords: Peer observation, Feedback, Medical education

Background ‘The medical school must ensure that appropriate

The General Medical Council which regulates medical training is provided. . .and that staff development
practice in the United Kingdom has, in its 2009 programmes promote teaching and assessment skills’
report ‘Tomorrow’s Doctors’, set the standards that it
The aim of this study was to address both of these issues
will use to judge the quality of undergraduate
within the context of an undergraduate pediatric course. As
teaching and assessments in individual medical
part of an ongoing process of course and faculty
schools. Two quotations from this report give
development a peer observation of teaching (PoT) process
indications of this which are relevant to the present
was offered as a developmental opportunity for members of
paper:
the teaching Faculty.
‘Everyone involved in educating medical students will PoT involves observers providing descriptive feedback to
be appropriately selected, trained, supported and their peers on learning and teaching practice [1] and can be
appraised’ seen as a means by which the quality of teaching and
learning process in higher education establishments is both
accounted for and improved [2]. PoT has attracted
increasing attention in higher education in recent years.
* Correspondence: [email protected] This arises, in part, to help prepare for internal or external
Department of Paediatrics, Children’s Hospital, University of Oxford, Oxford audit of teaching as, for instance, in HEFCE-driven
OX3 9DU, UK

© 2012 Sullivan et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative
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assessments of university teaching and is also partly a perceptions of the PoT process. Our overall aim was to
reflection of the awareness of the need to foster teacher improve opportunities for student learning in pediatrics in
development and professional growth and to adapt to the our institution.
changing demands of the higher education system [3].
A consequence of these two drivers is the potential for
confusion or conflict about the role of the observer. On the Methods
one hand, with evaluation and audit-driven process there is Peer observation was undertaken by Faculty members (PBS
the possibility that observation may acquire a threatening, and SHA) with specific training in PoT provided by a
confrontational dimension, which may alienate the teacher. Fellow of the Higher Education Academy with specialist
On the other hand, and probably depending in large knowledge of PoT. There was one-to-one training in the
measure on how it is approached, the peer observation techniques involved followed by peer observation of trainee
process may be perceived by the teacher as a constructive, observers’ teaching. Our 8 week pediatric course is
developmental adjunct to their teaching, which improves presented 6 times a year with the ensuing danger of
opportunities for student learning. becoming mechanical and stale. We therefore assessed that
In view of this possible controversy, there is a need there was a need for PoT to keep our course material and
for clear focus and goals: ‘we should be very clear lectures up to date and to affirm the efforts of our teaching
about exactly what our objectives are for the Faculty. Critically, and this was emphasized to teaching
implementation of peer observation, and the best way Faculty, the PoT process was developed to be constructive
to achieve these, before espousing a potentially divisive and developmental. As discussed in the literature [1], an
and detrimental procedure’ [3]. Shortland states that inappropriate methodology might lead to de-motivating
‘an inappropriate choice of methodology – may lead to feedback and would not achieve our aim of improving
de-motivating feedback, presenting a dilemma within student learning.
observation practice’ [1]. This is obviously a major Between October 2008 and January 2011, 15 Consultants
concern and one that is not only represented in the (by PBS), 3 Clinical Lecturers and 2 Specialist Registrars (by
literature, but in actual practice. At its worst, the aims SHA) were peer observed. Only 4 Consultants regularly
of this exercise introduce ‘conflict’ in a system that is contributing to the undergraduate course declined the invi-
meant to inspire ‘confidence, enthusiasm and a sense tation. The reasons given for declining were: from the most
of professional worth’ [3]. As one case report states: senior (n = 2) “not necessary”; from the most junior “too
‘Peer observation was designed to meet the twin aims of busy” and the fourth misunderstood the process and has
teacher development and quality assurance. Teachers’ subsequently agreed to participate. The teaching activities
views suggest these two aims may conflict’ [4]. observed included 10 lectures, 2 problem-based teaching
Ramsden points out that ‘there can be no single right sessions, 3 small group teaching activities, 3 case-based
answer to the problem of improving the quality of teaching sessions and 2 ward-based teaching rounds. The
university teaching’ [5]. If peer observation feedback is to teaching sessions were generally about one hour long.
