Use of Simulated Learning Activities in Occupational Therapy Curriculum. Final Report 22nd November 2010

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1 HealthWorkforce AUSTRALIA UseofSimulatedLearningActivitiesin OccupationalTherapyCurriculum FinalReport 22ndNovember 2010 ProfSylviaRodger 1 DrSallyBennett 1 MsCateFitzgerald 1 MsPhillipaNeads 2 1 DivisionofOccupationalTherapy SchoolofHealthandRehabilitationSciences TheUniversityofQueensland Australia 2 ClinicalSkillsDevelopmentService QueenslandHealth

2 UniversityofQueenslandProjectTeam ProfSylviaRodgerBOccThy,MMEdSt.,PhD DrSallyBennettBOccThy(Hons),PhD MsCateFitzgeraldBOccThy,MBA PhillipaNeadsBPhThy,MHSc,ACHSE ProjectAdvisoryCommittee MsSusanGilbertHunt:Representative,CouncilofOTRegistrationBoards(COTRB)/Occupational TherapyCouncil(OTC) AssocProfLynneAdamson:ChairofAustraliaandNewZealandCouncilofOTEducators(ANZCOTE) MrNigelGribble:ChairofAustraliaandNewZealandOTFieldworkAcademics(ANZOTFA) MsRebeccaAllen:ChairofProgramAccreditationCommittee(PAC)OTAustralia(OTAL) MrChrisKennedy:RepresentativeofOccupationalTherapyAustralianNational(OTAL) Acknowledgements ThisprojectwascompletedwiththefinancialsupportoftheHealthWorkforceAustralia. InfrastructuresupportwasprovidedbySchoolofHealthandRehabilitationSciences,TheUni versityofqueenslandandtheclinicalskillsdevelopmentcentre. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 2

3 Contents ProjectTeamandProjectAdvisoryCommitteeMembers 2 Contents 3 1.ExecutiveSummary 5 2.Background Background 10 Terminology 11 Contextofsimulationinoccupationaltherapy 12 Accreditationrequirements 13 Howcanplacementclinicalplacementcapacitybeincreased 14 3.ProjectApproach/Methodology 15 4.Findings A)LiteratureReview 18 B)MapofSimulatedLearningPrograms NHWTUniversityClinicalPlacementsSurvey29 Survey1:Mappingthecurrentuseofsimulatedlearninginoccupationaltherapycurricula29 Survey2:Potentialuseofsimulatedlearninginoccupationaltherapycurricula,38 perceivedbarriersandfacilitators A) C)Reportonoutcomeofstakeholderconsultation Consultationprocess 44 Keythemesemergingfromfora 45 D)Curriculaelements 47 E)Levelofagreementfromaccreditedschoolsandrespectiveaccreditationbodyon: Curriculaelementsthatcouldbeintegratedintothecurriculaandthatwouldmeet 49 accreditationstandards Perceivedbarrierstothiscurriculumbeingrecognisedandadoptedforclinicaltraining49 Thelikelyimpactonclinicaltrainingdaysrequiredinthecourseshouldthesecurricula50 elementsbedeliveredbyslas Thelikelytimeframeforimplementationshouldthesecurriculaelementsbeadopted50 5.Recommendations A)PriorityelementstobesupportedbytheSLENationalProject 51 B)ApproachestoaddressbarrierstoeffectiveultilisationandexpansionoftheuseofSLAsfor52 deliveringthepriorityelementsofthecurriculum References 56 Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 3

4 Appendices Appendix1:WorldFederationofOccupationalTherapistsminimumrequirementsforfieldwork60 Appendix2:Survey1:Currentuseofsimulatedlearningactivitiesinoccupationaltherapycurricula64 Appendix3:Simulationinoccupationaltherapy:Aresourcedocument 74 Appendix4:Survey2:Potentialuseofsimulatedlearningactivitiesinoccupationaltherapy curricula,barriersandfacilitators 82 Appendix5:Simulationscenariosfordiscussionatfocusgroups 93 Appendix6:OccupationalTherapySimulatedLearningActivitiesProject:ForumAgenda 109 Appendix7:ProjectAdvisoryCommittee:ForumAgenda 112 Appendix8:ParticipantsatFora 114 Appendix9:Modellingtheuseofsimulatedlearningactivities 117 Acronyms ACSOT AustralianCompetencyStandardsforGraduateEntryOccupationalTherapists ANZCOTE AustraliaandNewZealandCouncilofOTEducators ANZOTFA AustraliaandNewZealandOTFieldworkAcademics COTRB/OTCCouncilofOTRegistrationBoards(COTRB)tobecomeOccupationalTherapyCouncil(OTC) NHWT NationalHealthWorkforceTaskforce OTAL OccupationalTherapyAustraliaNational PAC ProgramAccreditationCommittee SLA SimulatedLearningActivities SLE SimulatedLearningEnvironments SPEFR StudentPlacementEvaluationFormRevised UQOT UniversityofQueenslandOccupationalTherapy Definitions Forthepurposesofthisreportthefollowingdefinitionsareused. Fieldwork:Clinicallearningthatstudentsundertakethatmaybecountedtowardsthe1000hours requiredbywfot.thisincludesclinicalplacements(seebelow)inadditiontoanyotherclinicallearning experiencesthatmightbecountedtowardsthesehours. Clinicalplacements:Shortorlongblocksoftimestudentsundertakeclinicallearning. Placementclinicaleducator:Occupationaltherapysupervisorofstudentsonplacements. Simulatedlearningclinicaleducator:Occupationaltherapysupervisorofstudentsundertakingsimulated learningactivities(slas). SimulatedLearningActivities(SLA):learningactivities/experiencesthatmakeuseofanysimulation modalitythatimitatesarealclinical/professionalsituation.simulatedlearningactivitiesmayextendpast thespecificuseofthemodalityegtoincludediscussionfollowingtheuseofthemodality,treatment planningafterusingsimulationmodalityandsoon. SimulatedLearningEnvironments(SLE):refertowherelearningtakesplace,namelythesimulated environments.examplesoftheseenvironmentsareinterviewrooms,mockhospitalwards,simulated livingspaces(egkitchen/bathroom)andsoon. SimulationModalities:thetypeofmediumusedforsimulation,includingbutnotlimitedto:roleplay, standardisedpatients/actors,useofclientswhonolongerreceivetherapy(pastclients),useof mannequins,parttasktrainers,computerpatients(usingscreenbased/virtualworlds)anddvdsofrealor simulatedclients. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 4

