Student Clinical Placements Research Articles

Nurse practitioner student clinical placement processes: A national survey of nurse practitioner programs

BackgroundProviding quality clinical sites and preceptors is one of the greatest challenges for nurse practitioner programs. PurposeTo conduct a national survey of nurse practitioner (NP) program directors to better understand the complex process for clinical site placement in the United States. MethodsIn 2018, a web-based survey was sent to program directors to ascertain the faculty and staff effort allocation and processes related to NP student placements, the number of required clinical rotations, the total hour requirement, and preceptor incentives and barriers. FindingsThere was a 47% survey response rate. Variation in processes was found across NP programs. Almost 14% of respondents said that students were required to find sites entirely on their own. Ten percent of faculty reported devoting 90% to 100% of their effort to finding preceptors. Preceptors and sites were rarely paid, but other incentives were common. DiscussionIt is vital for NP programs to streamline clinical placement processes, to foster academic-practice partnerships, and to advocate for federal funding to train the future NP workforce.

A Model of Interprofessional Education in Clinical Placements for Speech-Language Pathology and Dietetic Students

Purpose The value of interprofessional education (IPE) and interprofessional collaborative practice (IPCP) is well documented for health care professionals and settings. The World Health Organizati...

The Objective Structured Clinical Examination in evolving nurse practitioner education: A study of students' and examiners' experiences.

Assessment of advanced clinical competence is essential for safe practice and achieving international standards for nurse practitioners. It is of particular interest for countries that have recently been introduced to advanced nursing roles to investigate examination forms that ensure quality in nurse practitioner education. The aim of this study was to explore and describe the nurse practitioner students' and examiners' experiences with Objective Structured Clinical Examination, which is an exam form for assessing clinical competence. Five focus groups, consisting of 15 nurse practitioner students (n = 15) and five individual interviews with examiners (n = 5), were conducted in June 2016 and analysed using thematic analysis. The nurse practitioner students and examiners experienced the exam as an appropriate method of assessment for advanced clinical competence, although they experienced some challenges with its form. Consequently, the results of this study advocate for a course design that includes: constructive alignment between the course and the exam, more training with real patients, use of formative and summative assessment and a second exam with a real patient after the student's clinical placement. The lack of a clear nurse practitioner role in countries with evolving advanced nursing roles can challenge the expected level of advanced clinical competence in an educational context.

Midwifery students’ experiences of working within a midwifery caseload model

BackgroundWork integrated learning opportunities account for approximately half of the Bachelor of Midwifery program with the goal being to ensure that on graduation students are skilled to provide woman centred evidenced based midwifery care within any environment. There is increasing concern, however, over the quality of clinical experiences students are afforded. ObjectiveThis study explored the experiences of third year Bachelor of Midwifery students in South East Queensland undertaking a clinical placement within a midwifery caseload model. DesignA qualitative descriptive approach was adopted. Data were collected using semi-structured, digitally recorded telephone interviews. Thematic analysis was used to analyse the data set. SettingMidwifery student clinical placement in caseload practice ParticipantsTwelve third year Bachelor of Midwifery students from one university who had experienced a clinical placement in a caseload midwifery model of between 4 and 8 weeks. FindingsFive themes emerged. These were labelled ‘stepping in her shoes’, ‘bringing it all together’, ‘my own captive educator’, ‘knowing the woman’, and ‘it was hard – but it was worth it’. The three-way relationship between midwife, woman and student facilitated deep and active learning leading to a growth in confidence and readiness for practice. Students were afforded the opportunity to constantly integrate theory into practice within a woman centred social model of care where they also grew to understand how midwives operationalise caseload practice in a sustainable way. Students acknowledged the challenges they faced undertaking the placement, but all confirmed the value it had afforded them. Key conclusions and implications for practiceThis study has provided evidence that situating midwifery students within a continuity of care model facilitated a rich holistic learning experience for students. Not only did the placement enhance student's confidence and competence it also provided a real-world view of what working in that a caseload model could be like on graduation. This is vital if the profession is to support system level change ensuring all women have access to evidence informed maternity care.

