Practice education, also known as fieldwork, clinical placement or work placement, is an integral component of all allied health and social care pre-registration courses. Practice education involves “immersion of students in actual clinical practice, which is separate from the didactic components typically delivered in classrooms”.1(p.1299) For health and social care professions, this involves being placed in an organization outside of the university under the supervision of a qualified practitioner, called a practice educator or clinical supervisor, who is responsible for student learning and competency assessment. There is growing acknowledgment in health and social care professions that practice education placements need to be of the highest quality.2 The Oxford Living Dictionary defines quality as “the degree of excellence of something”.3(para.1). For practice education, quality structures have been broadly defined as: i) the academic and logistical infrastructure that needs to be in place to ensure students have the opportunity to learn in different contexts, ii) the domains of placement that can be monitored to ensure optimal outcomes for all stakeholders (academic, work place, practice educator/supervisor and student, and iii) the accountability mechanisms that promote best practice.4 These structures correlate with the findings of a recent systematic review of published research on what constitutes a quality placement in physiotherapy, which identified five constructs that constituted quality.1 These were: clinical education framework, clinical education sites, structure of clinical education, assessment in clinical education and clinical education faculty. While this review referred only to quality in physiotherapy practice education, it determined that there was inconclusive evidence on what constitutes a quality placement due to the broad and variable literature reviewed and the lack of rigor in published studies.
Individual studies from other disciplines examining quality from various stakeholders’ perspectives have identified similar indicators of a quality practice education placement. These relate to the characteristics and attributes of the practice educator, practice education site, university and the students themselves. First, from a practice educator perspective, quality indicators reported include being a competent practitioner and an enthusiastic student mentor, providing clear placement expectations, ensuring a graded program of learning experiences combined with modeling and practice, and using a consistent approach to feedback and supervision.5-8 The quality of supervision was also acknowledged by others as integral to successful placements.8,9 Second, from a practice education site perspective, a welcoming learning environment with a detailed orientation, as well as a sense of belonging and membership to the team, were the quality indicators highlighted.5,8,10 Third, the implementation of clear university expectations and the capability of the student have also been found to facilitate the quality of a practice education placement.7,8 While the former identifies desired quality characteristics that students will experience, there is some evidence that allied health and social care students felt that their actual practice education learning experience did not match their preferred or expected placement learning experience.11 Rather, they would have preferred to make more of their own decisions and be treated according to their abilities with more hands-on learning that met their developmental needs.
As allied health and social care disciplines have individually researched quality placements from their stakeholders’ perspectives, many of their respective professional bodies have also pinpointed what they consider to be quality for placements through the development of national quality frameworks for their discipline. For example, the discipline of radiography in the UK has defined their own standards of quality.12 These quality standards assign the responsibility for ensuring quality of placements to the university, the placement site, the practice educator and the student, as they consider that quality is a collaborative responsibility between these parties. However, it is unclear how these standards are implemented across the other stakeholder groups such as higher education institutions and placement sites. While not yet published, there have also been calls across other professions for the development of similar national quality frameworks, such as for physiotherapy in the USA2 and occupational therapy in Australia.13
Contemporary healthcare practice is increasingly acknowledging the positive impact of inter-professional learning and working on both the quality and safety of patient care.14 In acknowledgment of this influence, Health Workforce Australia commissioned a report in 2012, Promoting Quality in Clinical Placements, across healthcare professions.15 After the completion of a literature review and a national stakeholder consultation, the authors proposed five enablers of quality placements. These included: a culture of learning, effective supervision, learning opportunities, effective communication and resources/facilities to conduct placement activities. Two barriers were also identified: occupational stress and workplace incivility. This report sourced 23 frameworks (10 international and 13 Australian) that offered guidelines on quality for placement, but the findings were not integrated into a single, cohesive inter-professional framework.
For this reason, a scoping review is timely in order to clarify the core indicators of what constitutes quality in practice education placements from multiple stakeholders’ perspectives within allied health and social care professions. This scoping review will map multiple indicators extracted into a single inter-professional quality framework. An indicator is an explicitly defined measurable statement that includes the structure, process or outcome of educational or service provision.16 Quality indicators are used to generate review criteria and overarching standards that may operationalize a quality framework.16 Such a framework will define quality from multiple stakeholders’ perspectives and will have the potential to be used by a single profession or by a number of different professions where interprofessional placements are taking place in one clinical setting. A scoping review provides a method of collating the available literature on the topic of quality, clarifying its key concepts and indicators, and identifying any gaps.17 Such a scoping review has the potential to inform future development of inter-professional quality structures, standards and frameworks across universities, organizations and professions.
