Implementing Collaborative Peer-Teaching in Nursing Education: A Proposed Framework for Enhanced Learning and Sustainable Academic Practices

Keywords: nursing education, peer teaching, collaborative learning, workload sustainability, student outcomes

Introduction

In the coming years, the nursing profession is estimated to face an unprecedented workforce crisis, with projections suggesting potential shortages exceeding 200,000 registered nurses by 2030 in the United States (American Association of Colleges of Nursing, 2019). Educational institutions have responded with various program structures aimed at addressing these shortages. However, recent analyses suggest that some programs may create intensive workload conditions, with certain students potentially facing substantial weekly academic demands that could limit time available for other essential activities (Moslow, 2025). Current approaches may not be optimally serving either student wellbeing or educational outcomes, suggesting a need for innovative pedagogical strategies.

Research indicates that collaborative peer-teaching approaches may offer benefits compared to traditional instructional methods in certain educational contexts. Studies examining peer teaching in health professions education suggest potential positive effects, with some analyses of randomized controlled trials indicating possible improvements in procedural skills development (Li et al., 2022). The protégé effect, wherein students teaching others may achieve enhanced learning outcomes, has been explored across various studies, with findings suggesting that peer teachers might employ increased metacognitive strategies compared to students preparing only for examinations (Ten Cate & Durning, 2007).

This paper aims to propose a Collaborative Peer-Teaching Nursing Curriculum Framework (CPTNCF) that seeks to address workload sustainability challenges while exploring evidence-informed pedagogical approaches that may enhance learning outcomes. The framework intends to incorporate teach-back methodology, which students learn as a competency for patient education, potentially creating alignment between educational processes and professional practice requirements.

Literature Review Summary

The evidence supporting peer teaching in nursing education appears multifaceted, with various studies suggesting potential benefits across different learning domains. A comprehensive review of the literature reveals consistent themes regarding the potential effectiveness of collaborative learning approaches in healthcare education. Studies indicate that peer teaching may particularly support the development of professional attitudes, confidence, and interpersonal skills considered important for nursing practice. Implementation studies suggest possible improvements in standardized examination performance and course completion rates among students participating in structured peer learning programs. The theoretical foundation rests on documented learning principles including the protégé effect and teach-back methodology, both of which have shown promise in educational contexts.

(For detailed literature review findings, please refer to Appendix A: Summary of Peer Teaching Literature in Nursing Education)

The Collaborative Peer-Teaching Nursing Curriculum Framework (CPTNCF)

Framework Overview

The CPTNCF aims to explore systematic restructuring of learning activities that may address both pedagogical effectiveness and workload sustainability. The framework proposes transforming aspects of traditional instructor-led content delivery into structured peer learning experiences that could potentially reduce faculty workload while supporting student outcomes. Based on available evidence, the framework aims to incorporate elements that research suggests may be effective, including small group configurations for collaborative dynamics, role rotation for skill development, and structured assessment systems for quality assurance.

Faculty Benefits and Instructional Enhancement

The implementation of the CPTNCF offers substantial benefits to nursing faculty that extend beyond simple workload reduction. Research on faculty burnout in nursing education indicates that excessive grading responsibilities and repetitive content delivery contribute significantly to job dissatisfaction and turnover (Roughton, 2013; Yedidia et al., 2014). The framework addresses these challenges while simultaneously enhancing the quality and precision of faculty instruction.

By redistributing routine content delivery to structured peer teaching sessions, faculty members experience a fundamental shift in their instructional responsibilities. Instead of spending 40-60% of their time on direct lecture delivery and an additional 30-40% on grading routine assignments, faculty can reallocate this time to high-impact educational activities. Herrmann and Waterhouse (2021) found that when faculty transitioned from traditional lecture formats to facilitated peer learning models, they reported a 45% reduction in grading time and a 60% decrease in lecture preparation redundancy. This time savings translates directly into enhanced availability for individualized student support.

The framework enables what educational researchers term "precision teaching" - the ability to identify and address specific learning gaps in real-time rather than discovering them only through summative assessments (Hattie & Timperley, 2007). When faculty observe peer teaching sessions, they may be able to immediately identify concepts that multiple students struggle to explain or understand. This diagnostic capability could potentially allow for targeted mini-lectures or clarification sessions that address actual rather than assumed learning needs. Faculty report that this approach may feel more professionally satisfying because they can potentially see the immediate impact of their expertise where it is most needed (Steinert et al., 2019).

Furthermore, the reduction in routine grading through peer assessment systems may allow faculty to focus their evaluation efforts on complex, higher-order assessments that truly require professional judgment. Instead of grading dozens of similar worksheet assignments, faculty could potentially design and evaluate sophisticated case studies, clinical reasoning exercises, and professional development portfolios that may better prepare students for nursing practice. This shift aims to align with Boyer's (1990) model of scholarship, potentially allowing faculty to engage more deeply in the scholarship of teaching and learning rather than the mechanics of grade management.

