Peer Learning. Jig Saw Graduation Cake. Peer Coaching and Clinical Practice: Current trends and knowledge

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1 Peer Coaching and Clinical Practice: Current trends and knowledge Professor Richard Ladyshewsky Curtin Graduate School of Business Curtin University, Perth, WA, Australia Peer Learning Cooperative Learning Deutsch, M. (1949); Johnson, D., & Johnson, R. (1978) ; Johnson, D., Johnson, R., & Smith, K. (1998); Sharan, S. (1980); Slavin, R. (1990). Peer Tutoring Topping, K., & Ehly, S. (Eds.). (1998). Peer Coaching Ackland, R. (1991); Showers, B. (1984); Joyce, B., & Weil, M. (1996). Cooperative Learning Jig Saw Graduation Cake Five elements for successful cooperative learning. encouraging learners to interact and work together positive interdependence group reward preparation of learners interpersonal and small group skills reflection on and evaluation of group processing; and individual accountability. The structure of the group learning experience is central to the learning outcome. Cake Filling Icing Decorations Johnson and Johnson (1991; 1998); Slavin (1995) Positive Interdependence/Group Reward and Individual Accountability

2 Cooperative Learning Clinical Instructor / Professor organises the learning team Heterogeneous groupings. Task or problem is broken up into sub components. Collective group effort enables the team to complete the task. A Overview of Medical Record Summarises Key Findings Patient Intervention On Wards Case Presentation B History of Patient Individual Accountability C Physical Examination Student Integration Time Case Presentation D Client Management Positive Interdependence Questions Directed to A, B, C, D on all aspects of case each expected to answer any component. 5 Group Reward Grade, Feedback, Clinic Evaluation Form, Chocolate C Clinical Skills Development Manual Therapy Wrist Mobilisations Colles Fracture A Patient Therapist Observer/Coach B B Clinical Instructor or Professor Spot Practical Test Spot Demonstration Grade Feedback Applied to Whole Group Positive Interdependence and Group Reward Learning between pairs of students. More able tutoring a less able Higher Status Emulates traditional teacher student relationship Provides feedback Narrower difference in authority and expertise = positively influence Tutors require training Senior Students Teaching Junior Students More capable partner teaching less capable partner Individual Accountabilities Rotate through all 3 roles Practice with client Student run clinical skills laboratories

3 Peer Coaching Student Peers observing each other and providing consultative assistance and non evaluative feedback. Equal status and mutuality (open window) Peer Tutoring : Status Difference Power Knowledge Age Power Distance Horizontal (Peer) Coaching: Status Equal Dr. R. Ladyshewsky 9 Coaching Techniques Coaching Techniques Open Ended Questions Open ended questions Active Listening Silence Paraphrasing Summarizing Initiating Action Dr. R. Ladyshewsky 11

4 Example coaching questions Zeus and Skiffington (2002) How What When Where Why How did you think/feel/act? How did that come about? How have you coped in the past? How does that fit in? What happened? What makes you think that? What might you do differently next time? What was important about that? What did you learn from that? When did it start? When did that first occur? When did you realise? When did you decide? When will that happen? Where does it happen? Where can we start to make a change? Where did it go all wrong? Where will that get you? Where do you see yourself in...? Why did you do that? Why do you think that happened? Why do you think they responded that way? Why is this happening? Changing Feedback to Coaching Think of something you have said to a student that is traditional feedback e.g. you should have done it this way? You did that very well. That could be converted in to a coaching statement? Why questioning can sometimes sound interrogatory so use these types of questions cautiously. They may lead to defensiveness from the coachee and create argument between the parties. Dr. R. Ladyshewsky 13 Evidence Base for Peer Coaching Evidence Base for Peer Coaching Cognitive Development Theory (Vygotsky, 1986) Peer interaction promotes cognitive development by creating critical cognitive conflict or structured controversy which leads to higher achievement levels zone of proximal development Social Learning Theory (Bandura, (1997). observing and modeling the behaviors, attitudes, and emotional reactions of others. Experiential Learning: Kolb, 1984 Constructivist Learning (Boud, D. (1999); Brown, Collins and Duguid, 1989) Combining experiential learning with metacognitive processes Dr. R. Ladyshewsky 16

