The Benefits, Challenges and Impacts of Telehealth Student Clinical Placements for Accredited Health Programs During the COVID-19 Pandemic

Telehealth and in-person placements: Same, same, but different. A mixed methods investigation of speech and language therapy students' and practice educators' experiences and perceptions

BACKGROUND

Telehealth placements in speech and language therapy provide crucial opportunities for both learning and service delivery when clinicians, students and/or clients are separated by factors such as distance or illness. While the use of telehealth placements has increased in recent times, they remain a relatively underexplored phenomenon with limited information available about the perceptions and experiences of practice educators and students.

AIMS

The aim of this study was to explore experiences of telehealth-delivered speech and language therapy services and tele-supervision from the perspective of speech and language therapy students and practice educators.

METHODS AND PROCEDURES

This study used a sequential exploratory mixed methods design with a questionnaire study followed by a series of focus groups with Australian speech and language therapy educators and speech pathology students. Different questionnaires were used with students (n = 56) and practice educators (n = 27); each explored perceptions of interaction, engagement and student learning via multiple-choice and open-ended questions. Multiple-choice answers were analysed descriptively; open-ended questions were analysed with qualitative content analysis. The results informed the focus group questions. Separate focus groups were held with students (n = 17) and practice educators (n = 20); each explored student learning and development as well as educator supervisory practices. Data were analysed inductively using thematic network analysis.

OUTCOMES AND RESULTS

Responses from both student and practice educator questionnaires indicated that students develop some different skills on telehealth placements compared to in-person placements and telehealth placements were more suitable for some students compared to others. We constructed 12 basic themes related to student and educator practices, student learning, client care, perceptions about telehealth, and location of educator and student. These were grouped into three organising themes: processes, perceptions, place. The organising themes were summarised into the overarching theme 'telehealth and in-person placements: same, same, but different'.

CONCLUSIONS AND IMPLICATIONS

This study adds to the growing body of literature indicating that telehealth placements can meet student learning needs. It suggests that both educators and students need to learn new skills or adapt their current practices to engage in these placements. This paper includes recommendations for how to manage the different practices required by universities, educators and students to promote successful telehealth placements, particularly when the educator and student are not co-located.

WHAT THIS PAPER ADDS

What is already known on this subject Telehealth use has increased dramatically since the COVID-19 pandemic, both for clinical services and student placements in allied health services in general as well as speech and language therapy (SLT). Student placements conducted via telehealth are beneficial for student learning but some skills such as communication and interpersonal interaction develop differently. Placements can involve students delivering clinical services via telehealth and/ or remote student supervision (tele-supervision). What this paper adds to existing knowledge By drawing on the perspectives of students and practice educators, this paper demonstrates that the processes used for supervision, planning and clinical services are different in telehealth compared to in-person placements. It reveals that SLT students and educators have strongly held perceptions about the value and equivalence of telehealth placements that change over the course of a telehealth placement. This paper suggests placements that combine telehealth with tele-supervision are more complex and have fewer opportunities for incidental learning and developing professional workplace skills than placements where the educator and student providing telehealth services are co-located. What are the potential or actual clinical implications of this work? This paper will help universities, professional organisations and practice educators disentangle placements where students deliver services using telehealth from those where students also receive tele-supervision. This work identifies common perceptions about telehealth placements that educators can use to guide discussions with students, and guide the selection of effective work practices for students and educators during telehealth placements.

Telehealth usability in a university student physiotherapy clinic during COVID-19

BACKGROUND

'Telehealth' online delivery of physiotherapy was the only option during the Covid 19 pandemic in many areas. This was a challenge for physiotherapy training in student clinics where students, clinical educators (CEs) and clients were in three separate locations. The aim of this study was to determine the usability and acceptability of online delivery in a physiotherapy student clinic.

