As a result of Covid-19, the 2nd year Occupational Therapy students had their usual face-to-face placements suspended. The Occupational Therapy academic team at the University of East Anglia looked at a virtual alternative allowing their students to continue their learning to achieve their placement outcomes in line with statutory and professional body requirements and to progress on their course.
In the Blackboard learning environment, students took responsibility for a virtual caseload, with a mix of group and individual working; they conducted interviews with 'patients', completed their guided reflections in their handbook. They worked through the occupational therapy process with each of the six cases, using their professional reasoning. Occupational therapy theory and practice were interwoven through the practical and written activities in their handbooks, through the student’s learning contracts and their case presentations.
This case study will be added to the chapter: 'Enhancing the quality and capacity of the learning environment' in the HEE Technology Enhanced Learning (TEL) Thought Leadership document on simulation.
How was the Virtual Practice Placement delivered?
The placements were delivered using Blackboard and lasted three weeks;
Week 1: Induction week – “pre-placement briefing”
Students were introduced to the placement experience process and paperwork, and the theoretical and professional knowledge that they would need to work towards to fulfil the placement learning outcomes.
The week was divided into face to face, group and individual task and/or reflective sessions on the following areas:
- HCPC and RCOT conduct and standards of practice
- working on continuing professional development portfolio (using MyEvolution – a UEA developed an online platform for employability)
- gathering information and identifying problems
- time management
- occupational science
- placement outcomes and learning contracts
- occupational therapy models
- professional reasoning journal club
- work-life balance
All students wrote their own learning contracts for the placement that were reviewed and feedback was given to allow for individualised learning for the students alongside the standard placement learning outcomes.
Week 2 & 3: Clinical Case Studies (this case study used two-weeks of clinical case studies. This could be extended using the same PEEP model of delivery, in consultation with the Learning and Development Standards [or equivalent] of the professional body associated with any disciplinary group that you might consider using this model with, to ensure it meets their requirements).
Using the in-house expertise from a range of clinical backgrounds within the academic occupational therapy team, they were able to offer our students a breadth and depth of practice placement experience, using authentic cases.
Clinical case studies in week 2
Case study A: community neurology – low mood and anxiety
Case study B: social services community
Case study C: inpatient neurology – stroke
The virtual placement gave students the opportunity to work through several clinical case studies, to manage a virtual caseload.
- Students conducted live interviews with one of the ‘patients’, who were role-played by the academics to reflect a real face-to-face placement experience.
- Students took it in turns in their groups to carry out the initial interview in front of the rest of their cohort.
- Students also conducted virtual multidisciplinary visits to help them to develop their understanding of other roles in the multidisciplinary team and to demonstrate their knowledge and contribution of the Occupational Therapy role to the wider multidisciplinary team.
The clinical case study weeks were organised to support the students through the occupational therapy process as shown below.
- Background reading for the clinical case studies
- Initial interview and problem identification
- Setting goals and prioritising
- Further assessment and treatment planning/implementation and review
- Virtual multidisciplinary team visits and review of the week’s learning
Clinical case studies week 3
Case study D: child and family
Case study E: rheumatology
Case study F: dementia
In the third week, the student had opportunities for more autonomous working, alongside the group-supported working – reflecting the expected progression in student learning. Students filled in guided reflections within their handbook to evidence their learning.
Induction week learning outcomes
- To be aware of the virtual placement process for the placement
- To be aware and prepared for the independent and group learning process for the virtual placement through time management sessions etc
- To reflect on the HCPC and RCOT conduct, ethics and standards required
- To revise the Occupational Therapy models and Occupational Science theory that can be applied in the virtual placement setting
- To have a clear understanding and application of the Occupational Therapy process during the virtual placement experience
- To organise continuing professional development portfolios
- To be able to use MyEvolution as a platform for continuing professional development portfolio building and employability
- To have a clear understanding of the requirements of your summative assessment linked to your virtual placement experience
- To write your learning contract for the virtual learning placement experience
- To have a clear understanding of professional reasoning and how this applies when managing a caseload
- To build on your critical appraisal skills through the journal club
Overal placement learning outcomes
- Operate as a safe and professional learner evidenced through a performance which has not raised issues of concern / professional suitability – students to describe what they would do to operate as a safe and professional learner in their final report
- Analyse the role of governance in the regulation and monitoring of service delivery - students to complete mandatory training and read through relevant policies related to safe practice in the clinical area, analyse during case presentation
- Follow the standards of professionalism as outlined by the HCPC Guidance on conduct and ethics for students and the Professionalism Charter – these will be introduced in the induction week and evidenced in the workbook
- Initiate the supervision process for personal and professional growth – peer and long arm supervision content
- Appraise personal and professional learning needs and experiences and document using the portfolio – included in the workbook
- Display competence in professional knowledge, skills and attitudes within the simulated practice area – via the workbook activities and the case study presentation at the end of the placement
- Evaluate their practice learning experience and share constructive feedback with the long arm supervisor – via the weekly email templates and final report
- Examine appropriate theoretical knowledge, transferable skills and observations acquired to date to inform practice – included in the workbook through critical reflection.
