MODELS OF PRACTICE PLACEMENT PROVISION FOR THE …€¦ ·

MODELS OF PRACTICE PLACEMENT

PROVISION FOR THE

ALLIED HEALTH PROFESSIONS:

A Guide

Version 2 April 2007

NHS Education for Scotland AHP Practice-based Education Facilitators Programme

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MODELS OF PRACTICE PLACEMENT PROVISION FOR THE AHPS Version 2, April 2007 Changes since Version 1-November 2006 Pg 3 Table of contents updated

Page 7 Diagram revised and simplified and title added

Pg 34 Added bibliography and nursing references and acknowledgements

Pg 31 Added Barr et al reference

Acknowledgements Joanna Beveridge- AHP Practice Education Pilot Site Project Officer, NHS Borders Allister Kelly - AHP Practice Education Pilot Site Project Officer, NHS Dumfries and Galloway Paul Lambert- AHP Practice Education Pilot Site Project Officer, NHS Greater Glasgow Susan Shandley- Dietetics Practice Placement Project Officer, NHS Education for Scotland Jim Foulis and Ann Rae, Nursing and Midwifery Practice Education Coordinators, NHS Education for Scotland for sharing their references Karin Tancock, Occupational Therapy Clinical Placement Facilitator for Surrey and Sussex for sharing her Practice Placement Models resource pack Contact: [email protected] Shona Henderson, Practice Placement Tutor/ Lecturer in Occupational Therapy, Queen Margaret University, Edinburgh Moyra Muir, Practice Education Facilitator/Lecturer, Glasgow Caledonian University Christine Monaghan, Practice Placement Tutor, Dietetics, Glasgow Caledonian University All contributors of reflections on placement models Chartered Society of Physiotherapy for the use of their case studies AHP Practice-based Education Facilitators from across Scotland for their contributions, corrections and suggestions


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Glossary of terms AHP – Allied Health Profession

The term Allied Health Profession has been used throughout this document and includes the professions who come under the AHP umbrella as outlined in Building on Success: Future Directions for the Allied Health Professions in Scotland (SEHD, 2002) These are: Art Therapists, Dieticians, Drama Therapists, Music Therapists, Occupational Therapists, Orthoptists, Orthotists, Physiotherapists, Prosthetists, Podiatrists, Diagnostic Radiographers, Therapeutic Radiographers, Speech & Language Therapists.

CSP Chartered Society of Physiotherapy

COT College of Occupational Therapy

HEI Higher Education Institution

HPC Health Professions Council

Level 1

Equates to the first year of study in a pre-registration AHP course.

Level 2

Equates to the second year of study in a pre-registration AHP course.

Level 3

Equates to the third year of study in a pre-registration AHP course.

Level 4

Equates to the fourth year of study in a pre-registration AHP course

PP Practice placement Duration of time where a student is placed and where practice based learning occurs in the working/clinical environment. The term is synonymous with the term clinical placement and fieldwork placement.

PPP Practice placement provider

Practice placement providers are those organisations that provide practice placements either in the NHS or other organisations.

PE Practice Educator The identified clinician who facilitates practice based learning for allocated students in the working/clinical environment. This term is synonymous with clinical supervisor and fieldwork educator.


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Contents Acknowledgements

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Glossary of Terms

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Contents

4

Introduction

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Placements and Placement Issues 5 ● Partnership Working 6 ● Why look at models? 7 ● Benefits of Taking Practice placements 7 ● The Challenges of providing Practice Placements 8 ● This Document 8 ● Offering placements for the first time or changing to the Model you use currently.

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● Planning Practice Placements 9 Model 1: 1:1 or Apprenticeship Models

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Model 2: 2:1, 3:1, 4:1 – Peer assisted Learning models

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Model 3: 1:2 Models, Split models

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Model 4: Dedicated clinical educators, full-time teachers

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Model 5: Dedicated Facilities

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Model 6: Self directed learning, ‘long arm’ supervision, role-emerging models

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Model 7: Supported Distance Education (in development)

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Model 8: Interprofessional models (in development) 30 References

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Bibliography

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Appendix 1

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Introduction Practice placements are an integral part of the education of Allied Health Professionals (AHPs). It is during placements that students have the opportunity to translate theory into practice, experience the ‘real world of working’, learn about professional values and beliefs as well as fulfil statutory requirements for registration with the Health Professions Council (HPC) and their degree or masters course. Developing practice-based learning opportunities is essential for the NHS as it the best way that the future AHP workforce can be produced and sustained. About this document This document provides some tips for using different models of practice placement for AHPs and is designed to be used by service managers, practice placement coordinators, practice education facilitators and practice educators who are involved in delivering or organising practice placements for any of the Allied Health Professions. It is a working document and it is hoped that it will change over time to reflect change in practice and new evidence. It is not definitive, complete or comprehensive and it is envisaged that the document will be regularly undated over the course of the AHP Practice-based Education Facilitation Programme, 2006-2009. Practice Placements- Definitions The “Practice Placement” refers to the time that pre-registration students are on a placement within any area that AHPs practice or undertake their professional role. Practice placement models” or just “models” as they are generally called here refers to how the placement is structured with particular reference to the relationship between practice educator(s) and learner(s). Whist practice placements often are within the NHS, increasingly AHPs are working in social care settings, the voluntary sector and industry and some of the models mentioned here are applicable to these settings too. Similarly, most of the published literature concentrates on placements for pre-registration students but many of the models described could also be applicable to other learners such as assistant AHPs undertaking Higher National Certificates (HNCs) or AHPs returning to practice after an extended career break. All practice placements should provide the student with a variety of learning opportunities to enable them to achieve the relevant learning outcomes. These opportunities will usually be combinations of observation and enquiry, hands on assessment and treatment, self directed study, group work and tutorials as well as direct questioning/supervision from a practice educator (teacher, tutor etc) to reinforce clinical reasoning.


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Partnership Working The successful production of a competent, confident graduate AHP is the end product of numerous partnerships and collaborations. The Higher Education Institutes (HEIs), the NHS (including organisations such as NHS Education for Scotland), the professional bodies, the Health Professions Council, and the learner and future AHP all have a role to play. Practice placements and the models used by the health service to deliver them rely on all partners doing their bit to keep the process going. Figure 1 shows all of the components that come together to lead to a successful placement, some of which you may be aware of and have control over and some of which carry on in the background. Figure 1. Components of a Successful Practice Placement: Partnership Approach