METHODS

An observational cross-sectional design was used. Clients (adult clients or carers of paediatric clients), students and CEs participated in telehealth physiotherapy appointments over a Telehealth platform called NeoRehab. The three groups were then invited to complete the Telehealth Usability Questionnaire (TUQ). The 21 item TUQ uses a 7-point Likert scale and covers six constructs (Usefulness, Ease of Use, Interface quality, Interaction quality, Reliability, Satisfaction).

RESULTS

Data were analysed from 39 clients, 15 students, and seven CEs. The respective domain scores (SD) for Usefulness [(5.3 (1.5), 5.4 (0.7), 5.1 (0.7)] and Satisfaction [5.1 (1.6), 5.0 (1.0), 5.4 (0.7)] were similarly high across groups, while scores for Reliability [3.7 (1.5), 3.6 (1.0), 3.0 (0.5)] were similarly low across groups. Interface Quality [5.0 (1.5), 4.5 (1.2), 4.1 (0.8)] scores were similarly moderate. Ease of Use [5.6 (1.5), 5.3 (1.0), 4.1 (1.1)] scores were significantly higher in clients than CEs (p = 0.043). Interaction Quality [5.0 (1.4), 3.9 (1.3), 4.2 (0.9)] scores were significantly higher in clients compared with students (p = 0.03).

CONCLUSIONS

All groups agreed that the delivery format was useful, easy to use and provided a satisfactory service but was not reliable.

Development of a hospital-academic collaboration to implement an interprofessional telehealth breastfeeding support group

Accessible lactation support for breastfeeding parents, even in well-resourced areas, is often insufficient. At the same time, opportunities for real-life, sustainable interprofessional learning experiences for health professions students are scarce. Delivery of lactation support via telehealth allows for greater accessibility for both consumers and students. This study describes the development of an interprofessionally-facilitated telehealth breastfeeding support group, a partnership between a health professions graduate school and a teaching hospital in Boston, MA. Program conceptualization, theoretical basis, and development are reviewed. Occupational therapy and nursing students were involved in the group at various points of entry and with different degrees of engagement. Students developed skills in group facilitation, lactation support, and program evaluation. The group had consistent participation, ranging from 2 to more than 10 participants per session, serving parents across urban and rural areas. The group format and development could be replicated to provide needs for local communities of parents and interprofessional students.

Evaluation of a teleaudiology service in regional Australia

OBJECTIVE

Evaluate accessibility, effectiveness, acceptability and efficiency of a student- assisted teleaudiology model of care in a regional hospital in Queensland, Australia.

DESIGN

Prospective mixed method service evaluation study.

STUDY SAMPLE

Demographic, service and satisfaction data were collected from 233 patients (children aged ≥5 and adults) who received teleaudiology assessment. Satisfaction data was collected from 27 hospital clinic staff (medical, nursing and clinic assistants) and 28 university audiology clinical educator participants. Experience and satisfaction data were collected from 16 teleaudiology clinic university students. Quantitative data was analysed using SPSS software. Qualitative data were analysed using inductive content analysis.

RESULTS

Following introduction of the teleaudiology service in 2017 and evaluation during the first 6 months, 95% of patients were able to access audiology assessments on the same day as their Ear, Nose and Throat appointments. New referrals to the service were seen within a month. The audiology assessment battery was completed 95% of the time within an average of 33 minutes by the end of the study period. Patients, hospital and university staff and students reported high satisfaction with their experiences of teleaudiology, including its convenience and efficiency.

CONCLUSIONS

A student-assisted teleaudiology model of care can deliver accessible, effective, and efficient services with high levels of satisfaction by participants.

While allied health students prefer face-to-face clinical placement, telehealth can support competency development: results from a mixed-methods study

Introduction

Student clinical placements are a mandatory requirement within most accredited health programs. During the COVID-19 pandemic, many health settings that had traditionally provided placements cancelled their offerings. Telehealth services however, increased and emerged as an alternative placement setting.

