Immersive Clinical Experiences Research Articles

Examining Preceptors’ Perceptions of Need Around Facilitating Clinical Immersion Experiences

Context Clinical immersion experiences allow students to gain firsthand, authentic experiences to help them successfully matriculate into the profession. Preceptors supervise athletic training students during these experiences and are critical in the student’s clinical competence development. It is important to understand their needs to help facilitate a successful experience for the student. Objective To explore the needs of preceptors as they facilitate clinical immersion experiences for their athletic training students. Design Qualitative case study. Setting Athletic training practice settings facilitating clinical immersion. Patients or Other Participants Eight preceptors (6 female, 2 male) who met our inclusion criteria participated in our study. Data Collection and Analysis An exploratory, multiple-case study design was completed with preceptors. Results Four major themes emerged regarding preceptor needs for facilitating a clinical immersion experience: onboarding, communication on individual student needs, professional development as an educator, and relying on social support network. Conclusions Preceptors in our study communicated several needs that would better assist them in facilitating an immersive clinical experience for their students. Understanding these needs as a program administrator can better enhance the relationship between the didactic and clinical components of the educational program. Preceptors must also ask for additional information, resources, and support to help serve their needs in facilitating an immersive clinical experience for a student.

Embracing different languages and local differences: Co-constructive patient simulation strengthens host countries' clinical training in psychiatry.

Global education in psychiatry is heavily influenced by knowledge from Western, high-income countries, which obscures local voices and expertise. To adapt a human simulation model to psychiatric education in a context that is specific to local languages and cultures. We conducted an observational study consisting of six human simulation sessions with standardized patients from two host countries, speaking their native languages, and following an adaptation of the co-constructive patient simulation (CCPS) model. As local faculty became increasingly familiar with the CCPS approach, they took on the role of facilitators-in their country's native language. Fifty-three learners participated: 19 child and adolescent psychiatry trainees and 3 faculty members in Türkiye (as a group that met online during 3 consecutive months); and 24 trainees and 7 faculty in Israel (divided into 3 groups, in parallel in-person sessions during a single training day). Each of the six cases reflected local realities and clinical challenges, and was associated with specific learning goals identified by each case-writing trainee. Human simulation has not been fully incorporated into psychiatric education: The creation of immersive clinical experiences and the strengthening of reflective practice are two areas ripe for development. Our adaptations of CCPS can also strengthen local and regional networks and psychiatric communities of practice. Finally, the model can help question and press against hegemonies in psychiatric training that overshadow local expertise.

Evaluation of a novel virtual reality Immersive Clinical Experience to enhance medical education curriculum.

Medical students often find the transition to clerkship challenging and stressful. The use of virtual reality (VR) technologies such as screen-based learning, 360-video and immersive VR using head-mount-devices is becoming more utilized in medical education. Immersive technologies in particular have been shown to lead to greater enthusiasm and provide higher knowledge gain for students compared to screen-based VR. The University of British Columbia Faculty of Medicine has developed a novel immersive patient experience using VR to enhance the clinical skills program and evaluate student perception regarding its formal integration into curricula. Students reported positive feedback on the experience, and interest in more immersive learning opportunities in future sessions. VR technology has the potential to enhance medical education and provide a safe immersive learning environment to build clinical acumen.

Transformative care for people with disabilities: Empowering senior nursing students with competency based clinical education-A qualitative study of the impact

BackgroundPeople with disabilities (PWD) constitute 26 % of the U.S. population yet no nursing schools have compulsory clinical education specific to PWD. Inadequate education and negative attitudes lead to lack of preparedness for working with PWD. To meet the needs of this highly underserved population, nursing students need training and experience in the care of PWD. ObjectiveThe objective of this paper is to report three themes from the qualitative evaluation of two immersive clinical experiences with PWD for undergraduate nursing students designed to evaluate competencies for working with PWD. DesignCurriculum evaluation using qualitative methods. MethodologyDuring and after the clinical experience, qualitative data (reflection papers, debriefing responses, and group interviews) were collected with a volunteer sample of senior nursing student participants of the clinical experiences with PWD. Thematic analysis was used to identify changes in students' attitudes, perceived competence, and motivation for working with PWD. FindingsThree major themes are reported in this paper: A positive shift in perspective of PWD (attitudes), impact of the experience on students' practice with PWD (comfort, confidence, awareness and motivation), and revelations from the experience (attitudes and resource awareness). ConclusionsA comprehensive immersive clinical experience caring for PWD provides a real-world laboratory with important experiential learning activities that help students acquire and apply knowledge about the healthcare needs of PWD. Reflection activities facilitate synthesis of that knowledge. Results from this study suggest that this clinical experience can transform students' attitudes toward PWD, enhance their clinical skills, and motivate them to consider a nursing career with this highly under-served population.

