Practice-based Learning & Higher Education : Let the

Practice-based Learning & Higher Education : Let the

Practice-based Learning & Higher Education :
Let the learners lead the way re-introducing independent learning & development.
Nick Rowe - Institute of Health & Community Studies, Bournemouth University U.K.

Evidence-Based Practice, delivered by an Inter-Professional
Workforce = a system of Evidence-Based Healthcare that
supports the delivery of Evidence-Based Medicine

Is this OK ? [ This is OK because it follows the current
guidelines, published by ]
How deep should the student go ?
[The first year student requires a solid understanding of the
basic concepts of upon which, their future practice can be
developed. You can determine this by ]

Stimulus
Common Questions From
Assessors ~

Theory Practice cest quoi ?
[My experience and opinion is valuable, but I need to measure
and account for it. Information that supports me might be
found at ]

Is this OK ?
[ Related to ?]

How deep should the student go
?

[Where is YOUR evidence-base ?]

bromine.servlet.net/.../ninarios/STEPPING.jpg

Its about getting from here to there .
Shared values ?

Communication & Process

In considering the key principles of Higher
Education, it has been identified that:

The Education Provider (University) had no
jurisdiction in the placement area, other than
in a partnership advisory role. As such,
access to the staff concerned had to be
secured, and a mutually acceptable change
process found.

H.E. I dont understand
[Are staff familiar with Higher Education ?]

It will have a theoretical underpinning,
Practice Assessors (PA) of 3 NHS Trusts involved in
the delivery of the Dip HE Operating Department
Practice (ODP) programme, expressed on-going
difficulty in establishing the suitability, depth and
academic level of evidence, as required for the
assessment in practice of student ODPs at level C
and level I. This was formally raised at Strategic
Health Authority (SHA) Practice Assessment
Meetings, and again at programme Learning
Facilitators (LF) Meetings of throughout the year.
Set requirements for the assessment and mentorship
of students are published at both local (programme) 1
and national (governing body) level 2, with support
given from the academic institution 3, yet approaches
remain inconsistent and detrimental to both student
welfare and the academic process.
Re-evaluation of student work by the academic
institution has previously resulted in students failing
to achieve evidenced competency in practice and
was the stimulus for change, reflected in this casestudy. An urgent address of the issue was
undertaken, with a view to highlighting the issues of
evidence-based practice assessment and the
formulation of long and short term measures to
prevent a re-occurrence of student non-achievement
(as a result of failures within the assessment
process).
This work looks to highlight the need for change in
relation to the events that occurred, and illustrates
the collaborative approach taken with Partnership
Institutions, to inform staff and improve the
assessment process. Linked issues of Professional
Development, Evidence-Based Practice and Higher
Education were also considered.

Approach Methodology &
Design
Retrospective linked questioning helped to establish
the locality, process and involvement of the problem,
relative to its initiating incident. Analysis of current
core documentation relating to the Nursing and ODP
professions was undertaken to establish the
professional and working requirements of each
group. Topical academic consultation was sought, in
conjunction with healthcare providers. The search
strategy for information was conducted by accessing
a variety of databases (BNI, Blackwell Synergy,
CINAHL, MEDLINE) in relation to Nursing and Allied
Health Professions. This was widened to include the
Contributory
of the
issue constructed
British
Educationfactors
Index, and
supplemented
by
the following
of enquiry:
manual meta-search
engine lines
employment
(Ixquick).
Key words relating to the identified issues were
1.
Scope
of application
withinand
professional
body
entered.
Results
were filtered
appropriate
publications:
What
are the requirements
results
accessed and
reviewed.
Manual review of
concerning practice assessment, and are they
institutional
resources and personal texts was also
being met ?
employed. Non-statistical review of Likert
Questionnaire
provided
feedback
for
the single
2.
Definitions
of competency
and
evidence:
Is there
a clearstudy
understanding
of the basic
pillars
of
placement
(500 bed District
General
Hospital)
healthcare
placement
assessment,
and
of
the
and indication for future development.

[Case Study]

Having established that both Higher Education,
Clinical and Professional Practice were now on the
same side, the initial issues of concern were quickly
resolved:

In Healthcare

Theory Practice cest quoi ?

Institute of Health &
Community Studies

Step 3 : Develop From
Established
Principles

EBP = E.B.H.C.
I-P E.B.M.
Multi-disciplinary Working & Education
W

[In regards to what exactly ?]

iICS

It will be at a level which would qualify
someone to work in a professional field
It will usually be taught in an environment
which also includes advanced research activity.

