Peer learning in higher education: Patterns of talk and ...

LCSI-00124; No of Pages 13 Learning, Culture and Social Interaction xxx (2016) xxx–xxx

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Peer learning in higher education: Patterns of talk and interaction in skills centre simulation Anton Havnes a,⁎, Bjørg Christiansen b, Ida Torunn Bjørk c, Elisabeth Hessevaagbakke b a b c

Centre for the Studies of Professions, Oslo and Akershus University College of Applied Science, PO Box 4, St. Olavs pl., N-0130 Oslo, Norway Department of Nursing, Faculty of Health, Oslo and Akershus University College of Applied Science, PO Box 4, St. Olavs pl., N-0130 Oslo, Norway Department of Nursing Science, Faculty of Medicine, University of Oslo, P.O. Box 1130, Blindern, N-0318 Oslo, Norway

a r t i c l e

i n f o

Article history: Received 26 March 2015 Received in revised form 23 November 2015 Accepted 1 December 2015 Available online xxxx Keywords: Peer learning simulation nursing higher education peer interaction skills centre

a b s t r a c t This study conceptualises patterns of peer talk and interaction and the potentials for learning inherent in a peer tutoring setting in an undergraduate nursing education skill centre. Thirdyear students are responsible for training first-year students in performing nursing procedures. The paper identifies patterns of peer interaction as they occur in a pre-training reflection setting where students prepare for practising the procedures. Three interaction patterns are identified: a tutor-led question-and-answer pattern and two exploratory patterns: cumulative-exploratory and dispute-exploratory. The analysis additionally uncovered three ways of dealing with the object of learning: recitation, re-contextualisation and thematic errors and sloppiness. We suggest that analyses of peer learning need to go beyond the level of interaction and also address its content. Furthermore, interaction patterns might afford an expansive or more restrictive way of framing and dealing with the object of learning. © 2016 Elsevier Ltd. All rights reserved.

1. Introduction There has been increasing interest in learning inherent in peer–student interaction, often referred to as peer learning (Boud et al. 2001; Falchikov, 2001; Havnes, 2008; O′Donnell & King, 1999; Topping, 1996, 2005). Many researchers that see peer–student interaction as one of the richest learning resources (Slavin et al. 2003; Topping, 1996, 2005; Wiliam, 2011; Arendale, 2015); Slavin (1999, 74) understand collaborative learning as ‘one of the greatest success stories in the history of educational innovation’. When successfully organised and carried out, it can endorse high-level cognitive processes (King, 2002; Khosa & Volet, 2013; Orsmond et al. 2013); Boud et al. (2001, 8–9) that highlight five commonly shared outcomes: working with others; critical enquiry and reflection; communication and articulation of knowledge, understanding and skills; managing learning and learning to self- and peer-assess. A recent review of studies on collaborative learning across primary, secondary and tertiary levels (Kyndt et al. 2013) shows the strong positive effect of peer interaction on students' achievements (ES = .54). ‘Students indeed learn more when they work together than when they work alone’ (134). However, research indicates that peer learning is often organised and used by students in ways that run contrary to researchbased knowledge about how interaction among peers can support learning (Antil et al. 1998; Johnson et al. 1998; Slavin, 1995, 2011). Topping (2005, p. 632) suggests that there is a risk that teachers might ‘think they are implementing peer tutoring or cooperative learning, when all they are really doing is putting children together and hoping for the best.’

⁎ Corresponding author. E-mail addresses: [email protected] (A. Havnes), [email protected] (B. Christiansen), [email protected] (I.T. Bjørk), [email protected] (E. Hessevaagbakke).

http://dx.doi.org/10.1016/j.lcsi.2015.12.004 2210-6561/© 2016 Elsevier Ltd. All rights reserved.

Please cite this article as: Havnes, A., et al., Peer learning in higher education: Patterns of talk and interaction in skills centre simulation, Learning, Culture and Social Interaction (2016), http://dx.doi.org/10.1016/j.lcsi.2015.12.004

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A. Havnes et al. / Learning, Culture and Social Interaction xxx (2016) xxx–xxx