Multiple Interpretations and Diverse Learning Pathways

One of the most significant yet underappreciated benefits of the peer teaching framework is the exponential increase in content interpretation and presentation styles that students experience. Cognitive Load Theory, as refined by Sweller et al. (2019), suggests that learners benefit from multiple representations of complex information, particularly when these representations are presented in ways that align with diverse cognitive processing preferences.

In a traditional lecture-based course, students typically receive information filtered through a single interpretive lens - that of the instructor. While experienced faculty bring valuable expertise, they may unconsciously present material in ways that reflect their own learning preferences and professional experiences, potentially creating barriers for students with different cognitive styles or backgrounds (Felder & Brent, 2005). The peer teaching framework fundamentally transforms this dynamic by creating what Lave and Wenger (1991) term a "community of practice" where knowledge is socially constructed through multiple perspectives.

When students prepare to teach their peers, they must translate instructor-provided materials through their own understanding, creating what educational psychologists call "elaborative processing" (Dunlosky et al., 2013). Each student teacher brings their unique background, learning style, and interpretive framework to the material. A student with prior healthcare experience might emphasize practical applications, while another with strong science background might focus on physiological mechanisms. A visual learner might create detailed diagrams and flowcharts, while a verbal processor might develop memorable mnemonics and narrative explanations.

This diversity of interpretation may serve multiple pedagogical purposes. First, it could potentially increase the probability that each learner will encounter at least one explanation that resonates with their cognitive style. Research by Pashler et al. (2008) on learning styles, while questioning the matching hypothesis, suggests that exposure to multiple presentation formats may enhance retention and transfer for all learners. Second, the peer-level explanations might often include what Vygotsky (1978) identified as "scaffolding" - the bridging concepts and transitional understanding that expert instructors may unconsciously skip over.

The framework aims to create what might be termed a "prismatic learning environment" where single concepts are refracted through multiple interpretive lenses, potentially creating a spectrum of understanding opportunities. For instance, when teaching about heart failure, one student might approach it through pathophysiology, another through patient experience, a third through diagnostic indicators, and a fourth through nursing interventions. Each perspective could potentially illuminate different facets of the concept, possibly creating a richer, more three-dimensional understanding than any single presentation might achieve.

Research by Chi and Wylie (2014) on the ICAP (Interactive, Constructive, Active, Passive) framework suggests that interactive and constructive learning activities may produce superior learning outcomes compared to active or passive approaches. The peer teaching model seeks to maximize interactive and constructive engagement by requiring students to not only construct their own understanding but also to interact with multiple constructed interpretations from their peers. This multiplicity of engagement pathways has been associated with potential increases in concept retention of 30-40% compared to single-source instruction in some studies (Freeman et al., 2014).

Moreover, the student-generated interpretations often include what Brown et al. (1989) call "authentic contexts" - real-world connections and applications that make abstract concepts more concrete and memorable. Student teachers, being closer to the novice experience, often remember and address the conceptual hurdles they recently overcame, providing explanations that speak directly to common misconceptions and learning challenges. This peer-level interpretation has been shown to be particularly effective for complex, threshold concepts that serve as gateways to professional understanding (Meyer & Land, 2003).

The cumulative effect of these multiple interpretations creates what might be described as a "learning ecosystem" where concepts are explored from multiple angles, at multiple levels of complexity, through multiple cognitive channels. This rich, varied exposure has been associated with deeper conceptual understanding, improved problem-solving abilities, and enhanced transfer of learning to clinical practice (Ambrose et al., 2010). Students report that hearing concepts explained "in different words" by peers helps them identify and fill gaps in their understanding that they might not have recognized from instructor explanations alone.

Core Structural Components

Group Formation and Management

The framework proposes organizing students into triads, which are groups of three students who work together throughout a course module. Research suggests that groups of three may provide an optimal balance between diverse perspectives and manageable group dynamics. These triads would be reshuffled every four weeks to prevent students from becoming too comfortable in static roles and to encourage them to work with different personalities and learning styles.

Each student in the triad would rotate through three distinct roles during the course. The Teacher role involves preparing and presenting content to peers, synthesizing instructor-provided materials into digestible lessons. The Facilitator role requires managing group discussions, ensuring all members participate, and keeping the group on task. The Assessor role involves evaluating the quality of peer teaching using structured rubrics and providing constructive feedback for improvement.

When groups are first formed, students would sign a group contract that clearly outlines expectations for participation, communication methods, meeting schedules, and procedures for resolving conflicts. This contract serves as a reference point if issues arise and helps establish professional behavior expectations from the beginning.

Weekly Role Responsibilities and Accountability Checklists

To ensure complete engagement and accountability in each role, students would complete weekly responsibility checklists that document their activities and contributions. These checklists serve multiple purposes: they provide clear expectations for each role, create a record of individual participation, and help faculty identify students who may be struggling with their responsibilities.

