Does regular attendance in supplemental virtual near-peer tutoring in anatomy laboratory content improve anatomy performance for medical students?

Near-peer tutoring (NPT) programs are popular vehicles to supplement traditional delivery of medical school curricula, including for anatomy laboratory (AL) content. While NPT programs can result in improved preclinical coursework performance for tutees, little to no data specifically show a benefit of NPT in AL course performance. In 2021, NYIT College of Osteopathic Medicine launched an NPT program where qualified second-year students led group tutoring sessions for first-year students. This study investigated whether participation and level of attendance in AL NPT sessions were associated with greater examination-to-examination improvement in AL performance. Student attendance at AL sessions in the NPT program was categorized as either regular (10 or more sessions), moderate (5-9 sessions), infrequent (1-4 sessions), or never during one semester. For the first 2 years of the NPT program, attendance frequency at AL tutoring sessions had a significant impact on average exam-to-exam improvement (p < 0.05). Overall, students who attended tutoring at any frequency had greater exam-to-exam improvement than students who never attended (p < 0.05). However, this trend was only significant in 1 of 2 years investigated. These data show that NPT programs can, though not uniformly, benefit student outcomes in AL coursework. With these data, this study provides additional details on the level of attendance necessary for expected improvements in AL coursework.

Collaborative Learning Communities With Medical Students as Teachers.

In recent years, peer-assisted learning has emerged as a new and effective medical education modality. Near-peer tutoring utilizes a senior student serving as an instructor to a junior student. In 2019, the University of California, Irvine, School of Medicine (UCISOM) implemented a near-peer tutoring model beginning with first-year anatomy and physiology curricula. Following a successful pilot program, UCISOM launched a full-fledged near-peer tutoring program in 2020 named Collaborative Learning Communities (CLC) with Medical Students as Teachers. The rollout of CLC occurred in phases. In 2020, second-year medical students led the program for first-year students; in 2021, an additional program was led by third-year medical students for second-year students; in 2022, the program expanded to third-year medical students led by fourth-year students. Each program serves the unique learning needs of each student class, utilizing evidence-based teaching practices while allowing the opportunity for mentorship, interclass connectedness, and refinement of the tutor's teaching skills. In this paper, we describe the creation of CLC, its goals, leadership and curricular structure, and its various benefits, challenges, and limitations.

A peer-led kinesthetic forearm and wrist anatomy workshop: A multiple cohort study.

An understanding of forearm and wrist anatomy is necessary for the diagnosis and treatment of various injuries. Evidence supports the use of peer-assisted learning (PAL) as an effective resource for teaching basic science courses. First-year medical students across three class years participated in an optional PAL kinesthetic workshop wherein participants created anatomically accurate paper models of forearm and wrist muscles. Participants completed pre- and post-workshop surveys. Participant and nonparticipant exam performances were compared. Participation ranged from 17.3% to 33.2% of each class; participants were more likely to identify as women than men (p < 0.001). Participants in cohorts 2 and 3 reported increased comfort with relevant content after the workshop (p < 0.001). Survey responses for cohort 1 were omitted due to low response rates; however, exam performances were assessed for all three cohorts. Cohort 2 participants scored higher than nonparticipants on forearm and wrist questions on the cumulative course exam (p = 0.010), while the opposite was found for cohort 3 (p = 0.051). No other statistically significant differences were observed. This is the first study to examine quantitative and qualitative results for a PAL intervention repeated for three separate cohorts. Although academic performance varied, two cohorts reported increased comfort with relevant course material after the workshop. Results of this study support the need for further exploration of PAL workshops as an instructional method in teaching anatomy and highlight the challenges associated with repeating interventions over multiple years. As more studies attempt replication across multiple years, these challenges may be addressed, thereby informing PAL best practices.

Effects of students' peer teaching in a new pharmacokinetics teaching format.

