Transcript Practice-based Learning & Higher Education : Let the learners ‘lead the way’ – re-introducing independent learning & development. Nick Rowe - Institute.

Practice-based Learning & Higher Education :
Let the learners ‘lead the way’ – re-introducing independent learning & development.
Nick Rowe - Institute of Health & Community Studies, Bournemouth University – U.K.
iICS
Institute of Health &
Community Studies
[Case Study]
EBP = E.B.H.C. ∂ E.B.M.
I-P W
Step 3 : Develop From
Established Principles
Multi-disciplinary Working & Education
In Healthcare
Having established that both Higher Education, Clinical and
Professional Practice were now ‘on the same side’, the initial
issues of concern were quickly resolved:
Evidence-Based Practice, delivered by an Inter-Professional
Workforce = a system of Evidence-Based Healthcare that
supports the delivery of Evidence-Based Medicine
Is this OK … ? [ ‘This is OK because it follows the current
guidelines, published by …’]
How deep should the student go … ?
[‘The first year student requires a solid understanding of the
basic concepts of … upon which, their future practice can be
developed. You can determine this by …’]
Stimulus
Theory – Practice … c’est quoi ?
[‘My experience and opinion is valuable, but I need to measure
and account for it. – Information that supports me might be
found at …’]
Common Questions From Assessors ~
Is this OK … ?
H.E. – I don’t understand …
[‘In fact – many of the basic principles are comparable to
professional practice. Once you see past the ‘jargon’, then you
can work-out the ‘bells & whistles’ for yourself … It helps to
have some help with the paperwork though.’ ]
[ Related to … ?]
How deep should the student go … ?
[In regards to what exactly ?]
Theory – Practice … c’est quoi ?
[Where is YOUR evidence-base ?]
H.E. – I don’t understand …
[Are staff familiar with Higher Education ?]
Practice Assessors (PA) of 3 NHS Trusts involved in the
delivery of the Dip HE Operating Department Practice (ODP)
programme, expressed on-going difficulty in establishing the
suitability, depth and academic level of evidence, as required
for the assessment in practice of student ODPs at level C and
level I. This was formally raised at Strategic Health Authority
(SHA) Practice Assessment Meetings, and again at
programme Learning Facilitators (LF) Meetings of throughout
the year.
Set requirements for the assessment and mentorship of
students are published at both local (programme) 1 and
national (governing body) level 2, with support given from
the academic institution 3, yet approaches remain
inconsistent and detrimental to both student welfare and the
academic process.
Re-evaluation of student work by the academic institution
has previously resulted in students failing to achieve
evidenced competency in practice and was the stimulus for
change, reflected in this case-study. An urgent address of
the issue was undertaken, with a view to highlighting the
issues of evidence-based practice assessment and the
formulation of long and short term measures to prevent a reoccurrence of student non-achievement (as a result of
failures within the assessment process).
This work looks to highlight the need for change in relation
to the events that occurred, and illustrates the collaborative
approach taken with Partnership Institutions, to inform staff
and improve the assessment process. Linked issues of
Professional Development, Evidence-Based Practice and
Higher Education were also considered.
Approach Methodology & Design
Retrospective linked questioning helped to establish the
locality, process and involvement of the problem, relative to
its initiating incident. Analysis of current core documentation
relating to the Nursing and ODP professions was undertaken
to establish the professional and working requirements of
each group. Topical academic consultation was sought, in
conjunction with healthcare providers. The search strategy
for information was conducted by accessing a variety of
databases (BNI, Blackwell Synergy, CINAHL, MEDLINE) in
relation to Nursing and Allied Health Professions. This was
widened to include the British Education Index, and
supplemented by manual meta-search engine employment
(Ixquick). Key words relating to the identified issues were
entered. Results were filtered and appropriate results
accessed and reviewed. Manual review of institutional
resources and personal texts was also employed. Nonstatistical review of Likert Questionnaire provided feedback
for the single placement study (500 bed District General
Hospital) and indication for future development.
Contributory factors of the issue constructed the
following lines of enquiry:
1.
Scope of application within professional body
publications: What are the requirements concerning
practice assessment, and are they being met ?
2.
Definitions of competency and evidence: Is there a clear
understanding of the basic pillars of healthcare
placement assessment, and of the associated academic
& clinical descriptors currently employed ?
3.
Is the requirement for evidence-based practice evenly
applicable to pre and post registration development,
and how does it relate to assessment practice ?
References:
1
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It’s about getting from here … to there .
Shared values ?