In their review of the literature on peer–tutor learning, Roscoe & Chi (2007) found that peer-tutoring takes diverse form in terms of student interaction, with a particular attention on knowledge delivery in terms of tutor instruction and preparation for exams (see also Ashwin, 2002). There is a tendency, according to Roscoe & Chi (2007, p. 534) that: ‘Peer tutors, even when trained, focus more on delivering knowledge rather than developing it.” There has been great interest in implementation, guidelines for group interaction and documentation of improvement of exam results. Less attention has been on documenting what goes on in these interactions, for instance, group dynamics and communication patterns. On this background Roscoe & Chi (2007) suggest that, a key to understanding the learning potential of peer learning, and also further developing such initiatives, lies in understanding the details of peer interaction. In particular, they encourage ‘process-outcome evaluations’ (p. 561). While learning data mostly is collected from large numbers of students, Roscoe and Chi (p. 562) propose that ‘process data can be drawn from a smaller set of “representative students” in specific locations’, thus suggesting ‘direct examination of peer tutors’ instructional and learning activities (p. 539). Taking these views of situating the potential of peer learning in the details of peer interaction and local settings, the aim of the article is to describe at a general, conceptual, as well as concrete, case level, strengths and pitfalls of designing peer learning activities. There are two aspects of this aim: Firstly, identifying core dimensions of the relationship between peer interaction and learning, based on a literature review. Secondly, exploring peer learning in a concrete, local practise in which third year students tutor first year students. The design did not allow for comparing peer interaction and learning outcomes. Instead, the link between peer interaction and learning is addressed in terms of how knowledge is included in, or attended to, in peer interaction. The article is part of a project that had three foci. One addressed the learning potential of peer tutoring for the tutors (Bjørk et al. 2015), another addressed the learning potential for tutees in the concrete, peer-tutored hands-on simulation practise of nursing procedures (Christiansen et al. 2011). Here, the focus is on the learning potential of peer interaction in pre-training peergroup supervision, that is, in discursive, knowledge- and experience-based talk about nursing procedures. The key questions are: How do students, in this peer-tutored group setting, interact and attend to the learning of nursing procedures in a pre-practise supervision setting? Are there patterns of interaction and diverse ways of attending to the object of learning that potentially transform what students attend to and, thereby potentially afford diverse learning outcomes? The context is peer student interaction in simulation learning in nursing education where students practise nursing procedures in a clinical skill centre. Through detailed analysis of videotaped student interaction, the article attempts to document peer learning practises in a cross-level (Falchikov, 2001) peer-tutoring setting, focusing on learning processes as aspects of peer interaction. More precisely, clinical skill centre simulation training is the setting, the content is nursing procedures, peer tutoring is the structure, peer interaction is the activity, and peer learning is a potential aspect — and outcome — of peer interaction. The focus of our observations was on observing and identifying patterns of content-related peer interaction. The analytical focus has been on learning potentials embedded in peer interaction. Hence, there might be interaction going on that was not of interest for our analysis, for instance, diverse forms of off-task talk and interaction. We will first address the key notion at stake here — peer learning as an aspect of peer interaction. Secondly, we provide a short description of the learning context and the methodology before turning to results and discussion. While the analysis empirically is based on a cross-level tutor setting (Falchikov, 2001), it is conceptually enriched, in that, the analysis draws on research on peer learning across its diverse forms and contexts and learning in peer interaction more generally, including schools. The analysis is grounded in brief literature reviews and observation data, yet it is anticipated to be exploratory. As will be shown later, there is a vast literature that is of relevance for the analysis. We will draw on samples of relevant literature from a potentially large pool of references. As it will become clear in the Results section, a detailed analysis of student interaction to some extent necessitates the use of content- and discipline-specific terms. However, the framing and the final analytical elaborations are more general and expected to be of relevance in higher education generally. The article contributes to the field of research on peer learning by examining and systematising the learning potential of peer tutoring based on a spectrum of empirical research and theoretical positions beyond peer tutoring and higher education. The data analysis provides new insights to the relationship between peer interaction and learning. 2. Peer learning Peer learning—defined as ‘students’ learning from and with each other in both formal and informal ways (Boud et al. 2001, 4)—has probably existed in higher education since the inception. Students have lent support to each other with or without the involvement of teachers (Havnes, 2008; Orsmond et al. 2013; Topping, 1996). Topping (1996, 322) traces the practise back to the ancient Greeks. More recently, the emphasis has been on organising peer learning in a more structured way that includes all students (Boud et al. 2001; Falchikov, 2001; Khosa & Volet, 2013; Topping, 2005). There is increasing interest in ‘deploying helpers whose capacities are nearer to those helped, so that both […] find some cognitive challenge in their joint activities’ (Topping, 2005, 632). While peer interaction is also part of students' becoming academically and socially integrated in a higher education culture (Tinto, 1997; Havnes, 2008), the focus here is on peer learning as didactic initiatives organised as part of the educational programme. However, insights from peer learning generally, and across age groups, might advance the implementation of didactic models. A series of partly overlapping didactic models for students learning together have developed across higher education and primary and secondary schools, mainly from around 1990 onwards, for instance; collaborative learning and cooperative learning (Slavin, Johnson and Johnson), group mentoring (Huizing, 2012), peer tutoring (Topping, 1996; Roscoe & Chi, 2007), supplemental instruction (Centre for Supplemental Instruction, 1998; Rust & Wallace, 1994), peer assisted learning (Arendale, 2014), peer assessment (Dochy et al. 1999), dialogical pedagogy (Nystrand, 1997), reciprocal teaching (Brown & Campione, 1990) and classroom talk (Mercer, 1995). In the context of these examples of didactic initiative, peer learning is a more abstract concept, referred Please cite this article as: Havnes, A., et al., Peer learning in higher education: Patterns of talk and interaction in skills centre simulation, Learning, Culture and Social Interaction (2016), http://dx.doi.org/10.1016/j.lcsi.2015.12.004


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to by Boud (2001, 3) as ‘a two-way, reciprocal learning activity’ that is mutually beneficial and ‘a way of moving beyond independent to interdependent or mutual learning’. In these terms the notion of peer learning overlaps with social theories of learning emphasising diverse but overlapping conceptual frameworks for conceptualising learning as social process, for instance, communities of learning (Lave & Wenger, 1991), social regulation of learning and co-regulation of learning (Volet et al. 2009; Grau & Whitebread, 2012; Panadero & Järvelä, 2015) and interthinking (Littleton & Mercer, 2013). Interestingly, the expansion of didactically structuring of peer learning intersects with the emerging interest in sociocultural approaches to learning (e.g. Engeström, 1987a, b; Lave, 1988; Brown et al. 1989, Lave & Wenger, 1991, Chaiklin & Lave, 1993). However, rationales underlying peer learning tend to blend sociocultural and cognitive approaches to learning emphasising self-directed learning and the engagement of autonomous learners (e.g. Volet et al. 2009, Falchikov, 2001, O'Donell & King, 1999). Theoretically, the significance of peer interaction in student learning is advocated by proponents of both cognitive and sociocultural theories of learning, rooted in the theorising of Piaget and Vygotsky, respectively (Falchikov, 2001; O′Donnell & King 1999; Topping, 1996, 2005). Piaget takes as the starting point the primacy of individual capacities in the developmental loop of person–environment–person interaction. Vygotsky (1978) takes social practises and the socio-cultural environment as the starting point. Yet, both underscore learning as an aspect of confronting conceptions and challenges beyond what has already been acquired. In Piagetian terms, this implies accommodative learning and the adjustment of conceptions or mental schemes based on experience and attending to cognitive conflict. In Vygotskian terms, this implies stretching one's capacity — acting in interaction with peers beyond what the person is able to do independently — as a forerunner of individual development. The blending of individually oriented cognitive psychology and sociocultural theories of learning is expressed by Volet et al. (2009, 224) in terms of emphasising ‘the importance of empirically scrutinising the fluctuation patterns between individual and social forms of regulation.’ Following the perspective of Vauras et al. (2003), the blend self-regulation and shared-regulation are interrelated aspects of peer learning. From within a Vygotskian framework Littleton & Mercer (2013, 10) emphasise “the dynamic relationship between intermental (social interaction) and intramental (individual thinking)”. 2.1. Basic principles of learning-rich peer interaction At this stage of the argument we keep in mind the argument by Roscoe & Chi (2007) that studies of peer tutoring tend to downplay interactional factors and emphasise structural factors. The focus is on implementation and outcomes, rather than on process data: ‘the literature says more about what interventions work than why’ (560). However, there is more research on the meaning-making processes inherent in peer interaction, how students interact and how they frame the content and express knowledge, uncertainty and understanding in school settings with younger students. A series of interconnected aspects of peer interaction that may enhance learning can be identified: the structuring of peer interaction settings, the dynamics of peer interaction and the way knowledge or problems are attended to (task- or problemorientation). 2.1.1. Structuring (Johnson & Johnson, 1987, 1998; Slavin, 1995, 2011). Slavin (1995, 2011) emphasises that the key characteristics of learningrich group activities presuppose a structure that includes ‘positive interdependence’ and ‘individual accountability’. There is also the need for some level of heterogeneous grouping and opportunities for discussion (Slavin, 1999). A third structural element is the degree to which students (student tutors and tutees) are trained in peer learning activities. Extending Slavin's basic principles, Johnson & Johnson (1987, 1998) add the need for preparing and training group members in non-competitive group dynamics, interpersonal skills and group reflection. Structuring may also take place internally to peer interaction. For instance, Grau & Whitebread (2012) distinguished between self-regulation (regulating your own participation), co-regulation (regulating the activity of another member of the group) and social regulation (regulation of the collective activity of the group). 2.1.2. Interaction Others address the manner in which the interaction is guided or co-regulated in the group. There is a particular emphasis on establishing contrasting viewpoints within the group, providing opportunities to discuss and scaffolding questioning and argumentation (Howe, 2013; Nussbaum, 2008; Rojas-Drummand & Mercer, 2003) and exploratory talk (Rojas-Drummand & Mercer, 2003). In their recent study of classroom talk, Rojas-Drummand & Mercer (2003, 102) found that exploratory talk in which partners engage critically but constructively with each other's ideas is an essential component of peer learning. ‘The expression of contrasting opinions during group work is the single most important predictor of learning gain’ (Mercer, 2008, 94). Further, group work is most efficient when teachers do not intervene. Howe (2013) emphasises the need to challenge students to resolve uncertainties and disagreements. In their review on tutor learning, Roscoe & Chi (2007) underscore questioning instead of explaining, and knowledge-building instead of knowledge-telling, as key components of learning-rich peer tutoring. Webb et al. (2008) found that giving explanations promotes learning more than receiving explanations and giving answers. Referring to previous research, Barron (2003, p. 308) summarised the main constituting components of learning-rich peer interaction: share original insights, resolve different perspectives through argumentation, explain one's thinking about a phenomenon, provide critiques, observe the strategies of others and listening to explanations (for references, see Barron, 2003). As peer interaction unfolds we may expect that these diverse aspects come together in diverse ways and form patterns. Please cite this article as: Havnes, A., et al., Peer learning in higher education: Patterns of talk and interaction in skills centre simulation, Learning, Culture and Social Interaction (2016), http://dx.doi.org/10.1016/j.lcsi.2015.12.004