INTRODUCTION: The aim of this work was to evaluate the impact of a teaching method in pharmacokinetics (PK) in terms of satisfaction and performance in the final test of students. MATERIAL AND METHODS: This method consisted of the development of a practical problem and a peer-tutored solution by small groups of three or four students. Students enrolled in the second year of pharmaceutical studies had to generate a PK practical problem, to propose a solution and to conduct a peer-tutored solution of the practical problem completed by another student group in a learning-connected classroom. Student's performance was assessed by individual semi-structured interviews and by comparing the scores obtained in the final test with those obtained in previous years. RESULTS: More than 70% of the students were highly satisfied with the new format of the PK course, especially concerning the development and the design of a practical problem. More than 94% of the students considered that the content of the lecture-based teaching was at least adapted and in accordance with the objectives of the PK course. Students reported very constructive discussions and interactions with peers and the teacher. In addition, students significantly increased their score at the final PK test compared to previous years (53.27±19.10% in 2015-2017 vs. 71.30±13.47% in 2018-2019, P<.0001). CONCLUSION: This new method including peer teaching was applied in PK and allowed to significantly increase the performance and the satisfaction of the students in PK.

Peer Tutoring Interventions for Students With or At-Risk for Emotional and Behavioral Disorders: A Systematic Review of Reviews.

This systematic review of reviews is the first to summarize peer tutoring outcomes for students with or at-risk for emotional and behavioral disorders (EBD). Eleven narrative literature reviews, three systematic reviews, and two meta-analyses of peer tutoring interventions that met inclusion criteria were summarized. Participants across the 16 reviews included more than 2,404 students with or at-risk for EBD in pre-kindergarten through grade 12 across 73 individual, unduplicated studies. Findings support the efficacy of peer tutoring for students with or at-risk for EBD regarding academic and behavioral outcomes. Lessons learned, and implications for research and practice derived from these reviews are provided.

Attendance of Near-Peer Tutoring Sessions Improves Academic Performance of First-Year Medical Students.

Introduction: Many medical schools have implemented near-peer tutoring (NPT) programs based on the substantial benefits of these programs to both tutors and tutees. This study correlated the frequency of attending weekly NPT sessions to students' academic performance, and also compared performance of high and low attending students. Methods: Twenty-one weekly NPT sessions were delivered by fourth-year (M4) students to first-year (M1) students. Attendance was recorded, and accordingly students were divided into three groups, high (15-21 sessions), moderate (7-14 sessions), and low (0-6 sessions) attendance groups. Pearson product-moment correlation coefficient was computed to assess the relationship between students' frequency of attendance and their overall performance on overall basic medical sciences at the end of M1 year and M2 mid-year NBME® CBSE. Students' performance was also analyzed using ANCOVA and Bonferroni post hoc test to compare differences between the three attendance groups. Results: An increase in number of attended NPT weekly sessions corresponds with an increase in students' performance on overall M1 basic sciences weighted average (r(196) = .240, p ≤ 0.001) and the M2 mid-year NBME® CBSE (r(196) = .325, p ≤ 0.001). High attending students performed significantly higher than low attending students on overall M1 weighted average of basic science courses (F(2, 192) = 8.518, p < .001) and M2 mid-year NBME® CBSE (F(2, 192) = 15.494, p < .001). Conclusion: Attending NPT weekly sessions is a valuable experience that is associated with an improvement in M1 medical students' academic performance. However, low performing students tend to miss attending NPT weekly sessions.

Children's learning-by-teaching with a social robot versus a younger child: Comparing interactions and tutoring styles.

Human peer tutoring is known to be effective for learning, and social robots are currently being explored for robot-assisted peer tutoring. In peer tutoring, not only the tutee but also the tutor benefit from the activity. Exploiting the learning-by-teaching mechanism, robots as tutees can be a promising approach for tutor learning. This study compares robots and humans by examining children's learning-by-teaching with a social robot and younger children, respectively. The study comprised a small-scale field experiment in a Swedish primary school, following a within-subject design. Ten sixth-grade students (age 12-13) assigned as tutors conducted two 30 min peer tutoring sessions each, one with a robot tutee and one with a third-grade student (age 9-10) as the tutee. The tutoring task consisted of teaching the tutee to play a two-player educational game designed to promote conceptual understanding and mathematical thinking. The tutoring sessions were video recorded, and verbal actions were transcribed and extended with crucial game actions and user gestures, to explore differences in interaction patterns between the two conditions. An extension to the classical initiation-response-feedback framework for classroom interactions, the IRFCE tutoring framework, was modified and used as an analytic lens. Actors, tutoring actions, and teaching interactions were examined and coded as they unfolded in the respective child-robot and child-child interactions during the sessions. Significant differences between the robot tutee and child tutee conditions regarding action frequencies and characteristics were found, concerning tutee initiatives, tutee questions, tutor explanations, tutee involvement, and evaluation feedback. We have identified ample opportunities for the tutor to learn from teaching in both conditions, for different reasons. The child tutee condition provided opportunities to engage in explanations to the tutee, experience smooth collaboration, and gain motivation through social responsibility for the younger child. The robot tutee condition provided opportunities to answer challenging questions from the tutee, receive plenty of feedback, and communicate using mathematical language. Hence, both conditions provide good learning opportunities for a tutor, but in different ways.

