Peer Mentoring in Clinical Education Clinical training methods have been discussed among disciplines with a variety of methods having been used with some success. However, there is limited empirical evidence to support particular methods over others. The purpose of this research was to initiate a pilot study that provided empirical evidence for clinical shadowing as ... Article
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Article  |   June 01, 2014
Peer Mentoring in Clinical Education
Author Affiliations & Notes
  • Ellen Ehrgott
    Department of Communication Sciences and Disorders, Western Illinois University, Macomb, IL
  • Amanda Silberer
    Department of Communication Sciences and Disorders, Western Illinois University, Macomb, IL
  • Financial Disclosure: Ellen Ehrgott is an Assistant Professor at Western Illinois University. Amanda Silberer is an Assistant Professor at Western Illinois University.
    Financial Disclosure: Ellen Ehrgott is an Assistant Professor at Western Illinois University. Amanda Silberer is an Assistant Professor at Western Illinois University.×
  • Nonfinancial Disclosure: Ellen Ehrgott has no nonfinancial interests related to the content of this article. Amanda Silberer has no nonfinancial interests related to the content of this article.
    Nonfinancial Disclosure: Ellen Ehrgott has no nonfinancial interests related to the content of this article. Amanda Silberer has no nonfinancial interests related to the content of this article.×
Article Information
Professional Issues & Training / Articles
Article   |   June 01, 2014
Peer Mentoring in Clinical Education
SIG 11 Perspectives on Administration and Supervision, June 2014, Vol. 24, 32-40. doi:10.1044/aas24.1.32
SIG 11 Perspectives on Administration and Supervision, June 2014, Vol. 24, 32-40. doi:10.1044/aas24.1.32

Clinical training methods have been discussed among disciplines with a variety of methods having been used with some success. However, there is limited empirical evidence to support particular methods over others. The purpose of this research was to initiate a pilot study that provided empirical evidence for clinical shadowing as a proposed clinical training method. The clinical shadowing included focused clinical observations and supported clinical experiences in a series of sessions led by graduate student clinicians. Empirical data was collected from undergraduate students to identify the perceived level of preparedness as a measure of effectiveness of a “shadowing experience” prior to entering their first semester of independent clinical experience in an effort to document increased effectiveness during clinical training.

Williams (1995)  described the goal of clinical education in speech-language pathology as the development of professionals who are independent, effective, and self-supervising. For years, clinical educators have searched for effective methods to facilitate the achievement of these goals by student clinicians. Although there are various methods of providing the necessary education and training to ensure the development of confidence and independence in student clinicians, an early method recommended by Edgar Dale (1954)  remains useful today. He determined that learning is 90% effective when the learner teaches the information or uses the information in an immediate situation. When students are given the opportunity to teach skills and concepts or to use information they have learned recently, they develop a better grasp of the concepts. More recently, an evaluation of training methods in clinical psychology found that students had the best experiences when they were allowed hands-on experiences and were engaged in “learning by doing” (Nel, Pezzolesi, & Scott, 2012).
A review of clinical training models for students from a variety of settings revealed similarities across disciplines, including speech-language pathology, occupational therapy, physical therapy, nursing, medical fields, and education (Boreen & Niday, 2000; Cookson, 2007; Li, Wang, Lin, & Lee, 2011; Milner & Bossers, 2004; Nel et al., 2012; Wainwright, Shepard, Harman, & Stephens, 2010). Beginning with their first clinical experience and continuing through internship, supervised clinical practicum experiences are crucial components of education and training of healthcare providers.
Students in speech-language pathology have reported a sense of being overwhelmed by the details in conducting independent therapy. Many have difficulty transferring the classroom knowledge to the clinical setting. Phillips (2009)  hypothesized that reducing the unknown of the clinical experience reduces stress and allows for a more successful experience. To reduce this stress, other clinical education experiences can be offered prior to client contact. At an early educational level, clinical education can take place through other modes of learning such as simulations, case-based learning, role playing, or micro-skill teaching (McAllister, 2005).
In addition to teaching specific clinical skills, clinical educators should provide assurance and stability that will ultimately lead to confidence and independence. This is particularly important with new student clinicians (Williams, 1995). Additional research found that when the student clinician is participating in a co-treatment environment, the learning can be more productive without the burden of complete responsibility on the part of the novice clinician (McAllister, 2005). Therefore the level of independence may play a role in the degree of success for the student clinician.
