Observational Study Exploring the Efficacy and Effectiveness of a New Model of Peer-Assisted Simulation-Based Learning Clinical Placement
Abstract
:1. Introduction
2. Materials and Methods
- All PYPT students. Those students enrolled in Integrated Clinical Science (PATH3002) and Clinical Science Fundamentals (PATH6006) were invited to participate in this study as peer learners.
- FYPT students enrolled in Physiotherapy Clinics 5 (PHTY4015) were selected to be peer teachers based on their need to complete a fieldwork placement in order to graduate. To be eligible, they were required to have completed successfully either the faculty-led simulation placement during their own penultimate year of study, or at least one clinical placement in each of the core areas of practice (cardiopulmonary, neurosciences and musculoskeletal). Final-year physiotherapy students who had failed any of these placements were excluded from participating as peer teachers.
- Over the duration of the clinical placements, 17 peer-teacher supervisors participated in the clinical and all were invited to participate in this study. Each was considered a clinical expert in their area of practice (cardiopulmonary, neurosciences or musculoskeletal) and had considerable experience supervising students on traditional fieldwork placements.
2.1. Development of the Model
- Penultimate-year placement fail rate of both student cohorts was collected and compared to 2019 data, where the student fail rate for the simulated placement was 9 percent.
- The quality of the teaching and feedback received from their peer teacher is most important for peer learners [17]. Accordingly, peer-learner students completed the ‘measure of quality of giving feedback scale’ [22]. This is a validated 20-question survey that takes less than 10 min to complete, where peer learners rated the quality of the feedback provided by their peer teacher on a 7-point scale (1 = not at all to 7 = very well). The survey was delivered to each peer learner via email using Qualtrics software (Qualtrics, version January 2021, Provo, UT, USA. https://www.qualtrics.com accessed on 8 April 2022) at the end of each week.
- The most important thing to capture from the peer teacher’s perspective was their impression of the PAL model, particularly in the context of their previous experiences of traditional fieldwork placements. Accordingly, peer teachers wrote plus/delta reflections of their perception of positive and negative aspects of the model at the end of their five-week placement.
- As personnel with significant clinical supervision experience, faculty supervisors wrote plus/delta reflections of their perception of positive and negative aspects of the new PAL model at the end of their period of supervision.
2.2. Implementation of the Placement
2.2.1. Allocation of Students to Placement
2.2.2. Training and Upskilling of FYPT Students to Be Peer Teachers
- Understood the PAL approach; simulation as a learning and teaching modality; and the bespoke model of the placement in terms of its structure; the lines of responsibility, reporting and communication; and outcomes.
- Were familiar with the 30 simulation scenarios, including the expectations of the SP in enacting their role.
- Understood the expectations for PYPT student performance and were confident in assessing this with guidance from their faculty supervisor using the rubric provided.
- Were confident and practiced in providing constructive feedback during the placement and final assessment findings to their students.
2.2.3. Training and Upskilling of Faculty Supervisors
2.2.4. Orientation and Consent to Participate in This Study
2.2.5. Data Collection Timepoints
2.3. Data Analysis
3. Results
“This placement was challenging but greatly enjoyable. It was my personal favorite placement and I felt the utmost support from the students, my peers, and the (de-identified for blind review) and primary supervisors.”
“In the scenario in which I have a student to supervise in the future, this placement will have been an irreplaceable experience to build confidence and exposure to supervising.”
“Having input from various sources and varying opinions I believe helped myself and the students have a greater learning experience.”
“I have been able to learn about the cases and different ways to approach/treat through the peer learning students e.g., understanding their clinical reasoning as to why they are performing a particular assessment/doing a task in a specific position and then being able to add that to my approach with patients.”
“In summary, I believe the standout benefit and positive aspects of the way in which this placement runs would be providing the students with peer-teachers who have recently done their clinical placements, are at a similar stage of learning with only one year additional experience, and are in a similar age bracket. I believe this facilitated their comfort within sim as they were provided with additional empathy and understanding of their stress and how they’re feeling, and encouragement to use the sim as a safe place to make mistakes and to trust themselves and develop their clinical reasoning skills. They were also provided with frequent examples as to how these skills were relevant in fourth year and our personal recent experiences with these situations.”