Higher Education • Educator Support

/training/accreditation

• Student support and preparation

• Quality Monitoring

The Learner • Self-directed

• Adult learner

• Reflective

• Supported

• Valued

The NHS or other Provider • Placement Site/ Learning

Environment

• Practice Educator- Facilitating learning

• Models of placement

• Quality Monitoring

Health Professions Council (HPC) • Standards for

Education and Training

• Validation of HEI programmes

• Standards of Proficiency and public protection generally

Successful Placement Experience

Professional Bodies • Placement Standards

• Accreditation of Educators

• Curriculum Content

The Patient/Client and Carers • Respected

• Valued

• Partner in Care

• Consenting

QUALITY LEARNING EXPERIENCE QUALITY CARING OR TREATMENT EXPERIENCE


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Why look at models? Most AHPs are familiar with taking students on placement; it is just something that is part of being a professional. Like any other area of practice, it is worth looking at the evidence to see if changes need to be made to practice placements in order to find benefits for the student, the educator, the service and ultimately the patient or client. No one model has all the answers to the challenges of providing practice placements for AHP students; each clinical setting, level of student and profession has its own challenges. Some features such as planning, preparation and communication are common irrespective of what model you use or what profession or area you practice in and these aspects are addressed below. Benefits of Taking Practice placements Most managers and clinicians recognise the benefits that participating in practice placements bring for the staff, the service and the students. Most of the AHP professional bodies are explicit about professional’s duty and responsibility to contribute to the education of future professions. This, from the Chartered Society of Physiotherapy Core Standards is typical: “Standard 7: There is a systematic, proactive and responsive approach to the provision of clinical education for pre-qualifying and post qualifying students. General guidance All services should accept their responsibility for contributing to the provision of quality learning experiences and supporting professional development of ALL staff.” CSP (2005)

In addition to this professional responsibility, changes to job descriptions and personal development planning introduced in recent years as part of Agenda for Change mean that student education is an explicit part of many experienced AHP’s Job Descriptions. With increasing implementation of the Knowledge and Skill Framework, undertaking placement education is one way of evidencing certain core and specific dimensions of the KSF (e.g. Core 2 Person and People development, G1 Learning and Development). Practice education is a good way for staff to remain updated to current academic thinking and to develop further their own clinical education skills. Evidence from student supervision (feedback forms, short reflections, even thank you cards) can also be included in your CPD portfolio or folder and be used when/if you need to produce a CPD profile for HPC audit. Running well planned and varied practice placements can also have benefits in terms of recruitment of future staff into your service. There is some evidence that positive student experiences can influence the first work destination of new graduate staff in nursing and the same may be true for AHPs (Andrews et al 2005).


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Quality practice placements can maximise the learning of students leading to well trained and prepared future practitioners who can ‘hit the ground running’ when they graduate and as a National Health Service, placements are crucial for ensuring that there is a steady supply of new AHPs to take up roles within the service. The Challenges of providing Practice Placements There no doubt that providing placements does provide challenges for a busy service. Managers and clinicians are under increasing strains from a variety of sources and it can be difficult to balance these while keeping the patients/clients needs at the centre of activity. Like most aspects of service delivery, planning placements using the best available evidence ensures that the impact on service delivery is minimised. This Document The models described here are not intended to be exhaustive nor a detailed critical appraisal, rather a practical guide for practice educators, practice education facilitators, placement co-ordinators and team leaders, to enable services to select the most appropriate model(s) to use in their area or as a starting for staff supporting practice education who might want to develop these models further into learning resources. The models of practice placement provision outlined in this document are adapted from many sources: from descriptions in the peer-reviewed literature, from professional body websites and from AHP practice educators working in Scotland and refer to models used to describe AHP practice placements as opposed to models from other professions (see References and Bibliography for details). It should also be noted that there are many other descriptions in the literature from professions as diverse as dentistry, medicine, social work, nursing and teaching that all provide insights into the process of teaching and learning in a practice setting. This document does not delve into the methodology of practice education that may be used on each placement (e.g. collaboration, mastery pathway, problem solving, reflective practice, and coaching -see Strohschein et al (2002) for a review of the distinction of methods and models of practice education) Neither does it set out in detailed standards that need to be met by any practice placement (such as educator, student, department and HEI responsibility; requirements for the placement environment; learning outcomes or goals/objectives). These standards are available from the Health Professions Council (www.hpc-uk.org ) Offering placements for the first time or changing to the Model you use currently. Offering placements for the first time or changing to new or innovative models should be done in partnership with the Higher Education Institute (HEI), the manager and the practice educator and evaluated for its effectiveness. It is suggested that you take time to look through this document and try to identify which models may be suited to your situation. If you have a clinical education co-ordinator within your service you could look at the different models together. The university practice placement tutors will also be


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able to give you some assistance. In addition, the AHP Practice-based Education Facilitator (PEF) in your health board area will be able to give support and advice to help with this. A list of the AHP PEFs in Scotland can be found in Appendix X. Planning Practice Placements Most professional bodies have quality standards or guidelines for practice placements; generally these are available from the website of your professional body. Generic standards are available and NHS Education for Scotland is currently undertaking a review of practice placement standards for AHPs as part of the AHP Practice-based Education Facilitators Programme. Quality standards allow you to consider what your profession considers to be important for running a quality placement and can be a starting point to monitoring your own placement opportunities they generally cover aspects of the learning environment, the practice educator (aka clinical or fieldwork educator, clinical teacher or trainer), the student’s obligation. The host HEIs have the central role in assuring the quality of placements and it is worth having a conversation with the HEI coordinator so that you have an understanding of this process. Things to consider for all placements:


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Prior to the placement During the placement

After the Placement

Educator preparation: has the educator had any training from the student’s HEI? Are you working using the most up to date theories e.g. adult learning, self direction, reflective practice? Student preparation: has your department or placement site given the student/HEI some kind of induction pack? Can this be developed as a multi-professional resource? Educator should review learning outcomes of placement, and make any plans for changes to caseload i.e. to allow induction of student on first day. Be familiar with expectations of students at each stage of a placement. Many issues on placement can be avoided by student and educator sharing expectations and understanding each other’s perspectives. Identify team members that can offer support to the educator and learning opportunities for the students. Immediate colleagues need to be aware of planned placements and be prepared to assist the educator with their caseload. Are there sufficient clients available for each student to meet their learning goals? Is another model more suitable for your clinical setting? Remember that direct client contact is only one experience students can have on placement. Contingencies for educator sick leave or other unforeseen circumstances should be made- some departments use ‘buddy’ or ‘standby’ systems. The amount of space and other resources required students needs to be considered, can thought be given to using shared learning space such libraries or looking at facilities used by other professions (e.g. medicine and nursing)

Planning of statuary requirements for students including Health and Safety, Cardiopulmonary Resuscitation, Moving and Handling and Fire Safety.

Agree and record learning outcomes/competencies with student Agree mutually convenient times for, and expectations of, supervision. Students need to be considered as individuals and their learning outcomes should reflect this. Discuss and agree diary sheets or outlines for the placement, allocating time for shadowing the educator, other team members, self-directed study time, time to work on learning outcomes (including policies and procedures, reflection on a critical incidents), supervision, peer discussion. Ensure there is adequate time set aside for educators to meet up with students for feedback Structure the placement to reflect the level of the student and the learning outcomes. Plan Caseload: are there sufficient clients/patients available for each student to meet their learning goals? Practice educators need to ensure that they have support mechanisms and coping strategies during placements. This can be in the form of peer support from another colleague or manager or links into the students host HEI if the issues related to student performance. Discussion undertaken with line-managers to modify clinical caseload, especially in the first few weeks

Ensure that you have a mechanism for getting feedback from the students about any improvements to the placement and also as your performance as an educator. Some of the best learning you will get is as a result of feedback from students. Feedback should be obtained after any final feedback or marking and some students will feel better with anonymous feedback. Review should be undertaken by placement coordinator or manager periodically on whether different models could or should be used. Educator Preparation/accreditation: When was the last time that placement educators undertook an update at an HEI? If education is a significant part of the educators role, consider getting these skills recognised by applying for accreditation from the professional bodies or undertaking further study in the area. PEFs or local HEIs will have more details of these programmes.


