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Quality Assurance in Physiotherapy and Occupational Therapy Fieldwork Placements
227
COMMENTARY
Quality Assurance in Physiotherapy and Occupational Therapy Fieldwork Placements The Experience of the University of East Anglia Hilary Lawler Catherine Wells Key Words Quality assurance, students, fieldwork.
Introduction Quality assurance has been a feature of private industry for many years and in the 1970s it took on greater significance when there was increased competition from overseas. Although there has always been a desire within health care to provide a service of high quality the issue was not addressed in a formal way in the National Health Service until the publication of the White Paper Working for Patients in 1989. That, coupled with the need to encompass further, more businesslike approaches to health care, ensured the development of quality assurance strategies. Educational institutions have been much preoccupied with the achievement of high quality research because that in turn attracted funding to departments. Recently the quality of teaching in universities has come under scrutiny. Schools of occupational therapy and physiotherapy are required to develop a quality assurance strategy. For those who have moved from the clinical situation in the NHS this does not pose a threat. Previous management experience within the health service has been used by the authors in developing quality assurance in fieldwork education. Outlined in this paper is one aspect of the quality assurance strategy of the School of Occupational Therapy and Physiotherapy (OPT) at the University of East Anglia (UEA): the method and process involved in developing minimum standards for fieldwork education. In the year 2000 it is anticipated that physiotherapy and occupational therapy will
form part of the teaching quality exercise within this university. Fieldwork forms a n integral part of a physiotherapy and occupational therapy course and as such occupies one third of the curriculum. It accounts for a minimum of 1,080 hours at UEA which easily achieves the requirement of 1,000 hours set by the professional bodies - the Chartered Society of Physiotherapy (CSP) and the College of Occupational Therapists (COT). According t o Whittington and Wright (1992) quality assurance provides objective evidence of the standard of the service provided. In a n era when it is evident that resources are limited, the ability t o demonstrate t o the purchasers of therapy education that they are getting value for money is of great importance. The change in the way in which physiotherapy and occupational therapy education is now funded offers a n appropriate time t o introduce fieldwork standards.
Why the Need for Quality Assurance? The joint physiotherapy and occupational therapy course had its first intake of students in 1991. There has been much effort put into negotiating and establishing sufficient placements both within the Region and beyond. The recently revalidated course has meant that some of the emphasis in the course has altered in order to meet the changing needs of the NHS and social services, leading in consequence to a further search for placements. This is happening at a time when there is considerable pressure throughout the country to find sufficient clinical experience for students of both professions.
It is difficult to ensure equity and quality of experience for all students when the fieldwork placements cover not only a wide geographical area but also a large number of different specialties, for example acute and community settings, mental health, social services and the private sector. The school has a responsibility for providing courses for therapists wishing t o undertake
Physiotherapy,May 1998, vol84, no 5
228
clinical supervision with UEA stLdents. These are provldea twice yearly and offer guidance and support to potential supervisors. There has bee& x u c h ~Lscussionboth locally and natiomliy i b o h t Accreditation of clinical placemer,ts, a d f^;e,dwork educators. It was decided mt t o eszaSLsh such a system at the present time. The CSP (1994) recommends that fieldwork education should be evaluated on a regular basis, and that this evaluation should involve all those who take part in the process.
Process The stakeholders in the provision of therapy education are the regional contractors, professional bodies, educational institutions, local physiotherapists and occupational therapists and the studer,ts. They all have an interest in fieldwork education being of the highest possible standard. Regular undergraduate contract review meetings are held by the purchasing Consortium (in this case East Norfolk Health Authority), and are attended by representatives from the regional occupational therapy and physiotherapy managers as well as faculty members. The fieldwork co-ordinators suggested to therapy managers and purchasers that minimum standards for fieldwork should be established, and an appropriate method of auditing them set up. It was agreed that the standards should be applicable to both professions and should be jointly owned by both the school and clinical colleagues. Each profession formed a small group of people which included the fieldwork co-ordinators from OPT to review the professions’ ‘Standards for Clinical Placements’ (CSP, 1996; COT, 199313) and to decide on their appropriateness and to identify any omissions. The meetings provided a n opportunity for wide-ranging discussion and a chance to understand in greater depth the needs of both parties. After this aspect was completed, valuable help was given by a member of a local NHS trust quality assurance department in developing outcome measures and the proformas for auditing them. The draft standards were circulated to all regional managers and to members of faculty. Some slight modifications were made. The second draft of the standards was piloted during a fieldwork placement in June/July with a view t o full implementation from the start of the new academic year in September. Feedback from everyone involved in the pilot study was welcomed.
