Clinical educator expertise: A scoping review.

BACKGROUND: Allied health clinicians supervising healthcare students in workplace learning play a key role in a learner's progression to autonomous practice, yet expert educator practice is not well understood. How expert clinical educators in allied health professions are defined, enact their role, develop educational expertise and bring value to workplace learning is unclear. METHODS: A scoping methodology was chosen to understand what is known about clinical educator expertise in allied health, focusing on definitions, characteristics, impacts and development. Searching seven databases, the authors used an iterative, systematic approach to the selection, collation and analysis of peer-reviewed and grey literature. RESULTS: Within 21 included papers, diverse terms and definitions were used to describe expert clinical educators across 9 allied health professions and 5 countries. Expert educator characteristics included advanced skills in facilitating learning, the ability to build positive relationships with learners and a proactive attitude to developing personal supervision skills through reflection. Impacts were identified for learners and educators, and the few sources examining educator development found that expert practice grows in a dynamic, multi-mode, non-linear fashion. CONCLUSION: A comprehensive picture of the expert clinical educator in allied health is not yet conceptualised, despite some characteristics being associated with expertise. The differences between expert and less proficient educators are unclear with little examination of the impacts, value or development of expert educator capabilities. We offer a framework for future research and advocate for focused studies that examine clinical educator expertise, to enhance approaches to professional development and recognition of excellence in clinical educator practice.

Allied Health Professions Accreditation Standards for Work Integrated Learning: A Document Analysis.

A key role of allied health (AH) professional regulatory and professional bodies is to ensure that AH education programs provide work-integrated learning (WIL) opportunities for students. The requirements are outlined via the respective profession's educational accreditation standards. Although a significant component of the AH professional degrees, researchers have not explored how standards specific to WIL are developed, nor how WIL might be conceptualised through the standards. This study explored how WIL is conceptualised through comparing the WIL education standards across Australian AH professions. Using a non-experimental explanatory mixed-methods research design, a document analysis of Australian education program accreditation standards (and associated documents) for 15 AH professions was undertaken. Data analysis included inductive textual and thematic analyses to compare AH professionals' conceptualisation of WIL. This study found a high degree of variation in how AH professions describe WIL. While there was a common requirement for students to demonstrate competency in WIL, requirements for WIL quantity, assessment and supervision varied. Four key themes were identified regarding the contribution of WIL to curriculum and student learning: (1) the relationship between WIL and the program curriculum; (2) WIL as a learning process; (3) learning from diverse WIL contexts; and (4) developing competence through WIL. Overall, the diversity in the standards reflected differing understandings of what WIL is. Thus, in the absence of frameworks for designing accreditation standards, the risk is that some AH professions will continue to perpetuate the myth that the primary purpose of WIL is to provide a bridge between theory and practice.

Exploring the outcomes of a reflective teaching strategy with students: A feasibility study.

Purpose: Reflection can be a valuable learning strategy for connecting theory with practice and illuminating insights and understandings from complex or messy experiences. This learning is critical for educators and health professionals who work or teach students in complex contexts. In anticipation of their future needs, speech-language pathology students, like many health profession students in Australia, are expected to demonstrate the ability to reflect on their practice as part of their professional practice or clinical education. It is challenging to support educators to facilitate reflection and students to learn when, why, and how to reflect for personally and professionally meaningful outcomes given the diversity in understandings and capabilities present in the literature. The purpose of this study was to investigate the feasibility of an evidence-based reflection intervention to clarify and support student reflective practice.Method: A convergent mixed methods design captured quantitative and qualitative results from 16 participants for a better understanding of the feasibility of a reflection intervention.Result: The diversity in the reflection literature also appears to be present in students' reflection approaches. This diversity can encourage student engagement and ownership of reflecting when considered within a rich learning environment.Conclusion: Findings are discussed for timely, intellectually and emotionally safe reflection interventions that develop students' reflective inquiry in the real-world.

From burden to benefit: a multi-site study of the impact of allied health work-based learning placements on patient care quality.