La enseñanza recíproca entre pares no-expertos: comparación entre enseñanza individual y enseñanza de pareja / Reciprocal Non-Expert Peer Teaching: Comparison between Individual and Dyadic Teaching

Resumen El objetivo de esta investigación es comparar la enseñanza recíproca individual entre alumnos (pares no-expertos) con la enseñanza no-experta realizada en pareja respecto a diversos aspectos relativos a la cualidad y calidad de las mismas. La primera enseñanza tiene como destinatario al compañero de díada (en reciprocidad); la segunda es realizada conjuntamente por los integrantes de una díada y tiene como destinatario a otra díada (y recíprocamente). En general, los estudios sobre la tutoría entre pares no-expertos referida a la enseñanza de conocimientos omiten la cuestión particular de la enseñanza compartida con un alter. La hipótesis central es que este tipo de docencia no-experta compartida genera diferencias de cualidad y calidad respecto a la docencia no-experta individual. Participaron 14 estudiantes universitarios de una misma clase agrupados aleatoriamente en díadas, los que, previo aprendizaje de la episteme a enseñar provista por un texto-fuente, realizaban primero una tutoría enseñante individual dirigida al compañero/a (y viceversa), y luego una tutoría compartida con éste dirigida a los integrantes de otra díada (y viceversa). Las sesiones fueron audio-grabadas. Esta comparación individual-colectivo se refiere tanto a aspectos cualitativos de la enseñanza, como a aspectos relativos a su calidad. En cuanto a los primeros, los datos muestran significativas diferencias respecto al estilo de enseñanza y a la dependencia respecto del texto-fuente, y diferencias moderadas relativas a la calidad. Se concluye con una propuesta de diferenciación de distintas modalidades de la relación individual-colectivo.

Abstract The objective of this research is to compare individual reciprocal teaching between students (non-expert peers) with dyadic non-expert teaching. In general, studies on non-expert peer tutoring related to knowledge teaching omit the particular issue of dyadic teaching with an alter. The central hypothesis states that this type of dyadic non-expert teaching generates differences in attributes and quality with respect to individual non-expert teaching. Seven dyads of university students from the same class were randomly grouped in dyads, who, after learning the episteme to be taught provided by a source-text, they performed first an individual teaching tutoring directed to the partner (and vice versa), and then a dyadic tutoring together directed to the members of another dyad (and vice versa). These sessions were audio-recorded. This individual-dyadic comparison refers to both different attributes of teaching, as well as aspects related to its quality. Regarding the attributes, data shows significant differences in terms of teaching style and dependence on the source-text, and moderate differences regarding quality. The research concludes with a proposal to differentiate various modalities of the individual-dyadic relationship.

Verbalized Studying and Elaborative Interrogation in the Virtual Classroom: Students with Social Anxiety Prefer Working Alone, but Working with a Peer Does Not Hurt Their Learning.

Due to public health measures enacted in response to the Covid-19 pandemic, educators and students alike have been suddenly thrust into the realm of online learning. To better understand how active and collaborative learning methods can apply to students studying in isolation, we compared the effects of two teach-and-question assignments: one that utilizes the active learning method of reciprocal peer tutoring and a solo version that requires individual verbalized studying and elaborative interrogation. We used a quasi-experimental design, with student participants enrolled in an online introductory human anatomy course. The first treatment group completed regular teach-and-question study assignments virtually with a peer, and the second treatment group completed the same assignment independently. We found no differences in exam scores between treatments, even for students with high social anxiety; however, student attitudes about the social versus individual assignment did differ for specific types of students. Students who reported experiencing high social anxiety preferred completing the active learning exercise by themselves, and students with low scientific reasoning ability preferred the partnered assignment. This research has potential implications for online classrooms. For instance, our results indicate that students who study independently, or in isolation, may have learning outcomes similar to those of students who study with a peer as long as they study actively. Because we found no negative impact on examination results, it also could be that virtually partnered or independent teach-and-question assignments could be helpful for instructors teaching large online classes to ensure all students are getting individualized feedback and attention.