achieve its goal of being motivating and helping people The pre-observation meeting generally took between
to learn [5], then it must be remembered that it is not 15 and 20 minutes and the post-observation feedback
an ‘automatic recipe for enhanced learning and about 25–30 minutes. Each observation therefore took
development’ [1]. However, research unequivocally about 2 hours.
indicates that ‘classroom observation methodologies. . .can The general approach that was adopted for peer
provide a different perspective on the observation process observation of teaching was based on Bell’s model
and thus play a part in developing observers as reflective [8]. Figure 1 illustrates the cyclical nature of the
practitioners of teaching and learning’ [1]. Irrespective of process.
the reason for observation of teaching, it is imperative This approach will now be discussed under these four
that the process is conducted in a structured and sub-headings:
managed fashion. As Fullerton observes, ‘The aim of  Pre-observation meeting
the observation is to help improve the skills of the  Observation
observed, therefore quality feedback is essential’ [6].  Post observation feedback
Despite a large literature on PoT, there are few  Reflection
accounts of its implementation in clinical teaching [7]
and as far as we are aware no accounts of clinical
teachers’ perceptions of PoT. The aims of this project Pre-observation meeting
were firstly to implement PoT methods as a constructive, Prior to the observations, a pre-observation meeting was
developmental process for members of the Pediatric held to clarify the process and enquire of the teacher
Teaching Faculty and secondly to assess teachers’ what they required from the review and to establish the
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The purpose of giving feedback has been well summarized

a) Pre-observation by King (1999), ‘Giving feedback is not just to provide a
judgment or evaluation. . . It is to provide insight’ [11]. If
feedback is to be effective certain criteria must be met.
Feedback should be:
d) Reflection b) Observation
 Descriptive - of the behavior rather than the
personality
 Specific - rather than general
c) Post-observation
 Sensitive - to the needs of the receiver as well as the
Feedback
giver
 Directed - towards behavior that can be changed
Figure 1 Peer Observation Process (Bell 2002, [8]).
 Timely - given as close to the event as possible
 Selective - addressing one or two key issues rather
context of the teaching event. Topics covered at this than too many at once
meeting were; At the end of the feedback session the observer and the
 Context of the teaching; how the session fits into the observee examined and discussed the results of the student
course questionnaire. Potential solutions to any concerns raised
 The content and its place within the curriculum of were collaboratively identified and discussed by the observer
the unit and the programme of study and observee. Each teacher received a letter providing a
 To what extent is this session relied upon to deliver written summary of the outcome of the observation process
teaching on the whole topic assimilating both the observer’s comments and the students’
 Identify specific learning objectives for this session comments together with potential solutions to any concerns
 Teaching approach to be adopted, anticipated raised.
student activities, time plan for the session
 Any potential difficulties or areas of concern Reflection
 Any particular aspects that the tutor wishes to have An important component of peer observation is the
observed opportunity for teachers to reflect on their teaching in the
 How the observation is to be conducted light of feedback from observation. All participants were
 The way in which the students will be informed and invited to reflect on their observation and to send an email
incorporated into the observation with comments on their experience of the process and
 Any particular concerns that either the observer or what, if any, value it had for them as teachers. This informal
the observed might have about undertaking the approach was considered to be more likely to achieve a
observation. response rather than any structured or formal approach
such as using a questionnaire.
This pre-observation meeting is an essential component
in establishing a ‘contract’ with the teacher to underline
Data analysis
that this is intended to be a developmental exercise and
Reflective feedback from the teaching faculty on PoT
not an evaluative/assessment process [9].
was analyzed using qualitative methods. Key themes
in the data were identified and content analysis was
Observation carried out via systematic coding using NVivo Version
During the observation notes were taken on the content, 9 (QSR International Pty Ltd, Doncaster, Australia).
style and delivery of the teaching and these were used to Data were analyzed using a grounded theory approach
inform the post observation feedback. With the teacher’s [12] with constant comparison. The use of direct
approval a short questionnaire scored with a Likert scale quotation gave additional richer perspectives on how,
and with space for free text comments (Additional file 1: when and why certain observations were made [13].
