Comparison of paired and single clinical placement models: a time-use analysis

Increasing capacity by moving away from one-to-one clinical supervision: using peer-assisted learning and a group model of student placements in community paediatric speech and language therapy to enable student-led service delivery

BACKGROUND

Health Education England (HEE) and the Royal College of Speech and Language Therapists (RCSLT) have identified the need to increase placement capacity. Speech and language therapy is a shortage profession in the UK, so services need to consider innovative placement models to increase their placement offers without increasing the time burden on speech and language therapists (SLTs).

AIMS

To increase capacity for pre-registration practice-based learning by using peer-assisted learning (PAL) in a group model of student placement to enable student-led service delivery which provides high standards of clinical care and student experience and is an efficient use of SLT time.

METHODS & PROCEDURES

A paediatric speech and language therapy service hosted eight student speech and language therapists (SSLTs) for their final pre-registration placement. SSLTs completed pre- and post-placement confidence ratings for a range of clinical skills; SSLTs and SLTs rated how useful different types of support were, and education settings provided feedback about working with the SSLTs. The number of clinical sessions completed by the SSLTs and the percentage of outcomes achieved for children with speech, language and communication needs were calculated. SLTs completed time-trackers for placement-related activities.

OUTCOMES & RESULTS

The impact of the placements was assessed using a tri-vector methodology consisting of: self-reporting by the student (using an evaluation form), feedback from the placement sites (schools) and analysis of targets set for individual children. SSLTs reported increased confidence in all clinical areas in their post-placement evaluation form. SLTs reported increased confidence in SSLTs working independently and an increase in the perceived benefit to the service for having SSLTs in comparison with the time invested in supporting SSLTs. SSLTs and SLTs found all types of support provided during the placement useful. Schools reported high levels of satisfaction for working with SSLTs. SSLTs completed more clinical sessions than an SLT would have been able to in the time SLTs invested in placement-related activities. Children achieved 60% of the targets set by SSLTs.

CONCLUSIONS & IMPLICATIONS

This placement model increased the capacity for SSLT placements by using PAL in a group model of student placement to enable student-led service delivery. The model provided high standards of clinical care and student experience and was an efficient use of SLT time. Wider use of this placement model would increase placement capacity and could also address vacancies in services.

WHAT THIS PAPER ADDS

What is already known on the subject SSLTs and SLTs are positive about the benefits of paired placements in comparison with individual placements. Other allied health professions have demonstrated that larger placements can be an effective way to support students and have used students to deliver student-led services. What this study adds to existing knowledge This paper is the first to look at whether PAL in a group model of student placements can be used in speech and language therapy to enable student-led service delivery which provides high standards of clinical care, maintains high standards of student experience and is an efficient use of SLT time. What are the potential or actual clinical implications of this work? This paper demonstrates that PAL can be used effectively in a group model of student placements in a paediatric SLT service to increase student capacity and enable student-led service delivery. The proposed placement model provides a high-quality placement for SSLTs and the children they work with, and is also an efficient use of SLT time.

Watch vs do: A randomized crossover design evaluating modified simulated patients and video learning for novice speech-language therapy students

BACKGROUND

Simulated learning activities are an effective tool for reducing speech-language therapy (SLT) students' anxiety and improving their confidence for clinical placements. Such activities include interacting with patients who are actors, clinical educators or peers and are known to decrease anxiety and increase confidence in SLT students. Screen-simulated patients using video are another alternative, which has not yet been fully evaluated in the education of SLT students.

AIMS

To compare the effectiveness of (1) modified simulated patient and (2) video simulated learning for increasing self-reported (a) confidence and (b) preparedness and (c) decreasing self-reported anxiety.

METHODS & PROCEDURES

This study used a randomized crossover design with 127 first-year graduate-entry master's SLT student participants. Students participated in two activities related to a clinical interaction with a paediatric client's carer: (1) a 1-hr modified simulated patient experience with clinical staff as the simulated patient; and (2) a video-learning task, with two videos of a clinician-carer interaction and an accompanying worksheet. Students were randomly allocated to a group of four students and the groups randomly allocated to receive modified simulated patient or video-learning first. Students were not blinded to the activities. The students completed a 19-item questionnaire at three time points: before either activity, after the first activity and after the second activity, to evaluate their self-reported confidence, clinical preparedness and anxiety.

OUTCOMES & RESULTS

A total of 62 students completed modified simulated patient first and 63 completed video-learning first. After either single activity the students had significantly increased confidence and preparedness scores, while only the modified simulated patient significantly reduced student anxiety scores. As a second activity, modified simulated patient resulted in further significant improvements in confidence, preparedness and anxiety; however, adding video learning as a second activity resulted in no significant benefit.

