Impact of placement type on the development of clinical competency in speech–language pathology students

"This is the peer reviewed version of the following article: Sheepway L, Lincoln M, McAllister S. Impact of placement type on the development of clinical competency in speech-language pathology students. International Journal of Language and Communication Disorders . 2014 Mar-Apr;49(2):189-203. doi: 10.1111/1460-6984.12059., online 1 Nov 2013, which has been published in final form athttp://dx.doi.org/10.1111/1460-6984.12059. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving."Background: Speech language pathology students gain experience and clinical competency through clinical education placements. However, currently little empirical information exists regarding how competency develops. Existing research about the effectiveness of placement types and models in developing competency are generally descriptive and based on opinions and perceptions. The changing nature of education of speech language pathology students, diverse student cohorts, and the crisis in finding sufficient clinical education placements mean that establishing the most effective and efficient methods for developing clinical competency in students is needed. Aims: To gather empirical information regarding the development of competence in speech language pathology students, and to determine if growth of competency differs in groups of students completing placements which differ in terms of caseload, intensity and setting. Methods & Procedures: Participants were students in the third year of a four year undergraduate speech language pathology degree, who completed 3 clinical placements across the year and were assessed with the COMPASS® competency assessment tool. Competency development for the whole group across the three placements is described. Growth of competency in groups of students completing different placement types is compared. Interval level data generated from the students’ COMPASS® results were subjected to parametric statistical analyses. Outcomes and Results: The whole group of students increased significantly in competency from placement to placement across different placement settings, intensities and client age groups. Groups completing child placements achieved significantly higher growth in competency when compared to competency growth of students completing adult placements. Growth of competency was not significantly different for students experiencing different intensity of placements, or different placement settings. Conclusions and Implications: These results confirm that the competency of speech language pathology students develops across three clinical placements over a one year period regardless of placement type or context, indicating that there may be transfer of learning between placements types. Further research investigating patterns of competency development in speech language pathology students is warranted to ensure that assumptions used to design clinical learning opportunities are based on valid evidence

Strategies for Ethics Education with Health Profession Students Before, During, and After Placements

Health professionals must practice ethically in order to ensure compassionate and effective client care; function as good interdisciplinary team members; and protect themselves from litigation, and conduct and ethics complaints. Ethics education is a routine inclusion in health profession degrees, but may only be taught in the classroom, divorced from practice. This article argues that students need ethics education before, during, and after practice placements. We suggest that many powerful opportunities for teaching ethics on and after placements are missed or under-utilised. We have reviewed the scant evidence, and the literature more broadly, to identify strategies for teaching ethics before, during, and after placements; and have added strategies drawn from our own experiences as clinical educators. We highlight where interdisciplinary perspectives can be added to ethics education. We conclude that more research is needed into approaches and strategies for teaching ethics in different contexts

Influences on Competency Development in Speech Pathology Students

Due to shortages of clinical education experiences for allied health students, there is a risk that curriculum decisions are made based on availability of experiences rather than evidence regarding competency development. This research was situated in the speech pathology profession in Australia. The aims were to establish current clinical education practices internationally and the drivers behind these practices, explore growth of competency in a cohort of students, and compare impacts of features of clinical placements on students’ competency growth. This was achieved through three related studies. University personnel from speech pathology programs in seven countries were surveyed regarding the clinical placement and supervisory models used and drivers for choice of these models. The COMPASS® competency assessment tool was used to compare competency development of third year speech pathology students in placements which differed by caseload, intensity and setting. Competency development across the final two years of an undergraduate program was also investigated. Traditional placement and supervisory models are most commonly used, with some correlations between frequency of use and opinions of effectiveness. Drivers for choice of models included availability of placements, clinical educator factors such as training and availability and standards of professional associations. Results indicate that competency follows a developmental continuum suggesting that learning and competency transfer between placements. Students in placements with a paediatric caseload had greater growth of competency than those with adult caseloads. There were no differences in competency growth between groups of students who completed different intensities of placements or settings. The sequences of placements experienced did not have a significant effect on competency over a longer term

Ethical awareness in allied health students on clinical placements: Case examples and strategies for student support

This paper takes an interprofessional view of the types of scenarios allied health students, including speech pathology students, may encounter on placement. The paper highlights that students are ethically aware and in some cases may experience ethical distress as a result of what they experience on placement. Sometimes the cause of this distress is the behaviour of the clinical educator, who cannot therefore be a support to the student in managing their ethical concerns. We suggest a structured approach to pre-placement preparation, support during placement, and post-placement for students, which provides a range of resource personnel and educational strategies to assist them to develop their ethical reasoning and manage ethical concerns