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The Models The 1:1 or Apprenticeship models What are 1:1 or Apprenticeship models? This is the model that most educators are comfortable and familiar with. It involves one educator supervising one student, in any clinical setting. Usually the educator shares part of their caseload with the student while continuing to carry the rest of the caseload. This model is described by Martin, Morris et al (2004). This model continues to evolve to reflect changes in thinking about education and learning, Higgs (1992) discusses this change and speaks of the educator as being more of a manager/facilitator (of learning) and the student as the self-directed learner. Advantages of the 1:1 model for: The Service

The Practice Educator The Student

Very familiar to many professionals

Non-threatening

Easy to implement

Suitable for any clinical area

Suitable for any level of student

Encourages student autonomy

Very familiar to many professionals

Easy to implement

Enhanced opportunities to assess students strengths and weaknesses

Can be implemented by less experienced educators

Easier to run where patient/client numbers are low

No competition with other students

Student integration into team may be easier

Encourages student autonomy

Easy to observe practice educator

Opportunity to build relationship with practice educator Easier to facilitate exchange of feedback

Challenges of 1.1 models

• Limited capacity to increase student numbers

• Time pressures on educator who has to manage existing caseload in addition to supervising student

• Student may become too dependent on supervisor

• Potential for personality clashes

• No support or shared learning with ‘peer’ or other student(s)

• May not reflect active (or self directed) learning advocated by many HEI’s 1.7 FAQs This is the model that we have always used, why would we change? The 1:1 model is still a valid way to provide a placement for a student but there is evidence as outlined in the rest of this document that other ways of providing a placement experience for a student have great benefits. These benefits are numerous and it is advised that you look at the other models described and see which may fit in with your area of work and experience as a PE. If this is the model you use, chances are that the way it is implemented could be undated to reflect changes in current learning theory.


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Model 2 Peer assisted learning, collaborative learning models (2:1, 3:1, 4:1) What are peer assisted learning or collaborative models?

These models encourage students to use each other for support and mentoring and to work with the practice educator and other student as part of a mini-clinical team. There is evidence to show that these models encourage students to develop improved communication, reflection and autonomy. There are many terms used to describe this kind of learning, Ladyshewsky (2000) gives a good summary of the different terms. As well as some evidence for improved learning outcomes, peer assisted learning models have the additional benefit of increasing the numbers of placements a site can offer. Most educators who have used the model say it is no more work than 1:1 models once they are familiar with the process (see case studies later). Most descriptions of these models involve one educator and multiple students (usually two), with the educator assigning an increasing proportion of their clinical caseload to the students to manage over the course of the placement Baldry Currens (2003). Peer assisted learning placements may take a little longer to plan initially (like any service change) and rely on the educator handing over the majority of their caseload to the students by then end of the placement, with the educator acting as facilitator/ manager rather than a teacher/instructor.

Advantages of Peer Assisted Learning models for: The Service The Practice Educator The Student

Some evidence to show that it improves achievement of learning outcomes (Martin and Edwards, 1998)

Can increase a department’s productivity

Suitable for large departments with high patient throughput

Increase capacity for practice placements

Lends itself to interprofessional placements

Allows educator to use group situation to pose questions and use small group to facilitate discussion and reflection

It can reduce PE’s stress and develops their knowledge and management skills

Makes students more independent, encourages problem-solving

Decreases students dependence on PE

PE may have time for non-student activities

Excellent scope for student peer support and shared learning

Encourages problem solving and independence

Helps to develop team working skills

Peer/ social support in rural locations

May enhance clinical competence (DeClute and Ladyshewsky, 1993)

Achievement of learning outcomes may be improved

Increased opportunity to discuss theory and practice with peer

Challenges of the Peer learning model

Organisation of placements can be time consuming initially

May not be suitable for some settings due to space restrictions e.g. domiciliary visits, ‘lone working’ or low patient through-put

Misunderstood by many clinicians therefore educators may be resistant to taking more than 1 student at a time

There may be a problem with rivalry between students

Placements should be tailored to individual needs of students


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Care must be taken to give students individual time and attention

educator needs to balance different learning styles and students of varying abilities

Ratio limited by the experience of educator and other clinical demands on educator

Requires more thorough knowledge of education theory

Additional Strategies for successfully managing the 2:1 model Prior to the placement

During the placement

Practice educators will require time and support to develop their skills and knowledge around this model of practice education

Identify and later introduce to students an experienced placement educator or a co-ordinator who can offer opportunities for students to reflect on the model away from their educator.

Identify small projects the students can work on together that would meet the students’ learning outcomes and be of potential benefit to the team/department. (For instance, finding examples of care pathways for a particular condition or comparing standardised assessments and suitability for use in your work setting.) These projects should be realistic reflecting the students’ stage of training.

Think of yourself as a team and agree joint responsibility for meeting the learning outcomes. Explain your expectations and what the student can expect from you and your team/department. Support the students to explore what they expect from the placement and from working with each other.

Set ground rules for the placement i.e. around individual as well as group supervision, roles of students if seeing a patient together, rationale for peer discussions, how many of the weekly learning aims will be individual and how many shared

Take into consideration each student’s learning styles when planning activities.

If appropriate, give students the responsibility of organising their own timetable.

Start each day running through everyone’s plan for the day. Check with the students that they understand the aim of each appointment/activity.

Take care of yourself as an educator. Allocate time within the week for your supervision, administration, phone calls and meetings. Use colleagues for support.

Your role is to act as a facilitator to aid student centred learning, not as a supervisor who is expected to impart all knowledge and observe the students at all times.

Facilitate the students to use models of reflection to aid self assessment.

Use students to provide feedback to each other as this helps reflection and critical evaluation


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2.6 FAQs Does this model need a lot more organisation than traditional 1-1 model? Peer learning models require to the educator to be more of a facilitator than a teacher, this is an important change for some educators. To make peer learning models work, thorough planning before the students arrive is essential. Factors to consider are caseload composition, provision made for student tutorials, sufficient space, and robust communication links with manager, HEI and colleagues. This is true of any model but is particularly important with peer assisted learning models Is student competition a big problem? Competition cannot be wholly avoided and can act as a motivator if handled sensitively. By emphasising the team aspect of working together to provide a service, the educator can avoid encouraging negative competitiveness. Individual development plans and personal feedback also reduce the students’ perceptions that comparisons are being made. Comparisons between students, particularly when raised as feedback, can be particularly damaging to a student’s confidence. Remember each student is an individual and take the time to get to grips with each student’s learning style. What if one student is quieter or more dominant than the other? It is important to clarify to the students how you evaluate their progress. This can be supported by working with each student to clarify learning outcomes, providing timely and specific feedback to each student and by avoiding comparisons between students. You may need to direct questions directly to the quieter individual to enable them to build their confidence.

