A guide for Practice Educators
London Cluster Placements Team
January 2012
Welcome to the London Cluster Peer Assisted Learning Resource Pack
This resource pack has been developed by the London Cluster Placements Team to support Practice Educators to incorporate peer assisted learning activities into clinical placements offered to dietetic students.
It is anticipated that Practice Educators will select the most relevant activities to support the stage of the student’s placement, the student’s key areas for skill development and the resources available in their clinical setting. It is also anticipated that activities will be adapted to meet specific student or service requirements.
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If you have any queries about the resources in this pack, please contact a member of the London Cluster Placements Team on either: or
Contents
Contents......
1.Introduction......
1.1.Introduction to Peer Assisted learning (PAL)
1.2.Using PAL for dietetic placements learning activities
1.3.Essential components to a successful PAL activity
1.3.1.Planning
1.3.2.Facilitated debrief sessions......
1.3.3.Feedback
Peer feedback
Supervisor feedback
1.3.4.Using PAL activities as evidence towards assessment
1.4.Frequently asked questions
1.4.1.Supporting students who are not getting on with each other
1.4.2.Supporting students who are progressing at different rates
2.Induction
2.1.Expectations and Orientation
2.2.Policies and procedures
2.3.Role of the Dietitian/ Dietetic Assistant
2.4.Meal Production Activity
2.5.Meal Service Activity
2.6.Ward Orientation
2.7.Dietetic Shadowing
2.8.Doctor and Nurse Observation activity
3.Assessment - Anthropometry
3.1.Commonly used anthropometric variables
3.2.Estimating anthropometric measurements
3.3.Choosing appropriate anthropometric variables to use
3.4.Gathering anthropometric data
4.Assessment - Biochemistry
4.1.Identifying relevant biochemical parameters
4.2.Identifying abnormal biochemistry
4.3.Biochemistry and dietetic interventions
4.4.Assessing biochemistry
5.Assessment - Clinical
5.1Medical notes familiarisation activity – part 1 of 2
5.2.Medical notes familiarisation activity – Part 2 of 2
5.3.Medication familiarisation activity
5.4.Familiarisation with unfamiliar clinical conditions
6.Assessment - Dietary
6.1.Compilation of oral nutrition support and enteral feed ready reckoner
6.2.Differing approaches to gathering dietary information
6.3.Qualitative and quantitative assessments of dietary intake
6.4.Food record charts/food diaries
7.Assessment - Environmental
7.1.Individuals
7.2.Groups
7.3.Populations
8.Nutrition and dietetic diagnosis
8.1.Identifying nutritional priorities
8.2.Identifying dietetic diagnosis statements
9.Intervention, planning and implementation
9.1.Identifying dietetic management goals
9.2.Implementing dietetic management goals
9.2.1.Devising implementation plans
9.2.2.Implementing the dietetic care process
10.Monitoring and evaluation
10.1.Identifying appropriate follow-up arrangements
10.2.Identifying appropriate outcome measures
10.3.Reviewing dietetic interventions
1.Introduction
1.1.Introduction to Peer Assisted learning (PAL)
Peer Assisted Learning has been defined by a number of different people:
“To get knowledge through study, experience, observation or teaching of an equal” (Lincoln et al, 1993)
“Peers helping each other to learn” (Crouch et al, 2001)
“Individuals with equal status actively help and support each other in learning tasks” (Ladyshewsky 2006)
The Oxford dictionary defines a peer as “an equal in civil standing or rank or equal in any respect”
Ladyshewsky (2006) states that PAL is “a natural way of learning or completing tasks if the same task has been set for more than one person” and that it is a “way of pooling resources and reducing duplication of effort”. In essence PAL is a way of increasing knowledge and skills by working in partnership with someone else.
There is a substantial amount of medical and allied health professional research in using PAL to enhance student learning (Cate & Durning 2007, Field et al 2007, Roberts et al 2009a & b) but little in the way of practical guidance.
1.2.Using PAL for dietetic placements learning activities
Students are usually allocated to placements in even numbers so as they are able to work in pairs. PAL activities can be used to facilitate induction into a new clinical area and support the development of key skills in assessment, identifying nutrition and dietetic diagnoses, planning and implementing interventions and reviewing, monitoring and evaluating dietetic interventions. PAL activities can also support the development of key professional skills such as communication skills, team working and reflective practice skills. Sections 2 – 10 of this resource pack include suggestions for PAL activities to support skill development in a range of areas.
1.3.Essential components to a successful PAL activity
1.3.1.Planning
Pairing students
We suggest that you either pair students randomly or if appropriate take transport arrangements into account. If you are basing students at sites that are some distance from each other than it would make sense to pair students according to who lives nearest the site at which they will be based. If the students will be required to make frequent visits to community clinics then it may be sensible to pair drivers or car owners with non-drivers. It is not advisable to allow students to select their own pairings as there may be one person in the group that everyone would prefer not to work with. Randomly allocating partners avoids making this obvious.