A qualitative exploration of health student perspectives of rural and remote placements during the early stages of the COVID-19 pandemic

Objective: To explore health student perspectives of rural and remote placements during the early stages of the COVID-19 pandemic. Setting: Australia. Participants: Allied health, nursing and medical students with a planned rural or remote placement between February and October 2020. Design: Semi-structured interviews (n = 29) with data thematically analysed. Results: Five main themes emerged from student experiences: (1) ‘Do we go? Don\u27t we go? Like how much risk is involved?’ related to student concerns regarding acquiring and transmitting COVID-19 on placement; (2) ‘We are sort of just standing at the door trying to watch’ encompassed student perceptions of missed clinical learning opportunities in response to health and safety measures related to COVID-19; (3) ‘I, as a student, sort of fell under the radar’ related to student perceptions of suboptimal supervision; (4) ‘It was a bit more difficult to engage with that wider community’ recognised student feelings of social disconnection and their lack of opportunity for community immersion; and (5) ‘We felt like we got something that is more than we expected’ emerged from student reflections on training during the pandemic and alternative placements (virtual, simulated and non-clinical) that exceeded expectations for learning. Conclusions: Although most students were willing and able to undertake their rural or remote placement in some form during the early stages of the pandemic and identified unanticipated learning benefits, students recognised lost opportunities to build clinical skills, become culturally aware and connect with rural communities. It remains unknown how these rural and remote placement experiences will impact rural intention and in turn, rural workforce development

Strategies for ethics education with health profession students before, during, and after placements

Health professionals must practice ethically in order to ensure compassionate and effective client care; function as good interdisciplinary team members; and protect themselves from litigation, and conduct and ethics complaints. Ethics education is a routine inclusion in health profession degrees, but may only be taught in the classroom, divorced from practice. This article argues that students need ethics education before, during, and after practice placements. We suggest that many powerful opportunities for teaching ethics on and after placements are missed or under-utilised. We have reviewed the scant evidence, and the literature more broadly, to identify strategies for teaching ethics before, during, and after placements; and have added strategies drawn from our own experiences as clinical educators. We highlight where interdisciplinary perspectives can be added to ethics education. We conclude that more research is needed into approaches and strategies for teaching ethics in different context

Development of learning strategies and resources to teach health care students cross-cultural interviewing skills

Introduction/Background:\ud The delivery of health services most often occurs as an interaction between a health professional and a patient. The effectiveness of this communication can often determine the quality of service delivery (Cass, 2007). Sociocultural differences between students and their patients in education, family structures, language skills, socioeconomic status and perceptions of health and illness can be barriers to effective communication. If these barriers are overlooked, miscommunication may result and lead to serious health consequences for patients and their families (Woodward-Kron et al, 2002).\ud Students need to learn to interview patients in a culturally appropriate way as a vital component of the safe practice of patient care. Faculties of Health around Australia should make it a priority to provide pre-clinical and clinical learning experiences which facilitate students' development of these communication skills in a manner which is safe and effective for both student and patient.\ud \ud The presenters are part of the project team for The Byalawa Project, funded by an Australian Learning and Teaching Council (ALTC) Competitive Grant. The Byalawa Project brings together academics from a wide range of disciplines across two universities. The project aims to develop high-quality, research-based teaching and learning materials to facilitate the acquisition of appropriate, culturally-safe interviewing and case-history taking skills of health practitioners. The materials will be designed for use by academics and clinical teachers in a broad range of health professions either in single-profession or interprofessional learning contexts.\ud \ud Purpose/Objectives\ud Participants will:\ud • Explore issues associated with cross cultural health interviewing\ud • Explore their own assumptions about the purposes of an interview in their clinical setting\ud • Understand some of the assumptions patients make in an interview or case history taking situation.\ud • Discuss approaches to teaching and assessment of cross‐cultural interviewing.\ud • Develop strategies which will be used towards creating free learning and teaching materials funded by an ALTC grant.\ud \ud Issues/Questions for exploration or ideas for discussion\ud • What assumptions and values do students and clinicians bring to interviews? How do these differ from those that the patient brings?\ud • What are our learning objectives/expectations when we teach students about cross cultural interviewing (eg. knowledge, behaviours, attitudes)?\ud • What techniques have participants used to achieve these objectives and what have they found to be useful or not so useful? How are best practice resources selected\ud and developed?\ud • What materials do participants want to help students learn about these issues in both classroom and clinical settings?\ud • How would participants use these materials in teaching students? Could these materials have a place in assessment