Establishing a tutoring and academic support center: Collaborating with nurse educator students.

Academic demands challenge many nursing students as they embark on their professional journey to become competent nurses or further their education. Challenges with incorporating successful retention strategies were problematic during the worldwide COVID-19 public health emergency. Academic student support services were urgently needed. This article describes the successful development of a funded college campus's academic support service center using virtual nurse educator tutoring services for undergraduate and graduate nursing students. The mission of the center is to assist nursing students to become independent, self-confident, and efficient learners who successfully fulfill all academic nursing program requirements. Evidence-based education was provided to train tutors and refine their technology competencies. Tutoring was provided for graduate students to fulfill the need for similar types of academic support services. Metrics were collected to evaluate the relationship between tutoring and academic success indicators. Initial evaluations of tutoring sessions by tutees suggest that peer tutoring as an adjunctive teaching and learning strategy can positively impact academic performance. Findings included improved student quantitative measures including higher exam scores and GPAs along with qualitative outcomes suggesting increased critical thinking skills, self-direction, and self-confidence. Nurse educator student tutors gained valuable teaching experience that promoted their overall academic role development.

Exploring peer tutoring from the peer tutor's perspective.

INTRODUCTION: Changing working practices, student numbers, workforce demands, and deficits, have created a need to consider new ways of radiography student training. One suggestion could be to implement Peer Assisted Learning (PAL) during clinical placements. PAL utilises social constructivist theories, where peer tutors teach lower or same level tutees, reinforcing and practicing material formally taught. The aim of this study was to trial an intervention of PAL, co-designed between the university and students and evaluated to identify opportunities and challenges. METHODS: Using participatory action research 8 final year student volunteers trialled a 3-week intervention, where they delivered PAL to first years, tutoring on first year radiographic clinical practice. Focus groups were held pre and post intervention to gather qualitative data. RESULTS: Focus group discussions were transcribed and collectively thematically analysed. Two students and the primary researcher took part in the analysis. CONCLUSION: Students identified benefits and challenges to PAL. Issue around preparing for and being a peer tutor are also discussed. Further study involving experiences of first year students and clinical colleagues is required. IMPLICATIONS FOR PRACTICE: Peer-tutoring has potential benefits to students to facilitate the development of skills related to image analysis and critique as well as radiographic anatomy and patient positioning.

Peer tutoring of computer programming increases exploratory behavior in children.

There is growing interest in teaching computer science and programming skills in schools. Here we investigated the efficacy of peer tutoring, which is known to be a useful educational resource in other domains but never before has been examined in such a core aspect of applied logical thinking in children. We compared (a) how children (N = 42, age range = 7 years 1 month to 8 years 4 months) learn computer programming from an adult versus learning from a peer and (b) the effect of teaching a peer versus simply revising what has been learned. Our results indicate that children taught by a peer showed comparable overall performance-a combination of accuracy and response times-to their classmates taught by an adult. However, there was a speed-accuracy trade-off, and peer-taught children showed more exploratory behavior, with shorter response times at the expense of lower accuracy. In contrast, no tutor effects (i.e., resulting from teaching a peer) were found. Thus, our results provide empirical evidence in support of peer tutoring as a way to help teach computer programming to children. This could contribute to the promotion of a widespread understanding of how computers operate and how to shape them, which is essential to our values of democracy, plurality, and freedom.

Benefits of semiology taught using near-peer tutoring are sustainable.