Although it can be useful to take learning styles into account when planning activities for students and might therefore seem sensible to put students with similar learning styles together, often students with complementary learning styles make good pairs. The activists’ tendency to jump in and have a go can be tempered by the reflector who might prefer to watch someone else before performing the activity themselves. The problem with this type of complementary pairing is that it can then be difficult to move the students beyond their comfort zone and encourage them to develop a more rounded learning style. It is important that the students are encouraged to be explicit with their peer about their individual learning style to support their effective peer working.
Planning for activities
It is essential to plan a PAL activity to ensure that the exercise meets its aims and objectives and facilitates a valuable learning experience. Core components of a PAL activity will include:
- An opportunity to brief the students in relation to the expectations of the activity
- Time for the students to complete the activity, including designated time for peer discussion and reflection
- Opportunity for a facilitated debrief with a supervisor and individualised feedback (see section 1.3.2 for further information)
Sections 2 – 10 of this resource pack include a series of briefing sheets for Practice Educators for a range of PAL activities. These briefing sheets have been designed to support you in planning PAL activities and include details of the aims and objectives of the activity and the resources required for the students to successfully complete the activity. It is envisaged that activities may need to be modified to suit individual learning environments and so this resource pack is meant to support practice educators to develop tailored PAL activities rather than be a definitive list of activities that can be used.
1.3.2.Facilitated debrief sessions
Debrief sessions can take two formats, debriefs following individual PAL activities and student led facilitated group discussions.
Debriefs following individual PAL activities
It is important that students have the opportunity to debrief from a PAL activity to consolidate learning and identify specific learning needs. Debrief sessions should be arranged as part of the planning of a PAL activity and should happen as near to the activity as possible. It may be helpful to prepare specific questions to direct the debrief session or you may want to ask the students to lead the direction of the session. It is particularly important that all students have the opportunity to participate in the debrief session. Students should be encouraged to be prepared to speak about the entire activity and not just the section they complete to promote a more holistic learning experience.
Student led facilitated group sessions
Student led facilitated group sessions also provide an important opportunity for students to meet and share their learning experiences. If you are only working with two students, it may be most appropriate to timetable these sessions at times when they are working more independently of each other to facilitate ongoing peer support and shared learning. In cases where there are only two students attached to one placement site other members (e.g. Band 5 Dietitians) could also be encouraged to attend these sessions and present a case they have seen in order to facilitate a greater breadth and depth of learning. Although student led, a facilitator (usually a member of the placement team) should also be present to support the students get the most out of these sessions.
Although the format of the sessions can vary, and should be directed by the students, it would be common for each student to prepare a case presentation of a patient that they have seen during the previous week. In the early stages of their training, students can present a case that they saw whilst shadowing a dietitian but as they progress they can report on cases in which they took a more active part in the consultation. Once a case has been presented the other members in the group are encouraged to ask questions, in early sessions the facilitator may need to lead the questioning but the students should actively participate and take on the leading of these group sessions. It may also be appropriate for students to present a reflection on a learning experience during the previous week. Student participation in these sessions can also be recorded by the facilitating dietitian using the proforma “observation of student in tutorials” (Appendix 1). This sheet can be used as a basis for giving the student feedback, or used by the student as evidence of meeting learning outcomes in the portfolio.
1.3.3.Feedback
Constructive feedback is crucial to student learning. When completing PAL activities, feedback is specifically important to ensure that each student is aware of their own progress and individual learning objectives. This helps to remove feelings of competition between paired students, and helps students to understand what they were expected to learn from a particular activity.
Peer feedback
Students on a PAL placement have the opportunity to learn from feedback given by their peer. The clinical observation form (Appendix 2) can be used by both practice educators and peers to provide structured feedback following a consultation. Peers may also find it helpful to use this form as a reminder of the skills they should be looking out for and of the things that it is useful to have feedback on. Peers may initially find it difficult to give constructive feedback, using the form provides a structured way of facilitating this. It is worth spending some time during the induction period to ensure that peers understand the importance of giving each other constructive feedback and feel comfortable doing this. If they are unable to give each other useful feedback then many of the learning opportunities will be lost. All of the students have also had opportunities to give each other feedback at University. Feedback should be given as near to the event that it refers to as possible as this is when it is most constructive and helpful.
Supervisor feedback
Although there are many benefits of peer feedback, supervisor feedback is vital to support skill development and the development of competence against the placement learning outcomes.
Individualised feedback
Individualised, supervisor feedback can be given as part of a debrief session but should also be based on episodes of direct observation of the students practice in a range of settings.
