PEER ASSISTED LEARNING: PLACEMENT C

1. PEER ASSISTED LEARNING: PLACEMENT C Jacklyn Jones: QMU, Edinburgh Chris Christie: NHS Forth Valley

2. WHAT IS PEER ASSISTED LEARNING? • A natural way of learning or completing tasks if the same task has been set for more than one person. • Allows pooling of resources/ reduces duplication of effort • Uses paired and team working throughout • Enables in-depth analysis of the processes and decision-making • Students learn from their own tasks and by observing and discussing tasks performed by their peers

3. How PAL works in practice • PAL is supplemented by the input of experienced supervisors and the use of student led enquiry sessions. • Students each carry out their own tasks but throughout the placement they observe and give formative feedback on their peer’s performance, swapping roles. • Summative assessment is undertaken by supervisors who observe student performance in the clinical setting and in the student lead enquiry sessions ensuring students are meeting the learning outcomes of the placement.

4. Does PAL work? • Evidence shows: • it enhances the student learning experience • learning is more effective when there is collaboration between students. • There are benefits to the student including: • improved team working skills • mutual support and companionship • reduced stress • greater ability for critical enquiry, reflection and reasoning • enhanced deep learning • increased clinical competence

5. Background to Project • Placement allocation system became a local system rather than a national system supported by the BDA • Requirement for all clusters to be self-sufficient with practice placements • At that time Scotland had a deficit of approx 900 placement weeks within the Scottish Cluster • Although significant commitment was given by the practice placement providers in Scotland there remained a deficit in placement weeks

6. Background to project contd. • PAL Training provided by London cluster for practice placement providers in Scotland (May 2009) • Following this some practice placement providers began to implement PAL within their practice placement provision • Scottish Dietetic Alliance (SDA) continued to review the supply and demand of practice placement weeks • NHS Education Scotland (NES) provided funding for a short life working group to implement PAL across practice placement provision in Scotland

7. Group Membership Chair: Judith Catherwood: AHP Associate Director (NHS Highland) Health Board reps: Chris Christie and Fiona Struthers (NHS Forth Valley) Karen Lauder (NHS Ayrshire and Arran) Michelle Macintosh (NHS greater Glasgow and Clyde) Catriona McLeod (NHS Tayside) Moira Smith (NHS Lothian) Val Reid (NHS Grampian) University reps: Jacklyn Jones (QMU, Edinburgh) Susan Lennie (RGU, Aberdeen)  Christine Monaghan (GCU, Glasgow)

8. Aims of the PAL implementation group Short term aims: • Support the immediate implementation of the PAL model for B practice placements in department who are currently providing at least 75% or their target provision. • Develop appropriate assessment tools for B placement to enable the implementation of the PAL model. • Assist relevant health board areas with programme planning Long term aims: • Implement the PAL model for B practice placements in all dietetic departments in the Scottish cluster • Consider whether the PAL model could be utilised for C placement provision

9. Intended Outcomes of the group • Identify the training needs of dietetic staff in implementing the model and propose how these needs are best met. • Develop model programmes and paperwork and support practice placement providers across Scotland in adopting the PAL model. • Work in partnership over a six month period to deliver the implementation of the PAL model in all practice placement types across Scotland. • Support an increase in the number and quality of placements being offered to meet future demand.

10. NHS Scotland NHS Health Boards NHS Ayrshire and Arran NHS Borders NHS Dumfries and Galloway NHS Fife NHS Forth Valley NHS Grampian NHS Greater Glasgow and Clyde NHS Highland NHS Lanarkshire NHS Lothian NHS Orkney NHS Shetland NHS Tayside NHS Western Isles Special Health Boards National Services Scotland National Waiting Times Centre NHS Education for Scotland NHS 24 NHS Health Scotland NHS Quality Improvement Scotland Scottish Ambulance Service State Hospital

11. PAL Training • Training took place in each health board area in Scotland • The training needs of the placement provider was considered and the training was developed individually for each health board area • Three training course run each year in Scotland covering introduction to clinical supervisory skills and PAL

12. Resource Development Scottish Peer Assisted Learning (PAL) Implementation Pack http://www4.rgu.ac.uk/scdp/placement/page.cfm?pge=65009

13. Contents of pack Introduction to Peer Assisted Learning Includes: Theory of PAL, Practice Placement Overview of PAL, Student and Supervising Dietitian Information, Student Led Feedback Session and Checklist, Sample timetable Induction – PAL Activities Includes: Introductions, Dietetic Shadowing, Health Hunt, Orientation to Acute Services, Orientation to Community Services, Menu Clerk/Catering Systems, Diet Bay/Catering Systems, Policies and Procedures, Records Clinical – PAL Activities Anthropometry, Care Homes, Dietetic Assistant/Food Workers, Enteral Feeding, Health Promotion Project, Home Visits, Nutritional Screening, Oral Nutritional Support (ONS), Patient Interviews, Texture Modifications

