Introduction of the problem
Clinical learning experience has become an integral and crucial component especially in nursing education since it provides students with many opportunities that are imperative in the acquisition of knowledge and skills pertaining to the nursing profession. Clinical placement contributes to more than half of the programme expectations through instilling the student with the first contact with practical aspect of nursing. Nevertheless, the first practical experience may prove challenging due to the unpredictability of the clinical learning environment. Guidance of mentors come in handy in allaying any anxiety experienced in this stage thus instilling confidence to the students (Chesser-Smyth 2005, p. 320). Development of the curriculum of operating department practitioners has greatly emphasized the role played by clinical placement in the overall growth of the profession. It has therefore captured the various needs of modern practice and packaged them systematically to enhance the learning process.
ODP profession is dynamic and demanding discipline that adheres to general national and professional standards and guidelines; the Health Professional Council (HPC) as a professional body and the College of Operating Department Practice (CODP) requires all ODP students o have a quality clinical placement experience in order to prepare them for future career. Consequently; the Development of the curriculum of Operating Department Practitioner’s (ODP’s) has greatly called attention to the role played by clinical placement in the overall growth of the profession. It has therefore captured the various needs of modern practice and packaged them systematically to enhance the learning process (College of Operating Department Practitioners 2006).
This curriculum admires the clinical mentors and value their fundamental participations; guidance of mentors come in handy in allaying any anxiety experienced in this stage thus instilling confidence to the students, as (Chesser-Smyth 2005) highlighted in her study.
Mentorship in the clinical environment has gained populace in the Operation Theatre; due to its influence in advancing the profession while enhancing the efficacy and effectiveness of the care and service delivered to the patients (Cloyd 2008). Over all, cooperation between the academic teachers and the clinical mentors take place thereby ensuring that vital knowledge and technical expertise is disseminated across the ODP profession and in tandem with the CODP, (2006) and the HPC (2009) guidelines and recommendations. With regard to this fact, mentors and teachers regularly interact with the students during their learning and clinical experience in order to install confidence while introducing their best practices.
Mentorship should provide the practitioners with the necessary imputes that allow the identification and carrying out of tasks while understanding the implications and real meanings of the such tasks, on the other hand mentors should always make every effort to support the students at their designated clinical area through a very unique knowledge and expertise harmony, (College of Operating Department Practitioners 2006).
Consequently, clinical mentors adheres to national standard and preparation; the HPC and the CODP -as the ODP masters organisations- in aligned with the Nursing and Midwifery Council (NMC) and the Quality Assurance Agency (QAA) requires clinical mentors to undergo essential preparation to equip them with necessary skills vital in facilitating the ODP students learning process, supervision and support of students and in the implementation of the assessment procedures.
Mentors must be registered with either HPC or NMC while holding an advance level of mentor ship award – mentorship level three (degree level) as minimum requirements- to be able to mentor ODP students and sing their competencies. Similarly, the Quality Assurance Agency for Higher Education (2004) recommends ODP to have the mandate to practice independently and continually apply the acquired skill and knowledge in their related area (Anaesthetic, Surgery and Post-operative).
By validating these standards and recommendations, the HPC and the CODP hoped to maximise the ODP’s student’s learning chances by bringing in the appropriate and qualified practitioners into the clinical learning environment. Same time the HPC and the CODP acknowledge the experienced practitioners who don’t hold the mentorship qualifications and appreciate their role in transferring their expertise to the next ODP generation.
Clutterbuck (2004) also asserted that mentors preparations equip the practitioners with the view of instilling the best mentorship in practice setting and in determining the quality and competencies in their students. The preparation coupled with competence is essential in order to instil positive perceptions of the clinical placement and operating department practice to the students.
ODP profession remains to be a unique field due to increased demand to utilize a combination of skills, gained through several approaches such as practice, lectures and close reflection to ensure effective delivery of services in a broad range of activities that form the critical care spectrum. The curriculum is divided in several components with each elaborating on the needs and expectations of the students and the concerned stakeholders. In a nutshell, the curriculum delves on the clarity of roles, learning approaches, educational philosophy, and the expected competencies and outcomes required at the end of the training. The curriculum, developed in liaison with the HPC gives the students accountability and autonomy in the anaesthetic, surgical and the post-anaesthetic care phases. The bridging of the theoretical-clinical gap and availing of adequate resources to the staff and students are imperative in aligning the Operation Theatre to high achievers in terms of efficiency and delivery of appropriate procedures as stated by the College of Operating Department Practitioners (2006).
It is essential to provide opportunities where the students will link the practical skills with the acquired theoretical knowledge (Duffy & Hardicre 2007). Moreover, the incremental demand to supply healthcare workforce who demonstrate higher standards in delivering patient care has occasioned the desire (Field 2004). Curricula must support the development of practical skills and theoretical knowledge. Consolidation of this experience requires effective supervision by competent clinicians who must act according to laid down organizational structures that are imperative in the development of their educational role. Field et al (2004) and Pearcey and Elliot (2004) asserted that development of strong structures and organizational processes greatly influence the effectiveness of the clinical experience in any setting.
In line with the HPC and the CODP, the Australian Council for Safety and Quality in Health Care (2003) noted that enhancement of continued support to the students and the health workforce is imperative in the achieving patient safety of the highest standards. It has therefore become mandatory to have quality education and the relevant clinical experience forming a sizeable proportion of the assessments and for consideration for the registration by the health professional council (CODP 2006).
