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

22 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Standardisedpatients Standardisedpatientsareactorsusedtopresentasapatientorconsumerandhavecommonlybeenused inmedicineandnursingtoevaluatehistorytakingandphysicalexaminationskills,communication,and professionalism,andtoprovidepracticehandlingdifficultpatientencounters.inareviewof23studies comparingstandardisedpatientencounterswithotherformsofteaching,lane&rollnick(2005) concludedthatstandardisedpatientsledtoimprovedcommunicationskillswhencomparedwithdidactic orotherinteractivemethodsofteachingcommunicationskills.interestingly,inarandomisedcontrolled trialcomparingtrainingofmedicalstudentsinasthmacareusingstandardisedpatientswithrealpatients, studentsindicatedtheirpreferenceforstandardisedpatientsforpracticingcommunicationskills, practicinghistorytaking,beingabletopracticelearninggoals.theyalsoratedtheoverallinstructiveness oftheencounterwithstandardisedpatientshigherthanwithrealpatients(bokken,linssen,scherpbier, vandervleuten&rethans,2010). Thebenefitsofstandardisedpatientshavebeenwidelyreported(Bokkenetal,2010;Hill,Davidson& Thodoroa,2010;Lane&Rollnick,2007).Standardisedpatientsreceiveuniformtrainingtoportraythe rangeofbehavioursrequiredtomeetthelearningobjectivesoftheparticularsimulationactivitythereby providingstudentswithconsistentassessmentandtrainingexperiences(lane&rollnick,2007).they providearealisticencounterforstudentsinwhichstudentsmaymakeerrorswithouttherisk,and providealearningexperiencethatcanbemanipulatedandcontrolled(edwards,mcguiness,&rose, 2000).Oneofthemostvaluableaspectsofstandardisedpatientsistheycanbetrainedtoprovide writtenandverbalfeedbacktostudentsfromtheperspectiveofthepatient,particularlyinregardto communicationskills(bokkenetal2010;issenbergetal2005;lindstromhazel&westfrasier,2004). Therearehowever,significantpragmaticdifficultiesintheuseofstandardisedpatients.Mostobviousis thecostinvolvedinhiringstandardisedpatients,althoughthisvarieswithcostsforstandardisedpatients reportedbetweenus$1035/hour(howley,glivamcconvey&thornton,2009),althoughsomecentres reporttheuseofstudentsfromotheryeargroupstominimisethis(richardsonetal2009).thereisalso substantialtimeandorganisationrequiredinplanningandimplementingstandardisedpatientsimulation activitiesandtheavailabilityofclinicaleducatorsisessentialtoensuresmoothoperation.finally,theuse ofstandardisedpatientsmaybelimitedbythestudents perceptionofrealismwhichmaybeinfluenced bythelevelofenvironmentaland/orpsychologicalfidelityofthepresentation. Afewstudieshavebeenpublisheddescribingtheuseofstandardisedpatientsinoccupationaltherapy curriculum(lindstromhazel,&westfrasier,2004;liu,schneider,&miyazaki,1997;velde,lane&clay, 2009;Wu&Shea,2009).Mostofthesestudiesusedothersimulationmethodsinconjunctionwith standardisedpatients. Inordertopreparestudentsforthecomplexitiesofclinicalpractice,LindstromHazel&WestFrazier (2004)adaptedtheproblembasedlearningcurriculumtousearangeofstandardisedsimulationsof clients,familymembersandahealthcareteam.althoughnospecificdetailswereprovidedaboutthe casesthatwereused,theauthorsreportedthatfieldworksupervisorscommentedonstudentsbeing moreclientfocussed,independentandabletoworkcollaborativelyfollowingthesesimulations.students (n=274)commentedinopenendedquestionsonanevaluationsurveythattheyvaluedtheauthenticity, thatitwasmoresimilartobeinganoccupationaltherapistthanroleplayinganditgavethempracticein discussionuncomfortabletopicssuchassexualexpressionandtoilethygienewithmoststudents agreeingthatithadenhancedtheirlearning. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 22

23 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Velde,Lane&Clay(2009)integratedtheuseofthreepaperbasedcaseswithstandardisedpatientsfor secondyearoccupationaltherapystudentspreparingforfieldwork.studentsfirstlydevelopgoalsfor theclientdescribedinthewrittencases,andeventuallydevelopedanddocumentinterventionplans appropriateforthecase.studentstheninteractedwithstandardisedpatientsinasimulatedlearning environmentcloselyreplicatingtheenvironmentinwhichtheclientwouldbeseen.inthiscasethe studentsinteractedwithaclientaroundergonomicdesignissuesinanofficesetting.studentsworked inpairswithoneinterviewingtheclientandtheotherobservingandprovidingfeedbacktothe interviewingstudentbeforereversingroles.additionallystudentsreceivedfeedbackfromthe standardisedpatientandeducators. Interventionsthatwereusedincludedstrengtheningandrangeofmotionexercises,modificationof theenvironment,andeducationaboutergonomicprinciples.twentythreestudents perceptionsof thisexperienceweregatheredusingawrittenevaluationoftheprogramgeneratingqualitativedata. Quoteswerecategorisedintothefollowinggroups: Ifeltlikeatherapist; Iintegratedknowledgeand appliedskills ;and Theexperiencecouldbeenhanced. Studentswerealsoaskedtoratetheuseof simulatedcaseswithotherteachingmethodsonascaleof14with1=doesnotenhancelearning throughto4=greatlyenhanceslearning.livesimulatedcasereceivedameanscoreof3.86compared withvideocases(3.14),papercases(2.86),classdiscussions(3.08),lectures(2.69)androleplay(2.54). Althoughthesedataarepromising,morerigorousmethodsareneededtoevaluatethisteaching approachinfuture. VanLeits(1995)comparedpaperorwrittencases,videotapecases,withbothsimulatedclientcases andrealclientcaseswithrespecttotheirabilitytopromotethedevelopmentofspecifictypesof clinicalreasoning.theauthorconcludedthatwrittencaseswerebestsuitedtodevelopingscientific andproceduralreasoning,withpotentialfornarrativeandpragmaticreasoningdependingonthe informationprovided.videotapedcasesweremorelikelytofosternarrativeorconditionalreasoning. Livesimulatedclientswerebeneficialfordevelopinginteractiveandnarrativereasoning.Finallywith realclientsprovidedopportunitiesforalltypesofreasoning. TheUniversityofQueenslandProjectTeammembershaveusedstandardisedpatientswithsecond yearoccupationaltherapystudentsfocusingonacaseofamanreturninghomefollowingmyocardial infarction(bennettetal.,inpreparation).inpairs,studentsparticipateintwo45minutesessions takingturnstointerviewtheclientandtoprovideeachotherwithfeedback.thecasewasdesigned aroundlearningobjectivesfordevelopingskillsingatheringinformation,providingeducation, motivationalinterviewingskills,handlinguncomfortabletopics,studentselfmanagementskillssuchas beingpreparedandmanagingtime,andcommunicationskillsdevelopment.ninetyfivestudents undertookapreandpostquestionnairetodeterminechangeinstudent sanxietyandconfidencein carryingoutinterviewsandtoascertaintheirviewsonthisinitiative.followingthestandardised patientexperience,studentsweresignificantlylessanxiousabouttheprospectofworkingwithreal patientsinfieldworkthanpriortothestandardisedpatientexperience(p<0.001).students confidence inestablishingrapport,usingappropriateinterpersonalskills,identifyingkeyclinicalinformation, interviewingpatientsaboutpersonalinformation,providinginformationtopatients,andinterviewing patientswithchallengingbehavioursallshowedstatisticallysignificantimprovement.over90%of studentsagreedthattheirinitialinterviewingskills,skillsineducatingpatients,andconfidencein interactingwithpatientsinfuturehadimprovedasaresultofinteractionwithstandardisedpatients. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 23

24 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Standardisedpatientshavealsobeenusedwithinaninterprofessionalpainassessmentand managementcurriculumforstudentsfromsixdifferenthealthprofessionsincludingoccupational therapy(wattwatsonetal2004).standardisedpatientspresentedasapersonwithadvancedcancer experiencingpainandwereinterviewedbyaninterprofessionalgroupofstudentsasastimulusfor consideringpainassessmentandthedevelopmentofpainmanagementplans.onevaluationofthe weeklongcurriculumwhichalsoincludeddidacticcontent,smallgroupworkandpanelpresentations frompatientswithchronicpain,thehighestratingsweregivenforthepanelandsmallgroupdiscussion withstandardisedpatients. Althoughfewdescriptionshavebeenpublishedintheliterature,itisclearfromperusingarangeof websitesthatanumberofoccupationaltherapyprogramsareusingsimulationintheirprograms.for example,atthomasjeffersonuniversityintheusa,standardisedpatientsareusedincoursework addressingbothassessmentsandinterventions.studentshavetheopportunitytopracticeundertaking astandardisedcognitiveassessmentwithastandardisedpatient.standardisedpatientsinthisprogram mayportrayapersonwithacerebrovascularaccidenttoprovidestudentswithpracticeinteaching clientsdressingandfunctionalmobilityskillsormayportrayapersonwithspinalcordinjurytoprovide studentspracticeintrainingclientsindressing,functionalmobility,homemakingtasks,andfeeding skills(a.lzapletal,personalcommunication,september14,2010) Potentialapplicationsforstandardisedpatientsinoccupationaltherapycanalsobeconsideredfrom studiesusingstandardisedpatientsinotherhealthprofessions.forexample,standardisedpatients havebeenusedtopreparephysiotherapystudentsforclinicalplacements(wojcik,2000),trainingthe examinationofclientswithshoulderpain(ladyshewsky,baker,jones,&nelson,2000),and neurologicalexamination(ecternanch,2000).useofstandardisedpatientsinoccupationaltherapymay alsobeinformedbythemedical,nursingandpharmacyliteraturewithstandardisedpatientsportraying peoplewithmentalillness(brenner,2009),peoplewithvaryingchronicconditions(linssen,vandalen &Rethans,2007),andtheuseofstandardisedpatientsfordevelopingcrossculturalcompetency (Rutledgeetal2004)andexperienceininterprofessionalteams(Westberg,Adams,Thiede, Bumgardner&Stratton,2006). Insummary,standardisedpatientsprovidenumerousoptionsforeducatingandassessingstudents particularlyaroundthecompetenciesrequiredforofcommunication,professionalskills,self management,interprofessionalcommunication,documentation,informationgatheringandservice provision. Mannequinsandparttasktrainers Mannequinsandparttasktrainersareasimulationmodalityfrequentlyusedtotrainmedicaland nursingstudentsinemergencyskills,cardiacevents,medicalsurgicalskills,obstetricskillsandprepost operativecare(cant&cooper,2009;kneebone,kidd,nestel,asvall,paraskeva&darzi,2002;maran &Glavin2003).Parttasktrainersaremodelledsegmentsofthebodysuchasanarm,orupperbody mannequintoteachspecificskillssuchasinjectionsorcardiopulmonaryresuscitation(bladstock&jull, 2007;Maran&Glavin2003).Furtherparttasktrainersmaybewornbystandardisedpatientssothat specificskillsmaybepracticedwithpatientreactionsbeingevident.mannequinshavedifferinglevels ofequipmentfidelity.lowfidelitymannequinsprovidetheuserwithlimitedfeedbacksuchasthose usedincprtrainingwhosechestrisesandfallswiththeintroductionofair.mediumfidelity mannequinsprovideamoderateamountoffeedback,drivenbycomputerprogramsthatallowthe instructortomanipulatethephysiologicalparameterssuchasbloodpressureandheartrate.ahigh fidelitymannequinprovidesmuchmorerealisticfeedbackwiththeassociatedcomputersystems allowingformorecomplexevents(bladstock&jull,2007). Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 24

25 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Onlyonestudywasidentifiedthatusedmannequinsinoccupationaltherapy.Wu&Shea(2009)designed ahighfidelityintensivecareunit(icu)simulationfor24preleveliifieldworkstudentsatsamuelmerritt University.Thecourseincorporatedasimulationofayoungadultwhohadsustainedatraumaticbrain injuryandwascomatose.thesituationwascomplicatedbyuseofastandardisedpatientportrayingan emotionallydistressedfamilymember.astaffmemberfromthesimulationcentreandanacademicoc cupationaltherapystaffmemberdirectedthescenariofromthecontrolroom.themannequinandmedi calmonitorsweremanipulated(forexamplevitalsignswerealteredtoreachacriticallevel)requiring studentstotakenoticeandrequestmedicalattention. ThiscaseintroducedstudentstotheenvironmentofICUandthedifficultiesofworkingwithaclientwho iscomatoseinasafecontextminimisingnegativeconsequencesshoulderrorsoccurduringthesimula tionactivity.clinicallearningobjectivesfocusedondevelopingstudentcompetenciesininterpreting changesinclients'vitalsigns,beingawareofprecautionswhenhandlingclientswhoareconnectedto monitorsandmedicalequipment,assessingcomatoseclientsandeffectivecommunicatingwithdis tressedclientsandfamilymembers.studentresponsetothesimulationwasextremelypositive,with 100%indicatingthatthesimulationwasaneffectivelearningmethod.Theauthorsrecommendedade quatetimebegiventodebriefingtoallowstudentstoengageinselfandpeercritiquing,brainstorming alternativeactions,andprioritizingtherapeuticgoals. Althoughotherusesofmannequinsandparttasktrainersarenotdescribedintheliteraturethereare reportsfromwebsitesoftheuseofmannequinsintrainingoccupationaltherapystudents.forexample atohiostateuniversityoccupationaltherapyandphysiotherapystudentshaveworkedtogetherusing bothstandardisedpatientsandmannequinstosimulatetheworkinginanicuenvironment.students wererequiredtoidentifyandunderstandvarioustubes,equipmentandlifesupportsystemsoftenseen intheicuenvironmentandtotrainfamilymembershowtopositionapersonwithsevereheadtrauma. ItisreportedthatstudentsgainedconfidenceandskillsinworkingintheICUenvironment,andlearnt abouttherolesofotherdisciplines. Virtualrealityandcomputerbasedpatients Virtualrealityreferstocomputergeneratedsimulationsofbothrealorimaginedenvironmentsandpeo ple(gaddis,1998).avirtualenvironmentmayalsoincludevisualstimuli,sound,motion,andsmell (McLaughlinetal2008).Useofvirtualrealityintraininghealthprofessionalsvarieswidelydependingon thetypeandcombinationoftechnologyandmultimediausedandonthelearningobjectivesofthecur riculum.forexample,virtualreality(sometimesincorporatinghaptics)hasbeenusedfortrainingspecific surgicalskills,virtualworldsusedfortraininginmedicalemergencyskills,andteachingcounsellingskills (Mantovani,Castelnuovo,Gaggiolo&Riva,2003). Virtualpatients,asubsetofvirtualrealitytechnologyareaninteractivecomputersimulationofreallife clinicalscenariosinwhichpatientcasesunfoldinresponsetolearnerinput(cook&triola,2009).oneof theadvantagesofvirtualpatientsisthatstudentshavetoconsideroptionsasthecasesunfoldandtoex periencetheconsequencesoftheiractions(poultonetal2009).unlikesomeoftheothersimulationmo dalities,virtualpatientscanbereadilyintegratedintocurriculaandmaybeusedattimeswhichsuitstu dentsandeducators(triolaetal2006).however,arecentreviewpointedoutthatalthoughstudents mayidentifysimilarinformationfromtheuseofvirtualpatientsandstandardisedpatients,theyarenot abletoprovideadequatelearningexperiencesincommunication,empathyandnonverbalskills,andare bestsuitedtodevelopingclinicalreasoningskills(cook&triola,2009). Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 25

26 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Occupationaltherapistsarefamiliarwiththeuseofhighlycomplexvirtualrealitysystemsforservice deliveryandrehabilitationbutreportsofitsuseinoccupationaltherapycurriculaarelimitedtomore basicusesofvirtualenvironmentsandvirtualpatients.anexampleoftheuseofvirtualrealityis describedbystansfield,butkiewicz,suma&kane(2005).usingavirtualhumanmodelprovidedwithin thevideogamingsoftwarehalflife2,theauthorsdevelopedavirtualclientwhohadhadastroke. Thevirtualclientwaspresentedhavingimpairedmovementonhisrightsideandpartialfacial paralysis.thevirtualclientwasusedtoprovidestudentswithpracticeininitialevaluation,andthe authorsstatedtheyplantodevelopthiscasefurther. Anoccupationaltherapycentrehasbeendevelopedinthe3DvirtualworldSecondLife (TothCohn& Gallagher,2009).Thecentrenotonlyprovidesstudentswithexperienceindevelopingvirtualreality environments,butrequiresthattheyconsiderstandardsforenvironmentaldesigns,andhowto providehealtheducationtoarangeofpatientgroups.inadditionthecentreisutilisedbyanyusersof SecondLifeinterestedinexploringtheseareas.Todatetheoccupationaltherapycentreincludes4 areas:1)ahomeenvironmentcontainingadaptationsthatmightimprovecapabilitiesofpersonswith decreasedmobility,impairedcognitivefunctioning(memory),andlowvision;2)anareaabout backpacksafetyawareness;3)anexhibitaboutcarpaltunnelsyndrome(cts)displayingtheanatomy ofthecarpaltunnel,strategiesforprevention,experiencesofpersonswhohadcts,andcurrent researchaboutcts;and4)anareaforhealthyagingprovidinginformationaboutmaintaining cognitiveandphysicalfunctioning. Thereareagrowingrangeofplatformsforvirtualrealitycasedevelopmentthatmaybeusedin occupationaltherapycurriculaincludingsecondlife,scenariobasedlearninginteractive(sbli),vp Sim,WebSPandsoon,eachwiththeirownadvantagesanddisadvantages.Howeversomeofthe basicfunctionsofvirtualrealitycasescenarioshavealsobedeliveredusingvideofootagewithin computerprograms(tomlin,1996).forexample,tomlin(1996)incorporatedvideotapedclipsof clientsorsimulatedclientswithinaprogramrequiringstudentstocommittospecificdecisionsand observingtheclientsresponsebeforebeingabletomoveforwardonacase(tomlin,1996).giventhe limitedevaluationofitsuseinteaching,thepotentialfortheuseofvirtualrealityinoccupational therapyeducationrequiresfurtherinvestigation. Comparingmodalities Lysaght&Bent(2005)comparedadvantagesanddisadvantagesoffourdifferentmodalitiesfor presentingcasesinanoccupationaltherapycoursedesignedtodevelopclinicalreasoningskills.the modalitieswerewrittencasebasedscenarios,videotapedcasestudiesofrealclients,facetoface interviewofaclientwhohadpreviouslyreceivedtreatment,andvideotapedsegmentsofaspectsof realclient slivesincludinginterviewswiththerapistandfamily.interestinglystudentswereableto achievethelearningobjectivesregardingclinicalreasoningregardlessofwhichmodalitywasused. Howeverstudentsandeducatorsindicatedeachmodalityhadspecificstrengthsandweaknesses. Studentspreferredtheabilitytolistentoorinteractwitharealclientasthisprovidedthemwiththe greatestinsightintoaclients experiences.however,clinicaleducatorsinthisstudyfeltthatthe abilityofalivepersontoprovidecontentrelatedtothelearningobjectiveswashighlydependenton thenatureofthecasepresentation,andwasunpredictableatbest.theauthorsrecommended standardisedpatientsbeconsideredasanalternative.theyconcludedthattherearepedagogical factorstoconsiderinchoosingmodalitiesforpresentingclinicalcases.theseincludedthespecific aspectsofcurriculuminwhichcaseswillbeused,thelevelanddetailofthecontentrequired,the degreeofcontrolrequiredoverlearningobjectives,andthepragmaticsofimplementingthesecasesin thecurriculum. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 26

27 Sofarthispaperhasconsideredsimulationmodalitiesseparatelyhoweveritisimportanttoconsider theuseofmultiplesimulationmodalitiestoachievemorecomplexeducationalobjectives.forexample, theuseofmultiplemodalitiesmaybeusefulforsimulatingacomplexwardenvironmentinwhich studentsneedtoattendtomultipleclinicalandprofessionalfactors/demands.theuseofintegrated andmultiplemodalitiesmayhelptobuildstudents abilitytodemonstratemultiplecompetencies simultaneously,asoccursinmoreadvancedpractice.todatetherehasbeenminimalconsiderationof theuseofmultiplemodalitiesintheliteratureandconsiderationofthismayenablefurtheranalysisof thepotentialofmodalitiestoenhancetheclinicaleducationofstudents. Simulatedlearningenvironments Animportantconsiderationintheuseofsimulationisthechoiceofsimulatedlearningenvironments. Theenvironmentinwhichsimulatedlearningprogramscanbeconductedcanbelow,mediumorhigh fidelity.forexample,lowfidelityenvironmentsmayinvolveuseofabasicinterviewroomina university,whereasahighfidelitysimulatedenvironmentsmaybeachievedthroughreplicationofa hospitalward,intensivecareunitoroperatingtheatres.itisclearfromtheliteratureontheuseof simulationinoccupationaltherapythatsimulationenvironmentsmaybequitedifferentinnature comparedwiththoseinthemedicalandnursingliterature.inaparticularlyinnovativeapproach,davies, Clarke&Stead(2006)developedandtestedaninterprofessionalsimulationexperienceinvolving occupationaltherapyandnursingstudents.thesimulationcentredonawrittencaseofachild returninghomefollowingaheadinjuryandrehabilitation.theoccupationaltherapyandnursing studentsjointlyvisitedasimulatedresidentialflatenvironment,inordertodevelopanappropriateplan forthechild sdischargefromhospital.thestudentswereextremelypositiveabouttheexperiencewith highlevelsofengagementbeingnoted.thisreviewhasnotedtheuseofdiversesimulation environmentsinoccupationaltherapycurriculaincludingintensivecareunits(wu&shea,2009)sparse tentstoreplicatemilitaryfacilities(rice&gerardi,1990),officeandworkplacesettings(velde,lane& Clay,2009)andresidentialsettings(Davies,Clarke&Stead,2006). Thescopeofpracticeofoccupationaltherapyisverybroadwithmanytherapistsworkingincommunity settingssuchasschools,workplaces,clients homes,andinemergingareasofpracticesuchas correctionalcentresandwithrefugesorasylumsseekers.forthisreasonuseofsimulatedlearning environmentsinoccupationaltherapycurriculamustbeconsideredverybroadly. UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Principlesofsimulationtobeconsideredincurriculumdesign Regardlessofwhichsimulationmodalitiesorenvironmentsareusedtherearekeyprinciplesthatshould beconsideredinthedeliveryofsimulatedlearningprograms.inasystematicreviewoffeaturesofhigh fidelitymedicalsimulationsthatleadtomosteffectivelearningissenbergetal(2005)notedthatthe bestavailableevidencesuggeststhathighfidelitysimulationsfacilitatelearninggiventhatcertain conditionsaremet.theseincludefeaturessuchasuseoffeedback,integrationofsimulationinthe curriculumwithclearobjectives,useofcontrolledenvironments,andhavingreproducible,standardised educationalexperienceswherelearnersareactiveparticipants. Althoughthisreviewhassofarconcentratedonthedifferentsimulationmodalitiesavailableand describedhowtheymightbeusedinoccupationaltherapy,choiceofmodalitiesusedincurriculum shouldbedependentonthedevelopmentalstageofthelearnerandtheeducationalgoals(mcgahie, Issenberg,Petrusa&Scalese,2010).Thatis,educationalgoalsandlearningobjectivesshoulddrive designanduseofsimulationincurriculawithattentiontothelocalsetting. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 27