5 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum ExecutiveSummary Background Simulatedlearningactivities(SLAs)areincreasinglybeingusedasameansforaugmentingandattimes supplementingaspectsofclinicalpractice.arangeofdefinitionsandterminologyareusedtodescribethe useofsimulationinhealthprofessioncurricula. TherequestforthisreportfromtheHWAusedtheacronymSLEvariablytorefertoSimulatedLearning Environments(SLE)andPrograms.Forthepurposeofcommunicationwithoccupationaltherapy stakeholderstheauthorsofthisreportselectedthephrase SimulatedLearningActivities (SLAs)tobe usedinplaceoftheacronymslesthroughoutthisreport,exceptwheresimulatedlearningenvironments (SLEs)arespecificallyaddressed.Simulatedlearningactivitiesrefertolearningactivities/experiencesthat makeuseofsimulationmodalitiesbutthatmayextendpastthespecificuseofthemodality,e.g.,to includediscussionfollowingtheuseofthemodality,treatmentplanningafterusingsimulationmodality andsoon. InoccupationaltherapythereareagrowingnumberofoccupationaltherapyprogramsusingSLAsto improvethequalityofteachingandlearningandtocontributetowardsdevelopmentoftheknowledge, skillsandattitudesrequiredforclinicalpractice.asinmanyotherhealthprofessions,thereisincreasing difficultyinobtainingclinicalplacementsforoccupationaltherapystudentsthroughoutaustralia. Simulatedlearningactivitieshavebeensuggestedasonewaytoaddressthisproblem.Fromtheliterature itisclearthatusingslasinoccupationaltherapycurriculamayincreaseplacementcapacitybyimproving thereadinessofstudentstocommenceplacements,howevertheextenttowhichslasmaypotentially augmentorreplaceaspectsofclinicalplacementshasnotbeenconsidered. Thisreportdescribesresultsfromacollaborative,nationalconsultationprocessinvolvingheadsor representativesofallaccreditedoccupationaltherapyschoolsacrossaustralia,andrepresentativesfrom OTAustraliaNational(OTAL),theCouncilofOccupationalTherapyRegistrationBoards(COTRB)/ OccupationalTherapyCouncil(OTC),AustraliaandNewZealandOTFieldworkAcademics(ANZOTFA),the AustraliaandNewZealandCouncilofOTEducators(ANZCOTE)andtheProgramAccreditationCommittee ofotal.twosurveyswereundertakentounderstandthecurrentandpotentialuseofslasin occupationaltherapycurricula,andrelatedbarriersandfacilitatorstotheiruse.particularconsideration wasgiventotheabilityofslastomeetclinicalplacementobjectivesandincreaseclinicalplacement capacity.threeforawereheldincludingrepresentativesfromthekeyoccupationaltherapystakeholders groupsindicatedabovetoconfirmthesefindingsanddiscussthepotentialforslatocontributetowards increasingclinicalplacementcapacity.afinalforumwasheldwiththeprojectadvisorycommitteeto makerecommendationstobringtohealthworkforceaustralia. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 5

6 Keyfindings: 1.Alloccupationaltherapyschoolsareusingsimulatedlearningactivities(SLAs)toimprovethequalityof teachingandlearningofoccupationaltherapystudentspriortoclinicalplacements. 2.TherewasconsensualagreementthatuseofSLAscouldbeexpandedandwouldcontributetoincreased placementcapacitybybetterpreparingstudentsto hitthegroundrunning. 3.AllparticipantsagreedthatSLAscanbedevelopedthatmeettheWorldFederationofOccupational Therapyfieldworkguidelines(WFOT,2002)andthesemayoccurpriorto,duringorfollowingclinical placements.asnotedthroughoutthisreport,wfot(2002)requirethatataminimum,studentsundertake 1000fieldworkhoursacrossabroadrangeofoccupationaltherapypracticeareas. 4.Therewasconsensusthatupto20%oftherequired1000hourscouldbedeliveredviaSLAsbasedon theconditionsindicatedbelow. 4.Individualoccupationaltherapyschoolswouldneedtodeterminehow,when,andtheextentofuseof SLAswithintheirownindividualcurriculum. 5.PriorityelementsofthecurriculumthatcouldbedeliveredbySLAsandcouldbesupportedbytheSLA nationalprojectwereidentified.thesepriorityelementsarelistedonpage51.anumberofexamplesare providedbelow.simulatedlearningactivitiescouldbeusedtodevelopcompetencein: UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum ConditionsforusingSLAstowards1000fieldworkhoursinoccupationaltherapycurricula: ThatSLAsaredesignedwithahighlevelofauthenticityforoccupationaltherapypractice; ThatSLAsaredesignedwithahighlevelofcomplexityrequiringstudentengagementandinteraction; ThatSLAsaredeliveredwithimmediacytointeractionwitharealclientandtooccupational therapyclinicalplacements; ThatSLAsaredesignedandassessedwithrespecttomeetingoccupationaltherapyclinical placementobjectives;and Thatnoonesimulationmodalitycanbeusedasa standalone alternativetoclinicaltrainingtime. Coworkercommunication(e.g.,interprofessionalpracticeandcommunication); Communication(e.g.,higherlevel,appliedverbalandnonverbalcommunication); Informationgathering(e.g.,assessmentofclientswithcomplexneeds,clientsatrisk,andappliedrisk assessment); Servicedelivery/intervention(e.g.,forclientswithcomplexneeds,clientsatrisk,andrisk management); Professionalbehaviour(e.g.,useofoccupationfocussedlanguage,andmanagingethicaldilemmas); Selfmanagement(e.g.,planning,responsivenesstofeedback,managingtimepressures); Documentation(e.g.,timely,accuratereporting);and Serviceevaluation(e.g.,modifyfutureservicedeliveryinresponsetoselfreflection/feedback). Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 6

7 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum 6.RecommendationstoaddressbarrierstotheuseofSLAsinoccupationaltherapycurriculawere developed.insummary,thekeyrecommendationsarethatthereis: 1. Developmentofanational,sharedbankofscenariosandresourcesrelevanttooccupationaltherapy; 2. Recurrentfunding(inblocksofatleast5yearsduration)fortheuseofstandardisedpatientsin occupationaltherapycurricula; 3. Educationandcapacitybuildingforoccupationaltherapyclinicaleducatorsandacademicsintheuseof SLAs; 4. DevelopmentofoccupationaltherapyrelevantSLEs(inadditiontosimulatedwardenvironments); 5. Research/evaluationoftheuseofsimulationinoccupationaltherapycurricula; 6. Equitableaccesstoresourcesacrosshealthprofessionsandbetweenmetropolitanandregionalareas; and 7. Flexibilityregardingtheuseofsimulationaccordingtoindividualschoolscurriculaneeds. Intotal,18specificrecommendationstoaddressbarriersweremade.Thesearelistedbelowandarationale foreachprovidedonpages5255. Insummary,alloccupationaltherapyschoolsacrossAustraliaandkeystakeholdersagreedthattheuseof simulatedlearningactivitiesinoccupationaltherapycurriculacouldbeexpanded,therebycontributingto anincreaseinclinicalplacementqualityandcapacity.implementationofkeyelementsofcurriculausing SLAswouldvarybetweenoccupationaltherapyschoolsandbedependentuponreceiptofsufficient fundingforresearchanddevelopmentaswellasrecurrentfunding.timeframesforspecificapproaches recommendedareindicatedbelow. Recommendations 1.DevelopmentofNationalSharedResources:OccupationalTherapyRelevantandInterprofessional SimulationResourceBank.Timeframe:Within2yearsofcommencementoffunding,andongoing. Recommendation1:Developmentofanonlinebankofsimulationresourcestosupportinterprofessional educationandcollaboration.thiswouldincludearangeofscenarios,software,virtualrealityapplications andotheronlineresources. Recommendation2:Developmentofanonlinebankofsimulationresourcesrelevanttooccupational therapycurriculumobjectivesincludingarangeofscenarios,virtualrealityapplicationsanddvds.this onlinebankofsimulationresourcesneedstobefreelyaccessibleacrossallaustralianuniversitieswith occupationaltherapyprogramsunderacreativecommonslicence. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 7

