Realising our value through Clinical Education: Health students’ experiences of clinical placements in Indigenous contexts

Dr. Alison Nelson1,2, Dr.  Kate Odgers-Jewell1

1The Institute for Urban Indigenous Health, Windsor, Australia, 2The University of Queensland, St Lucia, Australia

Background: The teaching of “cultural competency” in relation to Indigenous Health is a requirement or aspiration of all Australian universities offering health programs to broaden student’s knowledge and promote culturally responsive care (Universities Australia, 2011). However, content is often taught in isolation from practical experiences  and has the potential to promote only negative aspects of Indigenous health. In addition, health professionals report experiencing anxiety or inadequacy about working in this area (Wilson et. al, 2015). The Institute for Urban Indigenous health has worked with local universities to develop clinical placements which are used to provide practical experience in a scaffolded Indigenous health learning environment. This presentation will describe the clinical placements offered to students by IUIH and describe the change in attitudes and beliefs of students throughout the course of their placement.

Method: Student placement experiences are evaluated using  20 five-point Likert items relating to students’ perceptions of the learning environment, skills development, awareness and self-development, supervision and their overall experience. Two open-ended response items on the positive and negative aspects of the practicum and how these impacted students’ learning are also collected.

Results from the IUIH student database indicate an increase from 30 students/year across three disciplines to over 370 students/year across 20 disciplines. In addition, student clinical hours have increased by 440% over the past 8 years. Survey results will be reported in detail but indicate areas of strength and potential for growth and improvement.

Discussion: Service-learning experiences in urban First Australian contexts are shown to equip the emerging workforce with supportive networks, experience in culturally-responsive service provision and supported opportunities to develop ways of thinking, doing and partnering with First Australians towards optimising health and well-being.

References:

Universities Australia. (2011). National Best Practice Framework for Indigenous Cultural Competency. Canberra: Australian Government Department of Education, Employment and Workplace Relations. Retrieved September 9, 2015, from https://www.universitiesaustralia.edu.au/uni-participation-quality/Indigenous-Higher-Education/Indigenous-Cultural-Compet

Wilson, A.M., Magarey, A.M., Jones, M., O’Donnell, K. & Kelly, J. (2015). Attitudes and characteristic of health professionals working in Aboriginal health. The International Electronic Journal of Rural and Remote Health Research, Education Practice and Policy, 15(2). Retrieved  September 18, 2015 from http://www.rrh.org.au/publishedarticles/article_print_2739.pdf.


Biography:

Dr Alison Nelson (B. Occ Thy, M.Occ Thy (research), PhD) is an occupational therapist with extensive research, teaching and practice experience working alongside urban Aboriginal and Torres Strait Islander people. Alison has completed both a research Master’s degree and PhD in the areas of service delivery and perceptions of health for urban Aboriginal and Torres Strait Islander children and young people, and she has published widely in these fields. Alison is currently the Director for Organisational  Development at the Institute for Urban Indigenous Health where she brings together her experience working in both clinical and academic settings.  Alison has a particular interest in developing practical strategies which enable non-Indigenous students, researchers and practitioners to understand effective ways of working alongside Aboriginal and Torres Strait Islander Australians.

The Allied Health work readiness study: Identifying personal characteristics signalling work readiness in Allied Health students

Dr Maxine O’brien1, Ms Kelli Troy1, Ms Jayne Kirkpatrick1

1Darling Downs Health, Toowoomba, Australia

Background: Clinical placements associated with university degrees for the allied health professions aim to support the preparation of students for post graduate employment through the practical application of theoretical constructs. However, employers recognise that a range of individual skills and attributes outside of technical and academic achievement impact on work readiness. This project sought to identify these individual characteristics, and their relative importance.

Method: The study utilised the knowledge and experience of allied health Clinical Educators, experienced Clinical Supervisors, and Allied Health Directors, across six AH disciplines. Participants completed a brief demographic questionnaire before participating in one of three groups which employed the structured, Nominal Group Technique to seek answers to the research question “What do you believe are the most important personal characteristics signalling work readiness in allied health students?”

Results: Data were analysed by group and then overall, resulting in a complete list of 103 characteristics raised, 37 of which were judged as among the “most important” by study participants. Analysis revealed six characteristics which were identified and voted as among the most important by each independent group. Personal insight and self-awareness rose to the top of the list of most important characteristics, with resilience being second on this list, followed by communication skills, organisational skills, lifelong learning, and professionalism.  A further nine characteristics were selected by two of the three groups, while an additional 22 characteristics were raised and voted as among the most important by members of a single group.

