Therapy Project Office
Framework for Practice Educator
Training & Education Needs
Practice Educator Training Needs & Training Needs
Analysis
THERAPY PROJECT OFFICE ...4
EXECUTIVE SUMMARY...5
INTRODUCTION ...6
SECTION ONE...7
Educating the Educators: The Importance of Practice Education for Professional Practice. ... 7
The Roles of Practice Educators. ... 9
The Goals of Practice Educator Education and Training. ... 10
SECTION TWO. ...12
Multidisciplinary Practice Educator Competencies... 12
Introduction ... 12
Competency and good Practice Guidelines... 12
Survey of current HEI Practice Educator training in Ireland... 16
Introduction ... 16
Aim... 16
Methodology ... 16
Current training in Ireland... 16
Survey of Current Practice Educator Learning and Learning Needs... 23
SECTION THREE ...29
Section Three Introduction ... 29
Development of the Practice Educator... 29
Proposed Delivery of Practice Educator Education and Training ... 30
Competencies Addressed by the Current HEI Practice Educator courses. ... 30
Proposed Course Content... 32
Part 1: Multidisciplinary Topics... 32
Part 2: Therapy Course Specific Topics... 33
Part 3: Profession Education Topics... 33
Proposed Course Delivery ... 34
Part 1: Multidisciplinary... 34
International Examples ... 35
Part 2: Therapy Course Specific Topics... 36
Part 3: Profession Education Topics... 36
MULTIDISCIPLINARY PRACTICE EDUCATION FRAMEWORKS ...37
Recommendations for Implementation of this Framework ... 42 REFERENCES ...44 APPENDICES ...46 Appendix 1... 47 Glossary ... 47 Appendix 2... 48 Questionnaire A. ... 48 Appendix 3... 58 Questionnaire B... 58
Methodology for Questionnaire B... 64
Appendix 5... 65
Therapy Project Office
The Therapy Project Office was established in January 2007 to progress and initiate project activities on behalf of the National Implementation Group (NIG) for Clinical Placement Provision for Occupational Therapy, Physiotherapy and Speech and Language Therapy. The projects related to a number of key actions identified by the ‘The Report of the National Planning Group on Clinical Placement Provision for Occupational Therapy, Physiotherapy and Speech and Language Therapy’ (2004), under the three broad areas of:
Practice Education
Continuing Professional Development Quality Information for the Public.
The Therapy Project Office was funded by the HSE and staffed by three project managers, representing the professional bodies of the Association of Occupational Therapists of Ireland (AOTI), the Irish Society of Chartered Physiotherapists (ISCP) and the Irish Association of Speech and Language Therapists (IASLT). A collaborative, project management model was applied throughout the process. The Project Managers also worked in partnership with the Higher Education Institutes, Therapy Services, the Department of Health & Children and the Health Service Executive to build on existing work and to drive the projects forward.
Executive Summary
The aim of this project was to identify training needs for Practice Educators across the three professions of Occupational Therapy, Physiotherapy and Speech and Language Therapy and to recommend an educational framework to meet these needs.
To achieve this aim, two surveys on current Practice Educator training and training needs were carried out with relevant stakeholders. Practice Educator competencies were devised in conjunction with representative groups from the HEIs and Therapy Managers.
Drawing from a review of the literature and international examples of best practice, the development of an educational framework for Practice Educators is proposed as offering a valuable contribution to the overall quality in health care provision.
The proposed framework endorses a staged, developmental approach to provide a continuum of learning for Practice Educators. This is seen as enhancing and developing learning from novice Practice Educators to expert Practice Educators level.
The Irish practice education teams are viewed as key players in the development of Practice Educator competencies and in the delivery of an education and training framework for Practice Educators. The potential for developing Practice Educator education on a multidisciplinary basis is also strongly recommended.
Introduction
The aim of this project was:
to identify training requirements for Practice Educators across the three professions of Occupational Therapy, Physiotherapy and Speech and Language Therapy.
In order to achieve this aim the following objectives were outlined: Review literature and international examples of best practice
Identify multidisciplinary Practice Educator (PE) competencies in collaboration with the Higher Education Institutes (HEIs) and other stakeholders which could inform the development of a training and education framework
Identify what training is currently provided for Practice Educators within the practice education system (HEIs)
Identify what Practice Educators on the ground identified as their learning needs to become competent Practice Educators
Identify the gap between current training and the competencies needed
Identify an appropriate education framework with recommendations for implementation.
This report is divided into three sections:
Section one looks at current literature and outlines the importance of Practice Educator training not only for practice education of therapy students but also for enhancing the quality of professional practice.
Section two outlines the results of:
The multidisciplinary Practice Educator competencies which were identified as part of the collaborative work that took place between the Therapy Project Office, HEIs and other relevant stakeholders.
The survey of current HEI Practice Educator training in Ireland, across all of the Therapy Courses in the Republic of Ireland.
The survey of Practice Educator learning and learning needs across the three professions.
Section three outlines discussion and recommendations from sections one and two, linking them to current practice both here and abroad and outlines a framework and recommendations for practice education training and education within the Irish context.
Section One
Educating the Educators: The Importance of Practice Education for
Professional Practice.
Following the publication of the Bacon Report (2001) and on foot of the recommendations therein, additional professional educational courses for the three professions of Occupational Therapy, Physiotherapy and Speech and Language Therapy were developed to augment the supply of therapists to the expanding Health and Disability Sectors. With this came an increasing demand to accommodate therapy students on practice education placements. Guided by the Action Framework of the subsequent ‘Report of the National Planning Group on Clinical Placement Provision for Occupational Therapy, Physiotherapy and Speech and Language Therapy (2004)’ a National Implementation Group, representing all the stakeholders, has been working collaboratively to put structures in place to support Practice Educators who are providing these practice education placements, and also develop quality initiatives around it. One such structure has been the establishment of the new practice education teams in the Republic of Ireland. These new support teams consist of Practice Education Coordinators (PECs)1, Practice Tutors (PTs), and Regional Placement Facilitators (RPFs). These new roles when working within a practice education team have responsibility to link onsite practice education with the HEIs and are also the primary support for the Practice Educators on the ground as they take students.