The Impact of COVID-19 on Student Placements facilitated by University Departments of Rural Health

University Departments of Rural Health (UDRHs) facilitate clinical placements in rural and remote settings throughout Australia for students enrolled in tertiary health courses. UDRHs support students to travel to rural and remote regions, provide accommodation, and ensure clinical learning needs are met for students to complete these placements. In 2019, the 16 UDRHs across Australia supported over 16,500 placements (mostly in nursing, midwifery and allied health).1 Similar numbers of UDRH-facilitated placements were planned in 2020. However due to the risks of COVID- 19, associated travel restrictions, biosecurity zones and the constraints within health services, many of these placements were altered, postponed or cancelled. This had repercussions for student progress through their university courses and the types of placements that were offered. As student responses to these placement changes were not well understood, UDRHs were interested in student experiences of their UDRH-facilitated rural or remote placement during 2020. All 16 UDRHs agreed to participate in a study of student perspectives among students who had a placement organised by a UDRH. The aims of the study were to: 1) identify student perspectives of impacts to UDRH-facilitated placements due to COVID-19; 2) identify student perspectives of UDRH-facilitated placements during COVID-19; 3) understand student experiences of UDRH-facilitated placements during COVID-19. A core project team of researchers from eight UDRHs lead the project, with involvement from all 16 UDRHs asking their students to participate. All students with a planned placement facilitated by any UDRH (regardless of whether or not the placement went ahead) between February and October, 2020 were invited by email to complete an online questionnaire. A total of 1,505 students completed the questionnaire. Of these, 84% identified as female, 4% as Aboriginal and/or Torres Strait Islander and 62% were under 25 years of age. Half were studying nursing or midwifery and half were studying medicine (9%) or one of 19 different allied health disciplines. At the end of the questionnaire, all participants were asked if they were willing to be interviewed. Of those willing, 29 were randomly selected and interviewed. Interviewees included students who planned to undertake placements in all states and the NT. Of the 1,505 questionnaire participants, 20% did not complete their placement. Of students completing their placement, 60% indicated their placement was impacted by COVID-19 while 20% suggested their placement was not impacted. Where placements were impacted, students talked about their placement being changed to another service, another town, starting and completing the placement from ‘home,’ or the placement being undertaken from a metropolitan area via telehealth or in the form of a project relevant to a rural or remote location or service. Allied health students were more likely to report that their placement had been cancelled or changed to an online format 3 or a placement model with less direct client contact than nursing students. The decision to cancel or postpone these placements was said to be made mostly by either the health service or the university where the student studied, rather than students choosing not to go rural. Importantly, 80% of respondents indicated they had completed a UDRH facilitated placement, of which 84% were satisfied with their placement. Given the travel restrictions in all states, UDRHs have, therefore, continued to provide placements in difficult times. While financial and mental health issues were identified, the key issues raised by students were concerns for their clinical learning and development of their skills involving direct patient care. Stemming from this, students were also concerned about graduating on time and securing employment in their area of study after graduation. The interviewees outlined the complexity of UDRH-facilitated rural and remote placements during 2020. Students who did not complete their placement talked about the cost of cancelled flights and travel. The students who did complete their rural or remote placement talked about restrictions preventing them from moving around the rural/remote area, being alone in student accommodation, and the restricted duties and activities during placement due to COVID-19 related issues (e.g., lack of personal protective equipment, changes in student tasks, etc.). The many changes and uncertainty of placements also contributed to students’ worry about their placement, progress through their course and clinical learning. Similar to the questionnaire respondents, interviewees also raised financial concerns, worries about graduation, fears about finding employment after graduation, mental health and resilience issues, and the many difficulties of juggling work, family, travel and uncertainty during the pandemic. Overall, most students wanted to go on their UDRH-facilitated rural or remote placement to gain experience and to progress through their course, and the majority of these students completed their UDRH-facilitated placement. While there were changes in placements, locations, accommodation and the types of placement, most students were grateful to complete their planned placement. The cancellation of, and changes to, placements appears to have contributed to student concerns about clinical learning and progression through their course. Many of these concerns are not likely to be specific to UDRH-facilitated placements, but to all placements required in their course. What was clear from this study was the complexity of students’ lives throughout COVID-19 due to juggling financial issues, family concerns, seeking clinical experience, worrying about graduation and feeling insecure about future employment. This suggests that significant student support and flexibility is required for current and future cohorts of nursing and allied health students