Discussion: We believe that these results will be of interest to allied health students and staff, universities, recruiters and management. It is our hope that identification of these characteristics may also lead to the development of targeted education and support programs within DDH to assist students’ growth in these areas.


Biography:

Dr Maxine O’Brien has enjoyed a rich and varied career as a psychologist including clinical, teaching, supervision and research roles. Despite an abiding love for the clinical practice of psychology, Maxine also has a passion for useful, practical research and has completed a PhD and numerous publications. Accordingly, Maxine’s current roles within Queensland Health include that of Senior Psychologist, Alcohol and Other Drug Service, and DDH Acting Research Fellow. Maxine’s lengthy experience as a Clinical Supervisor has prompted curiosity about work readiness in health service staff, making her a natural fit for this research team.

Remotely satisfied: The experiences of health students undertaking Work Integrated Learning placements in the Northern Territory

Dr  Narelle  Campbell1, Annie Farthing2, Jessie  Anderson2, Leigh Moore1, Susan Witt1

1Flinders NT, Darwin, Australia, 2Centre for Remote Health, Alice Springs, Australia

Background: Placing undergraduate health students in underserved areas with a view to them taking up employment after graduation is a strategy of the Commonwealth government funded Rural Health Multidisciplinary Training (RHMT) program.  Students who are satisfied with their placements indicate a strong intention to return to take up remote and rural practice after graduation (see Smith et al 2018 and Smith et al 2017).  This presentation investigates the experiences and perceptions of nursing and allied health students who undertook a placement in the Northern Territory, in areas classified by the Modified Monash Model as MMM5, MMM6 and MMM7.

Method: Flinders NT auspices the RHMT program in the Northern Territory, supporting additional nursing and allied health placements.  After each placement, students are invited to participate in an anonymous survey which gathers a mix of quantitative and qualitative data about their placements.

Results: Over 2017 and 2018 the survey had a 33% response rate. Data from 309 nursing and allied health students will be presented with 92% indicating they were satisfied with their placement experience; 74% rating their experience as better or much better than their metropolitan placement/s; and 82% indicating the placement encouraged them to consider living and working in a rural or remote location after graduation.

Discussion:  Survey data demonstrates that students undertaking placements in the NT are very satisfied with the quality of their placement and their experiences have influenced them to consider returning.  It also shows the students rate their experiences in the NT as being generally “better than” previous experiences in metropolitan areas.

Flinders NT is commencing a Work Location Outcomes study in 2019 that will track the students for 10 years to see if intention has translated into outcomes and what the career trajectory of these placement students looks like.

Smith, T. et al 2018 DOI: 10.2147/JMDH.S150623

Smith, T. et al 2017 doi:10.1111/ajr.12375


Biography:

Annie Farthing has lived in Central Australia since 1992 working as a physiotherapist in urban and remote contexts, in community health, rehabilitation, aged care, disability and chronic disease. Annie is currently an academic at the Centre for Remote Health developing new and innovative placement opportunities for Allied Health students, as well as working as a locum for Tangentyere Council in their Integrated Team Care Program.

A picture maybe worth a thousand words but a narrative is priceless

Ms Maryanne Long1, Ms  Sonia  Wood1

1Southern Queensland Rural Health, Toowoomba , Australia

Research evidence suggests that peer to peer communication is a potentially influential tool to leverage interest and engage students in the conversation in relationship to the uptake of rural student placement pathways. A significant learning from the Educating Health Professionals in Interprofessional Care (ehpic™) training is the importance of sharing of stories. Informed by an interprofessional education framework, working collaboratively with students and other stakeholders, Southern Queensland Rural Health (SQRH) developed a project based on action research principles to create an innovative rural placement promotional resource. The narrative project engaged with students who discussed their recent rural placements from both a student learning and lifestyle / community engagement perspective.

The narratives took the form of written story-telling and one video production. The journeys of two University of Queensland (UQ) Social Work (S.W.) students transitioning from rural placement to graduate social work positions in rural towns are highlighted, thereby identifying a key employment pathway and addressing the critical issue of recruitment of graduate social workers.

The project resulted in the collation of a range of powerful narratives. Working with our partners, SQRH are currently trialing methods of the most effective way of sharing narratives with students. The target audience, SW students at UQ are currently being accessed via the promotions UQ SW Field Student Blackboard, guest lecture segments and the SQRH social media platforms and website.

Aligned with the action research cycle, currently the project is working through the observing and reflection phases prior to planning the next stage of this evolving project. Rates of pre and post project UQ SW student rural placement data will be monitored and will inform the next phase.


