Implementing a collaborative model of student supervision in New Zealand: enhancing therapist and student experiences.
This article will identify the purpose of a collaborative model of fieldwork supervision and describe how it supports students' learning and prepares them for future practice. It will bring together current literature and a case example of applying a collaborative model in a New Zealand health care setting. The goal is to challenge the belief that supervising more than one student at a time is double the workload and to allay fears that the students are disadvantaged in terms of learning opportunities and supervisor support. The discussion includes personal reflections from the second author, who was asked to write about her experiences of implementing the model shortly after completion of the final placement for the year. The thoughts Laura shares examine her experience of the model in her setting and provide practical suggestions to assist others to use the model in their practice context.
The collaborative model
Collaboration in this context is a reciprocal process where two or more people work together toward a common goal. It is closely aligned with peer learning, where participants engage in mutually beneficial experiences which involve the sharing of experiences, knowledge and ideas (Boud, Cohen, & Samson, 2001). Through formalised peer learning, supported by fieldwork educators who provide suitable learning opportunities, students are enabled to take responsibility for their learning and participate in quality learning experiences.
A collaborative model makes it explicit that students have primary responsibility for their own learning. Drawing on ideas developed by Knowles (1970), Tuinjman (1995), and Carnall (1998), those engaged in collaborative learning are framed as adult learners who are self-directed and able to identify their learning needs, accumulate and use experiences and knowledge, undertake critical reflection, and be goal directed. These understandings are reflected in the notion of peer learning, which is central to a collaborative model and requires that students to support each other's learning. When shared, these qualities allow adult learners to actively engage in the learning process.
Faced with the new way of delivering student placements, Laura was initially cautious.
I imagined that the university was so desperate for placements, that they were willing to compromise the quality of the placement experience for students. I was also concerned about safety for the patients, who might receive interventions from students with less than adequate supervision, and for the students, who would not have the opportunity to fully observe and learn from an experienced Occupational Therapist during the 8 week placement. For the students who would be coming here for their final placement before qualifying, I wondered if this experience would be sufficient to prepare them for working as a new graduate.
Such concerns are not uncommon, perhaps accounting for the fact that more than 70% of placements in clinically oriented services offered to AUT University's Department of Occupational Science and Therapy in 2008 were for one registered occupational therapist directly supervising one student. The predominance of offers of 1:1 placements aligns with a well defined role within traditional or role-established placements (Mulholland & Derdall, 2005). Despite its long history, however, the 1:1 model has an inherent problem. As reported by Thomas, Penman and Williamson (2005), it supports the notion that the student is the novice and the therapist is the expert, which reinforces dependency and is not consistent with the adult learning notions of independence, self reflection and critical thinking. This critique of established practice is not new, with Heath (1996) citing a number of authors who claimed that the 1:1 fieldwork model impedes the students' development of initiative, and their ability to problem solve, make decisions and think critically. Additionally, there is mounting evidence to suggest that collaborative models of fieldwork supervision are more supportive of adult learning (Martin & Edwards, 1998; Martin, Morris, Moore, Sadlo, & Crouch, 2004; Tiberius & Gaiptman, 1985).
What can a collaborative model offer?
A number of studies exploring a collaborative model have been published in the international occupational therapy and physiotherapy literature. It has been reported that the use of the model more closely represents the skills needed for working in a team environment (Bartholomai & Fitzgerald, 2007) and is overall more representative of current practice environments than the traditional 1:1 model of student supervision (Farrow, Gaiptman, & Rudman, 2000). Research confirms the advantages for both students and therapists, which include more open communication between therapists and students (Fosnaught, 1996). By allowing greater autonomy in the practice environment, a collaborative model enables students to become more self directed and independent, to share their opinions and experiences, and to develop their clinical reasoning abilities (Baldry Currens, & Bithell, 2003). When groups of students work together, they report that working collaboratively with a therapist and their peers facilitates active learning, fosters increased clinical competence and increases confidence (Bartholomai & Fitzgerald; Fosnaught; Martin et al., 2004; Martin & Edwards, 1998; Tiberius & Gaiptman, 1985). Furthermore, a recent study identified that new graduate occupational therapists perceive student experiences when they were encouraged to 'have a go' with plenty of 'hands on' experience, as ideal learning opportunities. They also identified placements with other students, the use of learning contracts and placements where their learning needs were considered, as those they most valued and enjoyed (Kirke, Layton, & Sim, 2007).