Appendix 1) was administered to the students at the end of
each observed session. The purpose of this was to help Results
validate any observation made by the observer. Post-PoT recommendations
Observation of teaching activities provided an opportunity
Post observation feedback to examine both content and delivery of individual course
The model of feedback for each peer observation was components so that suggestions could be made as to how
broadly based on the revised Pendleton rules [10]. these might be improved or refined. Some examples of
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these post-PoT recommendations to individual teachers are ‘I actually thought that the whole process was
listed: extremely useful and relevant’
 Ensure that learning objectives for the session are
Value of feedback
defined
A major theme was that of the value of feedback.
 Refinement of slides by updating old slides and
Teachers strongly valued receiving feedback from the
removing unnecessary ones
observer and from students and thought that it improved
 Embed video clips in PowerPoint rather than
their performance. An important component of this was
switching to VHS format mid-lecture
receiving ‘immediate feedback’.
 Convert Video to DVD to prevent further
deterioration of useful teaching material ‘One very rarely gets feedback – positive or negative
 Improve interaction with students on teaching so it was an interesting and worthwhile
 Update teaching materials on course website e.g. use experience’
up to date growth charts
 Avoid “contamination” in small group sessions too ‘Live feedback can only improve one’s teaching overall’
close together in a small room
 Improve session structure with less jumping ‘Useful to have feedback from the perspective of both
backwards and forwards between topics the students and another teacher’
 Identify what adult medicine teaches (e.g. Diabetic
Ketoacidosis) and ensure consistency Promotion of insight and reflection
Another major theme was that PoT gave teachers insight
The following letter extracts give a sense of how suggestions and promoted reflection on their teaching practice.
for improvement were handled:
‘Peer review is an essential way of gaining a
‘One of the disadvantages, of course, of using the perspective on one’s teaching’
white board is that one can end up talking to the
white board with one’s back to the students’ ‘It made me look critically at the presentation. . .think
more clearly about my objectives’
‘I thought a couple of slides which you used could be
ditched and we discussed that in our post-observation ‘All too often teaching takes place without the
de-brief. I think this will help deal with some of the opportunity for this kind of reflection’.
time pressures that you were experiencing’
Non-threatening process of PoT
The Peer Observation process was also useful to reinforce
The overwhelming majority of teachers thought that the
good teaching as the following letter extracts demonstrate:
process of PoT was constructive and non-threatening, al-
though the potential for the process to be threatening
‘The presentation was very lively and interactive and
was acknowledged. The peer aspect of the process was
well illustrated with case studies. I particularly liked
also appreciated.
your stick diagram to illustrate the differential
diagnosis of Wilms’ tumor and neuroblastoma’ ‘Helpful and non-threatening feedback on teaching skills’

What about the observees?: the reflective component of PoT ‘The way in which the observation was conducted was
The device of using an email ‘sound-bite’ to document considerate and unobtrusive’
evidence of the reflective component of Peer Observation
was vindicated by the 100% response rate from observees. ‘Less threatening than a more ‘senior’ member of the
Seven major themes emerged from the data. These were: teaching faculty sitting in on a session’
usefulness and relevance; value of feedback, insight and
reflection; non-threatening process; enhanced teaching ‘When done in a sympathetic, but informed way, this
quality; professional development; and the necessity of peer is a helpful tool’
observation for Faculty development.
Enhanced teaching quality
Usefulness and relevance Teachers described the tangible improvement in their
PoT was overwhelmingly described by the Teaching teaching practice that had resulted from the detailed and
Faculty as extremely useful, valuable and relevant to their specific feedback they had received from PoT. The over-
teaching practice. whelming perception of the teachers was that these changes
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had resulted in enhanced quality of learning for the become stale and mechanical. Power Point-based
students. lectures may be inherited from previous teachers and/or
repeated from course to course and from year to year
‘I was able to make some useful changes to the lecture
without being updated as new information arises. An
that has already led to improvements in the session’
example of this last point was the use of the 1990
Growth Charts for children rather than the World
‘Forced me into improving my audio-visual
Health Organization growth charts in widespread use
aids. . .which I had been meaning to do’
since 2009 in a teaching module on Normal Growth and
Development. Introduction of an impartial but informed
‘Resulted in a more effective teaching experience for
observer into the teaching session has been shown to be
the students’
a relatively straightforward way of keeping the course
material up to date and refreshing and reaffirming the
Professional development and worth teaching style of the lecturers. An important part of
Teachers thought that PoT enhanced their professional the process is ‘building a partnership’ or ‘working
development and feelings of worth. ‘I was fairly confident alliance’ between the observer and observee [14], and
that students liked my presentations and that it was a giving specific feedback that is focused on the task and
fairly interactive session, but hearing from them and you in line with personal goals [15]. In agreement with a
formally just boosted that belief and confidence’ study on the implementation of PoT in pharmaceutical
education we found that a particular strength of the
A necessary and important process process was the pre-observation meeting which
Finally, PoT was described by teachers as a necessary allowed for ‘customization of the process to meet the
and important process in a Teaching Program. The Faculty member’s specific needs’ [16].