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Micro-studies of peer interaction have identified diverse sets of patterns of peer interaction. Forman & Cazden (1985) found three patterns: parallel (lack of cooperation), associative (some sharing of information) and cooperative (monitoring and complementing each other). Hogan et al. (1999) distinguish between three patterns of interaction labelled as consensual (when one speaker carried the conversation and others being minimally verbally active audience); responsive (when ‘both questions and responses of at least two speakers contributed substantive statements to the discussion’); and elaborative (when ‘all speakers contributed substantive statements to the discussion’) (393–394). Barron (2003) distinguished between two patterns in a study of high achieving 6th-grade students solving the same mathematical problem: (reciprocal) engagement and non-engagement in shared problem solving. Engagement includes acceptance or discussion of contributions. Non-engagement includes rejection or ignoring. She found that the level of engagement in other group members' contributions varied radically across groups. Littleton & Mercer (2013, 15–16) distinguish between three patterns of classroom talk: disputational talk (e.g. confrontational and competitive); cumulative talk (sharing knowledge, elaborating each others' ideas, but not evaluating them critically); and exploratory talk (‘engaging critically but constructively with each other's ideas’). Littleton and Mercer also refer to Resnick (1999), who used the term accountable talk to describe what they refer to as exploratory talk. The overall patterns cutting across these diverse ways of conceptualising peer interaction concerns the degree of joint, shared, reciprocal engagement and critical challenging that characterise group members' participation, but also how group members jointly contributed to the problem solving process or the task at hand. ‘How participants manage these interacting spaces is critical to the outcome of their work and helps account for variability in collaborative outcomes’ (Barron, 2003, 307). This takes us to the third aspect; problem-orientation as a potentially integral element in peer interaction. 2.1.3. Problem-orientation How students address the object of learning — the content — is illustrated by, for instance, shared knowledge-building (Roscoe & Chi, 2007) and ‘peer modelling high-level content processing’ (Khosa & Volet, 2013, 18). Slavin et al. (1996, 50) also emphasise that ‘learners must engage in some sort of cognitive restructuring, or elaboration, of the materials in order to learn them’. In Littleton & Mercer (2013, p. 9) words: ‘Any collaborative learning and problem-solving must necessarily involve the joint management of a task.’ Furthermore, Slavin (1996, 52) emphasises that ‘group goals might operate to enhance the learning outcomes of cooperative learning […and…] also lead to group cohesiveness […] making them feel responsible for one another's achievement, thereby motivating students to engage in cognitive processes which enhance learning.’ However, group goals need to be linked to individual goals and individual accountability, he argues. From the tradition of argumentation theory, Nussbaum (2008, 346) addresses the need for exploring the relationship between modes of interaction and ways of dealing with the object of learning in terms of ‘resolving sociocognitive conflict, considering and evaluating diverse views, understanding conceptual principles, and creating social and cognitive norms where participants […] model for one another elaborative and metacognitive strategies’. Barron's (2003) distinction between interaction space and content space as aspects of peer interaction illustrates the distinctness, but also the interrelatedness of dealing with each other and with the object of learning in peer interaction. ‘Collaboration might productively be thought of as involving a dual-problem space that participants must simultaneously attend to and develop a content space (consisting of the problem to be solved) and a relational space (consisting of the interactional challenges and opportunities) (Barron, 2003, 310). Fig. 1 summarises aspects of learning-rich peer interaction. In the perspective of the emphasis on structural aspect structuring is added as third component—structuration space—referring to processes of structuration (e.g. Giddens, 1984) prior and parallel to interaction—or a metaperspective on learning-oriented peer interaction. The structuration space also connects to what Littleton & Mercer (2013, 20) call ‘ground rules for talk’. Ground rules are established through social norms or rules and may be explicitly or implicitly expressed and vary across cultural contexts. Because there categories of “spaces” may be aspects of peer interaction, they intertwine and the boundaries are blurring. Distinguishing them is for analytical purposes. Furthermore, in observed practises these diverse aspects may be operating simultaneously with patterns of peer interaction, as elaborated above. There are also pitfalls in peer learning as illustrated by Barron (2003, 313, quoting Sfard & Kieran, 2001, 70): “The road to mutual understanding is so winding and full of pitfalls that success in communication looks like a miracle.” For instance, in a study of first year undergraduate students Järvelä & Järvenoja (2011) identified a set of 5 categories that challenge peer collaboration: diverse personal priorities, goals and expectations may differ; group members may have different styles of working or communicating; some group members lack commitment to teamwork; challenges due to cognitive processes required in collaborative learning; external constraints. Barron (2003, p. 348) emphasise three pitfalls: competitive interactions, differential efforts to collaborate and self-focused problem-solving trajectories. 2.2. Principles versus practise Clearly, establishing learning-rich peer interaction is challenging. Group work ‘does not in itself constitute collaborative learning’ (Slavin, 1999, 650). Implementing a peer learning structure and providing guidelines do not ensure that peer learning takes place. For instance, Antil et al. (1998) found that while 93% of 85 school teachers claimed they practised peer learning, only five of 21 teachers interviewed (all indicating having daily peer learning activities) structured group work according to Slavin's (Slavin, 1999) criteria (positive interdependence and individual accountability), and only one also applied Johnson & Johnson's (1998) supplementary criteria (non-competitive group dynamics, interpersonal skills and group reflection). Littleton & Mercer (2013) found that most of the talk in classrooms tend to be disputational and cumulative, while exploratory talk—‘judged to be most educationally effective’ (p. 16)—is less common. In a recent article Deiglmayr & Lennart Schalk (2015, 77) argue, ‘a collaborative Please cite this article as: Havnes, A., et al., Peer learning in higher education: Patterns of talk and interaction in skills centre simulation, Learning, Culture and Social Interaction (2016), http://dx.doi.org/10.1016/j.lcsi.2015.12.004