The purpose of this research paper is to evaluate the live experience of the ODP students during their first year of clinical placement. The need for the paper was brought into fore by the lack of the research that are related to ODP practice and the evidence based deficit on this topic; thereby occasioning the need for concrete information that would be vital in informing policy changes in the university. More importantly, the relationships between the students and the clinical mentors would greatly benefit from the findings through exposure of the theory-practice gaps and factors impacting on the clinical environment.
Theoretical practice gap
Since 1970, the ODP profession has undergone extensive changes driven by technological advancements and increase in demand for skill mix and the overly dynamic nature of the educational system in terms of priorities (College of Operating Department Practitioners 2006). The reforms led to the several changes in the curriculum while more time was allocated to practical aspect of the learning. In line with this, students were expected to undertake clinical placements in a busy Operating Theatre in order to gain hands on experience and skills on areas of anaesthesia, surgery and eventually in the recovery process.
Curriculum for the Operating Department Practice encourages students to utilize self-directed learning that enhances their problem solving skills through emphasize on the acquisition of appropriate and relevant learning strategies. Self directed learning is mainly interested with help the students acquire the experience and knowledge through close interactions with the clinicians. According to Biggs and Tang (2007) constructive alignment, the modern society has shifted emphasis from lecture centred learning process to a more outcome based approach. Likewise, achievement of the outcomes learning occurs through overemphasis on the clinical placement experience and assessment of achieved outcomes and competencies.
This curriculum aims to educate individuals, who are keen on providing a professional care within the perioperative settings, and prepare them for a professional practice in order to meet patient’s requirements in the perioperative area. It also aims to enable the integration between knowledge and practice. ODP’s not only engaged in the three traditional area (Anaesthetic, Surgery and Recovery) but also can be seen to be working in other medical area like the Emergency and Accident Unit, Intensive Care Unit as well as Ambulance service.
The programme has a comprehensible structure that present and complies with the recommendation of the Quality Assurance Agency for Higher Education (2004), this structure is a modules-based path that extends for two years, where a core list of modules are organised and discussed each module has a set of learning outcomes and identified assessment process which meet the principle of the curriculum design according to Gray and Smith (2000), and help the integration between theory and practice. The programme can be considered as a picture of the spiral curriculum, for the acquisition of basic knowledge in the first academic year, that knowledge expected to be developed and enhanced in the second academic year (Biggs & Tang, 2007). For example, students will undertake the Principle of Anaesthetic Practice module in their first year, then they will undertake the Enhancing Practice in Anaesthetic module in their second year, the similar method applies to the Surgical and the Recovery modules. This will give the programme the positive values, like reinforcement of the topic, not only in the classroom but also when students exposed to repetitive practice in the clinical placements.
The module-based approach helps the integration between theoretical knowledge gained at classroom and practice experience gained in operating theatres (College of Operating Department Practitioners, 2006; Lyon 2004). The overall adopted approach also considered suitable to the nature of the programme and the expected standards and recommendations stated by the HPC and the CODP as they approved to be two of the most important stakeholders of this profession as been explained previously in this paper.
The major drawback of this approach, from my experience as a student then as a clinical mentor, is to control the progress and the gradual development of the practical experience in clinical practice and clinical assessment. Students tend to easily get confused and distracted in the massive word-wide Operating Theatres, especially, at early stages of the programme (Lyon 2004). Accordingly, this research concentrates on the students’ clinical experience during their first year of the programme; as it might be easy to distinguish the level of theoretical knowledge at classroom and gradually build-up that knowledge, but it might be difficult to distinguish the practical occurrence in the Operating Theatre (Coppus et al 2007). Similarly, it is very easy to distract student’s attention away from the basic desired objectives to much complicated aims, according to the nature of the placements. In fact, further researches are required to clarify these issues as currently there were no undertaken researches related to this matter.
The basic principle that is utilised in the learning proposal that has been adopted by the universities is that of Biggs constrictive theory (Biggs & Tang 2007). The theory believes that learning is a two way process and can be achieved by the application of the two basic concepts:
- The students who are learning construct meaning from all that they learn and comprehend. This is derived from cognitive psychology where it is seen that a student links all concepts that is learnt and accessed with previous experiences.
- The teachers on the other hand motivate the students through establishment of a clear connection between the planned learning activities and the intended learning outcomes (Biggs Tang 2007).
This curriculum is based on the constructivism theory of learning. In a study by Colliver (2002) he argued that constructivism is a philosophical insight of human nature but cannot be considered as a learning theory, he explained his claim; that teacher still had to construct learning to achieve intended objective which he called current knowledge he also claimed that current knowledge is different from reality, and he assume that current knowledge is determined by social and political aspect in away it means that we teach students what we want them to know. Colliver (2002) requested curricula to focus on future development not on current knowledge.
Scientific concept might be introduced following exploration with practical activities and experience (Baillie & Curzio 2009). Students’ build-up their confidence by exploring increasingly complex situations or successive activities if there been given the chance to participate, in this constructivist theory, the assumption is that what students learn is influence by what student does, it’s recommended that teachers/ mentors does not try to lecture or passively deliver the knowledge, but facilitate students learning and encourage them to actively engage on learning activities. Students’ participation might be restricted or limited with the Operating theatre environment, mentors willingness to take responsibilities of students’ action, and students’ personality and enthusiasm.