8 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum 2.SupportingUseofStandardisedPatients Timeframe:6months 5years(willvarydependingonindividualschools curriculumandcapacity) Recommendation3:Centresbeestablishedthatwouldrecruitandtrainindividualstoactasstandardised patientsacrossallfieldsofhealthincludingthetypesofpatientsneededinoccupationaltherapy.these centresshouldbeaccessibletoalluniversitiesofferingentryleveloccupationaltherapyprograms includingthoseinrural/regionalareas. Recommendation4:Recurrentfunding(inminimumoffiveyearblocks)isprovidedforestablishingand maintaininguseofstandardisedpatientsforalluniversitiesofferingentryleveloccupationaltherapy programs.caseswillneedtobereviewedandpotentiallymodifiedorreworkedatleasteveryfiveyears duetoadvancesinevidencebasedpractice,advancesinprofessionalknowledgeandpractice,aswellas changesinhealthpolicy,etc. Recommendation5:Clinicaleducators,practicingoccupationaltherapistsandoccupationaltherapy consumersfromarangeofcontextsengagewithoccupationaltherapyacademics/educatorstodevelop andcritiquetheresourcesdeveloped. 3.EducationandCapacityBuildingforClinicalEducatorsandAcademicsintheUseofSimulatedLearning Activities.Timeframe:2yearsfromcommencementoffundingongoing Recommendation6:Trainingisprovidedforoccupationaltherapyacademicsandclinicaleducators regardingtheuseofsimulationforbothoccupationaltherapycurriculaandinterprofessional education,particularlyslasthatwouldcontributetoincreasedclinicalplacementcapacity.training shouldbeaustraliawideandutilisebothfacetofaceandonlinetrainingmethods. Recommendation7:Thedevelopmentofthistrainingwilloccurincollaborationwithoccupational therapyacademicsandclinicaleducatorstoensurethatdatafromacomprehensivetrainingneeds analysisunderpinthedevelopmentoftrainingmaterials,methodsandapproaches. 4.DevelopmentofOccupationalTherapyRelevantSimulatedLearningEnvironments Timeframe:15years(willvarydependingonindividualschools curriculumandcapacity) Recommendation8:Accesstosimulatedlearningenvironments/skillcentresandtheirassociatedfacilities andtechnicalpersonnelisavailabletoalluniversities(whetherinmetropolitanorregionalareas)offering entryleveloccupationaltherapyprograms. Recommendation9:Simulatedlearningenvironmentsincorporateflexiblespacesandadequatestorage forawiderangeofequipment/furnishingstoassistinsimulatingaspectsofhomeenvironments,school environments,workplacesandarangeofcommunityenvironmentswhereoccupationaltherapistswork. Recommendation10:Accesstoward/clinicsimulationenvironments,mannequins,andassociated technicalsupportisprovidedtofacilitateipesimulationforalloccupationaltherapyprogramsin collaborationwithotherprofessions. Recommendation11:Allsimulatedenvironmentsdevelopedhaveaudiovisualrecordingcapacity,and accesstointerview/debriefingroomsandattendantresources. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 8

9 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum 5.ResearchintheUseofSimulationinOccupationalTherapyCurricula Timeframe:Within1yearoffundingcommencingongoing Recommendation12:Fundingtosupportresearchabouttheeffectivenessandimplementationofsimu latedlearningactivitiesisprovided. Recommendation13:Occupationaltherapyacademicsnationallyagreeonevaluationmethodologiestobe usedtoevaluateslasinoccupationaltherapyincludingevaluationdesign,outcomemeasuressothatmulti plesitescanbeused,datapooledandoutcomesreportedwithconfidencewithadequatesamplesize. Recommendation14:Evaluationoftheimpactofsimulationactivitiesonoccupationaltherapystudents satisfaction,clinicalcompetence,confidence,andlevelofskilldevelopment(asassessedbyacademicsand cliniciansinthefield)isspecificallyrequiredofanyprojectsfundedbyhwa. 6.Equity Timeframe:Immediatelyongoing Recommendation15:ThereneedstobeequityofaccesstoSLEs/skillscentresandstandardisedpatientsby allparticipatinghealthcareprofessionsincludingalliedhealthratherthanthecurrentfocusonmedicine andnursing. Recommendation16:Facilitiesandresourcesaswellasappropriateoccupationaltherapyenvironments mustbeavailabletoallowequityofaccesstoregionalandruraluniversitiesofferingoccupationaltherapy programs. 7.FlexibilityofSimulationAccordingtoLocal/IndividualCurriculaNeeds Timeframe:Immediatelyongoing Recommendation17:Resourcesforsimulatedlearningactivitiesandmodelsofdeliveryofsimulationmust beflexibleenoughtoallowoccupationaltherapyschoolsinvariousuniversitiestochooselocallyappropri atemechanismsforembeddingslasintoacademiccurriculaandclinicaleducationplacements. Recommendation18:AvarietyofmodelsforutilisingSLAsacrossoccupationaltherapyprogramsfromyear 1beadoptedwithuniversitieschoosingthemodelthatworksbestfortheirparticularcurriculumneeds. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 9

10 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Background Asinmanyotherhealthprofessions,thereisincreasingdifficultyinobtainingclinicalplacementsfor occupationaltherapystudents(casares,bradley,jaffe&lee2003;rodger,webb,devitt,gilbert, Wrightson&McMeeken,2008).Justsomeofthefactorscontributingtothisproblemincludechanging workplacedemands,financialconstraints,andincreasingstudentnumbers(casaresetal2003; Williams,Brown,Scholes,French&Archer,2010).Thepressuretodevelopinnovativeapproachesfor clinicaleducationexperienceswhilestillensuringthequalityofoccupationaltherapyservicesiswidely acknowledged(cook&cusick,1998;casaresetal.,2003;kirke,layton&sim,2007;rodgeretal., 2008). Simulatedlearningprogramsarerecognisedaseffectivemethodsoflearningandareincreasinglybeing usedasameansforaugmentingandattimessupplementingaspectsofclinicalpractice(bradley,2006; Maran&Glavin,2003).However,theextenttowhichtheyarecurrentlybeingusedorcouldbeusedin futuretocontributetowardsclinicalplacementobjectivesandincreaseboththequalityofandcapacity withinoccupationaltherapycurriculaisuncertain. In2006,theCouncilofAustralianGovernmentscommitted$1.6billiondollarstodevisesolutionsthat effectivelyaddressworkforceplanningandcomplementaryreformstoeducationandtraining.health WorkforceAustralia(HWA)isthenewlycreatedagencytofacilitatethisacrossthehealthand educationsectors.oneoftheprojectsoverseenbyhwaisthesimulatedlearningenvironment(sle) NationalProject.Aspartofthehealthworkforcereformpackage,COAGannouncedthatcapitaland recurrentfundingwouldbeavailabletobuildandoperateneworenhancecurrentsimulatedlearning Environments(SLEs).TheplanningprocessforthedistributionofSLEswillbeguidedbyanationally developedandendorsedapproachastowhataspectsofthevariousprofessions curriculaaresuitable forsimulatedlearning. In2010HealthWorkforceAustraliathereforeaskedhealthprofessionsacrossAustraliatoreportonthe useandpotentialuseofsimulationintheirdiscipline.toinformthisprojecthwarequestedscopingof occupationaltherapycurriculathatcouldbedeliveredviasimulatedlearningprogramsandforan analysisofpotentialbarrierstoadoption,necessaryactivitiesandlikelytimeframes.thedivisionof OccupationalTherapyatTheUniversityofQueenslandwasawardedtheopportunitythroughtenderto coordinatediscussionsacrossaustraliaregardingtheuseofsimulatedlearninginoccupationaltherapy onbehalfofhwa.thisreportsummarisesthosediscussions. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 10

