Student perspectives of a Student-Led Groups Program model of professional practice education in a brain injury rehabilitation unit

Student-led activities of daily living group program in a hospital inpatient rehabilitation setting

INTRODUCTION

Occupational therapists have vital roles in inpatient rehabilitation to focus on independence in activities of daily living. Occupational therapy interventions are uniquely designed to address goals of service users and can be delivered individually or in group formats. Group interventions promote service users' mutual support and enable therapists to increase frequency and intensity of service provision. Student-led programs have become an attractive model, benefiting students while providing positive treatment outcomes for service users. There is an emerging body of literature that explores service users' and students' satisfaction with student-led group models of practice within inpatient rehabilitation and occupational performance outcomes of service users participating in student-led programs. This study aimed to explore the satisfaction of service users and students in addition to the self-reported occupational performance outcomes of a student-led activities of daily living group program in inpatient rehabilitation.

METHODS

Data from 33 service users and seven students were collected retrospectively. The intervention involved a student-led activities of daily living group program, consisting of three groups: breakfast, morning tea, and home readiness group. All service users and students completed unique satisfaction surveys at the conclusion of their participation in the student-led program. Service users completed a self-reported activities of daily living performance measure pre- and post-program. Findings were reported in descriptive statistics, and pre- and post-program data were compared with the Wilcoxon signed-rank test.

RESULTS

All students were satisfied with the student-led program. Majority of service users were satisfied with all components of the student-led program. Median scores for self-reported performance increased significantly following the student-led program (P < 0.001).

CONCLUSION

This study highlighted that service users and students were satisfied with the service delivery of a student-led activities of daily living group program. The program was effective in addressing self-reported performance for service users in inpatient rehabilitation. The findings from this study have potential to inform clinical practice on the implementation of student-led programs in occupational therapy settings.

Racism in medicine: A qualitative study on the impact of discussion among medical students

Background: This study evaluated the impact of the Racism in Medicine Summit on student perceptions of various topics related to racism in medicine. The Summit was organized at the Wayne State University School of Medicine (WSUSOM) to educate students, faculty and staff on how structural racism affects the residents of Detroit and the historical relationship between healthcare and vulnerable populations. The Summit aimed at providing context for what students in Detroit will encounter as physicians-in-training and the skills they will need to master while working within similar communities.  Methods: Qualtrics surveys were created and distributed via email to attendees before and after the event. Responses were obtained via Likert scale and open-text questions.  Results: A total of 342 out of 445 participants (77%) completed both the pre- and post-survey. Quantitative analysis in post-survey responses revealed more familiarity among participants regarding specific instances of racism in the history of medicine, greater extent of thinking the history of racism impacts present-day Detroit residents, greater extent of thinking that racism influences medical care and/or medical outcomes, and belief that racism is reflected in medical research, compared to pre-survey responses (p < 0.001). Participants also reported more often considering racial or societal influences when studying medicine and more knowledge of what they can do to combat racism as a student and physician (p < 0.001).  Qualitative analysis revealed seven themes among participants: the history of racism in medicine, personal reflection, racism in research, bias and microaggression, actions to take against racism, resources for anti-racist education, and racism in medical education.  Conclusions: Demonstrable changes in medical student attitude and awareness surrounding topics of racism and healthcare were achieved after the Racism in Medicine Summit. This can serve as a model for other medical schools to raise awareness about racism in medicine.

Student-led rehabilitation groups and clinics in entry-level health education: a scoping review

OBJECTIVE

The purpose of this review was to identify, map, and describe the characteristics of student-led physical rehabilitation groups and clinics in entry-level health education.

INTRODUCTION

Student-led groups and clinics for physical rehabilitation are an emergent phenomenon in entry-level health professional education. Data gathered in this scoping review aimed to provide an understanding of the range and scope of student-led groups and clinics within a physical rehabilitation context, and establish the evaluation undertaken to date from a student, service user, and stakeholder perspective. It also aimed to identify other important factors in the design, execution, and feasibility of the concept. Finally, it aimed to identify gaps in the literature that can be addressed by further research.

INCLUSION CRITERIA

This scoping review considered studies and sources that identify student-led methods for carrying out physical rehabilitation for service users in either an exercise group or clinic environment. Students and groups/clinics on entry-level qualifying courses were considered. The review considered primary and secondary research in any paradigm as well as text and opinion articles.

METHODS

The JBI methodology for conducting scoping reviews was employed. The following databases were searched: MEDLINE, CINAHL, AMED, ERIC, Scopus, and SPORTDiscus. Searches were limited from January 1, 1998, to the date of the search (November 1, 2019). Non-English articles were excluded. To supplement the review, searches for gray literature were also undertaken. Data extraction was performed by two reviewers using a pre-determined data extraction form developed by the authors. The results of the review are presented in narrative form and supported by tables and figures.