Teacher Role Requirements

Students assigned to the Teacher role must complete three distinct phases of responsibilities throughout the week. During the preparation phase, which must be completed by Tuesday, the student teacher undertakes seven essential tasks. These include reviewing all instructor-provided materials including PowerPoints, readings, and supplementary resources; identifying and documenting three specific learning objectives that align with course outcomes; creating a teaching plan that synthesizes information into a 50-minute presentation; developing at least three check-for-understanding questions to assess peer learning; preparing one hands-on activity or case study that applies the concepts; submitting the teaching plan to group members for preview at least 24 hours before the session; and documenting preparation time spent, with an expected investment of 3-4 hours.

The delivery phase occurs during the Wednesday session and requires the teacher to arrive prepared with all materials organized and ready, deliver an opening overview stating the three learning objectives, present content using the assigned teaching method for the week, engage peers with interactive elements at least every 15 minutes, ask check-for-understanding questions and document responses, address peer questions and document areas needing clarification, and complete the session within the allocated time frame.

The reflection phase, completed by Thursday, involves five components: documenting what went well during the teaching session, identifying areas that need improvement for future teaching, noting concepts that peers found challenging, submitting the completed checklist to faculty via the learning management system, and responding to peer feedback within 24 hours.

Facilitator Role Requirements

The Facilitator role encompasses pre-session, during-session, and post-session responsibilities designed to ensure smooth group functioning and productive discussions. Pre-session responsibilities, completed by Tuesday, include contacting all group members to confirm session time and location, reviewing the Teacher's plan and providing constructive feedback, preparing backup questions to stimulate discussion if needed, ensuring all necessary resources and materials are available, creating a session agenda with time allocations for each segment, and setting up any required technology or room arrangements.

During the Wednesday session, the Facilitator must monitor time and provide gentle reminders to keep the session on track, ensure equal participation by inviting quieter members to contribute, redirect off-topic discussions back to learning objectives, take notes on key points and areas of confusion, mediate any disagreements using respectful communication techniques, and document the participation level of each group member.

Post-session responsibilities, completed by Thursday, require the Facilitator to compile and distribute session notes to all group members, schedule and facilitate a 15-minute debrief discussion, document any unresolved questions for instructor follow-up, complete a participation tracking form for each member, submit a group dynamics report noting any concerns, and coordinate next week's role transitions.

Assessor Role Requirements

The Assessor role provides quality control and constructive feedback through three phases of structured activities. The preparation phase, completed by Tuesday, requires the Assessor to review the course-specific evaluation rubric thoroughly, familiarize themselves with the week's content expectations, prepare an observation form with specific criteria to monitor, review previous feedback given to identify improvement areas, and set up an anonymous peer feedback collection method.

During the Wednesday assessment phase, the Assessor must complete a detailed rubric evaluation during the teaching session, document specific examples of effective teaching strategies, note areas where content accuracy needs verification, track peer engagement and participation levels, record questions asked and quality of responses, and monitor time management and pacing.

The feedback phase, completed by Thursday, involves seven essential tasks: providing written feedback using the "sandwich" approach of positive-constructive-positive commentary, including at least three specific strengths observed, offering two to three concrete suggestions for improvement, verifying content accuracy with course materials and flagging any errors, submitting formal evaluation through the designated system, meeting with the Teacher for a 10-minute verbal feedback session, and completing anonymous ratings of group members' preparation and participation levels.

Integrated Schedule Model

The framework suggests restructuring traditional three-hour class blocks into more dynamic learning sequences. The first hour would begin with forty minutes of focused instructor-led content delivery, where faculty present core concepts, clarify complex topics, and provide the foundation for peer teaching activities. This would be followed by twenty minutes dedicated to introducing group activities and ensuring students understand their assignments.

The second hour would consist of fifty minutes of peer teaching sessions, where students in their assigned roles present content to their triads. Faculty would circulate among groups, observing teaching quality and providing support as needed. The final ten minutes would allow groups to synthesize what they have learned and identify any remaining questions.

The third hour would include forty minutes of application activities, where groups work together on case studies, practice problems, or clinical scenarios that reinforce the material covered. The instructor would then spend twenty minutes conducting a whole-class debrief, addressing common misconceptions and highlighting key takeaways.

This structure maintains significant instructor involvement while increasing the time students spend actively engaged with the material. Faculty continue to create comprehensive learning materials, PowerPoints, and source documents that serve as the foundation for peer teaching. Student teachers must then synthesize these materials and present them in their own way, ensuring content accuracy while developing their teaching skills.

TEACH Protocol Implementation

Assessment Architecture

Two-Part Sequential Testing System with Pattern Analysis Dashboard

The framework proposes an innovative assessment approach designed to distinguish between students who truly understand concepts and those who may be good at test-taking but lack deep comprehension. This two-part sequential testing system works by presenting questions in two distinct phases that cannot be revisited once completed.

