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| PERSPECTIVE |
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| Year : 2022 | Volume
: 5
| Issue : 3 | Page : 130-134 |
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The value of vicarious experiences in health professions education
Roma Forbes
School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Australia
| Date of Submission | 30-Jun-2022 |
| Date of Acceptance | 09-Aug-2022 |
| Date of Web Publication | 26-Sep-2022 |
Correspondence Address:
Dr. Roma Forbes
School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane
Australia
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/EHP.EHP_15_22
Vicarious experiences are an educational approach that, when used effectively, can harness the benefits of learning with and from others. As a major source of self-efficacy, vicarious experiences can be used in myriad ways to enhance learning. With key design strategies including careful selection of people and tasks to observe, prompting, discourse, and collaboration, this faculty development paper outlines how health professions educators can capture the benefits of vicarious experiences in, and out of, the traditional classroom setting. Keywords: Online learning, self-efficacy, vicarious experiences
How to cite this article:
Forbes R. The value of vicarious experiences in health professions education. Educ Health Prof 2022;5:130-4 |
| Introduction | |  |
Vicarious experiences, through the observation of others, offer accessible and flexible approaches to enhancing self-efficacy of health professions students. Although providing vicarious experiences through synchronous or asynchronous approaches may seem simple, health professions educators must be intentional and strategic in their design to enhance students self-efficacy and learning in safe and effective ways. This faculty development paper outlines the concept of self-efficacy and the benefits of vicarious experiences. The paper then provides key design strategies for health professions educators to effectively embed vicarious experiences into their own teaching including strategic selection of who and what to observe, utilizing dialog, and facilitating collaboration between students. The paper ends with a practical example of a vicarious experience design that utilizes these key strategies.
Self-efficacy
Self-efficacy was first introduced by Bandura as an individual’s perception of their ability to successfully perform a specific action or task.[1],[2] Since this time, the construct of self-efficacy has been explored widely where it is now considered a significant determinant of whether an individual will decide to perform an action or task and the amount of effort they will sustain over time.[3] In health professions education, self-efficacy has been identified as a major factor influencing prerequisites to learning including motivation and goal attainment. Students with higher self-efficacy are more open to engaging in challenging tasks, continuing efforts in the presence of barriers, and better able to manage their behavioral and emotional responses.[2],[4]
Bandura et al.[2] outline three major behavioral outcomes of self-efficacy. The first outcome relates to how active an individual will be in their approach to learning. Individuals with higher levels of self-efficacy will adopt a more active role in attempting tasks, in which individuals with lower self-efficacy may avoid those tasks all together. The second outcome is the influence on task performance. Those with stronger self-efficacy would be anticipated to be more successful at their attempts at performing a task, with fewer negative reactions or self-talk. The final behavioral outcome of self-efficacy is persistence at a task rather than choosing to discontinue prematurely.[2]
Previous health professions education research has reported a significant relationship between self-efficacy and learning outcomes in medical,[5],[6] pharmacy,[7] physiotherapy,[8] and nursing students.[9] Self-efficacy has been further demonstrated to be a positive predictor of the performance of clinical skills across medical,[10] nursing,[11] and physiotherapy students.[8]
The role of vicarious experiences
Four sources of information are proposed to contribute to an individual’s self-efficacy. These are performance mastery of a task, vicarious experiences, verbal or social persuasion, and physiological or emotional arousal.[2] Zulkosky[12] proposes that self-efficacy to perform clinical tasks upon entering practice is gained from a range of experiences including both theory instruction and clinical experiences. Forbes et al.[13] demonstrated that physiotherapy graduates linked their self-efficacy to perform patient interaction skills from a range of experiences, with direct clinical practice and vicarious experiences identified as the most significant influences. Vicarious experiences have come to the forefront for consideration in health professions education design, given the opportunity to apply this strategy within asynchronous, online learning settings. We can expect to increasingly use vicarious experiences, given the impetus for remote learning and the need for flexible and psychologically safe approaches to health professions education within and outside the traditional classroom setting.