Students spend ample time with their clinical mentors during the surgical process and have access to the facilities during the recovery process, thereby enhancing the development of competence in delivering patient care in ODP. That the practitioners have to meet professional relationships, autonomy and accountability during their practice makes the curriculum a learning tool that helps in the formation of linkages between concepts and experiences to future scenarios through reflective abstraction (College of Operating Department Practitioners 2006, p.11. students taught by preceptors have been shown to offer a head start that is overly maintained over time as compared to clinical teachers (Corlett et al 2003, p.187).
The curriculum helps in cementing learning skills useful in helping the practitioners in integration of theory into daily practice. Learning of the processes in sound operating practice occurs through acquisition, effective integration and eventual application of the skills and knowledge overly gained from the educational experiences. According to Colliver (2002, p.49), self-directed learning ensures that the practitioners embrace and integrate the available knowledge thereby putting it into practice under the prevailing conditions in the operation theatres. The application of the Biggs theory of constructive alignment represents a paradigm shift from the traditional approach of learning. Unlike in the traditional approach, the OPD curriculum places the students at the centre of their professional development since they are required to amass as much experience and skills from the available resources in order to meet the school and professional body requirements (Biggs & Tang 2007, p. 43).
More importantly, the learning outcomes for the operating department practitioners conform to the systematic organization that is characteristic of the outcome based education (College of Operating Department Practitioners, 2006, p.1). Emphasis on self-directed learning and the need to provide appropriate environment for the lengthy clinical experiences enhances the achievement of the results (Harden, Crosby & Davis 1999, p. 8). Conformity of the curriculum with the outcome-based education with regard to the training and assessment methods has boosted the efficacy and effectiveness in the achievement of the course objectives by the students (Hubball & Burt 2004, p.57; Gibbons 2000, p. 24; Cox 2000, p.45). The curriculum stipulates the roles and expectations of the student particularly in the clinical setting. Skills in offering individualized care to post-operative patients and the analysis with an aim of detecting abnormalities in the physiological parameters is a requirement since it will enhance the student capability of delivering appropriate and timely care interventions (College of Operating Department Practitioners 2006, p. 4).
Despite the fact that different strategies such as clinical placements, reflective learning, observations and lectures are used in learning, planning must occur to ensure that the learning outcomes are achieved practically. Reflective learning that entails observation and critical thinking allows the students to achieve clinical competence in the long term. The theoretical learning has wide applications in the practice that are systemically reflected in the learning-centred curricula. In addition, a variety of strategies accompanied by implementation frameworks has enhanced the effectiveness of the learning centred approach thus causing a reduction in the theory-practice gap (Corlett, Palfreyman, Staines & Marr 2003, p. 183). Continuous intertwining of evaluation strategies during the implementation stages is vital in enhancing the achievement of the objectives of the training. The reliance on the autonomy of the students in determining the learning outcomes enhances the quality of care given to the patients (College of Operating Department Practitioners, 2006, p. 4). Mentors acts as facilitators and supervisors while ensuring strict adherence of evidence based practice takes place.
According to Hubball and Burt (2004, p.7), the curriculum must take into account several assessment strategies in order to achieve the desired objectives as stipulated in the ODP curriculum. Assessment is mainly undertaken through the utilization of the transcript and personal development plans thus providing the required evidence of successful completion of the task. Identification of strengths and weakness in view of the expected outcomes is achieved throughout the placement period. Through observation, critical analyses and case studies, reflective learning enhances the overall learning process thus making the students more knowledgeable while enabling them to embrace critical thinking. The integration of responsive and accountable curriculum that delves in outcome measurement has enhanced the professional development of ODP students (Corlett et al 2003, p. 184).
Lyon provided a model that has useful application in the learning and teaching centres (2004, p. 1279). Assessment of the conceptual frameworks using a multi method strategy including utilization of observations and interviews among the student population enhanced the achievement of the outcomes. Bridging the gap achieved success when the students received recognition as junior members of the larger surgical teams. Imperato (2000, p.150) asserted that opportunities offered in community and local hospitals impacts positively on the learning since the students’ contributions are overly appreciated by the seniors. The importance of trust and legitimacy cannot be overemphasized in the improvements of educational practice especially in the operational theatre. Another crucial intervention involves the effective and timely communication and negotiation of available opportunities in learning in the theatres goes a long way in managing the expectations between the surgeons and the students (Lyon 2004, p.1285).
Chan (2000) has noted that learning in the theatres requires a holistic approach that embraces science and art. Although it is overly difficult to select one learning style, the authors support a tailored made approach depending on the prevailing conditions. Communication barriers that hamper the development of professional relationship and the lack of adequate resources hamper the effective delivery of training in the operating department practice. In line with this, the employment of outcome based education, instructional methodologies and team-working skills are imperative in bridging the theory practice gap (Chan 2000). Likewise, the paradigm shift to constructive alignment utilized in ODP practice achieves similar success with regards to the outcomes. Clinical placement in community hospitals offers the best opportunity to address the barriers since the students receive the required attention from their clinical mentors and have adequate time to interact with the patients (Imperato 2000, p.150).
