A grounded theory study on interinstitutional near-peer mentorship in a simulation- based physical therapy education experience

Technical Summary: Interinstitutional Near-Peer Mentorship in Simulation-Based Physical Therapy Education

Problem Statement
Simulation-based education (SBE) is a standard instructional method in physical therapy (PT) education, particularly for acute care settings, used to enhance clinical reasoning, confidence, and readiness. While near-peer learning (NPL)—where students at different training levels learn collaboratively—has shown benefits in healthcare education, existing literature lacks investigation into interinstitutional NPL models. Specifically, there is a gap in understanding how students from different institutions and different stages of training (e.g., first-year vs. second-year Doctor of Physical Therapy students) interact when they are explicitly learning congruently within a shared SBE environment. Traditional interprofessional education (IPE) faces implementation barriers such as coordination across disciplines and variable student capacity; this study sought to explore if an interinstitutional, same-discipline NPL model could offer a scalable alternative to enhance simulation fidelity and collaborative learning without the logistical complexities of cross-disciplinary coordination.

Methodology
The study employed an inductively oriented constructivist grounded theory approach to analyze student experiences.

• Participants: 98 graduate-level PT students from two distinct institutions in Arizona: 41 first-year (PT1) and 57 second-year (PT2) students.
• Intervention: A one-day, high-fidelity acute care simulation involving a patient with a pneumothorax and rib fractures following a motor vehicle accident. Teams of four to five were formed, consisting of two PT1s and two to three PT2s.
• Procedure: The experience followed four phases: planning, prebrief, simulation, and debrief. PT2s were tasked with preparing communication strategies to mentor PT1s, while all students received identical case data (history, labs, orders) one week prior.
• Data Collection: Primary data consisted of written guided reflections from all participants (7 questions focusing on peer interaction, teamwork, and clinical application). This was triangulated with faculty field notes and analytic memos.
• Analysis: Data were de-identified and analyzed using constant comparative methods in NVivo software. The process involved iterative coding to develop initial and focused codes, leading to the construction of themes and a theoretical model. Trustworthiness was established through researcher reflexivity, data triangulation, and rich description.

Key Contributions and Results
The analysis yielded three primary themes and a theoretical model illustrating the impact of the interinstitutional near-peer mentorship model:

1. Heightened Expectations:

   • PT1s expressed anxiety regarding their relative inexperience compared to PT2s but also excitement about benchmarking their future progress.
   • PT2s felt a heightened sense of responsibility to lead and represent their institution, leading to significantly increased preparation. Unlike previous simulations with their own cohorts where complacency had set in, the novelty of working with unfamiliar peers motivated PT2s to review materials more thoroughly to avoid appearing unprepared.
   • Result: The interinstitutional dynamic served as a strong motivator for preparation that was not explicitly instructed by faculty.

2. Enhanced Engagement:

   • Working with unfamiliar peers forced students to move beyond established group habits and implicit communication patterns.
   • Bidirectional Learning: Contrary to the assumption that PT2s would solely teach PT1s, the model facilitated reciprocal learning. PT1s introduced specific techniques or concepts (e.g., specific special tests) not yet covered in the PT2s' curriculum, while PT2s provided mentorship on communication and clinical reasoning.
   • Communication: The need to explain concepts to peers with different curricular backgrounds improved the clarity and effectiveness of communication, mirroring real-world clinical interactions.

3. Deeper Application:

   • The experience simulated the reality of clinical practice where therapists must quickly adapt to working with unfamiliar colleagues from different backgrounds.
   • Students reported increased confidence in seeking assistance and networking, viewing the experience as preparation for PRN (per diem) work or rotating through different facilities.
   • The model fostered "cognitive congruence" (learners relating to peer teachers due to recent similar experiences) and "social congruence," reducing hierarchical barriers and creating a psychologically safe environment for error and growth.

Significance and Claims
The paper claims that an interinstitutional near-peer mentorship model amplifies the educational impact of SBE by:

• Increasing Readiness: The novelty of working with unfamiliar peers from a different academic year and institution drives higher levels of self-directed preparation.
• Enhancing Authenticity: The model mirrors real-world clinical teamwork where professionals must collaborate with colleagues they do not know well, thereby improving communication and adaptability.
• Offering a Scalable Alternative: This approach may provide a resource-efficient alternative to traditional Interprofessional Education (IPE). It achieves similar benefits in teamwork and communication skills by varying the didactic timepoints and institutions of the same discipline, rather than requiring complex coordination across different healthcare disciplines.
• Resource Sharing: The study demonstrates that interinstitutional collaboration can allow programs to share simulation centers, faculty, and equipment, potentially mitigating resource limitations for individual programs.

The authors conclude that while the model requires geographic proximity and schedule alignment, it effectively promotes confidence, clinical reasoning, and collaborative skills, offering a viable strategy for enhancing simulation fidelity and student engagement in physical therapy education.