These outcomes may be explained in terms of the opportunities students have to problem solve with peers, which reduces the need to ask the supervisor and facilitates a deeper understanding of the importance and process of reflection (Martin & Edwards, 1998). This type of learning ensures that students can become independent thinkers and have the resources to become life long learners. In addition, the use of a collaborative model has been reported to offer further benefits to students. For instance, being able to provide each other with emotional support during the placement, the opportunity to socialise together outside of the work environment, and reduced costs through sharing travel, accommodation, photocopying and text books (Martin & Edwards).
A collaborative model has been found to bring a number of benefits to occupational therapy departments. Within this model it is usual for a high proportion of the fieldwork supervisor's caseload to be allocated between the students (Baldry Currens & Bithell, 2003; Bartholomai & Fitzgerald, 2007), which results in a reduced clinical load for the therapist and can increase departmental productivity by increasing the number of patient contacts and decreasing waiting lists (Bartholomai & Fitzgerald). Additionally, students may work together on specific projects of benefit to the department (Baldry Currens & Bithell).
As with other models of fieldwork, there is a link between the supervision of students on placement and subsequent recruitment of newly graduated therapists to the organisation (Thomas et al., 2007). Students who are later employed within a service know what the expectations are and require less induction because they are already familiar with service protocols, values, expectations and the environment. Importantly the employer already has an awareness of what the new recruit can bring, as well as their skills and professional development requirements.
Preparation for future practice
Changes in health care priorities in New Zealand call for a diversification of occupational therapy practice into prevention of health problems, health promotion and working with communities (Fortune, Farnworth, & McKinstry, 2006). There is significant agreement amongst practitioners and educators of the need to provide fieldwork learning experiences that reflect that diversity (Adamson, 2005; Clark, 2004; Fortune et al., 2006; Thomas, Penman, & Williamson, 2005). A collaborative model is well suited for preparing graduates for these emerging roles, particularly when there is no occupational therapist on site, because students are placed in pairs or groups. With supervision, their role becomes one of envisaging new occupational therapy services or developing consultative roles as they learn to manage their time, be responsible for their own learning and cultivate effective communication skills.
Case example: Development of a collaborative placement in New Zealand
The Auckland University of Technology (AUT) was approached informally by an organisation providing aged care services. The facility wanted to develop an occupational therapy service and promote excellence in service provision. Discussions ensued regarding the implementation of a collaborative model of student supervision, which would require occupational therapy support. It was decided that the organisation would part fund an occupational therapy position in collaboration with the university and the appointment process was implemented with support from the university. Following the appointment of a registered occupational therapist to the organisation, the university provided initial training for the therapist in the model of collaborative supervision and ongoing support to the therapist and the students. This included topics that are usually covered in fieldwork educator workshops, such as learning styles, giving feedback and developing learning contracts. Laura, who was the therapist appointed to the role reflected:
In January 2006 I accepted a position as part-time, sole occupational therapist at an 80 bed, aged care facility, including a secure dementia unit. The hours for this position had been increased due to a contract negotiated between AUT and my employer, where AUT contributed financially to the salary and the occupational therapist was required to take multiple occupational therapy students on fieldwork placements. The contract, which was negotiated prior to my appointment, agreed that I would provide supervision for groups of students, three times a year. After a couple of months settling into my new job, one of the fieldwork lecturers from the University visited me for a day. We discussed the collaborative model and the preparation I would need to do, and brainstormed the learning opportunities within my setting for the students. The lecturer also explained the importance of being aware of students' different learning styles and identifying my own strategies to facilitate learning, supervision and the assessment process. By the end of this day, I was convinced that the students would bring an overall benefit to my organisation rather than being a cost or burden. With one student to 20 patients, the patients would experience significantly greater one-to-one therapeutic contact than I could possibly provide on my own, working part time. Having several students present at the same time would provide a critical mass to promote the role of occupational therapy, person-centred care and the importance of participation in occupation for our patients to the interdisciplinary team. They would be able to work on projects which would bring benefit to the organisation. They would also be able to support each other in many ways, which would offset the fact that my time with each of them would be limited.