teachers advocated that PoT should be more widely Teaching Faculty unanimously described the PoT
implemented. process as very useful and relevant to their teaching
practice and teachers appreciated the opportunity to
‘If we do not do this we are at risk of doing the same discuss their teaching and to have constructive
old thing without variation. I am sure that there are feedback. The success of this process was in no small
some academics who give the same talk today as measure related to the efforts expended on emphasizing
20 years ago – is this the way ahead? I think not. If
that it was not an evaluative assessment but being applied
you are not open to learning then you should not
by an equal as a professional developmental tool. There is
teach’
little doubt that when used in such a positive way peer
observation encourages and supports teaching Faculty.
‘I would recommend peer review to all
However, as a GP questionnaire revealed, anxiety is likely to
teachers. . .should be used more widely’
be provoked if PoT is imposed from outside and is not
conducted by a peer [4]. Moreover, as noted in another
Benefit for the observers study, PoT also gave the observing teachers the opportunity
The process of training to be an observer and to reflect on their own teaching practice and to borrow
implementing peer observation was also of benefit to the effective teaching techniques [7].
observers’ professional development. It promoted This study has also shown how important it is to
awareness and reflection on one’s own teaching style and individual lecturers to receive immediate feedback from
content and it was useful to learn from and borrow students. At the end of each course students are required
teaching techniques from other teachers. to complete the Oxford Course Evaluation Questionnaire
which is used to assess the students’ perceptions about
Discussion teaching, workload, goals, standards and assessment
This study has shown that PoT can be used as a methods [17]. It is based on this ongoing evaluation that
technique both to update and refine the content and we know that the course is successful in achieving its
delivery of a well-established teaching course, and to stated aims and objectives and that the great majority of
provide useful feedback to teaching Faculty. This students are satisfied with the organization and delivery
technique is useful therefore, to Course Directors who of the course. Nevertheless, only occasionally do
rarely get on opportunity to see the fine detail of the individual teachers get singled out for special mention so
content of course materials or to witness the interaction the immediate feedback provided by the simple
of teaching faculty and students in the front line. As a questionnaire designed for this study enabled lecturers
result of frequent repetition (our 8 week course is to see how their own lecture was received by the
presented 6 times each year) it is easy for lectures to students. Not all comments from students were positive.
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Examples included ‘spoke too quickly’, ‘too many slides’, Additional file
‘rushed at the end’, but when used in conjunction with
the feedback from the observation these comments had Additional file 1: Appendix 1. Feedback form.
a confirmatory effect and were taken constructively by
the lecturers. Competing interests
The advantages of PoT when adopted in this The authors declare that they have no competing interests.

developmental way are clear. Teachers described tangible Authors’ contributions

improvements in the quality of their teaching and an PS is Director of Teaching, Learning and Assessment and Head of the
University of Oxford, Department of Paediatrics. He is a qualified Physician
enhancement of their professional development and Educator of the Royal College of Physicians of London and a Fellow of the
worth. Nevertheless, it is important to emphasize the Higher Education Academy. He conceived and carried out the study and
limitations of PoT. The successful application of PoT wrote the paper. AB is tutor at the University of Oxford and holds the
University’s Postgraduate Diploma in Learning and Teaching in Higher
requires expertise, time and commitment. The fact that it Education and is a Fellow of the Higher Education Academy. She has a
took 30 months to complete 20 observations (at 2 hours special interest in Peer Observation and advised on the design of the study
each) indicates that the time factor is a significant and contributed to writing the manuscript. NG is Course Administrator for
the undergraduate paediatric course in the University of Oxford, Department
limitation. This is in agreement with another study which of Paediatrics and was responsible for the logistic and administrative
has emphasized concern regarding ‘the time it will add to arrangements of the study. SA is a Clinical Lecturer in the Department of
an already heavy workload’ [16]. In future it is intended that Paediatrics, University of Oxford with a special interest in Medical Student
Education. She contributed to carrying out the study, analysis of data and
PoT will be offered to all new lecturers and re-offered to writing of the manuscript. All authors read and approved the final
existing lecturers either on request or every five years. It is manuscript.
also hoped that other Faculty members may be willing to
Received: 19 September 2011 Accepted: 4 May 2012
acquire the skills necessary to undertake PoT and so share Published: 4 May 2012
the workload.
