Commentary on Secomb J (2008) A systematic review of peer teaching and learning in clinical education. Journal of Clinical Nursing17, 703–716

Abstract

Peer teaching and learning are becoming increasingly important within nurse education, this is evidenced by the global nature of studies: hence this timely review of the literature. Secomb (2007) is correct in her assertion that peer teaching and learning lacks definition in its implementation; but the practice in terms of incidental or informal learning is much more common than the review might suggest. Peer learning is often viewed as taking place informally, particularly in clinical practice and this is not without its difficulties. Respondents are unaccustomed to talking about their learning and may find it difficult to respond to a request to do so. If they do, they are more likely to refer to formal learning than informal learning because informal learning is perceived as part of their work and is therefore valued less (Eraut 2000). Eraut (2000) suggests that informal learning is often treated as a residual category to describe any kind of learning which does not take place within or follow from, a formally organised learning programme or event. However, he argues that this definition belies the importance of informal learning. The search terms used to conduct the review (peer, clinical education and undergraduate) are narrow in emphasis and reinforce the notion that peer learning and teaching lacks definition. As a result the studies unearthed for review may lead the reader into thinking that peer learning is intentional and formalised, whereas in reality, there may be no conscious awareness of peer learning. Opening up the search terms to include vicarious learning for example, leads to other studies from within Higher Education more generally which may be entirely applicable to professional education. Other terms which perhaps could have been considered to answer the question include story-telling and experiential learning. Eraut (1994) and Schon (1987) suggest that professional practitioners have a specific and unique way of learning. Eraut postulates that professionals learn on the job by deliberating on specific events, termed case-specific learning. However, he acknowledges that cases have to be viewed as special rather than routine and time must be set aside to deliberate their significance for learning to take place (Eraut 1994). Students can learn from each other using methods such as story-telling, (Bowles 1995) using fictional literature, (Fox 2003) listening to discussions between experts and students, (Cox et al. 1999) and sharing experiences (Diekelmann 1990, 1993, Nehls 1995). Story-telling is suggested to allow the students to construct and rehearse their thinking and provided opportunities for students to learn from each other. Spouse (2003) suggests that sharing experiences in this way is important for students because the stories carry a reality which is engaging for students. Students engaged in their story at any point by clarifying and enlarging various aspects or rehearsing parts that were especially pertinent. Students in the study used the story-telling and sharing of experiences to develop concepts of themselves in different roles according to who they were talking to. The story teller develops new insights to the situation based on the suggestions and sense-making activities of her friends. The group then benefits by developing a collective understanding. Indeed, those of the group who have not participated in the same nursing activity can gain what Spouse refers to as a ‘vicarious learning experience’ which helps them formulate suitable actions when they have to face similar situations. Therefore, raw or first hand experience may not be the only mechanisms by which students can engage in experiential learning. Secomb seeks to identify whether peer teaching and learning is an effective educational intervention in clinical learning and identifies a variety of educational measurements to analyse the literature. However, some of the terms chosen are also problematic and not straightforward. For example, within the psychomotor domain evidence was sought in relation to the competence and development of clinical skills (either self-reported or reflected in clinical performance scores); and clinician satisfaction. However, it is known that students are not necessarily well-placed to self assess their competency and furthermore, clinician assessment may be flawed (Duffy 2004). Similarly client confidence may not be an accurate marker to student competency as niceness may override competence or patients may take technical competence for granted (Calman 2006). Secombs’ work provides a useful overview of formal peer learning and teaching within clinical education. However, it should be remembered that there may be informal elements associated with peer learning and teaching which are nonetheless important and valuable within professional learning.