How do you manage your caseload if you have two or more students? Ideally, your caseload should be reduced at the beginning of the placement to enable you to spend more time with the students, and this will require support form your colleagues. This is not always possible and students will need to adapt to the fluctuations in caseloads. As the placement progresses the students should gradually assume responsibility for the majority of your workload, if appropriate, for the placement. This will obviously depend on the level of the student. For example, peer placements are being used in Scotland for second year Dietetics students who do not have direct patient contact. Think of the placement as being a joint responsibility and as a ‘team’ decide how best to manage the different elements and demands that make up a placement. After the initial induction period the students can work with you to problem solve time management and prioritisation issues,


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PERSONAL REFLECTIONS ON THE 2:1 MODEL OF SUPERVISION: Carol: Clinical Educator for Physiotherapy, Dumfries and Galloway Previously I had only carried out Clinical education placements on a 1:1 model and I had a few reservations about taking on 2 students at once. The questions I had prior to the placement starting were; “did I have adequate ability to provide a learning experience for 2 students?”; ”would I have enough time for each student?”; “would they feel intimidated?”; “was there enough space in the department?” and lastly “would I feel intimidated by two students questioning me?” Reflecting back on the experience of the 2:1 model generally I felt it went well from both sides. The evaluation forms from the students reflected that they had been satisfied with their learning experience. Time was scarce as I still carried a clinical caseload and in hindsight I would have reduced my caseload further. The students didn't feel at all intimidated when doing tutorials but then this is quite normal for them within the college setting. Occasionally space to treat patients was an issue but it wasn't an overwhelming problem. Rather than feel intimidated by 2 students questioning me, I felt very stimulated in a good way and discussions flowed much easier. Each student was given the opportunity to approach me privately however the need did not arise much within the 5-week period.

At the end of the placement, my reservations had been allayed and I actually felt it had been a far more satisfactory experience than the 1:1 model which I would be happy to do again. I would recommend it to others to give it a go but my advice would be to give yourself plenty of preparatory time and reduce your caseload as much as possible.


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Developing 2:1 Peer Assisted Learning (PAL) Model for Dietetics Christine Monahan- Dietetics Placement Coordinator, Glasgow Caledonian University Various dietetic student educators, both new and existing, are piloting the 2:1 PAL model across Health Boards in Scotland with support from Glasgow Caledonian University. It is being trialled in Placement-A which is a 4 week non-clinical placement. This starts at the end of level 2 and gives students the chance to see dietitians in practice (either in the acute or community settings). Below is an example of 2:1 PAL tasks for placement A.

Aim: To demonstrate an interest in and commitment to the work of dietitians. Task: Ask appropriate questions when with dietitians and other health professionals. Be punctual and manage workload within timeframe allocated. Both students: 1. Ask appropriate questions when with dietitians and other health professionals. 2. Be punctual and manage your workload within the timescale allocated. 3. Working together, discuss how you found answers to your questions during placement. Did you both use the same strategies? If not, why did your approach differ? What are the implications for your B placement? Did you both contribute equally to the collaborative tasks you were set? Did one person tend to take the lead most of the time? Was your peer reliable?

It can be seen from the above that the students get an enhanced placement experience by the contrasting their own experiences. In a 1:1 model, students could complete parts 1 and 2 only but with the 2:1 model the students can complete part 3 with their peer and reflect on how each approached the placement. If this model evaluates well, it is anticipated that all educators offering A-Placements will move to the 2:1 Peer Assisted Learning model. The introduction of 2:1 models for A-Placements has been well received by students and educators and has also led to an increase of 21 extra A-Placements since its introduction.


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Model 3 1:2 model, Split model, Shared Model 3.1 What is the1:2 model, Split model, Shared Model?

This model describes the situation where one student shared between two or more members of a team, ideally with one lead educator to co-ordinate activities, learning goals and assessment and is described by Gaiptman and Forma (1991). Essential features

• Various combinations of staff can work with this model e.g. 2 or more clinicians from the same organisation, an experienced PE and a new PE, and 2 PEs from different organisations

• Placements can be arranged around a patients journey e.g. from secondary care to primary care

• Gives the opportunity for all staff to be involved in student education i.e. part-time staff, staff with a large management responsibility, novice PEs

Advantages of the shared model for:

Challenges of the shared model

Placement needs to be well planned with all members of supervising team in agreement to lines of responsibility, role and reporting Can be difficulty in ensuring parity/reliably/validity of assessment if two educators are assessing the same student All team members must contribute to feedback so as broad a picture as possible can be gained about the progress of the student

The Service The Practice Educators The Students

Greater flexibility to improve placement capacity, cover leave arrangements Applicable in community or acute setting or mixed settings meaning lone workers (or part-timers) may be able to contribute more to placement provision Applicable for joint working across sectors Allows all members of the team, full-time, part-time, all clinical grades and support staff to contribute to placement education.

More opportunities for staff to be involved in education irrespective of hours worked Promotes team-work between PEs Peer support for PEs if there are challenging or complex students

Students get the opportunities to experience different communication, problem solving and treatment styles Suitable for all levels of students


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Additional Strategies for managing the 1:2 model Prior to the placement During the placement After the Placement

All members of the supervising team should meet to discuss approach to placement

Placement aims and expectations of student should be agreed and recorded by all staff involved

Agree communication lines and responsibilities between PEs i.e. times, method of communication

It is helpful to discuss with student the different learning styles and expectations

Consensus must be reached by all involved on the students halfway and final reports

3.6 FAQs

What do we do if we disagree about a student’s performance? When meeting with fellow educators it is important to acknowledge your differing styles of practice and the students learning style, however this should not impact on your expectations/ assessment of each student. If you are unable to agree on a students’ performance, it maybe helpful to discuss the issue with a lecturer or placement co-ordinator from the students’HEI. It would also be helpful to discuss assessment methods used by each educator to eliminate any subjectivity. You could also agree on an additional assessment to help clarify the student’s performance in a particular area that you are unsure of.

Can students cope with having to work with different educators? It is felt that students are able to cope with working with various educators and they will respond to seeing different styles of practice. One practitioner may be unable to provide a student with all the learning experiences required so sharing a student between practitioners can only be advantageous for the student.