28 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Potentialforsimulationtocontributetoclinicalplacementobjectives Allstudiesandprogramsidentifiedinthisreviewusedsimulationforpreparingoccupationaltherapy studentsforfieldwork.thatis,theyeitherprovidedfoundationalclinicalexperiencesorprovided intensivepreparationimmediatelypriortofieldwork.nostudiesorprogramswereidentifiedthat usedsimulationaspartofclinicalplacements. Maximisingdevelopmentofclinicalskillspriortoplacements,andintensivespreparingstudentsfor fieldworkarecrucialsothatstudentsenterplacementsaspreparedaspossibleensuringthat fieldworktimeisusedaseffectivelyandefficientlyaspossible(cook&cusick,1997).itispossible thenthatpreplacementuseofsimulationmayalsocontributetowardsincreasedcapacityof studentsundertakingclinicalplacements. Althoughitmaybepossibletoadaptordevelopsimulatedlearningactivitiestobedeliveredduring clinicalplacementstomeetspecificclinicalplacementobjectives,thefidelityorauthenticityofthe experiencewouldneedtobecarefullyconsideredsothatstudentsengagefullyandsothatitmeets accreditationstandards.mcgahieetal(2010)notedthatthecontexthas profoundeffectsonthe substanceandqualityoflearningoutcomesandhowprofessionalcompetenceisexpressedclinically (p.60). Conclusion Whileitisclearthatsimulationoffersmanypedagogicaladvantagesindevelopingclinicalskillsprior tofieldworkplacements,furtherdiscussionisneededregardingthepotentialforsimulationin occupationaltherapytoaugmentandorsupplementclinicalpracticeexperiences.elementsof occupationaltherapycurriculathatmaybedeliveredthroughsimulationidentifiedinthisreview include;(1)educationandassessmentincommunicationskills,professionalskills,andself managementskills,(2)interprofessionalcommunication,(3)documentation,(4)information gathering(assessment)and(5)serviceprovision(interventions).furtherresearchanddiscussionis requiredtodelineatethepotentialforsimulationfordevelopingcompetenciesrequiredforclinical practice. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 28

29 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum NHWTUniversityClinicalPlacementsSurvey ThedatafromtheNHWTUniversityClinicalPlacementsSurveyprovidedtotheUQOTProjectTeamby HWAwasexaminedinitiallyforcompletenesswithrespecttotheprovidersofoccupationaltherapy education.thesedatawereusedtoinformthemappingsurvey.thirteenofthe14accredited occupationaltherapyschoolsprovideddataaboutuseofsimulatedlearningactivities(slas)inthe NHWTUniversityClinicalPlacementsSurvey.AllrespondentswereprovidingSLAintheirprogramswith mostsimulationbeingusedinthefirsttwoyearsofthefouryearbachelorofoccupationaltherapy programs,andlessbeingusedinthethirdandfourthyear.thesimulationmodalitiesusedbythe majorityofschoolswerestudenttostudentroleplayandwrittencases.onlyafewrespondentstothe NHWTsurveyindicatedusingDVDs,standardisedpatients,orpastclients(clientteachers)withone makinguseofvirtualreality.althoughsomeindicatedinthissurveythatthesimulationlearning experiencesprovidedmettheclinicalplacementobjectivesforthatarea,itwasunclearwhat respondentsinterpretationofthisquestionwasandtherefore,howtheymadethatdecision.further informationwasrequiredtoclarifyresponsesfromthissurvey.findingsfromthenhwtuniversity ClinicalPlacementsSurveywereclarifiedthroughdistributionofafurthertwosurveysandfocusgroups atnationalfora. Survey1:Mappingthecurrentuseofsimulatedlearninginoccupationaltherapycurric Aim Thisfirstonlinesurveyaimedtomapthecurrentuseofsimulatedlearningacrossaccreditedoccupational therapyschoolswithinaustralia. Specificallyitaimedtoidentify/describe: Thenumberofhoursthatsimulationiscurrentlyusedwithinoccupationaltherapycurricula,andof thesehours,howmanyarebeingcountedtowardstherequired1000fieldworkhours, Whichclinicalplacementobjectives(basedonSPEFRdomains)simulationmightcontributetowards, Perceptionsofeducatorsregardingsimulation,andtheirperceptionsofstudents satisfactionwith simulatedlearningactivities. Method DesignAcrosssectionalsurveywasdesignedtomapthecurrentuseofSLAsinoccupationaltherapy curriculaacrossthe14accreditedoccupationaltherapyschoolsinaustraliacurrentlyoffering undergraduateand/ormastersentryprograms. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 29

30 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Datacollection QuestionnaireAquestionnaireoftheexistinguseofsimulationwithinaccreditedprogramswas developedbasedontheliterature,thenhwtdataprovidedbyhwaandinconsultationwiththeproject AdvisoryCommittee.Thequestionnairewasdividedintosixsections.Sectiononeaskedquestionsabout thenatureoftheuniversityprogramsuchastypesofprograms(i.e.,undergraduateorgraduateentry masters)deliveredandtheaveragenumberofstudentsineachyear.sectiontwoincludedquestions abouttheperceivedusefulnessofsimulatedlearningmodalitiesandactivitiesforpreclinicalteaching, numberofhoursthatstudentsareengagedinsimulationactivitiesbyyearlevelsandtheuseof simulationintermsofbothareasofpractice(e.g.,paediatrics,mentalhealth)andlifespanstages(e.g., childhood,adulthood,olderpersons).sectionthreeenquiredabouttheuseofsimulationincurriculato addresseightcoredomainsassessedusingthespefr(turpin,fitzgerald,&rodger,inpress)usedto evaluatestudentperformanceinoccupationaltherapyfieldworkplacementsacrossaustraliaincluding professionalbehaviour,selfmanagement,coworkercommunication,communicationskills, documentation,informationgathering/assessment,servicedelivery/interventionandevaluationduring serviceprovision.sectionfouraskedaboutaccesstoanduseoffacilitiesandequipmentrequiredfor useinsimulatedlearningprograms.sectionfiveaskedaboutparticipants perceptionsofstudent satisfactionwithsimulatedlearningactivitiesandforfeedbacktheymayhavereceivedfromstudents. Thefinalsectionofthequestionnaireaskedparticipantsfortheirviewsabouttheuseofsimulation contributingtowardstherequired1000hoursoffieldwork,andwhetheritiscurrentlyusedaspartof clinicalplacementswithintheirprogram.themajorityofquestionsweredesignedtooffereitherfixed responseoptionsand/orallowopenendedresponses. ParticipantsAninvitationtoparticipateinanonlinesurveywassenttoheadsofthe14accredited occupationaltherapyschoolsinaustralia.theywereaskedtoeitherrespondtothesurveythemselves ortonominatearelevantacademicwithintheirschooltocompletethesurveyonbehalfoftheschool. ProcedureandanalysisTheprojectwasclearedbyoneoftheethicscommitteesofTheUniversityof QueenslandconsistentwithNationalHealthandMedicalResearchCouncilguidelines.Aletterinviting participation,aparticipantinformationsheetandhyperlinktotheelectronicsurveywas edtothe headofeachof14accreditedoccupationaltherapyschoolsinaustralia.thesurveywasadministered electronicallythroughsurveymonkey TM andquestionnaireswerecompletedanonymously.datawere analyseddescriptivelyusingcountsandfrequencies. Results Responseswerereceivedfrom12of14occupationaltherapyschoolsprovidingaresponserateof86%. Allprogramsprovidedfouryearbachelorsprogramsandfive(42%)alsoprovidedgraduateentrymasters programs.inthefouryearbachelorprogramsthenumberofstudentsinthefirstyearoftheprogram rangedfrom45150andbyyearfourthishaddeclinedtobetween38100students.thefivegraduate entrymastersprogramshadbetween2050studentsinthefirstyearand2045inthefinalsecondyear oftheprogram. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 30

31 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum ResultsofSurvey1continued Useofsimulation Seventypesofsimulationmodalitieswereinvestigatedincludingwrittencasestudies/scenarios,role play,formerclients,dvdsofrealorsimulatedclients,standardisedpatients,mannequinsandpart tasktrainers,andvirtualreality.elevenoccupationaltherapyschoolsrespondedwithrespecttothe useofspecificsimulationmodalities. Alloccupationaltherapyprograms wereusingsomeformofsimulated learningactivitieswithintheir curriculum.figure1indicatesthe numberofoccupationaltherapy schoolsinaustraliausingthedifferent typesofsimulationmodalities. Allprogramswithfouryear undergraduateprogramswereusing writtencasestudies/scenarios,role playanddvdsofclients. Approximatelyhalfwereusing standardisedpatients.onlyasmall numberoffouryearprogramswere usingeithermannequinsandparttask trainersorvirtualreality.ofthefive programsofferingtheprogramas graduateentrymasters,allmadeuse ofwrittenscenariosandroleplay, threeprogramsmadeuseof standardisedpatientsandmannequins andlessthanhalfmadeuseofvirtual realityandpastclients. Figure1NumberofoccupationaltherapyschoolsinAustraliausing thedifferenttypesofsimulationmodalities(n=11undergraduate programs;n=5graduateentrymastersprograms) Number of programs Number of occupational therapy programs using different simulation modalities Undergraduates (N= 11 OT programs) Graduate Entry Masters (N= 5 OT programs) Type of simulation modality Mannequins Virtual reality Standardised patients Past clients Role play DVD/Video Written scenarios Whenconsideringthefouryearundergraduateprograms(N=11)itcanbeseenfromTable1thatwritten scenariosandroleplaywerethemodalitiesusedthemostoverthefouryearperiod,withstandardised patientsandmannequins/parttasktrainersbeingusedonaverageonlyfivehoursorlessacrossthewhole fouryearsofthecurriculum. Table1.Hoursspentusingvarioussimulationmodalitiesacrossfouryearsofundergraduateprograms Simulationmodality Averageamountofhoursspentusingmodalities Rangeofhours acrossfouryearsofundergraduateprogram Writtenscenarios Roleplay DVD Pastclients Virtualreality Standardisedpatients Mannequins/parttask trainers Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 31

32 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum ResultsofSurvey1continued Asimilarpatternisevidentwhenconsideringuseofsimulationinthetwoyeargraduateentrymasters programs(n=5).itcanbeseenfromtable2thatwrittenscenariosandroleplaywerethemodalities usedthemostoverthetwoyearperiodofthecurriculum,withstandardisedpatients,mannequins/part tasktrainersandvirtualrealitybeingusedonaverageonlythreehoursorlessacrossthewholetwo yearsofthecurriculum. Table2.Hoursspentusingsimulationmodalitiesacrosstwoyearsofgraduateentrymastersprograms Simulationmodality Averageamounthoursspentusingsimulation modalitiesacrosstwoyearsofgraduateentrymas tersprogram Rangeofhours Writtenscenarios Roleplay DVD Pastclients Mannequins/ parttasktrainers Standardisedpatients 3 06 Virtualreality 2 06 ThepatternofuseofsimulationoverthefouryearsofundergraduatecurriculaisshowninFigure2. Moreoccupationaltherapyprogramsmadeuseofsimulationintheearlyyears(particularly2 nd year) withlessuseinthefinalyearofcurriculum.thisisconsistentwithdatafromthenhwtsurvey. Figure 2. Use of simulation modalities across years of occupational therapy programs 12 -Ol c c E 2, z Written DVDlVideo...Roleplay -+-Palienl teachers patients -+-Virtual reality computer patients -+-Mannequins Student year level Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 32

33 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum ResultsofSurvey1continued Perceptionsofeducatorsregardingtheuseofvarioussimulationmodalities Participantsprovidedcommentsregardingtheperceivedusefulnessofvarioussimulationmodalitiesfor preclinicalteaching.withrespecttowrittenscenariosparticipantsidentifiedthattheywereusefulto helpstudentsengageinproblemsetting,problemsolving,andfordevelopingclinicalreasoning.itwas alsorecognisedthattheywere extremelycostefficientbutnotasengagingasthosesupplementedwith visualcontent.dvdsofclientsorsimulatedclientswereseenasameanstohelpstudentstoaccess informationeasilyandprovidebreadthofcontent,butlackedinteractivity.whileroleplayswere perceivedbyparticipantsasprovidingvaluablepracticeforskilldevelopment,theyrecognisedthatthe realismwasnotashighaswhenworkingwithstandardisedpatientsorpastclients.inparticular,students didnothaveenoughexperiencetoportraythesituationbeingroleplayedrealisticallyparticularlyinthe earlyyearsoftraining.participantsspokeofthevalueofpastclientsinhelpingstudentsgraspthedepthof issuesinvolvedandtounderstandsomethingoftheclients perspectives.standardisedpatientswere consideredveryrealisticandfacilitatedstudents engagement.thebenefitsoffeedbackprovidedby standardisedpatients(inadditiontoself,peersandclinicaleducators)wereparticularlynoted.however, thereweremanyconcernsaboutthecostsinvolvedwithstandardisedpatientprograms.participants identifiedvirtualrealityasausefulmodalityforencouragingstudents problemsolvingandreasoning withquestionsraisedaboutitscost,levelofimmediacy,andauthenticity.finally,inthissurvey participantsmadefewcommentsabouttheuseofmannequinsandparttasktrainersbutfelttheymight belimitedtooccupationaltherapypracticewithinmedicalsettings.thiswaslikelytobedueinparttothe limiteduseofthesemodalitiestodatebystaffinoccupationaltherapyprograms/schools. Perceptionsofparticipantsaboutstudentsatisfactionwithsimulatedlearningactivities Mostparticipantsrecognisedthatstudentsappreciateandvaluedanyopportunitiestoenhanceskill developmentandpracticeskillswithsimulation.theynotedthatstudentspreferedsimulation/video/ guestvisitstolectureformat/booklearning,butpreferedcontactinthe realworld tosimulationifgiven theoption.theyreportedthatsimulationwasnotasrealisticasitmightbe.oneparticipantcommented that Practicebasedblockplacementsarewhentheyfeeltheyareengagedin"realexperiences".Students certainlypreferbeingabletoengageinsimulationsasopposedtonothavingtheopportunity,however,it isviewedasdifferentto(andtoacertainextent,lessthan)theexperiencestheyhavewhileonplacement. Sowhileparticipantsperceivedthatstudentswerefairlysatisfiedwiththeskillsdevelopmentgained throughsimulation,theyemphasisedtheneedforstudentstohaverealworldexperiencesofthe complexities,sightsandsoundsanddemandsofrealworkplaces. Feedbackfromstudents Participantsnotedthatstudentsappreciatedtheopportunitytoworkwithpastclientsandrealistic practicescenarios.theyenjoyedroleplaysandanyactivitiesinwhichtheyhadtheopportunitytopractice theirskillsinasafeenvironment.dvdfootageofclientsandoccupationaltherapyinterventionswerewell received.studentswerealsoverypositiveabouttheinteractionwithstandardisedpatients,despitethe experienceinitiallybeinganxietyprovoking.theyaskedformorestandardisedpatientfieldworkinthe curriculum.theyfeltthatithelpedthemdevelopbothskillsandconfidence.specifically,theyfeltmore confidentaboutusingappropriateinterpersonalskills,identifyingkeyclinicalinformation,interviewing patientsaboutpersonalinformation,andprovidinginformationtopatients.studentswereperceivedtobe negativeaboutusingstandardisedpatientsifotherstudentswereabletointeractwith'real'clients. Interestingly,oneparticipantnotedthatstudentsreportedtransferringskillslearntfromsimulated learningactivitiestoplacements.someexamplesofdirectquotesfromstudentsinvolvedinstandardised patientinteractionsreportedbyparticipantsinclude: ItwaspracticalandrelateddirectlytooccupationaltherapywhichiswhatIlovedaboutit. Itmakesyoumoreconfidenttointeractwithpatients. "Ipreferstandardisedpatientstoroleplaybecauseyouhavetotakeitseriously." "Interviewingastandardisedpatienthelpedmetointernalisecontentfromthelectures." Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 33

34 Areasofpracticewithincurriculausingsimulation Ingeneral,simulationwasusedmoreextensivelywithscenariosinvolvingadultsorolderpeople.DVDs andwrittenscenarioswerethemostcommonlyusedsimulationmodalitiesaddressingscenarios involvingchildrenoryoungpeople,howevertherewassomelimiteduseofmannequins,pastclients, andstandardisedpatientstoaddressissuesinvolvingthisyoungeragegroupalso. Writtenscenarioscoveredthebroadestrangeofoccupationaltherapypracticeareas,followedbyDVDs androleplay.table3illustratestheuseofsimulationacrossarangeofpracticeareasinoccupational therapycurricula. Table3NumberofAustralianoccupationaltherapyschoolsusingsimulationacrosspracticeareas(N=12) Practiceareas Mentalhealth Acuteadults physical Chronicadult conditions Agedcare Paediatrics Intellectual impairment Work/ Occupational health Workingwith carers/families Inter professional practice Socialcare UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Written Role Standardised Past Mannequins DVD Virtual scenarios play patients clients reality Useofsimulationtomeetcompetencies Participantswereaskedaboutthecontributionofsimulationtomeetingnewgraduateoccupational therapycompetencies,usingtheframeworkoftheeightclinicalplacementobjectivedomainsinthe SPEFRthatisusedbyalloccupationaltherapyschoolsinAustraliatoassessfieldwork/clinicaleducation placements.participantsagreedthatsimulationcouldbeusedtomeeteachofthedomainsincluding; ProfessionalBehaviour,SelfManagementSkills,CoworkerCommunication,CommunicationSkills, Documentation,InformationGathering,ServiceProvision,andServiceEvaluation.Someexamplesofthe waystheywerecurrentlyusingsimulationtoprovidefoundationskillstohelpmeettheseobjectives aredescribedonthefollowingpage. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 34

35 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum ProfessionalBehaviour.Allparticipantsusedsimulationmodalitiesofsomesort(includingwrittencase studies,dvds,standardisedpatientsandvirtualreality)toprovidetrainingandpracticeinprofessional behaviourssuchassafepatienthandling,understandingrisks/hazardsandriskassessmentand managementprinciples,anddemonstratingprofessionalattitudesandpresentation. SelfManagementSkills.Onlyhalfoftheparticipantscurrentlyusedsimulationforthisclinicalplacement learningobjective.thosethatdidsoprovidedexamplesofusingsimulationtorequirestudentsto demonstrateeffectivepreparationandtimemanagementwheninteractingwithstandardisedpatients, reflectingonthequalityofinformationgatheredintimeconstrainedsettings,andpracticingscheduling andorderingtasks. CoworkerCommunication.Most(91%)ofparticipantswereusingvarioussimulationmodalitiesto providestudentswithskillsandpracticeincasepresentations/caseconferences,referrals,developing sharedteammanagementplanswithagreedpriorities,understandingtherolesandinteractionsofa healthcareteam,andpracticingcommunicationskillsrequiredinamultidisciplinaryteam.thereseemed tobegeneralagreementregardingtheuseofsimulationwithrespecttodevelopinginterprofessional collaborationskills. CommunicationSkills.Allparticipantswereusingsimulationmodalities(particularlyroleplayand standardisedpatients)todevelopclientandcarercommunicationskills.thisincludedmodelling professionalandclientcentredcommunicationwithclients,students useofappropriateverbalandnon verbalskillswheninteractingwithstandardisedpatients,demonstratingempathyandappropriately respondingtosensitiveissues,appropriateuseofterminology,andthedevelopmentofrapportwiththe client. Documentation.Approximately81%ofparticipantsusedsimulatedlearningactivities(basedonwritten casestudies,dvds,interactingwithpastclients,standardisedpatientsandvirtualreality)toprovide studentswithskillsinwritingup/documentingassessments,treatmentplanningdocumentation,writing progressnotes,completionofformalapplicationforms,homevisitreports,andhomemodification reports. InformationGathering.Allparticipantsdescribedusingmodalitiessuchaswrittenscenarios,DVDs, standardisedpatientsandroleplaytoteachstudentsskillsassociatedwithinformationgathering (assessment).forexample,studentsobservedanddiscussedadvdofastandardisedpatientbeing interviewedbyatherapistwithregardtosuiciderisk.studentsobservedstandardisedpatientsorpast clientsondvdstounderstandworkplaceassessment,riskassessmentandphysicaldemandanalysisof workplaces.studentspracticeduseofbothstandardisedandnonstandardisedassessmentswith standardisedpatients. ServiceProvision.Approximately91%ofparticipantsusedsomesortofsimulatedleaningactivitiesto helpstudentsdevelopskillsacrossawiderangeofinterventions(servicedelivery).theseincluded providingclienteducation,usingmotivationalinterviewingskills,counsellingskills,managingchallenging behaviours,neurologicaltreatmentmethods,gradingandadaptingtasks,engagingsignificantothers withservicedeliver,developingsuitabledutiesplans,mobilityandpersonalcaretasks,mentalhealth groupwork,andhealthpromotion. ServiceEvaluation.Approximately72%ofparticipantsusedsimulationmodalitiestohelpstudents developskillsinevaluationduringserviceprovision.examplesofthiswerereflectingonserviceprovision withstandardisedpatientsandrecognisingwhattheymightdodifferentlyinresponsebothself reflectionandfeedback,identifyingfactorsthatmightinfluenceserviceprovision,evaluatinggroupwork andriskmanagementstrategies,andcritiquingtheappropriatenessofassessments. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 35