Biography: To be confirmed

How can we expand clinical placements to better impact on future workforce development and need? A policy analysis approach

Ms Rachel Yates1

1Universities Australia, Deakin, Australia

Background and aim: Quality clinical placements in pre-registration years are essential to developing a skilled health workforce. They influence how clinicians act, and where they eventually work – with direct implications on health workforce ability and distribution.  Promoting clinical placements in areas of undersupply is therefore important in helping to address workforce need.

Using education and training programs to influence health workforce distribution has been an Australian policy approach for many years. However, policies have largely focused on medicine and/or rural locations. While a rural focus is important (there continues to be a lack of most health disciplines in rural Australia) significant shortages also exist or are forecast in specific service settings. This includes the predicted growth areas of disability and aged care – especially for non-medical workforce such as allied health and nursing.

While there is awareness of the need to expand placements, various policy and other barriers exist to placing health professional students in these settings – despite the many benefits placements bring.

The aim of this presentation is to:

  • highlight the benefits of allied and other health student placements;
  • examine policies and practice that support clinical education and workforce growth in undersupplied areas;
  • describe barriers and enablers to student placement including in aged care and disability services; and
  • propose a model to expand placements to settings of need.

Method: A mixed methods policy analysis approach is used which draws on: case studies; analysis of existing policies and research; and model building.

Results: Results of the analysis will be provided as part of the presentation.

Discussion: The advantages and disadvantages of different approaches will be discussed together with a proposed model to support expanded placements. Broader mechanisms through which more connected clinical education and health workforce policy development can occur will also be canvassed.


Biography:

Rachel is Policy Director Health and Workforce at Universities Australia. She has previous extensive experience in health policy, research and service delivery both locally and nationally and brings this experience to her current health professional education policy and advocacy role. She is passionate about good policy formulation and especially about how to better connect policy approaches between education and health for effective workforce development.

Sustaining clinical placement capacity through partnerships and collaboration

Liza-Jane McBride1, Cate  Fitzgerald2, Claire Costello3, Kristy Perkins4

1Queensland Department of Health, Brisbane, Australia, 2Metro South Health , Brisbane, Australia, 3Children’s Health Queensland, Brisbane, Australia, 4West Moreton Health, Ipswich, Australia

Background: The implementation of a state-wide allied health clinical placement capacity building initiative that provided dedicated clinical education resources since 2009 has enabled a system wide response to the provision of quality clinical placements in an environment of increasing university cohort growth and demand for clinical education placements.

Aim: The study aimed to investigate whether clinical placement capacity achieved through the initiative was being  sustained. Additionally, the study aimed to investigate the factors affecting the efforts of allied health staff to provide placement offers and the perspectives of key internal allied health and external university stakeholders on the barriers and enablers for sustainability of effort.

Methods: Data from 2010-2016 on clinical placement numbers, staff full-time equivalent positions, university program and student cohort data for five professions was reviewed. Qualitative response data from key stakeholder surveys was analysed thematically.

Findings: Key enablers for sustaining placement provision included collaboration between university and health sectors, efficiency through coordination of processes, sustained management support to placement provision, dedicated education roles, outcome data reporting and state-wide profession-specific governance and leadership. The initiative was found to be integral to developing and sustaining innovative placement models that contribute to increased placement offers. Barriers to sustainability centred on resourcing, continued increasing demand for placements and the changing healthcare context. Clinical placement activity continued to grow despite previous perceptions from key stakeholders that capacity had been reached.

Conclusion: Flexibility and responsiveness underpinned by collaboration, information and resource sharing within and across professions is pivotal to sustaining quality pre-entry student placements. Systems to routinely capture and review placement activity and qualitative perspectives have provided valuable feedback. This has allowed for the evolution of the initiative over time to respond to local health service needs and increasing demand for placements in a rapidly changing health service delivery context.


Biography:

Liza-Jane is the Chief Allied Health Officer for the Department of Health and leads the development, implementation and evaluation of strategies to ensure an appropriately skilled allied health workforce meets the current and future health service needs of Queensland. Liza-Jane is an experienced physiotherapist with over 20 years of practice experience in the public and private sectors in Queensland and overseas. She has postgraduate qualifications in health service management and is a Visiting Fellow with the Queensland University of Technology. Liza-Jane has significant experience in successfully delivering strategic policy results within the Queensland healthcare system, particularly in relation to allied health workforce reform, redesign and education issues.

