Peer assisted learning in undergraduate clinical ... Peer assisted learning in undergraduate clinical

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  • Peer assisted learning in undergraduate

    clinical medical education: a mixed methods

    study

    Joanna Hong-Meng Tai

    MBBS (Hons), BMedSc (Hons)

    A thesis submitted for the degree of Doctor of Philosophy at

    Monash University in 2015

    HealthPEER

    (Health Professions Education and Educational Research)

    Faculty of Medicine, Nursing and Health Sciences

  • Copyright notice

    © Tai 2015. Except as provided in the Copyright Act 1968, this thesis may not be

    reproduced in any form without the written permission of the author.

    I certify that I have made all reasonable efforts to secure copyright permissions for third-

    party content included in this thesis and have not knowingly added copyright content to

    my work without the owner's permission.

    Typeset in Garamond & Joanna MT

  • i

    Abstract

    Peer-assisted learning (PAL) involves students learning with and from each other. PAL

    activities may be informal, or undertaken formally in a curriculum, with or without

    educator facilitation. Reports on PAL in medical education suggest its value can extend

    beyond technical knowledge gain, to development of broader professional skills. However,

    the literature largely focuses on the value of PAL in the university environment, rather than

    how it occurs in the clinical context.

    Medical students at Monash University are required to engage in PAL in their pre-clinical

    years. The researcher’s experience as learner and teacher suggested students also formulated

    PAL strategies for clinical placements. However, activities were not formalised and unlikely

    to be optimised. This research aimed to identify students’ and educators’ use and

    perceptions of PAL during clinical placements to develop recommendations for PAL in

    clinical settings,

    A tri-phasic study was designed using Biggs’ Constructive Alignment as a framework to

    characterise students’ PAL experiences, examining the intended, enacted, and perceived

    curriculum. Year 3 was the focus of the study, as this first clinical year contains many

    unstructured learning opportunities which may afford PAL. Research methods comprised a

    curriculum map (Phase 1), student survey and an observational study of the students on

    their clinical placements (Phase 2), and interviews with experienced educators (Phase 3).

    Whilst the curriculum map identified few explicit learning objectives relating to PAL,

    students reported participation in PAL activities during clinical placements on average 20

    times per week. Observations supported this reported frequency of peer interactions: two-

    thirds of students’ time was spent in the company of peers. Survey and interview data

    revealed students valued teaching and feedback from peers, but doubted the accuracy of

    peer-generated information. The roles of ‘feedback giver’ and ‘observer’ were less valued

    by students. Significantly more female students reported that PAL contributed to a safe

    learning environment than males. PAL activities were reported to contribute to students’

    evaluative judgement: the comprehension of and ability to judge performance against

    notions of quality. Educator involvement was perceived to be a key ingredient for

    successful PAL. These data were used to develop a PAL Activity Matrix, which identified

    activities students could partake in within a clinical environment to optimise their learning.

    In Phase 3, expert educators reported the study findings resonated with their own broader

    experience of PAL in clinical education. The activity matrix was confirmed as representing

    ideal strategies. Potential barriers and facilitators to the uptake of PAL were illuminated.

  • ii

    These ‘real world’ considerations for culture, epistemic authority, and patient-centred care

    were included in the resultant implementation framework for PAL.

    This comprehensive study informs the current discourse on PAL in clinical medical

    education. It identifies barriers and facilitators to PAL, and presents strategies to improve

    the value of PAL. Future work could test the effect of PAL strategies on students’ clinical

    capacity, including technical competency, professional and communication skills, and

    preparedness and ability to teach. The use of PAL could also be examined in a broader

    range of clinical environments, at both undergraduate and postgraduate levels.

  • iii

    Publications during enrolment

    Presentations arising from thesis work

    Tai, J. Canny, B. Haines, T. Molloy, E. Engaging Medical Students in Peer Assisted Learning

    on Clinical Placements. ANZAHPE Conference 2013, Melbourne, June 24-27 (PeARLS

    presentation)

    Tai, J. Canny, B. Haines, T. Molloy, E. Medical Students’ Use of Peer Assisted Learning on

    Clinical Placements. AMEE Conference 2013, Prague, August 25-28 (ePoster)

    MONARC Peer Learning in Clinical Education Seminar, 4 June 2014, joint seminar

    presented with Samantha Sevenhuysen

    Tai J, Haines T, Canny B, Molloy E. Peer learning on clinical placements: what have

    students taught themselves to do? ANZAHPE Conference 2014, Gold Coast, July 7-10 (Oral

    Presentation)

    Tai J, Canny B, Haines T, Molloy E. Peer Assisted Learning on Medical Clinical Placements:

    An observational study. AMEE Conference 2014, Milan, August 30 - September 3 (Poster)

    Tai J, Canny B, Haines T, Molloy E. The development of medical students’ evaluative

    judgement through peer learning on clinical placements: a mixed methods study.

    ANZAHPE 2015 Conference, Newcastle, March 29-31 (ePoster)

  • v

    General Declaration

    In accordance with Monash University Doctorate Regulation 17.2 Doctor of Philosophy

    and Research Master’s regulations the following declarations are made:

    I hereby declare that this thesis contains no material which has been accepted for the award

    of any other degree or diploma at any university or equivalent institution and that, to the

    best of my knowledge and belief, this thesis contains no material previously published or

    written by another person, except where due reference is made in the text of the thesis.

    This thesis includes one original paper published in peer reviewed journals and five as yet

    unpublished publications. The core theme of the thesis is peer assisted learning in undergraduate

    clinical medical education. The ideas, development and writing up of all the papers in the thesis

    were the principal responsibility of myself, the candidate, working within the Health

    Professions Education and Educational Research (HealthPEER) unit, under the supervision

    of A/Prof Elizabeth Molloy, Professor Ben Canny, and Professor Terry Haines.

    The inclusion of co-authors reflects the fact that the work came from active collaboration

    between researchers and acknowledges input into team-based research.

    In the case of Chapters 2, 5, 6 and 7, my contribution to the work involved the following:

    Thesis chapter

    Publication title Publication status

    Nature and extent of candidate’s contribution

    2 Effects of same-level PAL in medical clinical placements: A narrative systematic review

    Submitted to Medical Education; under consideration after revision

    Led the conception of the study, undertook data collection, led data analysis & synthesis, drafted and prepared the manuscript for publication; 85%

    5

    A study of medical students’ peer learning on clinical placements: what they have taught themselves to do

    Published in the Journal of Peer Learning

    Led conception of the study, formulated study tools, undertook data collection, was main analyser of data both quantitative and qualitative, drafted and prepared the manuscript for publication; 85%

    5 Gender matters: students’ perceptions of peer learning in clinical education

    Submitted to Focus on Health Professional Education; under review

    Led conception of the study, formulated study tools, undertook data collection, was main analyser of data, drafted and prepared the manuscript for publication; 85%

    6

    Identifying opportunities for learning: an observational study of medical students’ use of peer assisted learning on clinical placements.

    Submitted to Teaching and Learning in Medicine; under review

    Led conception of the study, undertook data collection (observations and interviews), was main analyser of data, drafted and prepared the manuscript for publication; 85%

    6

    Building evaluative judgement through peer-assisted learning: opportunities in clinical medical education

    Submitted to Advances in Health Sciences Education; accepted pending minor revisions

    Led conception of the study, undertook data collection (observations and interviews), was main analyser of data, drafted and prepared the manuscript for publication; 85%

  • vi

    Thesis chapter

    Publication title Publication status

    Nature and extent of candidate’s contribution

    7

    The development of a framework t