Additional studies examined similar premises. Tolsgaard, Bjorck, Rasmussen, Gustafsson, and Ringsted (2012)  examined the effects of dyad training. Dyad training was defined in their investigation as the pairing of two equally trained students in clinical practicum, specifically, medical students in pre-clerkship training. Results revealed that the practicum students created partnerships due to shared experiences and collaborative learning style that increased the students' confidence and provided security in a new learning environment. Therefore, across disciplines, in an effort to maximize students' learning, programs often pair clinicians in early clinical experience.
In an attempt to replicate this type of learning opportunity for students in the Department of Communication Sciences and Disorders (CSD) at Western Illinois University (WIU), a modified version of the dyad training discussed in Tolsgaard et al. (2012)  was implemented. The purpose of this study was to investigate the effectiveness of pairing undergraduate students with graduate students with prior clinical experience. It was hypothesized that an undergraduate student, paired with a graduate student clinician with previous clinical experience, would perceive a higher level of preparedness compared to the undergraduate student who observed but did not participate in therapy with a graduate student. Positive results would support the use of dyad training in clinical education programs. It was predicted that the higher level of preparedness would correlate to the reduced anxiety of first time clinicians in the speech-language pathology program in order to allow student clinicians to be effective in their roles as student clinicians. The Tolsgaard et al. (2012)  study was modified in this study by pairing students who were not equally trained. A graduate student who had at least three semesters of supervised clinical practicum was paired with an undergraduate clinical student with no previous experience, other than clinical observations. This mentorship was expected to include goal writing, selection of clinical procedures, treatment planning, creation of materials and activities, and advice for interacting with clinical educators.
Methods
Using a modified dyad model in a quantitative pilot study, a clinical survey (Appendix A) was presented to undergraduate students who (a) received mentorship from a graduate student with previous clinical experience or (b) did not receive mentorship, but instead observed clinic sessions with no active role. Students rated their level of preparedness following the paired therapy experience or the observation experience before and, then again, after their first semester of independent clinical experience. The survey included four yes/no questions which were used to determine the participants' levels of experience in service roles. An additional 13 items required the student to rank comfort level of preparedness and of knowledge on a 5-point Likert scale (i.e., ranging from very comfortable to uncomfortable). The topics included items such as knowledge of speech and language disorders, paperwork requirements, administration of standardized tests, goal development, and knowledge of procedures for clinic scheduling. A separate supervisor survey, (Appendix B), was presented to clinical educators to corroborate the similarities among the student participants. Clinical educators, with at least ten years of experience supervising students, rated the presence of characteristics used to describe successful student clinicians using a 5-point Likert scale (ranging from a high degree to a low degree for the presence of that characteristic).
Participants
Students who participated in the study were undergraduates in CSD at WIU. Students were required to be enrolled in their third year of CSD coursework, have initiated clinic observations, and have a minimum grade point average of 3.0 on a 4.0 scale. Also, these students were scheduled to enroll in clinic the following fall semester to begin their first independent clinical experience. Nine students volunteered to participate and were randomly assigned to the experimental group or the control group.
The experimental group included five undergraduate students who were paired with a graduate student clinician with previous experience. These participants observed five, 50 minute, on-campus therapy sessions and actively participated in five, 50 minute therapy sessions. These ten sessions occurred with the same, paired graduate clinician. The control group included four students who observed ten, 50 minute, on campus therapy sessions; however, the students in the control group were not paired with a graduate student and chose any ten random therapy sessions. The experimental and control groups both completed their observations in the same semester.
Procedure
The clinical educators at WIU were informed of the study details, the names of the participants, and, if applicable, their pairing. Graduate students were also informed of the study and encouraged to facilitate in the participants' learning experiences. The graduate clinicians in the paired experience continued to earn clinical hours because of their leadership role in all of the activities in spite of the participants' assistance with the collection of data, presentation of therapy materials, and the guidance of a minimum of one therapy activity. Participants in both the experimental and control groups were encouraged to ask graduate clinicians questions and clarification throughout the ten sessions. All participants had access to clients' background information and history of therapy.