Physiotherapy, May 1998, vol 84, no 5
Standards Thirteen standards which covered the various aspects of the placements were devised. The key personnel involved in the placement were identified as the placement provider, student, supervisor, visiting tutor, fieldwork co-ordinator snd administrative assistant. Standards are set out at the end of this article. Each standard comprises a statement followed by a number of expected outcome measures. The outcome measures then form the basis for the questions on the audit proformas. The people involved in the placement complete the appropriate colour-coded audit form and return it t o the school. The placement provider completes one annually and the others a t the end of the student’s placement.
Evaluation The standards were piloted during the summer and the audit proformas returned. The number of responses received from the groups of participants varied (see table). Returned audit proformas Physiotherapy
Placement provider Fieldwork educator Visiting tutor Student
No
%
12 14 12 27
41 64 83 100
Occupational therapy No % 15 27 15 29
53 60 100 100
The students achieved 100% as on this occasion they were asked t o post their forms back t o the school with their fieldwork assessment forms. There is a difference between the occupational therapists and physiotherapists which is reflected in all the other groups. There is no obvious reason far this. It will be interesting to see whether it continues. Further investigation will be required if it remains a feature of the response rate. The main problems encountered were (a) lack of clarity of the wording in some questions, which led t o inappropriate responses, (b) the wording in the source box at the top of each audit form did not ensure accurate identification of the response source. Consequently the wording of some of the outcome measures and the questions on the audit proformas has been altered. None of the placements achieved all the standards. However some of those where they did not achieve (for example provision of honorary contracts to visiting tutors and students, o r supplying enough information to the students
229
before the placement) have already been rectified. It was also decided t o reduce the number of standards from 13 to 12, owing t o repetition of information. The standards do not include anything relating to the fieldwork educators’ needs to keep themselves abreast of current thinking in their specialty. Professional people have a responsibility to keep themselves up to date, to be able to offer the best possible management of a patient’s condition. The need t o demonstrate continuing professional development (CPD) may be specified within the terms of the awaited revised Professions Supplementary to Medicine Act. It is possible t h a t if OPT moves towards accreditation of the placements and the fieldwork supervisors then the presentation of evidence of CPD in clinical education and a therapist’s own specialty skills will be required. This may then form the basis for an additional standard. The effectiveness of the system depends on a considerable amount of administrative support which is ongoing throughout the year.
Conclusion
This has been a time-consuming but very valuable experience. It has been a useful vehicle for cooperation not only between faculty and clinicians but also between the two professions. An important aspect of a joint school is that there must be equity of experience across the two professions. Therefore the students within each profession should be, so far as possible, offered equality of opportunity and standard of experience. I t is hoped that this initiative will go some way t o ensuring that this is in fact the case.
Acknowledgments Many thanks to physiotherapy and occupational therapy colleagues in trusts throughout East Anglia for their participation in the development of the standards. Robbie Meehan BSc for her secretarial support. Rachel Friel for her help with formating the standards.
Authors and Address for Correspondence Hilary Lawler MA MCSP is a lecturer in physiotherapy and fieldwork co-ordinator and Catherine Wells BEd DipCOT is a lecturer in occupational therapy and fieldwork co-ordinator at the School of Occupational Therapy and Physiotherapy, University of East Anglia, Norwich NR4 7TJ.
Further standards may be added or amendments made at a later date if the need arises. The revised standards have been circulated t o all involved in the process. The responses will be monitored by the fieldwork co-ordinators and any significant problems which arise will be addressed. At the end of the 1997198 academic year a full evaluation will be made and feedback given to all those involved. The results will form part of the annual undergraduate course evaluation document. It is also hoped that it will form the basis for a future publication.
This article was received on August 6, 1997, and accepted on February 27, 1998.
Minimum standards for fieldwork experience are a n integral part of OPT’S quality assurance strategy. They strengthen the clinical teaching aspect of the course and help t o demonstrate to university, funding and purchasing bodies the value placed on this aspect of the students’ degree course.
College of Occupational Therapists (1 993b). Guidelines for Assuring the Quality of the Fieldwork Education of Occupational Therapy Students, SPPI 65, COT, London.
References Chartered Society of Physiotherapy (1996). Standards for Clinical Education Placements, CSP, London. Chartered Society of Physiotherapy (1991). Curriculumof Study, CSP, London. Chartered Society of Physiotherapy (1994). ‘Guidelines for good practice for the education of clinical educators’, Physiotherapy, 80, 5,299-300. College of Occupational Therapists (1993a). Curriculum Framework for Occupational Therapy, SPPl61, COT, London.
Department of Health and Social Security (1989). Working for Patients, HMSO. Whittington, C and Wright, P (1992). Quality Assurance: An introduction for health professionals, Churchill Livingstone, Edinburgh.
