1. The development of a framework to facilitate a collaborative peer learning 2:1 model of practice placement education Ann-Marie Lynam Practice Education Coordinator School of Medicine, TCD November 2015

2. Overview of presentation: Background & Need Development of the framework Research study Findings to date Future Plans

3. 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)

4. 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)

5. 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)

6. 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)

7. 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)

8. Background & Need

9. 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)

10. 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

11. 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

12. Methodology

13. 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

14. Impact of Peer Learning on Learning Outcomes

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

16. Impact of Peer Learning on Learning & Clinical Skills

17. 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)

18. 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)

19. 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

20. 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. Educator T1 vs. T2 vs. T3 Peer Learning vs. Collaborative learning/Peer observation/Peer feedback

21. 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

22. Publication of Framework

23. References