Peer learning in the clinical setting
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Date
06/12/2019Author
Storrar, Neill Peter Forbes
Metadata
Abstract
Qualified doctors must work and learn together. Peer learning - where
students at a similar level teach one another - seems well suited to achieving
these complementary goals of competence and collaboration. Peer learning
is widely practised in medical education particularly in the classroom and
skills laboratory, but there is less evidence for its use in the setting of wards
and clinics where much of medical training takes place. While studies do
report peer learning in the clinical arena, there remain unanswered questions
about its measurable impact on performance – is peer learning effective in
the clinical setting? There is also a gap in the understanding of its impact on
peer relations. Critically, while many advocates of peer learning have
emphasised its social benefits, others have highlighted risks to students for
example through development of unhealthy competition. This leads many
students to be unwilling to engage in peer learning at all. These conflicts are
not well covered in current theoretical models of peer learning in medical
education.
We therefore do not have a clear understanding of the practical benefits of
peer learning in the clinical setting, or how students respond to the potential
conflicts involved in peer interaction. This thesis tests whether peer learning
in the clinical setting leads to gains in ability, and explores the contradictory
pressures that govern student decision making about peer learning. It is
structured as follows.
In Chapter One the concept peer learning is introduced and its role in the
clinical setting is briefly surveyed. The theoretical framework of the thesis –
Pragmatism – is defended, and is followed by a discussion on methodology.
In Chapter Two a published paper is presented based on students’ general
priorities in medical education. This confirms the plausibility of peer learning
in the clinical setting, and demonstrates the author’s development of key
research skills. Chapter Three the way students resolve potential conflicts in peer learning
is explored. Using Classic Grounded Theory – an established method of
theory generation – the novel theory of ‘Internal Negotiation’ is explained.
The theory predicts how students will balance educational and social
pressures when making decisions about engagement with peer learning. This
is followed by a discussion of the theory’s place in the wider literature and its
practical implications for those interested in improving peer learning projects.
Chapter Four presents the results of project testing the impact of a peer
learning project in the clinical setting. The project – dubbed Peer Practice –
was intended to promote abilities in basic consultation skills. The literature
review highlighted a major gap in the evidence for peer learning’s impact on
performance in the clinical setting. The effect of Peer Practice was tested
through the lens of the ‘practical trial’ using experimental cross-over type
design to answer questions about performance gain, impact on students’
view of peer learning, peer learning’s acceptability and other measures. A
small performance benefit from Peer Practice was demonstrated, and the
consequences for future work are discussed.
Chapter Five integrates the lessons of the preceding chapters. In summary
the thesis has developed a new and plausible theory of peer learning and
how students negotiate social and educational tensions when choosing
whether to take part; it has presented a rigorously designed experimental
study of peer learning in the clinical setting and demonstrated modest
performance gains amongst other benefits. It has thus added to the
knowledge of peer learning in medical education and drawn lessons for those
interested in promoting clinical competence through the use of collaborative
activities in the clinical setting.