Clinical environment that enhances learning is essential in the development of student during the placement in the operating department theatres. Ensuring proximity of the theatres with the other facilities is imperative since delegation of minor duties to the students is enhanced because the clinicians may be called upon especially when the condition worsens (Forrester, Heel & Henderson, 2005, p.4). Ensuring adequate clinicians to mentor the ever increasing numbers of learners is proving a challenge for many health care organizations. In this regard, the modernization in NHS has influenced negatively on the clinical placement capacity particularly in supporting learning (Atherton 2005). Allocation decisions in OPD must therefore be supported by timely and appropriate information for the identification of strategies vital in enhancing the quality and support required in bolstering learning in practice.
The requirements that students should rotate in the three different areas in the OPD makes it imperative to provide adequate human resources and facilities to enhance the achievement of the objectives of the clinical placement. On the other hand, rotation reduce pressure on one area and provide more placements to students, coordination, well link and communications between university and placement provider is vital her to organize the placement area and student rotation according to their academic components. For example if one trust offers placement for six ODP students at the time three of them can be allocated in anaesthetic the others might be allocated to surgery then students can be converted (Henderson et al (2005).
On the other hand, the responsibility of the clinical mentors to facilitate, direct and support students learning in the clinical placement is vital. It has been noticed by the QAA report, (2004) that mentoring in ODP students within the private sector and the trust-based practice demonstrated consistency in the assessment of practice and was clearly supportive and significantly enhanced students’ achievements. On the contrast, the report claimed the reliability of mentors and assessors in practice, recognised to be an issue that is critically affecting student’s perception of assessments and their confidence of the assessment in practice. It is recommended by QAA benchmark statements, (2004) that ODP students learning occur into the context of clinical practice.
The Health Professional Council visitors’ report, (2007) required to improve the clinical placement standards in relation to mentors qualifications and last mentorship updates, and to ensure the required information regards the programme nature, needs, objectives, assessment methods and expectations are accessible to practice placement providers. Therefore, the cooperation and good communications appears again to be one of the fundamental factors in the development of the ODP profession. Further training and education might help mentors in the operating theatre environments to support and facilitate the progress of the students, this required academic institutes to structure the process of mentor’s selection and keep them updated with best available methods and approaches (Hutchings et al, 2005).
Henderson et al (2005, p.77) noted that a paradigm shift to a clinically oriented program that allows the secondment of employed experts has occurred in many learning institutions in Australia and United Kingdom (Winch & Heel, 2006, p. 207). Clinical oriented programs play a pivotal role in enhancing learning by placing the patient and clinical practice at the core of the training. In view of the ODP, the students enjoy maximum contact with the real learning environment hence achievement of the course outcomes are greatly improved. The seconded clinicians serve to facilitate clinical laboratory sessions and largely the problem-based learning. The clinical lecturers offer a seamless link that is imperative in bridging the gap between theory and practice (Henderson, Winch & Heel 2006).
Through their roles as supervisors and facilitators, the clinical lecturers observe and assess the students on their competences, achievements of outcomes, critical thinking and their development over time (Elliot 2002, p.143). Teaching and learning is linked with the outcomes ensures that the teaching aspect is timely complemented with the practical aspect thereby cementing the skills in the students. Moreover, application of a joint model further support that nurses and clinicians are in a better position to install clinical skills in the students due to the immense expertise and knowledge they hold (Elliot 2002, p.143). Knowledge of the local practice environment and an established rapport between the clinicians and the lecturers helps in the facilitating the learning process (Elliot 2002, p.143).
The overly exploration of the learning environment helps in getting a clear view of the educational functioning particularly of the clinical area. The nurse teachers mainly enhance students’ opportunities for furthering their careers and specialized training (Chesser-Smyth 2005, p. 320). The nurses carry out orientation and close supervision thus helping the students to develop confidence in the practice (Priest, 2001, p. 34. Chesser-Smyth noted that career development is dependent on the close support and facilitation in the clinical setting that is imperative in enhancing the learning process in the operating theatres (2005, p.321). The close interaction between the clinicians and the students has made the clinical environment conducive for effective translation of theory into practice (Purkerson & Paulsen 2001, p. 13).
The development of the operating department practitioners is highly dependent on appropriate mentorship of the students and regular updating of the clinical guidelines in accordance to the changes in technology and improvements in the clinical field (Raman-Wilms 2001, p. 10). Improvements in technology have ushered in more sophisticated operation procedures that have occasioned the reform of curricula and more practical exposure for the students in the theatres. More importantly, the mentors act to take an individual through an important event that helps in the translation of theoretical learning to a clinical practice.
