Jane Morris

Evaluating Practice Education Models in Occupational Therapy: Comparing 1:1, 2:1 and 3:1 Placements

Practice education is an essential part of the education of health professionals, yet in spite of this there is an acknowledged shortage of placements. At the same time, educational research indicates that peer learning, and in particular problem-based learning, has advantages for students. Studies that have investigated models of placements where more than one student at a time share an educator have shown that this may bring benefits for both educators and students. This study was carried out with the aim of determining the impact of different models of practice placement (1:1, 2:1 and 3:1) on the quality of education for students and on the quality of the experience for educators, in both occupational therapy and physiotherapy courses at a university in the South of England. This article focuses on the occupational therapy component of the study. Six occupational therapy educators and 11 students took part, providing examples of all three models of placement. The findings indicated that while all three models provided both advantages and disadvantages for educators and students, the 2:1 model offered more opportunities for peer support and enhanced the quality of the educational experience through peer learning. In some settings, however, it is probably the case that only the 1:1 model is possible. The findings also suggest that the success of any placement model depends heavily on how well the placement has been planned.

Evaluation of Physiotherapy Clinical Educational Models: Comparing 1:1, 2:1 and 3:1 placements

Summary Nationally there is an increasing problem of clinical placement shortages for physiotherapy which is likely to become worse with the implementation of Government National Health Service plans. The purpose of this study was to compare experiences of clinical educators and students using three different clinical placement models. Method Eight clinical educators volunteered to experience 1:1, 2:1 and 3:1 placement models; 48 third-year physiotherapy students volunteered to attend these placements. Data were collected by face-to-face interviews with educators and students at the end of each placement. Department managers and visiting tutors were also interviewed when all the placements were completed. All interviews were recorded on audiotape, transcribed verbatim and assessed for accuracy. The data were analysed thematically using NVIVO software and assessed for reliability and validity. Results Themes emerged that had an effect on the success of a placement. These included the time the educator spent with individual students, size of department, number of patients and availability of accommodation. The experiences of the interviewees suggest that each of the models has advantages and disadvantages, but they all provide valuable learning opportunities. The results indicate that the success of any placement model depends heavily on how the placement is planned. Conclusion It is evident from the findings that all three models investigated have a place in physiotherapy clinical education. The 2:1 and 3:1 models provide different learning opportunities from the 1:1, but are no less important; they can now be promoted in the clinical setting with more evidence to support their use. If implemented these models will contribute to increasing placement numbers while still maintaining high quality learning environments for the students and rewarding experiences for the educators.

Collaborative reflection: how far do 2:1 models of learning in the practice setting promote peer reflection?

A number of health professional groups have been looking at alternative models to the traditional 1:1 model of practice education in order to meet the increasing shortage of practice placements for pre‐registration students. One such model that has been explored recently is the 2:1 or collaborative model where one practice educator takes responsibility for the education of two or more students. This paper presents the findings of a small research study undertaken to explore facilitation of learning in 2:1 collaborative models of physiotherapy practice education, and focuses on the potential for reflection with particular emphasis on peer reflection within the collaborative model. The study adopted a qualitative approach. Semi‐structured interviews were conducted with thirteen educators and eighteen third year physiotherapy students at a number of different NHS practice sites in southeast England. Additional focus groups were held with academic tutors and students at the end of the placement period. Findings from the study indicated that learning was facilitated in a variety of ways with students benefiting from peer learning and teaching approaches. Opportunities for peer reflection appeared to be increased in the 2:1 model. However, some practice educators highlighted the need for further guidance when promoting reflective practice. Further research into the role of reflection within 2:1 models and the facilitation of reflection during clinical education placements is needed.

Physiotherapy students' experiences of palliative care placements--promoting interprofessional learning and patient-centred approaches.

Learning in the practice setting is an integral and substantial component of health professional education (Chartered Society of Physiotherapy, 2002). The need to develop the skills necessary to enable future health professionals to function effectively within a team is well recognized and during the last decade there has been an increasing emphasis on interprofessional education in both campus-based and practice settings (Barr, 2002; Stew, 2005). We report on a small qualitative study that explored student physiotherapists’ experience of learning within a palliative care team. A key focus of this report is the interprofessional learning opportunities that arose from students working with members of the palliative care team. One of the authors (RL) undertook the project in part fulfilment of a BSc (Hons) degree in Physiotherapy. Six semi-structured interviews were conducted with final year students from one pre-registration course, who had all completed a placement in palliative care. Ethical approval for the study was sought and granted. Six key themes emerged from analysis of the interview data, including interprofessional working; support for learners; patient-centred care; physiotherapy in palliative care; emotional aspects of the learning environment and education. These are highlighted in italics below. Findings indicated that placements within a palliative care setting provided valuable opportunities for interprofessional learning (Hilton & Morris, 2001). For example, students worked alongside other health professional team members jointly assessing patients, developing treatment plans and contributing to discharge planning. They also took an active part in multidisciplinary (MDT) team meetings where they developed insight into patientcentred approaches. Students were exposed to a more diverse range of team members than in other practice settings, including clinical psychologists, counsellors, art therapists, music therapists and chaplains. As a result students felt they had an increased understanding of the contribution made by the many different health professionals who were involved in a patient’s care pathway. The diversity of the team within the palliative care setting lent itself to a holistic approach to patient management as all aspects, including the spiritual and creative needs of patients were met. Journal of Interprofessional Care, October 2007; 21(5): 569 – 571