Collaborative Allied Health clinical education

Dr Susan Waller1, Mr Chris O’Brien2, Mrs Karen Macgregor3, Mrs Andrina Mitcham4

1Monash University, Warragul, Australia, 2Bendigo Health Service, Bendigo, Australia, 3Central Gippsland Health, Sale, Australia, 4Mildura Base Hospital, Mildura, Australia

Background: In 2016, the Federal government has funded all University Departments of Rural Health to substantially increase the number of rural placements they facilitate with the objective of addressing the geographic maldistribution of the health workforce. To address this mandate, Monash University established the Rural Nursing and Allied Health (RNAH) Expansion program.

Targets set included 1848 multidisciplinary placement weeks in 2016, 2017 and 2018 with an average placement length of 5 weeks by 2018. Targets have now been set for 2020 at 2000 placements.

Aim

  1. Evaluation of strategies to strengthen and develop further allied health student placements and increased clinical educator capacity.
  2. To appoint and support the development of allied health educators in collaboration with regional health services.

Methods: Using surveys and focus groups of health service and university staff to:

  • Scope the barriers and enablers impacting on the future capacity of allied health student placements
  • Understand the barriers and enablers influencing the quality of student placements
  • Identify future priority areas where current capacity of student placements may not meet demand
  • Increase interprofessional student and staff learning and development opportunities

Outcomes: The appointment and ongoing development of allied health educators with adjunct academic appointments within local health services in Bendigo, Central and West Gippsland, and Mildura participating in a university led community of practice in order to deliver on the goals and objectives of the program.

The presentation will report on:

  • Findings of the staff scoping survey and focus group
  • Placement targets achieved and extended placements developed
  • Needs analysis: perceived enablers, barriers and opportunities
  • New interprofessional learning and development programs developed
  • Number and format of interprofessional learning and development sessions delivered (pre and post RNAH)
  • Contribution to programs & interprofessional value to allied health, nursing, & beyond.

Biography:

Susan is a Senior Lecturer in Monash Rural Health, Monash University. Susan is responsible for nursing and allied student placement support in the MRH footprint, facilitating the interprofessional simulated student clinic at Latrobe Community Health Service and teaching on the Masters of Advanced Healthcare Practice.

Chris O’Brien (B Physiotherapy) is an Allied Health Educator at Bendigo Health in regional Victoria. He has an adjunct appointment with Monash University supporting their Rural Nursing and Allied Health program, which aims to increase the quality and capacity of student placement experiences in Bendigo and the surrounding region.

Realising the value of a student led service learning placement in challenging mental health stigma: “This placement has changed me for ever”

Mrs Nicole Killey1, Mrs Jane Ferns2

1University Of Newcastle Department Of Rural Health, Coffs Harbour, Australia, 2University Of Newcastle Department Of Rural Health, Taree, Australia

Background: Service-learning (SL) placements aim to address health inequities experienced by underserved populations by linking purposeful service activities by health students with their academic curriculum to enrich their learning experiences. Through a collaboration between the University of Newcastle Department of Rural Health (UONDRH) and Momentum Collective (MC) a pilot SL placement was developed for occupational therapy (OT) students. MC is a regional community based organisation that provides support for people who are vulnerable or disadvantaged, including a residential mental health rehabilitation service.

Method: Two second-year OT students participated in a SL placement over seven weeks. Following completion of a needs assessment with consumers, students planned and implemented group and individual consumer programs. Based on their experiences and feedback from MC staff and consumers, students developed a report providing recommendations for future student led programs. The UONDRH SL placement evaluation was completed by students and MC management.

Results: Feedback from UONDRH SL placement evaluations highlighted unintended positive outcomes beyond the placement learning objectives. Students developed a greater understanding of consumers in the mental health setting challenging their preconceptions. MC highlighted the value of this placement in reducing the stigma towards consumers of mental health services.

Discussion: This SL placement emerged as an innovative solution for meeting the need for professional practice placement experiences.  While it was anticipated that students would have the opportunity to experience working in a community mental health service, the unintended outcome of reducing the stigma of mental health was inspiring.  This experience has broadened our understanding of the potential learning opportunities, specifically challenging students to reflect upon their own assumptions related to mental health and the associated stigma experienced by consumers, which will inform future placement design.


Biography:

Since graduating from University of Queensland I have worked primarily in adult rehabilitation and community settings across regional NSW and the UK.  I have an interest in student education and currently hold the position of Associate Lecturer Occupational Therapy with UONDRH, Coffs Harbour.

