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.
The following surveys were administered during the project. The qualitative data was coded and included in the poster presentation.
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:
- 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
- Matthewman LJ. Reciprocal peer coaching: A constructivist methodology for enhancing formative assessment strategy in tertiary education. International Coaching Psychology Review. 2017;13(1).
- 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.
- 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
- 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
- Timmerberg, J.F & Stolfi, A.M. (2014) Perceived challenges in clinical education: Perspectives from various stakeholders. Combined Sections Meeting. Las Vegas.
- 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.
10 Responses to “The Efficacy of Peer Learning on DPT Student Confidence with Clinical Effectiveness”
Debbie Thorpe
HI Tej
What a creative idea for learning! I love your graphic! Your results are interesting…I wonder if students had not already been so exposed to zoom all day, if your results may have been different? Your instructions for implementing peer learning are succinct and clear. It sounds like Lisa is looking forward to implementing! Peer learning works really well with younger students and I think could be a valuable style of learning with DPT students. You did a great job on your poster and I hope you are thinking of submitting it to perhaps NCPTA conference in the future!
Good luck on your remaining clinical rotations!
Best
Debbie
Jennifer Cooke
Congratulations on complete your capstone! This is very useful for us in clinical education and I look forward to using your tools and resources with our future students!
Anna Brown
Hey Tej,
First off, I loved the idea of this project. One of the things I have experienced on my own rotations is a sense of “is what I am experiencing normal? Are the challenges and experiences I am having normal?” I think the idea of pairing students during rotations. I’ve had the opportunity to talk to Leslie a few times in passing this clinical and it has been such a relief. I definitely like the idea of extending the intervention for 8 weeks to span the entire clinical. I think this gives students time to reflect on their own growth and experiences and compare.
However I also agree with the assumption that scheduling regular “meetings” and discussions between students is another time consuming thing in a busy time of our lives. We have 40 weeks of clinical time a week, a capstone, a seminar, and other assignments. I think you are onto something; students need connection in a way that allows them to share and compare experiences without adding another thing to a to-do list. Great work on the project, this is a big need for student’s mental-emotional health as well as their education.
Tejasee Phatak
Anna,
I definitely agree that this type of peer learning model needs to be implemented in a less time consuming way. I would like for students to use this model to their advantage without it being just another “check box” on our long to-do lists. It will be interesting to see if this will be more feasible to implement with first year students rather than us busy third years! Thank you for your comment, and good luck to you as we finish up this summer!
jchurst
Hey, Tej!
As I read your opening statements, I reflected that even just yesterday, I talked through a few different interventions and patient populations with a fellow student and came away with good ideas and different perspectives in clinic. I think you’re entirely right, that we are abundant resources for one another. I appreciate the acknowledgement that the self confidence increase comes not only from perhaps these reflections, but from the increased clinical time. However, I can say from my personal experience, being able to reflect with another student definitely helped me feel more sure in practice. I would have loved for this to be built into the curriculum when we were students, and I’m grateful for your contribution to the program!
I also appreciate this idea because of the emotional resource it provides students; just as Carolyn says, they were able to talk through the good, the bad, and the surprises of being in clinic. I think that such conversations might help reduce burn out, and help us as humans navigate our own development in a complex world. I’d be curious to see data beyond just self confidence, but also emotional well being! This personal support is echoed in the feedback from your participants, and I think it’s a key component. Graduate programs, while they often support us academically, and advisors are working harder than ever to show up emotionally, can be a hard place emotionally. I think this program is perfect because it can support emotional well being, because it’s peer-to-peer, and dodges some of the power dynamics that can come up when going to a faculty for help. I hope future students find it supportive!
Tejasee Phatak
Thank you for your comment, JJ! I appreciate you describing this peer learning model as an “emotional resource” for students, because that is exactly what I intended when I designed this study! I’m glad you were able to communicate with peers during this clinical experience to brainstorm ideas and build confidence in your own skills. I’m looking forward to seeing where your career takes you!
Carolyn Mistele
Hi Tej,
It is great to see your project as a whole come to fruition! I really enjoyed being a participant in your project and receiving the benefits of peer learning during my current clinical rotation. There is a stark change in social support when the DPT class transitions from seeing each other each day to perhaps not hearing from each other at all for multiple months when spread across the state/country on clinical rotation. I think that facilitating conversations among students about their experiences will be very beneficial, especially during the first clinical rotation when students do not have a frame of reference for how clinical affiliations work. Even during my third year, I found the conversations I had with my partner helpful. With the small sample size of participants, my partner and I were not perfectly matched based on our clinical settings (inpatient rehabilitation vs acute care), and I don’t think that we truly helped each other with any patient care ideas. However, it was very beneficial to have weekly conversations about our experiences, the good and the bad, to gain perspective and social support. I think that you implemented your program with very impressive organization, especially for a pilot study! I also appreciate how receptive you were to participants’ feedback throughout and enjoy seeing some of my comments reflected in your final instructions document. Your instructions are clear and concise and allow future clinical education coordinators to adapt the program as needed to fit their needs. While we cannot determine if the increase in clinical confidence you found stems from the peer learning versus time spent gaining experience during the clinical rotation, I believe that this program has great potential to help future DPT students. It may be a lasting legacy you have on the UNC DPT program!
Tejasee Phatak
Thank you for your kind words and enthusiastic participation, Carolyn! Your feedback was appreciated, and it really helped shape what a peer learning model could look like for future cohorts of DPT students at UNC. I hope that we will be able to match students according to their clinical settings more accurately in the future with a larger sample size. My hope is that we can get a whole class to participate so we can get a true picture of how peer learning can impact students. Even with our small sample of students, it was great to hear that camaraderie among peers helped alleviate some stressors and better our mental health during this rotation, which is always important!
Lisa Johnston
Tej-
Great job on this project! It was nice to see your idea turn into a really useful tool for future students. We are looking forward to implementing! Take care Lisa
Tejasee Phatak
Thank you for your guidance throughout this project, Lisa! I am happy that we were able to contribute a product for future students in our program!