- Analyse appropriate case material as a resource for client management – included in the workbook as analysis rather than description.
- Test professional reasoning both verbally and in writing – via the weekly emails and final report and case study presentation.
- Analyse theories of occupation within the practice learning environment - via the weekly emails and case study presentation.
- Display competence in therapeutic skills of assessment and intervention in the “simulated” practice environment - through the case management and case study presentation.
- Demonstrate the ability to address the physical, psychological, social and environmental needs of the client throughout interventions – via the weekly email and case study presentation and guided reflection.
- Examine the effectiveness of interventions - critical review of treatment plans in workbook.
- Demonstrate the ability to solve problems in a credible way – via case management and case study presentation.
- Complete effective records of appropriate information – by use of the workbook activities.
- Practice person-centred care – demonstrated in the case study presentation.
- Demonstrate an ability to participate in effective interprofessional working - via the “virtual visits” and written reflections in the workbook.
- Initiate appropriate professional relationships with clients, carers and colleagues – this can be displayed through online sessions during the simulated experience with other members of their cohort and communication with their long arm supervisor.
- Display competence in using a variety of communication skills required in the practice environment – written communication via emails and workbook and verbal through case study presentation and online forums.
- Complete service related information in line with local policies and procedures - as evidenced in workbook and case study presentation.
- Case study: the student should verbally present a case study or review an aspect of practice to inform the assessment process – this will be presented in the 3rd week of the simulated placement.
- Engage fully with the proposed timetable and associated handbook activities
- Fill in all paperwork fully as directed in your handbook and contact your long arm supervisor as directed in your timetable
- Be an active and engaged member of your group
- Contact your long arm supervisor if you encounter any difficulties during your placement
- Identify a group lead to email the clinical case study academic leads as directed in the timetable.
Long Arm Supervisors
- Email your group to introduce yourself ahead of the start of the placement. Check if you have any International students about them being able to use the proposed timetable despite the time differences. Also alert them to their roles and responsibilities for the duration of their placement
- Email an individual response to the students in your group – providing feedback on their end of week report
- Organise the case presentations for the students to deliver remotely to yourself and the rest of your group – students are given 10 minutes each for the case presentation
- Be ready to receive emailed “final assessment paperwork” from the students in your group. Please read through the emails and provide initial feedback on the first week email and the case presentation and prepare for “face to face” discussion
- Organise the face to face final discussion and feedback session with each student individually. Allow ½ hour per student and please fill in feedback form with any additional feedback from the discussion
- Troubleshoot any student issues relating to the placement.
Clinical Case Study Academic Lead
- Prepare your allocated clinical case study material and post it under the Placement Education page on Blackboard – there are individual folders for each Clinical Case study for you to populate
- Please post information on Blackboard for your clinical case
- Organise the initial interview format for your allocated initial interview slot where highlighted in the timetable
- Confirm the group leads who will email you the problem list and goal priority list
- Email feedback to the 6 group leads on the problem lists emailed to you on the initial interview day
- Email feedback to the 6 group leads on the goal priority lists emailed to you the day after the initial interview.
This was filled in by students for each of the six clinical case studies.
Write the information gathered during the initial interview here – this process will develop your communication and information gathering skills.
Problem list identified from initial interview – developing your problem identification skills.
Prioritising problems – justification as to why you have prioritised the problems that you have – developing professional reasoning.
Goal setting detail the goals that you have set for the case and why?
Any further assessments – are there any other assessments you would want to use to explore any other areas identified in the initial interview? Please state and explain your professional reasoning here?
Describe your treatment planning – applying your theoretical knowledge of the Occupational Therapy and the presenting condition into practice and a holistic approach to patient care.
Write a critical review of treatment – developing your evaluation and criticality skills.
What was the Occupational Therapy Role with this case study? Helping to define the role of Occupational Therapy within different areas of clinical practice.
Virtual multidisciplinary visits were designed to help the student develop their understanding of other roles in the multidisciplinary team and to demonstrate their knowledge and contribution of the Occupational Therapy role to the wider multidisciplinary team. The virtual visits were a mix of web-based research, and online face to face visits via Blackboard with some of the different professions.