Physiotherapy, May 1998, vol84, no 5
COMMENTARY
Quality Assurance in Physiotherapy and Occupational Therapy Fieldwork Placements The Experience of the University of East Anglia Hilary Lawler Catherine Wells Key Words Quality assurance, students, fieldwork.
Introduction Quality assurance has been a feature of private industry for many years and in the 1970s it took on greater significance when there was increased competition from overseas. Although there has always been a desire within health care to provide a service of high quality the issue was not addressed in a formal way in the National Health Service until the publication of the White Paper Working for Patients in 1989. That, coupled with the need to encompass further, more businesslike approaches to health care, ensured the development of quality assurance strategies. Educational institutions have been much preoccupied with the achievement of high quality research because that in turn attracted funding to departments. Recently the quality of teaching in universities has come under scrutiny. Schools of occupational therapy and physiotherapy are required to develop a quality assurance strategy. For those who have moved from the clinical situation in the NHS this does not pose a threat. Previous management experience within the health service has been used by the authors in developing quality assurance in fieldwork education. Outlined in this paper is one aspect of the quality assurance strategy of the School of Occupational Therapy and Physiotherapy (OPT) at the University of East Anglia (UEA): the method and process involved in developing minimum standards for fieldwork education. In the year 2000 it is anticipated that physiotherapy and occupational therapy will
form part of the teaching quality exercise within this university. Fieldwork forms a n integral part of a physiotherapy and occupational therapy course and as such occupies one third of the curriculum. It accounts for a minimum of 1,080 hours at UEA which easily achieves the requirement of 1,000 hours set by the professional bodies - the Chartered Society of Physiotherapy (CSP) and the College of Occupational Therapists (COT). According t o Whittington and Wright (1992) quality assurance provides objective evidence of the standard of the service provided. In a n era when it is evident that resources are limited, the ability t o demonstrate t o the purchasers of therapy education that they are getting value for money is of great importance. The change in the way in which physiotherapy and occupational therapy education is now funded offers a n appropriate time t o introduce fieldwork standards.
Why the Need for Quality Assurance? The joint physiotherapy and occupational therapy course had its first intake of students in 1991. There has been much effort put into negotiating and establishing sufficient placements both within the Region and beyond. The recently revalidated course has meant that some of the emphasis in the course has altered in order to meet the changing needs of the NHS and social services, leading in consequence to a further search for placements. This is happening at a time when there is considerable pressure throughout the country to find sufficient clinical experience for students of both professions.
It is difficult to ensure equity and quality of experience for all students when the fieldwork placements cover not only a wide geographical area but also a large number of different specialties, for example acute and community settings, mental health, social services and the private sector. The school has a responsibility for providing courses for therapists wishing t o undertake
Physiotherapy,May 1998, vol84, no 5
228
clinical supervision with UEA stLdents. These are provldea twice yearly and offer guidance and support to potential supervisors. There has bee& x u c h ~Lscussionboth locally and natiomliy i b o h t Accreditation of clinical placemer,ts, a d f^;e,dwork educators. It was decided mt t o eszaSLsh such a system at the present time. The CSP (1994) recommends that fieldwork education should be evaluated on a regular basis, and that this evaluation should involve all those who take part in the process.
Process The stakeholders in the provision of therapy education are the regional contractors, professional bodies, educational institutions, local physiotherapists and occupational therapists and the studer,ts. They all have an interest in fieldwork education being of the highest possible standard. Regular undergraduate contract review meetings are held by the purchasing Consortium (in this case East Norfolk Health Authority), and are attended by representatives from the regional occupational therapy and physiotherapy managers as well as faculty members. The fieldwork co-ordinators suggested to therapy managers and purchasers that minimum standards for fieldwork should be established, and an appropriate method of auditing them set up. It was agreed that the standards should be applicable to both professions and should be jointly owned by both the school and clinical colleagues. Each profession formed a small group of people which included the fieldwork co-ordinators from OPT to review the professions’ ‘Standards for Clinical Placements’ (CSP, 1996; COT, 199313) and to decide on their appropriateness and to identify any omissions. The meetings provided a n opportunity for wide-ranging discussion and a chance to understand in greater depth the needs of both parties. After this aspect was completed, valuable help was given by a member of a local NHS trust quality assurance department in developing outcome measures and the proformas for auditing them. The draft standards were circulated to all regional managers and to members of faculty. Some slight modifications were made. The second draft of the standards was piloted during a fieldwork placement in June/July with a view t o full implementation from the start of the new academic year in September. Feedback from everyone involved in the pilot study was welcomed.