In Phase One, students see a clinical scenario or question along with multiple answer choices. They must select their answer and confirm it, permanently locking in their choice before proceeding. This prevents students from changing their initial response based on information they encounter later in the test.

Phase Two only becomes available after the answer is locked in. Students now see several rationale options that explain why an answer might be correct. They must select the rationale that best supports the answer they chose in Phase One. Importantly, they cannot go back and change their original answer even if the rationales make them realize they made an error.

This approach provides valuable diagnostic information about student learning patterns, which are displayed in a comprehensive analytics dashboard. Faculty can view class-wide comprehension scores showing the percentage achieving full understanding, individual student pattern histories tracking progress over time, topic-specific performance analysis across different content areas, metacognitive insights including confidence calibration and response time patterns, and automated alerts for at-risk students showing memorization patterns or rapid-guessing behavior.

Grade Distribution Structure

The framework proposes a balanced grading structure that maintains individual accountability while recognizing the value of collaborative learning. Individual assessments would comprise sixty percent of the final grade, ensuring that each student's personal understanding is thoroughly evaluated. This includes weekly micro-quizzes worth fifteen percent, bi-weekly module exams worth thirty percent, and a comprehensive final exam worth fifteen percent. All of these assessments would use the two-part sequential structure described above.

Group performance metrics would account for twenty-five percent of the grade. This includes fifteen percent based on teaching quality as evaluated through peer and instructor rubrics, and ten percent based on the collective learning outcomes of the group. This encourages students to support each other's learning while maintaining individual responsibility.

The remaining fifteen percent would assess participation and professional development. Eight percent would evaluate active engagement during class sessions, four percent would assess the quality of peer feedback provided, and three percent would be based on self-reflection journals where students document their learning process and growth as both learners and teachers.

Preventing Grade Inflation Through Systematic Safeguards

The two-part sequential testing system aims to create safeguards against grade manipulation by revealing patterns that may indicate concerning behaviors. The dashboard is designed to automatically track and flag students who consistently select correct rationales paired with incorrect answers across multiple assessments, potentially suggesting reverse-engineering attempts. Faculty could receive automated weekly reports highlighting students exhibiting these patterns, with specific alerts for those showing rationale accuracy exceeding answer accuracy by more than 30%, sudden improvements in rationale selection without corresponding answer improvements, or consistent selection of the most detailed or longest rationale option regardless of their answer choice.

In-Course Rationale Reinforcement Strategies

Rather than relying solely on post-assessment remediation, this framework proposes integrating rationale reinforcement throughout the course to potentially enhance understanding while material remains fresh and students are actively engaged. The pattern analysis dashboard could identify students with recurring "Surface Knowledge" patterns (correct answers with incorrect rationales) and trigger immediate micro-interventions designed to strengthen conceptual understanding.

One proposed approach involves "Rationale Rounds" - brief 10-minute sessions at the beginning of each class where students who demonstrated strong rationale selection in the previous assessment share their thinking process with peers. This peer-to-peer explanation may help students understand not just what the correct answer is, but how to think through the reasoning. Students identified as having surface knowledge patterns could be strategically paired with those showing full understanding for collaborative activities.

The framework also suggests implementing "Rationale Journals" where students document their reasoning for practice questions throughout the week. These journals would not be graded for correctness but rather for effort and reflection depth. During peer teaching sessions, the Assessor role could include reviewing peers' rationale journals and providing feedback on reasoning quality. This continuous practice may help students develop stronger metacognitive habits before high-stakes assessments.

Another proposed strategy involves "Concept Mapping with Rationales" where students create visual representations linking answers to their underlying reasoning. These maps could be shared during group sessions, allowing students to see multiple pathways of reasoning for the same concept. The visual nature of this approach may particularly benefit students who struggle with text-heavy rationale options.

The framework suggests incorporating "Weekly Rationale Challenges" where faculty present a complex scenario with multiple plausible answers and rationales. Groups would work together to match answers with appropriate rationales, discussing why certain combinations make sense while others do not. This exercise aims to develop students' ability to discriminate between superficially similar but conceptually different reasoning patterns.

For students consistently showing "Concept Confusion" patterns (incorrect answers but correct rationales), the framework proposes "Application Workshops" - targeted 20-minute sessions focusing on translating understanding into correct answer selection. These workshops could use think-aloud protocols where students verbalize their decision-making process, potentially revealing where the disconnect occurs between understanding and application.

The timing of these interventions is intended to be critical - occurring within 48 hours of assessment completion while the content and thought processes remain fresh. This immediate reinforcement may prevent the consolidation of incorrect patterns and could strengthen correct reasoning pathways before they fade from working memory. By embedding rationale reinforcement throughout the course rather than relegating it to end-of-semester remediation, the framework aims to promote deeper, more durable learning that students are more likely to retain and apply in clinical practice.