RESULTS

This review identified 523 sources of information of which 111 were screened at full-text stage and 48 sources were eligible to be included in the final scoping review. A wide range of student-led groups and clinics that provide physical rehabilitation exist globally. Drivers for the clinics and groups vary; key aims included providing a learning environment for student skill development, serving as clinical placements, and providing a social enterprise. Evaluations focused on student experience, service user experience, and cost-benefit analyses.

CONCLUSIONS

Student-led groups and clinics are at different stages of development and use within entry-level curricula. The objectives and drivers for groups and clinics vary worldwide; therefore, the evolution of groups and clinics has driven a wide range and number of models globally.

A descriptive video analysis of interactions during inpatient brain injury rehabilitation groups

Introduction

An advantage of using groups in rehabilitation is the opportunity for peer learning and support. This study aimed to describe and understand the nature of interactions occurring in inpatient occupational therapy brain injury rehabilitation groups, using video-recorded group interactions, to inform recommendations for group facilitation.

Method

Video recordings of four occupational therapy rehabilitation groups were taken. Twelve adults with brain injury who participated in the groups and four facilitators consented to the study. The data were analysed using a qualitative descriptive approach.

Results

Interactions were predominantly facilitated by facilitators and shaped by the nature of the group activities. Facilitators used a number of strategies to encourage interaction including knowledge of group participants, activity choice and physical positioning of group members.

Conclusion

Group facilitators utilise a number of strategies to encourage peer interactions. However, during structured activity-based rehabilitation groups, participants with a brain injury may focus predominantly on achieving the goal of the group rather than initiating peer interactions.

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.

Establishing an occupational therapy assessment clinic in a public mental health service: A pragmatic mixed methods evaluation of feasibility, utilisation, and impact

INTRODUCTION

Employment of occupational therapists in generic roles in public mental health services (PMHSs) constrains capacity to undertake discipline-specific activity meaning consumers may be unable to access valuable occupational therapy assessments and interventions that could promote recovery. Establishing a dedicated occupational therapy clinic has been identified as one way of improving care provided and outcomes for organisations, therapists, and consumers. To inform such developments, this paper reports evaluation of feasibility, acceptability, and sustainability of a pilot clinic established within a PMHS.

METHODS

An observational evaluation was used combining quantitative and qualitative data collected from service documents, clinic records, and in semi-structured interviews with 42 stakeholders. Quantitative data were used to describe referrals and flow through the clinic. Framework analysis of qualitative data examined the process and outcomes of referrals and enabled understanding of acceptability, perceived impact and areas for improvement.

RESULTS

Substantial ground work, particularly stakeholder engagement, and redistribution of resources enabled establishment and successful operation of an assessment clinic for 12 months. Assessments were completed for 68% of the 100 accepted referrals, with the remainder in process or unable to be completed. Stakeholders agreed that the clinic enabled clinicians' timely access to specialist assessment, improving care for consumers. Occupational therapists valued the opportunity to deploy and develop discipline-specific skills and when there was some impact on work flow of occupational therapists' 'home teams', team managers judged the investment worthwhile. Strong leadership by the discipline lead and support from team managers who enabled allocation of occupational therapists to the clinic were critical to success.

CONCLUSION

An occupational therapy assessment clinic can be established and operate successfully within a public mental health setting. Redistribution of resources supported increased efficiency and consumer access to specialist interventions that support their recovery.

A mapping review of models of practice education in allied health and social care professions

Introduction

Practice education is fundamental to pre-registration learning for many health and social care professions, yet finding sufficient opportunities for students is challenging. One-to-one student–educator pairings are common, and while different models could increase placement opportunities, the associated terminology is inconsistent and an overview of advantages, challenges and available evidence is missing. This mapping review identifies, categorises and critically considers the evidence for different models of practice education used by health and social care professions.

Method

Papers from 2008 onwards reporting on practice education approaches in allied health or social care profession courses were identified in three databases. Data was extracted, methodological quality categorised and a typology of practice education models developed.

Findings

Fifty-three papers were reviewed and developed into a typology of 14 models. Mapping indicated issues with a lack of high-quality research and limitations in available outcome indicators. Pre-requisites for the effective operation of different models include preparation, communication and allowing sufficient time for new ways of working.

Conclusions

Practice education discourse is characterised by varied terminology and practices. Various models for structuring practice education exist, though the evidence for their effectiveness and impact on capacity is limited. Using consistent language and considering wider impacts and outcomes is recommended in future study.

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.