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learning setting alone does not guarantee that learners will, in fact, engage in interactive learning activities. Consequentially, studies employing detailed analyses of the actually occurring learning activities, using process data, are needed.’ Slavin's (1999) warning not to conflate group work with peer learning needs to be taken seriously in research as well as in practise. Pitfalls in peer learning may be linked to the structure, interaction and problem/task-orientation, and these are closely interrelated (Table 1). Structuring is largely set prior to the interaction, yet also maintained or re-structured—explicitly or implicitly—as the interaction unfolds (Giddens, 1984). Interaction is the focus of this article, however, the institutional structuring will be elaborated in terms of the presentation of the peer learning context. 3. The context 3.1. Skills centre The skills centre is a hybrid learning setting within higher education modelled like a hospital ward. It consists of several rooms that open onto a corridor, each room furnished with beds and equipment similar to a hospital room. There is a built-in monitor in each room where students can watch videos of procedures and a table in the middle and cameras that allow video documentation of students performing procedures. Additional equipment is stored in the corridor along the rooms. The students and teachers dress as nurses and are expected to act as (simulate) nurses and patients. The setting is not high-fidelity training with computerised whole-body simulators; instead, it is a traditional low-fidelity simulation setting where students practise on each other. Learning in skills centres is seen as vital in preparing students for performing professionally in ‘real life’ (Wellard et al. 2009). It has a long tradition in nursing and other health education programmes globally (Scott, 2001) and is also used in clinical settings for professional development purposes. In the skills centre, students are able to practise within a safe environment before they move on to clinical placement (Freeth & Fry, 2005). It is rich in hands-on experience with equipment, possibilities to experience patient roles and potentially rich in terms of feedback (Nicol & Glen, 2004). While research mostly focuses on ‘how to do’ simulation and high-fidelity technologies, (Berregan, 2011; Ross, 2012), this project expands the focus by including detailed analyses of student interaction. 3.2. The skills centre setting and training observed The skills centre training was structured in three stages from 9:00 am to 3:00 pm. Prior to the simulation training the firstyear students prepared by reading and watching the video. In each of the rooms at the skills centre groups of 2–3 student tutors and 6–9 tutees met in the morning. Over a series of full day training programme the students practise a series of diverse nursing procedures. Two teachers monitored the skills training. Each training session had the following structure: (1) A pre-training supervision organised as a discussion on the procedures to be practised that day and their conceptual underpinnings. (2) Simulation training on distinct procedures. During the practical training the students were divided into groups of 3 tutees and one tutor, each group gathering around a bed to practise nursing procedures. In practical training the tutees rotated taking the roles of nurse, patient and observer. Peer feedback from both student tutors and peer tutees took place at each turn of roles. (4) A debriefing session organised as a post-training supervision where the students discussed experiences, provided feedback and summarised the simulation training. (5) At the end of the day, all (third-year) student tutors had a 45-min post-tutoring supervision session with two teachers, drawing on experiences from their role as tutors. During the tutoring, the teachers were available for support but were expected to interfere only when the teacher found that support was needed or was called upon by the students. The student tutors prepared the tutoring session in groups and were given full responsibility for planning and conducting the session. They had a peer tutor course at the beginning of the semester, emphasising how to create a dialogue with the first-year students and initiate reflection among the tutees. The use of open questions was emphasised. They were also responsible for the assessment of the first-year students at the end of the skills centre module. The assessment was based on individual performance of practical skills at the end of module exam, in which first-year students were to demonstrate nursing procedures and the thirdyear students observed and graded the first-year students in terms of pass and fail. Table 1 Aspects of learning-rich peer interaction. Structure

Interaction

Problem/task-orientation

Heterogeneity Group goals Positive interdependence Individual accountability Training/competence Social regulation Ground rules for talk

Engagement in each others contributions Exploration Different viewpoints Critical engagement Questioning Resolve uncertainty and disagreement Interthinking

Structuration space

Relation space

Engagement in problem/task Joint management of task Knowledge-building High-level content processing Cognitive restructuring Resolve cognitive conflicts Understand conceptual principles Metacognitive strategies Content space