Clinical Immersion of Undergraduate Biomedical Engineering Students: Best Practices for Short-Term Programs.

Many biomedical engineering degree programs lack substantial immersive clinical experiences for undergraduate students, creating a need for clinical immersion programs that contribute to training objectives that emphasize current clinical needs (Becker in Eur J Eng Educ 31:261-272, 2006; Davis et al. in J Eng Educ 91:211-221, 2002; Dym et al. in J Eng Educ 94:103-120, 2005). Immersive clinical experiences have the potential to bridge the gap between clinical and non-clinical learning objectives in biomedical engineering curriculum. In collaboration with Indiana University Health Methodist Hospital, we have created, executed, and evaluated a two-week cardiovascular clinical immersion program for biomedical engineering undergraduate students at Purdue University. As of August 2022, this program has run 11 times since 2014 with 60 participants to date, exposing students to intensive and non-intensive care environments, facilitating interactions with medical professionals, and encouraging exploration of innovative technologies shaping the training of clinicians with direct patient interaction. The variety of cardiovascular topics discussed and clinical settings observed has provided students with a unique, highly beneficial learning opportunity. Keys to the continued success and growth of similar programs include: recruiting a diverse team, support from administrative staff/clinicians, a funded student intern position, and careful consideration of liability/risk management. Areas of future consideration include, streamlining the order of scheduled events, determining if offering course credit would be beneficial to students, and tracking career trajectories after participations.

The Grade Debate: Evidence, Knowledge Gaps, and Perspectives on Clerkship Assessment Across the UME to GME Continuum

Core clerkships are typically a medical student's first fully immersive clinical experiences where they learn to work in teams and contribute to patient care across specialties. Assessment of student clinical performance in the core clerkships can serve many purposes, including providing feedback that guides learning, ensuring achievement of competencies defined by each medical school, and determining readiness for advancement in the curriculum. With the increasingly competitive nature of the residency match, the purpose of assessment for determining grades may supersede the initially intended purposes for both students and educators.

Characteristics of Athletic Training Students' Patient Encounters During Immersive and Nonimmersive Clinical Experiences: A Report From the Association for Athletic Training Education Research Network

Context The 2020 Standards for the Accreditation of Professional Athletic Training Programs from the Commission on Accreditation of Athletic Training Education require programs to include at least one immersive clinical experience (ICE) in their clinical education curricula. Yet, it is unknown whether ICEs provide more opportunities and benefits than nonimmersive clinical experiences (N-ICEs). The purpose of this study was to compare characteristics of patient encounters (PEs) that occurred during ICEs and N-ICEs. Design Multisite panel design. Setting Twelve professional programs (5 undergraduate, 7 graduate). Patients or Other Participants Three hundred thirty-eight athletic training students logged PEs in the E*Value system. Main Outcome Measures For each PE, students reported clinical experience type (ICE, N-ICE), clinical site type, student role (observed, assisted, performed), diagnoses reported, and procedure(s) performed. Descriptive statistics were used to summarize PE characteristics. Generalized estimating equations were used to compare student role and clinical site type during PEs in ICEs and N-ICEs (P < .05). Results A total of 10 999 PEs occurred at ICEs and 18 228 PEs occurred at N-ICEs. Sixty-four percent of ICEs and 67.2% of N-ICEs occurred at collegiate settings. Students performed 70.6% of reported PEs during ICEs, and 72% of PEs at N-ICEs. Participants averaged 0.80 ± 0.64 diagnoses and 1.35 ± 1.12 procedures per PE during ICEs, compared with 0.82 ± 0.63 diagnoses and 1.33 ± 1.04 procedures per PE during N-ICEs. No significant differences between ICEs and N-ICEs were found in either student role (P = .50) or clinical site type (P = .71). Conclusion(s) Programs may intend to use ICEs later in their curricula to demonstrate progressive clinical autonomy; however, we found no statistically significant differences in student role for ICEs versus N-ICEs. The ICEs examined in this study may have been implemented without specific objectives, which may explain the lack of characteristic differences between the clinical experience types.