The action framework also identified a need for a professional education and training structure to support Practice Educators in their role.
According to Higgs (2005) such an education and training structure will have a two fold benefit. It will improve the quality of practice education on the ground and also develop the skills that therapists need professionally for providing, managing and developing quality services. Therefore according to Higgs (2005) the role of Practice Educators as “professional supervisors and mentors” is important in not only the development of practice education but also in the transformation and improvement of quality in “professional practice”. Higgs goes on to propose that the development of a strong Practice Educator education training structure will have benefits for all involved in the practice education process and will contribute to producing:
Students who will “enthusiastically and with vision” become the next generation of practitioners
“Educators and mentors” (including the Practice Tutors, Regional Placement Facilitators and Practice Education Coordinators,) who will not only shape the student’s path but who will become transformed in the process themselves
Practice Educators who, through their learning experiences, are actively engaged in transforming practice and themselves
The managers who provide placements being more able to balance service delivery and practice education within the wider organisational context
“Consumers and clients of the practice” whose needs and requirements are the main drivers for change in practice.
Therefore the role of practice education and the support for it is not only of paramount importance for the education of undergraduate and post graduate students, but also for the development of the professions and the overall Health Service. This argument is supported by Cross et al (2006) stating that:
“The future of any healthcare profession is largely dependent upon the quality of the learning opportunities it provides for future generations of practitioners as they work towards professional registration, and also for its qualified membership as they continue to enhance and develop their professional knowledge and skills”
Cross et al (2006:15) In reviewing other literature, McAllister and Lincoln (2005:1) found that practice education and the experience of having students offered “opportunities to both educators and students for professional growth” and that this professional growth and development implied a “movement along a continuum of professional skills and competencies”.
According to Dreyfus and Dreyfus (1984) this continuum is one of moving from “novice to expert status,” an acknowledgement that the role of the Practice Educator is constantly changing and evolving. McAllister and Lincoln (2005) refer to four stages of Practice Educator professional growth, drawing on work done previously by Dreyfus and Dreyfus (1986), Brenner (1984) and by McAllister (2001).
According to this the stages of development in being a Practice Educator are: Novice educator
Competent Practice Educator
Professional artistry as a Practice Educator.
(McAllister and Lincoln’s stages of Practice Educator development work is elaborated on in detail in section three).
This evolution in the Practice Educator role is achieved through the knowledge gained with hands on experience of facilitating students and is underpinned by education and reflection in practice education. It should also be noted that an alternative stage for the Practice Educator is acknowledged by McAllister and Lincoln (2005), that being one of burnout. It is referred to as a stage that should be acknowledged but which can certainly be avoided by development of personal and interpersonal skills though Practice Educator education.
The Roles of Practice Educators.
There are many different tasks and roles required of Practice Educators to operate as competent and organised Practice Educators and to respond to the varied needs of students. The “teacher as manager” model as described by Romanini and Higgs (1991) outlines the three stages of clinical placement as:
Preparation Implementation Evaluation.
According to Romanini and Higgs (1991), Practice Educators have five roles when becoming “learning programme managers”. They are:
Task manager
Group manager (if there is more than one student present) Individual development manager
Environmental manager Overall programme manager.
Other authors have expanded these roles to include those of role-model, colleague, teacher, evaluator, administrator, counsellor, and finally researcher. (McLeod et al.1997).
In the Irish context the Practice Educator is supported to fulfil these varied roles by the members of the practice education team. All of these are an extension of the skills and roles required of the therapist in the day to day clinical environment. Thus any Practice Educator training will enhance the competencies and skills that a therapist needs in managing both clinical and managerial responsibilities.
The Goals of Practice Educator Education and Training.
According to McAllister and Lincoln (2005) the provision of education for Practice Educators must meet the following goals:
Continuous development of clinical knowledge and skills
From the point of view of the Practice Educator this is the continuous development of clinical expertise (clinical knowledge and skills) and the development of professional artistry as a Practice Educator. This professional artistry as a Practice Educator as first discussed by Fish and Cole (1998), is described by McAllister and Lincoln (2005) as a Practice Educator who has “mature ethical and clinical reasoning” and who can then explain and impart this clinical knowledge and reasoning to students. Fish and Twain (1997) also see this professional artistry as “quality coming from deepening insight into one’s values, priorities and actions”. McAllister and Lincoln (2005) see professional artistry in this light, coupled with experience and commitment to development and growth as a Practice Educator.
The goals for Practice Educators when developing these skills would be: o Development of clinical expertise
o Development of professional artistry as a Clinical (Practice) Educator. Development of knowledge and skills in education
Practice Educators need to develop knowledge and skills in education in order to do their job effectively. These skills are first developed by the Practice Educator when they are a student completing practice education placements and then developed further as therapists when they engage with students during practice education. In the clinical environment, a therapist is not only educating students but also educates patients, families, peers and members of the multi-disciplinary team. Therefore educational skills are paramount in a Practice Educator’s skill set.
The goal for a Practice Educator when developing this area would be:
o Gaining skills and knowledge in practice education models and techniques.
Development of personal and interpersonal knowledge and skills
In order to have effective and satisfying interactions with colleagues, patients, and students, Practice Educators need to have personal knowledge and skills and excellent interpersonal communication skills (McAllister and Lincoln 2005:18-24).
The goals for Practice Educators in the development of these skills would be: o Extension of self-knowledge and self-awareness
o Extending counselling skills into the area of clinical education o Developing awareness of one’s need for control
o Extension of time management abilities. Development of cognitive skills
Clinical practice and all elements of the Practice Educator role involve using different types of knowledge alongside the application of reasoning skills (both ethical and clinical). In order to achieve this, the goals for Practice Educators when developing this competence would be:
o Articulating both clinical and ethical reasoning processes o Articulating professional knowledge
o Identifying different types of knowledge used in the clinical reasoning process.
McAllister and Lincoln (2005:2-8)
In conclusion the literature would suggest that a strong framework for Practice Educator training and continuing education is not only a necessary driver for quality practice education placement learning experiences for student therapists, but it is also a driver in promoting quality throughout the therapy profession. Such an educational framework should focus on the knowledge, skills and behaviours that a therapist has to fulfil in their role as a Practice Educator. It should particularly focus on the development of clinical, educational, interpersonal and cognitive skills.
