The Efficacy of Peer Learning on DPT Student Confidence with Clinical Effectiveness

The Efficacy of Peer Learning on DPT Student Confidence with Clinical Effectiveness

By: Tejasee Phatak, SPT

Background:

As I progressed through the required clinical experiences in the DPT program at UNC, I observed a lack of communication among students upon leaving campus. When we returned to the classroom months later, we would share our knowledge about patients, treatment methods, and various other aspects of physical therapy education. This knowledge was much more applicable, and I seemed to retain it more, when a classmate was telling me about a personal experience rather than only learning a concept in the classroom. Through this experience, I began to wonder whether it would be valuable to explore the efficacy of peer learning in developing clinical confidence among physical therapy students. Rather than only research the evidence surrounding peer learning in the clinic, I pitched a project idea to my eventual advisor, Lisa Johnston. Over the next six months, I developed a peer learning experience that I was able to administer with second and third year DPT students in our program at UNC. The volunteers who took part in this pilot project provided me with valuable data that I utilized to create the products listed below. I am excited to share the results of my Capstone project with you all, and I am optimistic that we will be able to implement peer learning within our clinical education curriculum in the future.

 

Statement of Need:

Peer learning has been used as an educational tool in various formats over time. Team-Based Learning (TBL)^1, Reciprocal Peer Coaching (RPC)^2, and multiple student to instructor ratio models have been studied for the contributions they make to clinical education. The 2:1 student to instructor model allows for peer support and collaboration, which is lacking in the 1:1 model.³ The 2:1 ratio also avoids creating competition among students or reducing time for feedback by an instructor, which is the case with the 3:1 option.³ Peer coaching groups using the 2:1 model have also produced more hypotheses and clinical concepts about patient care than individual learners.⁴  Lastly, paired students have displayed significantly more advanced clinical skills in the “cognitive, psychomotor, and affective domains”⁴ compared to students tackling the same clinical problem independently. ⁵

While extensive research has been conducted surrounding peer-based learning in the clinic, studies are lacking about peer learning outside the clinical environment. Concerns about adequate staffing⁶, meeting productivity standards⁷, and CI stress⁶ have limited widespread implementation of the 2:1 model. This study examines students’ opinions about how peer discussions outside the clinical environment shape their clinical confidence and knowledge.

 

Overview of Project:

I recruited students from the Classes of 2021 and 2022 to participate in a paired, peer learning experience during the 764 and 768 clinical experiences this Spring. Students were able to choose their pairs as long as they were both in a similar setting (inpatient vs. outpatient). The project spanned four weeks, during which each pair was required to meet once per week to discuss various aspects of their clinical. Suggested discussion topics were sent in advance of each week, though students were encouraged to discuss any exciting, challenging, or interesting topic relevant to their clinical. I used surveys to collect pre- and post- intervention data about the students’ self-perceived confidence in different areas of clinical practice. I also asked the participants to submit a short form each week notifying me about the topics they discussed. I conducted an exit interview with each participant to collect their concluding thoughts about the positives and negatives of the experience, and suggestions that could improve future iterations of this peer learning experience. Lisa Johnston assisted me through the process of coding the qualitative data I obtained. Please view my poster presentation below for a more detailed description of this project.

 

Health Literacy:

My poster has been written in a formal, academic format to allow for potential presentation at a conference. The instruction sheet titled “Implementing a Peer Learning Experience for DPT Students” details a step-by-step plan to recreate this experience. It is intended for use by Directors of Clinical Education (DCE) and Site Coordinators for Clinical Education (SCCE). The document allows for implementation via an educational institution or a clinical site. The instructions were written with enough depth to replicate my project and enough flexibility to adapt it to specific DPT cohorts in the future.

 

Products:

My evidence table provides an overview of the current research in the realm of peer-based learning in the clinical health sciences. Much of the research involves in-person peer learning experiences, though my project was adapted to create an at-home experience due to clinical site limitations.

Evidence Table

The following surveys were administered during the project. The qualitative data was coded and included in the poster presentation.

Pre-Intervention Survey

Post-Intervention Survey

Weekly Peer-Learning Form

My poster presentation outlines the entirety of the project and provides evidence to support its conclusions.

The Efficacy of Peer Learning on DPT Student Confidence with Clinical Effectiveness

This Instructions Sheet is intended to be distributed to DCEs and SCCEs to facilitate peer learning with DPT students in the future.

Instructions to Implement a Peer Learning Experience

 

Evaluation:

I utilized the Post-Intervention Survey and Debrief Interviews to collect feedback on the content and structure of the peer learning experience used in this capstone project. I have summarized the participants’ opinions from the survey and interviews below.

Post-Intervention Survey Responses:

Three open-ended questions were included in the Post-Intervention Survey to obtain students’ opinions on the positive and negative aspects of the peer learning experience, along with feedback about the synchronous weekly meeting schedule. Students reported the main positives of the experience were the opportunity to receive personal support and to brainstorm evaluation and treatment ideas for specific patients. Personal support from a peer was said to increase self-confidence and allow students to know that another student was going through the same challenges. Students valued the sense of accountability that having a partner created, and the pairs used each other as benchmarks of progress to compare against their own caseload and productivity.