Student Selection of Preceptors for Immersive Clinical Education Experiences Through an Advocacy Lens

Context Immersive clinical education is an integral component of athletic training curricula. The flexibility in the requirements allows programs to be innovative in their curricular design and to meet the needs of their learners. Objective The purpose of this educational technique is to describe the process for empowering students to choose preceptors and clinical sites that meet their needs. Background Traditionally, program administrators assign students to preceptors and clinical sites based on proximity and availability of clinicians surrounding the institution. However, this may limit the options for students to find preceptors and mentors who are best suited to prepare them for future clinical practice. Description In our program, we empower students to pursue their immersive clinical education experience with a preceptor and/or clinical site that will meet their personal and professional needs as a learner and future clinician. Advantages Preceptors and alumni have noted increased engagement when students are invested in the selection process. Students are encouraged to advocate for their needs personally and professionally, to place themselves in the best environment for their future success. More specifically, historically marginalized students have the opportunity to identify a preceptor with similar demographic characteristics, who may be better suited to mentor them as a future professional, when geographic proximity has been a challenge in the past. Conclusions Students and program administrators partner to select preceptors who provide opportunities for a successful immersive clinical experience, who align with the student's future career goals, and who provide mentorship. Historically marginalized students in less diverse regions may benefit the most from this model because they can overcome geographic proximity challenges to identifying effective preceptors and mentors.

Meaning Making Among Professional Master's Athletic Training Students

Context New approaches to education and pedagogy are needed in athletic training education to better support developmental benchmarks that cultivate skills for lifelong learning. Objective Explore and understand students' perceptions of their education and how those perceptions support their development toward self-authorship through the complexity of their meaning making. Design Qualitative, grounded theory. Setting Division I Commission on Accreditation of Athletic Training Education athletic training programs. Patients or Other Participants Twelve participants (9 female, 3 male; age = 24 ± 2 years) in their second year of athletic training education were recruited for the study. Of the 12 participants, 11 were engaged in an immersive clinical experience. Data Collection and Analysis Participants engaged in a semistructured video conference interview. Data were analyzed using grounded theory approach to understand the complexity of students' ways of making meaning cognitively, intrapersonally, and interpersonally. Data saturation, peer review, member checks, and theoretical triangulation were used to establish credibility. Results Participants exhibited meaning making in 2 distinct ways: (1) external guidance and (2) movement toward internal guidance. The categories were further broken down by theme. Placing responsibility for knowledge on authorities, need for step-by-step guidance, and seeking approval marked the themes of external guidance. Building confidence and role identity development marked themes of movement toward internal guidance. Conclusions Participants who were reliant on external guidance required external authorities for knowledge acquisition and learning. Some participants demonstrated deeper meaning making when discussing their experiences with clinical education.

Athletic Training Students' Perceptions of the Immersive Clinical Experience and its Influence on their Development

Context Immersive clinical experiences are critical clinical education components in athletic training. Program directors have indicated potential isolation from peers and faculty, a financial burden, and less engagement in quality learning during immersive clinical experiences. Objective To explore athletic training students' perceptions of the immersive clinical experience as it pertains to their development. Design Qualitative study. Setting Individual virtual interviews. Patients or Other Participants A total of 15 athletic training students who participated in the immersive clinical experience in the last 9 months took part in our study (males = 4, females = 11; age = 25 ± 5 years, range = 21–36 years). Data Collection and Analysis We conducted interviews and recorded and transcribed them verbatim. We developed a codebook using the consensual qualitative research tradition to identify domains and categories. Trustworthiness was established using member-checking, multiple researchers, and an auditor. Results Athletic training student perceptions of the immersive clinical experience revealed 2 domains: exposure and improved preparation for clinical practice. From increased exposure, participants gained additional experience with administrative duties, communication and relationships, interprofessional and collaborative practice, an increased quantity and quality of patient encounters, and preceptor influence on learning opportunities. From improved preparation, participants experienced socialization in which they were more integrated in facility activities, gained a greater appreciation for the value of the profession, had greater autonomy and inclusion, and perceived more value in the immersive clinical experience than in nonimmersive experiences. Conclusions Athletic training students who participate in immersive clinical experiences feel that they have increased exposure to athletic training practice and improved preparation for transition to practice.

