Clinical Placement Model Research Articles

Non-traditional mental health clinical placements: An effective means for reducing self-stigma in pre-registration nursing students.

Pre-registration nursing students report high rates of stigma, leading to low help-seeking attitudes when seeking help for mental health issues. Traditional mental health clinical placements can improve stigma related to attitudes and social distance for pre-registration nursing students. There are nil recorded clinical placement interventions that have decreased self-stigma for pre-registration nursing students, with this study highlighting a clinical placement model that is effective in significantly decreasing self-stigma. The knowledge around the mental health struggles experienced by pre-registration nursing students, and the effect of a non-traditional mental health placement in decreasing self-stigmatizing attitudes in this population, is important for the future of retaining mental health nurses. There is an opportunity to use the clinical placement model presented, and design interventions for nursing students that aims to promote help-seeking behaviours. INTRODUCTION: Traditional mental health clinical placements can improve pre-registration nurse stigma toward mental illness, particularly in measures of attitudes and social distance. However, they have not yet been shown to improve self-stigma, which affects mental health disclosure and help-seeking behaviour. The present study investigates nursing students' stigma following a non-traditional mental health placement immersed alongside people living with mental illness. Three stigma subtypes were measured using the Opening Minds Scale for Healthcare Providers: Attitudes, Social Distance, and Disclosure/Help-seeking. Pre-registration nurses (N = 848) completed the instrument pre- and post-placement. A multivariate analysis of variance (MANOVA) identified a large effect of placement on stigma (p < .001, = .101). Post hoc pairwise comparisons revealed all three types of stigma decreased after the non-traditional placement (Attitudes: p < .001, = 0.09, Social Distance: p < .001, = 0.07, Disclosure/Help-seeking: p < .001, = 0.04). These findings emphasize that attending a non-traditional mental health clinical placement can effectively reduce multiple types of nursing student stigma. Further research in this area could focus on which attributes of the clinical placement setting foster positive help-seeking. These results are noteworthy for stigma surrounding disclosure/help-seeking, as traditional (i.e. hospital-based) mental-health clinical placements have been found ineffective in reducing nursing student stigma in this domain. Further research into the effectiveness of non-traditional clinical placements in reducing nursing students' stigma regarding mental health disclosure and help-seeking, is required.

“This should be a compulsory placement for all nursing students”: An evaluation of pre-registration nursing students’ perceptions of learning on a mental health clinical placement

AimTo conduct a longitudinal exploration of pre-registration nursing students’ perceptions of their learning on an immersive mental health clinical placement grounded in learning from people with a lived experience of mental illness (otherwise known as consumers). BackgroundEnriching mental health clinical learning environments are crucial for positive mental health nursing outcomes. Though non-traditional clinical placement (i.e. non-hospital-based) models effectively increase student learning in a range of domains, little is known about the specific features of contemporary non-traditional placement settings that may be supporting student learning over time. DesignA survey design in the form of a standardised evaluation tool with additional qualitative response questions was used to examine nursing students’ perceptions of learning whilst on a non-traditional clinical placement over a 5-year period. Non-traditional placement settings are alternative placement options to traditional inpatient/community mental health settings. The TREND Statement Checklist was adhered to. MethodsSecond- and third-year students studying a Bachelor of Nursing (N = 753) from eight Australian Universities completed a Student Placement Feedback Survey between 2019 and 2023. Data were collected via an evaluation survey including 7-items (rated on a 5-point agreement scale) and three free-response questions. Quantitative and qualitative responses were analysed over all observations and compared between the five years of student evaluations. ResultsAcross five years, the immersive mental health placement was consistently rated by students as a highly valuable learning experience. Utilizing a Multivariate Analysis-of-variance (MANOVA) for the quantitative component revealed that student ‘learning from lived experience’ remained uniformly high and steady throughout 2020–2023. This was despite disrupted learning that ceased face-to-face tuition caused by the COVID-19 pandemic. An increase in ‘student enthusiasm for nursing’ was identified after the return to face-to-face learning. Qualitative analysis identified a greater need for preparedness prior to attending the placement and wellbeing support amongst students. ConclusionsOver the five years, pre-registration nursing students report clinical skill improvement and enhanced knowledge following the immersive mental health placement alongside an increased desire for further skill development. Learning from people’s lived experience of mental illness and specialised facilitators was valuable for student learning outcomes. Increased support is needed for student mental health vulnerabilities and wellbeing ahead of clinical placements. Further research is recommended on the aspects of non-traditional clinical placements that may be protective for student learning.