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The structure afforded a combination of conceptual learning and practical training and consisted of part of the curriculum for both tutees and tutors: tutees learning nursing procedure and tutors relearning these procedures, but included instruction and supervision of less qualified peers. An interesting additional factor is that the first-year tutees would themselves take the role as tutor two years ahead, which might trigger engagement and a commitment to achieve in the situation. 4. Methodology The study is grounded on detailed analysis of interactional events and was partly inspired by micro-ethnographic approaches, in which detailed observations of interaction in natural learning environments is emphasised (Erickson, 1992; Watson-Gegeo, 1997). However, the analysis goes beyond interaction itself; it pursues the role of peer interaction in the development of professional competence. Our analytical strategy also had parallels with the three level analyses of sociocultural discourse analysis (Mercer, 2004; Littleton & Mercer, 2013), emphasising linguistic (exchange patterns), psychological (interests and concerns) and cultural (social norms) levels of analyses. The students recruited were enrolled in a four year part-time BA nursing programme. Many students also worked part-time as unskilled workers in nursing homes. The data collection extended over three years and covered three cohorts of students. Students' interaction in the pre-training supervision in the skills centre was videotaped. Video recordings were transcribed verbatim. The project was approved by the National Ethics Agency. Participants' consent was obtained. The video recordings and interviews were confidential, and the written data was anonymous. 4.1. Analysis We are four researchers with diverse disciplinary and professional backgrounds and expertise, diverse methodological training and theoretical foundations. Three had a nursing background, sharing an insider view and knowledge on nursing procedures. One was one of the teachers supervising the peer tutoring sessions, she was not involved in the data gathering, but contributed to the analysis. The analysis progressed in a step-wise manner; alternating between individual and collaborative analysis, watching video and reading transcripts, analysis and reviewing literature. In the early phase of the analysis, we applied an open, abductive and exploratory coding approach. According to Erickson (1992) this implied reviewing the whole event (the transcript and video-recording), searching for patterns, that is, classify sequences of interaction according to their specific characteristics. The unit of analysis was sequences of the interaction or chains of utterances of diverse length. The classification of the patterns of interaction was sustained by the exploration of linguistic cues implying diverse ways of positioning an utterance in the context of other utterances, i.e. leading up to or responding to other utterances. That is, the cohesive structure and topics of talk (Littleton & Mercer, 2013); how utterances or statements relate to each other. This could be illustrated by utterances that tended to challenge previous statements or suggest alternative interpretations or experiences concerning some content. For instance, we discovered that some sequences of the peer interaction raised topics beyond the performance of the technical nursing procedures and also included contrasting experiences based on work experiences. We found that there seemed to be potential conflicts of interests among group members concerning focusing on the procedures as prescribed techniques, on the one hand, and the application of the procedures in diverse practical settings, on the other. Furthermore, we found that there was a dominant pattern of student tutor initiation of discussions. We also focused on the content of the students' talk; the knowledge demonstrated and the contextualisation of knowledge. For instance, how accurate tutors' and tutees' knowledge was and the degree to which knowledge of the procedures was framed in a wider context of professional practise or more narrowly on the procedures as techniques. Diverse patterns in the interaction seemed to accommodate distinct ways of dealing with the object of learning — the content. We also explored how diverse patterns were initiated and by whom (e.g. by student tutors or by tutees) and potential interests and concerns were pursued (Mercer, 2004). We identified three main patterns of peer interaction: • Dispute-exploratory. Students questioning prescribed solutions, ways of doing procedures, statements by the tutor or other tutees or the framing of the given question or task. • Cumulative-exploratory. Questioning is mainly tutor-led and often has pre-specified answers, but the interaction following the question is an exploration of a range of possible interpretations, answers or solutions of the question raised. • Tutor-led questioning with pre-specified answers. This is a pattern characterised by the recitation of pre-specified content knowledge. While the identification of the patterns of interaction was grounded in an analysis of the full set of video data, we limit the data presentation in this article to one pre-training tutoring session that lasted 22 min. The data we present consisted of six first-year student tutees and two third-year student tutors as they discussed the theoretical and conceptual aspects of nursing procedures: donning and removing sterile gloves and wound dressing, consisting of two distinct procedures; clean and infected wounds. By focusing on one session, we emphasise how these patterns emerge, alternate and are intertwined in student interaction as they unfold even over a relatively short period. The main purpose of the data presentation and for focusing on one session was to illustrate the diverse patterns of interaction and their learning potential in the context of earlier research. Please cite this article as: Havnes, A., et al., Peer learning in higher education: Patterns of talk and interaction in skills centre simulation, Learning, Culture and Social Interaction (2016), http://dx.doi.org/10.1016/j.lcsi.2015.12.004


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As the analysis evolved, we found that the patterns of peer interaction had aspects that go beyond how peers interact. In addition to illustrating diver ways that the group members interacted, these patterns also constituted diverse ways of dealing with the object of learning. We could additionally identify three ways of dealing with the object of learning: • Recitation • Recontextualisation • Thematic errors and sloppiness To a large extent a review of the higher education peer learning literature was done prior to the data gathering. As part of the analysis the review was extended, first to include literature on classroom talk and peer interaction in schools, later also to include peer assisted learning, supplemental instruction, group mentoring, peer-supported learning, interthinking and socially shared regulation of learning. From this vast and rich literature (e.g. Arendale's (2015) annotated bibliography of diverse models of peer assisted learning in higher education being a compilation of more than 1000 references) only a selection has been included in the article. The extended literature review further strengthened and enriched the original analysis. 5. Results Keeping to the configuration of principles of learning-rich peer interaction, we begin by addressing the dynamics of student interaction. Next, we illustrated that diverse patterns of peer interaction are potentially associated with ways of relating to the object of learning. It implies starting with the interaction space and taking the analysis to the content space (Table 1, Barron, 2003). 5.1. Patterns of interaction 5.1.1. Dispute-exploratory Excerpt 1 illustrates the dispute-exploratory pattern. A tutee challenges an authoritative ‘voice’, that is, what is said in a digital manual, about arranging a wound-dressing situation. The episode followed a nine-minute sequence dominated by the questionand-answer structure (see section 5.1.3). One of the student tutors asked whether the tutees had any questions. Excerpt 1. 1. S1: I have read that you should not use [...] the bedside table [on which to place the sterile equipment — authors], but what then should you use? In nursing homes, this is what is mostly used. 2. S2: A chair is too low. 3. S1: Yeah. 4. T2: Do you know why the bedside table should not be used? 5. S1: Because there might be food on it. That's where we put the patients' food, water and... 6. S3: But it can be sterilised... wipe it with a cloth, then it should be OK? 7. S1: On PPS [the digital manual explaining and showing how to conduct procedures], it is said that you should not use it. 8. T2: OK 9. S1: But what should we use then? 10. T2: It could have to do with the waste then, or…? 11. S1: Perhaps 12. T2: Because you can have it [the waste] at the end of the bed. 13. S4: You should use the triangular... you should not put the unclean material back on the table. 14. T2: But I have always used the bedside table... or mostly, generally. 15. S1: Yes, most people do. 16. S2: It [PPS] says bedside table or a chair. But that is an inadequate height to work in. But just... you wipe it off first — and afterward, of course. 17. S1: In the nursing home, we had a trolley that they... when they do wound dressing... that we can use. The nurses can put it [the package with sterile bandage] there and then take it to the patient. 18. T1: Well, here we use the bedside table, at least, yeah. 19. S1: Then it should be sterilised first. 20. T1: We wipe it off with some alcohol and let it dry for a couple of minutes, or a minute; then it is ready to be used. 21. T2: But must it be disinfected? You have the sterile paper [that the sterile bandage is wrapped up in] … or the package is sterile, so the surface will be sterile; will it not? 22. T1: Yes, in a way, but according to the book, we should wash it off (laughter) 23. S2: Wash it, yes, but I do not think it is necessary to disinfect it. 24. T2: [Addressing a teacher who had just arrived] What do you think? 25. Teacher: Wash 26. T2: Wash? Yeah... 27. T1: Then we have the answer to that. 28. Teacher: It is only on the inside of the package that it is sterile; see? Please cite this article as: Havnes, A., et al., Peer learning in higher education: Patterns of talk and interaction in skills centre simulation, Learning, Culture and Social Interaction (2016), http://dx.doi.org/10.1016/j.lcsi.2015.12.004