Mentorship is imperative since it equips the student with the skills and the meaning behind the application of the knowledge. A mentor must come in handy in the supervision and support of the student thus enhancing the integration of the students into the formidable clinical team. West (2007, p. 17) asserted that the student must also receive clarifications regarding the principles governing the mentorship and the applied method during the supervision. This in essence helps the students to feel like part of the team. Furthermore, demonstrating competence and supporting the student in coming up with best practice hence enabling the exploration of the practice issues with the learner. Through their commitment to the practice and mentorship, the mentors must be ready to help in the course development. Acting in a professional manner and embracing fairness is instrumental in instilling the required concepts and skills in the students during the clinical placement (College of Operating Department Practitioners 2006b)
Regular feedback while providing additional support given by the coordinators has also played a major role in the consolidation of the theoretical aspect in addition to the practical acquisition (Chesser-Symth 2005, p. 320). Provision of the much-needed feedback on the overall student performance must be undertaken accordingly by the supervisors without bias to enhance the professional development of the students. Furthermore, the students learn their shortcomings thereby providing the needed impetus to integrate the theory and practice. The diversity observed in the clinical placement and the different interpretations in the ODP curriculum makes it hard to apply in different settings (Andrews 2007, p.2)
Lambert and Glacken (2004, p.665) have emphasized the role of mentors as facilitators and assessors of learning in the workplace. Promotion of the usage of evidence based practice while acting as an important role model for the students is required from the mentors. In addition, mentors shaped the views of the students particularly as future candidates of becoming mentors thus putting into spotlight the importance of role modelling. However, ineffective planning, failing confidence levels and lack of adequate time are regarded the major barriers to effectiveness in mentoring (Heale, Mossey &Gorham 2009, p. 369). In executing their responsibilities, minimum standards that usually dictate mentors conduct are developed through pragmatic approach. Mentors have acknowledged the fact that assessment of the student performance is not only reliant on a set of predetermined behavioral outcomes but also on keen observation of the student participation and overall functioning (Gray & Smith 2000, p.132; Chesser-Symth 2005, p. 320). Mentors provide the needed facilitation and support learning thus offering the required guidance to the students particularly in clinical areas such as operating theatre. Supervision bolsters the overall capacity to improve by providing the necessary direction and guidance on the appropriate and correct procedures (Baillie & Curzio 2009, p. 69).
Mentors has the responsibility to encourage students to identify their own objectives and aims at their allocated placement in aligned with the undertaken module outcomes and objective, then they have the responsibility to facilitate, direct and support the learning process (Chesser-Symth 2005). They also have to be sure that these objectives are focused on what students are expected to know and be able to demonstrate and achieve, in additions the intended outcomes have to be appropriate to the curricula and well articulated with the assessment methods according to the QAA, (2005). Therefore the module handbook must provide clinical mentors and students with the required and adequate and clear information. These learning outcomes reflect the curriculum emphasis on learning opportunities in the clinical practice and the clinical assessment, which highlight again the importance of the clinical placement in this curriculum. Similarly, it place responsibility on students to participate in the construction of their learning. The basic method that is adopted by this curriculum is that the students are responsible for their own learning. It is believed that the students will have to learn from their own initiative and the space that is experienced by the students between their theory and practice has to be bridged through clinical experience and guidance by university teacher and mentors in clinical practice (Hubball & Burt 2004).
Personal attributes such as communication skills and interpersonal skills of the students are known to greatly influence the overall judgments of their performance during the placement. Effective supervision of the students not only assures maximum benefits in terms of learning from the lecturer but also helps the latter to offer the best treatment and care to the patient (Heale, Mossey &Gorham 2009, p. 369). Kilminster and Jolly (2000, p. 834), asserted that supervision must be introduced and maintained at all times to enhance the safety of the patient while ensuring the student learns as much as possible from the situation and interaction with the clinician. The authors further noted that behaviors and attributes in the clinical students may be injurious to learning and in patient care.
Regular meeting between the students, clinical teachers and the lecturers helps in the development of a learning course that serves to benefit the student by systematically aligning the placement objectives with the curriculum demands. This has proved advantageous since it helps in managing the expectations in the short-term and long-term. Socialization at professional level also helps in opening up the students and building their confidence thereby creating an atmosphere that allows them to embrace positive and negative criticisms (Baillie & Curzio 2009, p. 69). Kilminster and Jolly (2000, p. 834) noted that clear feedback is very crucial since it helps the clinical students to contribute partly in the supervisory process. However, regular meeting may prove a distraction to the clinician-student relationship in that it may end up suppressing the professional linkage hence leading to inefficiencies in assessments (Gray & Smith 2000). Personalizing their relationship makes the clinical lecturers to fail in offering constructive criticisms to the students since they avoid hurting their emotions.
Aims of the study
The aim of this study is to evaluate- with particular interest in the student’s perception- the clinical placement experience of the first year ODP students.
The study is aimed at evaluating the student’s perception of their live experience focusing on three main factors: theory practice gap, clinical environment and clinical mentors.
The evaluation was based on the following factors:
- To evaluate the first academic year components and report how the curriculum support the first year clinical placement
- To identify the available resources and facilities during the placement to ascertain their usefulness in helping the students meeting the objectives and learning outcomes.
- To evaluate the student allocation to supervisors or clinical mentor and the quality of mentoring time.
- To evaluate clinical environment atmosphere, resources and facilities such as welcoming environment, number of mentors and mentors availability, availability of learning resources and if students have access to them
- To evaluate the roles and impact of mentor support and the process of mentorship to the students during the clinical placement.
- To evaluate the role of reporting and feedback on the student perceptions and professional growth in the clinical placement.