How will the Covid-19 pandemic shape the future of primary care undergraduate teaching? Understanding modifications and developments deployed by UK academic units of primary care, and their implications for the future

BackgroundPrimary care has been under-represented in its contribution to the academic literature base on Covid-19 developments. We sought to understand how teaching and learning was modified and developed by primary care academic leaders to support the continuation of primary care-orientated learning during the Covid-19 pandemic; and explore how these changes may shape future educational delivery in primary care.MethodsWe adopted a qualitative approach, using semi-structured interviews of seven General Practice Heads of Teaching (GP HoTs) from UK medical schools. We used mixed deductive and inductive coding to analyse interview transcripts. Modifications and developments were coded to four a priori themes (clinical off-site; clinical on-site; synchronous remote; asynchronous remote). We concurrently used inductive coding to identify developments that did not readily fit into these categories. To understand how participants perceived the developments may shape primary care teaching in the future, we carried out an inductive thematic analysis.ResultsA range of modifications and developments were described. Examples of developments include: GP practices being provided with increased flexibility to support ongoing provision of clinical placements (on-site clinical), examples of initiatives enabling students to consult remotely from their homes (off-site clinical), transfer of face-to-face teaching to remote formats (synchronous remote) and development of new, interactive on-line teaching materials (asynchronous remote). One additional theme arose inductively: collaboration and co-operation.For future implications, five themes arose: the evolution of flexible and hybrid clinical placement models; an increased role for telemedicine; increased networking and collaboration; increased active student involvement in patient care; and opportunities for community-based teaching afforded by the pandemic.ConclusionThis study highlights how teaching was modified to support the continuation of primary care-based learning during the Covid-19 pandemic, and implications for the future. Collaboration and placement flexibility were notable features in the response. Participants perceived that flexible placement models containing a mixture of clinical on-site with remote synchronous and asynchronous teaching and learning activities, may persist into the post-Covid era. Further research is required to understand which developments become routinely embedded into primary care teaching in the post-Covid era and explain how and why this occurs.

Survey of clinical placements within pre-registration diagnostic radiography programmes in the UK and Ireland

IntroductionPlacement capacity is a challenge in supporting the clinical education of diagnostic radiography students within the UK at a time where growth in the workforce is required if service delivery needs are to be met. COVID-19 has been one of the catalysts in the growth of innovative and simulated clinical placement models. This survey seeks to understand the current picture of clinical education models and the drivers for it. MethodsA short online MS Forms survey with mixed question types was distributed to higher education institutions (HEIs) delivering pre-registration diagnostic radiography programmes in the UK and Ireland. Descriptive and thematic analysis of data was undertaken to gain insight into the clinical placement models used. ResultsResponses related to 24 programmes from 17 HEIs were collated. Capacity issues, increased student numbers and ability to achieve the learning outcomes were the drivers for the model and arrangement of clinical placements. Clinical practice hours varied widely across programmes as did the proportion of simulation-based education. Respondents felt an increase in the use of placements in modalities and other settings could further increase training capacity. ConclusionOpportunities to further change the clinical placement model have been identified which may alleviate some pressure points on capacity. Guidance around clinical practice hours may facilitate a sustainable approach to workforce training. Innovative placement models will require assessment strategies that align in order that students demonstrate relevant capabilities in a range of settings and value varied learning opportunities. Implications for practiceThe collective engagement and innovation of higher education institutions and service providers will be needed to create sustainable quality models of clinical training and assessment to meet diagnostic radiography workforce requirements.