36 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Currentaccesstoanduseoffacilities,equipmentandresourcesrequiredforuseinsimulatedlearning activities Participantswereaskedaboutaccesstosimulatedlearningenvironments(SLEs)suchassimulatedward environments,interviewingrooms,andsimulatedlivingenvironments(e.g.bathrooms,kitchens)and relatedresources.ofthe12respondents, Onlyfive(42%)hadaccesstosimulatedwardenvironmentsandthreeofthesehadvideocapture available.onlythreeofthefiveoccupationaltherapyschoolsthathadaccesstosimulatedward environmentsusedthem. Eight(66%)occupationaltherapyschoolshadaccesstointerviewroomswiththreeofthesenot havingvideocapturefacilities.sevenoftheeightoccupationaltherapyschoolsthathadaccessto interviewroomsmadeuseoftheminthecurriculum. Simulatedlivingenvironmentssuchaskitchensandbathroomswereavailabletonine(75%)of occupationaltherapyschools/universitieswithonlyfourhavingvideocaptureavailable.sevenof theseoccupationaltherapyschoolsmadeuseofthesesimulatedlivingenvironments. Ofthesevenoccupationaltherapyschoolsusingstandardisedpatients,onlytwohadaccesstoa standardisedpatientrecruitmentservice.thecostofhiringstandardisedpatientsrangedfrom $35/hrto$100/hr. Viewsabouttheuseofsimulationcontributingtowardstherequired1000hoursoffieldwork Onlythree(25%)occupationaltherapyschoolscountedsimulationlearningactivitiesusedwithintheir curriculatowardsthe1000hoursoffieldworkrequiredbywfot(wfot,2002).itwasevidentthattwoof theseprogramswereusingactivitiesincorporatingstandardisedpatientstowardsfieldwork.these schoolsonlycountedbetween515hoursofthissimulatedlearningexperiencetowardsfieldworkhours. Nooccupationaltherapyprogramswereutilisingsimulatedlearningaspartofeithertheirshortorlong blockclinicalplacements,howeverafewparticipantsnotedthatclinicians/practiceeducatorsmay independentlychoosetousesimulationfromtimetotimewithintheblockplacement. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 36

37 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Summary Insummary,allformsofsimulationmodalitieswereconsideredbyparticipantstohavesomevaluein occupationaltherapystudents learningofskills,knowledgeandattitudesrequiredfornewgraduate occupationaltherapycompetencies.atoneendofthecontinuum,writtencasescenarios/studiesand DVDsprovidedsimulationswithwhichstudentscouldengage.Allschoolsutilisedthesemodalities. Roleplayanddiscussionswithclientswhowerenolongerreceivingoccupationaltherapyserviceswere abitfurtheralongthecontinuumofsimulation.allschoolsusedroleplaytoasignificantextent.these modalitiesprovidedimmediateengagementforstudentswithmostconsideringthatroleplaywasleast effectivegiventheasyetlimitedskillsofearlyyearstudentsinportrayingtheclients situations.thisis whereinteractionwithclientswhowerenolongerreceivingserviceswasconsideredmoreuseful,as thisprovidedimmediacyandauthenticity. Ofahigherdegreeofsophisticationstandardisedpatientswereusedbyasmallernumberof occupationaltherapyschools.thesewerepositivelyviewedbystudentsandstaffparticularlyinrelation tothecapacitytoprovidestudentswithfeedbackfromactors(outofrole),aswellasfrompeersand clinicaleducators.intheseschoolsuseofstandardisedpatientswaspartofaseriesofscaffolded simulatedlearningactivitiesincorporatingwrittencasestudies,rolesplaysanddvdsculminatinginthe useofstandardisedpatients.hence,standardisedpatientswerenotusedasastandalonesimulation modality. Therewaslimiteduseofvirtualreality,mannequins/parttasktrainersacrosstheoccupationaltherapy schools.simulatedwardenvironmentswereonlyoneofmanyenvironmentsofusetooccupational therapyschools.homes,kitchens,bathroomsweremorefrequentlyusedsimulatedliving environmentsofinteresttooccupationaltherapists. Onlyaminorityofuniversities/schoolswerecurrentlycountingsimulatedlearningactivitiestowards fieldworkhours. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 37

38 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Survey2.Potentialuseofsimulatedlearninginoccupationaltherapycurricula, perceivedbarriersandfacilitators:aims,methodandresults Background Followingcompletionofthefirstsurvey,participantsinthisprojectweresentaresourcedocument outliningkeydataandissuesraisedfromsurveyone,acopyoftheliteraturereviewandadvdproviding examplesoftheuseofstandardisedpatientsinoccupationaltherapyattheuniversityofqueensland. Thiswasprovidedtoensureallparticipantshadthesamebasicknowledgeabouttheuseofsimulation priortocompletingthesecondsurvey.thesecondsurveyfocusedonpotentialuseofsimulatedlearning activities(slas),andinparticularitsabilitytomeetclinicalplacementobjectivesandtocontributeto increasedclinicalplacementcapacity.thesurveyalsoaddressedbarriersandfacilitatorsfortheuseof simulationinoccupationaltherapycurriculainaustralia. Aims Thissecondonlinesurveyaimedtomapthecurrentuseofsimulatedlearningacrossaccredited occupationaltherapyschoolswithinaustralia.specificallyitaimedtoidentify/describe: Thenumberofhoursthatsimulationiscurrentlyusedwithinoccupationaltherapycurricula,andof thesehours,howmanyarebeingcountedtowardstherequired1000fieldworkhours; Whichclinicalplacementobjectives(basedonSPEFRdomains)simulationmightcontributetowards; PerceptionsregardingbarriersandfacilitatorsofSLAsinoccupationaltherapycurricula. DesignAcrosssectionalsurveywasusedtomapthepotentialuseofSLAsinoccupationaltherapycurricula acrossaustralia,andperceptionsofpotentialbarriersandfacilitatorstotheiruse. QuestionnaireAquestionnaireofthepotentialuseofsimulationwithinaccreditedprogramswas developedbasedontheliterature,resultsfromthefirstsurvey,andinconsultationwiththeproject AdvisoryCommittee.Thequestionnairewasdividedintothreesections.Sectiononeaskedaboutthe abilityofdifferentsimulationmodalitiestomeetclinicalplacementobjectivesandthestandardsrequired tobecountedtowards1000fieldworkhours.thequestionnairealsoaskedabouthowsimulatedlearning activitiesmightbeusedtomeetclinicalplacementobjectivesandassociatedrequirementforfieldwork hours.sectiontwoaskedaboutbarrierstousingsimulatedlearningactivitiesthatmeetclinicalplacement objectivesandrequirementforfieldworkhoursandtheresourcesthateachuniversitywouldrequireto usesimulatedlearningactivitiesforthispurpose.thissectionalsoaskedwhichspecificsimulated environmentsrelevanttooccupationaltherapymightpotentiallybedeveloped/usedforclinicaleducation purposes.sectionthreeaskedparticipants viewsabouthowmanyoftherequired1000hoursfieldwork couldreasonablybeprovidedusingsimulatedlearningactivities.themajorityofquestionsweredesigned tooffereitherfixedresponseoptionsand/orallowforopenendedresponses. ParticipantsThisquestionnairewassentto36stakeholdersrelevanttothisproject.Thisincludedallheads ofoccupationaltherapyschools,anadditionalstaffmemberfromeachschool,projectadvisory Committeemembers,andallattendeesatthefournationalfora. ProcedureandanalysisTheprojectwasclearedbyonoftheethicscommitteesofTheUniversityof QueenslandconsistentwithNationalHealthandMedicalResearchCouncilguidelines.Aletterinviting participation,aparticipantinformationsheetandhyperlinktotheelectronicsurveywas edtothe headofeachof14accreditedoccupationaltherapyschoolsinaustraliawhowereaskedtonominatean additionalstaffmembertocompletethesurvey.theletterwasalsosenttoprojectadvisorycommittee members,andallplannedattendeesatthefournationalfora.thesurveywasadministeredelectronically throughsurveymonkey TM andquestionnaireswerecompletedanonymously.datawereanalysed descriptivelyusingcountsandfrequencies. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 38

39 Survey2:Results Responseswerereceivedfrom19ofthe36individualswhoweresentaninvitationtoparticipate.This providedaresponserateof53%. Participantswereaskedtheiropinionsastowhichsimulationmodalities(andrelatedsimulatedlearning activities)mightmeetclinicalplacementobjectivesandthestandardsrequiredtobecountedtowards 1000fieldworkhours.Theywerealsoaskedtoprovidecommentsabouteachmodality. Figure3Simulationmodalities(andrelatedsimulatedlearningactivities)thatmightmeetclinical placementobjectivesandthestandardsrequiredtobecountedtowards1000fieldworkhours. Number of study participants UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Standardised patients Use of simulation for occupational therapy fieldwork? Past clients Virtual reality DVD Written cases Simulation modalities Mannequins Role play Commentsabouttheuseofeachmodality sabilitytobecountedtowardsfieldworkhours Standardisedpatients:Almostallparticipants(95%)agreedthatstandardisedpatientscouldbeused towardsmeetingfieldworkhoursinoccupationaltherapy.howevermanyvoicedtheviewthatthiswould bestoccurearlyintheprogram,thatcasesshouldbesufficientlycomplex,andextended/repeatedcontact builtinwherepossible.concernswereraisedabouttheorganisationalinfrastructureandrecurrent fundingcoststodoso. Pastclients:Seventyninepercentagreedthatinvolvingstudentswithpastclientswouldmeetthe requirementsforfieldwork.thereweresomeconcernsraisedabouttheconsistencyoftheirpresentation, andthatthisapproachmightbefairlylimitedinlearningobjectives(egunderstandinglivedexperienceof theclient,communication,andassessment).theabilityofsustainedinteractionwiththesame pastclient wasraisedasanissueandanumberofparticipantsstatedtheythoughtthisapproachmightbesuitedfor averysmallnumberoffieldworkhours. Virtualreality:Themajority(63%)thoughtvirtualreality/computerclientscouldmeettherequirements forfieldwork.howeverthoseagreeingtotheuseofvirtualrealityindicatedthatthiswasunderthe conditionthatitwouldneedtobecomplexandinteractiveenoughandthatitwasusedatthebeginning ofanoccupationalprogramorwithinclinicalplacements.thosethatdisagreedthatitshouldcontribute towardsfieldworkhoursindicatedtheydidnotconsiderit realistic enoughtomeetwfotguidelines. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 39 Yes No

40 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum UseofDVDs:Justoverhalf(58%)ofrespondentsagreeduseofDVDsofrealorsimulatedclients wouldmeettherequirementsforfieldwork.conditionsforitsusewerethatitwaslinkedascloselyas possibletofieldwork(ieaspreparationbeforeforseeing real clients),andwasonlyusedforalimited numberoffieldworkhours.asexpressedbyoneparticipant: DVDscouldbeusedforarestrictedperiodoftimetowardsfieldworkhoursprovidingtheactivitiesand requirementsofstudentsviewingdvdswerepedagodicallysound.soobservingthedvdinandof itselfwouldnotbesufficientbutwouldneedtobeaccompaniesbysimulatedlearningactivitiessuchas completinganassessmentonthebasisofthedvdandgoingontoestablishatreatmentplan.this couldbefurtherimprovedifclipsofclientsorstandardisedpatientsondvdareshowedinstages, requiringfurtherdecisionsmakingandactionbystudents.theymaybeusedaspartofproject placementstoconveymaterialaboutthesettingthestudentisplanningfor. Thosedisagreeingwithitscontributiontowardsfieldworkhoursindicatedthiswasduetothepassive natureofdvdsandthatstudentswerenothavingtointeractwitha realliveclient andcouldnot interactwiththemonanongoingbasis. Writtencasescenarios:Themajority(63%)thoughtwrittencasescenarioswouldnotmeetthe requirementsforfieldwork.sevenrespondentsstatedthiswasbecausetheydonotmeetthe requirementsforinteractingwitha reallive person,andfourbecausewrittencasescannotrepresent thecomplexityofrealsituationssufficiently.anumberwhothoughttheywouldcontributetowards fieldworkhoursstatedthiswasbecausetheyprovideexposuretoarangeofclient sissuesandhelps developreasoningskills.conditionswerethatitmustbebasedonarealclientandbesufficiently complex,andforasmallnumberofhoursonly. Thesecomplimentandpreparefor[studentsfor] practicebutcannotrecreatethecomplexitiesofpractice.practiceexperiencesaremorecomplex, intense,confused,ambivalent,andcontradictoryinpracticethantheliteraturesuggests(finlay,2001) Mannequinsandparttasktrainers:Themajority(74%)thoughtthatmannequinsandparttask trainerswouldnotmeettherequirementsforfieldwork.thiswasmostcommonlybecausetheywere notseentomeetthewfotcriteriaforinteractingwithorforarealliveperson,andalsoduetothe limitedrangeofoccupationaltherapyskilldevelopmenttheymightbeusedfor.thoseagreeingwith theirusetowardsfieldworkindicatedthatuseofmannequinswouldneedtobepairedwitha standardisedpatientfamilymembersothereisincreased realism,andthatitbeusedjustpriorto placementwhererelevant. Roleplay:Roleplaywasconsideredby84%ofparticipantstonotmeetWFOTrequirementstobe countedtowardsfieldwork.thiswaslargelybecausestudentsdonottakeitseriouslyanddonothave skillstoportrayacaserealistically.thosethatthoughtroleplaycouldbecountedindicateditmightbe usedforpracticingspecificskillssuchasuseofassessmenttools,orusedimmediatelypriortoseeing clientstorefreshorpracticeskills. Summary Allsimulationmodalitieswereacceptedbythemajorityasusefulmeansfordevelopingreasoning, skills,exposingstudentstoabreadthofissuesandpreparingthemforfieldwork.howeveritappears thattheuseofstandardisedpatientswasthemodalitythatthemajorityagreedcouldreasonablybe usedtowardsfieldworkhours.althoughothermodalities(pastclients,vranddvds)werealso acceptedbythemajorityasmeetingfieldworkhours,thereweremoreconditionsonhowthismight bedoneandthenumberofhoursforwhichthismightusefullybeconsideredwasmorelimitedthan standardisedpatients.thesconditionswerefurtherexploredinthenationalfora. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 40

41 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Useofsimulationtomeetoccupationaltherapyclinicalplacementobjectives Participantswereaskedtheextenttowhichsimulatedlearningactivitiesmightbeusedtomeetclinical placementobjectivesandrequirementforfieldworkhourswithintheeightcoredomainsassessedusing thespefr(turpin,fitzgerald,&rodger,inpress).thisisusedtoevaluatestudentperformancein occupationaltherapyfieldworkplacementsacrossaustraliaandincludesthedomainsofprofessional behaviour,selfmanagement,coworkercommunication,communicationskills,documentation, informationgathering/assessment,servicedelivery/interventionandevaluationduringserviceprovision. AscanbeseeninFigure4mostrespondentsindicatedthatsimulatedlearningactivitiescouldbeusedto meetclinicalplacementobjectivespertainingtoprofessionalbehaviour,communicationskills, documentation,informationgathering/assessment,andservicedelivery/intervention.fewerrespondent thoughtsimulatedlearningactivitiescouldbeusedtomeetobjectivesregardingselfmanagement,co workercommunication,andevaluationduringserviceprovision. Figure4.Useofsimulationtomeetclinicalplacementobjectivesandalsofieldworkrequirements Use of simulation to meet placement objectives that could also meet fieldwork requirements? Simulation modalities Professional behaviour Self-management Co-worker communication Communication Documentation Information gathering Service delivery Service evaluation No Yes Examplesprovidedfor eachdomainofclinical placementobjectives weresimilartothose providedinsurvey1 (seepage35) Number of study participants Barrierstotheuseofsimulatedlearningactivitiesinoccupationaltherapycurricula Respondentsindicatedtheextenttowhichtheythoughtthefollowingfactorswouldbebarrierstousing simulatedlearningactivitiesthatmeetbothclinicalplacementobjectivesandrequirementsforfieldwork hours.barrierswerethenrankedinorderusingdatafromthecollapsedcategoriesof alot/wouldnot beabletousesimulationbecauseofthis.intable4itisclearthemajorbarriertotheuseofsimulation towardsfieldworkisadequatestartupandrecurrentfunding.availabilityofstaffingandfacilities/ equipmentswerealsoseenasmajorbarriers. Table4.Barrierstosimulation(N=16) Barrierstosimulation Inadequaterecurrentfundingtomaintainsimulatedlearningactivitiesinthecurriculum (Excludingacademic/clinicalstaffing) Percentagreeing Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia % Inadequatefundingavailabletoestablishsimulatedlearningactivitiesinthecurriculum 87.5% Lackofadequateacademic/clinicaleducatorstaffingcapacitytomaintainsimulated 79.7% learningactivitiesinthecurriculum Lackofaccesstosimulationfacilities(environments,technicalequipmentandsupport) 79.3% Lackofaccesstosimulationmodalityequipmentorpersons(egactors) 75% Lackofstaffexpertisetoestablishsimulatedlearningactivitiesinthecurriculum 62.5% Difficulttoaccommodatesimulatedlearningactivitieswithlargestudentcohorts 47.1% Lackofinterest/beliefinthevalueofsimulationforfieldworkpurposes 35.3% Difficultytimetablingsimulatedlearningactivitiesforthispurposeinthecurriculum 31.3%

42 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Barriers(continued): Participantsmadeanumberofcommentsregardingtheneedforrecurrentfundingforsufficient timeperiodstomakeuseofstandardisedpatients(giventhatthiswasthepreferredmodalitytobe countedtowardsfieldworkhours).asoneparticipantcommented: Recurrentfundingisessentialtoenablesimulatedlearningactivitiesofadequatecalibretomeet requirementsforfieldworktobedeliveredacrosslargecohortsofstudents.ifcurriculaweretobe alteredtoencompasssimulatedlearningactivitiesthereisaconcernthatlackofrecurrentfunding wouldjeopardisethecurriculuminvolvingsimulationandassociatedcurriculumtimetabling. ResourcesrequiredtofacilitateuseofSLAsandSLEs Participantswereaskedwhichresourcestheiruniversitieswouldrequiretousesimulatedlearning activities(slas)andsimulatedlearningenvironments(sles)withintheirclinicaleducationprogram (thatmeetclinicalplacementobjectivesandrequirementsforfieldworkhours).table5below indicatesfundingtorequiredtoestablishsimulatedlearningactivities,accesstostandardised patients,localsimulatedlearningenvironments,andrecurrentfundingforstandardisedpatientsand theirtraining,weretheresourcesrequiredbymostrespondents. Table5:ResourcesrequiredtofacilitateuseofSLAsandSLEs Resourcesrequired Percent Agreeing Fundingtoestablishsimulatedlearningactivities(egdevelopingcasescenarios, 94% supportingmaterialsegdvds) Accesstopoolofstandardisedpatients 94% Simulationfacilities/environmentsontheUniversitycampus(including 87.5% audiovisualequipment/facilities) Recurrentfundingforemploymentofstandardisedpatients 87% Trainingforstandardisedpatients 87% Trainingprogramsforeducatorsrunningsimulatedlearningactivities 81% Recurrentfundingforacademic/clinicaleducatorstafftomaintainsimulated 80% learningactivities Possessionofvirtualrealityequipmentandprograms 79% SimulationFacilities/environmentswithinreasonabletravellingdistancefrom theuniversity Technicalstaffforprogramming/runningsimulationsusingmannequins Possessionofmannequinsandassociatedprops 73.3% 64.3% 61.5% Simulatedlearningenvironmentsforoccupationaltherapycurricula Participantsindicatedthatsomeoftheenvironmentsoccupationaltherapyeducatorsmightrequire forslasincludeworkplaces,homes(notnecessarilyingoodcondition),schools,awholerangeof communitysettingsandservices,thecorporateboardroom,thecourtroom,prisons,homeless sheltersandvirtualcommunities.participantswereconcernedthat thecurrent/envisagedsimulated environmentsareverytraditionalandmedicalbased. Participantsfrequentlycommentedonthe needtoaccessnonmedical,communitybasedenvironments. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 42