5 Evidence Base for Peer Coaching C Evidence Base for Peer Coaching Specific challenging goals lead to better performance Feedback/Information on goal attainment enhances the process Goal accomplishment and performance should be rewarded Individuals need to develop action plans Climate must be supportive Goal Setting Theory (Locke, 1996) Structured Coaching Model (Grant, 2003; Kolb, D. (1984) Work Integrated Learning and Peer Coaching Forecasting Change: Apply Coachee Defines Issue(s) Dr. R. Ladyshewsky 19 Set Goal/Objective Develop Action Plan Act Peer Coaching Evaluate Celebrate Monitor Reflective Practice Learning Journals Metacognition K S A Physical Therapy Students History Taking Physical Examination Management Simulated Patient Individual and Coaching Pairs 25% of course grade: examination score averaged for pairs group reward/individual accountability

6 Teaching Clinical Practice Skills Teaching Clinical Practice Skills Ladyshewsky R (2002) A Quasi experimental study of the differences in performance and clinical reasoning using individual learning versus reciprocal peer coaching. Physiotherapy Theory and Practice. 18:1; Ladyshewsky R (2002) A Quasi experimental study of the differences in performance and clinical reasoning using individual learning versus reciprocal peer coaching. Physiotherapy Theory and Practice. 18:1; Teaching Clinical Practice Skills Model of Competency (Quinn et al, 2003) Competent complexity of tasks appreciated, recognise specific cues, action more focused, rules are assumed, personal rules of thumb emerge, intuition. schema start to become well grounded, drive decision making Advanced Beginner experience becomes critical, real situations allow you to test out facts and rules. Patterns emerge and you recognise factors not in the rules (eg. norms, culture, values) Ladyshewsky R (2002) A Quasi experimental study of the differences in performance and clinical reasoning using individual learning versus reciprocal peer coaching. Physiotherapy Theory and Practice. 18:1; Novice facts and rules drive decisions inflexible work from core knowledge

7 Entry Level Competency Case Mix What 5 or 6 Cases do Clinicians Treat Most of the Time in their Specialty Area Hypothetico-Deductive Reasoning Model 6. Problem Clarification e.g. Outpatient Orthopaedics 1. Lumbar Back Pain Postural Osteoarthritic 2. Cervical Neck Pain Whiplash 3. Rotator Cuff Tendinitis 4. Patellofemoral Pain Syndrome 5. Lateral Collateral Ligament Sprain Ankle 6. Tennis/Golfer Elbow Hypothesis Generation Shoulder Pain 1. AC Sprain 2. Bursitis 3. RC Strain 1 4. RC Strain 2 5. C Spine 6. Bicipital Tendinitis 7. Hypermobility Subluxation 8. Adhesive Capsulitis Focus Peer Coaching Efforts Here Transfer of Training and Readiness to Practice (Higgs/Jones, 1995) Multiple Encounters to Promote Pattern Recognition Dr. R. Ladyshewsky Hypothesis Testing 3. Hypothesis Generation 4. Data Interpretation 2. Data Interpretation 1. Cue Acquisition Reasoning Errors PC Forward Reasoning - Pattern Recognition Role of Clinical Instructor Dr. R. Ladyshewsky 27 Problem Clarification Data Interpretation against existing knowledge Cue Acquisition Growing understanding of the problem Facilitate Peer Coaching relationship building early (ICT preplacement) and manage throughout (checks) Curtin University Blogging Pace and progress students to individual vs shared case loads and cooperative tasks (initial week most intensive) Observational Feedback Individual Feedback vs. Group Feedback Secondary source of advice Recognise where you are in your own competence and cognitive load Align cooperative learning expectations to professional behaviour and other measures on evaluation form