Factors affecting physiotherapy clinical education: Perceptions of students and clinical educator

Introduction. Clinical education is the cornerstone of physiotherapy education. Clinical educators play a pivotal role in shaping students’ attitude towards their future role as physiotherapist. But the implementation of physiotherapy clinical education varies significantly between institutions. Research has shown several factors influencing the clinical education. Aim. To explore the factors affecting physiotherapy clinical education. Methods. This research used mixed-methods approach and recruited participants through purposive and convenience sampling. Data was collected through a survey using questionnaire and face-to-face interviews. Thirty-four physiotherapy students completed a questionnaire after attending 12 weeks of clinical placements. Twenty-six clinical educators and 9 students participated in the interview. Descriptive statistics including frequency percentage, median and percentiles were used for quantitative data analysis. Thematic analysis method was used for qualitative data analysis. Results. Quantitative study found greater student satisfaction in clinical education. But the qualitative study identified several factors affecting clinical education in the context of this study. These factors include student interest, learning style, culture, and ability to cope with challenges. In addition, clinical educator workload, teaching strategies, curriculum knowledge, academic-clinical partnership, peer learning, placement model and expectations were the other factors that influenced physiotherapy clinical education. Conclusions. The findings of this study are useful to physiotherapy clinical educators, students, and faculty. It provides insight into various factors affecting physiotherapy clinical education. Furthermore, it recommends evidence-based strategies to neutralize those factors influencing clinical education.

A call to reform undergraduate nursing clinical placements

A call to reform undergraduate nursing clinical placements

Clinical placement models for undergraduate health professions students: a scoping review

BackgroundClinical learning is fundamental to undergraduate health professions students. There are several calls for the transformation of health professions education, which have direct implications on clinical learning. Clinical placement models provide structure to clinical learning. Therefore, this scoping review could contribute to supporting curriculum transformation to enhance learning in the clinical environments for undergraduate health professions students.ObjectivesThis scoping review identified the characteristics of research evidence related to mapping the purpose, methodologies used, outcomes, and specific recommendations associated with clinical placement models in undergraduate health professions education.DesignA scoping review method was used in this study. A search string developed from the title of the review was used to search online databases to identify research published between January 2000 and March 2020.ResultsForty-eight articles reporting on ten clinical placement models were included in this review. The majority of these articles originated from Australia and predominantly report on nursing. The aims of these articles aligned with the evaluation of the implementation of a clinical placement model. Seven categories of outcomes of the clinical placement models are reported namely, relationships, influence, environment, facilitation, inputs, knowledge scores, and student perceptions.ConclusionsAs clinical learning is fundamental to undergraduate health professions education, clinical placement models should prioritise the development of competence among undergraduate students. Insights into outcomes reported in literature could guide educators in fostering optimal learning in students who may then be able to influence community health outcomes positively.

The impact of longitudinal integrated clerkships on patient care: a qualitative systematic review

ABSTRACT Background Longitudinal Integrated Clerkships (LIC) are a relatively novel type of clinical placement model within medical education, particularly within the UK. The research on LICs primarily focuses on the impact of the model on students, tutors, communities, and organisations. The impact of LICs on patients has not yet been adequately synthesised. This systematic review aims to fill this gap by examining empirical evidence regarding the impact of LICs on patient care using quality-of-care measures, namely, health process measures and outcome measures. Methods A systematic search was conducted in MEDLINE, PsycINFO, Academic Search Premier, Education Research Complete, CINAHL Complete, ERIC, Web of Science, and Scopus. Two reviewers independently conducted the screening process for study selection. Results across studies were analysed and summarised by thematic analysis. Results The reviewers screened 1632 records. Seven studies met the inclusion criteria following a full-text review, from which four themes were created. Three themes describe health process measures, including: 1) Advocacy within healthcare system, 2) Provision of supplementary and personalised care, and 3) Providing companionship with care. One theme described a health outcome measure: Therapeutic Alliance. Conclusion Current evidence demonstrates an overall beneficial impact of LICs on patient health processes and outcome measures. However, the available evidence is weak and limited. Further research is required to illuminate the true impact of LICs on patient health.