11 Terminology UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Arangeofdefinitionsandterminologiesareusedtodescribetheuseofsimulationinhealth professions curricula.whilehwausestheacronymslevariablytorefertosimulatedlearning Environments(SLE)andPrograms,specificterminologywillbeusedinthisreport. Forthepurposeofcommunicationwithoccupationaltherapystakeholderstheauthorsofthisreport selectedthephrase SimulatedLearningActivities (SLAs)tobeusedinplaceoftheacronymSLEs throughoutthisreport,exceptwheresimulatedlearningenvironments(sles)arespecifically addressed.simulatedlearningactivitiesrefertolearningactivities/experiencesthatmakeuseof simulationmodalitiesbutthatmayextendpastthespecificuseofthemodality(e.g.,toinclude discussionfollowingtheuseofthemodality,treatmentplanningafterusingsimulationmodality). Inordertoclarifytheterminologyforthepurposesofthisprojectthefollowingdefinitions/descriptions wereprovidedwitheachsurveyandforausedinthisproject. SimulatedLearningActivities/Opportunitiesrefertolearningactivities/experiencesthatmakeuse ofanysimulationmodalitythatimitatesarealclinical/professionalsituation.simulatedlearning Activitiesmayextendpastthespecificuseofthemodalityegtoincludediscussionfollowingtheuse ofthemodality,treatmentplanningafterusingsimulationmodalityandsoon. SimulationModalitiesrefertothetypeofmediumusedforsimulation,includingbutnotlimitedto: roleplay,standardisedpatients/actors,useofclientswhonolongerreceivetherapy(pastclients), useofmannequins,parttasktrainers,computerpatients(usingscreenbased/virtualworlds)and DVDsofrealorsimulatedclients SimulatedLearningEnvironmentsrefertowherelearningtakesplace,namelythesimulated environments.examplesoftheseenvironmentsareinterviewrooms,mockhospitalwards, simulatedlivingspaces(egkitchen/bathroom)andsoon. SimulatedLearningProgramsrefertothewholeorpartofthecurriculumthatcontainssimulation opportunitieswithinanindividualcourseorsubject. Remitofthisproject Thespecificremitofthisprojectwasto: 1.MapofSimulatedLearningActivities(SLAs)currentlydeliveredateachaccreditedoccupational therapyschoollocatedinaustralia,focusingonslasthatmeetclinicalplacementobjectives 2.ResearchopportunitiesforexpandeduseofSLAstoachievelearningoutcomesofclinical placements 3.Identifycurriculaelementsthatcould,byaccreditedoccupationaltherapyschools,bedeliveredvia SLAs.Thesecurriculaelementsshouldmeetclinicalplacementobjectivesandthereforecontribute toincreasedclinicalplacementcapacity. 4&5.GainnationalagreementfromeachAustralianaccreditedoccupationaltherapyschool, OccupationalTherapyAustralia,andtheOccupationalTherapyCouncil(OTC)onthecurricula elementsthatcouldbeintegratedintothecurricula,perceivedbarrierstothiscurriculumbeing recognizedbytheuniversitiesforclinicaltrainingpurposes,likelyimpactonclinicaltrainingdays requiredinthecourseshouldthesecurriculaelementsbedeliveredthroughslas,andthelikely timeframesforimplementationshouldthesecurriculaelementsbeadopted. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 11

12 ContextofSimulationinOccupationalTherapyCurricula HWAhaveaskedfornationalconsensusastovariouselementsoftheoccupationaltherapycurriculathat couldbeofferedassimulatedlearningactivities(slas).theseelementsmustmeetclinicalplacement objectivesandthereforecontributetowardsincreasedclinicalplacementcapacity.unpackingthisrequest requiresconsiderationofthecontextofoccupationaltherapyprogramsandoccupationaltherapy educationinaustralia.throughoutthisreportthetermsfieldworkandclinicaleducationwillbeused interchangeably. UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Occupationaltherapyisaclient centredhealthprofession concernedwithpromotinghealth andwellbeingthrough occupation.theprimarygoalof occupationaltherapyistoenable peopletoparticipateinthe activitiesofeverydaylife. Occupationaltherapistsachieve thisoutcomebyworkingwith peopleandcommunitiesto enhancetheirabilitytoengagein theoccupationstheywantto, needto,orareexpectedtodo,or bymodifyingtheoccupationor theenvironmenttobetter supporttheiroccupational engagement. (WFOT,2004). ScopeofOccupationalTherapy InAustralia,occupationaltherapistsworkwithindividuals throughoutthelifespanorwithgroups,organisations, communitiesorpopulationsinawidevarietyofinstitutional, organisationalandcommunitybasedsettings,involvingbroad rangingissueswhichconcerntheclient sactualorpotential occupationalperformance.althoughindividualoccupational therapistsmayworkindifferentroles,withdifferentclient groups,andindifferentworksettings,commontoallisthe understandingofoccupationandapplicationoftheoccupational therapyprocess,whichisunderpinnedbycoreoccupational therapyknowledge,skillsandattitudes.occupationaltherapists alsounderstandtheimportanceandnecessityofinter professionalteamworkforeffectiveandefficient practice (AustralianMinimumCompetencyStandardsforNew GraduateOccupationalTherapists OccupationalTherapy Australia2010,p.7). OccupationalTherapyCurriculainAustralianUniversities InAustralia,therearecurrently14accreditedschoolsprovidingoccupationaltherapyprograms(withfour newprogramsproposedtocommenceinfournewuniversitiesoverthenexttwoyears).aprogramrefers totheentirecollectionofcoursesorsubjects/unitsleadingtoanoccupationaltherapydegreequalification. AlloccupationaltherapyprogramsacrossAustraliaaredesignedtograduatetherapistswithentrylevel competenciesrequiredforregistrationasoccupationaltherapists.preparationofstudentstomeetthe requirednewgraduatecompetenciescommencesassoonasstudentsenrol.hence,studentsstartto developtheknowledge,skillsandattitudesrequiredtomeetclinicalplacementobjectivesbeforethey commenceformalfieldwork/clinicalplacementsandfurtherdeveloptheseattributesduringclinical placements.studentsareimmersedinprofessionalcoursesaspartoftheirprogramofstudywithinwhich theydevelop,learnandpracticetheskills,knowledgeandattitudesthatwillenablethemtomeetclinical placementobjectivesfromtheirfirstweekofuniversitystudy.studentsareassessedonplacementlearning objectivesduringclinicalplacementswhichtypicallyoccurasblockplacementsofvaryingdurationfrom shortplacements(13weeks)tolongplacements(714weeks).someoccupationaltherapyprograms providefieldworkexperiencesfromyearoneoftheirprogramwhileforothers,thisprimarilyoccursinlater years. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 12