Preceptor Perceptions of the Immersive Clinical Experience in Athletic Training Education

Context Clinical immersion is a newly required concept within athletic training education, and preceptors play a critical role in facilitating athletic training students' learning during those experiences. Objective To explore the perceptions of preceptors currently supervising athletic training students who participate in immersive clinical experiences. Design Qualitative study. Setting Individual phone interview. Patients or Other Participants Preceptors from various clinical sites (4 females [40%] and 6 males [60%]) with an average age of 41 ± 18 years. Participants also had an average 7 ± 8 years of experience as a preceptor. Data Collection and Analysis Interviews occurred via individual phone interviews using a semistructured interview script. All interviews were audio-recorded and transcribed verbatim. A 3-person research team analyzed the data and coded it into domains and categories based on a consensus process. Credibility was established with multiple researchers, an external auditor, and member checks. Results Three domains emerged from the data: (1) exposure, (2) benefits, and (3) insufficient training. Participants stated that as a result of exposure the athletic training students experienced increased responsibility and trust, increased realistic work environment, increased collaborative practice experiences, and skill use and refinement. Preceptors indicated that the added benefits of immersive clinical experiences led to confidence in clinical and professional interactions. Preceptors noted insufficiency in their training, specific to the expectations of an immersive clinical experience. Many preceptors sought out independent learning opportunities to enhance their role as preceptor. There was a misunderstanding as to what the main differences were between traditional and immersive clinical experiences, as well as a lack of communicated or standardized goals and objectives. Conclusions Participants indicated that the immersive clinical experiences were beneficial for the athletic training students' professional development. The insufficiency of training and misunderstanding of the immersive clinical experience are concerning and could be enhanced with clearly set goals and objectives.

University of Wisconsin School of Medicine and Public Health.

University of Wisconsin School of Medicine and Public Health.

Perceived Challenges of Clinical Immersion in Professional Master's Programs: A Report from the Athletic Training Clinical Education Network

Context A clinical immersive experience is a new requirement within the clinical education standards as outlined by the Commission on Accreditation of Athletic Training Education. Objective Determine athletic training program administrators' perceptions of challenges facing athletic training programs as they implement immersive clinical experiences during clinical education. Design Sequential mixed methods. Setting Commission on Accreditation of Athletic Training Education athletic training programs. Patients or Other Participants Twenty-four administrators (7 male, 17 female) from 24 institutions with undergraduate and professional master's programs (1 undergraduate, 12 professional master's, and 4 offering both undergraduate and master's programs) responded to the survey, which was Phase 1 of the study. Seventeen of those who previously completed the Phase 1 survey volunteered to participate in Phase 2 of one-on-one, semistructured phone interviews (4 clinical education coordinators, 12 program directors, 1 department chair). Data Collection Phase 1: 24 participants completed an online survey. Phase 2: 17 of the 24 respondents participated in a one-on-one, semistructured phone interview. Quantitative data collected in Phase 1 were analyzed by calculating means and frequencies, and in Phase 2, a general inductive approach was used to evaluate qualitative raw data from the interviews. Researcher triangulation and peer review were completed for credibility. Results The 3 subthemes that emerged specific to administrators' perceived challenges regarding immersive clinical experiences for students were (1) isolation, (2) financial burden, and (3) time engaged in learning. The 3 main subthemes that emerged specific to the administrators' perceived challenges regarding immersive clinical experience for programs were (1) lack of a definition of the experience, (2) scheduling, and (3) preceptor involvement. Conclusions Program administrators continue to seek clarity on when and how immersive clinical experiences should be implemented. These challenges, if not addressed, could influence buy-in from the faculty and preceptors, and affect the success of the student.

Educational Perspectives: Integrating a Student Post-Stroke Clinic within a First-Year Occupational Therapy Kinesiology Course

Purpose: In many occupational therapy graduate programs, student experiences with actual patient evaluation and intervention typically occur following several semesters of didactic instruction. We explored the impact of an early immersive and reflective hands-on patient experience on student learning and clinical skill development. Method: Following participation in five task-specific occupational therapy clinical sessions that were embedded into an applied kinesiology course, students performed reflections on the experience. These reflections included thoughts on kinesiology course content and clinical skill development through patient sessions over the semester. Results: A qualitative thematic analysis of student reflections was conducted. Findings reflected themes of improvement in observation skills, intervention abilities and communication. Conclusion: Early reflective and immersive clinical experiences may be helpful in the reinforcement of course content and in the development of clinical skills of occupational therapy graduate students prior to full intervention content exposure.

An immersive clinical experience to create sustainable clinical learning opportunities for nurse practitioner students.

A significant increase in nurse practitioner program enrollment has resulted in a critical need for committed preceptors willing to offer clinical learning opportunities for students. Academic practice partnerships have been proposed as a strategy to address the preceptorship crisis. This project evaluated the impact of a longitudinal immersive clinical experience designed for nurse practitioner students in collaboration with two federally qualified health centers and an underserved clinic within an academic health center. The study used a pre- and postsurvey method to determine the impact of an immersive clinical experience on preceptor perceptions of benefits and rewards, support, and commitment to the role. A statistically significant increase in preceptor perception of support was noted in three areas. Participants reported increased opportunity to share information with other preceptors, improved support from nursing faculty to help identify students' performance problems, and greater clarity in faculty responsibilities related to the preceptor role. Increases in perceptions of benefits and rewards and commitment to the preceptor role did not reach statistical significance. Immersive clinical experiences have the potential to improve the levels of preceptor support, commitment, and perceived opportunities for benefits and rewards, which may facilitate the development of high-quality, sustainable clinical learning opportunities for nurse practitioner students.