43 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Numberoffieldworkhoursthatsimulationmightbeusedfor Participantsinthesurveywereasked:Ofthe1000hoursrequiredforfieldworkwithinoccupational therapyprograms,approximatelyhowmanyhoursdoyouthinkshouldreasonablybeprovidedusing simulatedlearningactivities?findingsaresummarisedintable6below. Table6Numberoffieldworkhoursthatsimulationmightbeusedfor(N=18) Numberof %ofwfot1000hoursfieldwork Numberofrespondents(%) fieldworkhours % 4(22%) % 1(6%) % 7(39%) % 2(11%) % 1(6%) AsseeninTable6,thenumberofhoursthatparticipantsmostcommonlynominatedasbeingreasonable tocounttowardsfieldworkwas100hours.thisequatesto10%oftherequired1000fieldworkhours. Asoneparticipantresponded: Talkingwithacademics&students,&readingtheresearch,highqualitysimulatedlearningactivities clearlycanhaveanimportantplaceasteaching/learningactivitiesinentrylevelcurricula&canfacilitate thequalityofclinicalplacementexperiences&outcomesbuttheycannotreplacefieldworkplacements. Theycanconstituteasmallproportionof'fieldworkexperiences. Approximately25%indicatedthattheywouldnotreplacecurrentlyexistingclinicaleducationhoursin theirprogramswiththeuseofsimulatedlearningactivitieseveniffullyresourcedtodoso.reasonsfor thiswerenotclearbutcouldbethattheydidnothavesufficientpressureforplacementsordonotagree thisisthebestuseoffunding. Itshouldbenotedthattheseresultssummariseparticipants opinionspriortothefournationalfora.the resultsofthisstakeholderconsultationaresummarisedlaterinthisreport.participants viewsevolved overthecourseoftheforaastheyintegratedgroupmembersopinionsanddiscussionswithineach meeting. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 43

44 OutcomeofStakeholderConsultation ConsultationProcess UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum FourforawereconductedwithoneinBrisbanecomprisingstakeholdersfromoccupationaltherapy schoolsinqueensland,oneinsydneywithstakeholdersfromoccupationaltherapyprogramsinnew SouthWalesandOTALPACassessors,andoneinMelbournewithstakeholdersfromWesternAustralia, SouthAustraliaandVictoriaoccupationaltherapyschools,andOTALPACassessors.Thefinal(fourth) foruminvolvedtheuqotprojectteamandprojectadvisorycommitteemembersandanadditionalotal PACassessor. Asetformatforeachforumwasdevised(seeagendaforBrisbane,SydneyandMelbourne,Appendix6). Inpreparationforthesefora,aDVDwasdevelopedtoprovidefurtherinformationtostakeholdersabout theuseofstandardisedpatientsinoccupationaltherapycurricula.inadditionasetofsixsimulation scenariosweredevelopedwithkeyquestionsrelatedtotheaimsofthisproject(seeappendix5). Participantswereaskedtoprepareforeachforumby;(1)readingtheliteraturereview,(2)readingthe resourcedocument,(3)watchingthedvd,and(4)workingthrougheachofthesixsimulationscenarios provided.thegeneralformatforeachforuminvolvedasummaryoftheresultsofthetwosurveys followedbycommentsanddiscussion.thiswasfollowedbyasystematicdiscussionofthesimulation scenariosprovided,withrespecttotheoccupationaltherapycurriculumelementsaddressed,potential forfurtherdevelopmentofcurriculaelementsandthepossibilityofinclusionofeachsimulationmodality discussedinthescenariotowardsfieldworkhours.thisthenenableddiscussionoftheconditionsunder whicheachsimulationmodalitymightbeusedtocontributetowardsoccupationaltherapyfieldwork hours. ThefinalforuminMelbourneinvolvingtheUQOTProjectTeamandtheProjectAdvisoryCommittee consideredtheresultsofallforatodate,theuseofsimulationdescribedintheliteraturereview,andthe findingsfromthetwosurveys.participantsinthisforumthendevelopedrecommendationsforhwa basedonconsensusfindingstodateandthenationalviewofotal,otc,anzcote,anzotfaandthe UQOTProjectTeam.Theserecommendationswereputtoalltheforaparticipantsforfinalcommentin theweekof8thnovember2010.feedbackwasgatheredandamalgamatedintothefinalreport. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 44

45 AcrossallforatheuseofSimulatedLearningActivities(SLAs)inoccupationaltherapyprogramswere viewedas: Valuablecurriculumtools/resourcesbothinrelationtoclinicaleducationandteachingandlearning opportunities. Havingpotentialuseinpreplacement,duringplacementandpostplacementcourses/fieldwork. Supportingthecurrentintegrationofclinicalfieldworkintoacademiclearningacrossallyearsand thereispotentialforthecurrentuseofslastobeexpandedtosupportthisintegrationandclinical educationlearningoutcomes. Potentiallyincreasingthequalityandsafetyoutcomesofclinicallearningbyprovidingstandardized assessablecurriculumcomponentsavailabletoallstudentswithinacohort currentlythereis diversityandvariabilityinstudentlearningopportunitieswhenstudentsengageinclinical placementswithinthehealthandhumanservicesworkforcefacilities. AvaluableresourcetodevelopandenhanceIPEclinicaleducationstrategies especiallyinlater yearswhenstudentprofessionalidentityandhealthprofessionalroleestablished. Awaytoengagehealthprofessionalstudents(learners)intothefuturegiventheirfamiliaritywith virtualandcomputerbasedinteraction.participantsrecognisedthatstudentspreferascloseto reality aspossiblewithrespecttoclinicaleducation/learning. Needingtobedevelopedandsupportedbycollaborationwiththeclinicaleducatorswithinthe occupationaltherapyhealthworkforce. Havingpotentialtobeusedforgraduateentryandpostgraduateengagementinhealth professionals continuingprofessionaldevelopment(clinicaleducationandtraining)initiatives. FactorscontributingtothedevelopmentandadoptionofSimulatedLearningActivities(SLAs)tomeet placementobjectiveswithincurriculum: SLAtoolsandresourcesneedtobedevelopedincollaborationwiththeoccupationaltherapyhealth workforce.occupationaltherapyclinicaleducatorswereseenasavaluableresourcefor developmentofslaswithinoccupationaltherapycurriculumandtheirengagementwouldcontribute toauthenticity,students perceptionofvalidity,andthepotentialuseintheworkplaceduring placementcourses. SLAsneedtobedevelopedwithafocusonmeetingplacementobjectivesasdefinedwithinthe SPEFRlinkedtograduatecompetencies(ASCOT)(OTAL,2010). UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum KeyThemesEmergingfromOccupationalTherapySLAforums (Brisbane,Sydney&Melbourne) SLAsneedtobedevelopedleadingtointeractionwithastandardisedpatientorrealclient. SLAsneedtobeintegratedintocurriculumearlyinoccupationaltherapyprogramswithclinical learningscaffoldedtowardsmeetingplacementobjectiveswithincreasingcomplexity(couldequate toincreasinguseofmultiplemodalitiesinslasofvaryingfidelity). SLAswouldhavegreatvalueifusedforimmediatepreclinicalblockplacementlearning. SLAscouldbeusedtoassessachievementofthresholdcompetenciespriortoclinicalplacementsto enhancequalityandsafety(e.g.,safemanualhandlingpractices). SLAsneedtobedevelopedforuseduringblockplacements(linktokeyplacementobjectives, procedures/protocolsandclinicalreasoningrequirements). SLAshavepotentialforusepostclinicalblockplacementstoenhanceprofessionalreasoningpriorto graduation. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 45

46 KeyThemesEmergingfromOccupationalTherapySLAFora (Brisbane,Sydney&Melbourne) FactorsrelatedtothecontributionofSimulatedLearningActivities(SLAs)tomeetingWorld FederationofOccupationalTherapy(WFOT)guidelinesforfieldworkand1000clinicaleducationhours forprogramaccreditation: TherewasnationalconsensusthatSLAscanbedevelopedthatmeetWFOTfieldworkguidelines. TherewasconsensusthataproportionofWFOT(WFOT,2002)recommended1000hourscouldbe deliveredviaslasbasedthefollowingconditions: ThatSLAsaredesignedwithahighlevelofauthenticityforoccupationaltherapypractice; ThatSLAsaredesignedwithahighlevelofcomplexityrequiringstudentengagementandinteraction; ThatSLAsaredeliveredwithimmediacytointeractionwitharealclientandtooccupational therapyclinicalplacements; ThatSLAsaredesignedandassessedwithrespecttomeetingoccupationaltherapyclinical placementobjectives;and Thatnoonesimulationmodalitybeusedasa standalone alternativetoclinicaltrainingtime. Throughstakeholderconsultationitwasclearthatonlyasmallproportionofthe1000hoursfieldwork couldbemetthroughtheuseofslas.atthethreeforumsthisproportionrangedfrom1020%.atthe finalforumincludingrepresentativesfromassessors,otc,otaustralia,anzcoteandanzotfa,itwas Concludedthat Upto20%ofclinicalplacementhourscouldbemetthroughtheuseofsimulated learningactivities. TheextenttowhichSLAswouldbeusedineachoccupationaltherapyschoolandthe natureoftheseslaswouldbedeterminedbyeachindividualschoolinrelationtoitsspecificprogram(s) andassociatedcurriculum. FactorsimpactingontheuseofSimulatedLearningActivities(SLAs)inOTcurriculum: Needforaccesstoresourcesforsimulatedlearningactivitiesnationally. NeedforaccesstofundsforthedevelopmentandmaintenanceofSLAsineachoccupationaltherapy program(recurrentfundingforminimumof5yearblocksforsustainability). Academicstaffandoccupationaltherapyclinicaleducatorsneedtobetrainedinthepotentialuse andsupportedtodevelopandintegrateslasintocurriculum. Needforresearchtoevaluatesimulatedlearningactivitiesinoccupationaltherapy. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 46

47 Curriculaelementsthatcould,byaccreditedschools,bedeliveredviaSLAs.Thesecurricula elementswouldmeetclinicalplacementobjectivesandcouldcontributetoincreased clinicalplacementcapacity AllareasofoccupationaltherapycurriculumcouldinsomewaybesupportedbySLAshoweverpriority areashavebeenidentifiedfortheuseofsimulationguidedprimarilyby: coreoccupationaltherapytheorythatisunderpinnedbytheconstructsofperson,occupationand environment; theirabilitytocontributetowardsmeetingclinicalplacementobjectives; theneedtoensuresafetyforallstudentsandtheirclients; theneedforstudentstopractiseworkingwithpeopleexperiencingsensitiveand/orcomplexissues; theneedforsimilaropportunitiesfordevelopingcorecompetenciestobeavailableacrossall studentsinacohort;and theneedforscenariosthatareauthenticandpresentadegreeofcomplexity(appropriateforthelevel ofstudent). Asaresultoftheconsultationprocess,agreementwasreachedthattheuseofSLAsbeguidedbythe domainsofclinicalplacementobjectivesoutlinedinthespefr.thesewereconsideredimportant curriculumelementsthatcouldbedeliveredbyslas.theseelementsarelistedinorderintable7belowto reflectthefrequencywithwhichslasarecurrentlyormaypotentiallybeusedforeachplacement objectivedomain. Table7alsooutlineskeyexamplesofoccupationaltherapycurriculumelementsthatcouldbeprioritisedto bedeliveredbyslas.itisemphasisedthatgiventhevaryingnatureofoccupationaltherapycurriculain Australianoccupationaltherapyschoolsandthewidescopeofoccupationaltherapypractice,thatthe followingtableprovideexamplesonlyofpriorityareas.slasmaybeusedpriorto,duringorafterclinical placementsandtheirultimateusagewouldbedeterminedbytheindividualoccupationaltherapyschool. Domainsofclinical placementobjectives asassessedbyspefr Coworker Communication CommunicationSkills UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Table7:Prioritycurriculumelementsthatcouldbedeliveredthroughsimulation Prioritycurriculumelementsthatcouldbedeliveredthroughsimulation Keyexamples: Interprofessionalandcollaborativelearning(e.g.,describingtheroleandrange ofoccupationaltherapyservices,describingtheoccupationalperformanceofa persontoaninterprofessionalteam,collaborativeassessment,ensuringclient safety); Refiningskillsfortimely,accurateandappropriatecommunicationbetween healthprofessionals,(e.g.,handovers,communicationwithateamabout complexscenarios,assertivecommunication). Keyexamples: Developinghigherlevel,appliedverbalandnonverbalskills; Interactingwithclientswithchallengingbehaviours;communication impairments andwithclientsregardingsensitiveissue; Developingculturalknowledge,awareness,sensitivityandsafetyrequiredfor culturallycompetentcommunication; Communicatingevidenceaboutassessmentsandservicedelivery; Usingoccupationfocusedlanguage; Communicatingappropriatelyforoccupationaltherapyconsultancieswhere directclientcontactmaynotoccur; Developingpersoncentredpracticeattitudesandskills; Describingtheroleofoccupationaltherapytoclients/consumersusing appropriatejargonfreelanguage. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 47

48 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum CurriculaelementsthatcouldbedeliveredviaSLAs Information Gathering ServiceProvision Professional Behaviour SelfManagement Skills Documentation ServiceEvaluation Keyexamples: Assessmentofclientswithchallengingbehaviours;clientsatrisk(e.g.,suicide riskassessment),orassessmentwithrespecttosensitiveissues; Assessmentintheworkplaceorinhomes(e.g.,risk/hazard); Assessmentofclientswithcomplexneeds(e.g.,multiplecomplexhealth needs); Developingoccupationbasedgoalsusingapersoncentredapproach; Communicatingtherationaleforadministeringaselectedassessment. Keyexamples: Servicedeliveryforclientswithchallengingbehaviours(e.g.,peoplewhoare angryoragitated); Servicedeliveryforclientsatriskorwithcomplexneeds(e.g.,peoplewith mentalhealthissues,clientswithmultiplecomplexhealthissues;homeless, culturallydisplaced); Servicedeliveryforclientsregardingsensitiveissues(e.g.,palliativecare, distressedfamilymembers,discussingreturntosexualactivity,adjustment issues); Consultancymodelsofservicedelivery; Manualhandlingskillsdevelopmentandeducation; Appliedriskmanagementinhomesandinworkplaces. Keyexamples: Demonstratingawarenessofhazardsintheworkplace,theneedfor accountability,confidentiality,useofprofessionalandnondiscriminatory language; Opportunitiesforpracticingfutureroleasclinicaleducatororsupervisor/ mentor; DevelopingprofessionalreasoningintegratingdomainsoftheSPEFRlinked withascot(otaustralia,2010); Representingtheoccupationaltherapyprofessioninanappropriatemanner; Demonstratingappropriatebehaviourduringanethicaldilemmascenario. Keyexamples: Demonstratingindependentpreparation/planning; Managingtimepressures; Acceptingandactingonconstructivefeedback; Writingdocumentationinatimelymanner. Keyexamples: Writingdocumentationinanaccurate,timelymannertoreduceerror; Usingoccupationbasedlanguageindocumentation. Keyexamples: Demonstratingabilitytoevaluateandmodifyserviceprovisionfollowing selfreflectionandfeedbacktoenhancesafetyandqualityoffutureservice provision. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 48

49 Alloccupationaltherapyschools,andrepresentativesfromOTAustralia,COTRB/OTC,ANZOTFA,ANZCOTE andtheprogramaccreditationcommitteewereconsultedthroughoutthisproject. Therewasnationalconsensusthatsimulatedlearningactivities(SLAs)couldcontributetothequalityof occupationaltherapycurriculaandenhanceclinicalplacementcapacity. Theprioritycurriculumelementsandexamplesthatwereidentifiedthatwouldmeetaccreditation standardsareindicatedintable7onpage4748. Agreementwasreachedfromallparticipantsregardingthepotentialdeliveryofthesecurriculaelements viaslastomeetaccreditationstandardsgiventhefollowingconditions: ThatSLAsaredesignedwithahighlevelofauthenticityforoccupationaltherapypractice; ThatSLAsaredesignedwithahighlevelofcomplexityrequiringstudentengagementandinteraction; ThatSLAsaredeliveredwithimmediacytointeractionwitharealclientandtooccupational therapyclinicalplacements; ThatSLAsaredesignedandassessedwithrespecttomeetingoccupationaltherapyclinical placementobjectives;and Thatnoonesimulationmodalitycanbeusedasa standalone alternativetoclinicaltrainingtime. UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Levelofagreementfromaccreditedschoolsandrespectiveaccreditationbodyon curriculaelementsthatcouldbedeliveredviaslas,beintegratedintothecurricula,and meetaccreditationstandards. Levelofagreementfromaccreditedschoolsandrespectiveaccreditationbodyregarding perceivedbarrierstothiscurriculumbeingrecognisedandadoptedforclinicaltraining Themainbarrierstotheuseofsimulatedlearningactivities(SLAs)wereidentifiedinSurvey2(seeTable4), andweresubsequentlyconfirmedineachofthefora.stakeholderconsultationhighlightedthatthecritical barriersfortheuseofslasforclinicaltrainingpurposeswere: LackoffundingtoadequatelyresourcethedevelopmentSLAs. Needforrecurrentfunding(inatleast5yearblocks)forimplementingSLAs. NeedfortrainingacademicsandclinicaleducatorsintheuseofSLAs. NeedforresearchtoevidencetheeffectivenessofSLAsinoccupationaltherapy. Lackoffacilities/resourcesspecifictooccupationaltherapycurriculatosupportSLAs. TherewasstrongagreementthatuseofSLAinoccupationaltherapycurriculacouldnotoccurwithout certaintyofadequaterecurrentfundingforatleastafiveyearperiod.participantsperceivedhighrisks associatedwithalteringtheircurriculumandsubsequentchangeinrelationshipswithplacementproviders, unlesstherewasguaranteedsustainablefunding. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 49

50 Thelikelyimpactonclinicaltrainingdaysrequiredintheprogramshouldthese curriculaelementsbedeliveredbyslas AllparticipantsinthisprojectagreedthatSLAscanbedevelopedthatmeettheWorldFederationof OccupationalTherapyfieldworkguidelines(WFOT,2002). Aspreviouslynotedinthisreport,WFOTrequirethatataminimum,studentsundertake1000fieldwork hoursacrossabroadrangeofpracticeareas,acrossthelifespanandacrosshospital,community,and individuals,organisations,communitysettings. Therewasconsensusthatupto20%oftherequired1000hourscouldbedeliveredviaSLAsbasedon thefollowingconditions. UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum ConditionsforusingSLAtowards1000fieldworkhoursinoccupationaltherapycurricula ThatSLAsaredesignedwithahighlevelofauthenticityforoccupationaltherapypractice, ThatSLAsaredesignedwithahighlevelofcomplexityrequiringstudentengagementand interaction; ThatSLAsaredeliveredwithimmediacytointeractionwitharealclientandtooccupational therapyclinicalplacements; ThatSLAsaredesignedandassessedwithrespecttomeetingoccupationaltherapyclinical placementobjectives;and Thatnoonesimulationmodalitycanbeusedasa standalone alternativetoclinicaltraining time. Thisequatestoupto200hoursoffieldworkhours.Ifoneassumesthatastudents placementday consistsofsevenhours,thenthismeansslascouldcontributeuptoapproximately28days. TheextenttowhichSLAwouldbeusedinanyoneoccupationaltherapyschoolandthenatureofthese SLAswouldbedeterminedbyindividualschools/universities.Itisthereforeimportanttonotethat individualoccupationaltherapyschoolsmaydecidethataproportionoftheagreedmaximumof20%of fieldworkhoursusingslasoccursduringclinicalplacements.whereslasareusedduringclinical placementsthisproportionwouldnotnecessarilycontributetoanoverallreductioninclinicaltraining days,butcouldpotentiallyreduceclinicaleducators workloadandimprovequalityandsafetyof studentpractices. Thelikelytimeframeforimplementationshouldthesecurriculaelementsbeadopted Arangeofapproacheshavebeenrecommendedonpages5355tosupporttheadoptionofSLAs withinoccupationaltherapycurricula.timeframesfortheseapproachesareprovidedalongsideeach approach.implementationtimeframeswillvarybetweenschoolsdependingonexistingresourcesand experiencewithslas,andwillbeinfluencedbytheleveloffundingreceivedfromhwafor approachesindicatedonpages4851.itispossiblethatsomeschoolswillbeginimplementingsome aspectsofcurriculaelementswithinoneyearoffundingbeingreceived.otherswilltakelongerto developthecapacityforimplementation. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 50

51 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Recommendations: PriorityelementstobesupportedbytheSLENationalProject Background AlistofcurriculaelementsthatcouldbedeliveredbySLAshasbeenidentifiedandlistedinTable7on pages4748.fromthistable,ashortlistofpriorityelementsthatcouldbesupportedbythenationalsle projectwerethenidentifiedandaresummarisedbelowintable8.theseslaswouldbeguidedbycore occupationaltherapytheory,underpinnedbythepivotalconstructsofperson,occupationand environment. Table8.PriorityelementsofthecurriculumthatcouldbesupportedbytheSLAnationalproject Domainsofclinical placementobjectives asassessedbyspefr PrioritycurriculumelementsthatcouldbesupportedbytheNationalSLA project Coworker Communication CommunicationSkills Information Gathering ServiceProvision Professional Behaviour Selfmanagementskills Documentation ServiceEvaluation Interprofessionalcollaborativepracticeandcommunicationandenhancing clientsafetyandservicequality. Developmentofhigherlevel,appliedverbalandnonverbalcommunication skillsforinteractingwithclientswithchallengingbehaviours,clientswith complexneedsandtheircarers,clientsatrisk,orcommunicationabout sensitiveissues. Developmentofculturallycompetentcommunication. Assessmentofclientswithchallengingbehavioursorcomplexneeds;clients atrisk(e.g.,suicideriskassessment),orassessmentwithrespecttosensitive issues. Appliedriskassessments(e.g.,home/workplace). Servicedeliveryforclientswithchallengingbehavioursorcomplexneeds; clientsatrisk(e.g.,suicideriskassessment),orservicedeliverywithrespect tosensitiveissues. Servicedeliveryincorporatingriskmanagement. Developmentofprofessionalbehaviours,useofoccupationfocussed languageandmanagingethicaldilemmas. Developmentofplanningandinitiative,responsivenesstofeedback, managementoftimepressuresandcompetingdemands. Documentationusingoccupationfocussedlanguagewithemphasison accurateandtimelydocumentationtoreduceerrorandimprovequality. Developmentoftheabilitytoevaluateandmodifyoccupationaltherapy servicedeliveryinresponsetoselfreflection/feedbacktoenhancesafety andqualityoffutureserviceprovision. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 51