Following the completion of the ten sessions, participants completed two identical surveys. Survey 1 (Appendix A) was completed within five days of completing the paired or observation-only experience. Survey 2 (Appendix A) was completed following the students' initial semester of independent clinical experience the subsequent semester. Similar to the format through which Phillips (2009)  determined effective clinical supervision approaches, the surveys used in this study were intended to identify the perceived level of preparedness of the clinicians prior to and after their initial clinical experiences. Participants were instructed to answer four questions regarding their service experiences with yes/no answers. They were then instructed to rate their comfort in therapy knowledge and clinical preparedness on a 5-point Likert scale from not comfortable (1) to very comfortable (5). Clinical educators who supervised the participants' first clinical experience also completed Survey 3 (Appendix B). The survey measured the presence of positive characteristics seen in successful student clinicians. Twenty-four characteristics such as flexibility, ability to follow procedures, respectfulness, and ability to problem solve were rated on a 5-point Likert scale ranging from high degree (5) to low degree (1). This survey was presented to compare similarities of the participants' personal characteristics.
Results
Nine participants completed Survey 1 and Survey 2. Five participants were paired with a graduate student clinician and labeled as the experimental group and four did standard observations in the university clinic and were labeled as the control group. The surveys provided the empirical data for the research.
The first four questions of the survey revealed no statistical difference between the experimental and control groups in relation to the amount of support received from a graduate student or with interpersonal skills through a class, therapy training, or service occupation. The remaining individual raw data from the 13 items scored using the 5-point Likert scale was analyzed and is available in Table 1. The scale was used to measure the degree of preparedness for the clinical experience as perceived by the clinicians themselves, for a possible total of 65 points. Activities such as goal development, administration of standardized tests, and knowledge of the confidentiality policy were items on the survey. The data from the surveys were totaled for both groups for Survey 1 and Survey 2 independently. Basic statistical analysis was performed with a series of t-tests to compare the group means between Survey 1, Survey 2 and the overall totals. Within group mean differences were also compared for each of the two surveys.
Table 1 Raw Data for Experimental and Control Groups on Survey 1, Survey 2, Group Gotals and Means.
Raw Data for Experimental and Control Groups on Survey 1, Survey 2, Group Gotals and Means.×
Experimental group Survey 1 Score (possible 65 points) Survey 2 Score (possible 65 points)
Participant 1 41 56
Participant 2 44 59
Participant 3 40 47
Participant 4 39 62
Participant 5 40 47
204 (mean=40.8) 271 (mean=54.2)
Control group
Participant 6 33 56
Participant 7 50 54
Participant 8 47 49
Participant 9 56 54
186 (mean=46.5) 213 (mean=53.25)
Table 1 Raw Data for Experimental and Control Groups on Survey 1, Survey 2, Group Gotals and Means.
Raw Data for Experimental and Control Groups on Survey 1, Survey 2, Group Gotals and Means.×
Experimental group Survey 1 Score (possible 65 points) Survey 2 Score (possible 65 points)
Participant 1 41 56
Participant 2 44 59
Participant 3 40 47
Participant 4 39 62
Participant 5 40 47
204 (mean=40.8) 271 (mean=54.2)
Control group
Participant 6 33 56
Participant 7 50 54
Participant 8 47 49
Participant 9 56 54
186 (mean=46.5) 213 (mean=53.25)
×
It was determined that there was no significant difference between mean scores on Survey 1 when comparing the experimental group and the control group (p=0.235). As revealed in Survey 2, there was also no significant difference between groups following the first semester of independent clinical experience (p=0.5607). Results of the t-test, however, showed a significant difference (p=0.0014) within the experimental group between scores on Survey 1 and Survey 2. The control group had no significant difference in their perception of preparedness following both the observations and their initial clinical experience (p=0.2336).
Following the participants' first clinical experience, the clinical educators of the students in both the experimental and control groups completed Survey 3. The survey asked 24 questions specific to characteristics such as maturity, organization, creativity, and good communication skills that are thought to be positive for becoming a successful student clinician. Results of the survey are available in Table 2. Students could receive a maximum score of 120 points. The group mean scores of the experimental group (mean=96.8) and control group (mean=92.75) were compared statistically using a standard t-test. Results of a t-test revealed no significant difference in personal characteristics displayed between groups (p=0.5441) as perceived by the clinical educators.
