The Peer-to-Peer Concept in Health EducationSUN-MEETING, HELSINKI

AUGUST 16, 2018

Agenda

1. Why Peer-to-Peer?

2. Brief Theoretical Background (Pedagogy)

3. Implementation & Research Background

4. Peer-to-Peer Skill-Based Simulation in Nursing (a new Laerdal Medical Product)

Demo / Minor Break

5. Peer-to-Peer and Your Organization (Discussion)

Peer-to-Peer.....

…is a flexible, learner centered education methodology

where students are practicing together to improve

clinical competence and confidence.

Why?THE PEER-TO-PEER CONCEPT

Evidence of an emerging challenge

Both reports document that simulators and sim-centers are underutilized.

The main reasons:

1. Lack of faculty/staff trained in simulation methodology

2. Lack of time in curriculum for simulation

2 STRATEGIES TO MANAGE THE CHALLENGE OF LACK OF TRAINED FACULTY IN SIMULATION

Lack of Trained Faculty

Train more Faculty! Change Educational Model

Train-The-Trainer Course Improve Teacher-Student Ratio

Input vs. Output

We need a better balance between the two!

1. Competence– «can perform»

2. Confidence– «will perform»

Learning as output from Simulation

Brief Theoretical BackgroundTHE PEER-TO-PEER CONCEPT

Relevant Pedagogical Theories

Behaviorism

Experiental Learning

Mastery Learning Theory

Self-Directed Learning

Behaviourism

The learner form associations between stimuli in the environment and a corresponding behavior change on the individual level

Feedback systems trigger immediate behavior change

Experiental Learning

Knowledge is gained continuously through personal as well as environmental experiences

The students needs to:

1. Reflect on the experiences

2. Use analytical skills to conceptualize the experience

Kolb’s learning cycle

Critical thinking is key

Mastery Learning

Learning progression is based on mastering basic learning objectives before going into more advanced learning objectives and tasks.

If a student does not achieve mastery on a test, the student is given additional support in learning and reviewing the information and then tested again. This cycle continues until the learner accomplishes mastery, and they may then move on to the next stage.

In a mastery learning environment…….providing enough time and employing instructional strategies ……all students can achieve the same level of learning.

Example:

◦ Basic skill-based training poorly performed needs to be rehearsed again and again until it is mastered before one can go on to more complex simulation training or clinical practice.

Self-Directed Learning

Self-direction is based on the assumption that the learner grows in capacity to be self-directed and that the teachers job is to help adults learn by supporting and nurturing this capacity

SDL takes into account that students / learners has some previous experience that should be combined with resources from experts in the learning process

SDL assume that learners will mature differently, i.e. the learner are not ready to learn the same content at the same time

SDL assume that learning is internally motivated, due to curiosity, urge to grow, satisfaction of accomplishment, desire to achieve

ImplementationTHE PEER-TO-PEER CONCEPT

Goldsmith et al, 2006

▪ First and third year nursing students

▪ Administration of medications and aseptic technique

Stone et al, 2013

▪ Review

▪ 1813 studies screened, 18 studies selected for reviewed

▪ Undergraduate nursing students (1st – 3rd year)

▪ Qualitative, quantitative and nixed methods included

▪ Results:▪ 16/18 studies with positive outcomes / improvements

▪ Peer learning encouraged independent study, critical thinking, and problem solving skills

▪ Increased levels of knowledge in areas as problem solving and communication

▪ Critical thinking improved

▪ Cognitive and motor skills improvement

▪ Students gained confidence and experienced a decrease in anxiety

▪ Subjective increase in confidence levels when completing clinical skills, problem solving, and critical thinking

“At a time when there is pressure to train more nurses and minimize costs, peer learning could

utilize resources more effectively with students teaching and supervising more junior students,

thus decreasing the demand on the responsible faculty members”

“Peer learning may also be more successful when peers are

close in experience or stage of training as it provides a more relaxed, less intimidating, more

“user friendly” learning experience than sessions conducted by registered nurses”

Pålsson et al, 2017

▪ Aim: To investigate the effects of peer learning in clinical practice education on nursing students' self-rated performance

▪ Undergraduate

▪ Method:▪ Quasi-experimental

▪ Intervention group vs. Control

▪ Base line and follow-up questionnaire

▪ Results:▪ Intervention group improved on 13/20 variables / tests

▪ Control improved on 4/20 variables / tests

Gazula et al, 2017

▪ Review

▪ Students of similar academic backgrounds▪ Interchanging roles of tutor and learner

▪ 8 articles included▪ Mostly medical studies and physiotherapy

▪ Results:Reciprocal Peer Tutoring has the potential to enhance:

◦ Cooperative learning

◦ Communication

◦ Metacognition

◦ Enhanced retention of the topics

◦ Improved course grades

◦ Improved knowledge and skills

House et al, 2017

▪ Aim: Determine the effectiveness of peer-taught simulation

▪ Quasi-experimental study

▪ Emergency medicine

▪ Method:▪ Intervention group (n=111)

▪ Groups w/ 1 peer-leader

▪ The peer teacher was instructed to run the basic medical simulation

▪ Control group (n=65)▪ Simulation led by physicians

▪ Pre- & Post-tests (“teaching objectives for each case were used for test development”)

▪ Results:▪ Improved knowledge in both groups (pre- & post-test)

▪ Pre-test: Control group 65%, Intervention group 66%

▪ Post-test: 75% (both groups)

▪ Students in the physician-taught group thought their experience was better than those in the student-taught group

Peer-to-Peer Skill-Based Simulaton in NursingA LAERDAL MEDICAL PRODUCT

The Solution

The solution is an easy-to-implement package comprising of:

▪ 10 localized skill-based scenarios

▪ Supplemental e-learning resources for faculty

▪ Supplemental e-learning resources for students

to be run on a

Nursing Anne Simulator

Nursing Anne

together withScenarios

Key Benefits

1. Self-paced learning

2. Increased simulation flexibility

3. Increased simulation capacity without need for more staff

4. Help faculty / staff to implement new simulation programs

5. Standardized scenarios with feedback to guide improvements

6. Allow students to come better prepared for faculty led simulation

7. Increased simulation practice to improve competence and confidence

8. Prepare students / learners for faculty-led simulations, tests, formal exams and clinical practice