52 Background UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Recommendations:Approachestoaddressbarrierstoeffective ultilisationandexpansionoftheuseofsimulatedlearningactivities (SLAs)indeliveringthepriorityelementsofthecurriculum Therewasnationalconsensusthatsimulatedlearningactivities(SLAs)couldcontributetooccupational therapycurriculaandenhancementofclinicalplacementcapacity.themainbarrierstotheuseof simulatedlearningactivities(slas)wereidentifiedinsurvey2(seetable4),andweresubsequently confirmedineachofthefora.inaddition,stakeholderconsultationhighlightedthecriticalbarrierof fundingtoadequatelyresourcethedevelopment,andrecurrentfundingfortheongoinguseofslas. Recommendationsaboutapproachestoaddressbarriers ThekeyapproachestoaddressbarrierstouseofSLAsarisingfromconsultationwithstakeholdersinclude; (1)developmentofoccupationaltherapyrelevantsharedresources,(2)supportfortheuseofstandardised patients,(3)educationandcapacitybuildingforclinicaleducatorsandacademicsintheuseofsla,(4) developmentofoccupationaltherapyrelevantsimulatedlearningenvironments,(5)researchontheuseof simulationinoccupationaltherapycurricula,(6)equity,and(7)flexibilityofuseofslasaccordingtolocal andcurriculaneeds. 1. DevelopmentofOccupationalTherapyRelevantSharedResources:NationalScenario/ResourceBank Timeframe:Within2yearsofcommencementoffunding,andongoing. Theprimarybarrieridentifiedinthesurveysandforawastheneedforfundingtoenabletheestablishment andmaintenanceofsimulatedlearningactivitiesthatwouldmeettheconditionsidentifiedbythe occupationaltherapyprofessiontobecountedtowardsrequiredminimumfieldworkhoursfor occupationaltherapyprogramaccreditation.thedevelopmentofcasescenariostosupporttheuseofslas nationallywithinoccupationaltherapycurriculaisapriority.thereispotentialforduplicationofeffort withineachoccupationaltherapyschoolandthereforeconsiderableinefficienciesifresourcesarenot sharedacrossaustralia.hence,itisrecommendedthatthereis: 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 52

53 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum 2.SupportingUseofStandardisedPatients Timeframe:6months 5years(willvarydependingonindividualschools curriculumandcapacity) Standardisedpatientsarerecommendedasthekeysimulationmodalitythatmeetstherequirementsfor fieldworkwithinoccupationaltherapyinaustralia.standardisedpatientsinoccupationaltherapy curriculaarenotusedasastandalonesimulationmodality.rather,theyformpartofascaffolded simulatedlearningactivityincorporatingothersimulationmodalitiessuchaswrittencasestudies,roles playsanddvds,culminatingintheuseofstandardisedpatients.thereforepriorityshouldbegivento resourcesandfundingforclinicaltrainingprogramsthatutilisestandardisedpatientsinadditiontoother simulationmodalities.theserecommendationsemanatefromtheunanimouslydescribedbarrierstothe useofstandardisedpatientstodateinoccupationaltherapycurriculathatrelatedtolackoffunding, resources,personnelrequirements,establishmentandtrainingcostsandrecurrentfundingforboth standardisedpatientsandclinicaleducatorsinvolvedinthesesimulatedlearningactivities. Theutilisationofstandardisedpatientstoenhanceclinicalcapacityisentirelydependentonarecurrent fundingmodel(ofatleastfiveyearsminimumduration)whichisadditionaltocurrentuniversity/school budgets.recommendationsarisingarethat: Recommendation3:Centresbeestablishedthatwouldrecruitandtrainindividualstoactas standardisedpatientsacrossallfieldsofhealthincludingthetypesofpatientsneededinoccupational therapy.thesecentresshouldbeaccessibletoalluniversitiesofferingentryleveloccupationaltherapy programsincludingthoseinrural/regionalareas. Recommendation4:Recurrentfunding(inminimumoffiveyearblocks)isprovidedforestablishingand maintaininguseofstandardisedpatientsforalluniversitiesofferingentryleveloccupationaltherapy programs.caseswillneedtobereviewedandpotentiallymodifiedorreworkedatleasteveryfiveyears duetoadvancesinevidencebasedpractice,advancesinprofessionalknowledgeandpractice,aswellas changesinhealthpolicy,etc. Recommendation5:Clinicaleducators,practicingoccupationaltherapistsandoccupationaltherapy consumersfromarangeofcontextsengagewithoccupationaltherapyacademics/educatorstodevelop andcritiquetheresourcesdeveloped. 3.EducationandCapacityBuildingforClinicalEducatorsandAcademicsintheUseofSimulated LearningActivities. Timeframe:2yearsfromcommencementoffundingongoing ThepotentialuseofSLAsinoccupationaltherapycurriculumwhilstbeingstronglysupportedbyall stakeholdersconsultedwillrequiresignificanttrainingandsupportforadoptionandfurtherintegration intocurricula.theutilisationofslastoenhancethesafeclinicalpracticeofstudentsandalsothe promotionofqualityclinicallearningwillrequirefocussedtrainingprogramsforacademicsandclinical educators.thiscapacitybuildingwillenhancethefuturesustainabilityofslaswithinbothacademic curriculaandclinicalteachingpractice.henceitisrecommendedthat: Recommendation6:Trainingisprovidedforoccupationaltherapyacademicsandclinicaleducators regardingtheuseofsimulationforbothoccupationaltherapycurriculaandinterprofessional education,particularlyslasthatwouldcontributetoincreasedclinicalplacementcapacity.training shouldbeaustraliawideandutilisebothfacetofaceandonlinetrainingmethods. Recommendation7:Thedevelopmentofthistrainingwilloccurincollaborationwithoccupational therapyacademicsandclinicaleducatorstoensurethatdatafromacomprehensivetrainingneeds analysisunderpinthedevelopmentoftrainingmaterials,methodsandapproaches. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 53

54 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum 4.DevelopmentofOccupationalTherapyRelevantSimulatedLearningEnvironments Timeframe:15years(willvarydependingonindividualschools curriculumandcapacity) Inorderforstudentstofullyengageinsimulatedlearningactivitieshighfidelitysimulationenvironments arerequiredthatarebroadenoughtomeetthescopeofpracticewithinoccupationaltherapyandare adequatelyresourcedwithappropriateequipment/furnishingsandotherrelevanttechnologies(e.g., videorecordingfacilities).itisrecommendedthat: Recommendation8:Accesstosimulatedlearningenvironments/skillcentresandtheirassociated facilitiesandtechnicalpersonnelisavailabletoalluniversities(whetherinmetropolitanorregional areas)offeringentryleveloccupationaltherapyprograms. Recommendation9:Simulatedlearningenvironmentsincorporateflexiblespacesandadequatestorage forawiderangeofequipment/furnishingstoassistinsimulatingaspectsofhomeenvironments,school environments,workplacesandarangeofcommunityenvironmentswhereoccupationaltherapistswork. Recommendation10:Accesstoward/clinicsimulationenvironments,mannequins,andassociated technicalsupportisprovidedtofacilitateipesimulationforalloccupationaltherapyprogramsin collaborationwithotherprofessions. Recommendation11:Allsimulatedenvironmentsdevelopedhaveaudiovisualrecordingcapacity,and accesstointerview/debriefingroomsandattendantresources. 5.ResearchintheUseofSimulationinOccupationalTherapyCurricula Timeframe:Within1yearoffundingcommencingongoing Thereiscurrentlylimitedevidencefortheeffectivenessofsimulatedlearningactivitieswithin occupationaltherapy,andtherearemanyareasforwhichlimitedevidenceexistswithincognatehealth professions.thislackofevidencereducestheconfidenceofacademicsandclinicaleducatorstoengage insimulatedlearningactivities.henceitisrecommendedthat: Recommendation12:Fundingtosupportresearchabouttheeffectivenessandimplementationof simulatedlearningactivitiesisprovided. Recommendation13:Occupationaltherapyacademicsnationallyagreeonevaluationmethodologiesto beusedtoevaluateslasinoccupationaltherapyincludingevaluationdesign,outcomemeasuressothat multiplesitescanbeused,datapooledandoutcomesreportedwithconfidencewithadequatesample size. Recommendation14:Evaluationoftheimpactofsimulationactivitiesonoccupationaltherapystudents satisfaction,clinicalcompetence,confidence,andlevelofskilldevelopment(asassessedbyacademics andcliniciansinthefield)isspecificallyrequiredofanyprojectsfundedbyhwa. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 54

55 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum 6.Equity Timeframe:Immediatelyongoing Diversityinthescopeofpracticefortherangeofhealthprofessionshasattimescreatedinequitiesin termsofaccessofoccupationaltherapyacademics,educatorsandstudentstooptimalclinicallearning environments.theseinequitieshavebeenevidencedinrelationtothedistributionoffunds(including recurrentfunding)andaccesstoclinicallearningenvironments(e.g.prioritisationofgovernment supportedstudentaccommodationproximaltoclinicalfacilities).thepotentialcontributionofslesto theclinicaltrainingofoccupationaltherapyandotheralliedhealthstudentsneedstobesupported equitably. InrelationtothegeographicallocationofSLEsconsiderationneedstobegiventoequityofaccessacross thenationtoensuretheenhancedclinicallearningofallstudents.notalloccupationaltherapyschools arelocatedincapitalcities.thereforethefollowingrecommendationsaremade: Recommendation15:ThereneedstobeequityofaccesstoSLEs/skillscentresandstandardisedpatients byallparticipatinghealthcareprofessionsincludingalliedhealthratherthanthecurrentfocuson medicineandnursing. Recommendation16:Facilitiesandresourcesaswellasappropriateoccupationaltherapyenvironments mustbeavailabletoallowequityofaccesstoregionalandruraluniversitiesofferingoccupational therapyprograms. 7.FlexibilityofSimulationAccordingtoLocal/IndividualCurriculaNeeds Timeframe:Immediatelyongoing Therearecurrently14accreditedoccupationaltherapyschoolsacrossAustraliaeachwithdifferent modelsofcurriculumanddifferentmodelsforclinicalplacements.therearenomandatoryclinicalareas requiredforfieldworkwithinoccupationaltherapy;ratherstudentsareexpectedtogainadepthand breadthofclinicalexperienceworkingwithchildren,youth,adultsandolderpeopleandinhospitals, communitiesandwithindividualsandorganisations.hencestudentsareplacedinawiderangeof practiceareas.forexample,approximatelyhalfofoccupationaltherapystudentplacementsdonot occurinhospitalsettingsbuttakeplaceincommunitysettings,educationalenvironmentssuchas schools,workplacesettings,correctionalcentres,andindividuals homes.placementsmayforinstance taketheformofconsultanciestoindustryrelatedtoworkplaceinjuries,preventionandhealth promotionoradvocacy.itisrecommendedthat: Recommendation17:ResourcesforSLAsandmodelsofdeliveryofsimulationmustbeflexibleenough toallowoccupationaltherapyschoolsinvariousuniversitiestochooselocallyappropriatemechanisms forembeddingslasintotheiracademiccurriculaandclinicaleducationplacements. Recommendation18:AvarietyofmodelsforutilisingSLAsacrossoccupationaltherapyprogramsfrom year1beadoptedwithuniversitieschoosingthemodel/sthatworksbestfortheirparticularcurriculum needs.appendix9providesanumberofdifferentmodelsagreedbyprojectstakeholdersto demonstratethispotential. Pre-bLock PLacement) During block placements Post block PLacements) Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 55

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58 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum Neistadt,M.E.,Wight,J.,&Mulligan,S.E.(1998).Clinicalreasoningcasestudiesasteachingtools. AmericanJournalofOccupationalTherapy,52(2), NestelD;TierneyT.(2007).Roleplayformedicalstudentslearningaboutcommunication:guidelinesfor maximisingbenefits.bmcmedicaleducation,7:3doi: / OccupationalTherapyAustralia(OTAL)(2010).AccreditationStandardsforNewGraduateOccupational Therapists.Melbourne,VICAuthor. OhioStateUniversity.(2010).OccupationalandPhysicalTherapyStudentsLearnTogetherintheICU. StudentNewsandEvents.Retrievedfrom: Papadakis,M.A.,CroughanMinihane,M.,Fromm,L.J.,Wilkie,H.A.,&Ernster,V.L.(1997).A comparisonoftwomethodstoteachsmokingcessationtechniquestomedicalstudents. AcademicMedicine,72(8), Paskins,Z.,&Peile,E.(2010).Finalyearmedicalstudents'viewsonsimulationbasedteaching:a comparisonwiththebestevidencemedicaleducationsystematicreview.medicalteacher,32 (7), Poulton,T.,Conradi,E.,Kavia,S.,Round,J.,Hilton,S.,Poulton,T.,etal.(2009).Thereplacementof 'paper'casesbyinteractiveonlinevirtualpatientsinproblembasedlearning.medicalteacher, 31(8), Resnick,M.L.,Sanchez,R.,Resnick,M.L.,&Sanchez,R.(2009).Reducingpatienthandlinginjuries throughcontextualtraining.journalofemergencynursing,35(6), RiceV.J&Gerardi,S.M.(1999).PartII.Workhardeningforwarriors:TrainingmilitaryOccupational Therapyprofessionalsinthemanagementofcombatstresscasualties.Work13, Richardson,L.,Resick,L.,Leonardo,M.,Pearsall,C.,Richardson,L.,Resick,L.,etal.(2009).Undergraduate studentsasstandardizedpatientstoassessadvancedpracticenursingstudentcompetencies. NurseEducator,34(1),1216. Rodger,S.,Webb,G.,Devitt,L.,Gilbert,J.,Wrightson,P.,McMeeken,J.,etal.(2008).Aclinicaleducation andpracticeplacementsinthealliedhealthprofessions:aninternationalperspective.journalof AlliedHealth,37(1),5362. Rosen,K.R.,&Rosen,K.R.(2008).Thehistoryofmedicalsimulation.JournalofCriticalCare,23(2), Ruggeroni,C.(2001).EthicaleducationwithVirtualReality:immersivenessandtheknowledgetransfer process.inriva,g&davide,f.(eds).communicationsthroughvirtualtechnology:identity CommunityandTechnologyintheInternetAge(119133).Amsterdam:IOSPress. Rutledge,C.M.,Garzon,L.,Scott,M.,Karlowicz,K.,Rutledge,C.M.,Garzon,L.,etal.(2004).Using standardizedpatientstoteachandevaluatenursepractitionerstudentsoncultural competency.internationaljournalofnursingeducationscholarship,1,article17. Shearer,R&Davidhizar,R.(2003).Usingroleplaytodevelopculturalcompetence.TheJournalofnursing education,42(6),2736. Stansfield,S.,Kane,M.,Butkiewicz,T.,&Suma,E.(2005).InteractiveVirtualClientforTeaching OccupationalTherapyEvaluativeProcesses.ProceedingsoftheACMSIGACCESSConferenceon Computers&Accessibility,Baltimore,Maryland. Tomlin,G.,&Tomlin,G.(2005).Theuseofinteractivevideoclientsimulationscorestopredictclinical performanceofoccupationaltherapystudents.americanjournalofoccupationaltherapy,59(1), TothCohen,S.,&Gallagher,T.(2009)Developmentandevaluationofhealthandwellnessexhibitsatthe JeffersonOccupationalTherapy EducationCenterinSecondLife.JournalofVirtualWorlds Research,2(2).Retrievedfromhttps://journals.tdl.org/jvwr/article/ view/708/502 Triola,M.,Feldman,H.,Kalet,A.L.,Zabar,S.,Kachur,E.K.,Gillespie,C.,etal.(2006).Arandomizedtrial ofteachingclinicalskillsusingvirtualandlivestandardizedpatients.journalofgeneralinternal Medicine,21(5), Turpin,M.,Fitzgerald,C.,&Rodger,S.(inpress).DevelopmentoftheStudentPracticeEvaluation FormRevisedEdition(SPEFR )Package.AustralianOccupationalTherapyJournal. Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 58

59 UseofSimulatedLearningActivitiesinOccupationalTherapyCurriculum VanLeit,B.(1995).Usingthecasemethodtodevelopclinicalreasoningskillsinproblembased learning. AmericanJournalofOccupationalTherapy,49, Velde,B.P.,Lane,H.,Clay,M.,Velde,B.P.,Lane,H.,&Clay,M.(2009).Handsonlearning:theuseof simulatedclientsininterventioncases. JournalofAlliedHealth,38(1),E1721. WattWatson,J.,Hunter,J.,Pennefather,P.,Librach,L.,RamanWilms,L.,Schreiber,M.,etal.(2004). Anintegratedundergraduatepaincurriculum,basedonIASPcurricula,forsixhealthscience faculties.pain,110(12), Westberg,S.M.,Adams,J.,Thiede,K.,Stratton,T.P.,Bumgardner,M.A.,Westberg,S.M.,etal.(2006). Aninterprofessionalactivityusingstandardizedpatients.AmericanJournalofPharmaceutical Education,70(2),34. Williams,B.,Brown,T.,Scholes,R.,French,J.,&Archer,F.(2010).CaninterdisciplinaryclinicalDVD simulationstransformclinicalfieldworkeducationforparamedic,occupationaltherapy, physiotherapy,andnursingstudents?journalofalliedhealth,39(1),310. Williams,B.,French,J.,Brown,T.,Williams,B.,French,J.,&Brown,T.(2009).Caninterprofessional educationdvdsimulationsprovideanalternativemethodforclinicalplacementsinnursing? NurseEducationToday,29(6), Wojcik,R.K.(2000).Structureandoutcomesofsimulatedpatientlearningexperiencesintegratedinto entrylevelphysicaltherapisteducationinoneacademicprogram.physicaltherapy,80,s42. WorldFederationofOccupationalTherapists.(2007).Strategicplan Retrievedfrom: WorldFederationofOccupationalTherapists.(2008).WFOTEntrylevelcompetenciesforoccupational therapists.forrestfield,wa:worldfederationofoccupationaltherapists. Zapletal,A.L(personalcommunication,September14,2010). Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 59

60 Use of Simulated Learning Activities in Occupational Therapy Curriculum Appendix 1 World Federation of Occupational Therapists Minimum Requirements for Fieldwork (pp ) Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 60

61 I World Federation of Occupational Therapists Revised Minimum Standards for the Education of Occupational Therapists 2002 '" Clare Hocking, New Zealand Delegate Nils Erik Ness, Norw-egian First Alternate

62 I :1 1 I WORLD FEDERATION OF OCCUPATIONAL THERAPISTS 'I I 1 \1! REVISED NlINIMUM STANDARDS FOR THE EDUCATION OF OCCUPATIONAL THERAPISTS "'" 2002 Developed by Care Hocking, New Zealand Delegate Nils Erik Ness, Norwegian FirstAlternate Further information may be obtainedfrom [email protected]

63 Fieldwork FieldwOl'kis central to the educationalprocess. Itincludes curriculumcontentandisan educaiional method, but is prese11ted in a separate category because additional standards apply. The purpose of fieldwork is for students to integrate knowledge, professional reasoning and professional behaviour within practice, and to develop knowledge, skills and attitudes to the level ofcompetence requil:ed ofqualifying occupational therapists. As with all aspects of the curriculum,. student achievement on:fieldworkis assessed. Congruence: Depth & Breadth: 24 Fieldwork experiences are consistent with the philosophy and purpose of the programme. Consistency does n.ot,exclude fieldworkplacementsin sites where occupational therapy practice is emerging. $htdentsexperiencea rangeofdifferent fieldwork placementsthatrequirethem to integrateknowledge, skills and attitudes to practice with a range ofdifferent people who have differentneeds, and in different circumstances. The range of student experiences alwaysincludes: People of different age groups People who have recently acquired and long-standing health needs Interventions thatfocus on the person, the occupation, and the environment. Studentexperiences willnormallyalso encompass at leastthreeofthefollowing parameters: A range of personal factors such as gender, ethnicity etc that is reflective of the population thatwill be recipients of occupational therapy communityi group and population approaches Healthconditions thataffect different aspectsofbodystructure andfunction and that cause different kinds of activity limitations Different delivery systems such as hospital and community, public and private, health and educational, urban and rural, local and international Existing and emerging services, such as services being developing for and with people who are disempowered, dispossessed or socially challenging; organisations and industries that may benefit from occupational therapy expertise; or arts and cultural services.. Each studentwill complete sufficient houts of fieldwork to ensure integration of theory to practice. A minimum of1,000 hours,is nor.m.a11y expected. The 1,000 fieldwork hours refers to the time each student spends implementing an occupational therapy process, or an aspect of an occupational therapy process with or for a real live person: Interpreting the person-occupation-environmentrelationship and how that relationship influences the person's health and Establishing and evaluating therapeutic an.d professional relationships Planning and preparing for an occupational therapy assessment or intervention. Implementing an occupational therapy process (or some aspect of it) Demonstrating professional reasoning and behaviours Generating or using of the contexts ofprofessional practice. Fieldwork placements axe ofsufficient duration to allow integration of theory to Itisexpected thatatleastsomeplacementswill be up to 2 monthsin duxation. tocal Context: International Perspective: Quality Improvement: Educational Facilities and Resources C<mgrueltce: Fieldwork is distributed throughout everyyear of the curriculum. To ensure a depth of lear.ru.ng, fieldwork is guided by a learning contract and supervised and assessed by an occupational therapist with at least one year's experience or an occupational therapy educator. There is no requirement that the supervisor is on site. Supervision refers to the process ofover seeing the student's implementation ofan occupational therapy process, where the supervisor is responsible for the quality of the student's practice andfor the safety ofthe recipient ofoccupational therapy. It is likely that supervision will initially include: Discussion with the student Review ofthe student's intervention plans and records, and Observation. ofthe student's actions. The amount and frequency of supervision -will progress from close, on-site supervision to independent practice as students progress through the programme. The level of supervision will also vary with students"'knowledge base, familiarity with the practice setting and their learning needs; the contexts of practice - including the presence or absence of other health professionals; the complexity of the dccupational therapy intervention to beprovided and the level of proficiency required for it to be; effective; and the safety risks for both students and recipients of occupational therapy. The number of students placed at a fieldwork site willbe in proportion to the number of available clients. The roles and responsibilities of students on #eldwo:rk placements, fieldwork supervisorsandeducatorswithintheeducationalprogrammeare known, clear, explicit and relevant to the local context. Students and fieldwork supervisors are adequately prepared and supported to fulfil their respective roles and responsibilities. Fieldworkexperiences areinformedbyinternationalexpectations ofpl'ofessional service provision. That is, practice is guided by theory and research findings, and serviceis provided to all peoplewithout prejudice (inclusive practice). Evaluation of studentperformance on fieldwork is: Consistent with the philosophy and purpose of the progranune and the learning contract. Gear 'and explicit, and Approprlate'"to the kvel of the sm.dent. Mechanisms for feedback between students, graduates, fieldwork supervisors and educators are in place and inform ongoing improvement of fieldwork planning, preparation and provision. The educational resources fit wen with the philosophy and purpose of the programme. For example aprogrammedesigned to produce graduates sldlledin providing therapy for people with physical health conditions will normally require anatomical models, andexamples ojrehabilitative equipment. A programme that emphasises developing economically viable employment optionsfor disadvantaged populations may require opportunities for students to experience local work settings and the occupations perfonned there. 2S