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OCCUPATIONAL THERAPY PRACTICE EDUCATOR - REFLECTIONS ON THE TEAM MODEL OF SUPERVISION IN A DISTRICT GENERAL HOSPITAL

As a service we have offered practice placements to students regularly but always on a 1:1 basis, using full-time staff members of staff only. Our staff levels then changed, and we became a department where the majority of the OT’s where part-time. We decided we could offer a placement where a student was shared between 2 or 3 therapists. We tried to keep the student within the same clinical area i.e. dept of medicine for the elderly, medical unit. The HEI where the student came from did not have a problem with us using 2 PEs. What we didn’t realise was that this was the ‘team’ approach we were trying! The first student we tried this with was a mature student which upon reflection was fortunate, as she had the maturity and flexibility to deal with 2 educators. She did not feel that this model had a detrimental effect on her placement experience and said in fact she welcomed the opportunity to spend time with different educators and see different styles of working. The educators involved found it was helpful to not always have sole responsibility for the student. We recognised that good communication was essential between PEs which was helped as we were all on the same site. What we did not do was select a main educator who would take the lead for the assessment of the student, however we worked closely during the assessment process and gave joint feedback to the student at half way and final report times. In the future, we plan to use this model with our colleagues in SW and primary and community services, so a student would have a placement on 2 sites. This will mean we will have to ensure our communication structure is very firm, and that we must identify a key practice educator for the student. This model works well for us in a small DGH setting. Using this model has also meant that we can include more members of staff in PE – i.e. therapists who only work a few hours a week, or staff who are new to practice education working with more experienced PEs. Practice Educator, Occupational Therapy NHS Borders

OCCUPATIONAL THERAPY PRACTICE EDUCATOR - REFLECTIONS ON JOINT STUDENT PLACEMENT ACROSS HEALTH AND SOCIAL SERVICES. Overall, this type of placement was a success. It was an 8-week placement, which was split into two 4-week blocks for each area. It was felt that this was a short period of time within each area as by the time the student had settled in it was time for them to move on. The placement gave the student the opportunity to follow a pathway of patient care. The student was able to intervene with patients in hospital and then once home, which was an ideal situation - continuity of care for the patient and a greater understanding the whole picture for the student. It was felt that this aspect of the placement worked really well. It was positive that the student could stay in the same accommodation and still work in the same locality. Working in a hospital and a community OT Dept allowed the student to observe the similarities and differences in working practices/ teams/ documentation/ policies etc. It would have been beneficial for both educators to meet prior to start date to discuss goals, however staff thought the student would be responsible for setting their own goals and learning objectives through the use of a learning contract. This can only be set up and discussed when the student has an idea of what is available in the particular placement settings. Practice Educator, Occupational Therapy NHS Orkney


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Model 4 Designated clinical educators (DCE), full-time teachers 4.1 What is the designated clinical educator model?

This model uses a member of staff who are not carrying their own caseload, to instruct and supervise a number of students during a clinical placement. Clients are obtained from other staff members’ caseloads allowing the students to experience a range of client groups. This model is often used in associate with peer learning models using one PE with a small group of students. By the end of the placement the students are often managing more patients than would be possible for one member of staff. The educator is employed specifically to teach students during semester time and may then return to clinical duties when students are not on placement. Positions can be jointly funded by HEI and PPP to provide an agreed number of placements at a particular level. (Stiller et al 2004) 4.4 Essential features

• PE has a greatly reduced (or nonexistent) caseload for the duration of the placement

• PE may be employed by the Health Board or the HEI Advantages of the dedicated clinical educator model for:

The Service The Practice Educator The Student

Suitable for large institutions and acute settings rather than community May promote more single system working across patient flows Can encourage a more holistic approach to patient assessment and treatment Commitment to an agreed number of placements per year for HEI’s Positive effect on patient waiting lists Opportunity for academic staff to improve clinical skills Can free time of clinical staff whose clients are being seen by students during the placement

Educator has only one role when students are present-not trying juggle student teaching and clinical treatment Offers the educator a clinical role in non-student time and the possibility of research and close contact with HEI’s Helps to promote education as a viable career pathway Offers a career pathway for generalist AHP’s

May have better consistency of assessment and evaluation of students Ideal for use where close supervision is needed to develop highly specialised skills


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Challenges of the dedicated clinical educator model Seen as expensive as for the duration of the placement the educator is supernumerary Education skills may rest predominantly with one or two individuals making this model susceptible to problems with absence/leave Risks making education a ‘specialist’ part of the professional role as opposed to reinforcing the notion that practice education is the responsibility of all suitably prepared professionals Less support for educator with challenging student Not all staff have the opportunity to teach Can be issues with communication between the students and the ‘responsible clinician’ from whose caseload the patient has been taken. This can complicate ward rounds, care meeting etc. Sudden increase in clinician’s workload at the end of placement as clients are transferred back to responsible clinician. Additional strategies for managing the dedicated clinical educator model The most challenging thing about the DCE model is arranging agreement for funding and governance of the new position with the participating HEI and placement provider. Clarity needs to be achieved in role, responsibility and funding of the new position but once this has been done there are real advantages for HEI, placement provider, educator and students.

Prior to placement

During placement

There will be a pre-existing arrangement between the HEI and the provider about the number of students to be taken. A 4:1 student to educator ratio works well, but can be up to 6:1 if all of the students are seeing patients/clients in the same clinical area. The educator will need to inform the other staff that students will be starting and the educator will be requiring patients to be used as student patients. The educator should also ensure that they have access to planned admission and elective surgery lists to plan for possible new patients in the days to come

Educator will have to manage and increasing numbers of patients split between all the students and must rely on the students to feedback about the progress of their patients as well as conversations with clients, carers, ward staff and written records. The educator should try to be present with the student for part of the first assessment and treatment and the educator must quickly identify weak students to ensure safety at all times. Communication between student and educator is essential and is often undertaken via pager and telephone, making this model suited to larger acute hospitals with that infrastructure already present. Communication between students and ‘responsible clinician’ is important so that the clients needs and progress are accurately reported during case conferences, ward meeting etc. This may also provide an opportunity for students to present/feedback in these meetings. Staff need to be reminded that placements are at an end and that students will be handing clients back to the ‘responsible clinician’


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4.6 FAQs Who pays for this member of staff? There are different ways to finance this, by joint arrangement (contract or SLA) between one or several HEIs and the placement provider. The department or board may decide to create a Practice/Clinical education post to formalise existing relationships and to encourage a career path in practice based education. What does the educator do when there are no students? This partly depends on the arrangement for funding the posts. They may return into the normal work of the department, offering backfill or extra help in busy areas, they may have a clinical research remit or they may have other management duties to attend to. How do other members of staff get experience of supervising students if the same person is doing it all the time? This model is suited for times in the pre-registration course when students are learning the bulk of their technical and clinical reasoning skills. There are opportunities for other staff to take students in the department at other stages in the course. Does the educator carry his or her own caseload? Not usually, the educator obtains suitable patients from other staff members for the students to assess and treat. The ultimate responsibility for those patients’s care sits with the educator, so in effect all of the students’ patients build up over the placement to become the responsibility of the educator. The educator is also responsible for countersigning case notes and needs to inform the students about case conferences, discharge meetings etc to ensure smooth and timely patient care.


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Model 5 Dedicated facilities, “Dental School Model” What is the dedicated facilities model?

Dedicated student facilities are used to provide a learning environment where students can learn clinical and diagnostic skills in a closely monitored environment. The facilities also permit a more flexible approach to the teaching needs of the individual students by providing 1: 1, 1:2, and 1:3 teaching opportunities. These facilities are used within podiatry and prosthetics and orthotics in Scotland currently as well as for Dental Student training and are described by Snyder (1996) Advantages of the dedicated facilities model for:

The Service The Practice Educator The Students

Identified learning centre for the specific profession. Guaranteed number of placements per term / semester / year. Availability of large number of patients with broad range of medical and surgical history from which students will gain valuable experience. Provides a resource for patients within the NHS for the treatment of complex and resource draining pathologies. Could provide an ideal platform for interprofessional placements Provides opportunity for patients of a high clinical risk to be referred to centre that can provide integrated care package.