Section Two.
Multidisciplinary Practice Educator Competencies
IntroductionThe first step in developing a framework for learning and education required the identification of the skills and competencies needed by Practice Educators. As part of the work of the Therapy Project Office (TPO), three separate teams of the Practice Education Co-ordinators (PECs) (or other nominated individual) from the courses of Occupational Therapy, Physiotherapy, and Speech and Language Therapy were brought together under the respective project manager to work on practice education projects. As part of that work these three teams devised and ratified multidisciplinary Practice Educator competencies. These were then ratified by three professional manager teams working with other TPO projects.
These competencies form a framework which should be used by Practice Educators to help them identify their own educational and learning needs in their professional role, and to guide their own CPD in the area of education and development.
Competency and good Practice Guidelines
Competencies can be defined as “personal traits, characteristics or skills which can be shown to be directly linked to effective performance.” (Boyatzis 1982)1
This competency framework also includes guidelines for good practice to aid in achieving the competencies. They should also facilitate Practice Educators in recognising their achievement of individual competencies. The multidisciplinary Practice Educator competencies are divided into the five areas of:
Educational competencies
Assessment / evaluation competencies Professional practice competencies Supervision competencies
Management and administration competencies
A full outline of the Practice Educator competencies and corresponding good practice guidelines are included below in Tables 1-5.
Table 1: Education Competencies
The Practice Educator demonstrates the ability to:
Competencies Guidelines for Good Practice
Understand learning styles Understand individual differences in processing and learning styles
Apply knowledge of learning styles to student practice education processes Demonstrate familiarity with learning styles and an understanding of how ones
own learning style interacts with other learning styles
Understand models of practice education Understand a range of models of practice education. E.g. 1:1 model, 1:2 peer learning model, group etc.
Show an understanding of teaching styles, such as reflective learning, problem based learning etc.
Create a positive learning environment for students Structure the placements to optimise student learning while maintaining a quality service to clients
Use all available resources to promote the student’s professional development
Table 2: Supervision Competencies
The Practice Educator demonstrates the ability to:
Competencies Guidelines for Good Practice
Educate, monitor and mentor students Establish and maintain an effective working relationship with the student
Present clear performance expectations initially and throughout the placement appropriate to level of practice
Organise initial planned learning; goal setting and be able to re-evaluate in collaboration with the student
Identify students competency level, learning goals and supervision needs
Prepare the student as appropriate for clinical practice
Assess and identify each individual student’s supervision needs Anticipate and prepare student for challenging situations as appropriate Match student competency levels to direct and indirect clinical demands
Table 3: Assessment/Evaluation competencies
The Practice Educator demonstrates the ability to:
Competencies Guidelines for Good Practice
Assess the student fairly
Use the student assessment tool accurately to measure student’s performance based on objective information (e.g. direct observation, discussion with student, review of student’s documentation etc.)
Encourage student development and learning Involve and encourage the student in self reflection and self assessment using formal and informal evaluation sessions
Use evaluation processes to counsel students on strengths and opportunities for development
Table 4: Professional Practice competencies
The Practice Educator demonstrates the ability to:
Competencies Guidelines for Good Practice
Develop all clinical practice skills of the student Assist students in developing and refining clinical practice skills in conjunction with the Practice Education Team
Facilitate the development of clinical reasoning Demonstrate strong clinical reasoning
Facilitate effective clinical reasoning in students Guide student’s integration of theory and practice
Guide student’s integration of therapeutic concepts and skills, and encourage reflective practice
Facilitate documentation skills Use documentation format and requirements in accordance with local and professional guidelines
Demonstrate an ability to train students in the use of clinical recording processes Incorporate legal, ethical and professional issues that influence
practice
Implement legal and professional guidelines that influence practice (e.g. confidentiality, role delineation etc.)
Implement the philosophies, policies, protocols and clinical guidelines of the service provider
Deliver service in line with professional standards of practice and the professional association guidelines
Adhere to professional practice standards and the code of ethics of the professional association
Maintain own CPD in the area of practice education Assume responsibility for, and pursue professional development to expand knowledge and skills
Be a model of professional conduct and behaviour Demonstrate appropriate professional conduct and behaviour at all time
Table 5: Management/Administration competencies
The Practice Educator demonstrates the ability to:
Competencies Guidelines for Good Practice
Communicate and collaborate with the practice education team Establish effective communication links with the practice education team when appropriate
Induct student effectively Provide pre-placement information to facilitate advance student preparation Provide complete orientation of student to placement site
Inform student of mission, goals, philosophy and standards of organisation / service
Set out an organised and systematic placement programme
Manage time effectively Effectively balance own caseload and the student’s learning needs Manage own time efficiently and encourage student in developing time
management skills
Complete and distribute in a timely manner all student evaluations, including but not limited to the mid / final evaluation
Develop student clinical management and prioritisation skills Assist the student in developing and refining clinical management and prioritisation skills
Implement quality improvements Encourage ongoing evaluations of the student’s placement / education along with the practice education team
Survey of current HEI Practice Educator training in Ireland.
Introduction
Following the developing of Practice Educator competencies, the current level of Practice Educator education and training was explored.
Aim
A survey was carried out with the aim of collecting information on the Practice Educator courses that are currently being provided by the HEIs in the Republic of Ireland.
Methodology
In order to collate this information Questionnaire A (Appendix 2) was sent to the Practice Education Co-ordinators (PEC) of each of the courses of Occupational Therapy, Physiotherapy and Speech and Language Therapy in the Republic of Ireland. As some of the courses did not have a PEC in situ at the time, the Department Head was asked to nominate another staff member to responds to the questionnaire. The data was a mix of qualitative and quantitative data, and any clarification (if needed) was obtained by a follow up phone call to all concerned.
Current training in Ireland
GeneralFrom the questionnaire it was clear that all Therapy Courses are providing practice education and training for Practice Educators who facilitate their students on placements. The majority of the Therapy courses provide training as annual education days on practice education topics that are requested formally via feedback forms etc. or informally by the Practice Educators. Most of these courses are organised and run by the Practice Education Co-ordinators in conjunction with the Practice Tutors and Regional Placement Facilitators and generally are run as uni-disciplinary courses for their own Practice Educators. Most Therapy courses provide this annual training / education on a “first come first served” basis and also use this forum to identify any further Practice Educator education needs.