\u201cPerceptions, expectations and satisfaction levels of occupational therapy students prior to and after practice placement and comparison of practice placement models\u201d

BackgroundPractice placements in occupational therapy are fundamental components in developing a student’s professional identity. Various models of placements are available to expose and expand students’ participation in various community-based services. The purpose of this study was to compare occupational therapy students’ perceptions and expectations prior to placements with their perceptions and satisfaction levels upon completion of placements, and to compare clinical placement models (role-established and role-emerging).MethodsThe study included 155 undergraduate occupational therapy students, who completed questionnaires prior to and upon completion of their placements. The questionnaire included items that were divided into categories of placement setting and supervision, personal skills, professional skills, and community. Paired t-tests and two-way repeated measures analyses of variance (ANOVA) were used in order to examine the change in scores over time, and a-parametric tests were used in order to compare the two models.ResultsFor all students a significant decrease in scores was found from pre- to post-placement regarding setting and supervision (t[df] = 3.96[154], p < .001), and a significant increase in scores was found from pre- to post-placement regarding personal and professional skills (t[df] = 7.82[154], p < .001; t[df] = 14.24[154], p < .001, respectively). Comparison between placement models indicated nonsignificant differences regarding personal and professional skills. However, role-established post-scores were significantly higher than role-emerging scores regarding setting and supervision, but significantly lower regarding the contribution of services to the community.ConclusionsPractice placements promote a student’s personal and professional skills. Students were less satisfied with the setting and supervision in comparison to their pre-placement expectations. Both models may contribute to students’ professional development. Role-established model had an advantage in students’ satisfaction with settings and supervision, while role-emerging models had an advantage in students’ perceptions regarding contribution to the community. Role-emerging model may contribute to developing and expanding areas of practice in the community.

Undergraduate paramedic student experiences working in snow resort medical clinics: a non-traditional interprofessional clinical placement model

&lt;p&gt;&lt;strong&gt;Abstract&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;This study investigates the experiences of undergraduate paramedic students completing interprofessional clinical placements in snow sport injury clinics. Qualitative methods were used to investigate the experiences of participants (n=6) undertaking a non-traditional ambulance clinical placements as part of a multidisciplinary healthcare team. Ethical approval was obtained through X University. Data were collected via one-on-one face-to-face interviews and analysed using holistic and focused coding. Results were divided into three main categories, namely pre-placement, intra-placement and post placement phases. As it was a new placement, student capabilities were not initially known by clinic staff. Nevertheless the workplace culture was inclusive and supportive, and paramedic skills were applicable in the clinic environment. Despite the placement costs being excessive, participants viewed it as an investment in their future careers. Benefits of the placement included improved maturity levels, acquisition of professional networks, an understanding of interprofessional practice and an exposure to clinical skills not normally practiced on traditional ambulance placements. The interprofessional clinical placement appears to be a valid alternative to traditional ambulance placements. However, using this model to replace mainstream placements is problematic due to the costs involved, the limited number of spots available and the seasonal occurrence of snow sports. &lt;/p&gt;

Nursing students' perceptions of a collaborative clinical placement model: A qualitative descriptive study.

Clinical placements are specifically designed to facilitate authentic learning opportunities and are an integral component of undergraduate nursing programs. However, as academics and clinicians frequently point out, clinical placements are fraught with problems that are long-standing and multidimensional in nature. Collaborative placement models, grounded in a tripartite relationship between students, university staff and clinical partners, and designed to foster students' sense of belonging, have recently been implemented to address many of the challenges associated with clinical placements. In this study a qualitative descriptive design was undertaken with the aim of exploring 14 third year third year nursing students' perceptions of a collaborative clinical placement model undertaken in an Australian university. Students participated in audio recorded focus groups following their final clinical placement. Thematic analysis of the interview data resulted in identification of six main themes: Convenience and Camaraderie, Familiarity and Confidence, Welcomed and Wanted, Belongingness and Support, Employment, and The Need for Broader Clinical Experiences. The clinical collaborative model fostered a sense of familiarity for many of the participants and this led to belongingness, acceptance, confidence and meaningful learning experiences.