64 Use of Simulated Learning Activities in Occupational Therapy Curriculum Appendix 2 Survey 1: Current Use of Simulated Learning Activities in Occupational Therapy Curricula Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 64

65 Simulation in Occupational Therapy Curricula 1. Introduction We are interested in understanding more about the current use of simulation in occupational therapy curricula across Australia. We appreciate your time in completing this questionnaire. If you have any queries please contact What to do 1. This questionnaire refers to a number of terms which are defined below. You will be able to return to this page to review the definitions as you need throughout your completion of the questionnaire. 2. There are 3 pages of questions to complete. Please note that it is possible for you to exit and re-enter the survey more than once as you complete it. 3. Once each relevant question has been answered on each of the pages of the online questionnaire, click the DONE button at the end. This will submit your responses. Please complete the survey by: 28th September, 2010 All information supplied will remain confidential. Individual participants will not be identified in any publications arising from this survey. Thank you very much for your assistance. DEFINITIONS For this survey we will use the following definitions: Simulated Learning Activities refers to learning activities/experiences that make use of any modality that imitates a real clinical/professional situation Simulation Modalities refers to the type of medium used for simulation, including but not limited to: role play, standardised patients/actors, use of clients who no longer receive therapy, use of mannequins, part task trainers (part-mannequins that can be worn), computer clients/avatars (eg using virtual worlds), written case studies of real clients, DVD of real or simulated clients. Simulated Learning Environments refers to where learning takes place, namely the simulated environments. Examples of these environments are interview rooms, mock hospital wards, simulated living spaces (eg. kitchen/ bathroom) and so on. Simulated Learning Programs refers to the whole or part of a course curriculum that contains simulation opportunities Page 1

66 Simulation in Occupational Therapy Curricula 2. Section 1 1. Which one of the following best describes your position: 1. Associate lecturer (A) 2. Lecturer (B) 3. Lecturer C/Senior Lecturer, 4. Associate Professor (D) 5. Professor 6. Research staff 7. Clinical educator (University based) 8. Clinical education coordinator 9. Clinical education support staff 10. Higher education worker (HEW) Other (please specify) Which of the following programs does your occupational therapy program have? Please select all that apply: gfedc gfedc gfedc gfedc Bachelor program (4 years) Masters program (2 Years) Dual Degree Both Bachelor and Masters programs 3. Please indicate the average number of students in each year of your program, where applicable: Bachelor Year 1 Bachelor Year 2 Bachelor Year 3 Bachelor Year 4 Masters Year 1 Masters Year 2 Dual Degree Page 2

67 Simulation in Occupational Therapy Curricula 3. Section 2 * 1. Are simulated learning activities of some type used in your occupational therapy program? Yes No know Don't 2. If simulation is NOT used in your curriculum, please provide your thoughts about why not, then skip to the end of the questionnaire and click DONE. Thank you for your time Which simulated learning activities and modalities do you think are most useful for pre-clinical teaching in occupational therapy? Please Comment: 5 6 Page 3

68 Simulation in Occupational Therapy Curricula 4. Approximately how many hours of student contact with each of the following simulation modalities are used in each of the following years of your occupational therapy program? Please scroll across the page to answer for each modality. Written case scenarios (Hours) Role play with other students (Hours) Standardised patients(actors) (Hours) Interaction with clients no longer requiring therapy (Hours) Mannequins or part-task trainers (Hours) DVDs of real or simulated clients (Hours) Computer clients/virtual reality (Hours) Bachelor Yr 1 Bachelor Yr 2 Bachelor Yr 3 Bachelor Yr 4 Masters Yr 1 Masters Yr Other (please specify) 5. Are you aware of the use of simulation activities in block clinical placements? If so, please describe: Page 4

69 Simulation in Occupational Therapy Curricula 6. With which lifespan stages do you use simulation modalities? Please indicate whether or not each of these modalities are used with these lifespan stages by using the drop down menus: Written case scenarios Role play with other students Standardised patients (actors) Interaction with clients no longer requiring therapy Mannequins or part-task trainers DVDs of real or simulated clients Computer clients/virtual reality Children Young people Adults Older people Other (please specify) 7. For which areas of practice do you use the following simulation modalities? Please select as many of the options as apply: 5 6 Written case scenarios Role play with other students Standardised patients (actors) Interaction with clients no longer requiring therapy Mannequins or part-task trainers DVDs of real or simulated clients Computer clients/virtual reality Mental health Acute adult physical conditions Chronic adult conditions Aged care Paediatrics Intellectual disability Work/Occupational health Working with carers/families Inter-professional practice Social care (eg. Working with refugees) Other (please specify) 5 6 Page 5

70 Simulation in Occupational Therapy Curricula 8. For the development of which of the following competencies do you use simulation? Please select as many of the options as apply and briefly describe (NB: the text boxes will expand to 300 characters): a) Professional Behaviour (eg. ensuring client safety) b) Self Management (eg. time management skills) c) Co- worker Communication (eg. explaining information to others) d) Communication Skills (eg responsiveness to clients/significant others) e) Documentation (eg. forming documents appropriate to audience) c) Information gathering (eg. standardised or observational assessments, initial interviewing/history taking) d) Service provision (eg. client education, counselling skills, physical intervention, mental health intervention) e) Evaluation (eg. interpreting evaluation strategies during service provision) 9. Do you have access to any of the following simulation environments/facilities at your university to use in program teaching and learning (either on- or off-site)? Please select as many of the options as apply: With video capture Without video capture Simulated ward environments gfedc gfedc Interviewing rooms gfedc gfedc Simulated living environments gfedc gfedc (eg bathroom, kitchen etc) gfedc gfedc Tele-health facilities/equipment gfedc gfedc Other (please specify) Do you use any of the following simulation environments in your OT programs? Please select as many of the following options which apply: With video capture Without video capture Simulated ward environments gfedc gfedc Interviewing rooms gfedc gfedc Simulated living environments gfedc gfedc (eg bathroom, kitchen etc) gfedc gfedc Tele-health facilities/equipment gfedc gfedc Other (please specify) 11. Do you assess any simulation experiences you utilise? Yes No Other (please specify) Page 6

71 Simulation in Occupational Therapy Curricula 12. Please indicate which of the following tools (if any) you use for assessment or for feedback following the use of simulation: Assessment of students Feedback to students Do not use Videotapes of interviews gfedc gfedc gfedc Peer feedback written/verbal gfedc gfedc gfedc Tutor/staff written feedback gfedc gfedc gfedc Tutor/staff verbal feedback gfedc gfedc gfedc Patient/consumer/actor feedback written/verbal gfedc gfedc gfedc Reflective journals gfedc gfedc gfedc SPEF-R gfedc gfedc gfedc Adapted SPEF-R gfedc gfedc gfedc Other (please specify) 5 6 Page 7

72 Simulation in Occupational Therapy Curricula 4. Section 3 1. Please comment on any feedback you may have had from students about their engagement with simulation activities: What is your perception of student satisfaction with simulation learning opportunities or modalities? Is simulation currently used within your program to contribute to the students 1000 hours of professional practice education as prescribed by W.F.O.T? gfedc Yes gfedc No gfedc Don't know 4. If you answered 'Yes' to question 3, please describe HOW simulation is currently used within your program to contribute to the students 1000 hours of professional practice education as prescribed by W.F.O.T? Is simulation currently used as either a whole or part of block placement practice education experience (i.e. as fieldwork time within short or longer block placement traditionally used in your OT program)? Yes No Don't know 6. If you answered 'Yes' to question 5, please describe the length of simulation placement, year level of students, and example of how it is used? If your occupational therapy program uses standardised patients, approximately how much does it cost your program for the use of a standardised patient per hour? 8. If your occupational therapy program uses standardised patients, do you have access to a standardised patient recruitment service? Yes No Don't know Page 8

73 Simulation in Occupational Therapy Curricula 9. Do you have any other comments/thoughts to share? 5 6 Page 9

74 Use of Simulated Learning Activities in Occupational Therapy Curriculum Appendix 3 Simulation in Occupational Therapy: A Resource Document Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 74

75 Simulation in Occupational Therapy Curricula A Resource Document October, 2010 Purpose of this document The purpose of this document is to facilitate reader s reflection on curriculum issues related to simulation. It provides examples of the use of simulation from the literature and responses from a survey of the current use of simulation in occupational therapy programs across Australia. Purpose of Simulation Project Health Workforce Australia (HWA) have asked for national consensus as to the elements of the occupational therapy curricula that could be offered as simulated learning programs (SLP) in occupational therapy. These curricula elements should aim to meet clinical placement objectives and therefore contribute to increased clinical placement capacity. The recommendations resulting from this project will inform HWA about the future use of simulation in occupational therapy curricula across Australia. Increasing placement capacity in occupational therapy To contribute towards this aim of increasing placement capacity in occupational therapy, simulated learning activities must be able to meet two criteria. They must: a) contribute to meeting clinical placement objectives and also b) meet WFOT standards required to be counted towards 1000 fieldwork hours. The full explanation of the WFOT fieldwork requirement is attached for your reference. The purpose of fieldwork is to integrate knowledge, professional reasoning and professional behaviour within practice, and to develop knowledge, skills, and attitudes to the level of competence required of qualifying occupational therapists (WFOT, 2002) The 1,000 fieldwork hours refers to the time each student spends implementing an occupational therapy process, or an aspect of an occupational therapy process with a real live person (WFOT, 2002,p.24). In this document: Simulation: definitions Simulation for increasing placement capacity in occupational therapy Simulation Modalities: Written cases and DVD/Video Role plays and Standardised patients Mannequins and Virtual Reality 4 Simulated environments and Current use of simulated learning Results of survey of current use of simulation What is simulation? Simulation is an educational technique that recreates all or part of a clinical experience. Simulation has been defined as a technique- not a technology- to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2004, p i2) Simulated Learning Activities refer to learning activities/ experiences that make use of any modality that imitates a real clinical/professional situation. Simulation Modalities refer to the type of medium used for simulation, including but not limited to: role play, standardised patients/actors, use of clients who no longer receive therapy, use of mannequins, part task trainers (part-mannequins), computer clients/avatars (eg using virtual worlds), written case studies of real clients, DVD of real or simulated clients. Simulated Learning Environments refer to where learning takes place, namely the simulated environments. Examples of these environments are interview rooms, mock hospital wards, simulated living spaces (eg kitchen/ bathroom) and so on. Simulated Learning Programs refer to the whole or part of a course curriculum that contains simulation opportunities. Bennett, S., Rodger, S & Fitzgerald, C. (2010). The University of Queensland, Prepared for HWA. Not for distribution or replication

76 Page 2 Simulation in Occupational Therapy Curricula Simulation Modalities Written cases Regardless of which simulation modality is used a well developed case scenario is essential Description: A case study is a detailed account of a client or consumer providing information about the history and context of their situation that students need to analyse and make recommendations form. Written case studies may be delivered either on paper or on computer. Examples of current use (from the literature): Developing clinical reasoning skills Stimulus for treatment planning Preparation for clinical placements Providing insight into client experiences Highlighting professional and ethical issues Used for a very wide range of issues! Examples of current use in Occupational Therapy Curricula in Australia (in addition to the above) Identifying goals Developing team management plans Introduction to interprofessional practice Stimuli for a practicing documentation. Advantages Cases studies are the backbone of simulation learning programs. Regardless of which simulation modality is used a well developed written case scenario is essential. May be best suited to developing knowledge and clinical reasoning skills Easily adapted and flexible for integrating into curricula Minimal cost. Disadvantages Cases commonly used can only proceed in a single direction Lack the richness and interactive challenges that are present in real situations. Not able to provide adequate learning experiences in practical skills requiring direct person. DVD/Video of simulated or real patients DVDs, standardised patients and patient actors are all highly regarded Description: Presentation of simulated or real patients cases in video or DVD format, regardless of what technology they are viewed through. Examples of current use (from the literature): Demonstrating particular clinical issues Providing insight into client experiences Demonstrating particular clinical techniques Highlighting professional issues Teaching inter-professional skills Stimulus for treatment planning Preparation for clinical placements. Current use in Occupational Therapy Curricula in Australia (in addition to the above) Demonstrating: Safe handling Neurological techniques Discussing sensitive issues Counselling Communication Grading and adapting Providing client education Home visit assessments Home modifications Assessments Considering suitable duties Analysis of workplaces Provides stimuli for identifying goals, carrying out assessments and interventions, and documentation. Advantages Flexible for integrating into curricula Multiple methods of delivery/access to DVD (eg DVD or Video machine at University, take home copy of DVD etc, streamed on website) Potential for watching again to review case or revise particular skill or techniques May be best suited to developing knowledge clinical reasoning skills, and developing under standing of client experiences Minimal cost once developed. Disadvantages Lack of interactive challenges that are present in real situations Largely passive teaching modality reduces responsibility on students Not able to provide adequate learning experiences in practical skills requiring direct person contact. Bennett, S., Rodger, S & Fitzgerald, C. (2010). The University of Queensland, Prepared for HWA. Not for distribution or replication

77 Page 3 Simulation Modalities cont. Role play Description: Role-plays between students of same or different year level. Examples of current use (from the literature): Developing clinical reasoning skills Used as stimulus for treatment planning Highlighting professional and ethical issues Provides practice in: Communication and counselling skills History taking and carrying out assessments Group facilitation Practical skills requiring direct person contact eg manual handling, muscle testing, ADL training, Providing client education Discussing sensitive issues Collaborative goal setting Developing cultural competence Interprofessional practice. Current use in Occupational Therapy Curricula in Australia (in addition to the above) Practicing: Neurological techniques Splinting and oedema management Grading and adapting Explaining technical information to clients Motivational interviewing Talking with concerned family members. Standardised patients Description: Standardised patients are actors who are trained to present as a patient or consumer according to a script written specifically for the learning activity. Examples of current use (from the literature): Provides practice in: Communication and counselling skills History taking and carrying out assessments Providing client education Collaborative goal setting Manual handling, transfers, ADL training Discussing sensitive issues Managing concerned/distressed relatives Developing cultural competence Treatment planning Interprofessional practice Receiving feedback. Current use in Occupational Therapy Curricula in Australia (in addition to the above) Practicing teaching community living skills Stimuli for treatment planning To engage students in professional and self management learning objectives (eg professional presentation, time management etc) Standardised patients are commonly used to develop DVDs/Videos to demonstrate specific issues. Advantages Broad applications Development of basic level of skills Safe means to attempt more complex skills Can be altered depending on whether the educational goal addresses knowledge, attitudes or skills Encourages students to draw on previous experiences Provides reciprocal learning with those role-playing patients gaining insight into some of the issues faced by the patient they portrayed Inexpensive Can provide learning experiences in practical skills requiring direct person. Disadvantages Limited by the knowledge and skill of participants Students identifying lack of realism and poor "acting" skills detract from its Benefits. Advantages Realistic encounter which increases student engagement Uniform (standardised) presentation providing all students with the same type of experience or testing situation Can portray behaviours required to meet learning objectives Students may make errors/practice difficult conversations/skills without risk to patient Standardised patients can provide feedback to students from the perspective of the patient Improves students confidence Suited to developing both basic and more advanced/complex skills. Disadvantages Costs involved (up to approx $55/hr) Organisational complexities (ie to enable all students to interview an SP may require running multiple interviews at the same time etc) May be limited by the student s perception of realism which in turn may be influenced by the level of environmental and/or psychological fidelity of the presentation. Each simulation modality has specific strengths and weaknesses Interviewing a standardized patient helped me internalize content from the lectures (Year 2 student) Bennett, S., Rodger, S & Fitzgerald, C. (2010). The University of Queensland, Prepared for HWA. Not for distribution or replication

78 Simulation Modalities cont. Mannequins/Past-task trainers Mannequins (Human patient simulators) have different levels of fidelity: Low fidelity mannequins provide the user with limited feedback such as those used in basic CPR training whose chest rises and falls with the introduction of air. Medium fidelity mannequins provide a moderate amount of feedback, driven by computer programs that allow the instructor to manipulate the physiological parameters such as blood pressure and heart rate. High fidelity mannequins look more realistic (eg eyes blinking), plus much more realistic feedback provided with the associated computer systems Part task trainer: Modelled segments of the body such as an arm, or upper body mannequin on which to practice specific skills Examples of current use (from the literature): Familiarisation with complex medical situations and environments eg ICU environments Communicating with comatosed patients Interpreting changes in clients' vital signs Precautions when handling clients who are connected to monitors and medical equipment Burn care, wound care, pressure sore care Inter-professional teamwork Stimulus for treatment planning. Current use in Occupational Therapy Curricula in Australia (in addition to the above) Paediatrics Adult physical conditions Occupational health Communicating with carers Interprofessional practice. Advantages Minimal negative consequences should errors occur during the simulation activity Provides familiarisation with complex medical situations Some (limited) ability to provide adequate learning experiences in practical skills requiring direct person contact. Disadvantages Authenticity? Limited by the student s perception of realism which may be influenced by the level of physical/ environmental and/or psychological fidelity of the presentation. Limited range of applications in occupational therapy Costly (unless there is access to skills centre that has this equipment). Virtual Reality Description: Virtual reality (VR) refers to computer generated simulations of both real or imagined environments and people. Varies widely depending on the type and combination of technology and multimedia used. It can include virtual environments and avatars, or case based simulation computer patients requiring students to make decisions as the case unfolds. The latter may be delivered through software alone or software integrating video clips. VR may also be used in teaching to provide students with awareness of conditions or disabilities. VR differs to virtual learning communities in which students and staff interact through blogs, discussion lists and so on. Examples of current use (from the literature): Interviewing/ assessments Clinical reasoning/decision making Potential for developing an understanding of the lived experience Considering environments and need for adaptations Developing cultural competence Inter-professional teams. Advantages Students have to consider options as the cases unfold and experience consequences of their decisions. Well suited to developing clinical reasoning skills Readily integrated into curricula May be used at times which suit students and educators Potential for wide applications. Disadvantages Not able to provide adequate learning experiences in communication, empathy and non-verbal skills and any skills requiring direct person contact Authenticity? Current use in Occupational Therapy Curricula in Australia (in addition to the above) Manual handling Risk assessment. Link to a video describing a virtual adapted home in Second Life developed by students at Thomas Jefferson University: Bennett, S., Rodger, S & Fitzgerald, C. (2010). The University of Queensland, Prepared for HWA. Not for distribution or replication

79 Simulated learning environments Options that are currently use or could be used in occupational therapy: Medical wards ICU environment Interviewing rooms Living spaces (bathrooms, kitchens, bedrooms) Community places (bus stops, shops, banks etc) Schools/ classrooms Work places Virtual environments Others? Factors to consider when designing simulation activities Which specific aspects of curriculum will the case/simulation be used for? What are the learning objectives for the course? What are the characteristics of the learners? What level complexity of case content is required? How will the cases/simulation be implemented in curricula? How might multiple simulation modalities be used to build complexity? What environments might be used to improve the fidelity/authenticity of the simulation activity? What equipment is needed? What are the costs? Survey of simulated learning activities in occupational therapy curricula in Australia: Current practice Questionnaires about the current use of simulation in occupational therapy curricula were sent to 14 occupational therapy programs across Australia. We received 11 responses ( 79% response rate). In addition to fixed response items, we asked participants for their comments on a number of items. Here is what we found.. Figure 1. Use of simulation modalities in occupational therapy curricula Simulation modality Mannequins/part-task trainers Virtual reality/compuer patients Standardised patients Clients no longer requiring therapy Role play DVD/Video Written cases Number of occupational therapy programs Figure 1 indicates the number of occupational therapy programs in Australia using the different types of simulation modalities at some point in their curriculum. All occupational therapy programs used written cases, DVD/video of clients or simulated clients and role-play with other students. Only 2 programs made use of mannequins (human patient simulators) or part-task trainers. Below is a sample of participants comments: Written case scenarios: enable students to engage in problem-setting and problem solving ; Help develop clinical reasoning ; Extremely cost-efficient but not as engaging as those supplemented with visual content DVDs: Supported with written information help students access information easily ; Can provide breadth of content ; Are well received Role-play: Valuable for initial practice of skills, but the realism is not as high as with standardised patients or real clients Client teachers: Interaction with clients no longer receiving therapy help students really grasp the depth of issues involved and understand something of the client s perspective ; They love real clients who tell their stories and always ask for more! Standardised patients: Extremely realistic for students and they are actively engaged ; Very effective and can provide feedback to students ; Expensive to use ; Difficult to timetable (Cost of SPs ranged between $35-$55/hour) Virtual reality/computer patients: Provides sense of the unexpected-have to problem-solve as the case unfolds ; Cost? Mannequins/part-task trainers: Interesting idea Bennett, S., Rodger, S & Fitzgerald, C. (2010). The University of Queensland, Prepared for HWA. Not for distribution or replication

