Practice education: A snapshot from Australian university programmes

Mapping Simulated-Based Learning Experiences Incorporated Into Professional Placements in Allied Health Programs: A Scoping Review

SUMMARY STATEMENT

Emerging literature continues to demonstrate the use of innovative practices such as simulated-based learning experiences to prepare students for professional placements. This scoping review aimed to provide a broad overview of how simulated-based learning experiences have been implemented within or immediately before the professional practice placements of entry-level allied health programs. Four databases (MEDLINE, EMCARE, CINAHL, and Scopus) were searched up to August 2020. Kirkpatrick's evaluation framework was used to categorize outcomes, and the Simulation-Based Research Extension for the CONSORT statement was used to appraise the quality of simulation reporting. The search revealed 6584 unique abstracts with 321 full-text articles reviewed. Forty-eight studies met the inclusion criteria. This review has shown a clear trend toward using simulation within or immediately before the professional practice placements of allied health programs. Using Kirkpatrick's evaluation framework, most studies reported on student reaction (level 1) and learning (level 2) obtained during the simulation experience. There was limited evidence showing how the benefits gained in simulation translated to the clinical environment (level 3) or impacted the organization (level 4). Further research is required to review the optimal proximity of simulation to allied health professional placements and how gains are obtained from simulation transition to the clinical environment. In addition, more consistent reporting of simulation methodologies and evaluation methods are needed to strengthen the evidence base.

Competition or collaboration in regional Australia? A cross-border and multi-university approach to maximising rural health investments, community health and health workforce outcomes

AIM

To describe the establishment of a cross-border and multi-university collaboration in rural Australia to mitigate potential competition, maximise Rural Health Multidisciplinary Training (RHMT) Programme investments and regional health workforce outcomes.

CONTEXT

Rural Health Multidisciplinary Training programme investments have enabled the establishment of 19 Australian University Departments of Rural Health (UDRH) and 17 Rural Clinical Schools. The importance of these investments is acknowledged. However, in regional settings, due to limited clinical placement and training opportunities, there is potential for heightened competition between universities who are operating within shared geographical footprints. Competition between universities risks focusing RHMT programme activity on individual reporting requirements and activities, in preference to: regional needs; existing community-university relationships; and place-based approaches to health workforce development.

PARTICIPANTS

A rural New South Wales and Victorian RHMT-funded departments, collectively known as the Sunraysia Collaboration.

APPROACH

Strategic and operational processes, structures and actions underpinning collaboration formation and relationship consolidation will be described. Co-design methodologies employed to collectively define collaboration vision and aims, governance framework and guiding principles, reporting structures and co-contributions to teaching, research and service will be discussed. Collaboration sensitivity to the social, cultural, relationship and economic connectedness within the region and existing health workforce flows will also be explored.

CONCLUSION

The Sunraysia collaboration demonstrates one approach towards mitigating potential competition between RHMT Programme funded universities within rural and remote Australia. The collaboration is an exemplar of co-design in action providing an alternative approach to address RHMT Programme parameters and regional needs whilst supporting rural-remote health workforce training and education innovations.

Development of the Student Practice Evaluation Form - Revised (Second Edition) (SPEF-R2): The second action research cycle

INTRODUCTION

The Student Practice Evaluation Form - Revised Edition (SPEF-R) was used across Australian universities from 2008 to 2020 to assess occupational therapy student performance on practice placement. Evolution of practice contexts, placement models and professional competency standards prompted updating of the tool. This paper describes the second and final action research cycle in the development of the SPEF-R2.

METHODS

Cycle 2 included three phases: (a) piloting of the SPEF-R2 and post-pilot survey to determine utility and applicability; (b) post-pilot focus groups/interviews; and (c) final amendments for publication and launch. Quantitative data were summarised descriptively, and qualitative data were analysed using qualitative content analysis and reported using illustrative quotes.

RESULTS

In Phase 1, 23 participants piloted the SPEF-R2 and completed a post-pilot survey. Results indicated participants found the SPEF-R2 relevant to a range of traditional and contemporary settings, easy to understand and an improvement over the previous version of the tool. Most participants found it more concise and less repetitive than the SPEF-R. Participants particularly valued additions regarding culturally responsive practice, student health and well-being and reflective practice. In Phase 2, five post-pilot focus groups/interviews were held, gathering a deeper understanding of its utility. Discussion highlighted desire for an additional core item within the self-management domain (Domain Two). Increased confidence in rating and provision of feedback on student performance were also evident. Reflection on findings led to final amendments and publication of the SPEF-R2.