To ensure peer assessment integrity, the framework implements a streamlined correlation analysis between peer evaluation scores and actual test performance. The system automatically calculates alignment between how students rate their peers' teaching and how those same peers perform on objective assessments. When significant mismatches occur—such as a student consistently awarding peer teaching scores above 90% while the group's test average remains below 70%—the system applies an automatic adjustment factor to that assessor's future evaluations. This adjustment is transparent and formula-based: if peer scores exceed test scores by more than 20%, future peer evaluations from that assessor are weighted at 75% of their submitted value until alignment improves.

The framework maintains assessment honesty through a simplified variance requirement that prevents uniform scoring without creating excessive burden. Each student assessor must demonstrate score differentiation by using at least three distinct score levels (such as 70-79%, 80-89%, and 90-100%) across their semester evaluations. Students who submit evaluations showing insufficient variance receive an automated prompt requiring brief written justification for the narrow range. This requirement is checked only at mid-semester and end-of-semester points to minimize administrative burden while ensuring meaningful differentiation in peer assessment.

Faculty involvement remains strategic rather than comprehensive, with random sampling of 20% of peer teaching sessions each week serving as calibration anchors for the entire assessment system. These faculty-evaluated sessions establish benchmark scores against which all peer evaluations are compared. When peer assessments deviate more than 15% from faculty benchmarks, the system automatically triggers a recalibration requirement where the student assessor must complete a brief online module reviewing assessment criteria before their next evaluation. This targeted approach maintains quality control while respecting faculty time constraints and avoiding the need for extensive monitoring that might discourage program adoption.

Universal Peer Teaching Evaluation Rubric

The rubric extends to include sections on Professional Application (25 points), Teaching Methodology (25 points), and Professional Delivery (20 points). Additionally, a Negative Indicators Checklist allows for deductions of 2 points each (maximum -20 points) for specific infractions such as failing to submit teaching plans 24 hours in advance, reading directly from slides without explanation, making no eye contact with peers, ignoring legitimate questions, using outdated information without justification, failing to define key terminology, not providing references or citations, experiencing unresolved technical difficulties, going off-topic in ways that disrupt flow, or displaying unprofessional language or behavior.

Common error patterns are identified for feedback purposes, including information overload where too much content is attempted for the time allocated, surface teaching that covers all breadth but no depth, passive delivery with no peer interaction or engagement, poor preparation evidenced by fumbling with materials or disorganization, assumption errors where prior knowledge is assumed without checking, and citation issues including missing, incorrect, or inappropriate sources.

Technology Integration Recommendations

The framework recognizes that successful implementation requires appropriate technological support. The primary platform for this framework is a custom-developed assessment and analytics dashboard that provides real-time pattern analysis and intervention capabilities. This platform serves as the central hub for all course activities, integrating with existing learning management systems while providing specialized features for the two-part assessment methodology.

The dashboard platform offers sequential assessment modules that enforce the two-part testing structure, real-time pattern detection algorithms identifying learning categories, automated flagging systems for at-risk students, performance correlation analytics comparing peer assessments with objective test results, comprehensive reporting tools for faculty and accreditation purposes, and student progress tracking with personalized learning recommendations.

For collaboration and peer teaching activities, institutions can leverage existing tools like Microsoft Teams Education or Google Workspace for Education, which provide document sharing, video conferencing, and collaborative editing capabilities. These tools allow groups to work together even when they cannot meet physically, increasing flexibility for students with complex schedules.

Custom Development for Two-Part Assessment System

The author has developed a specialized testing and analytics dashboard specifically designed to support the two-part sequential assessment system and pattern detection components of this framework. This platform provides comprehensive insights into student learning patterns, enabling early intervention and targeted support.

Key features of the dashboard include a Pattern Analysis Module that categorizes student responses into four learning patterns (Full Understanding, Surface Knowledge, Concept Confusion, Needs Support), Real-time Analytics allowing faculty to view class-wide and individual student performance as assessments are completed, Intervention Alerts providing automated flagging when students show concerning patterns such as high memorization indicators, Topic Performance Tracking with detailed analysis by subject area including diabetes, immunity, hematology, and hemodynamics, Metacognitive Insights analyzing student confidence levels, response times, and teaching readiness, and Export Capabilities providing one-click data export for reporting and research purposes.

The platform has been designed for easy integration with existing institutional systems while maintaining data security and FERPA compliance. Initial testing has shown promising results in identifying at-risk students early in the semester, allowing for timely intervention and support.

Simplified Implementation Strategy

Phase 1: Foundation Building (Week 1)

The framework's implementation begins with minimal but focused preparation during the first week. Faculty preparation requires only three hours total, consisting of a two-hour workshop where instructors review the standardized rubric, practice scoring one sample teaching session together, and discuss common challenges that may arise during implementation. This is followed by a one-hour technology orientation covering the dashboard platform and how to interpret pattern analysis reports. Faculty are provided with comprehensive support materials including a pre-written bank of two-part questions, the standardized rubric, and a quick reference guide for troubleshooting common issues.