Nurse practitioner residency and fellowship programs: The controversy still exists.

Postgraduate training, otherwise termed residency or fellowship training, for nurse practitioners is a growing trend. Many new graduates are seeking intensive and immersive clinical experiences supported by evidence-based didactic learning directly related to their clinical experience. This article describes current trends and evidence supporting fellowship training.

The Reflective Scribe: Encouraging Critical Self-Reflection and Professional Development in Pre-Health Education.

Much has been said about the formative process that occurs via the "hidden curriculum" of medical education during which many students experience a disconnect between the professional values espoused within the formal curriculum and the implicit values communicated through interactions with peers and mentors. Less attention, however, has been paid to the formation of the future medical self that takes place during students' premedical years, a time in which many undergraduate students seek out immersive clinical experiences -such as medical scribing- before applying to medical school. Despite the fact that medical scribes undoubtedly are affected by their clinical experiences, scribes are rarely offered opportunities to reflect on them. The authors contend that the developmental processes of medical scribes, especially those who intend on pursuing a career in the health professions, ought to be supported. This can be achieved, at least in part, through engaging in well-designed reflective sessions with other scribes. Encouraging students to reflect on their experiences can help them make sense of troubling events and give voice to the inconsistencies and value conflicts within medical practice that are so often ignored. The authors describe the development of their new Reflective Scribe program and offer suggestions for future directions.

Evaluation of undergraduate nursing students' clinical confidence following a mental health recovery camp.

In the present study, we evaluate the impact of participation in a mental health recovery camp on the clinical confidence of undergraduate nursing students in dealing with individuals with mental illness. Twenty undergraduate nursing students who participated in the recovery camp completed the Mental Health Nursing Clinical Confidence Scale both before and directly after attending the camp. Data were analysed using descriptive and inferential statistics. Participation in the recovery camp was associated with a statistically-significant increase in students' level of overall confidence between the pretest and post-test data (P < 0.005). The results also demonstrated that students over the age of 25 years and who do not have a family history of mental illness are more likely to self-report a higher level of confidence in both the pre- and post-results. The clinical confidence of undergraduate nursing students improved through participation in an immersive clinical experience within the recovery camp.

Re-envisioning clinical education for nurse practitioner programs: themes from a national leaders' dialogue.

As the need for primary care providers increases, nursing education programs face significant challenges to meet future workforce needs. A more resource-efficient approach for the clinical education of nurse practitioner students is needed. A think tank involving 20 thought leaders representing multiple disciplines was convened to discuss this issue. This article presents seven themes that emerged from this national leaders' dialog: academic practice co-design, standardized preclinical preparation, standardized student assessment, entrustable professional activities, immersive clinical experiences, interprofessional education for team-based care, and innovative education practices.

Medical simulation in paediatric anaesthesia

Paediatric anaesthesia presents unique challenges. Highrisk patients, premature babies, neonates, infants, small toddlers and children with multiple congenital anomalies are included in this group of patients. Infants and neonates are more at risk of an adverse incident perioperatively and also suffer higher morbidity and mortality than older children. Centralisation of tertiary paediatric services and reduced working and training hours present a challenge to the training and maintenance of paediatric anaesthesia skills. In many countries, paediatric emergencies and surgery are often managed outside tertiary paediatric centres. The provided care may be given by doctors and nurses who only have occasional exposure to paediatric patients. The care of paediatric patients involves anaesthetists and competent medical and nursing support in the perioperative period. Medical simulation creates a realistic, safe and reproducible setting or environment that represents a clinical scenario for medical training. Medical simulation utilises standardised patients, a computer-based system, part-task trainers and full-body mannequins. Full-body paediatric mannequins, available in neonatal, infant and child sizes, have realistic vital signs and clinical features, airways (tongue swelling and stridor), breathing patterns and sounds, cardiovascular characteristics (heart sounds and murmurs), and other signs such as abdominal distension, seizures and bulging fontanelle. These mannequins can be intubated and cannulated (intravenous and intraosseous) and can have chest tubes inserted. Clinical feedback on treatment and interventions facilitates an immersive clinical experience for participants.