Physiotherapy

Peer Assisted Learning for B or C Placements Suzanne Ford, Dietetics Link Tutor University of Plymouth Scottish Student Training Forum December 2007 Faculty of Health & Social Work Task 1 On your own: In 60 seconds Write down as many celebrity couples as you can think of (dead or alive!) In pairs: Do the same again Faculty of Health & Social Work Peer Collaboration: Natural way of learning or completing tasks if the same task has been set for more than one person A way of pooling resources and reducing duplication of effort Faculty of Health & Social Work Peer Tutoring Learning between pairs More able tutors the less able – more advanced tutors less advanced (eg CBA) Emulates the traditional teacher/student model BUT the narrow difference in authority and expertise positively influences this model Most gained by the tutor Ladyshewsky 2004 Faculty of Health & Social Work Peer Coaching     Pairs of students working together Observing each other Engaging in clinical reasoning, problem solving Providing non judgemental feedback  Significant gains in performance produced for all involved Ladyshewsky 2004 Faculty of Health & Social Work Peer Coaching Can choose what main aims or focus of coaching will be and design activities and timetable accordingly Eg  Peer Skill Development Support Or  Peer Evaluation and feedback Faculty of Health & Social Work Components of peer learning  peer observation / collaboration during patient  assessment and treatment  discussion  joint analysis  hypothesis (differential diagnosis) generation  mutual problem solving  peer skills practice and teaching  self and peer evaluation  NB: Cannot usually contribute to evidence for portfolio Faculty of Health & Social Work Models of supervision Paired Group Team Shared Individual Split Faculty of Health & Social Work Placement B Learning Outcomes Professional Practice 1 Is able to collect and record relevant medical, nutritional, social, cultural, financial and personal information and food intake details in line with established standards and procedures Demonstrate the above using for example a case study or patient record cards Use appropriate questioning style to elicit relevant information Is able to assess client information qualitatively and quantitatively Analyses the gathered data before making a decision Demonstrate the above using, for example, dietetic record cards, dietary assessments, care plans or case study Is able to plan and justify dietary advice to patients seen in Placement B Using the patients identified in Professional Practice 2, demonstrates the above using for example care plans, case study and record cards Is able to review, monitor and evaluate dietetic practice with patients or clients Demonstrates the above using, for example, care plans, case study and other documented evidence 2 3 4 Faculty of Health & Social Work Disadvantages to student (Crouch et al, 2001) 2:1  Difficult to maintain student privacy  Peer learning not always used to its best advantage  Student spends less time with facilitator  Students can reinforce negative skills/knowledge/behaviour 1:1  No peer company  No-one at their level to measure them  Lack of peer learning opportunities  No peer to discuss things with  No peer to practice techniques  High workload of facilitator meant:  Student had less time with facilitator  Facilitator less accessible  Students perceived they would receive lots of feedback which didn‟t always happen  Facilitator can assume role of teacher – student becomes passive learner Faculty of Health & Social Work Concerns and Barriers Unable to distinguish individual abilities Competition Different abilities Personality clashes Others…see workshop 1! Faculty of Health & Social Work Points to consider for students and facilitator Resources Space Environment Case load Support from colleagues Personal qualities Organisational skills Teaching/Learning styles Approachable Good communicators Faculty of Health & Social Work Points to consider in Peer Coaching 1. Maximise Interdependence – design learning activities that the students can‟t achieve individually 2. Promote Individual Accountability – each student is responsible for their own actions 3. Reduce Competition Faculty of Health & Social Work Strategies for success - I  Spend equal time with each student and their patients  Organise individual time for each student at the start of the placement  Use weekly review sheets to monitor each students progress (or learning contracts)  Private space for peer discussion / skills practice Faculty of Health & Social Work Strategies for success - II  Use team members to allow individual growth  Consider tutoring / coaching strategies being used  Don‟t presume – discuss situation openly  Resist didactic teaching methods Faculty of Health & Social Work Strategies for success - III  Explicit ground rules – written and verbal “setting up”  Open discussion  Directed questioning  Allow enough time for each part of the coaching  Plan repetition of tasks so students are comfortable with this method Faculty of Health & Social Work Planning PAL in detail Activities Timing Sequence Roles Special points – managing difference Demands skills from supervisor: good time management planning communication/facilitation Faculty of Health & Social Work Structure student learning Agree individual learning goals, action plans and objectives Set shared and individual learning activities Evaluate individual performance according to learning contract and objectives - NOT through comparisons Faculty of Health & Social Work Things to consider….. Managing different learning styles eg Reflective ‘v’ Activist. Different knowledge, ability, and confidence levels in different types of tasks Set tasks appropriately. Realistic but different expectations for things such as time Faculty of Health & Social Work Facilitation I - Setting Up Establish ground rules Feedback to supervisor Select joint activities and find suitable patients Also - designated time apart: Ensure equal individual supervisor time Provide feedback of a personal nature individually University of Plymouth Faculty of Health & Social Work Facilitation II Student discussion and constructive interaction Minimise competition Promote sharing of ideas