Preceptor teaches resident, resident teaches student, student teaches their peers. Can this way of learning really be beneficial? But residents were just students themselves mere months ago. Isn’t this complicated? Why wouldn’t learners just learn from their preceptor? All of these questions come to mind when one thinks about layered learning. From an outside view one might think how does this make any sense. Let’s start at the beginning and work our way through. It may be a surprise to some but this way of learning has outstanding benefits! It not only works for students but for all levels of learning from a PGY3 medical resident to fellows.
What even is layered learning? According to Loy et al, layered learning is a teaching strategy that involves training residents to precept students with a senior clinical pharmacist overseeing the process.1 It is a common learning model used in residency programs and is supported by ASHP.3 Two surveys of PGY1 programs within the Veterans Health Administration found that 85% to 90% offered precepting opportunities in general. More specifically, the PGY2 residency programs offered opportunity to precept PGY1 residents at 59.3% of programs and the opportunity to precept students at 74.1% of programs.1 Each person has a specific role that is clearly defined so that the process runs smoothly. This model seems to be most beneficial to the resident. Not only are they learning clinical information, they are also having the added benefit of learning how to precept and teach at the same time. As residents ourselves, our environment is surrounded with teaching opportunities no matter if assigned or incidental. These teaching and precepting roles are a huge part of pharmacy practice. Being able to refine them early on will lead to more benefit for the pharmacy resident as well as any students or future residents that they may encounter and teach as well. There are many strategies for a successful layered learning model.
When people think of their favorite teachers, there are many attributes or teaching strategies that people will bring up. Many would probably say their favorite teacher was encouraging, relatable, or accessible for help. These teachers must be basing their skills off of some type of experience or strategy that they learned in school or through practice. The layered learning model is no different for the healthcare field. There are specific strategies that have been shown to create a beneficial environment for all parties involved. The steps include orientation to layered learning, pre-experience planning, implementation, and post-experience evaluation.4 Orientation, according to ASHP, is crucial to the success of the experience for both the preceptor and learner.4 It sets expectation and gives all parties an idea of the daily workflow and patient care responsibilities. Without these expectations, the resident and student may not be living up to the ideas that the preceptor has.
Pre-experience planning should be done in terms of a rotation syllabus and projects for the student and resident.4 It allows for effective time management for all parties. Most importantly in this step is the baseline assessment. It gives the preceptor an idea of where their resident’s knowledge is and it allows the resident to see where the student’s knowledge is so that all deficits can be worked on and the most is made of the rotation. Post-experience evaluation is needed to sum up the whole process.4 It allows for feedback so that all those involved can better themselves for either their next rotation or their next precepting experience.
This is all well and good but what have been the real, proven benefits of layered learning? Some may still be skeptical especially because these residents were students not long ago. Residents are there to learn so how can they be learning clinical information as well as precepting skills at the same time. The Durham Veterans Affairs Medical Center implemented the layered learning model into their practice. The study found that from the perspective of the clinical pharmacist overseeing the model, they can increase the amount of students they take which is ever growing in the current times.1 For the resident, it allows for increased leadership skills and more practice in teaching which is greatly involved with the role of a pharmacist.1 Lastly, for the student, it allows them more exposure to different levels of practice.1 They may feel intimidated by a clinical pharmacist but with a resident they might be able to learn more and be more willing to answer a question even if they don’t know for sure. It also increases networking responsibilities by meeting more people in the field of pharmacy and increasing their opportunities to better themselves such as through research.
There is no direct data related to peers teaching peers but according to an article by Mercer and Wegerif, the idea of exploratory talk can stimulate the learning environment. This idea to me seems like it could be easily incorporated into a layered learning environment. In this communicative process, it allows the students to talk through a learning point leading to ideas of how to better understand a topic.2 Prescott DC et al., conducted a survey that echoes these benefits. The survey found that the benefits of layered learning included an increase in patient access to pharmacy team (42.3%), increase in the number of precepting opportunities for learnings (34.9%), and improved patient education (33.2%).3 There is no direct data on if this model enhances patient outcomes but anecdotally, one could think with multiple people looking at the same patient and increased time, it could possibly lead to better patient outcomes. In conclusion, layered learning involves multiple people in different roles all coming together for one common goal: to learn the most they can.
Although this blog focuses mainly on residents, layered learning could be beneficial in many different environments such as doctor helping another doctor in an area they are unsure in. The majority of data is in residents and teaching hospitals, however, research in other fields would be interesting. Incorporating layered learning into everyday life can help out each of us as we continue on through our residency year so why couldn’t it help in another environment? Whether that learning is clinical or how to teach or precept, every party involved is benefitting and refining their skills. No matter if you are a pharmacy resident or medical attending, layered learning is involved in all aspect of the healthcare field.
References:
1) Loy BM, Yang S, Moss JM, Kemp DW, and Brown JN. Application of the layered Learning Practice Model in an Academic Medical Center. Hospital Pharmacy 2017;52:266-272
2) Mercer, N., & Wegerif, R. Is “exploratory talk” productive talk? In K. Littleton & P. Light (Eds.), Learning with Computers: Analyzing productive interaction. 1999:79-101
3) Prescott DC, Coffey CP, and Barnes KD. Innovative learning in pharmacy practice: The Perceived benefits of and barriers to a layered learning practice model. Journal of the American Pharmacists Association 2020: 1-5.
4) New Practitioners Forum Resident Advancement Advisory Group. Residency Guide: Recommendations for Practice and Engagement in a Layered Learning Model as a Resident. ASHP New Practitioners Forum. 2019
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