Abstract
BackgroundClinical 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/designThis 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.DiscussionUse 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 registrationAustralian New Zealand Clinical Trials Registry, ACTRN12616001339448. Registered 26 September 2016.
Highlights
Clinical placements are a critical component of the training for health professionals such as occupational therapists
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 use of simulation in health-related fields like occupational therapy is not unusual, but simulation typically relates to specific activities
Summary
The use of simulation in health-related fields like occupational therapy is not unusual, but simulation typically relates to specific activities. These costs are not typically transparent, and this information will be very useful to the occupational therapy profession, universities and the health and human services sector who host placements. Multisite trials that aim to exert high levels of control of the trial’s implementation would typically centrally train an SCP delivery team and data collection team and dispatch them to each university to implement the SCP program in parallel with that university’s TCP program While this might provide evidence of the effect of a highly controlled intervention, the current study is pragmatic and will provide evidence of the effectiveness of a ‘real-world’ implementation because each university is responsible for implementing the RCT, in terms of delivering the program as well as collecting the data, at their own institution.
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