Preparation For Clinical Placement Research Articles

Embedding simulation in genetic counselor education from the first week of training: Learning outcomes, standardized clients, and students' satisfaction.

Health professional educators routinely utilize simulation to prepare students for practice. However, there is little evidence to show whether simulation enhances learning for genetic counseling students. This study aimed to (i) develop simulation learning outcomes and standardized clients for genetic counselor student education and (ii) evaluate students' experiences of learning from face-to-face and virtual simulation in the first week of training in an Australasian master of genetic counseling program. Using the principles of co-design, eight experienced genetic counselors from across Australasia attended an online discussion and one-to-one meetings to develop simulation learning outcomes and build detailed authentic standardized clients. Six learning outcomes were identified: establishing an effective counseling relationship, eliciting information, assessing need, delivering difficult news and helping clients cope with complex emotions, effective communication and facilitating adaptation. Standardized clients were mapped to the learning outcomes and other requirements of the program. Between 2019 and 2022, 106 first year students participated in face-to-face or virtual simulation workshops with two standardized clients on Day 5 of their training. Following the experience, 103 students completed an anonymous survey using a modified version of a validated satisfaction with simulation scale (n = 49 face-to-face in 2019 and 2020 and n = 54 virtual in 2021 and 2022). Responses were analyzed using descriptive statistics and content analysis. Mean satisfaction overall was 95.9% (SD 3.5), 96.2 (SD 4.0) face-to-face, and 95.8 (SD 3.7) virtual. Overall, responses indicated that simulation-based learning and working with standardized clients was a valuable learning experience (100%), developed communication skills and created a sense of reality (99%). For a minority of participants (n = 4), the simulation was too challenging. Key learning related to consolidation of counseling skills, reflective practice, and preparation for clinical placement. In conclusion, exposing novice student genetic counselors to authentic clinical scenarios using standardized clients in face-to-face or virtual classrooms enhanced clinical learning.

Impact of pre-registration extended immersive ward-based simulation on student learning in preparation for clinical placement

BackgroundGraduate nurses commonly experience significant challenges in transitioning to professional practice. The practice readiness of graduate nurses continues to be a concern for nurse educators and industry partners. Introduction of pre-registration extended immersive ward-based simulation can provide opportunities for students to practice the role of registered nurse before graduation. It is not clear if participation in simulation-based learning transfers to increased preparedness for dealing with real-life situations following entry into the workforce. ObjectiveTo report on student views on how ward-based immersive simulation assisted in preparing for clinical placement and graduate practice. DesignA qualitative, descriptive design was used to conduct a series of face-to-face focus groups. SettingSchool of Nursing and Midwifery metropolitan Western Australian university. ParticipantsFinal year baccalaureate nursing students who had participated in six four-hour simulation workshops between February and April 2021 were selected through purposive sampling. MethodsFocus group and interview data was transcribed from audio recordings. A six-phase approach was used to analyse data into themes and sub-themes. The study adhered to the consolidated criteria for reporting of qualitative research. ResultsThree focus groups and one interview were conducted. Eight themes emerged. Student learning was identified as occurring in a variety of ways, such as how to work as a team and was influenced by a number of factors, such as the capacity for students to self-reflect. ConclusionsLearning opportunities for students to practice how to think and work independently as a registered nurse is something that can be supported by pre-registration extended immersive ward-based simulation. Understanding of what will be expected of them once qualified can make students more prepared for professional practice enabling them to apply knowledge gained from simulated experiences to a similar situation as a graduate nurse.

Practical Tips for Setting Up and Running OSCEs.

Objective structured clinical examinations (OSCEs) are used to assess students' skills on a variety of tasks using live animals, models, cadaver tissue, and simulated clients. OSCEs can be used to provide formative feedback, or they can be summative, impacting progression decisions. OSCEs can also drive student motivation to engage with clinical skill development and mastery in preparation for clinical placements and rotations. This teaching tip discusses top tips for running an OSCE for veterinary and veterinary nursing/technician students as written by an international group of authors experienced with running OSCEs at a diverse set of institutions. These tips include tasks to perform prior to the OSCE, on the day of the examination, and after the examination and provide a comprehensive review of the requirements that OSCEs place on faculty, staff, students, facilities, and animals. These tips are meant to assist those who are already running OSCEs and wish to reassess their existing OSCE processes or intend to increase the number of OSCEs used across the curriculum, and for those who are planning to start using OSCEs at their institution. Incorporating OSCEs into a curriculum involves a significant commitment of resources, and this teaching tip aims to assist those responsible for delivering these assessments with improving their implementation and delivery.

