Learning from the ‘mistakes’ of others – improving clinical practice and practice evaluation skills using social media and a protected performance environment


When did you first introduce the innovation?

Between 12 and 24 months ago

Please describe the innovation you have developed

The method is used for second year radiography students in their Radiographic Practice module. After viewing 2 examples of clinical practice (videos of a ‘lecturer’ presenting narrated demonstrations of 2 different radiographic techniques; these are viewed via iTunesU), undergraduates in radiography critique one presentation and discuss its relevance to their level of training for the UK practitioner. They comment on accuracy of the clinical performance (and also the information provided on the commentary), compare the technique shown to other techniques they have researched, and suitability of equipment available. The students also work in groups to produce a similar demonstration to the second video; this aims to improve on the original video, whilst maintaining the appropriate aspects of it. Both parts are used as modular assessment.

What prompted you to develop this innovation?

It is acknowledged that there are several ways to produce diagnostic images of different body areas. Gold standard is to use an evidence base to make the best technique choice for the individual patient in terms of image quality, patient condition, equipment available and radiation dose implications. Students at all levels need to work accurately when positioning patients for examinations, assessing tube angle in relationship to planes of body parts and equipment.

When in clinical practice, there is a need for students to work safely and in the interests of their patient. This means that it may sometimes be difficult for them to implement new or different ways of working because they fear that they will produce error, which is detrimental to their patient, or even be criticised.

Therefore we need a mechanism that will be a positive experience and that will develop their level 5 skills in:

1.The evaluative and evidence based approach required by the radiographer in practice (HCPC, 2013). This has been part of the curriculum at Bangor for many years and we have used a discussion forum and ‘foolproof recipe’ approach in the past. The ‘usual suspects’ (students who most regularly participate in verbal interaction in sessions) engaged in this but not all students benefitted equally.

2. Understanding accuracy in terms of radiographic practice, geometric and radiation interaction with matter/ safe administration of dose

It was also hoped that the new method would encourage effective all-round engagement with the group and with the lecturer.

The Health and Care Professions Council. 2013. Standards of Proficiency: Radiographers. London: HCPC

In your view, what is it about this innovation that makes it different/important?

It uses what is essentially a ‘social media’ trigger to enhance and encourage student engagement. Use of social media as an aid to learning is not brand new as a concept but the concept of asking the student to improve on a performance that they have critiqued is.

Learning from their own mistakes is a negative mechanism for the learner but observing errors made by others can distance the learner from negative feelings about their own learning by using an ‘anonymous’ position when judging errors. It is not an unfamiliar concept that learners can experience negative feelings about making errors, both educationally and in health care (Pjil Zieber 2015, Maats and O’Brien 2014) but there is scientific evidence that the human brain ‘learns’ from the mistakes of others (Howard-Jones et al, 2010). Indeed, Howard-Jones et al’s research shows that the brain shows more neural activity under fMRI when mistakes made by others are observed.

By implementing a mechanism where students can essentially ‘improve’ on inappropriate or inaccurate practice, in a safe, protected and confidential environment, undergraduates can reflect on and learn from video evidence of others’ practice.

Howard-Jones, P.A; Bogacz, R; Jee H., Yoo; Leonards, U; Demetriou, S. The neural mechanisms of learning from competitors. NeuroImage, Vol. 53, No. 2, 11.2010, p. 790 – 799

Maats H, O’Brien K. 2014. The science behind mistakes. Retrieved from: http://www.edutopia.org/blog/teaching-students-to-embrace-mistakes-hunter-maats-katie-obrien

Pijl Zieber M, 2015. The educational conundrum of making mistakes. Retrieved from:

To what extent does your innovation make use of existing approaches, resources or technologies?

EBL – because they must use the evidence base to support their findings and devise their presentation.

PBL – as a format

Existing resources include: X-ray room to devise, practise and present their presentation; internet access to view video; iTunesU app. Students can use an anatomical model or a volunteer ‘live’ simulated patient for their demonstration.

To what degree has this innovation led to changes in education or clinical practice?

Education: this is a development of EBL and PBL delivery that has previously existed in the same module (this originally involved a fictitious scenario that required students to devise a digital presentation). The X-ray suite had not previously been used for assessment. It has led to formalisation of ground rules for group behaviour and organisation, replacing the guidelines that were carried in the module previously.

In terms of changes in clinical practice, students feel more confident when challenging clinical practice and are more willing to use techniques that are less familiar (but more effective) than those they encounter every day in clinical practice. They are more confident when justifying their choice of technique if challenged by others.

What evidence do you have of the impact of the innovation?

The student’s ability to reflect on practice has been shown to go beyond the level expected at level 5; it was originally anticipated that students would gain more confidence with the expected level of application of knowledge but, once the pilot scheme was under way, the possibilities for developing synthesis and evaluation became apparent.

The main evidence for impact:

a) the oral section for year 2 ‘modification of technique’ assessment shows average scores to have risen by approximately 5% overall.
b) evaluative essay (average) scores associated with the module have risen by approximately 5%.
c) student feedback shows other aspects that they feel they understand better as a result of the exercise: the role of the radiographer in the healthcare team, surface markings and anatomical structures, the needs of the learner (in readiness for their role in student training as a health professional and role model), how to reflect on suitability of available equipment, the status and role of the UK radiographer when compared to other cultures in health service provision.

To what degree has the innovation been disseminated in your organisation or elsewhere?

As the first year of implementation was essentially a pilot scheme, the last academic year only saw this innovation shared within our faculty with a view to consideration for adaptation for other professions. This is the first attempt at dissemination outside the university.

Please provide details of any plans you have to disseminate the innovation in the future.

This method will be shared and discussed in October 2015 at the radiography Simulation Special Interest Group inaugural meeting (Society of Radiographers HQ, London).

Proposals for dissemination at professionally related conferences will be submitted in October and November 2015 (For educational streams at UK Radiological Congress 2016 and European Radiological Congress 2016), and in summer 2016 for Bangor University CELT (Centre for Excellence in Learning and Teaching) conference.