References
This study had a number of limitations. The department
1. Shortland S: Observing teaching in HE: A case study of classroom
of Pediatrics is relatively small and only three peer observers observation within peer observation. Int J Educ Manag 2004, 4(2).
have been trained to date although there are plans for more 2. Hammersley-Fletcher L, Orsmond P: Evaluating our peers: is peer
observation a meaningful process? Stud High Educ 2004, 29(4):489–503.
Faculty members to be trained in this process. There was
3. Cosh J: Peer observation in Higher Education - A reflective approach. Innovat
also a challenge with other time pressures to complete the Educ Teach Int 1998, 35(2):171–176.
post-observation meeting and letter in a timely fashion. 4. Adshead L, White PT, Stephenson A: Introducing peer observation of teaching
to GP teachers: a questionnaire study. Med Teach 2006, 28(2):e68–e73.
However, we believe that giving immediate feedback is one
5. Ramsden P: Learning to teach in higher education. 2nd edition. Oxon:
of the most important aspects of the process and Routledge Falmer; 2003.
consequently prioritized the post-observation feedback. 6. Fullerton H: Observation of teaching: Guidelines for observers. Birmingham:
SEDA Publications; 1993.
Another potential limitation of the study was the lack of
7. Finn K, Chiappa V, Puig A, Hunt DP: How to become a better clinical teacher: a
anonymity with the e-mail ‘sound-bite’ received from the collaborative peer observation process. Med Teach 2011, 33(2):151–155.
teachers. We do not think that this is likely to have 8. Bell M. Peer observation of teaching in Australia. York: LTSN Generic Centre; 2002.
9. Siddiqui ZS, Jonas-Dwyer D, Carr SE: Twelve tips for peer observation of
influenced our results as feedback revealed that teachers felt
teaching. Med Teach 2007 May, 29(4):297–300.
very comfortable with the peer aspect of PoT and did not 10. Pendleton D, Scofield T, Tate P, Havelock P: The consultatation: an approach
view the process as threatening. to learning and teaching. Oxford: Oxford University Press; 1984.
11. King J: Giving Feedback. BMJ 1999, 318(7200):2.
12. Lingard L, Albert M, Levinson W: Grounded theory, mixed methods, and
Conclusions action research. BMJ 2008, 337:a567.
In summary, our study showed that PoT can be effectively 13. Atkinson S, Abu-el Haj M: Domain analysis for qualitative public health
data. Health Policy Plan 1996, 11(4):438–442.
implemented within an undergraduate pediatric curriculum
14. MacKinnon MM: Using observational feedback to promote academic
for the development of the teaching staff and ultimately to development. Int J Acad Dev 2008, 6(1):21–28.
improve the quality of student teaching. 15. Archer JC: State of the science in health professional education: effective
feedback. Med Educ 2010, 44:101–108.
16. Trujillo JM, DiVall MV, Barr J, Gonyeau M, Van Amburgh JA, Matthews J, et al:
Practice points Development of a Peer Teaching-Assessment Program and a Peer
Peer Observation of Teaching can be used to: Observation and Evaluation Trial. Am J Pharm Educ 2008, 72(6):1–9.
17. Trigwell K, Ashwin P: Undergraduate students' experience of learning at the
 identify the need to update teaching course materials University of Oxford, Oxford Learning Context Project: Final Report; 2003.
 demonstrate to students departmental commitment
doi:10.1186/1472-6920-12-26
to good teaching practice Cite this article as: Sullivan et al.: Peer observation of teaching as a
 reaffirm good teaching skills of teaching faculty faculty development tool. BMC Medical Education 2012 12:26.
 provide developmental feedback to help faculty
refine teaching methods
 maintain high standards in undergraduate teaching