Vicarious experiences, the focus of this article, refer to the observation of others where an individual can reflect on, interpret, or model what they have observed to potentially influence their own self-efficacy across similar tasks.[2] Other authors have described vicarious experiences as those opportunities where students can actively “listen in” on educators, experts, or fellow learners in relation to a task.[14] Unlike other learning experiences where a student may be both observing and interacting, the term vicarious experience is reserved for those activities, formal or incidental, in which the learner does not physically interact in any way with the source of the content to be mastered.[15]
Vicarious experiences can be powerful, especially where students are able to actively model behaviors or tasks that they observe.[2] Central to the success of vicarious experiences is not just the observation itself, but also the opportunity provided to the students to evaluate the deeper experience and the outcomes, or “pay-off,” of those being observed. Vicarious experiences can also provide health professions educators with flexible approaches for teaching and learning. Vicarious experiences can be used asynchronously, where video observations can be provided to students with discussion facilitated in-person or asynchronously. For many health professions educators, vicarious experiences also provide a relatively “safe” approach to learning where students can benefit from observing and processing experiences without being faced with high psychological or physical risk to themselves or others. Lastly, vicarious experiences through observation can promote students’ curiosity in health professions education to foster learning efficiency and enjoyment in learning.[16]
| Embedding Vicarious Experiences Into Health Professions Education | | |
The role of the educator
Vicarious experiences can often be misunderstood as activities where health professions educators should be relatively “hands-off,” leaving students to independently observe and process their thoughts. Despite such assumptions, the educator is central to the effective design of vicarious experiences. The educator must consider the timing of the experience within the students’ overall program of learning, the complexity of the task/s being observed, and the relevance of the person/s whom the students are observing. The role of the educator is also paramount in designing how dialog and discourse can be facilitated throughout, or following, the vicarious experience. This is important for helping students gain meaning of situations and settings that they have not yet constructed independently with a goal of enhancing self-efficacy.[17],[18] The remainder of this article addresses these important design considerations for health professions educators.
Strategic selection of who to observe
The strength of the effect of a vicarious experience on self-efficacy depends on the degree that the observer identifies with the person observed.[2] Where health professions students can relate psychologically to the person being observed, they are better able to participate, and benefit, at both cognitive and affective levels.[19] Most often, the choice of a person to be observed will be a student at a similar stage of learning. Put simply by Versland,[20] “if the successful person appears to be of similar competence to the vicarious learner, the vicarious learner seeks to replicate the efforts and strategies to achieve similar success.” Observing fellow students may be accessible and effective, but it may not always be safe for the student being observed. When designing video observations of clinical tasks, health professions educators can consider using actors or other peers to simulate the role of a student. Vicarious experiences can also feature people; students of which can psychologically or socially relate to other than fellow students. Featuring a recent learner or a member of the intended health profession as an expert can provide an impetus for modeling and may contribute to developing professional identity.[18] The health professions educator should provide reasoning and an explanation to students regarding why the person observed was selected. This allows students to understand the relevance to their own learning journey and to reflect on how their own skills may compare and contrast to those observed.
Choice of task
The task selected for students to observe must be relevant to the students, their goals, and their stage of learning to influence self-efficacy. By focussing on the relevance of a task, the vicarious experience can more actively engage and motivate students and may also contribute to social outcomes of their learning, such as building a sense of belonging and commitment to the student group or intended profession.[21] To facilitate this, vicarious experiences should feature situations and skills that are relevant and meaningful enough that the learner can feel invested in the outcome. Students’ attention can be drawn toward the relevance of a task by asking them to note the consequences of the skill, task, or behavior or develop their own feedback that they would provide to the person being observed. This can be completed independently, particularly in asynchronous settings, or students may actively share their evaluations with other learners online through the educator facilitating a “pause and discuss” once learners have had an opportunity to observe and evaluate.