Design of study
Case study is a powerful research methodology that offers an overly detailed contextual basis especially of a selected number of cases and conditions (Jon & Greene 2003). Case study is mainly based on an in-depth exploration or investigation of an event, individual or group of subjects with the main aim of linking the causation with various underlying principles. In this case, the ODP clinical placement was evaluated based on factors such as the theory-practice gap, clinical environment and the clinical mentors. The study design employs a longitudinal approach whereby the investigation of the clinical placement experience was conducted with the student undergoing the assessment after a considerable period during their first year of clinical placement (Yin 2009). Since much of the collected data is of qualitative nature, analysis is undertaken concurrently with the observation whereby the initial observations play a major role in shaping the subsequent data (Texas State Auditor’s Office 1995). Considering the fact that the main aim of the study was to evaluate the clinical placement experience of Operating Department Practitioners (ODP’s) student’s during their first year, case study provided the most appropriate methodology. It appropriateness is due to it’s in depth exploration of the clinical scenario hence producing sound findings (Yin 2009).
Justification of the study method
The case study provides the best approach taking into account that the study was only applicable to one student. The approach is also vital since it is premised on explanation building where a researcher takes an in-depth analysis or evaluation of a particular study topic. Case studies give a holistic view of an event or situation taking into account its merits and demerits. More importantly, case study is appropriate owing to its capacity to explore and thoroughly describe the overall facets of the clinical placement (Yin 2009). It also fits in identifying the close interaction between individuals and the external environment. In view of this, Yin (2003) asserted that, ‘’the case study approach allows investigators to retain the holistic and meaningful characteristics of real life situations’’ (p. 2).
The suitability to utilize a theoretical framework in the synthesis and discussion of information is a major advantage offered by the study approach (Saarikoski 2003). Case studies usually offer data that is consistent with alternative theoretical approaches thereby making its findings more applicable in research work particularly in the development of systematic reviews and meta-analysis of a particular topic. The author utilizes information oriented sampling thus ensuring that the case that will provide the highest load of information is picked (Yin 2009).
Selected cases offer a holistic view of the live experiences in the clinical environment by revealing broader perspectives through the utilization of more common action oriented approaches. In-depth interviews and analysis of the case enhances the holistic description of the clinical experience by explaining its causes and implications (Gillham 2000). In this case, the study method and in depth interview offers a holistic view of the clinical placement experience while shedding light on the causes and solutions to theory-practice gap and the importance of the clinical environment and the clinical mentorship. In depth interview is more detailed and provides a holistic and sounder view of the study topic (Saarikoski 2003).
The study has shortcomings in that the study findings could not be utilized to reflect the clinical placement experience in other institutions offering operating department practice since the prevailing conditions during the study period are dissimilar. More importantly, the case study was prone to bias considering the fact that purposive sampling that led to the selection one student without utilization of systematic or random methods (Gerring 2006). Since the sample size involved only one student in the clinical placement, it became crucial to avoid generalization of the findings of the clinical experience unless the variables and other parameters are similar (Yin 2009).
Usage of cross sectional study would also have been feasible considering the lengthy period required to complete undertaking the clinical placement. Cross-sectional study is a research method which involves the overly observation of a proportion or the whole of the population with particular interest in collection of data in a specific period (William & Trochim 2006). However, limitations in terms of funding and available time to carry the study prevented its application to the research. Its applicability is further hampered by the inconsistencies with regard to the available resources to each student.
Conduct of the study
Utilization of in-depth interviews proved useful in the collection of data from the participant due to its propensity to collect much detailed information on a specific situation (Gerring, 2006). In-depth interviews is generally a technique applied in qualitative research and involves the carrying out of individual interviews targeting a specific number of participants with the aim of understanding the perspectives of particular situations. It entails the interviewer taking the participant through a list of questions that enhance the understanding of the study topic. The technique enhances the collection of vivid and detailed information that are invaluable in creating a picture of situation under study. Moreover, lack of lead questions and tendency to ask follow up questions is imperative in gathering of adequate information and facts about the understanding of the clinical situation (Gillham 2000).
Feasibility of the in-depth interviews
Compared to other study techniques, in-depth interviews elicit responses that depict nuances and contradictions while giving an interpretive perspective particularly when addressing sensitive topics. Milena, Dainora and Alin (2008) asserted that its application ensured timely collection of concrete information taking into consideration that it allows the interviewer to ask for clarifications. In contrast, other techniques could not achieve the depth of information required from the respondents.
In-depth interviews were feasible and preferred because of its propensity to enhance the collection of more detailed information than what is offered by other data collection tools. Considering that the collected data was qualitative in nature, the method was essential in providing a relaxed atmosphere hence ensuring adequate data and clarifications are sought at the time of the interview with the student (Milena, Dainora & Alin 2008). The student was asked unstructured questions during the interview, only after the participant accepted to sign the consent form and willingly agreed to answer the questions. The study was imperative in forming a baseline that was used to evaluate the clinical placement experience. The interview entailed listening to one participant’s explanations on the technical skills garnered in the clinical placement.
In-depth interviews require a face to face meeting between the students and the interviewer where detailed information is collected. The interview method provides the much needed information particularly on the overall behaviour of the students and their experiences during the clinical placement. A study conducted using in-depth interviews provided concrete results on the involvement of nurses in oral geriatrics when compared to another done using questionnaires (Wardh et al 2000). More importantly, in-depth interviews are pivotal in helping the interviewer to have a firsthand knowledge of the clinical situation in its context and thus improving his understanding on the dynamics surrounding it. That the interviewer has face to face contact with the interviewer makes the evaluator to capture some unique and unanticipated responses that may serve to help in addressing the situation.