Allied health clinical placements take place within an increasingly overstretched health care system where demand for services often exceeds availability of resources. Within this environment, student placements are often perceived as an additional burden to an already overwhelmed workforce. This study explored whether the quality of patient care was enhanced when services were re-designed using a collaborative partnership approach to more purposefully integrate students into delivery of care. Using an embedded multiple case study design, data were collected through focus groups and interviews, patient experience surveys, and secondary administrative data sources. Cases were across physiotherapy and occupational therapy in six different hospital settings. Perception of care provided by students was viewed positively by all stakeholders, including patients. Perceived health outcomes of faster improvement of health condition, improved mobility and function identified through our qualitative findings were supported by quantitative service delivery markers such as increased therapy sessions, more patients being discharged home instead of to other care facilities and reduced length of stay. Health care providers and students alike perceived improvements in service efficiencies whilst maintaining high quality care. This study has provided preliminary evidence towards improved patient care when a partnering approach is adopted whereby students are intentionally integrated into services that otherwise might not have been delivered. Furthermore, it has shifted the associated narrative from students as additional burden to students as benefit.

Beyond mere respect: new perspectives on dignity for healthcare workplace learning.

Introduction: Although dignity in workplace learning in healthcare is gathering interest, we know little about stakeholders' conceptualizations in this area across professional groups. Dignity breaches in workplace learning are common, often with serious and long-lasting consequences for the affected. Conceptualizations shape behaviours and experiences. To prevent dignity violations in students' learning, it is thus important to understand stakeholders' understandings of the topic. This study therefore explores the dignity conceptualizations around workplace learning that students, placement educators and university staff hold across seven allied health professional groups. Methods: Using a social constructionist perspective, we conducted individual and group narrative interviews (n = 51) with students, placement educators and university workplace learning staff from seven allied health professional groups. We used the 5-step Framework Analysis to explore and develop themes, identifying differences and similarities across stakeholder groups. Results: We identified eight distinct, yet interrelated, dimensions of dignity from participants' narratives: dignity as respect, dignity as self-x (the various relationships we have with ourselves), dignity as feeling safe, dignity as understanding otherness, dignity as supporting others, dignity as equality, dignity as professionalism, and dignity as belonging. Dignity as respect was identified across all participants, although mutual respect and a culture of respect were only present in academic participants' talk. The remaining seven dimensions all present important factors extending our understanding of the construct of dignity. Discussion: In line with existing research, our study identifies the absence of an unambiguous, positive conceptualization of dignity in workplace learning among stakeholders. It adds novelty in two ways: by identifying dignity dimensions that require informed action beyond respecting others, and by revealing a tension between dignity as professionalism and dignity as equality. We suggest revising existing dignity concepts in workplace learning to address this tension and to reinforce that active care, team integration and skilled support are all non-negotiable elements of dignified behaviour within workplace learning.

Preparing students for the future through developing evaluative judgement.

In today's environment, health students need to be prepared for an ever changing workplace and workforce. They need to understand what demonstrates good quality work and how to assess their standard of work. Evaluative judgement can contribute to student and graduate self-regulation and autonomy in their learning. This toolbox article describes how to implement strategies for developing evaluative judgement in allied health placements. These strategies were developed as part of an occupational therapy program in rural Western Australia, where experiential education is provided through service-learning with both direct and indirect supervision. Practical advice is provided on the use of peer-assisted learning, rubrics, self-assessment and feedback. Challenges and opportunities in implementing strategies to develop evaluative judgement, such as how to achieve effective feedback, are also discussed. The suggested toolbox may be adapted to various clinical placement contexts. Developing evaluative judgement can help to prepare our students to be lifelong learners. This article empowers educators to promote this capability in their students to create work ready graduates, who are able to operate independently and in rapidly evolving, technologically enabled environments.

Simulated versus traditional occupational therapy placements: A randomised controlled trial.