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29. T1: Yes, isn't it. 30. Teacher: You cannot sterilise the table; it is only the package that you have that is sterile. In this case the student tutor passed on the initiative to the tutees: Do you have any questions? However, the problem was raised by a tutee (1), and it addressed a contrast between her work experiences and how wound dressing is prescribed in the digital manual (PPS). She pointed to a tension between what the work setting affords and the routines recommended in the manual. The subsequent interaction went beyond the question-and-answer pattern, potentially scaffolded by T2 responding by raising an open question (4). At one stage, T2 challenged the other tutor (21). The discussion was no longer tutor-led; instead, the tutors were driven into discussing the problem raised by one of the students. T1 stuck to an authoritatively prescribed way of doing the procedure (18) while T2 deviated from her superior position as ‘more competent’ and became a discussion partner, joining the tutees in searching for alternative understandings and ways of solving the problem. Questions and comments by both student tutees and tutors were a follow-up of previously posed questions or comments. Questions and tutors' engagement were embedded in the tutees' questioning and discussion. For instance, one tutee said ‘But what should we use then?’ (9), with a tutor responding, ‘It could have to do with the waste then, or…?’ There was a flow of critical reflection, exploratory talk, confrontation of diverse perspectives—even within utterances (1, 16)—and argumentation in the discussion that included both tutees and tutors, until the teacher was invited in. The question to the teacher (24) had a striking impact on the discussion. There was no reference to the question that prompted the debate (1) or the diverse views expressed by the tutors and the tutees. The teacher's response was short: ‘Wash’ (25). It presented a ‘correct’ answer, particularly acknowledged by T1 (27). The teacher's statement was followed by a short elaboration on the clean/sterile issue (28, 30); it represented an authoritative answer that ended the discussion. The teacher did not respond to the issue raised by S1 (1), possibly because she had overheard only part of the discussion (e.g. utterance 23), to which a correct/incorrect response is appropriate. 5.1.2. Cumulative-exploratory Excerpt 2 illustrates the pattern of a more cumulative mode of interaction, yet can be understood as exploration. The proceeding discussion entailed wound dressing and the handling of sterile bandages. The student tutor's initial question marked a change of topic, though still in the context of wound dressing. Excerpt 2. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41.

42. 43.

T2: Very good. Why do we use an apron? S5: For example, to protect our working clothes. S2: I would think it is primarily to protect the patient. S3: Protect the patient from us. S5: Even though our working clothes should be clean… S2: But not sterile. But, then, an apron isn't either, in fact. T2: It is to protect us mainly from waste coming from the patient. S5: And who was it that said...was it you [addressing another tutee] who said that you should not talk while you [do wound dressing]... S4: Yes, that was our supervisor last time who... S2: You should not bend over... [Another student demonstrates by using her hand to show how spit might come from your mouth when you talk] S1: There was one who meant that you do not need a mask when doing wound dressing, but I said that you need it because if there are two [nurses] doing the wound dressing, there might be spit or particles coming from our mouths; then you can... T2: Avoid talking... S2: Use a mask...

Again, we have an example of potentially contrasting views (32 versus 33). There was no dispute or disagreement in this example, there was, rather, a joint search for multiple explanations. In isolation, the initial question (31) could be seen as a closed one. Yet, the main dynamic in the interaction was initiated by the utterances of the tutees (particularly S2 and S5), that is, the diverse answers to the questions, not the question-answer linkage. While the first tutee's response was a reply to the tutor's question, the second was an alternative response to the first tutee, as much as an answer to the initial question. In (38), a student tutee raised a parallel issue, which led to other explorations among the student tutees (40, 41) and one student tutor joining in (42). As a whole, it was the chain of tutee utterances that brought the discussion further into the thematic field. The tutees brought in alternative views and perspectives to supplement previous utterances. The comments from the tutor were in line with the utterances from the tutees, which made the tutor–tutee interaction a joint sharing of ideas and knowledge. This communication pattern could be framed as cumulative-exploratory talk, with the tutor (T2) taking on the role as discussion partner rather than that of a superior. 5.1.3. Question-and-answer The student tutors were trained to pose open questions, initiate reflection and active participation among the tutees and to focus on facts. Yet, the question-and-answer pattern was established at the very beginning of the tutoring situation by T1 saying Please cite this article as: Havnes, A., et al., Peer learning in higher education: Patterns of talk and interaction in skills centre simulation, Learning, Culture and Social Interaction (2016), http://dx.doi.org/10.1016/j.lcsi.2015.12.004


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‘The purpose — what is the purpose of wound dressing?’ In this pattern of talk, following shortly after, the question had a prespecified answer, as illustrated in Excerpt 3. Excerpt 3. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56.

T1: S2: T2: S6: T2: S2: T2: S6: T2: S2: S6: S2: T2:

If there are infections or such, how can we see it? You smell or take tests. There are sort of four signs of… Colour — yellow, green... Mmm… And then you have… The patient's temperature What about red? Red is a sign of infection. Mm… And… there are three signs characterising infection. Swelling The temperature Pain Mm… Very good.