The topics covered in these courses change each year and there is no formal follow-on through the courses. Recently, courses have being changing this practice and some of the new Therapy Courses have had a different structure in place from the onset. They are aiming to run courses each year at both basic and intermediate/advanced level. The basic Practice Educator course would repeat common themes whereas the topics on the intermediate /advanced one day course change to meet the needs of the more senior Practice Educators.
For a broad outline of Practice Educator training provided see Appendix 2. For an outline of the topics covered in these Practice education and training days see Tables 6, 7 and 8 below for each therapy course under the three disciplines.
Table 6: Content of the current HEI Physiotherapy Practice Educator courses
Physiotherapy Practice Educator courses
TCD UCD UL Basic & Adv
RCSI
Supervision principles and responsibilities * * *
Communication skills * *
Assessment skills, form, pass / failing criteria. * * *
Learning styles * * * *
Teaching methods * * * *
Coaching and mentoring * * *
Giving feedback *
Peer learning *
Dealing with underperforming / excelling students
*
Clinical and EBP updates * *
Creating a positive learning environment *
Learning contracts & objective setting *
Curriculum- practice education components *
HEI policies and procedures for PE *
University philosophy * *
Table 7: Content of the current HEI Speech and Language Therapy Practice Educator courses
Speech and Language Therapy Practice Educator courses
TCD UL NUIG UCC
Supervision responsibilities * * * *
Communication skills * * * *
Criteria for passing and failing students * * * *
Learning styles * * * *
Teaching and learning methods * * * *
Coaching and mentoring skills * * * *
Course structure and education programme *
Information regarding college systems *
Problem solving and contracting skills *
Feedback and problem-solving *
Overview of curriculum *
Problem-based learning. *
Table 8: Content of the current HEI Occupational Therapy Practice Educator courses
Occupational Therapy Practice Educator courses
TCD UL NUIG UCC
Supervision responsibilities * * * *
Communication skills including feedback skills * * * *
Assessment skills and use of assessment tool * * * *
Criteria for failing & passing students * * * *
Learning styles * * * *
Teaching & learning methods * * * *
Coaching and mentoring * * *
The curriculum and students learning * *
Different models of supervision. * *
Clinical teaching skills *
Input from students on their experience of PE * *
Setting learning objectives * *
Use of a learning contract * *
Giving and receiving feedback * *
Multi-disciplinary
More recently, Colleges have started running regular multidisciplinary Practice Educator courses.
The University of Limerick (UL) provides a multidisciplinary programme for its Practice Educators. They run a one day basic multidisciplinary course that covers topics such as adult education, learning styles, giving feedback, developing communication skills and coaching the student etc. This course is run biannually for therapists from all three disciplines who wish to take students or are currently taking students.
The College also runs an advanced one day course for therapists once they have completed the basic course. The course content changes from year to year and is based on feedback from Practice Educators. Topics include supervision, communication skills, assessment skills, criteria for passing and failing students, learning styles, teaching and learning methods and coaching & mentoring.
In parallel with this each of the three Therapy Departments also run a single disciplinary course for Practice Educators. Course content would cover such topics as the college curriculum, the use of assessment forms, supervision policies and procedures around the practice education of students which may be unique to that individual course.
The National University of Ireland Galway (NUIG) has also a multidisciplinary course for Practice Educators from Occupational Therapy and Speech and Language Therapy. The areas covered in this course are assessment processes, giving and receiving feedback etc. delivered over three days by an external lecturer. The structure of this course is developmental in that Practice Educators must complete day 1 before they can move to day 2 and must have completed the first two days before progressing to day 3. This has been delivered twice to date and on both occasions feedback has been positive. Funding has now been confirmed to continue this course over the next three years. The multidisciplinary element in particular came in for a lot of praise. Practice Educators enjoyed the sharing of ideas and the development of a support network of Practice Educators outside the constraints of professional boundaries. As the Irish Health Care system evolves it is seen that it is important to have a multidisciplinary attitude to Practice Educator support. This approach promotes the development of informal networks and that the all important “support / input of colleagues” which was identified by therapists as a key way of developing Practice Educator competency can be extended to include colleagues in other disciplines.
As part of Practice Educator training, the Department of Occupational Therapy in University College Cork (UCC) runs a two day single discipline Practice Educator workshop. As a follow-on to this they support those educators who are interested in studying further to do two modules from the faculty’s multidisciplinary Masters in Advanced Healthcare. These two modules are:
“Thinking, reasoning and reflective practice”
“Educating for professional development in practice.”
If a Practice Educator completes the UCC two day workshop and these two specified Master modules they become an “Accredited Practice Educator”. Practice Educators can
also gain transferable credits for these two modules, and if they wish to proceed with further education they can complete the full Masters programme or progress to doctorate level.
Post Graduate Courses
Following on from the example of UCC, other Therapy Courses are also linking practice Educator education in with their post graduate programmes. In NUIG the Occupational Therapy and Speech and Language Therapy Departments link in with the University’s post graduate Diploma in Clinical Education which is co-ordinated by the School of Medicine. This post graduate course is open to all health care professionals and offers Practice Educators a diploma and masters option if they wish to take their practice education training further.
New Developments
Up to this year the Physiotherapy Department in University College Dublin (UCD) has run a standard one day Practice Educator workshops as outlined earlier. Currently a programme in clinical education is being developed in conjunction with the Centre for Teaching and Learning. It is planned to roll out this course over the academic year of 2008-2009. The course will include induction days outlining the practice education procedures and policies for practice education placements. After participating on these induction days, Practice Educators may wish to then carry on to the certification or diploma course. The induction days would count for credit towards these post graduate courses. The plan is to offer this as a two year post graduate diploma. After the first year a Practice Educator can obtain a post graduate certificate and after completing year two, they can achieve a post graduate diploma. The structure is that there would be a combination of lectures, problem based learning, on-line learning and group work. The focus in each semester would vary from emphasis at first on teaching, learning theories and assessments in semester one to models of supervision and their assessment in semester two. Competencies, expectations and becoming a reflective practitioner would be looked at in more detail in year two.