Picture guided learning - A picture-based clinical skill teaching resource in undergraduate nursing in South Australia

A competent nursing graduate is required to perform psychomotor skills related to clinical procedures, articulate knowledge to support their activities, work in a team with efficient time management skills and have strategies to perform in the increasingly busy clinical environment and with complex patient acuity. Student Evaluation of Teaching data from an undergraduate nursing clinical subject 2014-2018 identified an inconsistency in clinical skill teaching/delivery by educators which needed to be addressed. This study aimed to evaluate the outcome of implementing the Clinical Skill Storybook as an additional teaching resource for students’ clinical skill development. A descriptive analysis approach was applied to summarise quantitative and qualitative subject evaluation data along with Clinical Skill Storybook evaluation questionnaires (2018-2020). Data analysis identified five themes: (1) Clinical Skill Storybook as a Learning Resource, (2) Self-directed learning and peer support, (3) Developing clinical skill competency, (4) Preparation for clinical placement, and (5) Maintaining teaching consistency. It was evident that the Clinical Skill Storybook provided an easy-to-follow visual guide which assisted students’ confidence and competence of skill development. The subject evaluation highlights that students were significantly more satisfied with the teaching resources than in previous years. The implementation of the Clinical Skill Storybook actively improved students’ skill acquisition, confidence, and readiness for placement. The findings indicated that picture-based resources such as the Clinical Skill Storybook are beneficial for nursing students’ clinical skill development. Further involvement with stakeholders such as clinical venues in developing the clinical skill storybook is planned for future exploration.

Simulations with Standardized Patients for Nursing Students in Preparation for Clinical Placements in Mental Health Care

BackgroundNursing students often express uncertainty about clinical placement in a mental health care setting. Simulation with standardized patients may provide an opportunity for students to explore clinical situations in mental health nursing before their clinical placement, thereby increasing these students’ overall satisfaction and confidence levels with regard to mental health nursing. MethodA qualitative descriptive design was selected. Twenty-four undergraduate nursing students participated in four focus-group interviews after mental health simulations with standardized patients were conducted. Thematic analysis was used to analyze the data. ResultsThree main themes were identified: (1) preview into everyday life in a psychiatric ward, (2) adjusting assumptions and apprehensions regarding mental health nursing and, (3) mutual respect during the nurse-patient meeting. ConclusionsThe simulations were valuable in preparing students for mental health clinical placements by increasing their belief in capability to act appropriately in clinical scenarios.

Nursing students\u2019 transfer of learning outcomes from simulation-based training to clinical practice: a focus-group study

BackgroundSimulation-based training is used to develop nursing students’ clinical performance in assessing and managing situations in clinical placements. The use of simulation-based training has increased and become an integrated part of nursing education. The aim of this study was to explore nursing students’ experiences of simulation-based training and how the students perceived the transfer of learning to clinical practice.MethodsEight focus group interviews were conducted with a total of 32 s- and third-year nursing students who participated in a simulation-based training organized as preparation for clinical placement. The transcribed interviews were analysed with thematic analysis.ResultsThree major themes emerged from the focus group interviews; first, the simulation-based training promoted self-confidence; second, understanding from simulation-based training improved clinical skills and judgements in clinical practice; and third, simulation-based training emphasised the importance of communication and team collaboration.ConclusionsThis study revealed students’ transfer of learning outcomes from simulation-based training to clinical practice. The students’ experiences of the simulation-based training remain as enduring and conscious learning outcomes throughout their completion of clinical practice. The organisation of simulation-based training and its implementation in the curriculum are crucial for the learning outcomes and for students’ experiences of the transfer of knowledge to clinical practice.

‘Speaking up for safety’: A graded assertiveness intervention for first year nursing students in preparation for clinical placement: Thematic analysis

BackgroundThe international literature highlights patient safety as a critical issue in contemporary health care. Poor interpersonal relationships and ineffective health care team communication are identified as dominant human factors contributing to clinical errors and adverse events. Of concern is that some students appear to lack the skills to speak up for themselves, their patients and others when witnessing unsafe practice on clinical placement. Study aimsTo elicit student and staff perspectives on the quality, effectiveness and appropriateness of an assertiveness-based communication activity prior to clinical placement. DesignThe study used a qualitative design. A communication module was offered in the second week of the practice laboratory and involved the use of two graded assertiveness frameworks. SettingSchool of Nursing, Midwifery and Paramedicine, at a regional university in South East Queensland, Australia. ParticipantsOf the 535 first year undergraduate nursing students enrolled in the laboratory courses, 73 (13.6%) completed an anonymous online survey. Individual interviews were conducted with a university student wellbeing coordinator and student mentor to gain their perspectives of the data. MethodsAn evaluation survey with seven qualitative questions and individual semi-structured interviews were employed. Data was analysed using a thematic approach. ResultsFive major themes emerged from the survey data: vicarious learning, establishing boundaries, support in practice, advocacy awareness and practice utility. Three themes emerged from the interviews: empowerment and confidence; support and preparation for advocacy; and authentic learning. ConclusionsFindings indicate that teaching assertiveness skills and establishing a preparatory framework for ‘speaking up for safety’ early in a nursing students tertiary education can have important psychosocial implications for their confidence, empowerment and success. The activity provided an authentic learning experience with perceived practical application to the workplace and, has the potential to enhance first year curricula by improving communication tools used for students preparing for practice.