CONCLUSION

Extensive consultation with the occupational therapy community informed the development of the SPEF-R2, reflecting contemporary practice and meeting the expectations of Australian occupational therapists. Action research was an effective approach to the development of the SPEF-R2. Use of the manual and training website and support from universities are paramount if practice educators are to use the tool effectively.

Learning occupational therapy practice using standardised patients in a practical examination - experiences of students and teachers

BACKGROUND

The use of simulated learning activities in occupational therapy education has emerged in the past decade. Studies describing experiences of using standardised patients in practical examination in occupational therapy is lacking.

OBJECTIVE

To describe teachers' and students' experiences of a newly implemented practical examination in occupational therapy education using standardised patients.

MATERIAL AND METHODS

A qualitative study using data from student questionnaires, a focus-group with five teachers, and teachers' reflective diary notes. Data were analysed with problem-driven content analysis.

RESULTS

Three categories were identified: The practical examination as a learning situation included a structured learning environment and scenarios with standardised patients with the right level of complexity. The teacher's role was influenced by the educational approach applied to create equal conditions for all students, students' thoughts about being assessed and the teachers' emphasis of being well prepared. The examination was an opportunity for developing practical skills. The students valued being prepared for clinical practice and the teachers valued the examination as a bridge between theory and practice.

CONCLUSION AND SIGNIFICANCE

A carefully planned practical examination can contribute to developing professional occupational therapy competences and is a tool for educators to replicate the authentic clinical settings students encounter in fieldwork.

Student-resourced service delivery of occupational therapy rehabilitation groups: patient, clinician and student perspectives about the ingredients for success

BACKGROUND

A number of innovative models of student practice placements are emerging due to pressures on universities to provide quality practice placements and on health services to deliver rehabilitation efficiently, safely and cost-effectively. The student-resourced service delivery (SRSD) group program is one such model in occupational therapy. There is a paucity of research evidence to guide services in planning, implementing and evaluating the SRSD model.

OBJECTIVE

The study aimed to explore and identify the factors that key stakeholders perceived as contributing to the successful development and implementation of the occupational therapy student-resourced service delivery group programs.

METHODS

Participants in this multi-site study were rehabilitation inpatients, clinicians, Clinical Education Liaison Managers and students completing practice placement in the student-resourced service delivery group program. Data were collected using face-to-face semi-structured interviews and focus groups.

RESULTS

A total of 83 participants consented to the study. Four themes emerged from the data. Planning needs to be an iterative process that commences before and continues during the program. Support processes need to be established for students and clinicians during and across placements. The creation of an engaging, client-relevant and graded group dynamic is critical for success. Establishing a culture whereby groups are valued by the clients, therapy and multidisciplinary teams is important.

CONCLUSIONS

The above-mentioned factors were perceived as contributing to successful operationalisation of a student-resourced service delivery group program, and may be helpful when developing student-resourced service delivery professional practice placements in other settings.IMPLICATIONS FOR REHABILITATIONStudent-resourced service delivery of groups are one way to achieve additional professional practice placements for students and delivery of therapy services for patients.Ongoing investment for planning and preparation, provision of continual support for students, a culture of valuing groups and students, and creating a group dynamic that engages group participants were perceived by stakeholders as key ingredients for successful implementation of the student-resourced service delivery group model.Clinicians and educators are encouraged to use the perceived success factors identified in this study as a resource for future student-resourced service delivery program development.

Development of the Student Practice Evaluation Form-Revised (Second Edition) (SPEF-R2): The first action research cycle

INTRODUCTION

The Student Practice Evaluation Form-Revised Edition (SPEF-R) is used by all Australian universities to assess the capability and performance of occupational therapy students on block practice placements. The occupational therapy landscape in Australia has evolved significantly since the SPEF-R was developed. This study aimed to review the SPEF-R and develop a revised edition, the SPEF-R2.

METHODS

The first cycle of an action research process involved four phases: (a) mapping the SPEF-R to the Australian Occupational Therapy Competency Standards 2018 (AOTCS); (b) development of the SPEF-R2; (c) national consultation through an online survey with clinicians, university staff and students; and (d) reflection and further amendments.

RESULTS

In phase 1, good alignment was found between the AOTCS 2018 and the SPEF-R. In phase 2, the SPEF-R2 was developed to further enhance alignment, including expanded content related to culturally responsive practice, reflective practice and clinical/professional reasoning, resulting in two items being added to the tool. Further wording adjustments were made to improve clarity, reduce duplication and improve relevance to the contemporary occupational therapy landscape. In phase 3, survey results indicated that the SPEF-R2 was well received overall, with most participants viewing it as an improvement on the SPEF-R. Cultural content and reflective practice additions in particular received positive feedback. Concerns were raised by some participants, including perceived repetition, the length of the tool and time required for completion, and addressed by further amendments in phase 4. Three items were removed or consolidated elsewhere, and three items became core items.