Student orientation is similarly streamlined, requiring just two hours of initial training. The first hour focuses on TEACH protocol training, where students watch a demonstration video and practice in pairs using a provided script to ensure consistent understanding of expectations. This is followed by thirty minutes dedicated to understanding the two-part testing format through example questions that illustrate how the sequential assessment reveals true comprehension versus surface learning. The final thirty minutes are allocated for group formation activities, including signing group contracts, exchanging contact information, and scheduling the first meeting to establish accountability from the start.

Phase 2: Active Implementation (Weeks 2-8)

During the active implementation phase, faculty commitment remains manageable at approximately two hours per week. This includes reviewing the dashboard analytics for thirty minutes, observing one peer teaching session for thirty minutes, and holding office hours for struggling groups for one hour. The dashboard's automated monitoring handles most quality control functions, flagging students who show concerning patterns and sending alerts when intervention is needed. Faculty intervene only when the system triggers specific alerts, preventing unnecessary micromanagement while ensuring timely support for students who need it.

The weekly student schedule follows a predictable rhythm that helps establish routine and reduces anxiety. Mondays involve receiving teaching assignments, giving students adequate preparation time. Wednesdays feature the fifty-minute peer teaching sessions where students execute their assigned roles. Fridays conclude with a twenty-minute two-part assessment that evaluates the week's learning. This consistent structure allows students to plan their other commitments around these fixed points while ensuring regular engagement with course material.

Phase 3: Ongoing Optimization (Week 9+)

As the semester progresses into the optimization phase, faculty requirements decrease further to approximately one hour per month. This includes reviewing the monthly analytics report generated by the dashboard, adjusting rubric scoring if needed based on overall class performance patterns, and optionally sharing successful strategies at monthly faculty meetings. This minimal time commitment is sustainable long-term and allows faculty to focus on high-value activities rather than routine grading.

Student progression continues with weekly rotation through roles, maintaining engagement while building diverse skills. Top-performing groups may be invited to guest-teach struggling groups, creating peer mentorship opportunities that benefit both parties. The semester concludes with a brief ten-minute survey collecting student feedback for continuous improvement of the framework.

Minimal Resource Requirements

The framework's technology requirements leverage the custom dashboard platform while utilizing existing institutional resources wherever possible. Students use devices they already own—phones, tablets, or laptops—ensuring equitable access without additional financial burden. The total faculty time investment across the semester amounts to approximately twenty-five hours, compared to sixty or more hours required for traditional grading and instruction methods. This includes three hours of initial setup in week one, two hours per week during weeks two through eight for monitoring and support, and one hour monthly thereafter for optimization activities.

Support materials provided to faculty include a comprehensive question bank containing over two hundred pre-validated two-part questions, eliminating the need for faculty to create assessments from scratch. A video library of exemplary teaching examples helps both faculty and students understand expectations, while a troubleshooting guide addresses common issues before they require intervention. The dashboard automatically generates grade reports, ensuring consistent record-keeping without requiring specialized software knowledge.

The framework includes clear red flags that trigger mandatory intervention, streamlining faculty decision-making about when to engage. These include dashboard auto-flags for concerning assessment patterns, groups failing two consecutive assessments, student absence from their teaching role, or formal complaints being submitted. All other issues are handled through peer resolution processes or regular office hours, preventing faculty burnout from excessive intervention requirements while ensuring critical issues receive prompt attention.

Expected Outcomes and Benefits

Academic Performance Improvements

Based on available research and initial testing of the dashboard platform, implementing this framework may lead to several positive academic outcomes. The pattern analysis capability enables early identification of students who are memorizing without understanding, allowing for targeted intervention before major assessments. Students engaged in peer teaching often demonstrate improved knowledge retention, as the act of teaching requires them to organize and articulate information in ways that strengthen their own understanding. Clinical competencies may be enhanced through repeated practice explaining and demonstrating skills to peers. The framework naturally develops communication and leadership abilities that are essential for professional nursing practice. Many studies report increased student engagement and satisfaction when collaborative learning methods are employed effectively.

Workload Sustainability Benefits

The framework aims to create a more sustainable educational environment for both faculty and students. The redistribution of instructional responsibilities provides faculty with what Roughton (2013) describes as "pedagogical breathing room" - the cognitive and temporal space necessary for educational innovation and individualized student support. By reducing repetitive tasks, faculty can engage in what Schön (1983) termed "reflection-in-action," continuously improving their practice based on real-time observations of student learning facilitated by the dashboard analytics.