Table 2 Raw data and means of supervisor survey of student clinicians after first semester of clinic.
Raw data and means of supervisor survey of student clinicians after first semester of clinic.×
Experimental Group Survey 3-Clinical Educator Description of Personal Characteristics
1 88
2 116
3 93
4 93
5 94
Mean=96.8
Control Group
6 93
7 84
8 101
9 93
Mean=92.75
Table 2 Raw data and means of supervisor survey of student clinicians after first semester of clinic.
Raw data and means of supervisor survey of student clinicians after first semester of clinic.×
Experimental Group Survey 3-Clinical Educator Description of Personal Characteristics
1 88
2 116
3 93
4 93
5 94
Mean=96.8
Control Group
6 93
7 84
8 101
9 93
Mean=92.75
×
Discussion
The primary purpose of this pilot study was to determine if there was evidence to support pairing undergraduate students with graduate students prior to beginning clinic. Evidence of a significant increase in the students' perception of their knowledge and preparedness for their initial clinical assignment based on this experience would then warrant a discussion regarding the changing of clinical policy in the training of student clinicians at WIU. The paired clinical experience would allow the students to have a supported initial clinical experience with a graduate student to provide information on clinic procedures and standard therapeutic practices. Additionally, if the results of this study indicated an increased level of preparedness, a larger study with controlled conditions that were not considered in this pilot study would be merited.
It was hypothesized that compared to the participants who did observations, the students in the paired experience would show an increase in their perception of preparedness after they participated in clinic with a graduate student with previous clinical experiences. Although the results did show an increase in the perceived level of preparedness of the experimental group, the increase occurred only following the independent clinical experience. The increase was not evident following the paired clinical experience. This is a possible indication that the whole experience collectively increased the students' level of preparedness and the results are not isolated to the paired student experience.
However, despite limited statistical support for paired clinical training, other factors were observed that supported the use of this model for clinical training. First, in unsolicited comments, the participants reported increased confidence and knowledge of clinical procedures. For example, the participants commented that they learned the reporting procedures used in the university clinic, the purpose of the documentation, the materials that were available, and even where the file room was located with client files. Second, a number of undergraduates requested to participate in this experience. Students often welcome opportunities to engage in clinical experiences. The inexperienced students saw the paired clinical training as a supported method of developing clinical skills through peer training without sole responsibility of client interaction. Third, the graduate students with whom the participants of the experimental group were paired commented that they increased their knowledge base for clinical procedures and the rationale for therapy methods after having to explain them to the undergraduate research participant.
Finally, the clinical educators reported that the participants in the experimental group had fewer general knowledge questions and fewer procedural errors when completing the required clinical procedures during their initial clinical experience. This may have occurred because the student clinicians were able to use the graduate student mentors as a resource for additional support. In fact, the participants were observed asking questions and making comments about their experiences following the sessions. These anecdotal comments of the participants support research by McAllister (2005)  who found that peer learning reduced contact time and dependence with clinical educators.
Limitations
There are a number of limitations in this study that affect the findings. First, there were a limited number of participants in the study for which it made it difficult to apply statistical analysis. Secondly, the results demonstrated the difference in the level of preparedness between the two groups prior to and following the independent experience, but did not measure the level of preparedness of either group prior to the observation and clinical experience paired with a graduate student, or observations alone. One way of isolating this result would have been to include a survey prior to the observation experience that would have provided information before the ten sessions had occurred. This would allow between group and within group comparisons of pre-experiment, following paired experience, and following their independent clinical experience. Third, the fact that the unsolicited comments indicated higher levels of preparedness by participants in the paired experience may indicate a lack of sensitivity in the survey to identify the perceptions of the participants. Fourth, the difference in results of the two surveys may reflect the anticipated different point of reference when answering questions following a semester of clinical experience. This was evidenced by one participant's survey responses that decreased by two points between Survey 1 and Survey 2. The participants evolving point of view likely changed the degree of emphasis on the fine points of their clinical interactions. Many of the details for which they focused early in the clinical experience had become routine and did not occupy their attention.