In considering the key principles of Higher Education, it
has been identified that:
• It will have a theoretical underpinning,
• It will be at a level which would qualify someone to
work in a professional field
Communication & Process
The Education Provider (University) had no
jurisdiction in the placement area, other than in a
partnership advisory role. As such, access to the
staff concerned had to be secured, and a mutually
acceptable change process found.
Considering the development of independent learners,
it has been expressed that ‘we do not use assessment
as well as we might, and tend to assess the product
rather than the process’ 10. This is perhaps reflected in
the range of questions raised by assessment staff, in
relation to the case concerned. In order to work and
learn independently (as outlined by the requirements of
Higher Education and the published standards of the
professions concerned), then the aims and objectives of
the process needed to be fully understood, in order for
the concepts to be applied to specific clinical or
educational issues.
Comprehension often relies upon good communication
11. The challenge lay in ‘translating’ the required
elements of both professional practice and Higher
Education into a shared language, and finding a means
of access and delivery to the workplace. Concerns
tended to be focussed upon the language used in
Higher Education, and a need for ‘concrete’ answers to
assessment questions (which remain variable in relation
to knowledge, experience and specific circumstances).
Comparison of the events (and opinions) surrounding
the initiating incident and the available guidance and
literature, highlighted that there were fundamental
flaws in the understanding and application of
professional & educational practice.
This provided the focus for addressing the issue at
workplace level.
Step 1 :
Remove the
Jargon
Jargon:
• noun . words or expressions used by a
particular group that are difficult for others to
understand.
Feedback and Communication
(Single Placement Case-Study Only – 12.04.07)
Following the session, a Likert-Scale questionnaire was
administered to participants by their Education Co-Ordinator,
with collated results being fed-back to the education provider.
• Strong agreement (83%) was expressed by the sample
group in regard to the content and administration of the
session, although there was initial doubt expressed as to the
need for practice to be examined.
• It will usually be taught in an environment which also
includes advanced research activity. 4
The system of assessment in question required an
evidence-based approach, in that any learning or
assessment outcome that met the required levels of
proficiency, was required to be supported by
demonstrable evidence that indicated how the outcome
was achieved 5 . This also links to the on-going
requirement for practitioners (Nursing6 and ODP7) to
have an evidence-based approach to clinical practice,
as outlined by the NHS Executive (1996)8, and as a
component requirement for professional registration
(NMC 2004 6), (AODP, 2003 9). Whilst specialist
healthcare practice has a wide practical application and
retains many of its vocational traits, the development of
demonstrable evidence, is a key requirement of
professional practice.
Final consensus concluded that the ‘paperwork’ was not in
fact, the main concern; rather, demonstrating the underlying
principle. (Students) and staff were subsequently able to
achieve this by mutually accessing auditable evidence and
independently validating their rationales for practice and
theory.
Both the clinical placement and the education
provider were familiar and in agreement with the
requirement for staff currency, so an existing Mentor
Update format was chosen as a means of accessing
the workplace environment. A group examination of
related current standards of Education, Assessment
and Professional Conduct, enabled a clear
framework of acknowledged obligations to be
identified. Many of these were directly applicable to
the range of issues, as identified in the research
lines of enquiry. As such, it was possible for
assessment staff to relate the requirements of their
own Codes of Conduct, to the wider aspects of
professional support and development.
Step 2 : Find Common
Ground
Professional ‘Codes’ extend beyond clinical
applications into the basic framework of society, as
do the concepts of ethics and accountability, yet (not
uncommonly 12), many of the staff concerned did not
feel empowered to make rationalised arguments in
order to meet their role requirements.
‘Medicine is a profession for social service, and it
developed organisation in response to social need’. (C.
Mayo U.S. Physician – 1931) – Need creates process, yet the
process often becomes centre of attention.
In examining some of the ‘markers’ of
professionalism 14, it was found that – once again,
the educational and clinical groups had a
commonality in purpose, which was shared with the
student group they aimed to develop.
•
•
•
•
Specialized Body of Knowledge
Set of Skills
Group Mission or Identity
Standards of Behaviour and Practice
On entering a profession, practitioners (at all levels)
subsequently take-on the responsibilities and
accountabilities that are required for the objectives of
that role to be accomplished 6,7. In examining the
‘evidence’ of their professional existence, assessment
staff were able to approach both their own
judgements, and those of others (student and
employer), from an evidence-based perspective. Far
from being viewed as being ‘taught to suck eggs’, the
group found that they could consider issues
independently, in a manner that both validated
clinical and educational practice, and enhanced both
their own learning and that of the students. Many
expressed that where once they had felt threatened
by ‘academia’, it could be used as an effective ‘tool’
in professional communication and development,
once basic principles had been established.