80 Page 6 Simulation in Occupational Therapy Curricula Survey of simulated learning activities in occupational therapy curricula in Australia: Current practice continued. Patterns of use of simulation across 4 year occupational therapy programs are shown in Figure 2. Figure 2. Use of simulation modalities across years of occupational therapy programs Number of programs Student year level Written DVD/Video Role play Patient teachers Standardised patients Virtual reality computer patients Mannequins Use of simulation (regardless of which modality was used) was greatest in the second year of occupational therapy programs, with amount of use of simulation being similar in the first and third year of curricula. Least use of simulation occurred in year 4. This is not surprising given that clinical placements commonly occur in the later years of the curriculum, but also indicates the importance of using simulation for pre-clinical teaching. Participants frequently commented on how useful simulation activities are for initial clinical reasoning and skill development. However they also frequently commented on student preference for real clients and real experiences. As one participant stated: I think students are fairly satisfied with the skills development but they missed the real world experiences of the complexities, sights, sounds etc of a real workplace. Use of simulation for developing competencies for occupational therapy practice In occupational therapy curricula clinical competencies and related objectives are generally encompassed within the following domains: We asked about the use of simulation for developing competencies in these SPEF-R* domains. 1. Professional Behaviour:Conducts self in a professional manner 2.Self Management Skills: Demonstrates effective self management skills 3. Co-worker Communication: Communicates effectively within the workplace/environment 4. Communication Skills: Communicates effectively with service users and significant others/stakeholders/organisational clients 5. Documentation: Develops and maintains appropriate documentation. 6.Information Gathering (Assessment): Demonstrates effective information gathering skills 7. Service Provision (Intervention): Develops and conducts/manages effective service provision 8. Service Evaluation: Demonstrates effective evaluation skills The following is a summary of responses: Professional Behaviour: Simulation used for client safety, ethics, infection control, risk management, demonstrating professional approach, explanation of procedures and hazards, explaining role occupational therapist. Self Management Skills: Simulation used for managing treatment plans, scheduling tasks, ordering tasks, time management, receiving feedback. Co-worker Communication: Simulation used for demonstrating roles and interaction of health professions, shared team management plans, practicing interprofessional communication, case conferencing, referrals. *Student Placement Evaluation Form-Revised Communication Skills: Simulation used for learning and practicing skills for clear communication, listening, questioning, rapport building, showing empathy and practicing paraphrasing, modelling of professional and client centred communication, appropriate use of language, interacting with clients/consumers, carers and other professionals. Documentation: Simulation used as a stimulus for writing treatment plans, progress notes, documenting case files, home visit reports, home modification reports, equipment applications, and completion of relevant forms. Information Gathering: Simulation used for learning about and practicing standardised and non-standardised assessments and interpretation, different interview methods, identifying client goals. Examples of assessments: assessment of sensitive issues (eg suicide risk assessment) workplace assessment, risk assessment, physical demands analysis, paediatric assessments, neurological assessments. Service Provision: Simulation used for client education, counselling, physical intervention, mental health groupwork, neurology treatment sessions, manual handling, equipment demonstration, health promotion, personal care tasks, manufacture of orthosis, facilitation techniques, developing suitable duties plans, grading and adapting, and engaging significant others to support service provision. Service Evaluation: Simulation used for evaluating team based management responses; reflecting on service provision, identifying factors influencing service provision, evaluating groupwork and risk management. Bennett, S., Rodger, S & Fitzgerald, C. (2010). The University of Queensland, Prepared for HWA. Not for distribution or replication

81 Page 7 Simulation environments Simulation environments available to occupational therapy programs in Australia are indicated in Figure 3. Figure 3. Do you hllyt lic:c:us 10 lin'll of lht following slmul"lion tnyironmtntsff3c:llilits 3t your university 10 UH In progr3m 1t3c:hlng 3nd lt3mlng 'tither on 0( off sllt)? Plt3H Hlte:l3S m3ny of lht options lis 3pply: """"..-..h...""... SImI*IIed Iiomg...s (fig blithradm. o 2,, Number of occupational therapy schools with access to these environments " Simulation contributing towards 1000 fieldwork hours? We asked if simulation was currently used in occupational therapy programs to contribute to the 1000 hours of fieldwork prescribed by the World Federation of Occupational Therapists. Only 27% (3 of 11) occupational therapy programs were currently using simulation activities for this purpose. The following is an example of how it was used to count towards fieldwork hours: Second year students undertook face to face interviews with a standardised patient requiring students to prepare for and deliver an initial interview in one session and individually tailored client education in the follow-up interview. Students were expected to demonstrate a range of professional behaviours, self-manage time, demonstrate client centred assessment and intervention, following specific guidelines, and receiving feedback using a modified (shortened version) of the SPEF-R. Interviews were observed by a peer and clinical educator and written and verbal feedback provided. Occupational therapy programs currently using simulation activities towards fieldwork hours were only doing so for a small number of hours (approx 5-6 hours). Interviewing the standardised patient was so real. (Year 2 student) It makes you more confident to interact with patients (Year 2 student) It helped students put it all together for the first time (Survey participant) Bottom line: Simulation activities are being used by all occupational therapy programs in Australia and is well received by students on the whole. All simulation modalities have their place in teaching, with some being suited to initial skill development and others to practicing integration of more complex skills and behaviours. Delivery of occupational therapy services often occurs in the community and outside of the health care sector (eg education and workplace settings). Therefore a broad range of simulation environments is important. Simulated learning activities are contributing less than 1% towards fieldwork hours, in only a few occupational therapy programs. Finally, participants in this study appreciated being able to put their views forward on this topic. Further discussion and research in simulation in occupational therapy is required. Bennett, S., Rodger, S & Fitzgerald, C. (2010). The University of Queensland, Prepared for HWA. Not for distribution or replication

82 Use of Simulated Learning Activities in Occupational Therapy Curriculum Appendix 4 Survey 2: Potential use of Simulated Learning Activities in Occupational Therapy Curricula- Barriers and Facilitators Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 82

83 Simulation in Occupational Therapy (Survey 2) Simulation in Occupational Therapy Curricula - Survey 2 We are interested in understanding more about the potential use of simulated learning activities for meeting clinical placement objectives and contributing towards 1000 fieldwork hours as prescribed by WFOT. We appreciate your time in completing this questionnaire by the 15th October. If you have any queries please contact [email protected] What to do: 1. Please read the Simulation Resource Document and one-page summary of the WFOT requirements for fieldwork which have been provided with the inviting your participation in this survey. A literature review has also been provided as a further resource. Content in these resources may help inform your responses. 2. There are two (2) pages of information and five (5) pages of questions to complete. Please note that it is possible for you to exit and re-enter the questionnaire more than once as you complete it. 3. Once each relevant question has been answered on each of the pages of the online questionnaire, click the DONE button at the end. This will submit your responses. Please complete the questionnaire by 15th October, All information supplied will remain confidential. Individual participants will not be identified in any publications arising from this survey. Thank you very much for your assistance. Preamble Page 1

84 Simulation in Occupational Therapy (Survey 2) Health Workforce Australia wish to understand which clinical elements may be delivered through simulation to meet clinical placement objectives and therefore contribute to increased clinical placement capacity in occupational therapy. To contribute to clinical placement capacity in occupational therapy, simulation modalities (and related simulated learning activities) must be able to meet two criteria. They must: a) meet the standards required by WFOT to be counted towards fieldwork hours; and b) contribute to meeting clinical placement objectives. In occupational therapy curricula clinical placement objectives are generally encompassed within the following domains: 1. Professional Behaviour : Conducts self in a professional manner; 2. Self Management Skills : Demonstrates effective self management skills; 3. Co-worker Communication: Communicates effectively within the workplace/environment; 4. Communication Skills: Communicates effectively with service users and significant others/stakeholders/organisational clients; 5. Documentation: Develops and maintains appropriate documentation; 6. Information Gathering: Demonstrates effective information gathering skills; 7. Service Provision: Develops and conducts/manages effective service provision; 8. Service Evaluation: Demonstrates effective evaluation skills. The following questions ask your opinions about the ability of simulation modalities (and related simulated learning activities) to meet clincal placement objectives and to be counted towards fieldwork hours. In this questionnaire simulated learning activities refer to learning activities/experiences that make use of modalities but that may extend past the basic use of the modality eg discussion following the use of the modality, treatment planning after using simulation modality and so on. Section 1 * In your opinion could the following simulation modalities (and related simulated learning activities) be designed to meet the WFOT requirements and therefore be counted towards fieldwork hours? (For this question please assume resources are not an issue). For each modality please describe your reasoning or conditions for your response. You may wish to provide an example as further explanation. 1. Could learning activities using Written Case-based Scenarios be used towards fieldwork hours? Yes No Reason and Examples * 2. Could learning activities using Role Play between students be used towards fieldwork hours? 5 6 Yes No Reason and Examples 5 6 Page 2

85 Simulation in Occupational Therapy (Survey 2) * 3. Could learning activities using Standardised Patients be used towards fieldwork hours? Yes No Reason and Examples * 4. Could learning activities with Clients No Longer Requiring Therapy be counted towards fieldwork hours? 5 6 Yes No Reason and Examples * 5. Could learning activities using Mannequins or part-task trainers be counted towards fieldwork hours? 5 6 Yes No Reason and Examples * 6. Could learning activities using DVDs of Real or Simulated Clients be used towards fieldwork hours? 5 6 Yes No Reason and Examples * 7. Could learning activities using using Computer clients / Virtual Reality be used towards firlwork hours? 5 6 Yes No Reason and Examples 5 6 Page 3

86 Simulation in Occupational Therapy (Survey 2) 8. Other (Please describe and provide reasons and examples): Section In your opinion can simulated learning activities be used to meet clinical placement objectives and requirements for fieldwork hours within the following 8 domains? If Yes, please provide 3 examples (if possible). 9. Can simulated learning activities be used to meet 'Professional Behaviour' clinical placement objectives in a manner that also meets requirements for fieldwork hours? Yes No If 'Yes', please provide up to three (3) examples: 10. Can simulated learning activities be used to meet 'Self-Management Skills' clinical placement objectives in a manner that also meets requirements for fieldwork hours? 5 6 Yes No If 'Yes', please provide up to three (3) examples: 11. Can simulated learning activities be used to meet 'Co-worker Communication' clinical placement objectives in a manner that also meets requirements for fieldwork hours? 5 6 Yes No If 'Yes', please provide up to three (3) examples: 5 6 Page 4

87 Simulation in Occupational Therapy (Survey 2) 12. Can simulated learning activities be used to meet 'Communication skills' clinical placement objectives in a manner that also meets requirements for fieldwork hours? Yes No If 'Yes', please provide up to three (3) examples: 13. Can simulated learning activities be used to meet 'Documentation' clinical placement objectives in a manner that also meets requirements for fieldwork hours? 5 6 Yes No If 'Yes', please provide up to three (3) examples: 14. Can simulated learning activities be used to meet 'Information Gathering' clinical placement objectives in a manner that also meets requirements for fieldwork hours? 5 6 Yes No If 'Yes', please provide up to three (3) examples: 15. Can simulated learning activities be used to meet 'Service Provision' clinical placement objectives in a manner that also meets requirements for fieldwork hours? 5 6 Yes No If 'Yes', please provide up to three (3) examples: 16. Can simulated learning activities be used to meet 'Service evaluation' clinical placement objectives in a manner that also meets requirements for fieldwork hours? 5 6 Yes No If 'Yes', please provide up to three (3) examples: 5 6 Section 3 Page 5

88 Simulation in Occupational Therapy (Survey 2) 17. In what ways can you envisage simulated learning activities being used for interprofessional education or practice that might contribute towards fieldwork hours? In which ways can you envisage simulated learning activities being used to support the clinical learning of students in rural/remote regions? For students on clinical placements: For students in remote locations during programs (ie.not on clinical placements): 19. Simulated learning environments refer to where the simulation takes place. Examples of these environments are interview rooms, mock hospital wards, simulated living spaces (eg kitchen/ bathroom) and so on. Please list any other specific simulated environments relevant to occupational therapy that might potentially be developed/used for clinical education purposes and briefly describe how it could be used. Environment 1: Environment 2: Environment 3: Environment 4: Environment 5: Page 6

89 Simulation in Occupational Therapy (Survey 2) 20. To what extent do you think the following factors are barriers to using simulated learning activities that meet both clinical placement objectives and requirements for fieldwork hours? Difficulty timetabling simulated learning activities for this purpose in the curriculum: Difficult to accommodate simulated learning activities for this purpose with large student cohorts: Inadequate funding available to establish simulated learning activities in the curriculum: Inadequate recurrent funding to maintain simulated learning activities in the curriculum (Excluding academic/clinical staffing): Lack of staff expertise to establish simulated learning activities in the curriculum: Lack of adequate academic/clinical educator staffing capacity to maintain simulated learning activities in the curriculum: Lack of access to simulation facilities (environments space, technical equipment and support): Lack of access to simulation modality equipment (eg mannequins, virtual reality equipment) or persons (eg actors): Lack of interest /belief in the value of simulation for fieldwork purposes: Please specifiy any additional information here: Would not be Not at all A little A lot able to use simulation Other because of this 5 Section 4 6 What facilities or resources would your university require to use simulated learning activities within your clinical education program (to meet clinical placement objectives and requirements for fieldwork hours)? If you don't work at a university please skip to section 5. Page 7

90 Simulation in Occupational Therapy (Survey 2) 21. Simulation facilities/environments on the University campus (including audiovisual equipment/facilities): Yes No If 'Yes', please specify: Simulation facilities/environments within reasonable travelling distance from the University (including audiovisual equipment/facilities): Yes No If 'Yes', please specify: Funding to establish simulated learning activities (eg developing case scenarios, supporting materials eg DVDs): Yes No If 'Yes', please specify: Recurrent funding for academic/clinical educator staff to maintain simulated learning activities: Yes No If 'Yes', please specify: Training programs for educators running simulated learning activities: Yes No If 'Yes', please specify: 5 6 Page 8

91 Simulation in Occupational Therapy (Survey 2) 26. Recurrent funding for employment of standardised patients: Yes No If 'Yes', please specify: 27. Training programs for standardised patients: 5 6 Yes No If 'Yes', please specify: 28. Access to a pool of standardised patients: 5 6 Yes No If 'Yes', please specify: Technical staff for programming/running simulations using mannequins: Yes No If 'Yes', please specify: Possession of virtual reality equipment and programs: Yes No If 'Yes', please specify: 31. Possession of mannequins and associated props: 5 6 Yes No If 'Yes', please specify: 5 6 Page 9

92 Simulation in Occupational Therapy (Survey 2) Section Of the 1000 hours required for fieldwork within OT programs, approximately how many hours do you think should reasonably be provided using simulated learning activities? How many currently existing clinical education hours in your program could be reasonably replaced by the use of simulated learning activities if you were fully resourced to do so? (If you are not from the University program, please just answer N/A.) To what extent do you think that increased simulation opportunities and resources for pre-clinical learning increases the subsequent quality of clinical placement experiences and outcomes? Not at all A little bit A lot A great deal Other (please specify) Page 10

93 Use of Simulated Learning Activities in Occupational Therapy Curriculum Appendix 5 Simulation Scenarios for Discussion at Focus Groups Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 93

94 THE UNIVERSITY OF QUEENSLAND..,.,... AUSTRALIA Simulation Scenarios for Discussion at Focus Group Use of Simulation in Occupational Therapy Curricula Health Workforce Australia Project,.M HealthWorkforce AUSTRALIA Preamble The Council of Australian Governments have committed $1.6 billion dollars to education reforms which include the building of new simulated learning environments (SLEs) or upgrading existing ones. The HWA have asked for national consensus as to the elements of the occupational therapy curricula that could be offered as simulated learning programs (SLP). Simulated learning programs (SLPs) such as the use of DVDs, standardised patients (actors) and simulated environments to provide training for students are recognised as effective methods of learning however the extent to which they are being used or could be used to substitute for clinical experience in pre-registration occupational therapy curricula is uncertain. These scenarios will serve as a stimulus for discussion in the three fora being held in Brisbane, Sydney and Melbourne during October and early November We ask that you read the scenarios and consider the questions listed after each. This document has been prepared as an online form and in the format of a workbook. It is hoped that after reading each scenario you will be able to capture your thoughts and reflections with the questions as prompts. For the discussions and outcomes of the forum you are attending it will be important to have deliberated on how each simulated learning activity or modality within the scenario relates to clinical placement objectives in occupational therapy. Please spend some time thinking about these scenarios prior to attending your scheduled focus group meeting. Bring this booklet and worksheets with you to the focus group/forum you are attending as they will be collected at the end of the workshop to support the project documentation required for analysis and project reporting to HWA. The workbook will be de-identified prior to analysis. Each scenario has been developed to cover either a single simulation modality or multiple modalities. The modalities covered in these scenarios are: written cases, DVDs, role play, standardised patients, clients who are no longer patients, mannequins/part task trainers, and virtual reality. While it is generally recognised that each play an important role in student education, the focus of this document is to consider their role in meeting clinical placement objectives and contributing towards 1000 hours of fieldwork as required by the World Federation of Occupational Therapists (WFOT, 2002). (Refer to Appendix I for an excerpt from the WFOT guidelines.) In developing these scenarios, consideration has also been given to specific clinical placement objectives based on those identified in the Student Placement Evaluation Form Revised (SPEF-R) (The University of Queensland, 2009), as this tool is used uniformly to evaluate students fieldwork performance across the country. Hence a number of the following objectives are covered in the scenarios listed: Professional Behaviour, Self Management Skills, Co-worker Communication, Communication Skills, Documentation, Information Gathering, Service Provision, and Service Evaluation. These objectives are linked to the various aspects of the occupational therapy process - namely information gathering (referral, goal setting, assessment), intervention planning and provision (service provision), and evaluation post intervention (discharge, exit, onward referral and service evaluation). It is acknowledged that during each stage of the occupational therapy process a range of professional behaviours, self management skills, client and carer communication and co-worker communication skills are required. A number of these are captured in each scenario. Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

95 Please consider whether using previous clients no longer receiving therapy in curriculum such as in the scenario below would contribute to: a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. SCENARIO 1: PANEL OF PREVIOUS OT CLIENTS NO LONGER ACCESSING OT SERVICES. A panel of people who have received OT services talk to the class a person post CVA who is living at home and driving, someone who has had a TBI and is now studying at TAFE, a lady with Parkinson s who has just ceased driving, and a young man with Schizophrenia. They provide a narrative of their lived experience with disability and views about OT services provided. After the panel, the four ex-clients spend time with small groups of students where they can discuss in more detail their experiences as OT clients and now as ex-clients, and students can ask questions needed to complete an assignment on the lived experiences of disability and current levels of occupational performance and participation. Students are using the OPHI 2 and Role Change Assessment as a guide to some of their interviewing in a small group. In the example above, clients no longer receiving therapy are used towards meeting objectives pertaining to Information Gathering. Are there other placement objectives that could possibly be met through this simulation modality? Key to Placement Objectives: Professional Behaviour Self Management Skills Co-worker Communication Communication Skills Documentation Information Gathering Service Provision Service Evaluation Does the use of clients no longer receiving therapy (such as in this scenario) meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? The 1,000 fieldwork hours refers to the time each students spends implementing an occupational therapy process, or as aspect of an occupational therapy process with a real live person. Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g. Year level of student, where it occurs, who facilitates this, authenticity of the case etc.) (WFOT, 2002, p.24) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

96 Please consider whether using DVDs of clients or simulated clients in curriculum such as in the scenario below would contribute to: a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. Scenario 2: DVD Simulation Year 1 students in small IPE groups watch a DVD simulation of case studies such as adult with CP living independently, a couple with intellectual impairment who are having a baby, and a child with ASD living at home. They work through set trigger questions as an IPE group related to the DVD scenario. Groups have an IPE facilitator to assist their discussions based on the scenarios. They have to write a reflection on team roles with two of the cases viewed and their reactions to the case study ethical dilemmas and submit a journal on their learnings/reflections. Key to Placement Objectives: Professional Behaviour Self Management Skills Co-worker Communication Communication Skills Documentation Information Gathering Service Provision Service Evaluation In the example above, DVDs are used towards meeting objectives relevant to coworker communication and professional behaviours. Are there other placement objectives that could possibly be met through this simulation modality? What is simulation? Simulation is an educational technique that recreates all or part of a clinical experience. Simulation has been defined as a technique not a technology to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2004, p.i2) Does the use of DVD (such as in this scenario) meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g. Year level of student, where it occurs, who facilitates this, authenticity of the case etc.) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

97 Please consider whether using role play between students in curriculum such as in the scenario below would contribute to: a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. Scenario 3: Role Play used with student learning Manual Handling Students are asked to undertake several manual handling transfers with a fellow student. This activity occurs in a lab at the university with bed, wheelchair, toilet and hoist. Students practise describing to the fellow student how to move themselves in bed and how to move from lying to sitting on the edge of bed. With another student, in pairs, each student undertakes a bed to wheelchair transfer through supported standing, a hoist lift/ transfer from wheelchair to toilet/commode. Students receive feedback from tutor and the student undertaking the role play on the adequacy of their communication/explanations and the competency of each of the transfers undertaken In the example above, role-play between students are used towards meeting objectives related to professional behaviour, service delivery, and communication. Are there other placement objectives that could possibly be met through this simulation modality? Key to Placement Objectives: Professional Behaviour Self Management Skills Co-worker Communication Communication Skills Documentation Information Gathering Service Provision Service Evaluation Does the use of role play (such as in this scenario) meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g. Year level of student, where it occurs, who facilitates this, authenticity of the case etc.) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

