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Evaluation of a pilot to introduce simulated learning activities to support speech and language therapy students' clinical development

BACKGROUND

Speech and language therapy (SLT) education must meet the needs of the future workforce, training enough students who are competent practitioners able to meet the workforce demands. Increasing student numbers and the impact on placement providers mean students must be equipped for learning on placement. Simulation is a way of supporting students to develop their clinical skills and decision-making in a safe, supportive environment.

AIMS

To explore the perspectives of SLT students who were introduced to simulation during their undergraduate degree at a UK university as part of a pilot study. The aim of the pilot was to listen to the students' voices to begin to understand their lived experiences of simulation and to gather views on how simulation can support their clinical learning.

METHODS & PROCEDURES

Focus groups and semi-structured interviews were carried out with second-year BSc SLT students in semester 2 following the simulated learning activities and clinical placement. Qualitative data were gathered and thematic analysis was applied to the data to identify the barriers and enablers to students' clinical learning in simulation.

OUTCOMES & RESULTS

A total of 11 students responded out of a cohort of 38. Three key themes were identified from the analysis: individual learning needs, facilitator skill and programme-level organization.

CONCLUSIONS & IMPLICATIONS

Student experience of simulation was positive. One of the key elements students found to support their clinical skills was the importance of the safe space; support for learning instead of correction led them to engage in active learning. Key barriers to simulation related to having sufficient prior knowledge, the skills of the facilitator, group size and the wider learning landscape of the programme. In response to this pilot, there are plans to continue developing this model of simulation and embed simulation across the programme, led by a sound pedagogical approach with clear preparation and planning and building the necessary infrastructure. Other SLT programmes and practice educators developing simulation as part of their programmes or placement may wish to consider some of these findings to support the use of simulation in their workplace.

WHAT THIS PAPER ADDS

What is already known on this subject Simulation as a teaching methodology is widely used in medicine and nursing programmes. It is now used in various allied health professions and in some SLT programmes. There is evidence to suggest simulation increases student confidence and clinical skills without increasing the capacity on those offering clinical placements in practice. What is already known on this subject This study offers a practical example of introducing simulation in an established undergraduate programme for SLT students. It explains the background to this innovative way of teaching clinical skills and explains why this approach could be beneficial for the future speech and language therapist. What are the clinical implications of this work? This study gives practical examples of how simulation can work to facilitate student clinical learning and knowledge. It may offer ideas to those working in clinical practice to organize placements differently or add simulation elements to improve the student experience. Other educational establishments and placement educators may find the recommendations helpful in developing their own simulation approach.

Exploring the role of advanced clinical practitioners (ACPs) and their contribution to health services in England: A qualitative exploratory study

BACKGROUND

An extended role being explored globally is the advanced clinical practitioner (ACP). In England this is an extended role for allied health professions, nurses and midwives in a range of settings.

OBJECTIVES

This paper focuses on three research questions: 1) What is the role of ACPs in England? 2) What are the barriers and facilitators to implementing the role? and 3) What is the contribution of ACPs to health services in England?

DESIGN/SETTING

A qualitative, exploratory study to explore perspectives on the ACP role in a range of clinical settings.

PARTICIPANTS

We recruited 63 stakeholders, including 34 nurses, working in a ACP role or ACP education. A purposive snowball sampling technique identified participants meeting inclusion criteria.

METHODS

One-to-one semi-structured interviews throughout 2020, recorded and transcribed verbatim, anonymised and thematically analysed.

RESULTS

The ACP role in England was undertaken in a broad range of clinical contexts. In England 'advanced clinical practitioner' was not a protected title. There were high levels of variability and ambiguity of understanding and deployment of the ACP role in England. Facilitators to the implementation process included training and education, clinical supervision and organisational support. Lack of protection for the role and variances in experience were barriers. Employer support facilitated development of the ACP role, however where support was limited, at either an individual or organisation level, this was a barrier. Our study highlighted the wide range of ways the ACP role benefitted patient outcomes and workforce development.

CONCLUSIONS

This study outlines the contribution that ACPs can make to health services, contributing factors and key barriers and facilitators to implementing this role. The work showed the positive contribution ACPs can make to service redesign, workforce development and patient outcomes, whilst accepting there is much work to do to ensure protected status and parity across all professions and clinical contexts.

Skill-mix change and outcomes in primary care: Longitudinal analysis of general practices in England 2015-2019

BACKGROUND

Increasing the employment of staff with new clinical roles in primary care has been proposed as a solution to the shortages of GPs and nurses. However, evidence of the impacts this has on practice outcomes is limited. We examine how outcomes changed following changes in skill-mix in general practices in England.

METHODS

We obtained annual data on staff in 6,296 English general practices between 2015 and 2019 and grouped professionals into four categories: GPs, Nurses, Health Professionals, and Healthcare Associate Professionals. We linked 10 indicators of quality of care covering the dimensions of accessibility, clinical effectiveness, user experiences and health system costs. We used both fixed-effect and first-differences regressions to model changes in staff composition and outcomes, adjusting for practice and population factors.

RESULTS

Employment increased over time for all four staff groups, with largest increases for Healthcare Professionals (from 0.04 FTE per practice in 2015 to 0.28 in 2019) and smallest for Nurses who experienced a 3.5 percent growth. Increases in numbers of GPs and Nurses were positively associated with changes in practice activity and outcomes. The introduction of new roles was negatively associated with patient satisfaction: a one FTE increase in Health Professionals was associated with decreases of 0.126 [-0.175, -0.078] and 0.116 [-0.161, -0.071] standard deviations in overall patient satisfaction and satisfaction with making an appointment. Pharmacists improved medicine prescribing outcomes. All staff categories were associated with higher health system costs. There was little evidence of direct complementarity or substitution between different staff groups.

CONCLUSIONS

Introduction of new roles to support GPs does not have straightforward effects on quality or patient satisfaction. Problems can arise from the complex adaptation required to adjust practice organisation and from the novelty of these roles to patients. These findings suggest caution over the implementation of policies encouraging more employment of different professionals in primary care.

Appetite for more exchange, connection and collaboration among senior health professionals

Background

The COVID-19 pandemic has highlighted the value of global exchange around knowledge, skills and attitudes among senior healthcare professionals (SHPs). It has also revealed the need for strong peer-led networks and mentorship to tackle the high levels of burnout and ‘brain-drain’ already plaguing the National Health Service (NHS). We designed a survey to gauge the appetite for exchange programmes among SHPs.

Methods

Data collection was carried out via an online qualitative survey generated by SurveyMonkey software and analysed by three independent authors.

Results

155 responses were collected of which 87.7% were pre-COVID-19 pandemic. 74.2% had ideas to improve healthcare but could not take it forward. 86.6% felt frustrated/down-heartened about work. 74.3% wanted more sharing of teaching resources. 74.2% expressed interest in sabbatical programmes.

Conclusion

Our survey confirms the desire for more connection, collaboration and exchange among SHPs who are at high risk of burnout, silo-working and leaving the profession early. Sabbaticals have been used successfully in other industries, especially academia, for many years and show long-term investment and value from employers in their employees. Almost 75% of the SHPs in this survey were interested in this but logistics precluded easy access to them. HealthProMatch (HPM) is a platform where SHPs can connect, collaborate and arrange exchanges/sabbaticals with logistical ease. It focuses on bringing leadership, mentorship and quality improvement back home. HPM will pilot in the NHS within anaesthesia and hopes to increase job satisfaction and retention in this precious workforce group.