A preliminary evaluation of PubMed, CINAHL, Cochrane Database of Systematic Reviews, and JBI Database of Systematic Reviews and Implementation Reports found no existing scoping reviews on this topic.
This scoping review will consider studies that include participants from the following allied health and social care professions: physiotherapy, social care work, social work, speech and language therapy, orthoptics, occupational therapy, psychology, podiatry, radiation therapy, play therapy, medical physics, clinical biochemistry, dietetics/nutrition and dietetics, audiology, clinical engineering, radiography, perfusion, clinical measurement, clinical biochemistry and phlebotomy. Participants will include university students working towards a professional health or social care qualification, either in undergraduate or graduate entry programs.
The concept of a quality placement will be examined in this scoping review. This will be defined as any published quality framework, quality indicator, quality criteria, quality standard or quality protocol. It will include quality in relation to any aspect of practice education placements, including but not limited to, planning, delivering, implementing, assessing or evaluating. The perspectives of professional bodies, organizations, universities, researchers, practice educators and students will be included.
This scoping review will consider university student clinical or practice education placements for entry level students across allied health and social care professions, with no limitations to geographical location.
Types of sources
This scoping review will consider all available publications that have a focus on quality of practice education placements of any kind, including peer-reviewed journals, gray literature, policy documents from governments and organizations, and professional bodies. Sources will also include publications and papers with practice educators and students from allied health and social care professions listed as participants. Studies published in English from 1998 to the present will be included to ensure completeness and comprehensiveness of sources. This time frame was chosen in acknowledgment that quality of placements began to be reported in the late 1990s. Whilst pedagogical concerns, workplace expectations and evidence-based practice have influenced professional practices during this 20-year period, this has been an evolving process, with no definitive start date, and the process of sourcing placements and allocating students to clinicians for supervision, education and evaluation has not significantly changed during this time.
The proposed scoping review will be conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews.17
A three-step search strategy will be employed in this review. An initial limited search of MEDLINE and CINAHL will be undertaken, followed by analysis of the text words contained in the titles and abstracts, and of the index terms used to describe each article. A second search using all identified keywords and index terms will then be undertaken across all included databases and official websites of professional bodies as these are sources of unpublished information. Thirdly, the reference lists of all identified reports, articles or frameworks will be searched for additional studies, and further search terms may apply at this stage.
The databases to be searched will include: CINAHL, Embase, Emcare, MEDLINE, ProQuest Nursing and Allied Health, and Scopus. A full search strategy for CINAHL is detailed in Appendix I. The search for gray literature and policy documents will utilize Google Scholar and official websites of universities, organizations and professional bodies. These websites are listed in Appendix II.
Following the search, all identified citations will be collated and uploaded into EndNote V5.5.1 (Clarivate Analytics, PA, USA) and duplicates removed. Titles and abstracts will then be reviewed by two independent reviewers for appraisal against the inclusion/exclusion criteria. Any disagreements will be resolved through discussion and consensus with a third reviewer. Full publications will be retrieved for all included studies and policy documents. The results of the search will be summarized and presented in a PRISMA flow chart.18
Results will be charted using the data extraction tools, which are aligned with the aim of this research, as indicated in the scoping review methodology developed by the Joanna Briggs Institute.17 Two draft data extraction tools have been developed, one for published research (Appendix III) and one for published frameworks (Appendix IV). These data extraction tools will be piloted in two papers/frameworks by two reviewers to determine their suitability. This tool may be further refined during the review process, and modifications will be reported in the final scoping review report. Data extracted will be mapped into a spreadsheet in tabular form to monitor and manage the findings.
The data extracted will include: author(s), year of publication, type of publication, origin/country of origin, setting, discipline, aim/purpose, study population and sample size, methodology/methods, outcomes/results, quality indicators and key findings that relate to the scoping review question.
Presentation of results
The results of the scoping review will be presented in tabular and diagrammatic form to represent an inter-professional quality framework extracted from the data. A narrative summary will describe the resulting inter-professional quality framework. An infographic will summarize the key indicators of the quality framework, and their relationship to each other, where appropriate.
We thank Senior Research Librarian Debbie Booth from the University of Newcastle, Australia, for assisting with the development of the literature search strategy.
This project is funded by the Health and Social Care Professions Office of the National Health Services Executive, Ireland. This review is the first step in this project that aims to identify what constitutes a quality placement across health and social care professions in Ireland. Following this scoping review, the aim is to develop an interprofessional quality framework with associated quality assessment/evaluation tools for implementation in Irish Health Services. The funders are not participants in the project.
Appendix I: Search strategy for CINAHL
Appendix II: Websites of the professional bodies to be searched for gray literature
Appendix III: Draft data extraction instrument for published articles
Appendix IV: Draft data extraction instrument for quality frameworks
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