In isolation, the initial question could be interpreted as an open one, but the follow-up questions clearly communicated that the tutor expected a pre-specified answer from the tutees. The subsequent ‘fishing’ for the correct answer was a way of scaffolding recitation. When the tutor was satisfied with the answers, she moved on to the next question or theme. There was an aspect of cumulative interaction, however, within a question-and-answer pattern, possibly due to the complexity of the object of learning. 5.2. Ways of dealing with the object of learning The focus on content-related aspects of peer learning moved the analysis beyond the issue of how peers interact to how diverse ways of interaction potentially transform the object of learning and, presumably, student learning and the learning outcomes. From this observation we expanded the analytical focus to include how the object of learning was co-constituted through content-related interaction. We then identified three ways of dealing with the object of learning interweaved with the patterns of interaction. 5.2.1. Meeting expectations through recitation In spite of being trained to ask open questions and initiate tutees' reflection, the typical tutor approach often seemed to expect specific answers in terms of how topics were introduced (Excerpts 2 and 3). A correct answer to the question was met by confirmation by the tutor, or a request for further information. There was no need for elaboration by any of the participants. The frame of reference was the curriculum and authoritative knowledge specified in a digital training programme (PPS) and handbooks. 5.2.2. Meaning-making through recontextualisation In contrast, the cumulative-exploratory and dispute-exploration patterns of peer talk were characterised by tutees suggesting additional or contrasting interpretations and viewpoints, discussion and attempts to resolve uncertainties and disagreements. In Excerpt 1, the context of reference for discussing wound dressing included a range of different practical conditions in a hospital ward or nursing home. Thus, the object of learning, and the context of meaning-making of nursing procedures, was expanded beyond the immediate educational setting and curricular learning (Excerpts 1-1). This kind of knowledge-building through exploratory talk and contrasting views occurred in spite of one of the tutors' attempt to narrow the discussion to focus on the procedure, independent of context, or as practised in the skills centre setting (e.g. 21). On the one hand, the guidelines for wound dressing and putting on sterile gloves are concrete and detailed. The tutees were expected to learn how to perform the techniques as well as to conceptualise why, when and how to use sterile gloves. While the student tutors tended to focus particularly on facts and details, on some occasions, the tutees raised issues from the perspective of performing the procedures under diverse work conditions — a hospital ward, a nursing home or a patient's home (Excerpt 1) — and in such ways, introducing other conditions under which to perform the procedures. 5.2.3. Thematic errors and sloppy talk The third way of dealing with the object of learning is more directly related to content knowledge and professional concepts and practises across the diverse patterns of interaction. It also has to do with incorrect or inaccurate uses of terminology. For instance, the students made linkages between the use of sterile gloves and wound dressing. Sterile gloves are expensive and should be used only when needed. They are not needed when the wound is infected; instead the nurse would then use disposable gloves to protect him/herself. Sterile gloves are used to protect the patient from the surroundings, which is the case when the wound is not infected. The dressing of infected and uninfected wounds thus involves diverse procedures, only one requiring sterile gloves. In the context of such more precise conceptual issues, the students — both tutors and tutees — engaged in many instances of thematic errors during their talk. Please cite this article as: Havnes, A., et al., Peer learning in higher education: Patterns of talk and interaction in skills centre simulation, Learning, Culture and Social Interaction (2016), http://dx.doi.org/10.1016/j.lcsi.2015.12.004

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6. Discussion All three patterns of interaction would be in the category of engagement in the perspective of Barron's (2003) categories. There were no unconstructive, competitive disputes as described by Littleton & Mercer (2013), at least not openly expressed. The observed patterns of talk categorises three modes of engaged peer interaction, and the engagement was in the content. How they interacted and how they related to the content was to some extent related. While our analysis largely supports the conceptualisations of peer interaction that was summarised in the review part, it addresses the issue of how diverse patterns of peer interaction relate differently to the content, or object of learning, and thereby, potentially to what students learn. Broadly speaking, the three patterns of peer interaction identified can be distinguished according to two main categories. One being the degree to which the tutor–tutee relationship was tutor-driven; tutors asking questions and tutees responding. The cognitive process implied finding the expected or pre-defined correct answer. The curricular learning material was the key point of reference, and the present situation constituted the discursive context. In these respects the question-and-answer pattern has similarities with delivery of knowledge (Roscoe & Chi, 2007), for instance, the “fishing” of correct answers. In contrast, in the patterns of dispute-exploratory and cumulative-exploratory the tutees actively took part in initiating the topics or adding new dimensions. In both cases wider issues, beyond the question being asked, were raised. The interaction had the characteristics of problem-solving, inclusion of alternative solutions as well as the raising and reframing of problems. Contrasting views were proposed, elaborated and argues were made, but this was distinct for dispute-exploratory interaction. These occasions of exploration and dispute resonate with aspects of peer interaction that support learning: Littleton & Mercer's (2013) notion of exploratory talk, Roscoe & Chi's (2007) notion of knowledge-building and Khosa & Volet's (2013) notion of high-level content processing. When tutees introduced new, and for the tutors unexpected, themes in the way S2 did in Excerpts 1–2), it can be understood as an example of cognitive conflict in a Piagetian way. In the context of peers' arguing, we can also assume that some degree of sociocognitive conflict was created (Nussbaum, 2008), which could be associated with a Vygotskian perspective. To conceptualise the observations of how diverse patterns of interaction seem to generate diverse ways of dealing with the object of learning, we need to look beyond the peer learning literature. While our data illustrates that the question-and-answer pattern may restrict learning to the recitation of curricular knowledge, the re-contextualisation of patterns expands the object of learning and includes potentially diverse contexts of application of curricular knowledge. From an activity theory perspective, Engeström (1987a, b) depicts the activity of learning in schools predominantly as ‘schoolgoing’: the context of meaning-making of learning tends to be the curriculum and preparation for the examination. In contrast, Engeström frames ‘expansive learning’ as dealing with a current task in a wider perspective of social practises, beyond the current situation and beyond established knowledge. In professional education, such an expansive approach is particularly essential. For instance, Grimen (2008) underscores that professional education is heterothetic, meaning that the aim of the programme (the context of making meaning of the object of learning) is outside of the programme itself. Professional knowledge achieves legitimacy in the field of practise. This issue brings us back to the skills centre as a learning context, which is a simulation of a professional work context. In a preceding section, we described the skills centre as an on-campus hybrid learning setting which mimics ‘real life’ work situations, most commonly, a hospital setting, building on the idea of ‘real life’ replication (Bland et al. 2011). There is an assumption that the imitation of ‘real life’ ensures transfer (Lynagh, 2007; Wellard et al. 2009). In the dispute-exploratory and cumulative-exploratory interaction patterns, the replication metaphor does not hold. In line with van Oers (1998, 474), we see context under these circumstances not only as ‘a concrete external situation, but it can assume the character of a mental framework as well’. It implies emphasising contextualisation as an act rather than as a context in a given circumstance. The disputeexploratory interaction pattern illustrates that contextualisation is an active process of ‘adding new meaning to a given situation in order to characterise this situation in terms of what could (or should) be done’ (482). According to this perspective, human action (e.g. simulating a nursing procedure) gains meaning by the values attributed to sociocultural activity that is beyond the concrete context. Contextualisation is ‘the result of a process of identification of a situation as a particular activity-setting’ (482) that exceed beyond the actual context). Contextualisation also implies re-contextualisation, for instance, by reframing theory and research-based knowledge as practical knowledge and re-situating the skills centre experiences to external contexts like a hospital ward (Excerpt 1). These expanded learning processes are potential aspects of the current situation. Van Oers (1998) regards these active processes of contextualisation and re-contextualisation as key aspects of all learning. They are also crucial aspects of simulation learning. Exploring the process of contextualisation implies focusing on student participation in the on-going activities. However, the object of learning is transformed in the process of how students interact in meaning-making processes. Thematic errors and sloppiness become interesting when framed in the context of learning as a process of change and move from not knowing, via inaccurate knowing and talking, to accurate professional communication. In strict professional terms, sloppy terminology should be avoided. Notably, in Excerpt 1, the teacher corrects the students' sloppy talk about cleaning/sterilising the bedside table. We would expect more sloppy talk in peer learning situations than in teacher-led activities. The sloppy use of terms may be understood as a stage in the process of professional learning and development; a stage in the process of professional development and the move from a peripheral to a full participation in a community of practise (Lave & Wenger, 1991). Vygotsky (1962) makes a distinction between everyday and scientific concepts. Vygotsky's point is that the gradual internalisation of scientific concepts implies replacing the everyday meanings of words with their scientific meanings. He sees this process of concept formation as an essential aspect of formal learning. The distinction between clean and sterilised is inevitable in nursing practise with patients, but it is no surprise that first-year students employ the everyday meanings of these Please cite this article as: Havnes, A., et al., Peer learning in higher education: Patterns of talk and interaction in skills centre simulation, Learning, Culture and Social Interaction (2016), http://dx.doi.org/10.1016/j.lcsi.2015.12.004