• (80%) strongly agreed that University / Placement relations
had been greatly improved, with clear channels of
communication established for individual & group discourse.
[ Individual requests for consultation have been received, in
addition to similar requests from other placement providers at
Learning Facilitator Meetings.]
• (100%) strongly agreed that the review of professional
standards had provided a linked understanding of the
academic requirements for students and those undertaking
the Assessor role. In addition, they independently
acknowledged strategies for role development and felt better
empowered to gain access to further information & resource
support (previously addressed as a barrier to implementing
(evidence-based) research 9.
• (88%) expressed greatly improved understanding of the
programme documentation, and the requirement to link this to
Evidence-Based Practice, in-line with published standards.
In addition to receiving clarification of assessment issues, it
was expressed that (the session) had ‘given (Assessment)
Staff confidence in the process and the potential to access
support from University staff’ with reduced potential for unsubstantiated student ‘sign-off’. In this respect, the process
had been successful in achieving its original objectives.
Conclusions & Ideas For Further
Consideration (Active Learning Step 4 ?)
Both the Practice Environment & Higher Education had
established common ground, with mutual benefit to all
involved. It was anticipated by those concerned, that this
would result in greater efficiency in the assessment process,
which in-turn would improve evidence-based practice and
subsequent patient care. Morale was improved, and the
process proved to be inclusive, as opposed to critical.
This approach aims to be repeated at the remaining placement
institutions with the intent of improving assessment
standardisation, communication links and aid staff
development. Further analysis of the wider findings will help
to inform and direct future practice and related change, and
perhaps demonstrating transferability to other fields of workbased learning.
Higher Education / Evidence-Based Practice / Professional
practice: shared values – common goals.
If we fail to engage others, … we remain separated from the wider
(healthcare) community . Invite people on-board –
(but preferably in a language they understand).
V. Volny, Vermilion Sea Institute.
BOURNEMOUTH UNIVERSITY, 2006. The Essential Guide to Pre-Registration Operating Department Practice - Clinical Staff Guide. Bournemouth: BU / ODP, version 3. 2 ASSOCIATION OF OPERATING DEPARTMENT PRACTITIONERS, 2006. Qualifications Framework for Mentors Supporting
Learners in Practice: Standards and Guidance for Mentors and Practice Placements in Support of Pre-registration Diploma of Higher Education in Operating Department Practice Provision. London: AODP, Issue 2. 3 BOURNEMOUTH UNIVERSITY, 2006. The Essential Guide to Pre-Registration Operating Department
Practice - Clinical Staff Guide. Bournemouth: BU / ODP, version 3. 4 UNIVERSITIES SCOTLAND, 2004. What is Higher Education ? Available from: http: / www.universities-scotland.ac.uk/Facts%20and%20Figures/HigherEducation.pdf [Accessed : 01.05.2007]. 5 HEALTH PROFESSIONS COUNCIL, 2005.
Standards of Education and Training. London: HPC. 6 NURSING & MIDWIFERY COUNCIL, 2004. The NMC code of professional conduct: standards for conduct, performance and ethics. London: NMC, Standards.07.04. 7 HEALTH PROFESSIONS COUNCIL, 2004. ODP Standards of Proficiency. London: HPC. 8
NHS EXECUTIVE, 1996. Promoting Clinical Effectiveness: A framework for action in and through the NHS. London: NHSE. 9 ASSOCIATION OF OPERATING DEPARTMENT PRACTITIONERS, 2003. Scope of practice. London: AODP, Issue 1 Revised 2004. 10 Hoskins, S. 2004. Developing Independent
Learners. Available from: http: / www.business.heacademy.ac.uk/resources/landt/learning/independant [Accessed : 01.05.2007]. 11 GOLEMAN, D. 1996. Emotional Intelligence. London: Bloomsbury. 12 PARAHOO, K., 2000. Barriers to, and facilitators of, research utilization among nurses in Northern Ireland. Journal
of Advanced Nursing 31(1), 89-98. 13 MAYO, CH, 1931. Collected papers of the Mayo Clinic and Mayo Foundation, 23:1020. Rochester, MN 14 PLAUT, M. 2006. What does it mean to be a member of a profession ? Available from: http: / www.medschool.umaryland.edu/Professionalism/professionalism_dmrt.pdf
[Accessed : 01.05.2007].