BACKGROUND: Near-peer tutoring appears to be an efficient approach for teaching clinical skills. However, the clinical experience gained in the form of student medical internships may offset any interest in such tutoring programme. We then investigated the long-term benefits of this programme. METHODS: This study was conducted in a medical school that experimented in near-peer tutoring for semiology intended for undergraduate medical students. Objective Structured Clinical Examinations and a written semiology test were used to assess students' clinical skills immediately on its conclusion and repeated one and 2 years after the tutoring was completed. RESULTS: 116 students were evaluated initially (80 tutored and 36 untutored), 38 at 1 year (16 tutored and 22 untutored), 42 at 2 years (21 tutored and 21 untutored). In the global score for Objective Structured Clinical Examinations: at 1 year, the tutored group scored 14.0 ± 1.05 and the untutored group scored 11.3 ± 2.3 (p < 0.001), at 2 years, the tutored group scored 15.1 ± 1.5 and the untutored group scored 12.4 ± 2.2 (p < 0.001). We found a similar but smaller difference for the written semiology test. The difference for Objective Structured Clinical Examinations between tutored and untutored students vanished over time for cross-cutting skills. CONCLUSIONS: Near-peer tutoring in semiology for undergraduate medical students led to better results that remained with the passing of time. Though internships do allow an improvement in the clinical skills of untutored students, they did not reach the level of tutored students.

Weekly near-peer tutoring sessions improve students' performance on basic medical sciences and USMLE Step1 examinations.

PURPOSE: This study examined the relationship between attendance at weekly near-peer tutoring (NPT) sessions offered in the second year of medical school and academic performance on basic science and USMLE Step 1 examinations. METHODS: Twenty-four weekly NPT sessions were delivered across all modules in the second year of medical school. Attendance of the sessions was recorded and students were divided into three groups: high (16-24 sessions), moderate (7-15 sessions), and low-no (0-6 sessions) attendance groups. Pearson product-moment correlation coefficient was computed to determine the relationship between students' frequency of attendance and their performance on overall basic sciences, two NBME CBSEs, and USMLE Step 1 examinations. Students' academic performance was also analyzed using ANOVA and Bonferroni post hoc test (p < 0.05) to compare differences between the three groups. RESULTS: Pearson correlation analyses revealed that attending peer tutoring sessions was significantly correlated with students' performance in overall basic sciences, CBSE mid-year, CBSE final, and USMLE Step 1 examinations. The high attendance groups significantly outperformed the low-no attendance groups on overall basic sciences (p = 0.007), CBSE mid-year (p < 0.001), CBSE final (p < 0.018), and USMLE Step 1 (p = 0.048) examinations. CONCLUSIONS: Attending NPT sessions are significantly correlated with students' performance on basic sciences and on USMLE Step1 examinations. Attendance of weekly NPT sessions is a valuable experience for M2 students.

Arranging peer-tutoring instruction to promote inference-making.

Peer-mediated instructional strategies (e.g., peer tutoring) have been effective at teaching academic responses in previous research. This study extended the literature by programming for inference-making, or derived relations. Across two experiments, researchers investigated the use of peer tutoring and inference-making to teach fraction-pictogram-percentage relations to 8 third-grade participants. In each experiment, participants served as both tutors and tutees in homogenous, reciprocal tutoring sessions. In Experiment 1, one tutor taught fraction (A)-pictogram (B) relations and the other tutor taught percentage (C)-pictogram (B) relations. In Experiment 2, each tutor taught one half of each of the relations. Results of both experiments demonstrated that the tutors learned all relations they taught, the tutees learned all relations they were taught, and all participants derived equivalence relations and demonstrated transfer of functions for comparative relations. A comparison of the two experiments suggests instructors should consider the difficulty of training relations when they design peer-tutoring instruction that engineers inference-making.

Learning pharmacology through peer tutoring.

OBJECTIVE: Knowing the effectiveness of peer tutoring methods in pharmacology learning for medical students. METHOD: This was a quasi-experimental study with a post-test only design. Subjects were second-year medical students who were divided into four control groups and four experimental groups. Students in the experimental group experienced peer tutoring methods. The difference in motivation and performance scores in both groups was analyzed using t-tests. RESULTS: Motivation in the experimental group was higher than in the control group, for interest motivation (79.09±13.11 vs 75.24±13.46; p=0.411), value motivation (80.89±11.57 vs 76.54±12.20; p=0.292), perceived motivation (66.26±7.44 vs 666.20±10.09; p=0.977), and as well as total (76.33±9.33 vs 73.31±10.30; p=0.159). The performance score in the control group was higher than the treatment group (60.45±6.39 vs 60.67±4.72; p=0.649). CONCLUSION: Quality control, monitoring, and evaluation are required to produce an effective peer tutoring program. One of which is through rigorous peer tutor recruitment, tutor training, and ensuring the commitment of the peer tutors.