13 AccreditationRequirements OccupationaltherapyprogramsneedtomeetboththeminimumstandardsdesignatedbyTheWorld FederationofOccupationalTherapy(WFOT,2002)andbythenationaloccupationaltherapypeak bodyassociationotaustralialimited(otal)tobeaccredited. Graduationfromanaccreditedprogramisessentialforindividualgraduatestoregistertoworkasan occupationaltherapistinstateswithregistration(qld,wa,nt,sa)andinallstates/territoriesof AustraliafromJuly2002.Withrespecttoclinicalplacements/fieldwork,theaccreditationofOT programsisguidedbytheprogram sadherencetotheminimumstandardsforfieldworkasprescribed bywfot(wfot,2002).thewfotfieldworkstandardsareattachedasappendix1. WhenconsideringelementsofcurriculathatmightusesimulationinawaythatOTALprogram accreditorscouldagreemightcontributetowardsincreasedclinicalplacementcapacity,thiscriteriaof withorforarealliveperson becomescritical.thereforethenatureofdifferentsimulation modalitieswerecarefullyconsideredthroughoutthisprojectwithrespecttotheirabilitytomeetthis criteria. AcrossAustraliaalluniversitiesusetheStudentPlacementEvaluationForm Revised(SPEFR)(The UniversityofQueensland,2009),asthetoolforevaluatingoccupationaltherapystudents fieldwork/ clinicalplacementperformanceforshortandlongblockplacements.thistoolassessesthedomains of: UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum WFOTrequiresthatasaminimum,studentsundertake1000fieldworkhoursacrossabroadrange ofpracticeareas,acrossthelifespanandacrosshospital,community,andindividuals, organisations,communitysettings.aparticularcriteriaatthecentreofwfotfieldworkstandards isthatitrefersto timestudentsspendimplementinganoccupationaltherapyprocessoraspectof anoccupationaltherapyprocesswithorforarealliveperson. (WFOT,2002,p.24) ProfessionalBehaviour, SelfManagementSkills, CoworkerCommunication, CommunicationSkills, Documentation, InformationGathering, ServiceProvision,and ServiceEvaluation. Eachofthesedomainscontainsparticularclinicalplacementlearningobjectives.Thedomainsare linkedtothevariousaspectsoftheoccupationaltherapyprocessnamelyinformationgathering (referral,goalsetting,assessment),interventionplanningandprovision(serviceprovision),and evaluationpostintervention(discharge,exit,onwardreferralandserviceevaluation).itis acknowledgedthatduringeachstageoftheoccupationaltherapyprocessarangeofprofessional behaviours,selfmanagementskills,clientandcarercommunicationandcoworkercommunication skillsarerequired. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 13

14 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Howcanplacementclinicalplacementcapacitybeincreased? Thefollowingwereguidingprinciplesconsideredthroughoutthestakeholderconsultationprocessinthis project. Increasedclinicalplacementcapacitymightbeoperationalisedby: Reducingthenumberofhoursstudentsneedtoengageinclinicallearningwithinthecontextof clinicalplacementsbyutilisingslaswhichmeetaccreditationstandardspriorto,during,andfollowing clinicalblockplacements. Reducingtheworkloadofclinicaleducatorswhilststudentsareonplacementby: utilisingslastobetterpreparestudentstoenterplacementsatthehighestlevelofclinical competencypossibletoensureclientsafety,andtooptimisestudents levelofindependence,and incorporatingsimulationactivitieswhilststudentsareonplacements. TocontributetowardsHWA saimofincreasingclinicalplacementcapacityinoccupationaltherapy, simulatedlearningactivitiesmustbeabletomeettwocriteria.theymust: a) Contributetomeetingclinicalplacementobjectives,andalso b)meetwfotstandardsrequiredtobecountedtowards1000fieldworkhours. TheWFOTrequirementsstatethatfieldworkis withorforarealliveperson. (WFOT,2002). Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 14

15 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum ProjectApproach/Methodology Comprehensiveconsultationwithrelevantstakeholdersincludingoccupationaltherapyschoolsin Australia,OTALandCOTRB/OTCwasundertaken.Aliteraturereview,developmentofeducational resources,twosurveys,andfinallyamulticityforumserieshavebeencompleted.therecommendations resultingfromthisprocesswillinformhwaaboutthefutureuseofsimulatedlearningactivities(slas)in occupationaltherapycurriculaacrossaustralianuniversities.themethodologyusedforthisprojectis describedbelow. Stage1 MappingofSimulatedLearningPrograms(SLAs)currentlybeingdeliveredateachaccredited occupationaltherapyschoollocatedinaustralia.mappingfocusedonslasthatmeetclinicalplacement objectives. 1.1TofacilitatethemappingofSimulatedLearningPrograms(SLAs)theUQOTteamestablishedaProject AdvisoryCommittee.KeystakeholdersanddecisionmakerswithintheOccupationalTherapyProfession wereinvitedtoengageasmembersofthiscommitteeincluding: Chair/representativeofCouncilofOTRegistrationBoards(COTRB)/OccupationalTherapyCouncil(OTC) ChairofAustraliaandNewZealandCouncilofOTEducators(ANZCOTE) ChairofAustraliaandNewZealandOTFieldworkAcademics(ANZOTFA) ChairofProgramAccreditationCommittee(PAC)OTAustralia RepresentativeofOTAustralianNational(OTAL) ThisAdvisoryCommitteeassistedwithengaging,supportingandcommunicatingtheintentionofthe projecttosignificantoccupationaltherapyprofessionstakeholders,educatorsandprogramaccreditors. Theirrolewastoadvisetheprojectteamonthecriteriaforidentifyinghowsimulationmayexpandclinical trainingcapacityandprocessesforestablishingwherecommonaltiesanddifferencesexistinhow simulationisusedacrossoccupationaltherapyschoolsnationally. 1.2AdetailedprojectplanwasdevelopedinconjunctionwithaProjectAdvisoryCommitteeandtheplan wasthensubmittedtohwaforfeedback. 1.3AnalysisofinformationfromtheNHWTuniversitysurveyregardingcurrentuseofSLAsintheclinical trainingofoccupationaltherapystudentsandthepotentialfutureuse. ThedatafromtheNHWTUniversityClinicalPlacementsSurveyprovidedtotheUQOTProjectTeamby HWAwasexaminedinitiallyforcompletenesswithrespecttotheprovidersofoccupationaltherapy education.thesedatawereusedtoinformthemappingsurvey(see1.4). Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 15