CONCLUSIONS & IMPLICATIONS

This study demonstrates the effectiveness of two low-resource clinical-learning activities for novice SLT students that can be applied in a range of settings. Of the two activities, modified simulated patient had greater effectiveness, as it was the only activity to decrease anxiety. An investigation of the pedagogical principles within the activities revealed that modified simulated patient activity had more opportunities for peer learning, supervisor feedback and verbal reflection in comparison with video learning that may explain the increased benefits.

WHAT THIS PAPER ADDS

What is already known on the subject Simulated learning activities are an effective teaching tool for SLT students, increasing confidence and decreasing anxiety in preparation for placement. Simulated patients require more resources than video simulation. Both simulated patients and video simulation provide a safe learning environment, where students can learn without risk to clients. What this paper adds to existing knowledge This study is among the first to investigate a modified version of simulated patients; our modification involves a clinical educator performing the role of both the simulated patient and simulation facilitator. It is the first to evaluate simulation via video learning for SLT students. The paper demonstrates the effectiveness of these two activities, and the slight advantage of modified simulated patient, for increasing novice students' confidence and preparedness and decreasing their anxiety about clinic. It also unpacks the pedagogical principles used in each activity to explain the reasons that modified simulated patient had greater effectiveness. What are the potential or actual clinical implications of this work? The two educational activities required no specialist equipment and can be applied in a range of pre-clinical and clinical settings by university staff and/or community clinical educators. Increasing confidence and preparedness, and decreasing anxiety will help ensure that student learning on scarce clinical placements is maximized.

Maximizing clinical rotation placements for US medical students: exploring an optimization model

BACKGROUND

For years, US medical schools have relied on community-based, private clinicians to educate medical students. There has been a steady decline in the number of physicians willing to take on medical students in their clinical practices. Recent issues related to the pandemic raise questions about how many patients students should see to have a meaningful clinical experience.

METHODS

As part of a 16-week longitudinal clinical experience, medical students spend 2 days each week in a family medicine or internal medicine clinic. As repetition enhances learning, maximizing the number of patients students see is important. Using a mixed integer linear program, we sought to determine the optimal schedule that maximizes the number of patients whom students see during a rotation. Patient visits were collected from January to April 2018 for clinics used by the medical school. By maximizing the minimum number of patients per learner over all non-empty day-clinic combinations, we deliver equitable rotation plans based on our assumptions.

RESULTS

For this pilot study, multiple experiments were performed with different numbers of students assigned to clinics. Each experiment also generated a weekly rotation plan for a given student. Based on this optimization model, the minimum number of patients per student over 16 weeks was 87 (3 patients per day) and actually increased the number of students who could be assigned to one of the clinics from 1 student per rotation to 8 students.

CONCLUSIONS

The mixed integer linear program assigned more students to clinics that have more total visits in order to achieve the optimal and fairest learning quality. In addition, by conducting various experiments on different numbers of students, we observed that we were able to allocate more students without affecting the number of patients students see.

Clinical placement models for undergraduate health professions students: a scoping review

BACKGROUND

Clinical learning is fundamental to undergraduate health professions students. There are several calls for the transformation of health professions education, which have direct implications on clinical learning. Clinical placement models provide structure to clinical learning. Therefore, this scoping review could contribute to supporting curriculum transformation to enhance learning in the clinical environments for undergraduate health professions students.

OBJECTIVES

This scoping review identified the characteristics of research evidence related to mapping the purpose, methodologies used, outcomes, and specific recommendations associated with clinical placement models in undergraduate health professions education.

DESIGN

A scoping review method was used in this study. A search string developed from the title of the review was used to search online databases to identify research published between January 2000 and March 2020.

RESULTS

Forty-eight articles reporting on ten clinical placement models were included in this review. The majority of these articles originated from Australia and predominantly report on nursing. The aims of these articles aligned with the evaluation of the implementation of a clinical placement model. Seven categories of outcomes of the clinical placement models are reported namely, relationships, influence, environment, facilitation, inputs, knowledge scores, and student perceptions.

CONCLUSIONS

As clinical learning is fundamental to undergraduate health professions education, clinical placement models should prioritise the development of competence among undergraduate students. Insights into outcomes reported in literature could guide educators in fostering optimal learning in students who may then be able to influence community health outcomes positively.

