Beyond CompetenceDr Anja Timm

Senior Research Fellow in Medical

Education 20 June 2012

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Beyond competence: enabling and inspiring healthcare students to engage confidently with the transition from classroom to workplace learning

£200k

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August 2010 – October 2012

Audiology Medicine Nursing

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Researchers

Stuart Ekberg – Southampton

Alison Ledger – Leeds

Regina Karousou - Southampton

Faith Hill – PI Southampton

Trudie Roberts – PI Leeds

Anja Timm - Project Manager

Sue Kilminster – Co-investigator

Project Team

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Project Purpose

1. To increase the knowledge and understanding of:– the changing context of clinical placements– the transition from classroom to workplace– the student experience

2. To develop, produce & disseminate advice & resources for:– students– teaching staff – HEIs – the NHS & others– professional bodies

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Data Collection Methods• Qualitative fieldwork:

– Interviews with placement coordinators & clinical leads

– Individual interviews with students

– Focus group interviews with students

– Self-report diaries / online blogs

• Quantitative study:

– Questionnaire administered to two cohorts

Preliminary analysis of the quantitative data from the survey

Survey focus

Students were asked about:

•Your current or last placement

•Problematic aspects placements

•Thinking back to your first placement

•Demographic information

The survey was anonymous, but students were asked to self-disclose their name and contact details if they wanted to participate in a prize draw (£100 for Amazon Vouchers) or take part in workshops for student resource production. 8

Survey at Southampton• Development: February to March 2012

• Ethics approval granted: April 2012

• Live for six weeks / ended 30 May 2012

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Population Participants Response rate

Audiology(Y3 and Y4)

50 32 64%

Medicine 271 134 49%

Nursing 382 196 51%

Total 703 362 51%

Q4 Did you feel part of the team?

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Suggestions for including students in the team (audiology)

• Introducing students to all staff members during induction

• Providing students with access to departmental protocols

• Including students in staff meetings

• Inviting students to social outings

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Q6 Did any of the following hinder your workplace

learning? Total (362)

Limited availability of clinical teacher 48%

Absence of clinical teacher 43%

Lack of constructive feedback 33%

Staff not identifying learning opportunities 33%

Lack of responsiveness to your level / needs 29%

Differences between workplace-practices and university-teaching (skills / behaviours etc.) 27%

Lack of suitable patients 23%

Teaching approach 21%

Communication difficulties 13%

Did not experience any problems 20%

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Q6 Did any of the following hinder your workplace

learning?

Audiology

Limited availability of clinical teacher 44%

Differences between workplace-practices and university-teaching (skills / behaviours etc.) 34%

Lack of constructive feedback 31%

Staff not identifying learning opportunities 28%

Lack of responsiveness to your level / needs 25%

Did not experience any problems 22%

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Hindrances (audiology)• At the beginning sometimes other staff have to take

over because of time constraints.

• I don't feel as though I was hindered. However, I feel my clinical experience may have been limited by being placed only in smaller placement centres who don't have the facilities for certain appointment types.

• Limited working space in the department - lack of organisation

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Problems / suggestions (audiology)• Structured 'study afternoons' would be helpful.

• One of my supervisors talked as little as possible and usually only to correct when I had done something wrong. It would have been nice to discuss the appointment beforehand and agreed on a plan of action. It would also have been good to practice a procedure (for example go through unfamiliar software) first without the patient present.

• Placement supervisors need to be more responsive and adaptable for each student and not run the timetable as they always have done. Sometimes students need more/less observation time.

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Q8 Thinking about all your placements, have you witnessed or experienced any incidents of bullying or harassment either towards yourself or other people? (bullying or harassment refers to something happening which is unwelcome, unwarranted and causes a detrimental effect).

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all respondents

In Audiology, there were five out of 32 students who responded by either saying yes, or prefer not to answer.

Q14 How confident did you feel about…• Knowledge (scientific / theory)

• Knowledge (practice-based / clinical)

• Patient contact

• Clinical environment

• Policies and regulations for students on placements

78%

66%

40%

47%

50%

17Disclosing student status

Student quotes from interviews - Audiology

I’m also, more than anything, finding out that we get to see the emotional impact on a patient when you find out, oh dear, this patient doesn’t actually want hearing aids, what do you do next? We’re not taught that in a wet lab session of course, you know, you’ve just got a dummy in front of you and you talk to it. (Rakesh)

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I think actually when you get to a department and you don’t know anybody and you’ve just about figured out where the toilets are and where the tea is, and then you sit there thinking, “What should I be doing?” and they’d go and look at me and think I’m not doing anything. I think that’s quite tough. And yet what can you do? You don’t know where anything is, you’ve got no experience. You don’t want to suddenly volunteer to take on something and then they say, “You shouldn’t have been doing that.” So actually I think, to settle in, to be given something to do straight away is quite good. (Jennifer)

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...people didn’t necessarily like having a student with them, because it was almost – it was inevitable that you were going to overrun. Because when you get more competent at things then you start to cut corners, so all the fully trained audiologists, they know how to do things, without compromising patient care, but they can do things a lot quicker. Whereas I’m sat there doing a hearing test exactly how I have to, because otherwise if you don’t then they’re like, “Oh you didn’t do this properly,” and, “Well I know, but look what time it is.” So that got quite stressful sometimes. (Erin)

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The data set as a whole • Overall, the dataset is congruent in that the

quantitative work mirrors the concerns raised as part of the qualitative research phase.

• Whilst the interviews clearly identify an issue in that female audiology students experience unwelcome touching by patients – this is not borne out by the survey results.

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Key issues for audiology students Induction could be more student-centred

It can be tricky to negotiate conflicting ways of practicing audiology as well as the gap between theory and practice.

Protected time to learn / study is being eroded

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A couple of questions for you:

• Where should we be disseminating this information?

• What format might work best for you and your colleagues?

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Beyond Competence website(s)

http://www.southampton.ac.uk/medu/research/education_research/beyond_competence/index.page

This site provides information and in due course, you will be able to access our reports, recommendations, etc.

In addition, we are in the process of producing student resources based on our research. Student resources will be hosted on a dedicated website (just for students), which is currently under construction.

Contact details: A.Timm@soton.ac.uk / 02380 599659

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