Development of a Tool to Monitor Paramedic Clinical Placements: A Case Study of Innovation Overcoming Tradition

Introduction This paper discusses a trial of the use of CompTracker© – an online platform used to link the student, preceptor and academic in a time sensitive manner during student clinical placement – within a cohort of 330 first and second year paramedic students studying at an Australian university. CompTracker© allows for preceptors to identify and assess clinical competencies, and for the student to reflect after each case is completed on placement. The tool was initially piloted, and then remodeled on several attempts to improve its overall functionality and relevance for the placement learning experience. The study aims to educate and inform other health disciplines that may have an interest in using online tools for competency tracking and education in diverse workplaces. Methods Multiple surveys were conducted over a 3-year period, using both Likert 5-point scales and open-ended questions, to evaluate 330 first and second year students’ and 261 preceptors’ experiences. Results Of the 54 student responses, 92% felt the tool was useful and 67% felt it was easy to use. Within the preceptor results, 63 ± 2% preferred CompTracker© over traditional paper-based methods. Conclusion CompTracker© can be used to support students and preceptors in clinical placement. The flexibility of this online tool makes it adaptable to most clinical workplaces, and should be considered in any workplace that requires the use of competency-based clinical assessment and used in place of traditional paper-based portfolios.

Allied health pre-entry student clinical placement capacity: can it be sustained?

Objective Meeting the demand for clinical placements in an environment of increasing university cohort growth and changes in health service delivery models is challenging. This paper describes the outcomes of a quality review activity designed to gain key stakeholder perspectives on the enablers and barriers to sustaining effort to placement provision and reports on: (1) measures used to determine the effect of a jurisdiction-wide initiative in clinical education for five allied health professions; (2) outcomes of data related to key factors affecting placement supply and demand; and (3) qualitative perspectives from management, workforce and university stakeholders on placement sustainability. Methods This study reviewed clinical placement, staff full-time equivalent numbers, university program and student cohort data for five allied health professions from 2013 to 2016. In addition, qualitative response data from key stakeholder surveys was analysed thematically. Results In the study period, the rate of growth in placement offers did not match that of university program student numbers and full-time equivalent staff numbers. All stakeholders agreed that sustaining placement provision is enabled by collaboration, continuation of management support for dedicated clinical education staff, a focus on clinical education capacity building activities, outcome data reporting and statewide profession-specific governance, including leadership positions. Collaborations and networks across health and education sectors were reported to enhance efficiency, minimise duplication, streamline communication and support information and resource sharing within and across professions and stakeholders, ultimately sustaining placement provision. Identified barriers to sustainability centred on resourcing and the continued increasing demand for placements. Conclusion Sustaining pre-entry student placements requires stakeholder flexibility and responsiveness and is underpinned by collaboration, information and resource sharing. Dedicated clinical education positions were highly valued and seen as a key contributor to placement sustainability. What is known about the topic? The increasing demand for student placements and strategies used to enhance placement capacity are well known. To date, there have been limited studies investigating cross-sectoral trends and health service enablers and barriers to sustaining responses to placement demand. What does this paper add? This paper describes outcomes of a clinical placement capacity building initiative within public health services, developed from a unique opportunity to provide funding through an industrial agreement. It presents key allied health staff and university partner perspectives on enablers to sustaining placement supply in an environment of increasing placement demand. What are the implications for practitioners? This paper demonstrates that key enablers for the sustainability of placement provision are collaboration between university and health sectors, continuation of management support for dedicated clinical education staff, outcome data reporting and statewide profession-specific governance and leadership. It supports current practices of profession-specific and interprofessional clinical education resource and strategy development and the sharing of expertise for sustained placement provision.

A mixed-method study of chiropractic student clinical immersion placements in nonmetropolitan Western Australia: Influence on student experience, professional attributes, and practice destination

To explore the influence of nonmetropolitan clinical immersion placements (CIPs) on undergraduate chiropractic student experience, professional attributes, and practice destination. Students enrolled in an Australian undergraduate chiropractic program were invited to complete a service experience questionnaire and an open-ended reflective feedback form following a nonmetropolitan CIP (Part A). Online searches were performed to gather data on graduate practice location (Part B). Sixty-four students participated in Part A. All agreed that the placement was educational and should be retained in the program. Students agreed that the placement enhanced respect for individuals and awareness of others in need, highlighted the importance of respect for all people, improved empathy for the disadvantaged, and provided an opportunity to improve communication skills. Most indicated that they were more likely to practice in a country setting as a result of their placement, with those participating in a country placement more likely to practice in nonmetropolitan regions after graduation. Many chiropractic programs around the world are adopting CIPs. This study is the 1st to investigate the possible influence of nonmetropolitan CIPs on the development of desirable attributes in Australian chiropractic students. It also discusses the potential influence of nonmetropolitan CIPs on future practice location decisions. These results support the utility of CIPs to help meet the educational objectives of chiropractic programs and possibly address the maldistribution of the chiropractic workforce in Australia.