However, the method is rather time consuming in that the interviewer is required to spend at least one hour with the participant during the data collection compared to observations and questionnaires. In addition, the attitudes and the behaviours of the participant may be affected by the presence of the interviewer thereby leading to distortion of results and outcomes. The information given by the respondent may surpass the scope of the study particularly if the interviewer does not effectively take charge of the interview.
Andrews, M., 2007, Contemporary issues in mentoring practice: in West S, Clark T. & Jasper, M. (eds). 2005. Enabling Learning in Nursing and Midwifery Practice. Chichester: John Wiley & Sons. pp. 1-10.
Atherton, J., 2005. Teaching and Learning: Assessment. Web.
Australian Council for Safety and Quality in Health Care., 2003. Safety and Quality and the Health Reform Agenda. Canberra: Australian Council for Safety and Quality in Health Care. Web.
Baillie, L. & Curzio, J., 2009. ‘A survey of first year student nurses’ experiences of learning blood pressure measurement’, Nurse Education in Practice, Vol. 9, pp. 61–71. Web.
Biggs, J & Tang C., 2007, Teaching for Quality Learning at University. Maidenhead: McGraw-Hill and Open University Press.
Chan, D. (2001) ‘Development of an innovative tool to assess hospital learning environments’, Nurse Education Today, 21 (8) pp. 624–631. Web.
Chesser-Smyth, P. (2005) The lived experiences of general student nurses on their first clinical placement: A phenomenological study. Nurse Education in Practice, 5 (3) pp. 320–327. Web.
Cleland, J.A, Knight, L.V., Rees, C.E., Tracey, S. & Bond, C.M. 2008. ‘Is it me or is it them? Factors that influence the passing of underperforming students’, Medical Education, 42, pp 800-809. Web.
Cloyd, J., Holtzman, D., O’Sullivan, P., Sammann, A., Tendick, F., A scher, N. (2008) ‘Operating Room Assist: Surgical Mentorship and Operating Room Experience for Preclerkship Medical Students’, Journal of Surgical Education, 65 (4), pp 275-282. Web.
Clutterbuck, D. (2004) Everyone needs a mentor. London: Chartered Institute of Professional Development. Web.
College of Operating Department Practitioners (CODP) (2009) Standards, recommendations and guidance for mentors and practice placements: Supporting pre-registration education in Operating Department Practice provision. London: CODP. Web.
College of Operating Department Practitioners. (2006a) Curriculum Document. London: CODP. Web.
College of Operating Department Practitioners. (2006b) Qualifications Framework for Mentors Supporting Learners in Practice. London: CODP. Web.
Colliver, J. (2002) Constructivism: ‘The View of Knowledge That Ended Philosophy or a Theory of Learning and Instruction?’, Teaching and Learning in Medicine, 14(1) pp.49–51.
Coppus, S.F., Emparanza, J.I, Hadley, J., Kulier, R., Weinbrenner, S., Arvanitis, T.N., Burls, A., Cabello, J.B., Decsi, T., Horvath, A.R, Kaczor, M., Zanrei, G., Pierer, K., Stawiarz, K., Kunz, R., Mol, B.W. & Khan, K.S. (2007) A clinically integrated curriculum in evidence-based medicine for just-in-time learning through on-the-job training: the EU-EBM project, BMC Medical Education, 27(7) pp. 46. Web.
Corlett, J. (2000) ‘The perceptions of nurse teachers, student nurses and preceptors of the theory–practice gap in nurse education’, Nurse Education Today, 20 pp. 499–505. Web.
Corlett, J., Palfreyman, J., Staines, H. & Marr, J. (2003) ‘Factors influencing theoretical knowledge and practical skill acquisition in student nurses: an empirical experiment’, Nurse Education Today, 23 pp.183–190. Web.
Cox, M. (2000) Faculty learning communities: change agents for transforming institutions into learning organizations. Boston, MA: Anker.
Duffy, K & Hardicre, J. (2007) ‘Supporting failing students in practice 1: Assessment’ Nursing Times, 103(47), pp: 28-9. Web.
Elliot, M. (2002) Clinical education: a challenging component of undergraduate nursing education. Contemporary Nurse, 12(1) pp. 69–77. Web.
Field, D. (2004) Moving from novice to expert – the value of learning in clinical practice: a literature review. Nurse Education Today, 24 pp. 560–565. Web.
Forrester, K., Heel, A. & Henderson, A. (2005) Supervised clinical placement and legal accountability. Journal of Law and Medicine, 12(4) pp. 416–421. Web.
Gibbons, M. (2000) Universities of the new production of knowledge: Some policy implications for government: Changing modes: New knowledge production and its implications for higher education in South Africa. Pretoria: HSRC. Web.
Gerring, J. (2006) Case Study Research: Principles and Practices. Cambridge: Cambridge University Press. Web.
Gillham, B. (2000) Case Study Research Methods. London: British Library Cataloguing. Web.
Gray, M. & Smith, L. (2000) ‘The qualities of an effective mentor from the student nurse’s perspective: findings from a longitudinal qualitative study’, Journal of Advanced Nursing, 32 (6) pp.1542-1549. Web.
