The 2:1 Learning Model in Clinical Education

Have you ever wondered how you could organize an externship for two students at the same time? Did you ever envision that mentoring two students at the same time could actually be a more efficient use of your time?

Current clinical placement models in health care disciplines are increasingly using creative clinical models to enhance student learning and increase placement capacity. One such model is the 2:1 student-to-clinical educator ratio supervision model or the “2:1 Learning Model”.

After you complete your self-study with this online professional development module, you will be able to:
1. Describe characteristics and advantages of Peer Assisted Learning (PAL) and Reciprocal Peer Coaching (RPC).
2. Identify different types of feedback and evaluation methods that can be utilized during a 2:1 Learning Model.
3. Learn from “real-life” Clinical Educators and students to appreciate their perspectives about different types of learning models.



(summarized from Claessen, 2004)

What is Peer Assisted Learning (PAL)?

  • A Peer Assisted Learning model is where two students collaborate together during the learning process (Ladyshewsky, 2000)
  • In a PAL model, this collaboration can consist of students observing each other and providing each other with support, consultation, and feedback.
  • For example, the students may conduct an assessment together, where one student administers the test and the other student scores the test. They can also analyze data, plan and carry out therapy sessions, write progress notes and reports together.
  • It is known that learning occurs at a faster rate and is of higher quality when students work in groups (Johnson & Johnson, 1987).

What are some benefits of PAL?

  • The PAL model allows students to become more actively engaged in their learning experience (Callan et al., 1993).
  • The PAL model gives students the opportunity to engage in self-directed learning, to problem-solve together, and to work as a team (Lincoln & McAllister, 1993).
  • Ladyshewsky (2002) found the following advantages of a PAL model:
    • Encouragement of student responsibility for their own learning
    • Helps students to wean themselves from considering the CE as the sole source of knowledge
    • Opportunity for students to explore alternative solutions to problems in a safe environment
    • Development of interpersonal skills, such as social interaction and communication skills
    • Enhancement of student satisfaction with the learning experiencing
    • Enhancement in the students’ self-esteem

What is Reciprocal Peer Coaching (RPC)

  • An elaboration of the PAL model where students coach one another during clinical activities, under supervision of the CE (Ladyshewsky, 2002)
  • The RPC Model depends on equality and mutuality between students:
    • Equality describes the extent to which learners take direction from one another
    • Mutuality is the extent to which the learners’ conversations are extensive, intimate, and connected

Possible Activities in a RPC Model

  • Learning through demonstration (to and from each other and from the CE)
  • Observing one another (and/or their CE)
  • Performing clinical activities together (e.g., assessment, therapy, analyzing results, preparing materials/sessions, etc.)
  • Providing each other with consultative assistance
  • Discussing and problem-solving together
  • In some placements, providing each other with non-evaluative feedback (peer-evaluation or peer-critiquing)

Feedback and Evaluation during a 2:1 Learning Model

  • Feedback can be provided by everyone involved in this type of learning model, including the CE, the student (self-critiquing), the peer (peer-critiquing), and sometimes even the client/patient
  • Regardless of who is providing the feedback, feedback should be descriptive and specific, not general. For example, students do not find comments such as, “Great job,” very useful.
  • Feedback may be provided orally during or after sessions, during spontaneous interactions, during a scheduled feedback meeting, or given as written feedback
  • To avoid confusion and misunderstandings between the CE and the students, it is crucial to let the students know the expectations for the feedback process:
      • How and when the feedback will take place
      • The type of feedback


  • Students give feedback on their own performance
  • This helps develop insight into their own clinical skills and ultimately helps them grow into competent clinicians
  • Initially, the CE might take more of a leadership role through modelling to teach the students how to give specific feedback about their performance
  • Next, the student might then be invited to share how she/he thought the client performed and comment on her/his own performance
  • As the placement proceeds, the student can be expected to take more initiative with self-critiquing and should feel at ease to discuss what she/he sees as important


  • It can feel intimidating to have to give and receive feedback from a peer in front of a CE
  • Non-evaluative feedback is recommended whereby the student is not judged and the feedback is descriptive
  • Feedback starting with, “It appears to me that….” and “From my perspective….” can be useful for the students to say when providing peer feedback
  • The CE can model and redirect the focus of the feedback from the student to the client. For instance, “I noticed that after you asked the client about what was upsetting him, he was able to attend during the therapy task.”
  • Peer-critiquing may also take place between the students when the CE is not present and should be encouraged, especially as students become more independent