Community Ambulance Response Trolleys (Cart): Preparing Students for the Paramedic Workplace

Introduction The curriculum of undergraduate paramedicine programs invariably includes clinical placement experiences. Engagement in learning in the workplace is however constrained by lack of familiarity with workplace cultural expectations. Strategies assisting students to understand workplace expectations have the potential to enhance engagement on placements and with workplace transition. This study examines whether one classroom practice initiative heightens students’ understanding of specific paramedic workplace expectations. Methods Community ambulance response trolleys (CART) (a system developed to mimic equipment management strategies of the paramedic workplace) was introduced on one campus of an Australian university. Another university campus was selected as a comparison site and did not operate CART. The CART campus students were assigned to a team and made responsible for maintaining and restocking all equipment utilised in practical classes, simulating strategies used within the paramedic workplace where a paramedic team shares responsibility for stocking and upkeep of equipment. Both cohorts completed a questionnaire exploring their experiences in the classroom and preparation for clinical placements. Results The CART system had a positive influence on the ability of students to collaborate within the classroom and become familiar with industry expectations around equipment management. This increased confidence with transition to learning within the workplace environment. Conclusion The CART strategy was effective in mimicking workplace practices and expectation and evidence indicated that CART can assist students with their ability to transition into a vocational environment.

APPLICATION OF THE IQIPP-AH STUDENT GUIDE IN AUDIOLOGY CLINICAL EDUCATION

Background Using reflection tools benefits the ongoing development of clinicians. However, there is a paucity of instruments appropriate for reflection in audiology clinical education, despite the availability of such tools in other disciplines. This paper describes a tool – Improving Quality in Practice Placements - Allied Health (iQIPP-AH) Student Guide – for promoting self-reflection. Material and Methods A prospective, cohort study in Master of Audiology Studies students (n=23). The tool was applied as an assessment task within a clinical placement course, followed by descriptive analysis of quantitative responses and thematic treatment of qualitative responses. Results Less than 75% of the cohort reported completing tasks associated with: (i) pre-reading in preparation for clinical placement; (ii) participation in team activities during placement; and (iii) provision of feedback to practice educators and universities post-placement. Major qualitative themes included lack of established learning goals, willingness to seek educator feedback, willingness to network and engage with other staff, desire to strive for independence, need for resumé writing, improvement in clinical skills, and the intention to continue with reflection and proactivity. Up to 52% of students intended to take further action in relation to the tool’s Quality Indicators. Conclusions The iQIPP-AH Student Guide has the potential to be a useful reflective tool for students in audiology

Comparison of standardized patients with high-fidelity simulators for managing stress and improving performance in clinical deterioration: A mixed methods study

The use of standardized patients in deteriorating patient simulations adds realism that can be valuable for preparing nurse trainees for stress and enhancing their performance during actual patient deterioration. Emotional engagement resulting from increased fidelity can provide additional stress for student nurses with limited exposure to real patients. To determine the presence of increased stress with the standardized patient modality, this study compared the use of standardized patients (SP) with the use of high-fidelity simulators (HFS) during deteriorating patient simulations. Performance in managing deteriorating patients was also compared. It also explored student nurses' insights on the use of standardized patients and patient simulators in deteriorating patient simulations as preparation for clinical placement. Fifty-seven student nurses participated in a randomized controlled design study with pre- and post-tests to evaluate stress and performance in deteriorating patient simulations. Performance was assessed using the Rescuing A Patient in Deteriorating Situations (RAPIDS) rating tool. Stress was measured using salivary alpha-amylase levels. Fourteen participants who joined the randomized controlled component then participated in focus group discussions that elicited their insights on SP use in patient deterioration simulations. Analysis of covariance (ANCOVA) results showed no significant difference (p=0.744) between the performance scores of the SP and HFS groups in managing deteriorating patients. Amylase levels were also not significantly different (p=0.317) between the two groups. Stress in simulation, awareness of patient interactions, and realism were the main themes that resulted from the thematic analysis. Performance and stress in deteriorating patient simulations with standardized patients did not vary from similar simulations using high-fidelity patient simulators. Data from focus group interviews, however, suggested that the use of standardized patients was perceived to be valuable in preparing students for actual patient deterioration management.