98 Please consider whether using written case studies in curriculum such as in the scenario below would contribute to: a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. Scenario 4: Written Case, DVD Simulation, Virtual Reality, Mannequin, Simulated Ward Environment and Standardised Patients. (Case is Mrs Groves Obese Older Lady with Osteoarthritis and Fractured Neck of Femur) First Level of Information Provided: Written Case Year 1 students are provided with a written case study that you have obtained from a clinician at the Arthritis Foundation in your city. Mrs Groves is an obese elderly lady in her 80s who has been living alone at home since her husband passed away five years ago. She has significant osteoarthritis in her lower lumbar spine and right hip, and concomitant pain. She fatigues easily and has been less able to look after herself recently due to fatigue and pain, frequently skipping meals (as she stays off her feet as standing causes pain). She lives in a two bedroom low set house with small garden. The students task is to determine (1) what they would include in an initial interview with Mrs Groves, (2) what would be the focus of the home visit and (3) what aspects of the environment they would focus on when visiting her home. In the example above, written case studies are used towards meeting objectives relevant to information gathering. Are there other placement objectives that could possibly be met through this simulation modality? Key to Placement Objectives: Professional Behaviour Self Management Skills Co-worker Communication Communication Skills Documentation Information Gathering Service Provision Service Evaluation Does use of written case studies (such as in this scenario) meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g. Year level of student, where it occurs, who facilitates this, authenticity of the case etc.) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

99 Please consider whether using virtual reality/computer clients in curriculum such as in the scenario below would contribute to:. a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. Level 2 information: Virtual Reality The students are required to access the Virtual Reality (VR) program that simulates a home environment. This may be available through a VR program called Second Life or it could be a program that has been developed as a computer based program specifically designed for this purpose. The program would enable the students and an avatar (i.e. the educator) to interact with the environment. Within the VR program there is a typical home consisting of an entry way, kitchen, living room, bathroom and bedroom. This has been established as Mrs Groves home. The students are required to access the virtual home of Mrs Groves and using the information they prepared in Level 1 conduct a virtual home visit within the VR program. The students must integrate their knowledge of Mrs Grove and her functional strengths and potential limitations and perform and home and risk management assessment based on the virtual layout of the home. The programming enables the students to interact with the home environment so that they can trial moving home furniture, trial fitting proposed equipment and assistive devices, measure for equipment prescription and view the mobility and functioning of Mrs Groves as a VR person within the environment. The students are required to write a report of their VR home visit including recommendations for adaptation In the example above, virtual reality is used towards meeting objectives relevant to service delivery and documentation. Are there other placement objectives that could possibly be met through this simulation modality? Does this use of virtual reality (such as in this scenario) meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g. Yearlevel of student, where it occurs, who facilitates this, authenticity of the case etc.) The purpose of fieldwork is to integrate knowledge, professional reasoning and professional behaviour within practice, and to develop knowledge, skills, and attitudes to the level of competence required of qualifying occupational therapists. (WFOT, 2002) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

100 Please consider whether using DVDs of clients or simulated clients in curriculum such as in the scenario below would contribute to: a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. Level 3 Information: DVD Simulation Once they have determined the above, you show them a DVD of an OT conducting the initial interview at Mrs Groves home. The students compare their interview plan with what they see on the DVD. You discuss with them the similarities/differences. You then show them on the DVD a tour of her house entry, lounge, kitchen, bathroom and access to clothes line. You ask the students to note aspects which they predict might be challenging for Mrs Groves. You then show them on the DVD the OT taking Mrs Groves through various rooms in the house demonstrating for her what Mrs Groves can do (eg making a cup of tea, getting on/off toilet, moving from lying in bed to standing, taking the washing basket to clothes line). You ask the students to identify what they notice about how she uses each room (what she does in each room), her strengths and difficulties in managing these tasks in each room and the environmental barriers/facilitators in each room. You then ask them to problem solve what measurements they may wish to take for possible modifications such as grab rails, shower chairs, ramp to outside. You then show them the DVD that has the OT doing the measurements she considered important. You have a copy of these and provide to the students who are asked to go off to determine what products, designs they may need to modify various rooms in particular bathroom, outdoor ramp and toilet, and kitchen. This final task comprises an assignment in which they write up an OT Report on their home visit and recommendations for adaptations. In the example above, DVD Simulation is used towards meeting objectives relevant to information gathering, service delivery and documentation. Are there other placement objectives that could possibly be met through this simulation modality? Does the use of DVDs (such as in this scenario) meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g. Year level of student, where it occurs, who facilitates this, authenticity of the case etc.) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

101 Please consider whether using mannequins in curriculum such as in the scenario below would contribute to: a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. Level 4 Information: Mannequins in a Simulated Ward Environment Students attend a simulated orthopaedic ward at a specialised Skills Development Centre for a half day. Mannequins are in each of four beds. Three OT students are allocated to each patient. The CNC, doctor and students attend a briefing case conference at the start of the day. One of the Mannequins is Mrs Groves. Students are required to: (1) ensure appropriate positioning of Mrs Groves (mannequin) in bed, (2) write in case notes/record clipboard at end of bed re progress notes, discharge plan, (3) practice hygiene hand washing between patients, and (4) find out some specific information from the CNC about the patients status. At the end of the session the students undertake a ward round moving from bed to bed discussing patient progress and recommendations by way of case conference. In the example above, mannequins in a simulated ward environment is used towards meeting objectives relevant to information gathering service delivery and documentation. Are there other placement objectives that could possibly be met through this simulation modality? Does this use of mannequins in authentic simulated ward environments (such as in the scenario above) meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? Key to Placement Objectives: Professional Behaviour Self Management Skills Co-worker Communication Communication Skills Documentation Information Gathering Service Provision Service Evaluation Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g. Yearlevel of student, where it occurs, who facilitates this, authenticity of the case etc.) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

102 Please consider whether using standardised patients in curriculum such as in the scenario below would contribute to: a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. Level 5 Information: Simulated Ward Environment and Standardised Patient. In the simulated orthopaedic ward at a specialised Skills Development Centre a standardised patient acting as Mrs Groves s daughter is introduced. Students are required to: (1) talk to the standardised actor, Mary who is the daughter of Mrs Groves about her discharge situation particularly in relation to her ability to manage meals for herself and possible need for supervision with showering. Mary becomes distressed about her mother s slow recovery and at times angry with the OT who she sees as interfering with family business. Mary feels that the youthful looking student has no idea about what she is juggling with a full time job, teenage children and her elderly mother and tells the student so. (2) provide carer education to Mary regarding falls risks and safety at home as she will leave with a walker. In the example above, a simulated ward environment and a standardised patient is used towards meeting objectives relevant to communication, service delivery and documentation. Are there other placement objectives that could possibly be met through this simulation modality? Does the use of standardised patients in an authentic simulated ward environment meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g. Year level of student, where it occurs, who facilitates this, authenticity of the case etc.) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

103 Please consider whether using DVD Simulation in curriculum such as in the scenario below would contribute to: a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. Scenario 5: DVD Interview and Standardised Patient (Case is Mr Deftros, 32 year old man with Mental Health condition) Level 1 information provided: DVD Simulated Interview Students are involved in the management of a Standardised Patient (SP) acting as a 32year old male client of a community mental health service. The client is from a non-english Speaking background and for the last 10 years has been in receipt of the disability pension. He has been diagnosed with Schizophrenia. He has recovered from a recent exacerbation and has the goal of returning to work. Students observe a DVD of the SP in which he is interviewed by a clinical educator the aim of the interview is for the educator to gather information from the SP with respect to his recent illness management strategies and current goals. The students are debriefed and are requested to write a report using the data obtained in the interview. This report will be presented to their educator as an initial service provision plan. Students are also required to write a reflection about their reaction to the DVD interview. In the above example, DVD Simulated Interview is used towards meeting objectives relevant to information gathering, service provision and documentation. Are there other placement objectives that could possibly be met through this simulation modality? Does the use of DVD simulated interview meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? Key to Placement Objectives: Professional Behaviour Self Management Skills Co-worker Communication Communication Skills Documentation Information Gathering Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g., Year level of student, where it occurs, who facilitates this, authenticity of the case, etc.) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

104 Please consider whether using standardised patients in curriculum such as in the scenario below would contribute to: a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. Level 2 Information: Standardised Patient Students are allocated to groups of three and one of the students conducts the MSE and a risk assessment with a Standardised Patient (SP) acting as a 32year old male client of a community mental health service. The client is the same as used in the Level 1 activity (i.e., from a non-english Speaking background, in receipt of the disability pension, recovering from a recent exacerbation with the goal of returning to work). The second and third students observe using an observational checklist. In a second session with the SP, the second and third students conduct the Role Change Assessment. Once again the observational checklists are completed by the students not conducting the assessment. Students are required to document the results of the assessment into a report for the client s medical file and to verbally present a summary of the report to the educator in the context of reporting to the clients treating team at case conference in the community mental health setting. Students are debriefed after each interview with the educator, and the standardised patient provides structured feedback regarding student s communication skills. Sessions are videotaped for feedback purposes. In the example above, a standardised Patient is used towards meeting objectives relevant to communication, co-worker communication and information gathering. Are there other placement objectives that could possibly be met through this simulation modality? Does the use of the modality of a Standardised Patient scenario meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g., Yearlevel of student, where it occurs, who facilitates this, authenticity of the case etc.) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

105 Please consider whether using standardised patients and simulated environments in curriculum such as in the scenario below would contribute to: a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. Scenario 6: Consultancy to a Warehousing industry facility with the focus on OH&S Management including provision of a Health and Wellness program. Level 1 information: Standardised Patient as Service Manager, Simulated office environment. Students attend a simulated office environment. In groups of 3 students are required to interview the Standardised Patient (SP) acting as Manager of a warehousing company for the aviation industry. Students are required to conduct an assessment of the needs of the workforce in relation to occupational health and safety audits and consultancy with respect to instituting workstation assessments and developing a risk management strategy for the facility. Students are required to pre-plan the interview process and roles within this so that they each take turns in the role of interviewer (second and third students observe using observational checklist). The SP manager is required to demand certain information and requests a scope of the project from the students at the end of the interview. Students are required to prepare a full scoped business plan of the proposed service to this facility. In the second interview with the SP Manager they are required to present this scope and discuss issues including costs and timeframes, etc. Students are debriefed after each interview with the educator and the standardised patient provides structured feedback on student s communication skills. Sessions are videotaped for feedback purposes and students write up an overall assessment. In the example above, a Standardised patient and a Simulated office environment is used towards meeting objectives relevant to communication, information gathering and documentation. Are there other placement objectives that could possibly be met through this simulation modality? Does this use of a standardised patient and simulated office environment (such as in this scenario) meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g. Year level of student, where it occurs, who facilitates this, authenticity of the case etc.) The purpose of fieldwork is to integrate knowledge, professional reasoning and professional behaviour within practice, and to develop knowledge, skills, and attitudes to the level of competence required of qualifying occupational therapists. (WFOT, 2002) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

106 Please consider whether using multiple standardised patients in curriculum such as in the scenario below would contribute to: a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. Level 2: Complexity added with multiple standardised patients acting as Manager and workforce of 5 of the facility, Simulated office and Packing environment. Student conducts 2 workstation assessments of workers in the Warehousing facility. One is in a simulated office environment and the other is in a simulated packing of equipment environment where the workers are required to perform multiple floor to shelf movements. Standardised patients act as the workers in the warehousing company. Students: 1. conduct 2 individual workstation assessments 2. provide immediate feedback to SPs on performance as required 3. write full workstation report in required format In groups of 3 students complete a full report of results of multiple individual assessments to the SP Manager and provide recommendations for OH&S requirements and future auditing. Students are debriefed after each interview with the educator and the standardised patient provides structured feedback on student s communication skills. Sessions are videotaped for feedback purposes and students write up an overall assessment. In the example above, a Standardised patient and a Simulated office environment is used towards meeting objectives relevant to communication, information gathering and documentation. Are there other placement objectives that could possibly be met through this simulation modality Does this use of a standardised patient and simulated office environment (such as in this scenario) meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g. Year level of student, where it occurs, who facilitates this, authenticity of the case etc.) The purpose of fieldwork is to integrate knowledge, professional reasoning and professional behaviour within practice, and to develop knowledge, skills, and attitudes to the level of competence required of qualifying occupational therapists. (WFOT, 2002) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

107 Please consider whether using workshops, role play, standardised patients and simulated environments in curriculum such as in the scenario below would contribute to: a) meeting clinical placement objectives, and b) meeting WFOT standards required to be counted towards fieldwork hours. Level 3: Complexity added with workshops Role play, Standardised Patients and Simulated work environment In three groups of three students each the students prepare and present components of a Risk Management Strategy for the SP workers of the Warehousing facility. Educational information provided in the program must present latest evidence based linked to the information gathered in the workstation assessments. The three groups of three students present this information as a role play to each other. Their performance is evaluated by their peers, videotaped and feedback provided. In the next phase the students present their prepared workshops in a series of 3x2 hour sessions to a group of six SP workers including the SP Manager of the service. SP s acting as managers are required to respond to the information based on scripted data. The groups that are not presenting on the day are required to complete an observational checklist and evaluation of the service. SP participants are also required to complete an evaluation. Students in groups of 3 are required to write up a report on their performance and the evaluation results. They are required to present this data to the SP Manager in a subsequent session. Students are debriefed after each workshop with the educator and the standardised patients provide structured feedback on evaluation forms as well as SP manager providing feedback on the student s communication skills. Sessions are videotaped for feedback purposes. In the example above, role play, Standardised patients and a Simulated office and training environment are used towards meeting objectives relevant to communication, information gathering, service provision and service evaluation. Are there other placement objectives that could possibly be met through this simulation modality? Does this use of standardised patients and simulated office environment (such as in this scenario) meet WFOT requirements to be counted within the 1000 hours of fieldwork (refer to Appendix 1)? Would there be any conditions under which you would consider this to be appropriate to consider towards fieldwork hours? (e.g. Year level of student, where it occurs, who facilitates this, authenticity of the case etc.) The purpose of fieldwork is to integrate knowledge, professional reasoning and professional behaviour within practice, and to develop knowledge, skills, and attitudes to the level of competence required of qualifying occupational therapists. (WFOT, 2002) Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

108 Are there any other points you would like to capture here to prompt discussion at the Forum? Rodger,S., Fitzgerald,C. & Bennett, S. (2010) The University of Queensland, Prepared for HWA. Not for distribution or replication.

109 Use of Simulated Learning Activities in Occupational Therapy Curriculum Appendix 6 Occupational Therapy Simulated Learning Activities Project: Forum Agenda Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 109

110 Occupational Therapy Simulated Learning Activities Project Forum Brisbane, Sydney, Melbourne am Arrive for morning tea 10.00am Format of the Day Setting the Scene (30 mins) 1. Project update 2. Objectives of the day 3. Summary of key findings to date am 10.45am 11.00am 12noon 12.30pm 1.30pm Comments from floor on Findings from Survey 1` and 2 to date. WFOT Fieldwork Guidelines/interpretation on what is fieldwork WFOT Review of Scenarios: discussion from responses to workbook and initial reactions Lunch Review of Scenarios continued: discussion from responses to workbook Group Decision making Key questions: What recommendations on the use of SLE in OT curriculum would this group like to take to the OT stakeholders from the profession - ANZCOTE, ANZOTFA, OTC, OTAL. 1.50pm 2.00pm Where to from here? Close

111

112 Use of Simulated Learning Activities in Occupational Therapy Curriculum Appendix 7 Project Advisory Committee: Forum Agenda Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 112

113 Project Advisory Committee Forum Melbourne 4 th November pm Arrive for Lunch 2.00pm Summary of Survey Data and key themes emerging from forum consultations. 3.15pm Potential frameworks for elements of curriculum delivered via SLA s 4.00pm Afternoon Tea 4.20pm Formulation of recommendations from project. * Priority areas of OT curriculum that could be supported via the SLE national project. * Approaches to address barriers to effective utilisation and expansion of SLE s for delivering the priority elements of the curriculum. 5.50pm Where to from here? 6.00pm Close.

114 Use of Simulated Learning Activities in Occupational Therapy Curriculum Appendix 8 Participants at Fora Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 114

115 PROJECT REFERENCE GROUP Project Team Professor Sylvia Rodger Project Manager, HOD, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland. Dr Sally Bennett Project Manager, Teaching and Research, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland. Cate Fitzgerald Project Manager, Clinical Education Liaison Manager, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland. Phillipa Neads Principal Project Officer, Queensland Children's Hospital Project, Queensland Health Project Advisory Group Jim Carmichael Chair of Occupational Therapy Council (OTC). Ms Rebecca Allen* Senior Lecturer, Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Nigel Gribble* Director of Fieldwork and Lecturer Faculty of Health Sciences School of Occupational Therapy and Social Work, Curtin University, Perth, Western Australia Lynne Adamson Associate Professor, Occupational Science and Therapy Deakin University Waterfront Campus, Geelong, Vic Chris Kennedy Senior Policy Advisor, Occupational Therapy Australia, FITZROY, VIC Brisbane Forum Dr Louise Gustafsson Teaching and Research, Division of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Queensland. Associate Professor Ev Innes Associate Professor - Occupational Therapy School of Health & Human Sciences, Faculty of Arts & Sciences, Southern Cross University Gold Coast Tweed Heads Campus (Lakeside) Ms Yvonne Pennisi Lecturer in Occupation Therapy, School of Health & Human Sciences, Faculty of Arts & Sciences, Southern Cross University Gold Coast Tweed Heads Campus (Lakeside) Professor Matthew Yau Head, Discipline of Occupational Therapy School of Public Health, Tropical Medicine & Rehabilitation Sciences, James Cook University, Douglas Campus, Townsville Dr. Fiona Barnett Senior Lecturer, Occupational Therapy, School of Public Health, Tropical Medicine and Rehabilitation Sciences, Townsville Campus Representative for Mrs. Kerry Garbutt Mrs. Louise Myles Lecturer/Tutor, Occupational Therapy, School of Public Health, Tropical Medicine and Rehabilitation Sciences, Townsville Campus Representative for Yvonne Thomas Dr. Michael Lyons Senior Lecturer - Occupational Therapy, School of Health & Sport Sciences, Faculty of Science, Health & Education, University of the Sunshine Coast, Maroochydore Penelope Taylor Clinical Coordinator, Occupational Therapy, School of Health & Sport Sciences, Faculty of Science, Health & Education, University of the Sunshine Coast, Maroochydore Ailsa Gillen Senior Lecturer in Occupational Therapy, School of Health and Sport Sciences, Faculty of Science, Health and Education, University of the Sunshine Coast, Maroochydore.

116 Sydney Forum Deanne Karadjov Clinical Educator - Occupational Therapy, Clinical & Professional Fieldwork, Faculty of Health Sciences, The University of Sydney. Representative for Professor Lindy Clemson. Dr. Reinie Cordier Lecturer, Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney. Dr Rosalind Bye Head of Program, Occupational Therapy, School of Biomedical and Health Sciences University of Western Sydney Mrs. Lee Zakrewski Occupational Therapy Program, School of Biomedical and Health Sciences, Campbelltown Campus, University of Western Sydney Professor Susan Ryan Deputy Head of School, School of Health Sciences, Occupational Therapy, Faculty of Health, The University of Newcastle, Callaghan, NSW. Carol Hills Lecturer & Research Assistant, School of Health Sciences, Occupational Therapy, Faculty of Health, The University of Newcastle, Callaghan, NSW. Katherine Moore Acting General Manager for Community Health, Sydney South West Area Health Services, NSW Health. Jill Hummell Manager, Community Integration Program, Westmead Brain Injury Rehabilitation Service, Wentworthville NSW Melbourne Forum Lieve De Clercq Senior lecturer/ Professional Practice Coordinator, School of Occupational Therapy, La Trobe University, Bundoora, Victoria Dr. Primrose Lentin Senior Lecturer, Department of Occupational Therapy, Faculty of Medicine, Nursing and Health Sciences, Monash University, Peninsula Campus Representative for Associate Professor Louise Farnworth. Ms. Deirdre Slater Lecturer, Occupational Therapy Program, School of Primary Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus Susan Gilbert Hunt* Occupational Therapy Program Director, School of Health Sciences, University of South Australia, City East Campus, Adelaide Associate Professor Matthew Molineux School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, WA Representative for Dr. Angus Buchanan Helen McDonald Acting Course Coordinator /Senior Lecturer, Discipline of Occupational Therapy, School of Exercise, Biomedical & Health Sciences, Edith Cowan University, Joondalup WA Sharon Armitage Practice Education Coordinator, Discipline of Occupational Therapy, School of Exercise, Biomedical & Health Sciences, Edith Cowan University, Joondalup WA Dr. Mandy Stanley Senior Lecturer, School of Health Science, Occupational Therapy, City East, University of South Australia, Adelaide Mrs. Annette McLeod Boyle Lecturer, Bachelor of Health Science, (Occupational Therapy), School of Community Health, Faculty of Science, Charles Sturt University, Albury-Wodonga Dr Linsey Howie Associate Professor & Head, School of Occupational Therapy,Faculty of Health Sciences, La Trobe University, VIC * Attended both the Melbourne forum and the PAG forum.

117 Use of Simulated Learning Activities in Occupational Therapy Curriculum Appendix 9 Modelling the Use of Simulated Learning Activities Rodger, Bennett, Fitzgerald & Neads, 2010 The University of Queensland on behalf of Health Workforce Australia 117

118 SLAs:Preblockplacement Buildingclinicalcapacityfromtheoutsetoftheprogram Embedded simulated T&L and fieldwork opportunities meeting placement objectives Intensive clinical education simulation module/s immediately pre- block placements.

119 SLAs:Duringblockplacements OT specific/ipe Simulation opportunities in placement environment supported by uni program staff or CEs OT specific simulation opportunities in practice contexts across multiple sites/regions supported by uni program staff or CEs

120 SLAs:Postblockplacements Embedded simulated (fieldwork) opportunities in class room in work integrated contexts or simulated environments context to enhance development of professional reasoning (PR) integrating domains of SPEF-R linked with ACSOT.