At present this new programme is still in the planning stage but should have final sign off to run in 2008. The plan is to have the first year of the programme specifically aimed at Practice Tutors (who are recently in post). It is hoped that the following year the same
module will be open to all Practice Educators or members of the extended practice education team as the standard Practice Educator education programme for the Physiotherapy Department in University College Dublin. All educational days and modules completed will have European Credit Transfer credits assigned. These can then be carried and added to credits for Higher Diplomas or Masters if a Practice Educator wishes to do so.
Other Educational / CPD opportunities offered
All of the HEIs are involved in the organisation and provision of continuing professional development (CPD) opportunities and professional support for therapists which are not directly related to practice education. For example, clinical updates and evidence based practice opportunities that are offered to therapists to develop their clinical skills in recognition for their contribution to the practice education of students.
In Occupational Therapy the four courses also offer a range of CPD courses and opportunities for practicing therapists. These to date have covered such areas as evidence based practice, reflective practice, designing learning environments, clinical reasoning Occupational Science, models of Practice, ‘Reading, writing and engaging in research’, report writing, opportunities to attend student research presentations, practice skills and educational facilities for university staff to provide customised onsite teaching and learning supports.
The Physiotherapy Department in Trinity College offer other CPD opportunities not directly related to practice education such as on site in-service training. The Physiotherapy Department in the Royal College of Surgeons (RCSI) offer Practice Educators access to library, e-journals and online databases. The Physiotherapy Department in the University of Limerick offer a number of clinical study days, a research seminar and a student final year project poster presentation day. Some courses offer Practice Educators a chance to lecture on the undergraduate course, and to give practical demonstrations / lectures also.
In Speech and Language Therapy the individual colleges offered workshops and study days on various topics relevant to the profession.
HEI methods of identifying Practice Educator training needs
The identification of training needs is done in a variety of different ways by all of the disciplines. Some send out surveys to their Practice Educators, managers and tutors.
Currently in Occupational Therapy, the main method of identifying the learning and education needs of Practice Educators is via direct communication with the Practice Eduation Co-ordinators and with the other members of the practice education team. Site visits were particularly mentioned. Course evaluation forms and feedback questionnaires are also used. The Occupational Therapy Department in Trinity College have put a ‘partnership committee’ in place at which the views and needs of Practice Educators can be articulated.
In Physiotherapy, needs are identified formally through questionnaires before during and after Practice Educator courses and study days, and informally through discussions with Practice Educators, Practice Tutors, Regional Placement Facilitators, placement provider managers, students etc.
In Speech and Language Therapy, Practice Educator’s training needs are currently identified through feedback questionnaires, annual supervisory meetings, through ‘Clinical Steering Committee’ or through feedback from Speech and Language Therapy line managers.
Survey of Current Practice Educator Learning and Learning Needs
Introduction
After having devised Practice Educator competencies and collecting information from the HEIs on all the Practice Educator education and training provided, the next step was to get feedback from the Practice Educators themselves.
Aim
The aim of this survey was to identify Practice Educators current level of Practice Educator education and training and to elicit their views on their own education and training needs.
Methodology
In order to identify what Practice Educators identified as their learning needs, questionnaire B (see Appendix 3) which was made up of mostly open ended questions was sent to a sample of Practice Educators across the three disciplines of Occupational Therapy, Physiotherapy and Speech and Language Therapy. The total response rate was N= 258 (see Appendix 4 for further break down of methodology).
Results Profile
From the sample in this survey, it is found that the majority of therapists taking students are a minimum of five years qualified (81%). This profile was similar across the three professions (see Table 9 below).
Table 9: “How many years of practice have you completed?”
% < 2 years 2 – 4 years 5 – 10 years >10 years
Did not answer
OT 7% 15% 40% 38% 0%
PT 0% 16% 46% 35% 4%
Practice Educators were asked how many years they had been taking students. The results indicated a relatively even spread of those with a small amount of experience up to those with more than 10 years experience of having taken students (See Table 10 below).
Table 10: “How many years have you been taking students?”
% < 2 years 2 – 4years 5 – 10years > 10years Did not answer
OT 26% 28% 24% 19% 2%
PT 19% 39% 28% 11% 4%
SLT 18% 26% 36% 20% 0%
In this survey Practice Educators were asked to give the number of HEIs that are offered practice education placements by their department / service. This is relevant as different HEIs offer different training courses and may have different requirements for their Practice Educators particularly with regard to student assessment. 51% of Physiotherapy Practice Educators surveyed take students from just one college with 45% taking students from 2 or more colleges. In Occupational Therapy 37% of Practice Educators take students from one HEI with 61% taking from two or more HEIs. In Speech and Language Therapy, the figures are similar with 36% taking from one HEI and 63% taking from two or more. (See Table 11 for further break down below).
Table 11: “How many HEI’s does your department provide placements for?” % 1 HEI 2 HEIs 3 HEIs 4 HEIs 5 HEIs1 Did not answer
OT 37% 36% 20% 5% 0% 2%
PT 51% 26% 5% 5% 9% 4%
SLT 36% 38% 17% 8% 0% 1%
What is Essential Learning for Practice Educators?
The respondents were asked what they considered to be essential learning for a Practice Educator. The main areas that were listed are:
Knowledge of course structure and curriculum Student assessment
1There are currently only 4 courses of Physiotherapy, Occupational Therapy and Speech and Language
Therapy in the Republic of Ireland. The resources and structures discussed in this document are only there to support the students from these colleges. Any students taken from outside this jurisdiction are at the discretion of the placement provider and fall outside these resources and structures.
Teaching skills Good communication
The ability to manage feedback.
Further responses are outlined in Table 12 below.
Table 12: “What do you consider to be essential learning for a Practice Educator?”