4

The system of assessment in question required
an evidence-based approach, in that any
learning or assessment outcome that met the
required levels of proficiency, was required to be
supported by demonstrable evidence that
indicated how the outcome was achieved 5 .
This also links to the on-going requirement for
practitioners (Nursing6 and ODP7) to have an
evidence-based approach to clinical practice, as
outlined by the NHS Executive (1996)8, and as a
component requirement for professional
registration (NMC 2004 6), (AODP, 2003 9).
Whilst specialist healthcare practice has a wide
practical application and retains many of its
vocational traits, the development of
demonstrable evidence, is a key requirement of
professional practice.
Considering the development of independent
learners, it has been expressed that we do not
use assessment as well as we might, and tend to
assess the product rather than the process 10.
This is perhaps reflected in the range of
questions raised by assessment staff, in relation
to the case concerned. In order to work and
learn independently (as outlined by the
requirements of Higher Education and the
published standards of the professions
concerned), then the aims and objectives of the
process needed to be fully understood, in order
for the concepts to be applied to specific clinical
or educational issues.

Comprehension often relies upon good
communication 11. The challenge lay in
translating the required elements of both
professional practice and Higher Education into
a shared language, and finding a means of
access and delivery to the workplace. Concerns
tended to be focussed upon the language used
in Higher Education, and a need for concrete
answers to assessment questions (which remain
variable in relation to knowledge, experience
and specific circumstances). Comparison of the
events (and opinions) surrounding the initiating
incident and the available guidance and
literature, highlighted that there were
fundamental flaws in the understanding and
application of professional & educational
practice.

H.E. I dont understand
[In fact many of the basic principles are comparable to
professional practice. Once you see past the jargon, then you
can work-out the bells & whistles for yourself It helps to
have some help with the paperwork though. ]
Final consensus concluded that the paperwork was
not in fact, the main concern; rather, demonstrating
the underlying principle. (Students) and staff were
subsequently able to achieve this by mutually
accessing auditable evidence and independently
validating their rationales for practice and theory.

Feedback and Communication
(Single Placement Case-Study Only 12.04.07)

Following the session, a Likert-Scale questionnaire was
administered to participants by their Education CoOrdinator, with collated results being fed-back to the
education provider.
Strong agreement (83%) was expressed by the
sample group in regard to the content and
administration of the session, although there was
initial doubt expressed as to the need for practice to
be examined.

Both the clinical placement and the education
provider were familiar and in agreement with
the requirement for staff currency, so an
existing Mentor Update format was chosen as
a means of accessing the workplace
environment. A group examination of related
current standards of Education, Assessment
and Professional Conduct, enabled a clear
framework of acknowledged obligations to be
identified. Many of these were directly
applicable to the range of issues, as identified
in the research lines of enquiry. As such, it
was possible for assessment staff to relate the
requirements of their own Codes of Conduct,
to the wider aspects of professional support
and development.

Step 2 : Find Common
Ground

Professional Codes extend beyond clinical
applications into the basic framework of
society, as do the concepts of ethics and
accountability, yet (not uncommonly 12), many
of the staff concerned did not feel empowered
to make rationalised arguments in order to
meet their role requirements.
Medicine is a profession for social service,
and it developed organisation in response to
social need. (C. Mayo U.S. Physician 1931) Need
creates process, yet the process often
becomes centre of attention.
In examining some of the markers of
professionalism 14, it was found that once
again, the educational and clinical groups had
a commonality in purpose, which was shared
with the student group they aimed to develop.

Specialized Body of Knowledge
Set of Skills
Group Mission or Identity
Standards of Behaviour and Practice

(80%) strongly agreed that University / Placement
relations had been greatly improved, with clear
channels of communication established for individual
& group discourse.
[ Individual requests for consultation have been
received, in addition to similar requests from other
placement providers at Learning Facilitator Meetings.]
(100%) strongly agreed that the review of
professional standards had provided a linked
understanding of the academic requirements for
students and those undertaking the Assessor role. In
addition, they independently acknowledged strategies
for role development and felt better empowered to
gain access to further information & resource support
(previously addressed as a barrier to implementing
(evidence-based) research 9.
(88%) expressed greatly improved understanding of
the programme documentation, and the requirement
to link this to Evidence-Based Practice, in-line with
published standards.
In addition to receiving clarification of assessment
issues, it was expressed that (the session) had given
(Assessment) Staff confidence in the process and the
potential to access support from University staff with
reduced potential for un-substantiated
student sign(Active Learning
off. In this respect, the process had been successful
Step
4 ?) its original objectives.
in achieving