On the other hand, students felt that the discussions were time consuming during an already busy academic schedule. Third years especially noted difficulty adhering to the weekly schedule when simultaneously working on their own capstone projects, classes, clinicals, licensure applications, jobs, and social life. Though the flexibility of the discussion format was appreciated, one student noted that it was too flexible – the lack of consistent meeting time between this student and their partner resulted in them not completing some of the discussions on time. Several students wished the project would have required that they specify a recurrent meeting time to keep themselves accountable.

Debrief Interviews:

I conducted an informal interview with each participant (7/10 – 3 were lost to follow-up) at the conclusion of the 4-week process. Each interview was about 10 minutes long and students were encouraged to provide any and all feedback. The interviews revealed many of the same themes stated in the Post-Intervention Survey responses, along with a few additional suggestions. Students wished that this intervention would have lasted the entire 8-week duration of a clinical rotation. One student recommended that discussions should be on a 2–3-week basis rather than weekly to allow more time for significant changes in clinical development. Many participants agreed that this peer learning experience would be more appropriate for first year students, as they likely need more support and direction during their first clinical rotation. Though third year students reported appreciating having a peer for support, many of them were focusing on becoming independent and advocating for themselves as learners and had moved past the need for constant encouragement from a peer.

Further Evaluation:

My project was also evaluated by my Capstone Advisor, Lisa Johnston, along with my Committee Members, Jennifer Cooke and Kristel Maes. Each of these mentors provided invaluable feedback and direction each step of the way. These products are a culmination of their dedication to my project.

 

Self-Reflection:

I am really proud of the results of my capstone project. It was amazing to see my preliminary idea come to life and actually be implemented with my peers. My hope is for my Instructions Sheet to be distributed among DPT programs and clinical sites locally so that peer-based learning can be utilized on a broader scale. Using this model during the first-year rotation in our program at UNC would be a great starting point. As noted in the feedback I received from the participants, this model could be quite useful for first year students to have additional support and feedback from their own peers. It would also be a great way for our DCEs to receive feedback about what our students struggle with the most, in the hopes that we can find more ways to be part of a community even when we are not all together on campus.

 

Acknowledgements:

To Dr. Lisa Johnston, PT, MS, DPT: This project would not have been possible without you. Thank you for your continuous support and patience through the many revisions of this study. You were an incredible resource and supportive mentor over the past several months.

To Dr. Jennifer Cooke, PT, DPT: Thank you for your timely feedback throughout the capstone process. Your edits allowed me to produce clear and concise pieces of work. It was a pleasure working with you.

To Dr. Kristel Maes, PT, DPT: Thank you for providing a clinician’s perspective to this project. I truly appreciate the time you spent reading drafts of my products.

To my Participants: Thank you for taking time out of your busy schedules to be a part of this project. Your dedication and feedback made this project a success, and I am so grateful to each of you. Thank you for being such supportive friends through this process.

To the UNC DPT Class of 2021: We are almost there! Thank you for making the past three years an absolute blast. I am looking forward to seeing where your personal and professional journeys will take you.

 

Resources:

1. Huang C-Y, Wang Y-H. Toward an Integrative Nursing Curriculum: Combining Team-Based and Problem-Based Learning with Emergency-Care Scenario Simulation. Int J Environ Res Public Health. 2020;17(12). doi:10.3390/ijerph17124612
2. Matthewman LJ. Reciprocal peer coaching: A constructivist methodology for enhancing formative assessment strategy in tertiary education. International Coaching Psychology Review. 2017;13(1).
3. Moore A, Morris J, Crouch V, Martin M. Evaluation of Physiotherapy Clinical Educational Models: Comparing 1:1, 2:1 and 3:1 Placements. Vol 89 8 489 501. Physiotherapy (PHYSIOTHERAPY); 2003:13.
4. Ladyshewsky RK. Impact of Peer-Coaching on the Clinical Reasoning of the Novice Practitioner. Physiotherapy Canada. 2004;56(01):015. doi:10.2310/6640.2004.15341
5. Ladyshewsky RK. A quasi-experimental study of the differences in performance and clinical reasoning using individual learning versus reciprocal peer coaching. Physiother Theory Pract. 2002;18(1):17-31. doi:10.1080/095939802753570666
6. Timmerberg, J.F & Stolfi, A.M. (2014) Perceived challenges in clinical education: Perspectives from various stakeholders. Combined Sections Meeting. Las Vegas.
7. Ladyshewsky RK, Bird N, Finney J. The impact on departmental productivity during physical therapy student placements: An investigation of outpatient physical therapy services. Physiotherapy Canada. 1994;46(89-93).

Top Image: Establishing Effective Peer Learning Workflows | American College of Radiology. https://www.acr.org/Practice-Management-Quality-Informatics/ACR-Bulletin/Articles/February-2021/Establishing-Effective-Peer-Learning-Workflows. Accessed April 14, 2021.