Variable levels of perceived stress and anxiety reported by physiotherapy students during clinical placements – quantitative data

Kathy Stiller1, Deborah Gallasch2, Amy Conlon-Leard3, Michelle Hardy4, Anna Phillips5, Gisela Van Kessel5

1Central Adelaide Local Health Network, Adelaide, Australia, 2Royal Adelaide Hospital, Adelaide, Australia, 3The Queen Elizabeth Hospital, Adelaide, Australia, 4Hampstead Rehabilitation Centre, Adelaide, Australia, 5University of South Australia, Adelaide, Australia

Background: Clinical placements are often the first time physiotherapy students are exposed to ‘real’ patients and, as a result, stress and anxiety levels are heightened. While some stress is necessary for effective learning, excessive stress can interfere with learning and negatively affect academic performance and well-being. We have observed an apparent increase in students’ levels of stress and anxiety and the number struggling to cope with clinical placements. This study measured levels of stress and anxiety of physiotherapy students during clinical placements and examined factors influencing these. Relationships between stress and anxiety levels, the students’ baseline individual personal trait anxiety and academic performance were also examined.

Methods: Data were collected from March – December 2018. Physiotherapy students from the University of South Australia undertaking clinical placements (i.e. acute care, rehabilitation or primary/ambulatory care) at any Central Adelaide Local Health Network site in 2018 were eligible for participation. Outcome measures included the Trait portion of the State-Trait Anxiety Inventory (which measures general level of stress/anxiety and characteristics of an individual’s personality [STAI]) and perceived stress and anxiety (visual analogue scales [VAS]).

Results: Data were obtained from 159 of 175 (91%) clinical placements (85 [54%] females; mean [SD] age 24 [5] years; 137 [86%] undergraduates). Mean (SD) baseline STAI was 42 (9), reflecting slightly higher stress/anxiety than that seen in US college students. Perceived stress and anxiety levels (VAS) were highly variable between students over the clinical placements, with means (SD; ranges) of 53 (22; 5-100) and 51 (24; 0-100) respectively. Baseline STAI was significantly correlated with mean VAS stress and anxiety. Baseline and mean VAS stress and anxiety were significantly correlated with academic outcomes.

Discussion: Some, but not all, students demonstrated excessive levels of stress and anxiety during clinical placements. Interventions to better identify and assist these students are required.


Biography:

Kathy Stiller has a background in physiotherapy, having worked in ICU for over 20 years. More recently she has worked part time as the research coordinator for physiotherapy and then allied health.

Post placement reflection sessions – a placement capacity and sustainability initiative

Mrs Vicky Stirling1, Mrs Deborah Fitzgerald1

1Queensland Health, Gold Coast, Australia

Background: Allied Health university program and cohort growth to meet perceived workforce needs have led to an increase in demand for pre-entry student placements. To meet this demand Allied Health professionals within public and private health services need to have a dual focus on sustaining quality clinical education practices and building placement offers or capacity. Post Placement Reflection Sessions (PPRS) were implemented within a Queensland public health service to sustain and increase a clinician’s Clinical Educator (CE) capability to deliver quality clinical learning. The sessions were guided by contemporary educational theory, with reflections and learnings documented to enable review by the CE prior to the next placement they supported.

Method: An action learning approach to quality review the PPRS sessions, incorporating qualitative reflective journaling and peer discussion, was undertaken over a two-year timeframe. This methodology facilitated reflection on the impact of the sessions on stakeholders and enabled continual review and refinement of the PPRS design.

Results: Qualitative review of journaling and peer meeting documentation revealed information to guide future PPRS implementation process and design. Themes related to the perceived impact on CEs’ practices also emerged, as did reflections on the value of PPRS in supporting placement capacity and sustainability. The PPRS encouraged CEs to consider alternative placement models and approaches to student supervision for future placements. PPRS were also reported to enhance novice CEs’ confidence to educate students.

Discussion: The presentation will report on the refined design of the PPRS sessions and the key outcomes of the quality review undertaken. The reported impact on CE skill development and sustained effort for placement provision will be described. It became evident that CEs are seeking guidance and support on their education practices, with the PPRS enabling this in a planned and structured way that may not have occurred otherwise.


Biography:

Vicky Stirling has worked as a Gold Coast Occupational Therapy Clinical Education Support Officer (CESO) since 2011, supporting clinicians to deliver quality placement experiences. This position works within the statewide Occupational Therapy  Clinical Education Program (OTCEP). Vicky has also worked clinically in a variety of acute, rehab and outpatient settings as well academically in the University sector. She is passionate about reflective practice, the delivery of quality student learning experiences and promoting placement capacity and sustainability initiatives.

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2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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