Bourdieu and interprofessional education: what’s the relevance?

ABSTRACT Interprofessional education (IPE) is perceived to be one strategy to reduce professional compartmentalisation and improve collaborative practices. The unequal power relations existing between the various professions who need to collaborate for IPE remains largely unexamined and it is only in recent years that sociological theories have been employed within the interprofessional field. This paper uses selected findings from an exploratory case study into IPE conducted at the University of Malta and then examines these findings from a Bourdieusian perspective. The first part of this paper introduces the breath of theoretical perspectives employed for IPE and then goes on to provide an overview of Bourdieu’s theories of social practices. The second part outlines the context of this case study and presents selected findings. The third section discusses how these findings were examined using Bourdieu’s concepts helping us demystify the various ways in which health care professions worked and interacted, and how this all made sense within a wider societal context. It also highlights the relevance of taking into account Bourdieu’s concepts during the development of IPE.

The importance of the therapeutic relationship when providing information to parents of children with long-term disabilities: The views and experiences of UK paediatric therapists

The purpose of this study was to understand the views and experiences of paediatric therapists working in the United Kingdom regarding the importance of the therapeutic relationship when providing information for parents of children with long-term disabilities. The aim was to develop new perspectives, to encourage dialogue and reflection for change and to identify practical suggestions for health professionals when developing therapeutic relationships. This study employed an interpretive phenomenological methodology. Semi-structured, in-depth interviews were carried out with seven health professionals from a single National Health Service trust in the United Kingdom (children’s physiotherapists, occupational therapists and speech therapists). Resultant data were analysed using a systematic process of thematic content analysis. One main theme ‘The Importance of the Therapeutic Relationship: Balancing a Positive Relationship with Professional Responsibility’ is presented and discussed. Paediatric therapists recognize that fostering a positive therapeutic relationship is vital to facilitate parental engagement with the information they provide. Despite this it was felt that efforts to maintain a positive relationship needed to be carefully balanced with discharging professional responsibility to the child. A preliminary model ‘The Therapeutic Relationship Continuum’ is presented, aiming to help health professionals self-assess and reflect on the dynamic interface between the therapeutic relationship and information provision.

The role of national culture in shaping health workforce collaboration: Lessons learned from a case study on attitudes to interprofessional education in Malta

The World Health Organisation identifies interprofessional education (IPE) as a key element for preparing a collaborative workforce. However, global implementation remains challenging due to individual, professional and organisational barriers. A qualitative case study explored the concept of introducing an undergraduate IPE programme at the Faculty of Health Sciences, University of Malta. A combination of in-depth interviews and focus groups were conducted with a sample of sixty-four academics,health and education policy makers and newly qualified health professionals. The findings suggest that while participants support the notion of IPE, they identify multiple barriers that would challenge implementation. This includes particular cultural norms and values which participants perceived would conflict with IPE. These findings were interpreted through Hofstedes theory of cultural dimensions as a means of theorising about the role that culture could play in implementing such an approach. This study contributes to the health policy debate by highlighting the potential impact of national culture in the planning, development and delivery of collaborative initiatives. It also highlights new insights for European small states and other countries by providing a lens through which culture needs to be taken into account in the transfer of innovation across health systems.

Challenges of CPD for physiotherapists working as lone practitioners in amputee rehabilitation

Objectives: The aim of this study was to explore the issues around continuing professional development (CPD) for physiotherapists working as lone practitioners in amputee rehabilitation in the United Kingdom (UK). Design: Qualitative method using a phenomenological approach via one to one semi-structured interviews and thematic data analysis. Setting and participants: Ten physiotherapists with responsibility for amputee rehabilitation working as lone practitioners in hospitals or specialist centres in the UK. Results: CPD is valued and there is commitment towards the process. Current solutions are identified but there are frustrations around more structured CPD and organizational issues. These include inadequate access to learning opportunities, lack of professional feedback, insufficient time and limited learning skills. Conclusion: There are opportunities for improving CPD through organizational structures but specialist input is recommended to support lone practitioners and managers with the process, e.g., consultant or peripatetic therapists.