Physiotherapy, May 1998, vol 84, no 5
Standards Thirteen standards which covered the various aspects of the placements were devised. The key personnel involved in the placement were identified as the placement provider, student, supervisor, visiting tutor, fieldwork co-ordinator snd administrative assistant. Standards are set out at the end of this article. Each standard comprises a statement followed by a number of expected outcome measures. The outcome measures then form the basis for the questions on the audit proformas. The people involved in the placement complete the appropriate colour-coded audit form and return it t o the school. The placement provider completes one annually and the others a t the end of the student’s placement.
Evaluation The standards were piloted during the summer and the audit proformas returned. The number of responses received from the groups of participants varied (see table). Returned audit proformas Physiotherapy
Placement provider Fieldwork educator Visiting tutor Student
No
%
12 14 12 27
41 64 83 100
Occupational therapy No % 15 27 15 29
53 60 100 100
The students achieved 100% as on this occasion they were asked t o post their forms back t o the school with their fieldwork assessment forms. There is a difference between the occupational therapists and physiotherapists which is reflected in all the other groups. There is no obvious reason far this. It will be interesting to see whether it continues. Further investigation will be required if it remains a feature of the response rate. The main problems encountered were (a) lack of clarity of the wording in some questions, which led t o inappropriate responses, (b) the wording in the source box at the top of each audit form did not ensure accurate identification of the response source. Consequently the wording of some of the outcome measures and the questions on the audit proformas has been altered. None of the placements achieved all the standards. However some of those where they did not achieve (for example provision of honorary contracts to visiting tutors and students, o r supplying enough information to the students
229
before the placement) have already been rectified. It was also decided t o reduce the number of standards from 13 to 12, owing t o repetition of information. The standards do not include anything relating to the fieldwork educators’ needs to keep themselves abreast of current thinking in their specialty. Professional people have a responsibility to keep themselves up to date, to be able to offer the best possible management of a patient’s condition. The need t o demonstrate continuing professional development (CPD) may be specified within the terms of the awaited revised Professions Supplementary to Medicine Act. It is possible t h a t if OPT moves towards accreditation of the placements and the fieldwork supervisors then the presentation of evidence of CPD in clinical education and a therapist’s own specialty skills will be required. This may then form the basis for an additional standard. The effectiveness of the system depends on a considerable amount of administrative support which is ongoing throughout the year.
Conclusion
This has been a time-consuming but very valuable experience. It has been a useful vehicle for cooperation not only between faculty and clinicians but also between the two professions. An important aspect of a joint school is that there must be equity of experience across the two professions. Therefore the students within each profession should be, so far as possible, offered equality of opportunity and standard of experience. I t is hoped that this initiative will go some way t o ensuring that this is in fact the case.
Acknowledgments Many thanks to physiotherapy and occupational therapy colleagues in trusts throughout East Anglia for their participation in the development of the standards. Robbie Meehan BSc for her secretarial support. Rachel Friel for her help with formating the standards.
Authors and Address for Correspondence Hilary Lawler MA MCSP is a lecturer in physiotherapy and fieldwork co-ordinator and Catherine Wells BEd DipCOT is a lecturer in occupational therapy and fieldwork co-ordinator at the School of Occupational Therapy and Physiotherapy, University of East Anglia, Norwich NR4 7TJ.
Further standards may be added or amendments made at a later date if the need arises. The revised standards have been circulated t o all involved in the process. The responses will be monitored by the fieldwork co-ordinators and any significant problems which arise will be addressed. At the end of the 1997198 academic year a full evaluation will be made and feedback given to all those involved. The results will form part of the annual undergraduate course evaluation document. It is also hoped that it will form the basis for a future publication.
This article was received on August 6, 1997, and accepted on February 27, 1998.
Minimum standards for fieldwork experience are a n integral part of OPT’S quality assurance strategy. They strengthen the clinical teaching aspect of the course and help t o demonstrate to university, funding and purchasing bodies the value placed on this aspect of the students’ degree course.
College of Occupational Therapists (1 993b). Guidelines for Assuring the Quality of the Fieldwork Education of Occupational Therapy Students, SPPI 65, COT, London.
References Chartered Society of Physiotherapy (1996). Standards for Clinical Education Placements, CSP, London. Chartered Society of Physiotherapy (1991). Curriculumof Study, CSP, London. Chartered Society of Physiotherapy (1994). ‘Guidelines for good practice for the education of clinical educators’, Physiotherapy, 80, 5,299-300. College of Occupational Therapists (1993a). Curriculum Framework for Occupational Therapy, SPPl61, COT, London.
Department of Health and Social Security (1989). Working for Patients, HMSO. Whittington, C and Wright, P (1992). Quality Assurance: An introduction for health professionals, Churchill Livingstone, Edinburgh.
Physiotherapy, May 1998, vol84, no 5