(The top three for each profession are in italics)
OT% Physio% SLT %
Knowledge of course structure and
curriculum 11 4 11
Student assessment procedures 11 13 7
Supervision skills 8 0 5
Teaching skills 5 7 8
Current evidence based practice through
CPD 5 7 6
HEI Expectations of the placement 5 1 7
Giving / receiving feedback 5 8 11
Learning / teaching styles 4 7 7
Managing a weak / excelling student 4 3 1
Goal / objective setting for placements 4 4 1
Communication skills 4 8 1
Personal knowledge, experience or
competence in the training area 3 7 5
Time management skills 3 4 2
How to handle conflict / difficult situations 2 6 3
Problem based learning skills 1 0 5
In addition to these essential areas of learning, Practice Educators were asked to list what other elements would contribute to their competency. These elements included:
Further evidence based practice (EBP) updates and advanced clinical courses Information on learning contracts
The Practice Educators also list getting further experience with students as a contributing factor to developing their competency, along with access to more resources and further support from peers and HEIs.
Student Assessment
Information relating to student assessment forms and competence in student assessment was identified by therapists as being essential learning for a Practice Educator. As seen
already, a high percentage of Practice Educators across the professions take students from more than one HEI and therefore need to be competent in the use of more than one assessment form. This is not necessary in Physiotherapy as a common assessment form has been developed by the four HEIs. This form is currently being piloted. As part of the work of the Therapy Project Office, a common assessment form has been agreed across the four disciplines of Speech and Language Therapy which will be piloted in Spring 2008. The questionnaire sought to identify if the Practice Educators had been trained in all student assessment forms that they use.
Chart 1: Training in Assessment Forms Used1
Assessment Form Training
0 10 20 30 40 50 60 70
All Forms Some Forms No Forms Did not answer
% o f The ra pi s ts OT PT SLT
Across the three professions, less than 50% of Practice Educators are trained in administering all the forms they use. (Chart1: Occupational Therapy = 64%, Physiotherapy = 51%, Speech and Language Therapy = 24%, Multidisciplinary = 49.3%). This result may be influenced by the small number of practice education placements that are provided to students from a HEI outside of the Republic of Ireland. Even so this lack of consistency in training has obvious implications for maintaining the standard and quality of assessment using these forms. However, despite inconsistent training in the use of assessment forms the majority of therapists surveyed reported feeling confident completing a student practice education assessment form (Occupational Therapy: 75%, Physiotherapy: 80%, Speech and Language Therapy: 60%).
1 Please note that despite the fact that there is now one common practice education assessment form in
Physiotherapy it was only being implemented when this survey was sent out (May 2007). Up to then Physiotherapists were still using the four separate forms and this is reflected in the answer to this question. From September 2007 one form is now used.
Training in Practice education models
Over the past number of years a lack of capacity in practice education placements has led to requests for Practice Educators to take more than one student at a time. It would appear that the experience of taking more than one student at a time is more prevalent in Speech and Language Therapy with 65% taking more than one student at a time (see chart 2). This is closely followed by Physiotherapy with 51% and finally OT at 25%. Chart 2: “Have you as a Practice educator supervised more than 1 student at a time?”
Of the therapists who have supervised more than one student at a time (those who had answered “yes” in Chart 1), the majority reported that they have not been trained in the peer learning, or 2:1 model, (Occupational Therapy = 85%, Physiotherapy = 69%, Speech and Language Therapy = 56%). See Chart 3.
Chart 3: “Have you as a Practice Educator been trained in peer learning / 2:1 model or any other peer learning model”
Trained in Peer Learning / 2:1 Model
0 10 20 30 40 50 60 70 % of The ra pis ts 80 90
No Yes Did not answer
OT PT SLT OT STL % o f Practice Ed u cato rs
Did not answer No Yes 60 70 20 30 40 50 0 10
Other ways of developing competency
When Practice Educators were asked what other ways of learning had been beneficial in developing and maintaining their competency, ‘Input / support from colleagues’ was identified by a large percentage of therapists across the three professions. In addition, ‘being supervised’, and maintaining CPD were also mentioned (see Table 13.)
Table 13: “Aside from attending a university lead course what ways of learning / other courses have been beneficial in developing and maintaining your competency as a Practice Educator?”
OT% PT% SLT %
Input / support from colleagues 32 27 43
Being supervised and getting feedback 7 18 4
CPD 15 12 12
Working with and within the MDT 1 11 2
In-services 5 11 0
Experience or knowledge 10 4 6
Supervising others 4 3 1
Feedback 7 2 8
Section Three
Section Three Introduction
The aim of this report was to identify competencies and training requirements for Practice Educators, across the three professions. The discussion that follows below, draws on the information gathered in the two surveys and reviews it in relation to the Practice Educator competencies and current literature on education and training for Practice Educators. Based on this review, a framework for Practice Educator education and training in Ireland as recommended by the Therapy Project Office is outlined. This is followed by recommendations for the implementation of such a framework.
Development of the Practice Educator
McAllister and Lincoln (2005) as discussed already, outline that the provision of education for Practice Educators must meet the following goals:
Continuous development of clinical knowledge and skills Development of knowledge and skills in education
Development of personal and interpersonal knowledge and skills Development of cognitive skills.
(McAllister and Lincoln (2005:2-8) They also refer to four stages of Practice Educator professional growth:
Novice educator
Advanced beginner Practice Educator Competent Practice Educator
Professional artistry as a Practice Educator.
Within this developmental framework, the role of the Practice Educator is constantly evolving. This evolution in the Practice Educator role is achieved through the knowledge gained from hands on experience with students and is underpinned by education and reflection. The education and reflection needs of Practice Educators at the various levels are very different and should be supported accordingly for each level.
Proposed Delivery of Practice Educator Education and Training
As outlined earlier in this report, the standard structure for practice education has been a once or twice yearly educator day, with topics varying. A systematic approach which allows for a progressive continuum along which to develop these skills is called for. This is instrumental for the development of educators from novice to expert.
With the development of the Irish practice education structure and the current practice education teams there now exists the potential to address Practice Educator education and training needs in a more structured and organised way, at Department level, HEI level, and regional and national level. Even since the authors began collecting the information for this report (from January to November 2007) there has been a new wave of courses developed by the various Therapy Courses. As reviewed earlier, examples of this progression have been mentioned where the various HEIs have begun to address the issue of a staged and structured delivery of educational provision for Practice Educators.