The student experience of clinical supervision across health disciplines - Perspectives and remedies to enhance clinical placement.

Effective clinical practice supervision for health students is essential prior to commencing their respective professions. Students require adequate preparation before their clinical practice event with an experienced clinical supervisor able to impart professional 'know how' and skills to students. The purpose of this study was to describe final year health students' perspectives and experiences of clinical supervision, and to develop an interprofessional model of clinical supervision. Focus groups and semi-structured interviews were conducted with undergraduate health students across a range of disciplines. Some students provided email comments. Qualitative data was analysed thematically using NVivo (V11). Six key themes and their various sub-themes (refer Table 1) were identified: (1) undergraduate learning valued by the CP provider; (2) effective connections (communications) between student, CS, CP provider and university; (3) undergraduate student learning not being valued; (4) ineffective connections; (5) mitigating factors for students; and (6) the impact of increasing student numbers. Undergraduate health student clinical placement requires careful educational preparation, structuring and adequate support for both the student undergoing the practice event and for the clinical supervisor stewarding the undergraduate health professional. A prospective plan to ensure an excellent experience is required (Fig. 1).

EVALUATION OF THE DETERMINANTS OF CLINICAL MEDICINE TRAINING OUTCOMES IN WESTERN KENYA

Study Objective: To analyze the learner – lecturer / instructor interaction process within the context of theory learned during training put into clinical / medical practice. This was in order to generate limitation in both the teaching institutions that address Clinical Medicine training outcomes. 
 Study Design: Across- sectional study 
 Study Setting: This study was carried out in Lake Basin Region of Kenya. The area includes Kisumu and its surrounding counties of Vihiga and Nandi. 
 Study Subjects / Participants: Sixty six (66) Clinical Medicine students from various MTIs in Lake Basin Region of Kenya, 58 health workers, 3 heads of departments from KMTCs, and 5 heads of departments in the clinical placement sites that was visited for this study and 4 lecturers of MTIs. 
 Study Results: Analysis from observations of student / lecturer / infrastructure / leadership / linkage engagements were obvious and more so the absence of libraries in all RHTCs. In both the county Hospital and the referral Hospital (JOOTRH) there were libraries which were inaccessible to Clinical Medicine students. There were linkages and networking processes in all the training health facilities that were used as clinical placement sites. This was evident in the many students who were present from different MTIs in Kenya. Students for clinical placements came from all MTIs in Kenya among who were all KMTCs, GLUK, Uzima University College, Mt Kenya University, Moi University and others. There were evident interactions in many ways both academically and socially, and with the presence of ICT services, these students were linked together nationally regionally and internationally 
 Study Conclusion: This study therefore provides a tool to guide MTIs and clinical placement sites in Kenya on the best practice in linking theory based learning with clinical practice in achieving quality, competent, effective, and efficient Clinical Medicine training outcomes.

Authentic practice environments to support undergraduate nursing students' readiness for hospital placements. A new model of practice in an on campus simulated hospital and health service.

This paper reports on a unique practice based learning model to prepare undergraduate nursing students for clinical placement. The learning and teaching model described in this paper outlines the establishment of an entire on-campus simulated hospital and health service (SHHS) at the University of South Australia, School of Nursing and Midwifery. The model is pedagogically structured to immerse students in an authentic clinical environment to achieve deep learning in preparation for safe practice. A quality improvement cycle was used to evaluate the outcomes of the model in two phases: Phase 1: Purposive sampling of first and second year Bachelor of Nursing students from 2012 to 2015 who were surveyed about their satisfaction with the model of learning. Bachelor of Nursing students were invited to complete a survey about their experience with the teaching and learning model employed in the SHHS in response to the question, 'What aspects of the SHHS are the most important to your success?' Phase 2: External clinical stakeholders working with nursing students in clinical placements were asked to respond to questions about the preparedness of students educated in this model to transition to employment. The evaluation showed that the SHHS model positively influenced students' satisfaction and confidence and increased the perception of clinicians of the work readiness of students.

Variation in the Geographic Distribution of Physiotherapy Student Clinical Placements in Rural Saskatchewan.