Transformative Learning in Medical Education

This longitudinal study followed the clinical learning journey of 20 medical students over 4 years, from the beginning of their clinical immersion, through one of the three different clinical placement models: block rotation, longitudinal integrated clerkship, or community- and hospital-integrated learning, and then into Year 4 and the intern year postgraduation. This study explored how these different contexts can influence the process of transformative learning. The results identified six well-defined changes to their ways of seeing the world which participants described as insights shaped by their clinical training. These themes were self-awareness, patient centeredness, systems thinking, self-care, clinical skepticism, and understanding diversity. Further analysis explored how changes in worldview can be instrumental, communicative, and emancipatory. This study demonstrates that context matters and that longitudinal models of clinical education may facilitate emancipatory learning.

The impact of clinical placement model on learning in nursing: A descriptive exploratory study

Background: Learning in the clinical setting is an essential component of nursing education. Two common models of clinical learning place students in facilities using either block or distributed approaches. Aim: The aim of this study was to examine nursing students’ perceptions of the impact of block versus distributed model of clinical placement on their learning experience. Design: The study employed a descriptive, exploratory approach. Focus groups and an individual interview were conducted with third-year undergraduate nursing students. Setting: Students from four Australian universities took part in the study. Subjects: The average age of the 22 student participants was 37.5 years and 91% were female. More than half (55%) studied full time. Results: Thematic analysis of the data identified five overarching themes: We’re there to learn; Taking all that knowledge out and practising it; You actually feel a part of the team; Just prepare them for us coming; and It’s really individual. Conclusions: It is clear that both block and distributed modes of placement have inherent advantages and disadvantages that might be magnified depending on the individual student’s circumstances. Sequencing, consistency and preparation must be considered when planning either mode of clinical placement to ensure the best possible experience for students. Most significantly, students need to feel as though they are part of the team while on placement to get the most out of the experience. These findings have implications for education providers planning the integration of clinical placement into the nursing curriculum.

The impact of clinical placement model on learning in nursing: a descriptive exploratory study

Learning in the clinical setting is an essential component of nursing education. Two common models of clinical learning place students in facilities using either block or distributed approaches. The aim of this study was to examine nursing students’ perceptions of the impact of block versus distributed model of clinical placement on their learning experience.

Midwifery students׳ experiences of an innovative clinical placement model embedded within midwifery continuity of care in Australia

Backgroundmidwifery continuity of care experiences can provide high quality clinical learning for students but can be challenging to implement. The Rural and Private Midwifery Education Project (RPMEP) is a strategic government funded initiative to (1) grow the midwifery workforce within private midwifery practice and rural midwifery, by (2) better preparing new graduates to work in private midwifery and rural continuity of care models. Aimthis study evaluated midwifery students׳ experience of an innovative continuity of care clinical placement model in partnership with private midwifery practice and rural midwifery group practices. Methoda descriptive cohort design was used. All students in the RPMEP were invited to complete an online survey about their experiences of clinical placement within midwifery continuity models of care.Responses were analysed using descriptive statistics. Correlations between total scale scores were examined. Open-ended responses were analysed using content analysis. Internal reliability of the scales was assessed using Cronbach׳s alpha. Findingssixteen out of 17 completed surveys were received (94% response rate). Scales included in the survey demonstrated good internal reliability. The majority of students felt inspired by caseload approaches to care, expressed overall satisfaction with the mentoring received and reported a positive learning environment at their placement site. Some students reported stress related to course expectations and demands in the clinical environment (e.g. skill acquisition and hours required for continuity of care).There were significant correlations between scales on perceptions of caseload care and learning culture (r=.87 p<.001) and assessment (r=.87 p<.001). Scores on the clinical learning environment scale were significantly correlated with perceptions of the caseload model (rho=.86 p<.001), learning culture (rho=.94 p<.001) and assessment (rho=.65 p<.01) scales. Conclusionsembedding students within midwifery continuity of care models was perceived to be highly beneficial to learning, developed partnerships with women, and provided appropriate clinical skills development required for registration, while promoting students׳ confidence and competence. The flexible academic programme enabled students to access learning at any time and prioritise continuity of care experiences.Strategies are needed to better support students achieve a satisfactory work-life balance.