16 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum 1.4AnelectronicmappingsurveyoftheexistinguseofSLAswithinaccreditedprogramswasdeveloped inconsultationwiththeprojectadvisorycommittee(seeappendix2).thefocusonmeetingclinical placementobjectives,programaccreditationrequirementsandstudentlearningobjectivesfor competentperformancewerethekeyconsiderationsguidingthefocusofthemappingexercise undertakeninthissurvey.informationfromallaccreditedoccupationaltherapyprogramsacross AustraliawassoughttoclearlymapcurrentuseandeducationaloutcomesofSLAswithincurrent curricula.themethodsandresultsofthissurveyarepresentedonpages2937ofthisreport. Stage2 OpportunitiesfortheexpandeduseofSLEstoachievelearningoutcomesofclinicalplacementsusing nationalandinternationalexamples,supportedbyevidence,whereavailable,wereresearched. 2.1Aliteraturereviewofthepublishedandunpublishedoccupationaltherapyresearchliterature relatedtotheuseofslaswithinoccupationaltherapywasundertaken.thisreviewispresentedon pages1828ofthisreport. Stage3 Curriculaelementsthatcould,byaccreditedoccupationaltherapyschoolsbedeliveredviaSLAswere identified.thesecurriculaelementsmetclinicalplacementobjectivesandthereforecouldcontribute toincreasedclinicalplacementcapacity.forexample,thiscouldincludecurriculaelementssuchas assessmentandcommunicationskills. 3.1Basedontheresultsofthemappingsurveyandliteraturereview,theUQOTProjectTeamdeveloped aresourcedocument(seeappendix3)anddvdofstandardisedpatientsusedinoccupationaltherapy. Theseresourcesweredistributedinconjunctionwiththeliteraturereviewtoinformstakeholders includingheadsofoccupationaltherapyschoolsabouttheexistinguseofslasandtheirpotentialuse. GiventhelimiteduseofSLAsinoccupationaltherapytodate,theresourcesoutlinedpedagogical strengthsofusingslasinoccupationaltherapyandillustratedthisusewithexamplesprovidedby variousoccupationaltherapyschoolscurrentlyutilisingsimulatedlearning.theseresourceswere providedtoinformparticipantscompletionofasecondsurveyaboutthepotentialuseofsimulation,to provideavaluableplatformforongoingdialogue,andtoexpeditethediscussionneededforsuccessful implementationofstagefourandfiveofthisproject. 3.2Asecondsurveywasdevelopedtoidentifyparticipants viewsregardingthepotentialcurriculum elementsthatcouldbedeliveredusingslaswithparticularattentiontothepotentialformeeting clinicalplacementobjectivesandincreasingcapacity(seeappendix4).thesurveyalsoaskedaboutsles particulartooccupationaltherapycurricula,andcanvassedfeasibility,barriers,impactandtimeframes forthepotentialintegrationofslasintocurrentandfutureoccupationaltherapycurricula.the resultingdatawereusedtoinformfurtherdialogueinstage4tofacilitatenationalagreement.the methodsandresultsofthissurveyarepresentedonpages38to43ofthisreport. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 16

17 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Stage4 NationalagreementfromeachAustralianaccreditedoccupationaltherapyschoolwasgainedonthe following: ThecurriculaelementsidentifiedinStage3thatcouldbeintegratedintothecurricula. Anyperceivedbarrierstothesecurriculaelementsbeingrecognisedbytheuniversitiesforclinical trainingpurposes. Thelikelyimpactonclinicaltrainingdaysrequiredinthecourseshouldthesecurriculaelementsbe deliveredthroughslas. Thelikelytimeframesforimplementationshouldthesecurriculaelementsbeadopted. 4.1BasedonresultsofStages13,aconsultativeapproachusingaseriesofNationalForawasundertaken. TheNationalForainvolvedkeystakeholdersfromaroundAustraliaincludingheadsofschoolsortheir representatives,academicorfieldworkcoordinatorsfromoccupationaltherapyschools(asnominatedby headsofschools)andrepresentativesfromanzcoteandanzotfa,otaustralia,cotrb/otcandothers identifiedbytheprojectteamthroughtheprojectadvisorycommittee. Tofacilitatethediscussionsatthesefora,adocumentwithaseriesofscenariosincorporatingdifferent typesofsimulationwithinoccupationaltherapycurriculawasprovidedtoeachparticipantpriortothe fora,withkeyquestionsrelatedtoeachscenario(seeappendix5).thiswasdesignedtofacilitate discussionsofkeyissuesandtohelpmovetowardsconsensus.atthefora,theuniversityofqueensland ProjectTeamengagedwithkeystakeholdersto;(1)refinethedatacollectedonthecurrentandpotential useofslaswithinoccupationaltherapycurriculaandtheimpactonclinicaltrainingcapacity,(2)identify issuesassociatedwithadoptionofslaswithincurriculumincludingpotentialfacilitatorsandbarriers,(3) impactonclinicaltrainingdays,and(4)possibleadoptiontimeframesacrossallaccreditedoccupational Therapyschools.TheaimwastoreachconsensusontheSLAcurriculumpriorities,processesand recommendationsforoccupationaltherapy(seeappendix6).themesfromtheseforaaresummarisedon pages4546ofthisreport. Stage5 NationalAgreementfromOccupationalTherapyAustraliaandtheOccupationalTherapyCouncil(OTC) wasgainedonthefollowing: ThecurriculaelementsidentifiedinStage3meetingtheaccreditationstandardsforAustralian occupationaltherapyschools. PerceivedbarrierstothesecurriculaelementsbeingadoptedbyAustralianoccupationaltherapy schools. Thelikelihoodthatthesecurriculaelementswouldreplacethetraditionaldeliveryofclinicaltraining throughclinicalplacements. Thelikelytimeframesforadoptionofcurriculaelements. 5.1FollowingthenationalforaheldinStage4whichengagedheadsandfieldworkstaffofoccupational therapyschools,aforumwasconductedwiththemembersoftheprojectadvisorycommittee includingarepresentativefromotaustralia,chairoftheotprogramaccreditationcommitteeanda secondrepresentativefromthiscommittee,arepresentativefromtheotc,chairofaustraliaandnew ZealandCouncilofOTEducators(ANZCOTE),andChairofAustraliaandNewZealandOTFieldwork Academics(ANZOTFA)(seeAppendix7). Thisfinalforumaimedtoidentifyperspectivesrelatedtoaccreditation,facilitatorsandbarrierstoadoption ofsla,impactonclinicaltrainingdaysandpossibletimeframesforimplementation.inadditionthisforum discussedandreviewedoutcomesofthestage4foraandaimedtoachieveconsensualrecommendations todelivertohwa. AlistofthosewhoparticipatedintheforafromStage4and5areprovidedinAppendix8. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 17