Formal Evaluation

  • Evaluation usually occurs at designated times during a placement (e.g., midterm and final evaluations)
  • If feedback is connected to the student’s pre-discussed learning objectives and has formed a regular part of the clinical education process, there should be no surprises at the time of the evaluation (Westberg & Jason, 1991)
  • Students can be asked what they feel comfortable with, but the Clinical Teaching and Coordination Team at UBC recommend that the CE completes individual evaluations with each student separately, in private one-one-one meetings

Learn what our Clinical Educators have to say about their experiences with different types of learning models.

Speech-Language Pathologist, Child Development Center, Preschool Children

Type of Learning Model:2 CEs to 2 students (however the CEs alternated days, therefore each day, the students experienced a 2:1 Learning Model)

“It encourages the students to problem-solve between each other and seek out other ways to answer questions, find resources, etc. We have given them projects to work on jointly which is also a great opportunity for learning.”

“The students are not guaranteed to get the correct answer or approach by working with one another and still need to know when to go to a supervisor. We have had a few great dyads of students, but we can still sense the competition. This can sometimes add a layer of challenge to the student’s ability to collaborate with each other.”

“In the first week of the placement, the CEs provide our own education sessions with the students to establish our expectations and let the students know what clinical skills are critical to success at our site before they jump into seeing clients. Teaching in a small group has encouraged great questions and better learning. We’ve also told the students about their projects on the first day, which has established the expectation that the students will be working as a collaborative team on the projects. When we’ve encouraged students to provide feedback for one another, this has been challenging for them and can be awkward and uncomfortable. It worked better to give them specific direction (e.g., Provide feedback on one thing she did well, one thing she could have done differently, etc.). I’ve also had students do the same when observing my sessions.”

“I think students typically come to the placement used to observing one another. It helps if they come with the understanding that they will do better if they support one another and work as a team as opposed to treating the placement in a way where individualized learning will increase success.”

“I think it’s important that clinicians understand that this is meant to be a strategy to reduce clinician load as opposed to revolutionizing supervision. Student dyads naturally rely more on one another and less on us. We’ve been fortunate to have dyads who easily worked together and supported one another, but I think student-selection for placements such as ours is critical to success of 2:1 learning.”

“What we learned was that the 2:1 model was nothing revolutionary, but rather a way to encourage educators to take on two students.”

Read more about what our students have to say about different types of learning models

Student #1, Adult Rehabilitation

Type of Learning Model: 1 Clinical Educator to 4 students

“The learning model we had provided us with the opportunity to give each other feedback. During each debrief session, the students who conducted the session would give themselves/each other feedback, followed by the other two students that observed the session and then finally, our CE. This provided us with an opportunity to all learn from each other. This model encouraged the students to be the experts, which was very empowering. As well, having a 4:1 experience allowed for us all to lean on each other. There was always someone else who knew what I was experiencing and someone I felt comfortable turning to for advice, even if we weren’t working with the same clients.”

The only challenge that I found with the 4:1 model was that there was not a lot of opportunity for one-on-one time with our CE. This time would have been helpful for sharing feelings, thoughts or ideas that we would not feel comfortable sharing in a group. I would recommend for CEs to allot time for this, which could be planned for at the beginning of the externship.”

"I believe a CE can prepare for this model by ensuring that they have a plan to get to know each student individually (their strengths, weaknesses and learning styles) and treat each student as an individual, competent student clinician.

Having a 4:1 model also really relies on the cohesion of the individuals who are a part of it. If the students do not work well together, it would be very difficult to achieve what I have mentioned above. Although this wasn’t an issue for our group (we did EVERYTHING together: lived, worked out, grocery shopped, etc.), I can foresee it being an issue for individuals who do not work as well together, are living together in a rural area and/or are away from family and other support systems. Also, having someone like our Clinical Educator, who was able to create such a safe and supportive space for us, is crucial.”

“[Our CE] was an amazing Clinical Educator and truly made the 4:1 experience enjoyable and educational – so much so that I couldn’t picture the experience any other way.”