Case study A: community neurology – virtually visit a neuropsychologist
Case study B: social services community – virtually visit a social worker
Case study C: inpatient neurology – virtually visit a speech and language therapist
Case study D: child and family – virtually visit a teacher
Case study E: rheumatology - virtually visit a pain management consultant/rheumatologist
Case study F: dementia – virtually visit an admiral nurse
Students were guided to analyse how the visited professionals and the Occupational Therapy role fits into the team using the questions below. Students respond to the questions below for each of the six “virtual visits”.
1. What is the role of the profession that you have “virtually visited”?
2. How could the Occupational Therapist work with the professional that you have “virtually visited”?
Second-year placements enable the student to develop their core skills. Students worked with and took responsibility for a virtual caseload, developing individual and group work skills. They worked through the occupational therapy process with each of the six cases, using their professional reasoning. Occupational therapy theory and practice were integrated through practical activities, written activities in the placement electronic workbook and through the student’s learning contracts and their case presentations. The students continued to develop their portfolio and will draw upon this evidence in future learning.
An academic long arm supervisor was allocated for each student for the placement duration – to monitor and provide feedback on their individual progress towards the placement learning outcomes. Regular feedback between the students and the academic case study leads and academic long arm supervisors mirrored the usual clinical educator role provided in the face to face placement setting. For example, at the end of the first week of the clinical case studies, the paperwork was submitted and feedback given to individual students by the long arm supervisor.
All students individually prepared and delivered a face to face case study presentation at the end of the placement, which was presented to the long arm supervisor and their placement group members.
The academic long arm supervisor also met with their students individually for a final assessment conversation, guided by the evidence from the feedback process, handbook and case study presentation. This evidence enabled the long arm supervisor to establish whether the placement outcomes had been met or not. Students were required to complete a final report proforma to evidence their learning and demonstrate how they had achieved the virtual practice placement learning outcomes.
The placements were evaluated weekly by students and the academics involved were asked about their overall experiences as a clinical case study lead or as a long arm supervisor.
There were lessons to be learned about this type of placement provision, but overall the feedback was very positive.
“under difficult circumstances, this has been an excellent way to keep our learning path going”
"The placement had chances for us to gather information with initial interview, then prioritise the problems, setting goals and consider different assessments and interventions. Basically, following the OT process apart from being able to carry out interventions with patients. It was a great way to replace our placement under this situation. Thank you!"
Academic clinical case study lead feedback
“The fact that the students were dealing with multiple case studies across the two weeks was extremely beneficial for their learning. It is essential by this stage that they are confident with managing a variety of patients/service users on their caseload. This experience gave them the opportunity to begin to prioritise their work and develop their use of the Occupational Therapy process for each case, whilst still having the added bonus of additional time to research the associated conditions.”
“This placement gave the students a good environment to explore and practice their assessment/professional reasoning and to really get to grips with goal setting and prioritisation. It gave them real-time practice with their communication skills. The feedback from my group was positive, they felt it helped their confidence with communication. They all highlighted how it helped them to hone their time management skills, and to really understand the benefits of team working.”
Long arm supervision feedback
“It is useful as a lecturer to experience how the students behave and work outside of the university. It also helps us to keep in touch with what support the educators are likely giving a student on placement. The only issue with it is the added workload each long arm supervisor takes on as it worked out as more hours for the staff involved than was expected”
“I really noticed an improvement in Soap note writing/SMART goal setting/problem prioritisation between the two clinical weeks. From discussions with my group they really appreciated the differences in the communication required with the clients. They really got to grips with the biopsychosocial model and how this translates into real time practice.”
Overall, the feedback confirmed this model provides a valuable learning process for students as an adjunct to traditional face to face practice placements. This model of delivery has enabled the students to fulfil the practice placement outcomes required at this stage of their studies to continue to progress on their course. There have been some unique learning from this model of placement provision that is being explored further from a pedagogy and learning theory point of view and will be reported in a subsequent journal paper.
The future of a Peer Enhanced e-Placement (PEEP) model of practice placement delivery
Face to face practice placements remain essential. However, the evaluation from students and academics of the current virtual placement provided unique, added value learning from the peer group process compared to that usually gained on a traditional face to face placement. The importance of peer learning provides a pedagogical underpinning for a Peer Enhanced e-Placement (PEEP) model of delivery. The PEEP model of placement delivery offers an exciting alternative to replace perhaps one of the traditional face to face placements, to help with the future demands on placement capacity, whilst providing purposeful and valuable practice placement learning for students.
Case study developed by Dr Lisa Taylor, Associate Professor in Occupational Therapy School of Health Sciences and Associate Dean for Employability Faculty of Medicine and Health – Project Lead for the Virtual Practice Placement. If you require further information or have any questions, please contact email - Lisa.Taylor@uea.ac.uk Twitter - @drlisataylor