CONCLUSION

The Australian occupational therapy community considers the SPEF-R2 to be a timely and much-needed development. Piloting of the SPEF-R2 and final revisions prior to release are planned for subsequent action cycles and amendments will be made to the online platform and associated training resources.

‘You actually see what occupational therapists do in real life’: Outcomes and critical features of first-year practice education placements

Introduction

First-year practice education placements have numerous benefits for occupational therapy students but are resource intensive. In considering alternatives, it is critical to consider students’ voices to ensure that planned experiences enable students to achieve the outcomes they value and need. This study examined undergraduate occupational therapy students’ views about important outcomes and characteristics of first-year placements.

Methods

Focus groups were conducted with 18 occupational therapy students and analysed using constant comparative analysis.

Findings

Two overarching outcomes were valued: confirmation of occupational therapy as a career choice and experience to draw on for future learning and practice. These outcomes were achievable through four proximal outcomes: understanding occupational therapy; understanding clients; finding out about myself and developing skills. The extent to which the valued outcomes were attained was determined by eight critical experiences: observing an occupational therapist in action; seeing real clients with real issues; seeing positive impact; seeing the bigger picture; accessing the occupational therapist’s reasoning; hands-on doing; getting feedback on skills and thinking analytically/reflectively.

Conclusion

In designing first-year placements, practice educators and academics need to ensure that students are provided with experiences that incorporate reality, participation and making connections to a bigger picture of occupational therapy service provision.

Allied health pre-entry student clinical placement capacity: can it be sustained?

Objective Meeting the demand for clinical placements in an environment of increasing university cohort growth and changes in health service delivery models is challenging. This paper describes the outcomes of a quality review activity designed to gain key stakeholder perspectives on the enablers and barriers to sustaining effort to placement provision and reports on: (1) measures used to determine the effect of a jurisdiction-wide initiative in clinical education for five allied health professions; (2) outcomes of data related to key factors affecting placement supply and demand; and (3) qualitative perspectives from management, workforce and university stakeholders on placement sustainability. Methods This study reviewed clinical placement, staff full-time equivalent numbers, university program and student cohort data for five allied health professions from 2013 to 2016. In addition, qualitative response data from key stakeholder surveys was analysed thematically. Results In the study period, the rate of growth in placement offers did not match that of university program student numbers and full-time equivalent staff numbers. All stakeholders agreed that sustaining placement provision is enabled by collaboration, continuation of management support for dedicated clinical education staff, a focus on clinical education capacity building activities, outcome data reporting and statewide profession-specific governance, including leadership positions. Collaborations and networks across health and education sectors were reported to enhance efficiency, minimise duplication, streamline communication and support information and resource sharing within and across professions and stakeholders, ultimately sustaining placement provision. Identified barriers to sustainability centred on resourcing and the continued increasing demand for placements. Conclusion Sustaining pre-entry student placements requires stakeholder flexibility and responsiveness and is underpinned by collaboration, information and resource sharing. Dedicated clinical education positions were highly valued and seen as a key contributor to placement sustainability. What is known about the topic? The increasing demand for student placements and strategies used to enhance placement capacity are well known. To date, there have been limited studies investigating cross-sectoral trends and health service enablers and barriers to sustaining responses to placement demand. What does this paper add? This paper describes outcomes of a clinical placement capacity building initiative within public health services, developed from a unique opportunity to provide funding through an industrial agreement. It presents key allied health staff and university partner perspectives on enablers to sustaining placement supply in an environment of increasing placement demand. What are the implications for practitioners? This paper demonstrates that key enablers for the sustainability of placement provision are collaboration between university and health sectors, continuation of management support for dedicated clinical education staff, outcome data reporting and statewide profession-specific governance and leadership. It supports current practices of profession-specific and interprofessional clinical education resource and strategy development and the sharing of expertise for sustained placement provision.

Thriving in an expanding service landscape: Experiences of occupational therapists working in generic mental health roles within non-government organisations in Australia

INTRODUCTION

Occupational therapists are an integral part of Australian mental health services. Recent changes in the mental health sector mean that increasing numbers of occupational therapists now work in generic, non-profession-specific roles in non-government organisations. Previous research has identified a range of challenges faced by occupational therapists in generic roles, including reduced satisfaction and loss of professional identity. An exploration of potentially positive aspects and strategies that assist occupational therapists to succeed and flourish within generic roles is lacking. The aim of this study was to explore what assists occupational therapists to thrive within generic roles in Australia's non-government mental health sector.

METHODS

Semi-structured, in-depth interviews were conducted with 12 occupational therapists working in generic mental health roles across three non-government organisations spanning three Australian states. Data were analysed thematically using constant comparative analysis.