Implications
The question of whether or not using such a model to teach clinical skills with undergraduate and, ultimately, graduate students remains an important one. The results of this study indicate that there is a difference between the students who are mentored by graduate students with prior clinical experience compared to students who do not receive that mentorship. To that end, it would be beneficial to replicate this study on a larger scale with stricter inclusion and exclusion criteria as well as to include baseline testing and analysis using a repeated measures analysis of variance.
Conclusion
When considering the results from this pilot study that support earlier studies regarding clinical training, including the self-perception of the students paired with the graduate students, and the reports of the clinical educators, it is recommend that providing paired clinical training as a model in clinical education is a beneficial method. In addition, encouraging interpersonal communication skills between clinicians and their clients is important to develop in early clinical education. This skill will be valuable throughout the clinicians' entire careers.
References
Boreen, J., & Niday, D. (2000). Breaking through isolation: Mentoring beginning teachers. Adolescent and Adult Literacy, 44(2), 152–164.
Boreen, J., & Niday, D. (2000). Breaking through isolation: Mentoring beginning teachers. Adolescent and Adult Literacy, 44(2), 152–164.×
Cookson, P.Jr. (2007). Supporting new teachers. Teaching PreK-8, 37(5), 14–16.
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Dale, E. (1954). Audio-visual methods in teaching. New York, NY: Dryden Press.
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McAllister, L. (2005). Issues and innovations in clinical education. Advances in Speech-Language Pathology, 7(3), 138–148. [Article]
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Milner, T., & Bossers, A. (2004). Evaluation of the mentor-mentee relationship in an occupational therapy mentorship programme. Occupational Therapy International, 11(2), 96–111. [Article] [PubMed]×
Nel, P., Pezzolesi, C., & Scott, D. (2012). How did we learn best? A retrospective survey of Clinical psychology training in the United Kingdom. Journal of Clinical Psychology, 68(9), 1058–1073. [Article] [PubMed]
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Phillips, D. (2009). Supervisory practice in speech-language pathology: Pre-practicum assessments of student clinicians in graduate training programs. Perspectives on Administration and Supervision, 19(3), 107–113. [Article]
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Appendix A
Clinical Survey
Appendix B
Supervisor Survey
Table 1 Raw Data for Experimental and Control Groups on Survey 1, Survey 2, Group Gotals and Means.
Raw Data for Experimental and Control Groups on Survey 1, Survey 2, Group Gotals and Means.×
Experimental group Survey 1 Score (possible 65 points) Survey 2 Score (possible 65 points)
Participant 1 41 56
Participant 2 44 59
Participant 3 40 47
Participant 4 39 62
Participant 5 40 47
204 (mean=40.8) 271 (mean=54.2)
Control group
Participant 6 33 56
Participant 7 50 54
Participant 8 47 49
Participant 9 56 54
186 (mean=46.5) 213 (mean=53.25)
Table 1 Raw Data for Experimental and Control Groups on Survey 1, Survey 2, Group Gotals and Means.
Raw Data for Experimental and Control Groups on Survey 1, Survey 2, Group Gotals and Means.×
Experimental group Survey 1 Score (possible 65 points) Survey 2 Score (possible 65 points)
Participant 1 41 56
Participant 2 44 59
Participant 3 40 47
Participant 4 39 62
Participant 5 40 47
204 (mean=40.8) 271 (mean=54.2)
Control group
Participant 6 33 56
Participant 7 50 54
Participant 8 47 49
Participant 9 56 54
186 (mean=46.5) 213 (mean=53.25)
×
Table 2 Raw data and means of supervisor survey of student clinicians after first semester of clinic.
Raw data and means of supervisor survey of student clinicians after first semester of clinic.×
Experimental Group Survey 3-Clinical Educator Description of Personal Characteristics
1 88
2 116
3 93
4 93
5 94
Mean=96.8
Control Group
6 93
7 84
8 101
9 93
Mean=92.75
Table 2 Raw data and means of supervisor survey of student clinicians after first semester of clinic.
Raw data and means of supervisor survey of student clinicians after first semester of clinic.×
Experimental Group Survey 3-Clinical Educator Description of Personal Characteristics
1 88
2 116
3 93
4 93
5 94
Mean=96.8
Control Group
6 93
7 84
8 101
9 93
Mean=92.75
×
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