Purpose: Rural and remote Saskatchewan has a shortage of physiotherapists. Positive student experiences in rural and remote communities may influence whether graduates choose to work in these settings. The intention of the first full-time, 4-week clinical placement (CP) in the Master of Physical Therapy programme at the University of Saskatchewan is to provide clinical experiences in rural settings outside Saskatoon and Regina. This study examines the geographic distribution of and yearly variation in these CPs to determine whether this stated intent is being realized. Method: We analyzed the locations of physiotherapy student CPs from 2008 to 2016 using geospatial mapping. Results: Spatial patterning using mapping identified variability in the number of rural placements in geographical regions in Saskatchewan over a 9-year period. An average of 75% of CP experiences occurred in rural locations outside the two major cities in Saskatchewan between 2008 and 2016 (ranging from 58% in 2015 to 84% in 2009). Conclusions: The goal of providing all University of Saskatchewan physiotherapy students with a rural experience for their first CP is not being met. Securing more CPs in rural settings may have a positive impact on recruitment of physiotherapists to these communities.

Shifts in nursing and medical students' attitudes, beliefs and behaviours about interprofessional work: An interprofessional placement in ambulatory care.

To examine students' beliefs, behaviours and attitudes in relation to interprofessional socialisation, and their expectations and experience, before and after a 2-week clinical placement in ambulatory care. Interprofessional clinical placements for students are important for developing an understanding of interprofessional collaboration and identity, for the benefit of patient care. Ambulatory care environment involves collaborative management of complex chronic problems. This educator supported placement that enabled final-year nursing and medical students to work together. A descriptive matched before-after study was conducted. Students' completed an online questionnaire before and after their clinical placement. The questionnaire comprised of three sections: demographic information, the Interprofessional Socialisation and Valuing Scale and open-ended questions. Descriptive analysis and paired t-tests were conducted for the three subscales, and thematic analysis of qualitative responses was conducted. Sixty-two of the 151 students between 2011-2014 completed both surveys. There was a significant increase after placement in the overall Interprofessional Socialisation and Valuing Scale scores. The change was greater for nursing students compared with medical students, although for both groups the change was small. The majority had a good-to-very good experience learning each other's and their own professions and identified the nurse educator and teaching registrar as key to success. A clinical placement in an ambulatory setting for nursing and medical students resulted in an increase in self-perceived ability to work with others and in valuing working with others. Interprofessional clinical placements are essential for students to understand interprofessional practice for better patient outcomes and developing their own perspective of future work within an interprofessional team. Ambulatory care is an ideal environment for nursing and other health professional students to engage in interprofessional clinical placements.

Coping Mechanisms of Nursing Students in Clinical Placement

Coping Mechanisms of Nursing Students in Clinical Placement

Exploring Self-Perceptions of Anxiety among Nursing Students in the Clinical Setting and Select Demographics.

Clinical learning experiences are essential in nursing education but they are often anxiety provoking for learners. Understanding the factors associated with the anxiety levels of nursing students in clinical placements has become more complex over the years with increasing heterogeneity within the nursing population. A correlational study was conducted to examine the relationships between nursing students' self-perceived anxiety levels, as measured by the State-Trait Anxiety Inventory (STAI), and the students' age, gender, previous employment, and previous education. The findings revealed that nursing students have a higher than average level of anxiety and that male nursing students reported higher levels of anxiety compared to female nursing students. No significant correlations were found between age, previous education, previous employment, and self-perceived anxiety levels. Findings from this study provide an opportunity for discussion by nursing educators and identify a need for future research and practice.

Capacity building of midwifery faculty to implement a 3-years midwifery diploma curriculum in Bangladesh: A process evaluation of a mentorship programme.

When a midwifery diploma-level programme was introduced in 2010 in Bangladesh, only a few nursing faculty staff members had received midwifery diploma-level. The consequences were an inconsistency in interpretation and implementation of the midwifery curriculum in the midwifery programme. To ensure that midwifery faculty staff members were adequately prepared to deliver the national midwifery curriculum, a mentorship programme was developed. The aim of this study was to examine feasibility and adherence to a mentorship programme among 19 midwifery faculty staff members who were lecturing the three years midwifery diploma-level programme at ten institutes/colleges in Bangladesh. The mentorship programme was evaluated using a process evaluation framework: (implementation, context, mechanisms of impact and outcomes). An online and face-to-face blended mentorship programme delivered by Swedish midwifery faculty staff members was found to be feasible, and it motivated the faculty staff members in Bangladesh both to deliver the national midwifery diploma curriculum as well as to carry out supportive supervision for midwifery students in clinical placement. First, the Swedish midwifery faculty staff members visited Bangladesh and provided a two-days on-site visit prior to the initiation of the online part of the mentorship programme. The second on-site visit was five-days long and took place at the end of the programme, that being six to eight months from the first visit. Building on the faculty staff members' response to feasibility and adherence to the mentorship programme, the findings indicate opportunities for future scale-up to all institutes/collages providing midwifery education in Bangladesh. It has been proposed that a blended online and face-to-face mentorship programme may be a means to improving national midwifery programmes in countries where midwifery has only recently been introduced.