Encourage reflection Joint problem solving Judge when to “close down” the discussion Faculty of Health & Social Work What Questions do you would use to facilitate peer learning discussions? Faculty of Health & Social Work Facilitation III - Managing difference between students Questions of different levels can be directed during joint tutorials/discussion Questioning technique can enhance effectiveness of supervision eg timing, order, direction, phrasing University of Plymouth Faculty of Health & Social Work Some quotes from Students: “If you go and talk to a “Maybe it’s because we are on the same level…it helps me to work it out for myself when we talk it through together” supervisor, they’ll tell you what to do, you go and do it instead of thinking about it yourself in the first place. But whereas with C and me chatting, you have to think about it” “It [peer dialogue] takes you further into it, to more depth than if you were just left on your own Faculty of Health & Social Work Staff Evaluations: Aim: To explore peer coaching techniques for dietetic placements Objectives: produce resources for peer coaching including study days collate evaluations from those piloting peer coaching Free text answers given were highly instructive for the future of this scheme. Methodology: An evaluation questionnaire was sent to trainers who had piloted PAL in B or C placements . A 50% response rate yielded 4 responses to analyse. The respondents had facilitated an average of 3.75 sessions each out of an average of 8.5 sessions that the students did in total Results: Respondents asked to score between 1-10, 10 is highest score Relevance to Learning outcomes? Particularly helpful activities included Discussion: inpatient work, tutorial work, health promotion projects, seeing patients in new clinical areas 7.75 Level of difficulty in facilitating peer assisted learning? It’s a really good idea to help build students’ confidence. Would like more guidance on when to implement and how often The most effective time to use PAL was at the early part of the placement to develop confidence eg speaking to patients 4.75 in developing students‟ knowledge, skills or attitudes? Discussion: The results are encouraging, it would be useful to further investigate whether the process can be made any easier for trainers, as the result of 4.75 for ease of application is could be improved upon. Conclusion: Ease of application in your practice area? 8 7.75 Peer coaching is an effective way of facilitating learning, it was not difficult for experienced student trainers to use and can be applied in a range of areas. Future : Evaluations will be sought from students. Successful components of model to be further developed . Helpfulness of guidance provided by University of Plymouth (written and verbal)? 8.25 Faculty of Health & Social Work References Martin, M., Morris, J., Moore, A., Sadlo, G., and Crouch, V. (2004) Evaluating Practice Education Models in Occupational Therapy: Comparing 1:1,2:1 and 3:1 Placements B J OT 67 5 192 – 197 Johnson, D.W., Johnson, R.T., & Smith, K.A. (1998) Cooperative Learning Returns to college What evidence is there that it works. Change July/August 27-35 Ladyshewsky (2004) CSP Masterclass Workshop Cooperative Learning Enhancing clinical reasoning, professional competence and deep learning. CSP London. CSP (2002). Guidelines for Implementing Collaborative (Multiple) Models in Physiotherapy Practice Placements CE01 www.csp.org.uk/uploads/documents/csp_clinical_ed_ce01.htm Moore, A., Morris, J., Crouch, V., Martin, M., (2003). Evaluation of Physiotherapy Clinical Education Models Comparing 1:1,2:1 and 3:1 placements Physiotherapy 89 8 489-501 Faculty of Health & Social Work References Boud D (1988), „How to help students learn from experience‟. In: The Medical Teacher (2nd ed), Cox K & Ewan (eds), Churchill & Livingstone, Edinburgh. Crouch V, Moore A, Morris J, Martin M (2001), An Evaluation of Clinical Educational Models for Occupational Therapy and Physiotherapy: Comparing 1:1, 2:1 and 3:1 Placement Models, Full Report. University of Brighton. ISBN No. 190117747 Huddleston RJ & Standring J (1998), Clinical placements for the professions allied to medicine. Blackpool:NHSE (North West) and the Lancashire and South Cumbria Education and Training Consortium. Knowles M (1990), The adult learner: a neglected species (4th ed), Gulf Publishing Company, London Lincoln MA, McAllister LL, Lindy L (1993), Peer learning in clinical education. Medical Teacher, 15:1, 17-25 Tate S (2004), Ch. 2 „Using critical reflection as a teaching tool‟, In: The Development of Critical Reflection in the Health Professions, LTSN, London Tiberius R & Gaiptman B (1985), The supervisor-student ratio: 1:1 versus 1:2. Canadian Journal of Occupational Therapy, 52:4, 179-183 Triggs Nemshick M & Shepard K (1996), Physical therapy clinical education in a 2:1 studentinstructor education model. Physical Therapy, 76:9, 968-983 Faculty of Health & Social Work Workshop 1 - Concerns & Barriers – Overcoming and piloting PAL What are your concerns about implementing peer assisted learning specifically in your department? 1. List these difficulties on left hand side of paper 2. List ways in which they could be overcome on right hand side of paper 3. Identify any outstanding issues for further problem solving, or areas to monitor when piloting PAL 4. Identify clinical areas, activities or dietetic staff where the potential benefits outweigh barriers Faculty of Health & Social Work Workshop 2 students X & Y (both C placement) are asked to assess a patient and write an NG feeding regimen for an in patient with (insert clinical speciality), the patient is fearful of NG feeding and has deranged biochemistry 1. 2. How would you set this up? How would you facilitate discussion afterwards? Student X Quiet, reflective, methodical and pays attention to detail Student Y Enthusiastic, at ease communicating with others, likes to have a go but tends to miss detail Faculty of Health & Social Work Workshop 3: Design one week of peer assisted learning in your department for you to use at a later date How did you go about this? What sticking points are there? How you have you/will you manage to overcome them? Faculty of Health & Social Work