Peer-Assisted Learning (PAL): Perceptions and Wellness of First-Year Medical Students.

INTRODUCTION: Medical education is oftentimes stressful and has been documented to compromise student well-being, hinder performance, and contribute to burnout. Many medical schools aim to foster students' sense of well-being. This can be accomplished by peer-assisted learning (PAL), which has the potential to improve student wellness and performance in medical school. METHODS: The PAL program at Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine provides first-year medical students with educational sessions related to their curriculum, led by second-year medical students. The goal of this study was to determine the efficacy of PAL in promoting wellness and enhancing knowledge. Pre- and post-program surveys were distributed to students prior to and after the completion of PAL. Data analysis included frequencies of responses, qualitative analysis, and chi-square analysis. RESULTS: Thirty-eight out of 51 first-year medical students responded to the pre-program survey (response rate 75%) and 23 out of 51 responded to the post-program survey (response rate 45%). A majority of respondents from the pre-survey believed that PAL would provide them with tools necessary to be successful. These findings were similar in the post-program survey with a majority of attendees sharing that PAL enhanced their knowledge, reduced test-taking anxiety, and provided useful skills. DISCUSSION: Results from the pre- and post-program surveys suggest that PAL can enhance student well-being while improving knowledge of the material taught in medical school. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40670-021-01381-0.

Teaching space-group diagrams to chemistry students through a peer-tutoring approach.

Peer tutoring is a teaching strategy that offers a creative way of getting students more involved and accountable for their own learning in college-level chemistry courses. The authors have found that the 'Symmetry and Space Group Tutorial' [Jasinski & Foxman (2007). Symmetry and Space Group Tutorial, V1.55. http://people.brandeis.edu/~foxman1/teaching/indexpr.html] lends itself well to a peer-tutoring approach in a crystallography course for chemistry students. This in-class activity provides an opportunity for students to learn space-group diagrams, understand basic symmetry concepts, organize what they have learned, and explain it to their peers, which leads to a deeper overall understanding of the subject. We report on our experience in planning peer tutoring, advise on best practices, and demonstrate the positive impact on student learning and engagement.

Nursing students' experience of online peer tutoring based on the grow model: A qualitative study.

BACKGROUND: With the drastic change in the nursing education environment due to the coronavirus pandemic, several attempts have been made in Korea to help nursing students better adapt to the new learning environment. OBJECTIVE: This study aimed to explore nursing students' experience of online peer tutoring based on the Goal-Reality-Options-Will (GROW) model. DESIGN: A qualitative study using content analysis. SETTINGS: This study was conducted in the department of nursing at two universities in South Korea. PARTICIPANTS: The participants were 14 nursing students who participated as tutors and tutees in the online peer tutoring. METHODS: Three focus group interviews were conducted with the 14 students. Data were transcribed and analyzed using content analysis. RESULTS: Three categories and nine subcategories were extracted. Online peer tutoring allowed participants to learn using a new approach, promoted their efficiency of studying in multiple aspects, and encouraged them to persevere and advance in academics, thus proving its usefulness as an auxiliary strategy to enhance the efficiency of online learning. CONCLUSIONS: Structured online peer tutoring can be a useful tool for enhancing the effectiveness of non-face-to-face education for nursing students. This study's results can serve as meaningful basic data for planning and composing learning activities optimized for the future online nursing education environment.

Effects of a Peer-Tutorial Reading Racetrack on Word Fluency of Secondary Students With Learning Disabilities and Emotional Behavioral Disorders.

Reading difficulties that are not addressed at the primary level continue to exist at the secondary level with serious consequences. Thus, it is important to provide struggling students with specific reading support. In particular, many students with learning disabilities (LD) and emotional behavioral disorders (EBD) demonstrate reading obstacles and are at risk for motivation loss. A multiple baseline design was used to evaluate the effects of a motivational reading racetrack as peer-tutoring on the word reading skills of secondary students with LD with and without EBD. The intervention was conducted through 4-5 baseline and 16-18 reading units three times a week for 15 min over 8 weeks. The results showed positive effects indicating a highly effective treatment. In addition, follow-up results were also promising. Our findings indicate that this multicomponent intervention has a positive effect on the word fluidity of low-achieving students in secondary education with LD and/or EBD.