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Table 2 Patterns of interaction — relation space and content space. Pattern of interaction

Relation space

Content space

Question-and-answer Cumulative-exploratory Dispute-exploratory

Hierarchical roles are stated and accepted Hierarchical roles are challenged Roles are opened for transformation and co-construction

Agenda is set and the object of learning is predefined Agenda is set, but the object of learning is re-defined Agenda is challenged and the object of learning transformed

words, which is sloppy in a professional context. In these respects the “sloppy talk” and thematic errors could be understood in diverse directions. On the one hand, students' learning outcomes might be incorrect. On the other hand, the peer interaction setting provides an opportunity to practise the use of scientific concepts and a professional terminology. In the latter case “sloppy talk” could be understood as professionalism in progress. Learning the professional language is an essential part of professional education, which Littleton and Mercer emphasise when discussing peer interaction in work contexts (Littleton & Mercer, 2014, 28). Table 2 summarises key aspects of the three patterns of interaction in terms of how peers interacted and how they dealt with the object of learning. Essentially, we can expect that students learn in all these patterns of interaction and ways of dealing with the object of learning. However, we might expect that the learning outcomes vary. The three patterns of peer interaction that we have identified represent diverse ways of dealing with, or constituting, the object of learning that we could describe as argumentative, cumulative and “giving the correct answer”. The question-and-answer patterned tended to restrict the context of meaning-making to the procedure as technique (which it also is) and the educational setting, that is. The curriculum and the prescribed procedure guidelines were taken as frame of reference. The more expanded way of dealing with the object of learning in the dispute-exploratory patterns of interaction had recontextualisation as an essential element, which was not on the agenda for the student tutors. While Littleton & Mercer (2013) depict dispute as a not-productive pattern, in our analysis it stands out as potentially the most learning-rich pattern, because it opens a wider context of understanding a task or responding to a question. Interestingly, when Littleton and Mercer analyse interaction in the workplace, dessent (in contrast to ‘groupthink’) is a key aspect of interthinking (24–27). On this background the differences between our interpretations and some of the interpretations of peer interaction in schools might be explained by professional education being the context in which peer learning has been analysed. However, the emphasis on recontextualisation as a core aspect of peer learning challenges the perspective on simulation learning in skills centres being labelled as ‘real life’ replication (Bland et al. 2011). This study has illustrated that in the perspective of student learning of nursing procedures it includes understanding the skills in context. Interestingly, it was the tutees, those who were the key learners, that expanded the object of learning to include the skill in diverse contexts. We have explored peer learning in a cross-level peer tutoring structure as a social setting, which is a different setting than, for instance, classroom talk in schools (e.g. Littleton & Mercer, 2014) and problem-solving groups (e.g. Barron, 2003). As student tutors these third year students are given a position that in most cases would be a teacher position. The risk is that they take on the role of teachers that they are not prepared for, as they do not have the competences — with respect to conceptual understanding and professional skills. 7. Conclusion The starting point of this analysis rested on the assumption that peer interaction is a potentially powerful scheme for promoting learning. However, there is no guarantee that organising group work among student will, in fact, do so. Peer interaction and group work are not synonymous with peer learning. Peer interaction fosters learning under certain conditions. An implication could be to conceptually distinguish between peer interaction and peer learning. Our focus has been on modes of interaction and ways of dealing with the object of learning. The analysis has advanced potentially learning-rich dimensions of peer interaction in terms of illustrating, for instance, contrasting opinions, exploratory talk and argumentation appearing in dispute-exploratory and cumulative-exploratory patterns of interaction. The disparities particularly emerged in that the patterns of dispute-exploratory and cumulative-exploratory, and the contrast between these exploratory patterns and the question-and-answer pattern. We have further expanded the conceptualisation of peer learning by identifying links between modes of interaction and ways of dealing with the object of learning. Interestingly, we found that it tended to be the student tutees who raised the critical questions, challenged the textbooks and expanded the context of meaning-making beyond the present context of the skills centre, the training session and the curriculum. We found joint task engagement across all patterns, which might be an effect of simulation learning and the content being identified as crucial for professional practise and nursing students' achievements in placement. It also needs to be added that peer learning settings are complementary to other forms of curricular structures and processes. To further develop the understanding of peer learning, we need to also explore the details of how peer learning emerge from peer interaction as well as how peer interaction is integrated in the programme structure of higher education. References Antil, L.R., Joseph, R., Jenkins, J.R., Wayne, S.K., & Vadasy, P.F. (1998). 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