BACKGROUND/AIM: Professional practise placements in occupational therapy education are critical to ensuring graduate competence. Australian occupational therapy accreditation standards allow up to 200 of a mandated 1000 placement hours to include simulation-based learning. There is, however, minimal evidence about the effectiveness of simulation-based placements compared to traditional placements in occupational therapy. We evaluated whether occupational therapy students completing a 40 hour (one week block) Simulated Clinical Placement (SCP) attained non-inferior learning outcomes to students attending a 40 hour Traditional Clinical Placement (TCP). METHODS: A pragmatic, non-inferiority, assessor-blinded, multicentre, randomised controlled trial involving students from six Australian universities was conducted. Statistical power analysis estimated a required sample of 425. Concealed random allocation was undertaken with a 1:1 ratio within each university. Students were assigned to SCP or TCP in one of three settings: vocational rehabilitation, mental health or physical rehabilitation. SCP materials were developed, manualised and staff training provided. TCPs were in equivalent practice areas. Outcomes were assessed using a standardised examination, unit grades, the Student Practice Evaluation Form-Revised and student confidence survey. A generalised estimating equation approach was used to assess non-inferiority of the SCP to the TCP. RESULTS: Of 570 randomised students (84% female), 275 attended the SCP and 265 the TCP (n = 540, 94.7% retention). There were no significant differences between the TCP and SCP on (i) examination results (marginal mean difference 1.85, 95% CI: 0.46-3.24; P = 0.087); (ii) unit score (mean (SD) SCP: 71.9 (8.8), TCP: 70.34 (9.1); P = 0.066); or (iii) placement fail rate, assessed using the Student Practice Evaluation Form-Revised (100% passed both groups). CONCLUSION: Students can achieve equivalent learning outcomes in a 40 hour simulated placement to those achieved in a 40 hour traditional placement. These findings provide assurance to students, educators and professional accreditation bodies that simulation can be embedded in occupational therapy education with good effect.

Interdisciplinary eHealth for the care of people living with traumatic brain injury: A systematic review.

OBJECTIVE: To identify literature which discusses the barriers and enablers of eHealth technology and which evaluates its role in facilitating interdisciplinary team work for the care of people with a traumatic brain injury (TBI). DESIGN: Systematic review. DATA SOURCES: Studies were identified by searching CINAHL, Embase, Medline, PsycINFO, Scopus, and Web of Science. STUDY SELECTION: Studies included in the review were required to feature an eHealth intervention which assisted interdisciplinary care for people with TBI. DATA EXTRACTION: Descriptive data for each study described the eHealth intervention, interdisciplinary team, outcomes, and barriers and facilitators in implementing eHealth interventions. RESULTS: The search resulted in 1389 publications, of which 35 were retrieved and scanned in full. Six studies met all the inclusion criteria for the review. Four different eHealth interventions were identified: (i) an electronic goals systems, (ii) telerehabilitation, (iii) videoconferencing, and (iv) a point-of-care team-based information system. Various barriers and facilitators were identified in the use of eHealth. CONCLUSION: eHealth interventions have been reported to support interdisciplinary teams for the care of TBI. However, there is a substantial gap in existing literature regarding the barriers and enablers which characterize a successful interdisciplinary eHealth model for people with TBI.

Effectiveness and cost-effectiveness of embedded simulation in occupational therapy clinical practice education: study protocol for a randomised controlled trial.

BACKGROUND: Clinical placements are a critical component of the training for health professionals such as occupational therapists. However, with growing student enrolments in professional education courses and workload pressures on practitioners, it is increasingly difficult to find sufficient, suitable placements that satisfy program accreditation requirements. The professional accrediting body for occupational therapy in Australia allows up to 200 of the mandatory 1000 clinical placement hours to be completed via simulation activities, but evidence of effectiveness and efficiency for student learning outcomes is lacking. Increasingly placement providers charge a fee to host students, leading educators to consider whether providing an internal program might be a feasible alternative for a portion of placement hours. Economic analysis of the incremental costs and benefits of providing a traditional versus simulated placement is required to inform decision-making. METHODS/DESIGN: This study is a pragmatic, non-inferiority, single-blind, multicentre, two-group randomised controlled trial (RCT) with an embedded economic analysis. The RCT will compare a block of 40 hours of simulated placement (intervention) with a 40-hour block of traditional placement (comparator), with a focus on student learning outcomes and delivery costs. Six universities will instigate the educational intervention within their respective occupational therapy courses, randomly assigning their cohort of students (1:1 allocation) to the simulated or traditional clinical placements. The primary outcome is achievement of professional behaviours (e.g. communication, clinical reasoning) as assessed by a post-placement written examination. Secondary outcomes include proportions passing the placement assessed using the Student Practice Evaluation Form-Revised, changes in student confidence pre-/post-placement, student and educator evaluation of the placement experience and cost-effectiveness of simulated versus traditional clinical placements. Comprehensive cost data will be collected for both the simulated and traditional placement programs at each site for economic evaluation. DISCUSSION: Use of simulation in health-related fields like occupational therapy is common, but these activities usually relate to brief opportunities for isolated skill development. The simulated clinical placement evaluated in this trial is less common because it encapsulates a 5-day block of integrated activities, designed and delivered in a manner intended to emulate best-practice placement experiences. The planned study is rare due to inclusion of an economic analysis that aims to provide valuable information about the relationship between costs and outcomes across participating sites. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12616001339448 . Registered 26 September 2016.