Taking this one step further to a more regional and nationally coordinated level would see enormous economies of scale. A closer look at the various topics delivered in the current courses and analysis of how they could be structured and rolled out in a different manner at a number of levels allows us to see how this could be achieved.
Competencies Addressed by the Current HEI Practice Educator courses.
In order to assess if the current Practice Educator courses were enabling Practice Educators to achieve the Practice Educator competencies as outlined earlier in this report, a chart was drawn up comparing the content of the courses with these competencies (Please see Appendix 5).On reviewing this chart it is clear to see that the content of the current courses broadly1 covers the Practice Educator competency areas. The only areas that are not explicitly covered are professionalism and professional practice. None of the Practice Educator courses address these two areas as such areas should be addressed at a different level by therapy line management or by the Professional Bodies.
1 It must be noted that the HEIs were asked to outline the topics they covered in these courses. The means by
which they taught the modules or the depth gone into was not reviewed. These were they collated and grouped. This information was then used for this report.
Referring back to the survey of current Practice Educator learning needs as outlined in Section Two, Practice Educators were asked what they identified as essential learning for their role. Their responses are outlined in Table 14 below.
Table 14: Essential Learning for Practice Educators
Essential Learning for Practice Educators Knowledge of course structure and curriculum Student assessment procedures
Supervision skills Teaching skills
Current evidence based practice through CPD HEI Expectations of the placement
Giving / receiving Feedback Learning / teaching styles
Managing a weak / excelling student Goal / objective setting for placements Communication skills
Personal knowledge, experience or competence in the training area
Time management skills
How to handle conflict / difficult situations Problem based learning skills
Source: Survey of current Practice Educator learning and learning needs. Table 12 With one or two exceptions the areas outlined overlapped with the topics currently being covered by the Practice Educator courses and with the Practice Educator competencies that were developed. This demonstrates that the Therapy Courses are meeting the needs of the educators on the ground and are delivering the topics that educators have identified as essential learning. (See Table 13). However the level to which they are developing Practice Educator competencies is not clear. It also remains to be seen if these topics could be delivered in a more cost effective way and in a manner better suited to developing these competencies from novice to expert level.
Proposed Course Content
On review of the competencies needed and the content of the current courses provided by the various Therapy Courses, it is clear that all of the disciplines cover topics that can be divided into three parts.
Part 1: Multidisciplinary: topics that are common to all professions
Part 2: Therapy course specific: these are topics that are unique to the individual course but which may have some commonality across the same HEI (i.e. could be common to all the Therapy Courses in the same HEI).
Part 3: Professional education: these are topics that are profession specific, such as clinical updates, professional courses etc.
These topics have been highlighted in the competencies and course content table in Appendix 5.
Part 1: Multidisciplinary Topics In 2005 Higgs stated that:
“Across the health and social sciences we have much more in common when it comes to broad principles and strategies of education and practice development than our differences in terminology would imply”
Across the three professions the needs of Practice Educators are very similar. This came across very strongly in the responses to the two questionnaires used in this project. When the content of the various courses (Tables 6, 7 and 8) was analysed it was clear that there was a great deal of overlap and that the general topics that are outlined below were being covered in the various Practice Educator study days across Occupational Therapy, Physiotherapy and Speech and Language Therapy.
These topics are:
Supervision models and responsibilities Communication skills
Assessment skills - understanding passing / failing students Learning styles
Teaching methods including:
o Problem based learning o Clinical teaching skills
Setting goals / learning objectives and / or learning contracts Coaching and mentoring
Dealing with underperforming / excelling students (this links in with coaching students)
Giving and receiving feedback (positive and negative) Peer learning.
If the same topics are being delivered across the professions then a standard way of delivering these courses warrants attention. A multidisciplinary course structure across the three professions could be put in place to develop Practice Educators from novice to expert. What such a framework would include is outlined later in the report.
Part 2: Therapy Course Specific Topics
Theses are topics that are unique to the school and the HEI where the school is located. These topics include:
Curriculum: structure of the individual school and student standards and levels at the different stages
Therapy course culture and ethos
Therapy course specific / HEI policies and procedures surrounding students failing / passing practice education placements etc.
Therapy course specific / HEI culture and philosophy
Accessing and navigating the HEIs information systems such as the library or on-line learning resources
Information re support from HEI to Practice Educators working with students.
Part 3: Profession Education Topics
Finally there are topics covered that are profession specific and education and training in these could be opened up to Practice Educators within the profession irrespective of which HEI they take students from. Examples include:
Clinical updates
Common Assessment forms (specifically Physiotherapy and Speech and Language Therapy as a common assessment form has been devised in these two professions).
Proposed Course Delivery
The course content as proposed by the Therapy Project Office is split into these parts of Multidisciplinary, Therapy course and Professional specific topics, and the methods by which these topics can be delivered is now discussed.
Part 1: Multidisciplinary
The multidisciplinary topics are areas of knowledge and / or skills that all Practice Educators irrespective of profession should be developing. As all Therapy courses aim to provide these same topics to their Practice Educators it would seem that economies of scale would certainly be achieved if a collaborative approach was to be agreed. At a minimum this could be done at HEI level (2-3 Therapy courses within the one HEI) or at best at national level to devise a set course to develop the skills at the levels needed by the Practice Educator. Such a course with standard topics and in an organised structure could be delivered a number of times a year, in various locations, in order to skill up the Practice Educator irrespective of profession or location.
A multidisciplinary course could be developed collaboratively and delivered in a manner agreed by all the HEIs. Over the past few years, many of the HEIs have already begun to develop multidisciplinary Practice Educator programmes.
A standard structure could give a strong identity to practice education across the professions. Recognition could be given to those who have completed such a standard course. There are many examples of such courses which have been run successfully in Canada and Australia with a recognition process built in (these courses will be discussed later). This is also similar to the preceptorship model which is used to support the practice education of student nurses in the Republic of Ireland. Qualified nurses are expected to complete a standard preceptorship course in keeping with their professional responsibility to student education. These are delivered at HEI level with a standard content and format irrespective of where the course is delivered. Nurses can progress to an advanced preceptorship course at a later stage.