Heale, M. & Gorham, J. (2009) Identification of facilitators and barriers to the role of a mentor in the clinical setting. Journal of Interprofessional Care, 23 (4) pp. 369-379. Web.
Health professional council, HPC. (2009) Standards of conduct, performance and ethics. Web.
Heath, P. (2002) National Review of Nursing Education: Our Duty of Care. Australia: Commonwealth of Australia. Web.
Henderson, A., Winch, S., Grugan, C., Henney, R. & McCoy, R. (2005) Working from the inside’: An infrastructure for the continuing development of nurses’ professional clinical practice’, Journal of Nursing Management, 13 pp. 106–110. Web.
Henderson, A., Winch, S. & Heel, A. (2006) Partner, learn, progress: a conceptual model for continuous clinical education. Nurse Education Today. Vol. 26, pp.104–109. Web.
Henderson, A., Heather, B., Boyde, H., Storrie, K. & Lloyd, B. (2006) ‘An evaluation of the first year of a collaborative tertiary–industry curriculum as measured by students’ perception of their clinical learning environment’, Nurse Education in Practice, 6 pp. 207–213. Web.
Hogard, E., Ellis, R., Ellis, J., Barker, C. (2005) ‘Using a communication audit to improve communication on clinical placement in pre-registration nursing’, Nurse Education Today, 25 pp.119–125. Web.
Hubball, H. & Burt, H. (2004) ‘An Integrated Approach to Developing and Implementing Learning-centered Curricula’, International Journal for Academic Development, 9(1) pp. 51–65. Web.
Imperato, J., Rand, W., Grable, E. & Reines, H. (2000) ‘The role of the community teaching hospital in surgical undergraduate education’, American Journal of Surgery, 179 pp. 150–3. Web.
Jefferson, G. (1997) Research methods in social sciences. London: sage publications. Web.
Jon, S. & Greene, R. (2003) Sociology and You. Ohio: Glencoe McGraw-Hill.
Kilminster, S. & Jolly, B. (2000) ‘Effective supervision in clinical practice settings: a literature review’, Medical Education, 34 pp.827-840. Web.
Lambert, V., Glacken, M. (2004) ‘Clinical education facilitators: a literature review’, Journal of Clinical Nursing, 14 pp. 664–673. Web.
Lyon, P. (2004) ‘A model of teaching and learning in the operating theatre’, Medical Education, 38 pp. 1278–1287. Web.
Marks, D. & Yardley, L. (2003) Research Methods for Clinical and Health Psychology. London: Sage Publications Ltd. Web.
Mukhopadhyay, S. & China, S. (2010) ‘Teaching and learning in the operating theatre: A framework for trainers and advanced trainees in obstetrics and gynecology’, Journal of Obstetrics & Gynaecology, 30(3) pp.238-240. Web.
Papp, I., Markkanen, M., Von Bonsdorff, M. (2003) ‘Clinical environment as a learning environment: student nurses’ perceptions concerning clinical learning experiences’, Nurse Education Today, 23(4) pp. 262–268. Web.
Pearcey, P., Elliott, B. (2004) ‘Student impressions of clinical nursing’, Nurse Education Today, 24 pp. 382–387. Web.
Priest, S. (2001) ‘A program evaluation primer’, Journal of Experiential Education, 24 pp. 34–40. Web.
Purkerson Hammer, D., & Paulsen, S. M. (2001) Strategies and processes to design an integrated, longitudinal professional skills development course sequence. American Journal of Pharmaceutical Education. Vol. 65, pp. 77–85. Web.
Quality Assurance Agency for Higher Education, QAA. (2004) Standards of conduct, performance and ethics. Gloucester: QAA. Web.
Quality Assurance Agency for Higher Education. (2004) Benchmark Statements: Health Care Programmes. Operating Department Practice.QAA: Gloucester. Web.
Raman-Wilms, L. (2001) ‘Innovative enabling strategies in self-directed, problem-based therapeutics: Enhancing student preparedness for pharmaceutical care practice’, American Journal of Pharmaceutical Education, 65 pp. 56–64. Web.
Saarikoski, M. (2003) ‘Mentor relationship as a tool of professional development of student nurses in clinical practice’, International Journal of Psychiatric Nursing Reserve, 9(1) pp.1014–1024. Web.
Saarikoski, M., Leino-Kilpi, H. (2002) ‘The clinical learning environment and supervision by staff nurses: developing the instrument’, International Journal of Nursing Studies, 39(3) pp.259–267. Web.
Texas State Auditor’s Office. (1995) Methodology Manual, rev. 5/95. Web.
Wårdh, I., Hallberg, L., Berggren, U., Andersson, L.& Sörensen, S. (2000) ‘Oral Health Care-A Low Priority in Nursing: In-depth Interviews with Nursing Staff’, Scandinavian Journal of Caring Sciences, 14(2) pp. 137-142. Web.
West, S. (2007) A good placement experience: the student’s perspective of their needs in the practice setting: enabling Learning in Nursing and Midwifery Practice. Chichester: John Wiley & Sons.
William, M. & Trochim, W. (2006) Research Methods Knowledge Base. London: Web Center for Social Research Methods. Web.
Yin, R. 2009. Case Study Research: Design and Methods. California: Sage Publications.
Yin, R., 2003, Case Study Research, 3rd edn. London, England: Sage Publications.