Offers close, structured dependency (high ratio) supervision to students when learning clinical diagnostic and technical skills. Provides opportunity for peer review and peer support for clinical teachers. Provides an educational career pathway for professionals

Provides opportunities for peer support as ratios are often 4 – 8 :1 Facilitates a consistent learning experience and assessment process for students. Exposure to a variety of learning / teaching styles that can respond to suit the need of individual students. Negates the need for considerable cost, in both time and money, required for travelling between smaller placement sites. Dedicated facilities have the capacity to provide demonstrations and tutorials to large groups of students. May provide a more reliable assessment for whole cohorts

Challenges of the dedicated facilities model

• May be a duplication of existing clinical service

• Perceived as expensive to administer/run and significant infrastructure cost to establish and maintain

• Educator may not have current and continuing clinical commitment to maintain clinical skills and current practice developments

• ‘Protected’ environment may not be the most accurate reflection of ‘true’ clinical practice

• Close, structured supervision, although necessary at certain times of training, could be a disadvantage to students in modern multi disciplinary practice if this is the only practice placement model they have been exposed to.

• This model may not always provide the access to as wide a range of experience and independent learning as other models of placements.


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FAQ’S

Is this an expensive model?

This is a model that can demonstrate economy of scale. The dedicated facility can permit one practice educator to manage varying sizes of student groups depending upon the care being provided. This permits the practice educator to effectively care for many more clients that they could work as a lone practitioner whilst also teaching undergraduate students. The facility can house equipment and accommodation that is available to significantly larger numbers of patient and students than that available for single placement sites. Does this lead to isolation / institutionalisation for students? Opinions vary, but generally not. Students have the benefit of peer support while undergoing their clinical education in larger groups. They can readily participate in peer teaching sessions and can conduct case reviews with large groups of students in contrast to individually placed students, who may not have the benefits of the larger peer group. The Dedicated Facility provides the main clinical teaching base for the student but additional placements are provided outwit the facility in order that they do get exposure to a variety of Primary Care and other Secondary care providers. This experience provides the student with an understanding of professional life within a spectrum of health care settings while maintaining the consistency of their clinical education, professional development and assessment within the Dedicated Centre. Does this lead to institutionalisation of staff? Not necessarily; professional isolation is not confined to one model of care delivery. The ethos of any department is vital in maintaining an outward looking perspective using evidence based practice for clinical and educational interventions.

Does this model fail to give students a variety of clinical experiences and tend to produce “cloned” practitioners? No. With repeated work and teaching exposure to students, staff develop an understanding of students’ characteristics, abilities and inabilities and are therefore ideally placed to take necessary action. With exposure to both internal and external placement personnel, students naturally adopt specific and personally identifiable characteristics of the staff with whom they work. Additionally they are influenced by, and selectively adopt, the clinical and interpersonal skills of the staff to whom they are exposed.


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Model 6 Self directed learning, ‘long arm’ supervision, role-emerging model What is the role-emerging model? This model involves student(s) undertaking a placement in a setting where they are supervised by someone who may not necessarily be of their own profession. Professional supervision is provided at a distance either via telephone or video link or often by face to face supervision by a member of HEI staff. Supervisor in host site should be identified to deal with any concerns from student and coordinate placement outcomes. The student(s) often investigates and organises the placement experience in a ‘non-traditional’ setting such as private business or corporations, commercial outlets, voluntary sector. Students will often work in pairs to realise some of the benefits of peer-learning. Huddleston (1999), Bossers et al (1997) 6.2 Advantages of the role-emerging model for: The Placement provider The Practice Educator The Student

Opportunity for placements in emerging areas, especially industry

Highlights role of profession to service offering placement

Strengthens relationships between public and voluntary sector

Can improve/expand the service offered to clients i.e. initiatives started by the student may continue after their departure

Allows placement opportunities for isolated or remote services

An industry/business has a project undertaken by student AHPs eg Health and safety, ergonomic assessment,

Promotes self-directed learning for students Alleviates time pressures from therapist

Placements will represent a ‘real world’ environment

High level of autonomy for students

Good opportunity for peer learning if students are paired

Promotes professional growth for students

Exposure to the possibilities of employment outside the NHS/ social care settings

Greater scope for creativity in treatment planning for service users

Increased understanding of service delivery

Experience working alongside other professionals Potential to include experience as part of research

6.3 Challenges of the role-emerging model

• Quality assurance process can be complicated- can be difficult to ensure a fair and reliable assessment

• Setting up of placements can be more problematic than traditional placements due to supervision arrangements


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• Can be challenging for some students who do not have supervison fom someone of their own profession close at hand

• More often used with students with practice placement experience towards the end of their training

• All prospective placement settings should have undergone health and safety checks by the HEI to ensure that adequate procedures exist

• The placement should have appropriate insurance which extends to the students on placement

• If students are in pairs, it may be beneficial to have differing learning styles that compliment each other. 6.5 Additional strategies for managing the role-emerging model Prior to the placement During the placement After the placement

HEI will identify a suitable student – the student should ideally be near to completion of their studies, familiar with the locality, and feel confident about their abilities to manage such a placement

Establish learning outcomes which all parties are in agreement with and have copies of

Ensure set procedures are in place, and all parties are aware of their responsibilities

Pre-placement visit recommended for student

Students may benefit from specific advice about their placement site, and also the purpose and value of role-emerging placements

• All parties involved must agree on clearly defined placement aims

Organise a joint supervision session with the student, on site supervisor and practice placement educator during the first week, and thereafter for weekly supervision, the half way and final report.

Ensure on-site supervisor can contact PE at any time during the placement, and that communication happens regularly

Record weekly supervision/ feedback to student. The student and placement educator should then agree the information they need to pass onto the on site supervisor.

It may be appropriate for the student to give a presentation or write a report on the potential for their professions involvement in this work setting.

A structured feedback session for all parties concerned may be beneficial to determine whether the placement can be used in the future.

6.6 FAQs I am interested in participating in a role-emerging placement – how would I go about this? You will firstly need to link with your HEI, who will help you with the process. Have a think about the voluntary and private sectors that you work with - could the student be offered a placement with them? What could the student learn there? What might be missing?


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Can all students participate in a role-emerging placement? Not all students are suitable for this type of placement – the HEI will identify students who are willing to participate. Students should ideally be confident in their role, motivated to participate in this type of placement, and nearing the end of their training. It can provide an excellent experience for many students. How can I be sure that I am providing a fair and accurate assessment for the student? By having placement aims agreed at the start of the placement, you will be able to use the evidence produced by the student to assess them. The student should be encouraged to keep a reflective diary and share parts of that with the PE, as they feel able to. Communications with the on-site supervisor should also be used as an aid to assessment.

