The development of a framework to facilitate a collaborative peer learning 2:1 model

of practice placement education

Ann-Marie Lynam

Practice Education CoordinatorSchool of Medicine, TCD

November 2015

Overview of presentation:

Background & Need

Development of the framework

Research study

Findings to date

Future Plans

Background & Need

Changes in approach to learning Self-directed learning, self-assessment and reflective

practice are skills which need to be viewed as outcomes of practice placement education

(Bowles, 2008)

Traditional didactic learning → integrated approach (Kolb, 1984; Parker & Kersner, 1998)

Emphasis on peer learning & reflective practice(Schon, 1987; Boud & Walker, 1998; Fade, 2004; Morris & Moore,

2006)

Background & Need

A collaborative peer learning 2:1 model One educator working with two or more students

(Zavadak, Konecky-Dolnack et al., 1995)

Promotes: Student-directed learning Reflective practice Student-led assessment

Continuous professional development Lifelong learning

Promoters & barriers reported (Baldry Currens, 2003; Dawes & Lambert, 2010)

Background & Need Further skills promoted by 2:1 model:

Communication skills Teamwork skills Clinical skills Observation skills Feedback skills

(Lincoln & McAllister, 1993; Morris & Stew, 2007; Baldry Currens, 2003; Triggs, Nemshick &

Shepherd, 1996; Lekkas, Larsen et al., 2007; Grundy, 1994) Clinical competence improved:

Patient evaluation, programme planning & implementation, communication, management, professionalism & documentation

(DeClute & Ladyshewsky, 1993)

Background & Need

2:1 Model - based on peer learning:‘Umbrella’ term – “to get knowledge through study, experience or

teaching of an equal” (Lincoln & McAllister,

1993)

Incorporates 3 aspects: Collaborative Learning –”indirect teaching in which the

instructor identifies the task and organises the students to work out a solution, independently of the educator”

Peer Observation – “involves one student observing the other student and sharing those observations in an objective manner”

Peer Feedback – “involves formative feedback from one student to another (not assessment)”

(DeClute & Ladyshewsky, 1993; CSP, 2002)

Background & Need

BSc (Hons) Human Nutrition & Dietetics (TCD/DIT)

Practice Placement Education learning outcomes, performance indicators, staged competency criteria & assessments developed

(EFAD, 2009; Bowles, 2008; INDI, 2005) Five competency based learning outcomes – knowledge &

practice, professionalism, communication, team working & service delivery. (Crehan, Moloney et al., 2010)

Spiral curriculum – practice placement education: Practice Placement A – catering, 140 hours Practice Placement B – primary care/public health, 370 hours Practice Placement C – acute clinical care, 444 hours Assessment forms completed every 1-2 weeks

2:1 model trialled in four sites – outcome was development of ‘The Lynam Framework’ (Lynam, Corish et al., 2014)

Background & Need

Background & Need

Training sessions developed for students & educators Opportunity for role play of practical skills of peer observation,

peer feedback & reflective practice based on theories of : Collaborative learning (Parker & Kersner, 1998) Behavioural change (Rapoport & Pearson, 2007) Reflective practice (Fade, 2004)

Delivered to students in Year 2 as part of Professional Practice Studies Module.

Delivered to Practice Placement B educators (18 locations)

Delivered to Practice Placement C educators (11 locations)

Aims & Objectives

Research Aim - To introduce a collaborative peer learning 2:1 model and explore perceptions of students & educators via the following objectives:

To establish students’ and educators’ opinion on the impact of the three aspects of peer learning, i.e. collaborative learning, peer observation and peer feedback, on the attainment of competence

To explore whether a 2:1 model facilitates learning opportunities for the development of desired clinical and learning skills, specifically student-directed learning, student-led assessment, reflective practice, behavioural change skills and clinical reasoning skills

To explore experience/benefits/limitations of the 2:1 model for students and educators

Methodology

Overview: Longitudinal Study, mixed methods research design

(Johnson, Onwuesgbuzie et al., 2007)

Sequential explanatory design (Creswell, Plano-Clark et al., 2010)

Cohort of students followed over 3 years:

3 Timepoints: Quantitative Data – Timepoints 1, 2 & 3 Qualitative Data – Timepoints 2 & 3

Methodology

Figure 1: Process of Data Collection

Professional Practice Studies Module

Timepoint 1

Practice Placement B

Timepoint 2

Practice Placement C

Timepoint 3

Students Educators

Questionnaire

N=24

Questionnaire

N=22

Interview

N=6

Questionnaire

N=23

Interview

N=7

Questionnaire

N=29

Interview

N=8

Questionnaire

N=30

Interview

N=8

Results

Results-to-date:

Timepoints 1, 2 & 3: September 2013 – April 2015

Initial preliminary analysis – Student perspective

High student response rates for both quantitative and qualitative research

Impact of Peer Learning on Learning Outcomes

Timepoint 1 2 3

Learning Outcome Mean Std Dev Mean Std Dev Mean Std Dev P Value

(Total Scores) Knowledge & Practice 2.020 0.565 2.014 0.769 2.422 0.733 0.108 Professionalism 2.139 0.796 2.286 0.983 2.797 0.964 0.053 Communication 1.890 0.546 1.961 0.902 2.440 0.749 0.007 Team Working 1.725 0.734 1.992 1.066 2.450 1.099 0.042 Service Delivery 1.933 0.563 2.242 0.960 2.758 1.077 0.032