International Examples
The Preceptor Education Programme (PEP) in Canada is a multidisciplinary programme developed in the Faculty of Health Sciences at the University of Western Ontario in conjunction with the Canadian Ministry of Health and Long-Term Care. The topics and format of the Preceptor Education Programme were chosen based on extensive review of existing Canadian preceptor programmes and a survey of clinicians, students and HEI faculty members. The goals of the course are outlined in the module topics below1:
Module 1: Orientation - welcome the student, roles and expectation Module 2: Developing learning objectives
Module 3: Giving and receiving informal feedback Module 4: Understanding and fostering clinical reasoning Module 5: Fostering reflective practice
Module 6: Dealing with conflict
Module 7: The formal evaluation process.
This course is structured to deliver very practical skills to the Practice Educators over a 2 day course. Further education days build on these topics and develop the Practice Educators’ skills and knowledge further.
The Advanced Clinical Education (AEA) in Australia was devised on a multidisciplinary basis and is run across three universities in Melbourne (La Trobe, Deakin and Monash Universities) for all of the Therapy Disciplines. It is run over three days in a block or three separate days over one month and offers a Certificate of Advancing Clinical Education. In order to be eligible for this, participants must complete the three day programme and a self-directed learning element as well. Participants use a learning contract to develop their knowledge or skills in an area of clinical education of personal interest. This multidisciplinary course is appropriate for all allied health and health professionals. The broad lay out of the course is as follows:
Table 15: Curriculum of Advanced Clinical Education (AEA) course, Australia
Module1: Module 2: Module 3:
Preparation and beginning Practice in action Assessment and evaluation The supervision experience
- learning theory
Elements of effective supervision
The process of student assessment
Making clinical reasoning explicit
Culturally sensitive supervision
Challenges associated with assessment of students How context and culture
shape learning
Identifying and managing challenging attitudes and behaviours
The why and how of evaluating the clinical experience
Student characteristics Reflective practice for the clinician and student Planning and orientation
Supervisory styles
Source: http://www.advancingclinicaleducation.com.au/
Part 2: Therapy Course Specific Topics
It is proposed that this section of the overall course would cover a standard list of topics and should aim to give the Practice Educator an understanding of the various policies and procedures (e.g. relating to assessment, failing procedures etc.) and culture of each college. This understanding is very important as all these processes etc. differ from one HEI to another. A standard one day course could run each year for new Practice Educators and for others who wish to update their knowledge.
Part 3: Profession Education Topics.
Professional education topics are generally clinical updates, training days and courses specifically designed to up-skill the therapists in the defined profession. In the past the Therapy Departments in the HEIs have provided such courses in recognition of the role of therapists as Practice Educators and more recently, to contribute to the promotion of a culture of continuous professional development. On a national level, it would be of benefit for the HEIs to collaborate on a programme of professional education topics that could be delivered nationwide. Having a national plan would help to promote ease of regional access to all therapists (irrespective of affiliated therapy course).
Multidisciplinary Practice Education Frameworks
Having considered the three main components of a multi-disciplinary Practice Educator course and having outlined examples of best practice from Australia and Canada, evidence from supporting literature is now explored and will be used to inform the recommendations for a multidisciplinary education framework for Practice Educators that is proposed to meet the needs of Irish Practice Educators.
Professional Development for Practice Educators: McAllister and Lincoln
A structured system to develop Practice Educators though the stages from novice to finally becoming a “professional artist” in practice education as proposed by McAllister and Lincoln (2005) is laid out below. Their system recommends modular learning at each stage which needs to be supported by experiential learning, i.e. students are carefully selected to match the stage that the Practice Educator is at in order to develop the Practice Educators skills. Within the Irish context, such a model could be underpinned by the supporting structure of the practice education teams. If planned and structured correctly, such an approach would develop Practice Educators as well as giving strong recognition to the importance of the role of partnership with the practice education team.1. Professional Development of Novice Practice Educators (McAllister and Lincoln 2005)
Education:
Introductory workshops that cover basic theory and clinical skills of clinical education Goals and expectations of practice education
Expectations of all stakeholders in the process: students, clinical educators, site managers, universities, clients
Planning for placements
Management of placement and learning programmes Models of practice education
Assessment of student performance Giving and receiving feedback Learning styles
Learning process Reflective practice.
Further provision by other stakeholders:
Carefully selected students that match the site and Practice Educator at this level Mentoring and support from the Therapy course e.g. Onsite Practice Tutor or
another very experienced Practice Educator, Regional Placement Facilitator or Practice Education Coordinator
Inclusion in a learning community of Practice Educators
Sharing student placements with more experienced Practice Educators Promotion of reflective practice as Practice Educators.
2. Professional Development of Advanced Beginner Practice Educator
Education:
Intermediate level workshops o Learning from reflection
o Development of personal and interpersonal skills o Refining teacher as manager skills
o Self directed learning- reading and networking.
Further provision by other stakeholders:
More students with different learning needs, different levels of competence.
3. Professional Development of a Competent Practice Educator
Education
Advanced level workshops
o New models and approaches to practice education o Research in practice education
o Evaluate innovate practice
Co-author and co-present papers with HEI staff
Further provision by other stakeholders:
Placement with challenging students who need support or extension Work in partnership with these educators to evaluate teaching and learning
Invited to become involved with cross disciplinary supervision with health professionals from other disciplines.
4. Professional Development of Professional Artist in Practice Education.
Education:
Advanced level workshops
Undertake higher degrees in practice education Supported to initiate research into practice education
Advocate for the importance of quality practice education to the future of our profession
Heighten awareness and responsiveness to gender, culture and socioeconomic variables.
Further provision by other stakeholders:
HEIs invite the Practice Educators to:
Develop, prepare and run programmes for Practice Educators Provide leadership in multidisciplinary Practice Educator education Become resources / mentors for peers
Become consultants to university programmes and clinical co-ordinators
Hold formal university or professional association consultancy, committee roles or policy development.
Lincoln and McAllister (2005) also strongly advocate that this type of structure be supported by improving the status and recognition of Practice Educators. Practice Education should be afforded more status within the HEIs, workplaces, the Professional Bodies, and amongst Practice Educators themselves. The recognition of the transferability of these skills to the general work of patient care should also be stressed.