OCCUPATIONAL THERAPY STUDENT - REFLECTIONS ON A ROLE-EMERGING PLACEMENT The steady emergence of placements described as ‘role-emerging’ provided me with the opportunity to be part of a period of change as the profession extends its scope into another fields. Homelessness is one such field. Arriving on my first day was like delving into another world. I soon adjusted to my new environment that subsequently shattered many stereotypes I previously had unequivocally accepted. The experience has offered me a level of autonomy I could only dream of in a conventional role. The necessity in such a setting to address and develop my ability to risk assess, problem solve and to think and act creatively while at the same time generate my own caseload has propelled me closer to registration. However it has not come without difficulties. Ironically, while practicing within a system littered with barriers, I have gained a greater understanding as to why so many, in modern western society, find themselves perpetually climbing a ‘greasy pole’ in an attempt to get out of homelessness. Unfortunately, their motivation has been eroded as a consequence of such hardships and, coupled with a deep grained suspicion of ‘professionals’, engagement with services has proved problematic. Moreover, attempts to reconcile both the demands of the university as well as those of the placement provider and the clients have provided another challenge. As a result of these difficulties I have, at times, experienced considerable anxiety regarding my readiness for a basic grade post. Despite all this my enthusiasm has wavered little, in part due to the continuous encouragement from superiors and peers. I am already missing the people and the place that has acted as the transition from student to practitioner and, most importantly, has exposed me to the infinite possibilities of Occupational Therapy beyond tradition. Level 3 Student BSc Hons in Occupational Therapy Glasgow Caledonian University


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Model 7 - Supported Distance Education Model What is the supported distance education model?

The supported distance education model is similar to the long-arm model previously descried. Its focus is the use of technology to provide clinical supervision to student on rural and remote placements. An agreed supervisor on site to assists with administration, supervision and support but professional supervision offered via web/video links Lin (2002) Newbury and McKenzie (2004) (Chase SLT reference in ?Allied health) Distance education includes distance teaching – the instructor’s role in the process, and distance learning – the student’s role in the process. Perraton in Knebel 2001 Advantages of the supported distance education model for: The Service

The Student

Opens up placement opportunities in setting with no AHP of the right type on site

Students can have more control over their learning

Challenges/Considerations

• Reliant on high levels of technological competency from both student, educator and HEI

• Suited to level 4 placements when students are nearing the end of degree or level 1 where students are shadowing another professional

• It may take more time for a student and PE more time to establish a relationship if they previously do not know each other

• Communications need to be structured and formalised, as visual and non-verbal cues may be absent. Strategies for managing the supported distance education model Prior to the placement During the placement

Ensure that all parties are proficient in the use of IT and that IT support is available for when systems breakdown Schedule supervision sessions

Supervision sessions need to be well planned by all parties so that a useful learning experience occurs


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Model 8 Interprofessional Placement Models What are Interprofessional placement models? This very broad heading covers and vast and ever increasing range of models of practice placement that involves students from various health and/or social care professions undertaking a placement at the same time in the same clinical area. The express aim of these placements is to develop interprofessional learning that is purported to encourage better communication, teamwork and professional role understanding (Barr et al 2006) Interprofessional models range from complete coordination of health care cohorts on a large scale to smaller scale interprofessional learning opportunities that students who happen to be on the same clinical site undertake together. Interprofessional placement experiences many form part of a more traditional placement or the whole placement may e offered on an interprofessional model. Interprofessional placement models often involve facilitators or educators, especially trained, to facilitate mixed groups of students. (refs) Students come together for interdisciplinary sessions on topics common to all disciplines. Cox et al (1999) Interprofessional placements are not very common within the allied health professions in Scotland but most HEIs offering pre-registration programmes have IPL programmes for students that run within the university and increasingly into placement expereinces. Advantages of Interprofessional Models for: The Service The Practice Educator The student

Some evidence to suggest benefits for teamwork, communication and professional role understanding

May be a benefit to service users

Colleagues from other professions can input into a students evaluation

Practice educators from different professions working together on certain skills may lessen time commitment required

Improves team communication, decision making and planning

Increases awareness and learning of team roles and functions

A students professional development is enhanced as they become more aware of the role of other team members as well as their own

Students benefit from working together in an interprofessional peer group

Challenges in interprofessional models

• Participation in inter-professional sessions can take a lot of preparation time


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• A balance should be struck between the time spent on profession specific skills and inter-professional issues- the HEI will determine this mix as part of their curriculum development

• Matching cohort timings, student proficiency and technical ability can be difficult.

• Students may not have sufficient knowledge and competence in their own profession to engage with others if IP placements occur too early in the curiculum

• There needs to be a sound understanding of the processes involved from the HEI and practice educators perspectives

• Training and support for facilitators is important to the longer term success of an interprofessional initiative (Reeves et al 2002)

• Placement aims need to be relevant and achievable by all students

• Clinical setting needs to be suitable for all students to learn in and safe for patients

• HEIs need to ensure that inter professional activities meet course requirements Additional strategies for managing the inter-professional model Prior to the placement During the placement

All parties must be aware of the format and expectations of the placement

All the clinicians involved in the teaching sessions should contribute to development of the interdisciplinary sessions

Times and venues for teaching sessions should be pre-planned

Risk assessment and health and safety issues need to be considered

Students should attend at least one interdisciplinary session per week

Patients/ service users should be at the core of all activities

‘Mistakes’ should be seen as both understandable and a learning opportunity

Student reflection should be core to the process

There should be identified lead practice educators for each interdisciplinary session

Information from Scottish HEIs on Interprofessional Education (IPE) All Scottish HEIs that offer AHP pre-registration courses have an IPE component running through the curriculum. The way that these programmes run varies from institution to institution but all the HEIs are increasingly looking towards the service to help support interprofessional placement opportunities. Future versions of this document will have much more information on IPE and IP placement models as well as details of the Scottish HEIs’ programmes. Future versions of this document will have a greater variety of interprofessional


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REFERENCES

Andrews GJ, Brodie DA, Andrews JP, Wong J and Thomas BG (2005) Placement matters: students’ clinical experiences and their preferences for first employers. International Nursing Review 52 142-153 Baldry Currens, J (2003) The 2:1 Clinical Placement Model: A review. Physiotherapy 89(9) 540-554 Barr H. Freeth D. Hammick M. Koppel I. Reeves S. 2006 The evidence base and recommendations for interprofessional education in health and social care. [Journal Article] Journal of Interprofessional Care. 20(1):75-8, 2006 Jan. Bossers, A, Cook, J, Polatajko, H and Laine, C (1997) Understanding the role-emerging fieldwork placement. Canadian Journal of Occupational Therapy 61(1) 7-10 Cox, PD, Beaton, C, Bossers, A, Pepper, J and Gage, M (1999) Interdisciplinary pilot project in a rehabilitation setting Journal of Allied Health Spring 28 (1) 25-29 CSP (2005) Service Standards of Physiotherapy Practice. http://www.csp.org.uk/uploads/documents/csp_service_standards_2005.pdf Accessed 18/10/06 DeClute, J and Ladyshewsky, R (1993) Enhancing clinical competence using a collaborative clinical education model. Physical Therapy 75(6) 504 -510 Gaiptman, B and Forma, L (1991) The split Placement Model for Fieldwork Placements. Canadian Journal of Occupational Therapy 58(2) 85-88

Higgs J.(1992) Managing clinical education: the educator-manager and the self-directed learner. [Journal Article, Tables/Charts] Physiotherapy. 1992 Nov; 78(11): 822-8.