Health professions educators should not be tempted to leave students with one long, onerous observation, regardless of the length of the task being observed. To aid learning and collaboration among students when using video-based observation, longer observations can be broken up into key parts. This “segmenting” of information can allow students to better engage with new information as well as give them control over the flow of new information.[22] Signaling, also referred to as cueing,[23] can be provided by highlighting key text on the screen during a video observation to draw students attention. If using a live observation, one or more instructors can also harness signaling by using a “pause and discuss” model to draw students’ attention to key parts of the task. By highlighting the key information, this helps direct learner attention, thus targeting elements of the observed task for processing in the working memory.[22]
Focussing on the real-world outcomes of tasks
Focussing students’ attention on the outcomes of a task or skill being observed allows them to build on previous learning at a social level.[24] In addition, drawing attention to the “real-world” outcomes that arise from effective use of skill or task can foster more engagement and may further contribute to the development of self-efficacy.[18] If an outcome of a learning activity is wider than just the use of an explicit procedural skill, health professions educators should aim to design vicarious experiences that convey meaningful and complete clinical scenarios, rather than just the procedural skill itself. This can include the spectrum of a clinical encounter from the person observed selecting a clinical procedure, performing the procedure in a clinical setting, and then highlighting the outcomes when a procedure if performed effectively. For example, when teaching the skill of administering an intramuscular injection, rather than having students observe the technique, the observation should include the health professional discussing options with the patient, explaining the procedure to the patient and finish with the health professional outlining follow-up care. Students then not only benefit from observing the technical procedure itself, but also the more subtle or intangible outcomes such as developing patient rapport, effective ways of seeking consent, and the importance of patient education skills in follow-up care. This gives students a valuable insight into what tangible and intangible skills are required for success, in a real-world sense, when they step out of the classroom and into the real world.
Utilizing discourse and dialog for, and within, vicarious experiences
Dialog between students with or without educator involvement is often referred to as “discourse” within educational literature. When used as part of a vicarious experience, discourse can have a significant influence on learning outcomes including self-efficacy. Dialog during or following an observation can allow the health professions educator to facilitate new knowledge and skills by linking to previous learning. Some authors have suggested that discourse that features the experiences and opinions of others has an additional benefit of influencing and establishing beliefs.[18]
Discourse between students can augment vicarious experiences through allowing students to share their feedback, thoughts, and opinions during or following an observation. But discourse can provide the means for a vicarious experience in and of itself. Research has suggested that students are able to learn vicariously through the act of sharing through conversation, narratives, and discussion.[17],[25],[26] Health professions educators can therefore think flexibly about the use of discourse to harness the benefits of vicarious experiences by facilitating dialog within an observation, following an observation, or through the use of dialog alone. For the purpose of this article, however, the use of discourse as an adjunct to a vicarious experience will be outlined for health professions educators.
There are myriad ways in which health professions educators can utilize dialog alongside or within observations to mediate self-efficacy through vicarious experiences. Listening in to a monolog or commentary provided by others as part of an observation can be simply applied through featuring the person being observed explaining the steps of a task they are undertaking or provided by an instructor using a voice-over. Voice-overs can be added to video through simple programs such as YouTube or Zoom. Going one step further, educators may ask their students to provide the monolog of what they are observing as self-generated explanations.[27] Health professions educators may consider using these self-generated explanations for sharing between students or for submission for student assessment.