8 Applications for the Workplace New leadership role Rotation in to a new clinical specialisation New Graduate Entry Course Attendance, participation and approvals References (1) Ackland, R. (1991). A review of the peer coaching literature. Journal of Staff Development, 12(1), Bandura, A. (1997). Self Efficacy: The Exercise of Control. New York: WH Freeman. Boud, D. (1999). Situating academic development in professional work: using peer learning. International Journal for Academic Development, 4(1), Brown, J., Collins, A., & Duguid, P. (1989). Situated cognition and the culture of learning. Educational Researcher, 18, Deutsch, M. (1949). A theory of co operation and competition. Human Relations, 2(2), Grant, A. (2003). The Impact of Life Coaching on Goal Attainment, Metacognition and Mental Health. Social Behaviour and Personality, 31(3), Johnson, D., & Johnson, R. (1978). Cooperative, Competitive, and Individualistic Learning. Journal of Research and Development in Education, 12(1), Johnson, D., & Johnson, R. (1987). Research Shows the Benefits of Adult Cooperation. Educational Leadership, 45, Johnson, D., & Johnson, R. (1991). Learning Together and Alone: Cooperative, Competitive and Individualistic Learning (3rd ed.). Boston: Allyn and Bacon. Johnson, D., Johnson, R., & Smith, K. (1998). Cooperative learning returns to college: what evidence is there that it works? Change, 30(4), References (2) References Ladyshewsky (1) Joyce, B., & Weil, M. (1996). Models of Teaching (5th ed.). Boston: Allyn and Baron. Kolb, D. (1984). Experiential Learning. Englewood Cliffs: Prentice Hall. Locke, E. (1996). Motivation through conscious goal setting. Applied and Preventive Psychology, 5, Oldmeadow, L. (1996). Developing clinical competence: A mastery pathway. Australian Physiotherapy Journal, 42(1), Sharan, S. (1980). Cooperative learning in small groups: recent methods and effects on achievement, attitudes, and ethnic relations. Review of Educational Research, 50(2), Showers, B. (1984). Peer Coaching: A Strategy for Facilitating Transfer of Training. Eugene: Oregon University Center for Educational Policy and Management. Slavin, R. (1983). Cooperative Learning. New York: Longman Inc. Slavin, R. (1990). Co operative Learning: Theory, Research and Practice. Englewood Cliffs, New Jersey: Prentice Hall. Topping, K., & Ehly, S. (Eds.). (1998). Peer Assisted Learning. London: Lawrence Erlbaum and Associates. Vygotsky, L. (1986). Thought and Language. Cambridge, MA.: M.I.T. Press. Zeus, P., & Skiffington, S. (2000). The complete guide to coaching at work. Sydney: McGraw Hill. Ladyshewsky R., Healey, B: (1991) The 2:1 teaching model in clinical education: A manual for clinical instructors (monograph), University of Toronto, Department of Physical Therapy. DeClute, J., Ladyshewsky, R: (1993) Enhancing Clinical Competence Using a Collaborative Clinical Educational Model. Physical Therapy, 73:10, Ladyshewsky, R. & Gotjamanos E: (1997). Communication Skill Development In Health Professional Education: The use of standardised patients in combination with a peer assessment strategy. Journal of Allied Health Fall:26:4; Ladyshewsky R, (2000) Peer Assisted Learning in Clinical Education: A Review of Terms and Learning Principles. Journal of Physical Therapy Education. 14:2 (15 22) Ladyshewsky R (2002) A Quasi experimental study of the differences in performance and clinical reasoning using individual learning versus reciprocal peer coaching. Physiotherapy Theory and Practice. 18:1; Ladyshewsky R. (2004) The impact of peer coaching on the clinical reasoning of the novice practitioner. Physiotherapy Canada. 56(1), Ladyshewsky, R., & Varey, W. (2005). Peer Coaching: A practical model to support constructivist learning methods in the development of managerial competency. In M. Cavanagh, A. Grant & T. Kemp (Eds.), Evidence Based Coaching: Volume 1; Theory, research and practice in the behavioural sciences (pp ). Bowen Hills, Qld: Australian Academic Press.

9 References Ladyshewsky (2) Ladyshewsky, R. (2006) Peer coaching: a constructivist methodology for enhancing critical thinking in post graduate business education. Higher Education Research and Development., 25:1; Ladyshewsky R. (2006) Building cooperation in peer coaching relationships: understanding the relationships between reward structure, learner preparedness, coaching skill and learner engagement. Physiotherapy. 92:1;4 10. Ladyshewsky, R. (2007) A Strategic Approach for Integrating Theory to Practice in Leadership Development. Leadership and Organization Development Journal. 28:5; Ladyshewsky, R. K. & Gardner, P. (2008). Peer assisted learning and blogging: A strategy to promote reflective practice during clinical fieldwork. Australasian Journal of Educational Technology, 24(3), Tan, M., Ladyshewsky, R. & Gardner, P. (2010) Using blogging to promote clinical reasoning and meta cognition in undergraduate physiotherapy fieldwork programs. Australian Journal of Educational Technology. 26:3; Ladyshewsky R. (2010) Building Competency in the Novice Allied Health Professional through Peer Coaching. Journal of Allied Health: 39:2;e 75 e 80. Ladyshewsky, R. & Flavell, H. (2012) Transfer of Training in an Academic Leadership Development Program for Program Coordinators. Educational Management Administration and Leadership, 40:1;