Conclusions & Ideas For Further
Consideration

Both the Practice Environment & Higher Education had
established common ground, with mutual benefit to all
involved. It was anticipated by those concerned, that
this would result in greater efficiency in the
assessment process, which in-turn would improve
evidence-based practice and subsequent patient care.
Morale was improved, and the process proved to be
inclusive, as opposed to critical.
This approach aims to be repeated at the remaining
placement institutions with the intent of improving
assessment standardisation, communication links and
aid staff development. Further analysis of the wider
findings will help to inform and direct future practice
and related change, and perhaps demonstrating
transferability
to other
fields of work-based
Higher
Education
/ Evidence-Based
Practice / learning.
Professional

On entering a profession, practitioners (at all
practice: shared values common goals.
levels) subsequently take-on the
responsibilities and accountabilities that are
If we fail to engage others, we remain separated from the wider
required for the objectives of that role to be
This provided the focus for addressing the issue
(healthcare) community . Invite people on-board
accomplished 6,7. In examining the evidence
at workplace level.
(but preferably in a language they understand).
of their professional existence, assessment
staff were able to approach both their own
judgements, and those of others (student and
employer), from an evidence-based
perspective. Far from being viewed as being
taught to suck eggs, the group found that
noun . words or expressions used by
they could consider issues independently, in a
associated academic & clinical descriptors
a particular group that are difficult for
manner that both validated clinical and
currently employed ?
others to understand.
educational practice, and enhanced both their
3.
Is the requirement for evidence-based practice
own learning and that of the students. Many
V. Volny, Vermilion Sea Institute.
evenly applicable to pre and post registration
expressed that where once they had felt
development, and how does it relate to
threatened by academia, it could be used as
assessment practice ?
an effective tool in professional
communication
and development,
once basic
References: 1 BOURNEMOUTH UNIVERSITY, 2006. The Essential Guide to Pre-Registration Operating Department Practice - Clinical Staff Guide. Bournemouth: BU
/ ODP, version 3. 2 ASSOCIATION
OF OPERATING
DEPARTMENT PRACTITIONERS, 2006. Qualifications Framework for Mentors Supporting
3
Learners in Practice: Standards and Guidance for Mentors and Practice Placements in Support of Pre-registration Diploma of Higher Education in Operating Department Practice
Provision.
Issue 2. BOURNEMOUTH UNIVERSITY, 2006. The Essential Guide to Pre-Registration Operating Department
principles
hadLondon:
been AODP,
established.

Jargon:

Step 1 :

Remove the
Jargon

Practice - Clinical Staff Guide. Bournemouth: BU / ODP, version 3. 4 UNIVERSITIES SCOTLAND, 2004. What is Higher Education ? Available from: http: / www.universities-scotland.ac.uk/Facts%20and%20Figures/HigherEducation.pdf [Accessed : 01.05.2007]. 5 HEALTH PROFESSIONS COUNCIL, 2005.
Standards of Education and Training. London: HPC. 6 NURSING & MIDWIFERY COUNCIL, 2004. The NMC code of professional conduct: standards for conduct, performance and ethics. London: NMC, Standards.07.04. 7 HEALTH PROFESSIONS COUNCIL, 2004. ODP Standards of Proficiency. London: HPC. 8
NHS EXECUTIVE, 1996. Promoting Clinical Effectiveness: A framework for action in and through the NHS. London: NHSE. 9 ASSOCIATION OF OPERATING DEPARTMENT PRACTITIONERS, 2003. Scope of practice. London: AODP, Issue 1 Revised 2004. 10 Hoskins, S. 2004. Developing Independent
Learners. Available from: http: / www.business.heacademy.ac.uk/resources/landt/learning/independant [Accessed : 01.05.2007]. 11 GOLEMAN, D. 1996. Emotional Intelligence. London: Bloomsbury. 12 PARAHOO, K., 2000. Barriers to, and facilitators of, research utilization among nurses in Northern Ireland. Journal
of Advanced Nursing 31(1), 89-98. 13 MAYO, CH, 1931. Collected papers of the Mayo Clinic and Mayo Foundation, 23:1020. Rochester, MN 14 PLAUT, M. 2006. What does it mean to be a member of a profession ? Available from: http: / www.medschool.umaryland.edu/Professionalism/professionalism_dmrt.pdf
[Accessed : 01.05.2007].

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