Current Literature Summary

Current Literature Summary

Capricornia Allied Health Partnership (CAHP): a case study of an innovative model of care addressing chronic disease through a regional student-assisted clinic.

Faced with significant health and workforce challenges, the Central Queensland Hospital and Health Service commenced an innovative student-assisted clinical model of care. The Capricornia Allied Health Partnership (CAHP) in 2010. The clinic supports pre-entry allied health student clinical placements to: (1) address service delivery gaps for previously underserved people with chronic disease; (2) facilitate hospital avoidance and early discharge from the local hospital; (3) provide an attractive clinical placement opportunity for allied health students that will potentially lead to future recruitment success, and (4) demonstrate leadership in developing interprofessional skills of future health workforce trainees. This case study details the conceptual background of the initial model, the key features of the clinical placement and service delivery model, and discusses the current and future evaluation of the clinic.

Longitudinal integrated rural placements: a social learning systems perspective

There is currently little theoretically informed exploration of how non-traditional clinical placement programmes that are longitudinal, immersive, based on community-engaged education principles and located in rural and remote settings may contribute to medical student learning. This paper aims to theoretically illustrate the pedagogical and socio-cultural underpinnings of student learning within a longitudinal, integrated, community-engaged rural placement. Data collected using semi-structured interviews with medical students, their supervisors and other health clinicians participating in a longitudinal rural placement programme were analysed using framework analysis. Data interpretation was informed by the theory of social learning systems (SLSs). In a longitudinal, rural clinical placement students participate in an SLS with distinct yet interrelated learning spaces that contain embedded communities of practice (CoPs). These spaces are characterised by varying degrees of formality, membership and interaction, and different learning opportunities and experiences. They are situated within and shaped by a unique geography of place comprising the physical and social features of the placement setting. Within these learning spaces, students acquire clinical knowledge, skills and competencies, professional attitudes, behaviours and professional values. The process of connectivity helps explain how students access and cross the boundaries between these learning spaces and develop a more complex sense of professional identity. Longitudinal, integrated clinical placement models can be understood as SLSs comprising synergistic and complementary learning spaces, in which students engage and participate in multiple CoPs. This occurs in a context shaped by unique influences of the geography of place. This engagement provides for a range of student learning experiences, which contribute to clinical learning and the development of a more sophisticated professional identity. A range of pedagogical and practical strategies can be embedded within this SLS to enhance student learning.

The Idaho Dedicated Education Unit Model

Faculty face many challenges in delivering clinical education, including faculty availability, the complexity of the faculty role, and limited clinical placements. Dedicated education units (DEUs) are being explored as alternatives to traditional clinical placement models. The authors describe the successful development of a DEU that resulted in positive student outcomes at reduced cost to both the school and the medical center.

Revisiting 1:1 and 2:1 clinical placement models: Student and clinical educator perspectives

A recent systematic review suggests that more comparative research is required on the effectiveness of clinical placement models. This study explored perspectives of clinical educators and students who had participated in both the 1:1 (one student supervised by one clinical educator) and 2:1 (two students supervised by one clinical educator) models of clinical education across occupational therapy and physiotherapy programmes in Ireland. Qualitative data using a descriptive approach were gathered through individual semi-structured interviews with a convenience sample of 12 students and eight clinical educators. Transcripts were analysed using thematic content analysis. Three main themes emerged: learning opportunities and experiences; organisation and planning; relationships. Although clinical educators felt that the 2:1 model offered greater learning experiences than the 1:1 model, it presented organisational challenges. Students preferred the 2:1 model earlier in their clinical experience due to the benefits of peer learning, whereas the 1:1 model was favoured in the latter stages to demonstrate individual autonomy. Relationships forged during placement were significant, from the student's perspectives, but differed between models. Clinical educator and student perspectives indicated that learning from other members of the multidisciplinary team had a positive effect on learning within both models. Each clinical placement model requires specific organisational and planning skills to be effective. An awareness of individual student learning is essential to avoid dissatisfaction with the learning and assessment process on a 2:1 model. Recently established clinical education teams in Ireland may have a role to play in developing effective clinical learning.