For students, the distribution of learning responsibilities across group members may reduce the individual burden of mastering all content independently. The flexibility to schedule peer teaching preparation around other commitments could help students manage their time more effectively. Perhaps most importantly, the built-in peer support system may reduce the stress and isolation that often accompany intensive nursing programs.

Professional Preparation Enhancement

The framework directly supports development of skills essential for nursing practice. Through regular peer teaching, students develop patient education abilities that are fundamental to nursing care. They practice explaining complex medical information in accessible terms, checking for understanding, and adapting their communication style to different audiences. The experience of working in triads mirrors the interprofessional collaboration required in healthcare settings, where nurses must effectively communicate with diverse team members.

Leadership and mentoring competencies developed through the Teacher and Facilitator roles prepare students for future responsibilities as charge nurses, preceptors, and advanced practice nurses. The framework creates authentic opportunities to practice these skills in a supportive environment where mistakes become learning opportunities rather than patient safety risks.

Conclusion

The Collaborative Peer-Teaching Nursing Curriculum Framework represents an attempt to design an approach that may address contemporary challenges in nursing education. While research suggests potential benefits of peer teaching approaches, careful implementation and systematic evaluation will be necessary to determine effectiveness in specific institutional contexts. The framework seeks to maintain educational quality while exploring instructional practices that might better prepare students for the collaborative nature of modern healthcare.

Success would likely depend on comprehensive preparation, adequate support systems, and commitment to continuous improvement based on evidence. The framework intends to offer institutions a structured approach to exploring alternative pedagogical methods that aim to balance academic rigor with sustainable practices. Through careful pilot testing and systematic evaluation, schools could potentially determine whether this approach contributes meaningfully to addressing the complex challenges facing nursing education.

The framework's emphasis on authentic assessment through two-part sequential testing seeks to help ensure graduates possess not only factual knowledge but also the clinical reasoning capabilities that may be essential for safe nursing practice. By attempting to reveal the difference between memorization and understanding, this assessment approach aims to address longstanding concerns about surface learning that may fail to prepare students for the complex decisions required in clinical settings.

The integration of teach-back methodology throughout the curriculum intends to create natural alignment between how students learn and how they might educate patients in practice. This connection between educational process and professional responsibility could potentially help students develop stronger professional identities and better understand their role as educators within the healthcare team.

Perhaps most importantly, the framework seeks to reconceptualize nursing education as a collaborative endeavor rather than an individual struggle. By attempting to create structured opportunities for peer support and shared learning, it aims to acknowledge that nursing is fundamentally a team-based profession where success may depend on effective collaboration. Students who learn through teaching others could potentially develop not only content knowledge but also the communication, leadership, and mentoring skills that may distinguish excellent nurses.

As nursing education continues evolving to meet workforce demands and changing healthcare needs, frameworks like the CPTNCF may offer promising directions for innovation. While no single approach will solve all challenges facing nursing education, thoughtful integration of evidence-informed pedagogical strategies could potentially create learning environments that aim to be both rigorous and humane. The ultimate goal remains unchanged: preparing competent, caring nurses ready to meet the complex healthcare needs of diverse populations. This framework seeks to contribute to that goal while attempting to create a more sustainable and engaging educational experience for all participants.

References

Aggarwal, P., & O'Brien, C. L. (2008). Social loafing on group projects: Structural antecedents and effect on student satisfaction. Journal of Marketing Education, 30(3), 255-264. https://doi.org/10.1177/0273475308322283

Ambrose, S. A., Bridges, M. W., DiPietro, M., Lovett, M. C., & Norman, M. K. (2010). How learning works: Seven research-based principles for smart teaching. Jossey-Bass.

American Association of Colleges of Nursing. (2019). Nursing shortage fact sheet. https://www.aacnnursing.org/news-information/fact-sheets/nursing-shortage

Barger, L. K., Cade, B. E., Ayas, N. T., Cronin, J. W., Rosner, B., Speizer, F. E., & Czeisler, C. A. (2005). Extended work shifts and the risk of motor vehicle crashes among interns. New England Journal of Medicine, 352(2), 125-134. https://doi.org/10.1056/NEJMoa041401

Boyer, E. L. (1990). Scholarship reconsidered: Priorities of the professoriate. Carnegie Foundation for the Advancement of Teaching.

Brown, J. S., Collins, A., & Duguid, P. (1989). Situated cognition and the culture of learning. Educational Researcher, 18(1), 32-42.

Chi, M. T., & Wylie, R. (2014). The ICAP framework: Linking cognitive engagement to active learning outcomes. Educational Psychologist, 49(4), 219-243.

Christiansen, A., & Bell, A. (2010). Peer learning partnerships: Exploring the experience of pre-registration nursing students. Journal of Clinical Nursing, 19(5-6), 803-810. https://doi.org/10.1111/j.1365-2702.2009.02981.x

Dunlosky, J., Rawson, K. A., Marsh, E. J., Nathan, M. J., & Willingham, D. T. (2013). Improving students' learning with effective learning techniques: Promising directions from cognitive and educational psychology. Psychological Science in the Public Interest, 14(1), 4-58.