Discourse can also center on the learning that is actively occurring within the task being observed. Often this is through observing the dialog between a student and his/her educator which may include discussion regarding the task and may include observing the student receiving feedback. For example, students may observe a video of a clinical interaction where a student is providing real or simulated clinical care under the supervision of an educator. During or following the clinical interaction, the educator may discuss clinical reasoning with the student or provide feedback. Witnessing this dialog between the observed student and his/her educator can provide a powerful impetus for self-reflection in the building of self-efficacy and acts as an opportunity for students to add to their repertoire of personal experiences.[14] Prompting can be used to highlight these aspects of the observation for students to focus on or to facilitate reflection. Such prompts can be provided by educators to indicate where students can stop and reflect and/or discuss, especially during more challenging or complex aspects of the observed task.[28]
Harnessing social learning through collaboration
Health professions educators should aim to use vicarious experiences in a way that integrates social approaches to learning through students working collaboratively. As highlighted by Gholson and Craig,[15] undertaking observational tasks in pairs is more effective for learning than simply observing alone. These benefits have been attributed to the interaction and collaboration between students, encouraging a more social approach to observation.[27] Lee[19] has suggested that the additional advantage of collaborative approaches to vicarious experiences may be due to the opportunity to enhance empathy between students and those that they are observing. An interactive approach to dialog such as the use of peer discussion to build a shared understanding of content has thus been described as the most effective approach to designing vicarious experiences.[27] Students can actively participate in structured discussion synchronously when posed questions about the task, the outcome of the task, or the dialogs that have been observed. Ultimately, however, as pointed out by Mayes,[29] understanding the most effective approaches for dialog use in health professions education may be contingent on the choice relating to the preferences of students and consideration of the attitudinal or cultural implications of how to use dialog rather than a choice based on evidence.
Recognizing challenges in vicarious experience design
As health professional educators, it is critical to acknowledge that not all students will actively engage in dialog. Some students may opt completely out of discussion, or may engage minimally for the purpose of completing the learning activity.[26] Ellis et al.[26] recommend that educators be transparent and share with students the benefits of engaging for them to understand the value for themselves and others. Health professions educators may, however, take solace in the fact that those students who prefer to observe from the “sidelines” during vicarious experiences are still participating and may enhance their own self-efficacy through the questions and discussions raised by others.[19]
Maintaining confidentiality and psychological safety of both students and those being observed are paramount considerations, and challenges, for health professional educators. Some authors have suggested that barriers to the use of vicarious experiences are not so much due to the reluctance of educators, but more so concerns regarding sharing of student work and associated feedback.[29] These concerns are especially relevant where there are prevailing traditional perspectives that feedback must be personal and confidential.[30] The ultimate success of any use of feedback hinges upon the extent that the learning environment provides psychological safety for feedback to be shared openly and, in the case of vicarious experiences, the option for students to opt-out of the sharing of feedback if they wish.[29]
| An Example in Health Professions Education: Putting These Strategies Into Practice | | |
Health professions students are at a stage in their learning where the focus is on managing challenging situations during clinical encounters. For practical and pedagogical reasons, the educator decides that this activity will be provided online, synchronously, using a simulated video of a clinical encounter with goals that include enhancing student self-efficacy. The choice of a video allows the educator to overlay dialog and allows pause and discuss moments where students can break out into small groups at key points during the observation to reflect on the clinical situation and discuss clinical reasoning. This also allows the educator to provide prompts at these points to direct students to key learning moments. The video features a learner at a similar stage in training being supervised by their educator. The interaction with the patient includes a complex situation in which clinical reasoning is needed. In the video, the observed learner and their educator pause at key moments during the simulated encounter where there is discourse about the patients’ care. At the end of the encounter, the student groups are tasked with forming their own feedback for the learner they have observed and to discuss this among their groups. They can then view the observed educator giving feedback to the learner to reflect on how their feedback compared.
| Conclusion | | |
Fostering self-efficacy through vicarious experiences offers numerous benefits to health professions students with a range of strategies that can be applied to augment learning outcomes. Considering more flexible approaches to vicarious experiences, especially using video and asynchronous learning, can ensure that these valuable learning opportunities are not lost when activities move out of traditional classroom settings and into an online space. Health professional educators should consider several design elements that make vicarious experiences meaningful and valuable through careful selection of people and tasks observed, harnessing dialog, and embedding opportunities for collaborative learning.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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