Reflection and feedback during my OSCE: what have I learnt?

Background: An Objective Structured Clinical Examination (OSCE) is a type of examination frequently used in physiotherapy to assess awidevariety of physiotherapy skills. OSCEs are designed to assess clinical skill performance in physiotherapy including assessment and treatment methods. They are an integral part of physiotherapy preclinical assessment to prepare students for clinical placements. Purpose:This projectwas undertaken to analyse student’s perception of their OSCE experience in year one semester 2 Doctor of Physiotherapy (DPT) program for the years 2012–2013. Methods: Physiotherapy students completed two fifteen minute OSCEs for the subject Physiotherapy Theory and Practice 2 (PTP2), a second semester, year one subject. One OSCE was dedicated to electrotherapy examination whilst the second OSCE examines physiotherapy skills, which include exercise prescription and/or joint mobilisation/treatment techniques. Examiners have amarking scheme to keep the assessment of clinical skills objective, rather than subjective. The OSCEs are carefully structured with a vignette to include parts from all elements of the curriculum as well as a wide range of skills. Instructions are carefully written to ensure that the student is given a specific task to complete. At the completion of each OSCE section, students were asked to reflect on their performance and would they have any done anything differently if they were to have this vignette again. Students are then given immediate constructive feedback by the examiner about their performance, but no marks are given to the student at this time. Students then proceed to complete a further two OSCEs in another subject. Students are then asked to complete a questionnaire at the completion of their OSCE assessment regarding their understanding of their performance. The questionnaire comprises offifteen questions that are linked to learning outcomes for the physiotherapy subject. The questionnaire used a five point Likert scale ranging from strongly agree to strongly disagree. Data from PTP 2 was analysed for this presentation (2012–13). Results: The majority of students reported they were able to demonstrate their level of skill to the examiners, their performance was an accurate reflection of their skills and student’s reflection on their performance was useful to their learning. They also reported theyweremore confident in their preparation for clinical placements and identified the need to further practice their physiotherapy skills prior to their clinical placement the following year. In addition, the majority of students reported the OSCEs were a valid assessment for judging student’s level of knowledge and skill. Conclusion(s): OSCE assessment in physiotherapy is an acceptable form of assessing physiotherapy skills in year one DPT students. Reflection and feedback is an integral part of the student’s skills development in further physiotherapy skills in the preclinical program. Implications: OSCE assessment can be used in a variety of physiotherapy areas for assessment purposes. By integrating reflection and feedback within the OSCE process, student’s learning can be facilitated in a positive manner by this immediate feedback from the examiner.

Enhancing nursing students’ clinical placement experiences: A quality improvement project

Clinical experience is recognised as the core of nursing education. Quality clinical placements across a variety of venues are vital to the development of capable and competent professionals. However there is evidence, both anecdotal and empirical, suggesting that students’ clinical placement experiences are fraught with problems. The quality improvement project described in this paper aimed to improve the clinical learning experience of nursing students by strengthening communication and partnerships between the university and the two local health services. To achieve this goal, clinicians’ perceptions of the problems related to clinical placements and their recommendations for improvement were explored. Focus groups, brainstorming sessions, personal interviews and surveys were used to collect qualitative and quantitative data. Problems and priority issues were identified as more than five hundred clinicians expressed their concerns, claims and issues.Key findings from the project are described under five themes: communication breakdown between the university and clinicians; mentorship; preparation for clinical placements; clinical competence; and graduates’ readiness for practice.Utilising a quality improvement framework this project promoted vigorous debate and dialogue between university and health service partners. The nature and extent of the problems surrounding clinical placements were examined, high priority issues targeted for improvement, and the subsequent results measured through feedback from clinicians and students. The success of this project, although impressive in the early stages, will depend upon ongoing communication and evaluation to ensure sustainability of the improvements made.

Developing a learning pathway for student nurses.

It is essential to ensure equity and consistency of clinical learning for student nurses who will inevitably work in a variety of practice settings. This article describes the development of a learning pathway in response to the need to improve the quality of learning outcomes in the clinical environment. The North Devon and Exeter model uses a three-step approach, with particular emphasis on the preparation for clinical placements. The model gives equal responsibility to students and clinical staff, promoting a partnership, which takes the student through a quality learning experience. The philosophy that clinical learning should be enjoyable, stimulating and inspirational underpins the structure of the pathway.