18 LiteratureReview UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Findings: SimulationinOccupationalTherapyCurriculum:ALiteratureReview Background Clinicalplacements(professionalpracticeplacementsorfieldwork)areessentialforthedevelopment ofprofessionalcompetenciesrequiredforentryleveloccupationaltherapypractice.however,asin manyotherhealthprofessions,thereisincreasingdifficultyinobtainingclinicalplacementsfor occupationaltherapystudents(casares,bradley,jaffe&lee2003;rodger,webb,devitt,gilbert, Wrightson&McMeeken,2008).Justsomeofthefactorscontributingtothisproblemincludechanging workplacedemands,financialconstraints,andincreasingstudentnumbers(casaresetal2003; Williams,Brown,Scholes,French&Archer,2010).Thepressuretodevelopinnovativeapproachesfor clinicaleducationexperienceswhilestillensuringqualityofoccupationaltherapyservicesiswidely recognised(cook&cusick,1998;casaresetal2003;kirke,layton&sim,2007;rodgeretal2008). Simulatedlearningprogramsareincreasinglybeingusedasameansforaugmentingandattimes supplementingaspectsofclinicalpractice(bradley,2006;maran&glavin,2003).thispaperaimsto reviewtheuseofarangeofsimulationmodalitiesandtheirapplicationinoccupationaltherapy curriculabeforeconsideringthepotentialforsimulationtocontributetowardsmeetingclinical placementobjectives.toprovidebackgroundcontextforthisreview,keyrequirementsforclinical placementsinoccupationaltherapycurriculaareinitiallydescribed. Contextofclinicalplacementsinoccupationaltherapycurricula Theprincipalgoalofoccupationaltherapytrainingisthegraduationofstudentswiththenecessary skillstobecomecompetentoccupationaltherapists.theworldfederationofoccupationaltherapists (WFOT)(2008)hasrecentlydevelopedacompetencystandardsframeworkforentrylevel occupationaltherapiststhatdescribesprofessionalcompetenceastheknowledge,skillsandattitudes necessarytocarryoutsafeandeffectivepractice.competenciesareconsideredaproductofboth entrylevelpreparationandclinicalexperiencesandattentiontoboththequalityandquantityof clinicalexperiencesisnecessary.alignedwiththewfotcompetencies,occupationaltherapy Australia(OTAL)hasrecentlyrevisedthenationalcompetenciesfornewgraduateoccupational therapists(otal,2010).thisdocumentaccreditationstandardsfornewgraduateoccupational Therapists(ACSOT)(OTAL,2010)acknowledgesthatspecificunitsofcompetencearerequiredfor entrylevelpracticeandthatthesearegainedthroughbothpreclinicaleducationandappropriate clinicalpracticeeducationexperiences. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 18

19 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Students demonstrationofaminimumrangeofcompetenciespriortograduationhelpsensurethe qualityofservicedeliveredbyfutureoccupationaltherapists.akeyaspectofmeasuringcompetenceis theperformanceofstudentsduringtheirclinicalplacements.inaustralia,allaccreditedoccupational therapyprogramscurrentlyusethestudentplacementevaluationformrevised(spefr)(turpin, Fitzgerald,&Rodger,inpress)toprovidefeedbackandassessstudents knowledgeandskillsduring fieldworkplacements.thespefrwasdevelopedwithclosereferencetotheascot(otal,2010)that wasunderrevisionatthetimeofitsdevelopment.thespefrincludeslearningobjectivesforclinical placementswithineightdomains: ProfessionalBehaviour SelfManagementSkills CoworkerCommunication CommunicationSkills Documentation InformationGathering ServiceProvision ServiceEvaluation Inadditiontomeetingclinicalplacementobjectives,studentsundertakingaccreditedoccupational therapyprogramsneedtocomplete1000hoursofclinicaltrainingacrossabreadthanddepthof practiceexperiences(wfot,2007).cookandcusick(1998)identifiedthreeissuesarisingfromthis requirementfor1000hours,namely,issuesofclinicalplacementsupplyanddemand,demandson clinicalsupervisors,andtheneedforstudentstobewellpreparedforfieldworksothatfieldworktime isusedeffectively.simulatedlearningprogramshavepotentialtohelpaddresssomeofthese challenges. Method Thesearchesforthisliteraturereviewfocusedonidentifyingtheuseofsimulationandsimulation modalitiesinoccupationaltherapycurricula.theaimofthesearchwastoidentifyexamplesonly,of frequentlyusedsimulationmodalities(suchaswrittencasestudies,roleplayanddvd)andsearches werenotdesignedtobecomprehensive.morecomprehensivesearchesweredesignedforless commonlyusedsimulationmodalitieswithinoccupationaltherapycurriculasuchasstandardised patients,mannequins(humanpatientsimulators),parttasktrainersandvirtualreality. SearchesofMedline,CinahlandPsychInfobibliographicdatabaseswereundertakenforarticlesabout simulationinoccupationaltherapycurricula.inaddition,referencelistsofkeyarticleswerereviewed tolocaterelevantreferences.thefollowingsearchtermswereused: simulat*, standardi?ed patient*, virtualpatient*, virtualreality, Web3D, roleplay, casestudies mannequin* (and relatedspellingsofthisterm).thesetermswerecombinedwithtermsdesignedtolocateliterature withafocusonoccupationaltherapyeducation.severalbasicinternetsearcheswerealsoconducted usingthegooglesearchenginetoidentifyrelevantreferencesoroccupationaltherapyprograms utilisingstandardisedpatients,mannequins(humanpatientsimulators)orvirtualrealityintheir curriculum. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 19