A narrative literature review: Growing the workforce through increased fieldwork capacity in genetic counseling training programs

In response to mounting concerns regarding a perceived shortage of genetic counselors, the Genetic Counselor Workforce Working Group (WFWG) was established in 2013 to identify barriers to growth of the genetic counseling workforce. After completing a workforce analysis and confirming a shortage, the WFWG convened a strategic planning session in 2017 to identify goals and strategies that would increase the number of certified counselors to meet the current and future workforce demands and ensure access to genetic counselor services. Subcommittees were formed and charged with achieving assigned goals; one such subcommittee included a curriculum working group to build a dynamic and effective educational infrastructure to increase the number of genetic counselors graduated from accredited training program. This paper reports of progress of the WFWG Curriculum Subcommittee toward achieving this goal through a narrative literature review that identifies innovative education methods that help to increase capacity of fieldwork training, both in genetic counseling training programs and in other health professions. Of the five thematic areas identified in this study, four are analyzed for insight into building clinical capacity: systems/infrastructure, rotation structure/models, skill building, and novel techniques. While additional studies are needed to establish best practices in these thematic areas, there are several take-aways that training programs can begin to utilize as they look to expand training opportunities. While growth of the genetic counseling workforce will continue to be a long-term issue, programs should begin to think creatively and innovatively about how to reach beyond traditional fieldwork training formats to build capacity. The strategies explored in this paper offer feasible and untapped solutions that can help support efforts to establish a sustainable genetic counseling workforce.

An optimal environment for placement learning: listening to the voices of speech and language therapy students

BACKGROUND

Placements are a core component of learning within speech and language therapy (SLT) undergraduate and postgraduate university programmes. They facilitate the development of students' professional and clinical competencies and socialization into the profession. It is indicated that an optimal environment for placement learning often pivots on the mentoring, supervision and feedback the student receives.

AIMS

To explore the perspectives of student SLTs in the Republic of Ireland in relation to factors that would best support their learning and competency development on placement.

METHODS & PROCEDURES

Qualitative data were collected from an anonymous online student survey that consisted of eight open-ended questions. Thematic analysis was applied to the data. Excerpts from the data were selected to illustrate the themes constructed.

OUTCOMES & RESULTS

A total of 117 students responded. Four salient themes were generated that capture the students' perspectives of an optimal environment for placement learning and competency development.

CONCLUSIONS & IMPLICATIONS

This study supports quality assurance within the practice education of student SLTs and highlights aspects of an optimal learning environment that practice educators can strive to develop. In parallel, this study points to the need for improved supports from university personnel and placement site managers, and an increased need for student preparedness and self-reflection. Implications for continuing professional development specific to the role of a practice educator is described, in addition to the recommendation of an expanded perspective of supervision within SLT. What this paper adds What is already known on the subject Placements are an integral component of SLT undergraduate and postgraduate university programmes that enable students to translate theory to practice. Placement involves a transition from structured and predictable learning of the classroom to more dynamic learning environment within the placement site. Assessment of placement is carried out by practice educators using competency assessment tools. An optimal environment for placement learning often pivots on the mentoring, supervision and feedback that the student receives from their practice educator. What this paper adds to existing knowledge This study explores student SLTs' voices in relation to what they consider an optimal environment for placement learning should be and what they believe may best support them in their journey to develop their clinical competencies. It supports quality assurance of the practice education of our future colleagues. What are the potential or actual clinical implications of this work? The findings of this enquiry emphasize the distinction between competence as a SLT and competence as a practice educator and have subsequent implications for the content of continuing professional development for practice educators. In particular, an expanded perspective of the models and frameworks of supervision to promote and implement within the practice education of SLT students is presented.

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.

Supervision models in physiotherapy practice education: student and practice educator evaluations

Objectives: To establish the supervision models used during physiotherapy practice placements and to determine student and practice educators' evaluations of the quality of these placements.Design: Cross-sectional study set in clinical sites providing placements for physiotherapy students in Ireland.Participants: Practice educators and students completing placements in 2015/16.Outcome Measure: Questionnaire which measured 18 indicators linked to quality assured placements. Eight additional indicators in the practice educator questionnaire addressed the overall feasibility of the supervision model. Two open-ended questions captured comments on the benefits and challenges of each model.Results: The overall response rate was 72% (112/155). The majority (75%, n = 84) of participants reported a 1:1 (one student: one educator) model of supervision. Fourteen percent (n = 16) reported a 1.2 (one student: two educators) model and 9% (n = 10) a 2.1 (two students: one educator) model. There was generally positive agreement with the questionnaire indicating that all placements, irrespective of supervision model were positively evaluated by participants. Students, however, indicated a more negative evaluation of the placement than practice educators in indictors related to communication, the provision of feedback, establishing an effective relationship with their educator and diversity of available learning opportunities. Indicators relating to productivity and the placement representing an efficient use of resources and personnel received more negative or equivocal ratings by educators.Conclusions: While the 1.1 model remains the most widely used supervision model in physiotherapy practice education, other models also score positively, offering choice to placement providers when determining the model that best suits their service.