Students should be observed completing tasks at a minimum frequency of 2 – 3 times/week. There may be more periods of direct observation at the start of the placement but it is important that the level of observation does not drop as the placement progresses as feedback based on direct observation remains crucial throughout the placement to support the development of key skills.
Daily feedback & reflection
A half hour facilitated feedback session should also be timetabled into the programme at the end of every day, to encourage students to reflect on the days learning. This session can be done with both students as a pair. A record of this feedback can be kept in a student held log book to ensure that the content of this feedback and subsequent action plans are not forgotten about.
Weekly review meeting
A student led weekly review meeting should also be timetabled into each students programme. This session is designed to review the week’s progress and discuss objectives for the coming week. This session presents an opportunity to see students individually and can be used to hand over to a new supervisor if appropriate.
1.3.4.Using PAL activities as evidence towards assessment
Collaborative pieces of work can be used as pieces of formative assessment to facilitate feedback and action planning however they should not be used towards an individual student’s summative assessment. However, individual pieces of work that have been collated to form a larger project (e.g. a clinical audit or a health promotion project) can be used as evidence. Documentation of reflective discussion and the facilitator-completed review of a student’s contribution towards a feedback session can also be used as evidence to support summative assessment.
1.4.Frequently asked questions
1.4.1.Supporting students who are not getting on with each other
Students should behave in a professional manner just like everyone else in the department. We are not able to choose our work colleagues or members of the MDT, students should be reminded that they need to “get on” with everyone and form professional working relationships. It may be helpful to arrange a mediation process to allow each member of the pair to express their difficulties in a safe environment. Each student should have an equal time to speak and also a right to reply. It is also importantthat a practice educator is present to facilitate discussion between the students. Questions such as “What would you like to see happen?” “What would help you to work together?” and “Is there anything that you could do differently in future?” may be helpful. Often discussing issues openly rather than allowing things to fester can promote understanding between a pair and allow them to overcome their differences and work together more easily.
1.4.2.Supporting students who are progressing at different rates
It is important to ensure that each student has equal time with the dietitian available to them. Each student should have his or her own supervisor to ensure that weekly feedback and goal setting is done individually. It is also important to avoid any comparison of students’ performance. Build confidence by asking questions that you know the less confident student can answer. It is important to stretch both students, individual team members may be able to provide opportunities for students individually.
2.Induction
2.1.Expectations and Orientation
Aim: The aim of this activity is to ensure that students are aware of the basic arrangements for the functioning of the department and what is expected of them.
Objectives: By the end of this activity, students should be able to:
- Identify key staff members
- Obtain refreshment and locate the toilets,
- Understand their programme and what is expected of them.
- Find key locations in the base building(s)
Activity
Cover the following induction information with both students:
- Introduction to the department
- Who’s who, who sits where, hours of work, breaks, refreshments, toilets, fire exits
- Student programme
- Expectations –give students half an hour in their peer pair to come up with their expectations of placement.
Discuss with Practice Educator and talk through department’s expectations of the student. Both sign expectations agreement
- Arrange security passes, computer log-ins etc.
- Orientation activity – give the students a questionnaire that they can only find the answers to by visiting key locations in the Trust/ Building/ Area – send them to complete this together then debrief afterwards. Were there any surprises? Any places they couldn’t find?
2.2.Policies and procedures
Aim: To familiarise students with the key policies and procedures that are relevant to dietetic practice within the organisation where their placement is taking place.
Objectives: By the end of this activity, the students will be able to:
- Identify key policies that are relevant to dietitians working in your area
- Give a summary of the key points which affect dietitians.
- Describe how those points influence the day-to-day practice of dietitians.
Activity
Give the students access to the policies and procedures that affect dietitians working in your area.
The students need to divide the policies between them and read the ones that they have been allocated, taking notes of key points that are relevant to dietitians as they do so.
Each student will then present a summary of the key points of the policies they have covered, and how they affect the day-to-day work of a dietitian, to their partner and supervisor
2.3.Role of the Dietitian/ Dietetic Assistant
Aim: To introduce the students to the different roles of the dietetic assistant and dietitian and to the differences in their communication styles.
Objectives: By the end of this activity the students should be able to:
- Identify 3 key differences between the role of the dietitian and that of the dietetic assistant.
- Identify 3 similarities or areas of overlap between the 2 roles
- Identify 3 differences in the communication styles used.
Activity
Both students should observe the Dietitian/Dietetic Assistant undertaking a consultation and take notes on it, using the clinical observation checklist. The students should compare notes on the different aspects they observed and discuss any queries with the Dietitian/ Dietetic Assistant. As well as thinking about the different styles they have observed, the students should think about the differences between the two in terms of their professional roles and boundaries.