Unblocking the placements logjam through e-placements in healthcare

What do you do when you can't offer placements in a "place"? Go back to the digital drawing board and get creative, says Gilly Salmon.

Gilly Salmon is chief executive and principal consultant at Education Alchemists, Ltd. 

Placements are very important for students’ employability, and for contributing to social mobility. Nearly all universities pursue placements as part of their employability strategies.

Professional bodies, in health, education, engineering and many other disciplines, insist on a proportion of the learning happening real-world and in situ. Hence, placements are a requirement of many degrees, along with the increase in sandwich and apprenticeship approaches.

By the beginning of 2020, the health placement system was under pressure from increasing student registrations and provision of enough suitable placement locations and supervision.

Enter Covid-19 restrictions to the mix – traditional approaches to place became an anathema with only remote learning considered safe, shaking up students’ future employment hopes and motivation.

Sourcing of attractive and appropriate opportunities for work experience and purposeful learning became hugely demanding in the face of the primacy of safety for all and health staff diverted to the pandemic..

During 2020, the availability of location-based placements fell rapidly, and according to Sutton Trust polling, this trend is likely to continue through 2021.

Many HE students, already shattered by the reduction in their expectations of campus experiences, are worried about graduating in the time expected, achieving a professional status and securing their desired employment.

It is important not only to find rapid solutions to the placement logjam, but also to consider sustainability and student authentic experiences. A high quality approach, adaptable to different disciplines and professions and with the capability to roll with the punches of future uncertainties is required.

Trialling

Early in the pandemic, Dr Lisa Taylor at the University of East Anglia provided a response. The usual face-to-face practice placement for her second year Occupational Therapy students was suspended. She rapidly worked out how to create, not just a pale imitation of a face to face experience, but a way of satisfying the professional body’s standards and the student learning outcomes.

She delivered, with colleagues, a fully online placement for students in April 2020. All the resources and interactions were built on the university’s virtual learning environment. The design mirrored the “traditional” experience, including three full weeks at 9 am to 5 pm and familiar documentation, as if in the clinical setting.

The e-placement was achieved remotely but without fancy technology or additional funding. 35 of the 36 students completed the placement in the usual time, reached the standards and passed. The evaluation confirmed that the placement was “recovered”, and students had an authentic and beneficial experience. Skills and theory merged: taking patient histories, communicating with family members, clinical reasoning and planning treatments. In addition, dramatically improved peer and team learning was demonstrated.

Building an exemplar

Lisa and I quickly realised that this first experience might provide a sustainable model of placement delivery with rich and meaningful learning for students and agile adoption for staff. We anticipated that deploying existing placement outcomes, married with the best of evidence-based online learning, might ease the placement log jam. The original placement, now called a Peer Enhanced E-placement (PEEP), was reported as a case exemplar, then reshaped into a model, which others could adopt, adapt, and customise.

We developed a 3.5 hour fully digital workshop so that colleagues, with placement challenges could understand the key design, online learning concepts, teaching and supervision requirements, and acquire resources. This approach enabled staff to explore the PEEP model and customise it to their own situations.

Customising

We discovered that staff confidence in providing authentic and valuable online learning experiences for students can be built and scaled up through exposure to an evidence-based model.

The next critical next step is assisting placement customisation for implementation for their own profession, their specific learning outcomes, the location in the degree timetable and the team available.

Colleagues from 15 health professions, podiatry to nursing, created a breadth of ideas to build upon developing areas of professional practice which were easily slotted into the PEEP timetables.

For example, Operating Department Practitioners (ODPs) pre-Covid, had a significant proportion of their studies working alongside professional teams in operating theatres. Through exploring the PEEP model, with assistance, they produced creative ideas and plans to enable online student engagement, including a range of scenarios normally unavailable in place-based learning, such as air ambulance services.

Dietetics realised that students could engage with “whole of life” conditions – they normally only saw a snapshot in clinics.

In short, reach, breadth, depth, and future-proofing were created for e-placements. Typically, there are readily available media and resources within a community of practice or provided by the professional bodies, for adaption and reuse, all with the aim of achieving the required standard of professional assessment.

We estimate, from their plans, that more than 6,000 weeks of placement capacity will be recovered during 2021.

My conclusions so far

In our highly complex HE system, it’s those at the sharp end of education who are required to step up, not only to problem solve, but also to add meaningful value to students’ learning.

Staff should be offered approaches based on principles of design, with agile, remote, practical development, and easily adaptable and reusable resources. These provide immediate solutions for now, but also sustainable ways forward for uncertain futures.

Successful online placements offer insurance against disruptions and shortages of available locations and situations. When well-designed and delivered, they enable achievement of the required learning outcomes, purposeful student experiences, increased peer beneficial engagement, collaboration and learning 4.0 skills no less!

Online placement provision: yes, it’s not the way it’s always been done; no, it’s not intended to completely replace every placement opportunity. In the future it could be offered as an adjunct or in combination.

Of course, it is more Covid-safe. It’s easily tried out as a prototype. What do you need? – creativity and resolve. It might just unblock your logjam, future proof placements, improve graduates’ employability and prepare them for more digitised professional lives. And form a key part of carrying staff and students into your wider education transformation agendas.

The author benefited from funding from Health Education England Allied Health Professions Clinical Placement Expansion programme (CPEP) to increase placements within the NHS, covering some of the work reported.

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