20 Simulation Simulationisaneducationaltechniquethatrecreatesallorpartofaclinicalexperience.Simulationhas beendefinedas atechniquenotatechnologytoreplaceoramplifyrealexperienceswithguidedex periencesthatevokeorreplicatesubstantialaspectsoftherealworldinafullyinteractivemanner (Gaba,2004,pi2). Ithasbeenusedbymanyhealthprofessionstopreparestudentsforclinicalplace mentsaswellastoaugmentclinicalplacementexperienceswiththeaimofimprovingboththequality andsafetyofpatientcare(maran&glavin,2003). Theadvantagesofusingsimulationintrainingandassessmentarenumerous.Simulationprovidesalow risklearningexperienceforstudentstotrynewskills,orpracticeinmanagingsensitiveissueswithout adverseconsequencesandallowsrepeatedpracticeforskilldevelopment(issenberg,mcgaghie, Petrusa,Godon&Scalese,2005;Lane&Rollnick,2005).Fromaneducationalperspectivecasescanbe establishedtotrainandassessarangeofspecificskillsandbehavioursunderlyingclinicalcompetencies, inastandardisedmanneracrossallstudentswithinaprogram(lane&rollnick,2005;levine&swartz, 2008).Theselearningexperiencescanbeestablishedwithtargetedlearningobjectivesanddefinedout comes(issenbergetal2005).onthewhole,simulatedlearningprogramsarewellreceivedbystudents, withmanystudiesreportingstudents perceptionsofimprovedknowledge,skills,confidenceandmoti vationforlearning(baillie&cuzio,2009;cant&cooper,2009;lindstomhazel&westfrasier,2004; Paskins&Pelile,2010;Velde,Lane&Clay,2007). Simulationmodalitiesandtheirapplicationinoccupationaltherapy Simulationmakesuseofanumberofdifferentmodalitiestoimitaterealsituations,includingbutnot limitedto,writtencasebasedscenarios,dvdsofsimulatedorrealpatients,standardisedpatients,man nequinsandparttasktrainersandvirtualrealityorcomputerpatients(gabaetal2003;maran&glavin 2003).Examplesoftheuseofeachofthese(orpotentialuse)inoccupationaltherapywillbeconsid ered.throughoutthisreviewtheterm patient willbeusedtorefertopatient/clientgivenit sextensive useintheliteratureonsimulation.animportantdimensionofsimulationthatwillalsobeconsideredis itsleveloffidelity,ordegreetowhichthesimulationmimicsreality(maran&glavin2003ref).threeas pectscontributingtotheoverallauthenticityorfidelityoftheexperienceare;(1)equipmentormodality fidelity,(2)environmentfidelity,and(3)psychologicalfidelity.theextenttowhicheachoftheseaspects isattendedtointhesimulationwilldeterminethelevel(i.e.,high,mediumorlow)offidelityorauthen ticityachieved. Writtencasestudies Casesstudiesarethebackboneofsimulationlearningprograms.Regardlessofwhichmodalityisuseda welldevelopedcasescenarioisessential.problembasedlearningcurriculamakethemostextensiveuse ofcasestudies(eitheronpaperoroncomputer)withcasesbeingasrealisticaspossible.regardlessof thestructureofthecurriculumhoweverthereiswidespreaduseofwrittencasestudiesinoccupational therapyprograms.writtencasestudiesmayfocusonspecificissueswithincurriculasuchasteaching occupationaltherapystudentsaboutendoflifeissues(meredith,2010),oraimtodevelopclinicalrea soningacrossawiderangeofcases(neistadt,wight&mulligan,1998;vanliet,1995).althoughwritten casebasedscenariosandassociateddiscussionsandfeedbackprovideanopportunitytouseclinicalrea soningskillsincasesthatreflectcontentdrawnfromrealcases,thecasescommonlyusedcanonlypro ceedinasingledirection(poulton,conradi,kavia,round&hilton,2009)andlacktherichnessandinter activechallengesthatarepresentinrealsituations. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 20

21 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum DVDsofsimulatedorrealpatients AnalternativeformattowrittencasestudiesisthepresentationofcasesinvideoorDVDformat, regardlessofwhattechnologythesevideosareviewedthrough.anumberofpapershavediscussedthe useofvideosordvdsofsimulatedpatientsforpreparationforclinicalplacements(williams&brown, 2007;Williamsetal,2010).Williamsetal(2010)investigatedtheuseofDVDsimulationsforteaching interprofessionalskillsandconsideredtheiruseforsupplementinglearningforclinicalplacements. Threehundredandninetyfourstudentsfromnursing,occupationaltherapy,physiotherapyand paramedicswatcheddvdsofinterprofessionalteamsfromthesesamedisciplines. Practicinghealthprofessionalswerefilmedworkingwithactorsplayingtheroleofpatientsin11 differentscenarioscoveringtopicssuchasburns,intracerebralhaemorrhage,traumaticbraininjuryand myocardialinfarctionwiththelasttwobeingpresentedaslongitudinalcases.afterstudentsviewedthe DVDs,theyratedtheirperceptionsandattitudesabouttheclinicalrelevanceandlearnersatisfaction withthedvdsandparticipatedinfocusgroupdiscussions.using7pointlikertscaleswith7beingthe highestrating,student smeanscoresforperceivedclinicalrelevancewas4.37(sd0.60)andlearner satisfaction5.25(sd1.16).infocusgroupdiscussionsitwasclearthatstudentsfeltthedvdswereuseful forpreparingforclinicalplacementsbutthattheycouldnotreplacethereallifeexperiencesofclinical placements. Inastudyby(Liu,Schneider&Miyazaki,1997)useofvideotapesofstandardisedpatientsinteaching clinicalskillstooccupationaltherapyandphysicaltherapystudentsinageriatricrehabilitationcourse wascomparedwithuseoflivestandardisedpatients.studentsdemonstratedsignificantlybetter problemidentificationwiththelivesimulatedpatient,buttheirtreatmentplanningwasstrongerusing thevideotapedformat.students satisfactionwiththegroupinteractionandthecontentrating(i.e.,the students satisfactionwiththetopicscoveredintheinterview)wasstatisticallysignificantlyhigherfor thestandardisedpatientinteractionthanforthevideocondition,howevertheauthordidnotdescribe thesatisfactionmeasureorelaborateonspecificresults. Roleplay Roleplaysbetweenstudentshavebeenshowntobeeffectivefordevelopingarangeofskillsincluding communicationskills(nestal&tierney,2007),motivationalinterviewing(mounsey,bovbjerg,white& Gazewood,2006),andmorebroadlyforpreparationforfieldwork(Cook&Cusick,1998).Roleplaysare inexpensiveandhavebroadapplicationsrangingfromdevelopingculturalcompetence(shearer &Davidhizar,2003),practicingmanualhandling(Menzel,Hughes,Watres,Shores&Nelson,2007),or developmentofcomplexcombinationofskillsandattributessuchasthoserequiredbyoccupational therapistsinthemilitary(rice&gerardi,1990).oneoftheadvantagesofroleplayisthatitcanbe altereddependingonwhethertheeducationalgoaladdressesknowledge,attitudesorskills(maier, 2002).Roleplayencouragesstudentstodrawonpreviousexperiencesandimportantlyprovides reciprocallearningwiththoseroleplayingpatientsgaininginsightintosomeoftheissuesfacedbythe patienttheyportrayed(richardson,resick,leornardo&pearsall,2009).howeverroleplayislimitedby theknowledgeandskillofparticipantswithstudentsidentifyinglackofrealismandpoor"acting"skills asdetractingfromitsbenefits(nestal&tierney,2007). Anumberofrandomisedcontrolledtrialshavecomparedstudentsroleplayingwiththestudent interviewsofstandardisedpatientsforteachingstudentsinterviewingskillsforsmokingcessationwith nodifferencesininterviewingskillsfoundbetweengroups(mounseyetal2006;papadakis,croughan Minihane,Fromm,Wilkie&Ernster,1997).Althoughdemonstrationofskillsappearedsimilar,Mounsey etal(2006)notedthatstudentspreferusingstandardisedpatientstoroleplayandthatroleplaywas morelikelytobesuitedtotraininginbasicskillswhereasstandardisedpatientsmaybepreferablefor teachingmoreadvancedskills. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 21