Making connections and promoting the profession: Social media use by World Federation of Occupational Therapists member organisations.

BACKGROUND: World Federation of Occupational Therapists (WFOT) member organisations comprise 77 national occupational therapy organisations across the world. Each national organisation interacts with its members and the public using diverse methods. Increasingly, national organisations are broadening their communication methods. OBJECTIVE: The objective of this study was to examine if and how occupational therapy organisations are using social media for communication, and if so, the types of concerns or barriers they experience and what role they anticipate social media might play in the near future. METHODS: An online survey was developed; 57 of 77 WFOT member organisations responded. FINDINGS: This study identified that WFOT national organisations are using social media, to varying degrees, with or without an individual formally assigned to manage social media. Respondents reported that they used social media to: communicate with members, promote the organisation and promote the profession. Commonly expressed needs included assistance with guidelines for ethical social media use, developing technical expertise, and recognition of limits of time and competing priorities. Recommendations arising from this research are at the global, national, local and individual levels and incorporate active dissemination and pure diffusion approaches. Taking steps to increase the use of social media could indirectly impact occupational therapy practice through enhancing organisations' abilities to support practitioners to enhance their practice. LIMITATIONS AND RECOMMENDATIONS FOR FURTHER RESEARCH: Although 57% of WFOT member organisations returned usable responses, there may be some additional perspectives that were not captured. It would be helpful to contact non-responding organisations to explore their social media use and plans. Further research could examine how future initiatives put in place by WFOT impact social media use by member organisations.

New graduate occupational therapists feelings of preparedness for practice in Australia and Aotearoa/New Zealand.

AIM: The development of competent future allied health professionals through academic programmes, professional support and practical education is continually evolving. The aim of this study was to explore the feelings of newly graduated occupational therapists in Australia and Aotearoa/New Zealand regarding their education and work preparedness. METHODS: Newly graduated occupational therapists from Australia (n = 178) and Aotearoa/New Zealand (n = 53) who had completed their occupational therapy studies in 2007 were recruited. Participants completed an online survey which explored their preparedness for work; based on professional competencies. RESULTS: Most newly graduated occupational therapists felt somewhat prepared for practice. However, only 17.1% of Australian new graduates, and even fewer (8.5%) of Aotearoa/New Zealand new graduates felt very well prepared. Participants felt more prepared for the competencies required for 'managing inwards' (including interpersonal skills) and less prepared for those required for 'managing outwards' (including evidence-based practice). CONCLUSIONS: This study provides the first international comparison into the feelings of competence and preparedness for practice of new graduates of occupational therapy from Australia and Aotearoa/New Zealand. Given the importance of competencies, such as evidence-based practice to the progress of the profession, there is a need to further explore methods to increase feelings of preparedness in these areas.

Evidence-based practice and rehabilitation: occupational therapy in Australia and New Zealand experiences.

Evidence-based practice has become the dominant paradigm in the delivery of rehabilitation programme. However, occupational therapists in Australia and New Zealand have been slow in making the transition to become evidence-based practitioners. Collaboration between the university/tertiary institute and clinical setting is one way that clinicians can be assisted with incorporating research into their practice. Two case examples are presented outlining how collaborative practice can result in improved outcomes for all concerned.