Student #2, Child Development Centre, Preschool children

Type of Learning Model: 2 CEs to 2 students (however the CEs alternated days, therefore each day, the students experienced a 2:1 Learning Model)

“What I liked most about the 2:2 learning model was having another student to share my externship experience with. The other student and I often shared our activity ideas and provided suggestions and feedback session plans. We encouraged each other, provided moral support, and had someone to validate any thoughts, feelings, or concerns with. It was also nice to be around a familiar face when placed in a city where I did not know anyone else.”

“An advantage of this learning model is that it provides students with someone else to collaborate with when planning sessions or completing projects assigned by the CE. On days where the other student and I shared one CE, we took turns leading sessions. During the time where we were not leading the session, the other student would be given time to create materials and prepare for their next session.”

“The other student and I got to troubleshoot together, work on projects together, and glean from each other’s experiences as we took on our own clients, planned sessions, told each other what went well and what didn't, etc. It was great!”

“A Clinical Educator can maybe set aside time after each session to give feedback to students individually. As usual, it is important to keep in mind each student's different learning styles, and understand that some students learn at different paces.”

“Overall, this is a great model. The more people that are involved in a student's practical learning, the better! Having two students, or two clinicians, or both, means more perspectives, more therapy styles, more people to bounce ideas off of.”


  • For a Clinical Educator, the debriefing time should not double with a 2:1 Learning Model, especially if the following format is used to provide feedback:
    • The student who completed the assessment or therapy session initiates the feedback conversation regarding what she/he thought went well and goals for improvement
    • The student who observed the session then offers feedback to the first student
    • The Clinical Educator then provides feedback to the first student

  • The Clinical Educator will complete separate midterm and final evaluations for each student, which will take a bit more time as compared to completing a midterm and final evaluation for one student.
  • However, utilizing a 2:1 Learning Model can develop greater clinical competencies in students and greater satisfaction levels for both the students and the Clinical Educator involved (Claessen, 2004)
  • The 2:1 Learning Model, with the use of self-and peer-feedback, can easily be incorporated into the clinical education of SLP and Audiology students (Claessen, 2004).

Additional Recommended Readings for Continued Self-Study

For a Canadian perspective of implementing a 2:1 Learning Model
Claessen, J. (2004). Incorporating Reciprocal Peer Coaching, Clinical Reasoning, and Self-and Peer-Evaluation. Journal of Speech-Language Pathology and Audiology, 28(4), 156-165.

For an in-depth look at advantages and disadvantages
Dawes, J., & Lambert, P. (2010). Practice educators’ experiences of supervising two students on allied health practice-based placements. Journal of Allied Health, 39(1), 20-27.

For an accessible overview of terminology and literature
Briffa, C., Porter, J. (2013). A systematic review of the collaborative clinical education model to inform speech-language pathology practice. International Journal of speech-language pathology practice, 15(6), 564-574.

For an accessible overview of “Peer Assisted Learning”
Sevenhuysen, S., Thorpe, J., Molloy, E., Keating, J., & Haines, T. (2017). Peer-Assisted Learning in Education of Allied Health Professional Students in the Clinical Setting: A Systematic Review. Journal of Allied Health, 46(1), 26-35.

Claessen, J. (2004). A 2:1 clinical practicum, incorporating reciprocal peer coaching, clinical reasoning, and self-and-peer evaluation. Journal of Speech-Language Pathology and Audiology, Vol. 28, No. 4, 156-165.

Johnson, D., & Johnson, R. (1987). Research shows the benefits of adult cooperation. Educational Leadership, 45, 27-30.

Ladyshewsky, R. (2000). Peer-assisted learning in clinical education: a review of terms and learning principles. Journal of Physical Therapy Education, 14, 15-22.

Ladyshewsky, R. (2002). Enhancing clinical reasoning through reciprocal peer coaching. Workshop, McGill University, Montreal, Quebec.

Lincoln, M., & McAllister, L. (1993). Peer learning in clinical education. Medical Teacher, 15, 17-25.

Westburg, J., & Jason, H. (1991). Providing constructive feedback: A CIS Guide Book for Health Profession Teachers. Center for Instructional Support.

Join the Conversation:

Let us know about some of the useful strategies that you have implemented or you would like to implement during a 2:1 Learning Model with your students.

Contact Us: If you have questions or comments about this learning module, please email Cheryl McGee at