“In terms of the peer learners, my group reported learning a lot over the three weeks. I believe the framework provides them with a great experience to seek learning, whereby students (especially the quieter or weaker students) appeared less daunted to ask questions in the peer teacher model.”
“Being able to have a mentor relationship with each stream supervisor to discuss other methods of approaching patients or ask any questions that came up and I wasn’t able to answer.”
“This model of peer teaching demands self-reflective practice from students and in doing so encourages us as mentors to do the same. I believe self-reflection is an essential component of learning which has facilitated personal growth in communication, particularly within a group of various personalities as well as improving my teaching/educational skills.”
“Simulation environment was challenging for the students however created real life scenarios which would benefit them for practical placements it also allowed me to refine my skills further throughout (my) final year.”
“Establishing a difference between the year groups… this issue was amplified with mature age students or students who are older than their supervisor, however these are situations which are also encountered on fourth year prac for mature aged students and they will need to be given and learn strategies as to how they can manage their emotions regarding this and show respect towards those with more physiotherapy experience.”
“Having friends previously in our year group that you are supervising and having to try to create a professional boundary and provide constructive feedback.”
“It was the hardest clinical placement I undertook in terms of stretching my knowledge.”
“I felt a lot of responsibility for their performance when in reality the students had not prepared adequately and were not performing well.”
“Trying to create challenging situations for the more advanced peer-learners who are finding simulation scenarios simple.”
“Took some time to realize that supervising is largely managing/handling personal and interpersonal issues (such as students taking feedback personally).”
“I found it difficult for myself to ensure I was giving the student the best opportunity to pass the placement and improve, however I found it hard to also spend just as much time with my other students who were performing really well.”
“I believe some PYPT students found the peer-supervisor role difficult and found it challenging to accept feedback from a fellow peer. I can appreciate this viewpoint but found it difficult at times to work with certain students who had less confidence in the peer-teacher model. It was difficult to provide feedback and assist some students in developing their clinical abilities when the receptiveness to feedback was lacking due to a lack of confidence in my role as a supervisor. I also found it difficult at times treading the line of “peer” and “supervisor.”
“Learning to provide non-repetitive, summarized, and specific feedback was very difficult.”
“Having to provide individualized feedback to students (especially those performing well).”
“Having to feedback to a student when they were non-competent. Admittedly I found this to be particularly difficult when I was having to provide that feedback by myself and when students became emotional secondary to that feedback. I am a very empathetic and emotional person, and this amplified how difficult the feedback sessions could be, however this is also a reflection on how I could develop my resilience.”
“My observation was that some PYPT students were possibly more comfortable asking questions of the FYPT peer supervisors than they may have been asking questions of qualified clinicians.”
“Students tend to not be as forthcoming with constructive criticism—were ‘too nice’ especially to friends.”
“It was good to see how he developed over the prac and to hear his insights into the challenges that clinical supervision involves. I think these insights will serve him well as he starts to work as a new-graduate clinician.”
“It significantly lightened the load for me, which is important when staffing is getting ever more stretched.”
“Being a simulated situation, it was easy to time out and in as required which is a great safety feature. Having said that it wasn’t something that was required too often.”
“My impression was that the placement served its purpose well. As an ex manager I was confident that the students who had passed were well prepared to undertake their clinical placements in a hospital environment. Whilst clearly not at ‘expert’ level they were able to demonstrate safe clinical practice and come up with at least a basic intervention. Is clearly an ideal building block to prepare them for their final year of physio.”
“(There was) very good clear and specific training of FYPT students prior their supervision of their PYPT student group.”
“The responsibility of supervision definitely prompted the FYPT peer supervisors to revise their knowledge. I would suspect that had they been on a ‘regular’ clinical placement, their preparation would have been significantly less! My impression is that their revision of knowledge was internally motivated by not wishing to look foolish when asked questions by the PYPT students. Whereas on a regular placement, a significant proportion of students are relatively passive in their preparation and only revise knowledge when prompted by the external motivator of being asked to do so by a supervising clinician. I know that without doubt, the FYPT student that I was supervising worked exceptionally hard during this prac. He spent a lot of time reviewing previous learned material and was keen to discuss and clarify concepts with me.”