Aim

To compare the learning experiences for allied health students provided by telehealth and face-to-face accredited health placements.

Methods

Health students, from a university clinic between March to December 2020, delivering both face-to-face and telehealth consultations, were invited to complete a telephone survey with 3 demographic questions; and 10-items comparing their telehealth and face-to-face learning experiences. Pearson's chi-squared/Fisher's exact test was used to examine the association between each item and consultation setting. Qualitative survey data was thematically analysed using a descriptive approach.

Results

49 students from 2 universities and 5 disciplines completed the survey. Students rated their face-to-face experiences significantly higher than their telehealth experiences across all items (all p-values <0.01). Across 9 items students reported positive learning experiences in both settings. Students had greater opportunities to work in a multidisciplinary team in a face-to-face setting. Four themes were generated: (1) placements can vary in quality regardless of setting; (2) telehealth can provide valuable learning experiences and support competency development; (3) enablers for telehealth placements and (4) barriers for telehealth placements.

Conclusion

While telehealth can support student learning and competency development, in this study students preferred face-to-face experiences. To optimise telehealth placements consideration needs to be given to barriers and enablers such as technological issues and university curricula preparation.

Impact of the COVID-19 pandemic on student supervision and education in health care settings: A state-wide survey of health care workers

OBJECTIVE

To investigate student supervisor experiences of supervising students on clinical placements since the onset of the COVID-19 pandemic.

BACKGROUND

Studies on the impact of COVID-19 on student clinical placements have focused largely on student reports and have been specific to individual professions or topic areas. There is a need to investigate student supervisor experiences. This study was conducted in Queensland (Australia) in four regional and rural public health services and four corresponding primary health networks.

METHODS

The anonymous, mixed methods online survey, consisting of 35 questions, was administered to student supervisors from allied health, medicine, nursing and midwifery between May and August 2021. Numerical data were analysed descriptively using chi-square tests. Free-text comments were analysed using content analysis.

RESULTS

Complete datasets were available for 167 respondents. Overall trends indicated perceived significant disruptions to student learning and support, plus mental health and well-being concerns for both students and supervisors. Extensive mask wearing was noted to be a barrier to building rapport, learning and teaching. Some positive impacts of the pandemic on student learning were also noted.

CONCLUSIONS

This study has highlighted the perceived impact of the pandemic on supervisors' mental health, and on the mental health, learning and work readiness of students. This study provides evidence of the pandemic impacts on student clinical placements from a supervisor point of view. Findings can assist in future-proofing clinical education and ensuring that students continue to receive learning experiences of benefit to them, meeting curriculum requirements, in the event of another pandemic.

An innovation on clinical placement for occupational therapy mental health during the COVID-19: A mixed-methods feasibility study

The COVID-19 pandemic altered the health profession's education. Educational activities were shifted to online, and clinical placements were compromised in certain countries. A mixed-methods study included 17 undergraduates undergoing a mental health placement. The first 3 weeks of clinical placement applied online case-based learning in written and in video format. The last 2 weeks involved hybrid remote and physical onsite clinical placement. SPICES model utilizing various active learning activities, case studies and client attendance, facilitator engagement, discussion and feedback were implemented. A self-administered System Usability Scale (SUS), e-learning preference level, focus group discussion, and reflective writing was conducted at the end of each week and the students' final marks were compared with the past cohort who attended conventional physical clinical placement. Two-way mixed ANOVA indicates no significant interaction was found on the SUS (p = 0.062, ηp2 = 0.062) and preference scores (p = 0.285, ηp2 = 0.079) according to week and practical site. There was no significant difference in the final mark among the online and onsite placement of the current cohort (p = 0.350, d = 0.47). The current cohort reported better marks than the previous cohort who attended conventional placement (p = 0.006, d = 0.99). Qualitative findings show positive responses where online activities have minimal restriction on the learning process. This innovative approach is acceptable for substituting conventional clinical learning during this restricted situation.