RESULTS

Thriving was supported in three domains. First, occupational therapists facilitated their own thriving by keeping their occupational therapy lens, and managing ambiguity. Second, workplaces were supportive when their values aligned with occupational therapy core values, they recognised and valued the occupational therapy contribution, and their roles allowed opportunities for therapists to use their profession-specific skills. Third, the broader occupational therapy profession assisted thriving through preparation, validation and ongoing inclusion.

CONCLUSION

Despite some challenges, occupational therapists can and do thrive in generic non-government mental health roles. The preliminary framework of thriving provides valuable insights for those developing university curricula, those providing continuing professional development opportunities and for individual occupational therapists entering this expanding area of practice. Findings also provide insights into how individuals, academic curricula and the profession can respond and adapt to systemic transformations occurring in mental health service delivery.

Peer Assisted Study Sessions (PASS) preparing occupational therapy undergraduates for practice education: A novel application of a proven educational intervention

BACKGROUND/AIM

With rapid growth in occupational therapy education programmes across Australia and a corresponding increase in demand for placements, there is a need to ensure that students are well prepared for practice education. An occupational therapy education programme at a Victorian university introduced a specific Peer Assisted Study Sessions (PASS) programme to develop students' preparedness for practice education, supplementing core and existing teaching activities. The aim of this study was to explore the experiences of occupational therapy students, including their perception of its impact on learning and preparation for practice education.

METHODS

Using a phenomenological approach, semi-structured interviews were undertaken with 15 students who participated in PASS for Placement, 2 of whom were the student leaders. Interviews were transcribed verbatim and thematically analysed.

RESULTS

Seven themes emerged from the data: a safe environment; skill development; one of us; feeling connected; student-centred and student-led; different motivations; and learning through leading. Students were positive about the impact of the programme on their confidence and readiness for practice education. Student leaders also reported that it contributed to the development of leadership skills and overall levels of confidence regarding practice education.

CONCLUSIONS

This study supports the use of PASS to promote practice education preparedness, as there were positive outcomes for both students and student leaders. However, it indicates that participation in such programmes should be voluntary rather than mandatory. This study addresses a clear gap both in current practice and research, describing the application of a proven educational intervention in a new and innovative way. It is the first reporting of the use of PASS to support the preparation of students for practice education in any health discipline and subject to feasibility studies, could be adopted more broadly by disciplines beyond health, where work integrated learning is a mandatory element of the education programme.

Effectiveness and cost-effectiveness of embedded simulation in occupational therapy clinical practice education: study protocol for a randomised controlled trial

Background

Clinical placements are a critical component of the training for health professionals such as occupational therapists. However, with growing student enrolments in professional education courses and workload pressures on practitioners, it is increasingly difficult to find sufficient, suitable placements that satisfy program accreditation requirements. The professional accrediting body for occupational therapy in Australia allows up to 200 of the mandatory 1000 clinical placement hours to be completed via simulation activities, but evidence of effectiveness and efficiency for student learning outcomes is lacking. Increasingly placement providers charge a fee to host students, leading educators to consider whether providing an internal program might be a feasible alternative for a portion of placement hours. Economic analysis of the incremental costs and benefits of providing a traditional versus simulated placement is required to inform decision-making.

Methods/design

This study is a pragmatic, non-inferiority, single-blind, multicentre, two-group randomised controlled trial (RCT) with an embedded economic analysis. The RCT will compare a block of 40 hours of simulated placement (intervention) with a 40-hour block of traditional placement (comparator), with a focus on student learning outcomes and delivery costs. Six universities will instigate the educational intervention within their respective occupational therapy courses, randomly assigning their cohort of students (1:1 allocation) to the simulated or traditional clinical placements. The primary outcome is achievement of professional behaviours (e.g. communication, clinical reasoning) as assessed by a post-placement written examination. Secondary outcomes include proportions passing the placement assessed using the Student Practice Evaluation Form-Revised, changes in student confidence pre-/post-placement, student and educator evaluation of the placement experience and cost-effectiveness of simulated versus traditional clinical placements. Comprehensive cost data will be collected for both the simulated and traditional placement programs at each site for economic evaluation.

Discussion

Use of simulation in health-related fields like occupational therapy is common, but these activities usually relate to brief opportunities for isolated skill development. The simulated clinical placement evaluated in this trial is less common because it encapsulates a 5-day block of integrated activities, designed and delivered in a manner intended to emulate best-practice placement experiences. The planned study is rare due to inclusion of an economic analysis that aims to provide valuable information about the relationship between costs and outcomes across participating sites.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12616001339448. Registered 26 September 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-2087-0) contains supplementary material, which is available to authorized users.