“They sometimes lacked a deeper understanding of some of the clinical presentations but were well able to supervise and teach very well at the PYPT students level required.”
“When it came to giving feedback to the PYPT students I was impressed with just how well the FYPT students did this. They were very much on the mark with their assessments. Even though we gave feedback to the students together I took a very back seat role.”
4. Discussion
“This was a great set up! All parties get something positive out of it. It creates meaningful placements for both PYPT students and FYPT students.”
“I think it was a fantastic development in a difficult year. Amazing achievement by all staff involved in its planning and execution.”
“The near peer teaching method utilised in this simulation model approach was overall a great success.”
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
APP | Assessment of Physiotherapy Practice rubric |
FYPT | Physiotherapy students in their final year of study |
MQF | Measure of quality of giving feedback scale |
PAL | Peer-assisted learning |
PYPT | Physiotherapy students in their penultimate year of study |
SPs | Simulated patients |
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Student Group | Placement Weeks Relative to Each Other | ||||||
---|---|---|---|---|---|---|---|
PYPT Group 1, n = 93 | 1 | 2 | 3 | ||||
PYPT Group 2, n = 78 | 1 | 2 | 3 | ||||
FYPT Group 1, n = 13 | 1 | 2 | 3 | 4 | 5 | ||
FYPT Group 2, n = 11 | 1 | 2 | 3 | 4 | 5 |
Theme | Subtheme |
---|---|
Personal experience | Enjoyment |
Appreciation | |
Confidence | |
New skillsets learned | Overall collaboration |
Clinical skills | |
Professional, organisational and interpersonal skills | |
Attributes of the teaching model | Relatability |
Approachability | |
Mentorship and autonomy | |
Opportunity for reflective practice | |
Authenticity |
Theme | Subtheme |
---|---|
Hierarchy | Peer teacher to peer learner |
Pre-existing relationships | |
Peer teacher-centered issues | Preparation needed |
Responsibility | |
Mentoring good students | |
Behavioural factors | |
Time allocation | |
Peer learner-centered issues | Lack of buy-in to the peer-assisted learning model |
Delivering feedback | Provision of bespoke, succinct specific feedback Difficult conversations |
Theme | Subtheme |
---|---|
PAL model | Collaborative learning |
Perceived relaxed atmosphere for PYPT students | |
Pre-existing relationships | |
Insight | |
Outcome | |
Impact on Faculty | |
Simulation model | Environments |
Outcomes | |
Support provided | Training and handover |
Daily support | |
FYPT students | Enthusiasm, organisation, diligence and professionalism |
Level of clinical acumen | |
Level of teaching and communication acumen |
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Dennis, D.; Cipriano, L.; Mulvey, G.; Parkinson, S.; Reubenson, A.; Furness, A. Observational Study Exploring the Efficacy and Effectiveness of a New Model of Peer-Assisted Simulation-Based Learning Clinical Placement. Int. J. Environ. Res. Public Health 2022, 19, 4505. https://doi.org/10.3390/ijerph19084505
Dennis D, Cipriano L, Mulvey G, Parkinson S, Reubenson A, Furness A. Observational Study Exploring the Efficacy and Effectiveness of a New Model of Peer-Assisted Simulation-Based Learning Clinical Placement. International Journal of Environmental Research and Public Health. 2022; 19(8):4505. https://doi.org/10.3390/ijerph19084505
Chicago/Turabian StyleDennis, Diane, Lora Cipriano, Ginny Mulvey, Stephanie Parkinson, Alan Reubenson, and Anne Furness. 2022. "Observational Study Exploring the Efficacy and Effectiveness of a New Model of Peer-Assisted Simulation-Based Learning Clinical Placement" International Journal of Environmental Research and Public Health 19, no. 8: 4505. https://doi.org/10.3390/ijerph19084505