Huddleston, R (1999) Clinical placements for the Professions Allied to Medicine, Part 2: Placement Shortages? Two models that can solve the problem. British Journal of Occupational Therapy 62(7) 295-298 Ladyshewsky, R (2000) Peer-assisted Learning in Clinical Education: A Review of Terms and Learning Principles. Journal of Physical therapy Education, 14:2, p15. Lekkas, P.; Larsen, T.; Kumar, S.; Grimmer, K.; Nyland, L.; Chipchase, L.; Jull, G.; Buttrum, P.; Carr, L.; Finch, J. 2007 No model of clinical education for physiotherapy students is superior to another: a systematic review Australian Journal Of Physiotherapy VOL 53; NUMB 1 (2007) pp. 19-32 Lin, RS (2002) Distance Learning: An Innovative Approach to Orthotic and Prosthetic Education. Journal of Prosthetics and Orthotics 14(2) 75-77 Martin, M and Edwards, L (1998) Peer learning on fieldwork placements British Journal of Occupational Therapy 61(6) 249-252


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Martin, M, Morris, J, Moore, A, Sadlo, G and Crouch, V (2004) Evaluating Practice Education Models in Occupational Therapy: Comparing 1:1, 2:1 and 3:1 Placements British Journal of Occupational Therapy 67(5) 192-200 Newbury J and McKenzie (2004) Interactive videoconferencing system for rural health education: a preliminary report. Australian Journal of Rural Health 12, 157-159. Reeves, S, Freeth, D, McCrorie, P and Perry, D (2002) “It teaches you what to expect in the future …” interprofesional learning on a training ward for medical, nursing, occupational therapy and physiotherapy students. Medical Education 36, 337-344 Stiller, K, Lynch, E, Philips, AC, and Lambert, P (2004) Clinical Education of physiotherapy students in Australia: Perceptions of current models. Australian Journal of Physiotherapy 50:243-247 Strohschein J, Hagler P and May L (2002) Assessing the Need for Change in Clinical Education Practices. Physical Therapy 82(2) 161-172 Synder, D (1996) The use of simulated clients to develop the clinical skills of Speech and Language Therapy students European Journal of Disorders of Communication 31(2) 181-192


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APPENDIX 1

2.7 Peer-asssisted Learning Case study- managing 2 students with one educator Adapted from the Chartered Society of Physiotherapy. This case study outlines a fictitious placement situation in which two third year physiotherapy students are on a 5-week, in-patient medical/ respiratory ward placement in an NHS general hospital. The practice educator (PE) is an senior 1 physiotherapist, assisted by less senior staff.

Week 1

The student’s observe PE treatments together, assist with treatment, progress to treating individually with help from PE

Students work together for patient assessments; writing case notes, taking ward report

Peer discussion encouraged

PE identify students have different personalities, one stronger personality has potential to ‘overpower the other’

PE delegates 50% of workload to students by end of week

Week 2

Each students gains confidence with own patients

Objectives set with students individually, in own learning contract

PE consciously spends equal individual time with both students

During joint tutorials, PE asks open questions and direct specific questions suited to the level and needs of each student.

Week 3

Students reflect on treatment issues, problem solve together, tend to discuss questions before approaching PE. Atmosphere supportive and non-competitive

‘Quieter’ student becomes more confident, ‘over-confident’ student more appropriate

Each student has half way assessment with PE, students are compared against own


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learning contract and university objectives, not each other

Students have joint tasks to complete e.g. to prepare a joint presentation

Students treat 75% of clinicians workload

Week 4

Students work well together as a team, assist each other with patients / balance workload.

Joint tutorials continue, and individual sessions with PE with patients

Students support each other in computer aided documentation tasks

Each student spends half a day with another member of the Multidisciplinary Team, while other student has extra time with PE

Students treat 95% of clinicians workload

PE notes time available to spend away from students, with junior staff

Week 5

Final assessments. PE conducts final appraisals, giving agreed feedback from both

Students make joint presentation to staff group


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APPENDIX 2- Split Placement model Case study (1:2) Adapted from CSP

Students (S) Placement Practice Educator (PE)

4 x 2nd year students (S's)

5 weeks, Out Patient Department placement in large NHS Trust

2 x senior I are each the named clinical educators (PEs), though 2 senior II staff and 2 juniors also contribute to team teaching

Week 1

Group tutorials - induction and teaching on assessment and common conditions

Learning contracts - individually negotiated with PE

S's assess own new patients, must check with PE after each assessment

S's have an individual discussion session with PE daily (15-30 mins) to discuss treatment issues

S's encouraged to go to PE with issues first, but also discuss with other staff as available

S's practice assessment and treatment techniques with each other and discuss treatments in pairs / groups

PEs do not take on new patients of own, but see some follow up patients, students observe

Week 2

Daily group tutorials from all staff: junior staff assist seniors - recognise value to own CPD of teaching

Short daily individual S sessions with PE continue

S's begin to report back after combined subjective and objective assessment

S's continue to discuss in pairs and as a group, formally and informally when writing notes - atmosphere supportive and non-competitive

Week 3

S's reflect on treatment issues, problem solve together, tend to discuss questions before approaching PE

Group tutorials reduce to 3 times per week


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S's encouraged to share learning with each other, and 'teach each other' techniques learned, also prepare for presentations to peers and staff

Half way assessments: staff team discuss S's progress together beforehand; each S talks individually with PE, S's compared against own learning contract - not each other

S's spend some time observing each other and give feedback after treatment has ended

S's join in with junior in-service teaching session

Week 4

S's seek support from staff only when required. Still check findings of new patients before commencing treatment

Individual sessions with PE as requested, rather than daily

S's value discussion with junior staff - find clinical reasoning more on 'their level' than with seniors, also useful to discuss first jobs etc

Week 5

Final assessments - staff team discuss progress in preparation for final assessments, once completed, S's discouraged from comparing grades

S's make joint presentation to PE's

PE's begin to take on new patients of own, S's have no further new patients, try and discharge follow-up patients


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APPENDIX 3

QUICK GUIDE TO MOST APPROPRIATE MODEL FOR EACH CLINICAL AREA/

TYPE OF PRACTICE EDUCATOR Acute Community Part-

time worker

Manager Novice PE

1:1 model √√√√ √√√√ √√√√ Peer learning model

√√√√

1:2 model √√√√ √√√√ √√√√ √√√√ √√√√ Dedicated clinical educators

√√√√

Dedicated facilities

√√√√ √√√√ √√√√

Role-emerging model

√√√√ √√√√

Supported distance education

√√√√ √√√√

Interprofessional Model

√√√√ √√√√


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Appendix 4 Contact Details for AHP PEFs in Scotland Name Health Board Address Email Phone

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