14. What is happening in Scotland as a result? • Most practice placement providers have implemented aspects of PAL within their practice placement provision • There is wide variation in the use of PAL • Those providers implementing PAL have tended to implement this mode of placement delivery across all placements • In general only facets of PAL have been implemented depending on service needs rather fully integrating PAL

15. Evaluation • Ongoing national monitoring through the approval and monitoring process • Local monitoring through initiatives such as student and staff stories Formal evaluation is in 2011 • This is supported by NES funding • The evaluation is being undertaken by an external agency and is currently out to tender

16. Formal Evaluation Quantitative Data • Supply of dietetic practice placements provided by Health Boards during 2008-10 and projected placements to be delivered in 2011. • Demand for dietetic practice placements required over the same time frame. • Engagement with the implementation of PAL by practice placement providers. • The number of qualified dietitians who have experienced PAL within their practice pre-registration training during it’s implementation in 2009 and 2010. • Degree and robustness of implementation of PAL within Health Board Dietetic Practice Education providers Qualitative Data • The views and opinions of student dietitians, newly qualified dietitians, dietetic practice educators, HEI course tutors and programme leaders and dietetic managers/leads who have appointed newly qualified dietitians.

17. Experiences from NHS Forth Valley

18. Student training in Forth Valley 2 Acute hospitals 12 miles apart (Falkirk & Stirling), each with dietetic dept 1 community dietetic department (new to student training in 2008) Integrated student training programme (roughly 6/52 in both Acute & Community) 1 student based in Stirling & 1 in Falkirk Not providing full quota of allocated weeks for student training PRESSURE!!!!

19. How did we incorporate PAL? Already doing some PAL, just didn’t call it that! eg Health Hunt, H Promo, Facilitation sessions. Firstly into 2x B placements (July 09) Activities based on London activities Not full PAL programme Some PAL in every week from week 1-12 Since then, 8 x C placements plus more 2 x B placements with another 4 x C students starting end Oct 2010

20. PAL in C Placements Aim to be more patient-centred rather than process Patient interviews - assessment - care planning - delivery in a variety of settings- acute/community/renal HD unit etc N.B. students give each other feedback but are not undertaking summative assessments on each other Dietetic assistants/food workers

21. Example C placement Programme Induction week 2 weeks “Assessment” 3 weeks “Care planning” 3 weeks “Care Delivery” 3 weeks “Consolidation”

22. C placement programme Student led discussions Utilise existing assessment tools PAL used for learning, not evidence gathering …except…………

23. Student led discussions; evidence for C2Effective communication with colleagues C3 Reporting accurately to relevant people on actions taken P10 Reflects on practice at defined intervals and is able to describe how practice has changed P12 Takes lead role in Journal clubs and case discussions P13 Demonstrates responsibility for own learning by seeking out answers to questions P14 Continues to demonstrate professional attitude (listens to & respects others) Individual element to H promo project Individual element to Audit

24. Use of PAL in consolidation YES! If students overlap, eg C student in week 11 consolidation takes new student in week 2 (A,B or C) Student led discussion at end of week 11 to share experiences Professional Practice PAL ideal in week 10/11 Shared responsibility for a ward

25. Evaluation Usual evaluation tools/paperwork Questionnaire to C placement providers to assess readiness for C placement (B placements only) Student stories Staff stories Currently looking into patient stories (possibly honours project for undergrad student)

26. Student stories- the process When? After student has passed/reference is written By whom? By non-dietitian: AHP contacts/Charge Nurse Where? Nowhere near to Dietetic Dept How? Scribed interview which is then themed- not taped How long? 60-90mins Consent/Confidentialitynot guaranteed

27. Student stories- the questions Was your programme what you expected it to be? What are your thoughts about PAL? What was it like being in the Departments (hospital & Community)? Were there any specific events that you would like to discuss? What do you remember most? Do you feel ready to start working as a dietitian? (C students only)

28. Student stories-the findings 4 B + 8 C students undertook stories Very variable findings- often contradictory e.g 1 student loved being with lots of Dietitians, another would have preferred to be with fewer. Travel between bases but also to work- “I felt so tired” Wanting longer blocks in Acute or Community “Amazed by just how much knowledge dietitians have”

29. PAL feedback PAL means less patient contact” “Worked better than I thought” “Sharing experiences was good; we could find out more, if my PAL partner had a patient I was interested in I could learn about it” “ I had a previous poor experience of PAL but here it was good” “Can’t see why PAL is better than shadowing…I question the validity of PAL” “ I don’t feel in a position to give feedback to others”

30. Why do we still use PAL? No longer an issue of capacity We believe in the benefits of PAL for our students It’s evidence based- adult learning theories Students like it