Impact of collaborative learning, peer observation & peer feedback on learning outcomes

Timepoint 1 2 3

Learning Outcome Mean Std Dev Mean Std Dev Mean Std Dev P Value

Knowledge & Practice

Collaborative Learning 1.65 0.82 1.44 1.11 2.18 1.00 0.490 Peer Observation 1.76 1.08 1.59 0.89 2.28 0.98 0.180 Peer Feedback 1.60 0.79 1.66 1.10 2.37 0.89 0.132

Professionalism

Collaborative Learning 1.95 0.74 1.88 1.06 2.18 1.03 0.595 Peer Observation 1.44 0.92 1.76 1.10 2.79 1.00 0.000 Peer Feedback 1.62 1.01 1.65 1.12 2.74 0.96 0.001

Communication

Collaborative Learning 1.85 0.59 1.88 0.84 2.28 0.83 0.287 Peer Observation 1.59 0.78 1.94 1.20 2.47 0.84 0.022 Peer Feedback 1.62 0.71 1.82 1.03 2.56 0.99 0.008

Team Working

Collaborative Learning 1.75 0.81 1.95 1.05 2.30 0.98 0.135 Peer Observation 1.59 1.03 2.12 1.19 2.29 1.15 0.050 Peer Feedback 1.71 0.95 1.91 1.23 2.38 1.37 0.046

Service Delivery

Collaborative Learning 1.73 0.59 1.95 1.02 2.33 1.11 0.072 Peer Observation 1.71 0.84 2.03 1.28 2.26 1.18 0.191 Peer Feedback 1.76 0.87 1.82 1.20 2.41 1.21 0.052

Impact of Peer Learning on Learning & Clinical Skills

Timepoint 1 2 3

Clinical/Learning Skill Mean Std Dev Mean Std Dev Mean Std Dev P Value

(Total Scores) Active Listening 1.933 0.965 1.817 0.827 2.217 0.797 0.105 Demonstrating empathy 2.033 0.996 2.017 0.901 2.567 0.899 0.022 Clinical Reasoning Skills 1.767 0.613 1.817 0.653 2.133 0.945 0.399 Developing Confidence 1.717 0.720 1.617 0.614 2.067 0.995 0.318 Rehearsal 1.719 0.591 1.719 0.764 2.281 0.818 0.049 Reflective Practice 1.700 0.700 1.483 0.597 2.000 0.572 0.007

Qualitative Analysis

Deductive content analysis based on standard interview questions:

Learning opportunities /Usefulness/Preparation

Inductive content analysis Insight & experience of students & educators

Thematic analysis will follow: Inductive and deductive coding and theme development

(Fereday & Muir-Cochrane, 2006)

Discussion

Discussion Preliminary analysis of students’ responses focused on

placement quality - attainment of prescribed competences (learning outcomes) & desired learning & clinical skills

Peer Learning Prescribed competences (learning outcomes):

T1 (‘team work’), T2 (‘communication’), T3 (‘knowledge & practice)

Supported by literature – teamwork (Baldry Currens, 2003),

communication (Lincoln & McAllister, 1993), clinical skills (Triggs Nemshick & Shepherd, 1996; Lekkas, Larsen et al., 2007)

Learning & Clinical Skills T1, T2 & T3 (‘reflective practice’) Supported by literature (Lincoln & McAllister, 1993; Morris & Stew, 2003)

Discussion

Differences reported in levels of significance of total means between:

Peer Learning vs.

Collaborative Learning/Peer Observation/Peer Feedback

Specific data for each of the 3 aspects will inform further education – focus on specific learning outcomes for each aspect

Trend towards 2:1 model being most useful during Practice Placement B

? Perception not same need for learning opportunities (Baldry Currens, 2003) ? Difference in facilitation skills between Practice Placement B &

Practice Placement C educators (Ladyshewsky, 1995)

DeClute & Ladyshewsky (1993) – outcome measure was weighted score of clinical competence (only study to do so)

This study – student & educator perceptions reported

Future Plans

Establish the perceived impact of 2:1 model on attainment of competence & learning and clinical skills

Rationale – outcomes will be used to shape further development of 2:1 model, depending on the impact of each aspect of peer learning on:- five competency-based learning outcomes- six learning and clinical skills

Student vs. EducatorT1 vs. T2 vs. T3Peer Learning vs. Collaborative learning/Peer observation/Peer feedback

Future Plans

Perceived preparedness for & experience of 2:1 model Rationale: outcomes will be used to inform student & educator

training for different clinical settings.

Preparedness for 2:1 model: Student preparedness for participation of 2:1 model Educator preparedness for facilitation of 2:1 model Student & educator recommendations for preparation

Experience of 2:1 model: Advantages and disadvantages of 2:1 model Promoters & barriers of 2:1 model Practice Placement B vs. Practice Placement C Optimal number of weeks 2:1 before change to 1:1

Publication of Framework

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