Twelve tips for expanding undergraduate clinical teaching capacity

Undergraduate medical education has expanded substantially in recent years, through both establishing new programs and increasing student numbers in existing programs. This expansion has placed pressure on the capacity for training students in clinical placements, raising concerns about the risk of dilution of experience, and reducing work readiness. The concerns have been greatest in more traditional environments, where clinical placements in large academic medical centers are often the “gold standard”. However, there are ways of exposing medical students to patient interactions and clinical supervisors in many other contexts. In this paper, we share our experiences and observations of expanding clinical placements for both existing and new medical programs in several international locations. While this is not necessarily an easy task, a wide range of opportunities can be accessed by asking the right questions of the right people, often with only relatively modest changes in resource allocation.

Piloting a Short-term Volunteer Medical Mission as Clinical Placement for Family Nurse Practitioner Students.

Piloting a Short-term Volunteer Medical Mission as Clinical Placement for Family Nurse Practitioner Students.

From Innovative Idea to State-Supported Policy: Academic Progression in Prelicensure Registered Nurse Education Using the Partnership Model

Changes in the registered nurse (RN) employment market in 2012 and 2013 negatively affected both employment for RNs and associate degree-prepared nurses (ADNs) and clinical placement for students in ADN preparation programs. To address this challenge, ADN nursing programs partnered with a university to create an innovative alternative to traditional prelicensure RN nursing education by sharing curricula among them. With the program, students simultaneously complete the ADN nursing degree onsite at the community college and the bachelor of science degree in nursing (BSN) online, with both degrees conferred at the end of the respective nursing programs, in time for the graduate to sit for the National Council Licensure Examination-Registered Nurse (NCLEX-RN) and enter the workforce as a BSN-prepared nurse. This example of seamless academic progression is known in Kansas as the Partnership Model.

Physician Assistant Contributions to Medical and Higher Education.

Physician assistant (PA) programs were often early adopters or initiators of innovative models of teaching, learning, and assessment. Examples of these influences include interprofessional education, competency-based education, objective-structured clinical examinations, problem-based learning, evidence-based medicine, team-based learning, and the multiple mini-interviews. In addition, the contributions and presence of PAs in the academic health center teaching environment have also fostered appreciation from other health professionals for the skill level and capacity of PAs on the care team. This directly led to the increased utilization of PAs in a growing number of specialties in both inpatient and outpatient settings. However, the rapid expansion of PA educational programs has strained the profession's ability to meet critical student clinical placement needs, and PA educators must adopt or develop innovative ways to reconfigure how clinical education is delivered and assessed, including the use of advanced technology and simulation.

Building workplace social capital: A longitudinal study of student nurses' clinical placement experiences.

Quality clinical placement experiences have been associated with nurses' workplace social capital. Social capital is broadly understood as the social organisation of trust, norms and networks that benefit society. Building social capital in the workplace may benefit experiences of staff and students. The aim of this study was to assess the impact of building workplace social capital on student nurse perceptions of clinical learning experiences. A quality improvement process was measured through repeated student surveys. First, second, third year students (n=1176) from three universities completed a validated Student Clinical Learning Culture Survey (SCLCS) following their placement, at the commencement of quality improvement initiatives and five years later. The SCLCS measured students' perceptions of social affiliation, their motivation, satisfaction and dissatisfaction with clinical contexts. The first year of systematic changes focused on increasing student numbers along with improving communication, trust and knowledge sharing, antecedents to workplace social capital. No change was evident after the first year. Six years after commencement of building workplace social capital differences across all subscales, except dissatisfaction, were significant (p<0.001). Leadership that promotes open communication and connections across staff and students to achieve common goals can build workplace social capital that enhances student placement experiences.