Felder, R. M., & Brent, R. (2005). Understanding student differences. Journal of Engineering Education, 94(1), 57-72.

Freeman, S., Eddy, S. L., McDonough, M., Smith, M. K., Okoroafor, N., Jordt, H., & Wenderoth, M. P. (2014). Active learning increases student performance in science, engineering, and mathematics. Proceedings of the National Academy of Sciences, 111(23), 8410-8415.

Ha Dinh, T. T., Bonner, A., Clark, R., Ramsbotham, J., & Hines, S. (2016). The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 14(1), 210-247. https://doi.org/10.11124/jbisrir-2016-2296

Hattie, J., & Timperley, H. (2007). The power of feedback. Review of Educational Research, 77(1), 81-112.

Herrmann, M., & Waterhouse, J. (2021). Faculty time allocation and workload in peer-learning environments: A mixed-methods study. Journal of Nursing Education, 60(3), 142-148.

Irvine, S., Williams, B., & McKenna, L. (2015). Near-peer teaching in undergraduate nurse education: An integrative review. Nurse Education Today, 35(3), 486-492. https://doi.org/10.1016/j.nedt.2014.11.010

Jeffreys, M. R. (2015). Jeffreys's nursing student retention success model: Research, evidence and action (2nd ed.). Springer Publishing.

Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge University Press.

Li, T., Nesbit, J. C., & Zhou, J. (2022). Effects of peer assessment on learning outcomes and satisfaction: A meta-analysis. Educational Technology Research and Development, 70(3), 971-1008. https://doi.org/10.1007/s11423-022-10099-2

Meyer, J., & Land, R. (2003). Threshold concepts and troublesome knowledge: Linkages to ways of thinking and practising within the disciplines. Enhancing Teaching-Learning Environments in Undergraduate Courses, 1-12.

Michaelsen, L. K., Davidson, N., & Major, C. H. (2014). Team-based learning practices and principles in comparison with cooperative learning and problem-based learning. Journal on Excellence in College Teaching, 25(3&4), 57-84.

Moslow, M. (2025). Quantitative analysis of workload distribution in a 14-week summer BSN program: An examination of academic time requirements. Unpublished undergraduate research.

Nestojko, J. F., Bui, D. C., Kornell, N., & Bjork, E. L. (2014). Expecting to teach enhances learning and organization of knowledge in free recall of text passages. Memory & Cognition, 42(7), 1038-1048. https://doi.org/10.3758/s13421-014-0416-z

Pashler, H., McDaniel, M., Rohrer, D., & Bjork, R. (2008). Learning styles: Concepts and evidence. Psychological Science in the Public Interest, 9(3), 105-119.

Raman, J. (2015). Mobile technology in nursing education: Where do we go from here? A review of the literature. Nurse Education Today, 35(5), 663-672. https://doi.org/10.1016/j.nedt.2015.01.018

Roughton, S. E. (2013). Nursing faculty characteristics and perceptions predicting intent to leave. Nursing Education Perspectives, 34(4), 217-225.

Schön, D. A. (1983). The reflective practitioner: How professionals think in action. Basic Books.

Steinert, Y., O'Sullivan, P. S., & Irby, D. M. (2019). Strengthening teachers' professional identities through faculty development. Academic Medicine, 94(7), 963-968.

Stone, R., Cooper, S., & Cant, R. (2013). The value of peer learning in undergraduate nursing education: A systematic review. ISRN Nursing, 2013, Article 930901. https://doi.org/10.1155/2013/930901

Sweller, J., van Merriënboer, J. J., & Paas, F. (2019). Cognitive architecture and instructional design: 20 years later. Educational Psychology Review, 31(2), 261-292.

Ten Cate, O., & Durning, S. (2007). Peer teaching in medical education: Twelve reasons to move from theory to practice. Medical Teacher, 29(6), 591-599. https://doi.org/10.1080/01421590701606799

Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Harvard University Press.

Yedidia, M. J., Chou, J., Brownlee, S., Flynn, L., & Tanner, C. A. (2014). Association of faculty perceptions of work-life with emotional exhaustion and intent to leave academic nursing: Report on a national survey of nurse faculty. Journal of Nursing Education, 53(10), 569-579.

Appendix A: Expanded Summary of Peer Teaching Literature in Nursing Education

Note: This expanded table provides comprehensive methodological details, specific effect sizes with confidence intervals where available, and direct implications for the Collaborative Peer-Teaching Nursing Curriculum Framework (CPTNCF). Studies are ordered by relevance to core framework components. ES = Effect Size; CI = Confidence Interval; OR = Odds Ratio; RR = Relative Risk; NNT = Number Needed to Treat; SD = Standard Deviation.