Implementation of a collaborative model in practice
A key theme from the literature is the importance of being committed to making the model work and being well organised (Bartholomai & Fitzgerald, 2007; James & Prigg, 2004; Martin et al., 2004; Martin & Edwards, 1998). Laura's comment shows her commitment and awareness of the systems and resources she would need to put in place.
While I was feeling mentally prepared and excited about the students coming, I was aware that I had plenty of preparation to do before the first students arrived. I needed to organise space for them, discuss their arrival with staff, identify staff members they could go to in my absence, book group and individual supervision time, draw up timetables for the first 2 weeks, and put together a student resource file.
In contrast to 1:1 or traditional placements, where "the student is able to shadow the therapist closely", a collaborative model requires more detailed preparation. Part of that preparation was to "identify and formalise potential projects the students could complete throughout the placement and to book in-service slots for them to present their work to the team". Laura also discovered that with multiple students, she needed "to allocate a caseload for each student. In this case it was a ward each". As with any fieldwork placement, that involved identifying the learning opportunities available to each student, in order to guide the development of their learning contracts.
In collaboration with AUT, Laura understood that the students would have scheduled meetings each week: "a minimum of 40 minutes for individual supervision", and supervision as a group. Over time, processes developed to manage communication between Laura and the students. This included:
Making maximum use of group supervision sessions and check-ins. Sometimes I found myself giving information to a student in their individual supervision which all the students needed to know. Having a group check-in at the beginning and the end of the week gave the students a regular time to bring their issues/questions to me. Also, practical strategies were developed to ensure student documentation was checked and signed off. We devised a form where they listed all their entries and I checked them on a weekly basis.
To evaluate each student's progress, Laura "made use of informal observation" and booked "times each week to observe each student, particularly over the last 2 to 3 weeks". For the midway and final evaluations "it worked better for me to split them over two sessions rather than all on the same afternoon". Additionally, to save time during evaluations Laura stated that she "learnt to focus on criteria/issues which required further development and to give general positive feedback on criteria where they were doing well". A key piece of learning was "to have close communication with the university and not to be afraid to contact them".
Barriers to implementing a collaborative model
While the advantages of the model have been discussed above, there are disadvantages, which vary depending on the number of students involved. Martin et al. (2004) interviewed occupational therapy fieldwork supervisors and students about their experiences of a collaborative model comparing 1:1, 2:1 and 3:1 placements. For the 2:1 model, only three disadvantages were reported. These included: difficulty maintaining student privacy; not using peer learning optimally; some settings were inappropriate for the model. For the 3:1 model, a greater number of disadvantages were identified. Supervisors reported difficulty knowing individual students' strengths and weaknesses, difficulty in monitoring progress, having less time to spend with other staff members, and having less time to spend with each student individually to observe, provide feedback and listen to their reflections. Students in the 3:1 model were concerned that the supervisor would not be able to assess them accurately, and both supervisors and students reported that it took longer to build a relationship. In some settings space was an issue or there were not enough clients for all the students. In addition, Bartholomai and Fitzgerald (2007) identified barriers reported in the literature related to therapists' concerns about their ability to manage more than one student, not having sufficient time to prepare, perceived increase in workload, and lack of resources. Student incompatibility, unhelpful competitiveness, and differences in student competency were also identified as potential issues (Martin & Edwards, 1998; Martin et al.; Tiberius & Gaiptman, 1985).
Identifying these potential challenges is useful, because the issues can then be addressed by both universities and supervisors before the placement. For example, once the placement provider contract has been completed, universities can deal with privacy issues through the use of confidentiality agreements amongst the students. This would be the same as therapists or researchers asking group participants to keep information revealed within a group confidential. The benefits of collaboration should be outlined to students, to enable them to recognise the value of becoming productive team members. Similarly, supervisors might usefully consider relationship building strategies early in the placement, and seek assistance from the university regarding resources they need to develop, such as a confidentiality agreement specific to their site. It is important to remember that the knowledge, skills, and attitudinal shifts resulting from a collaborative partnership are legitimate learning goals and contribute to the students' demonstration of competence.
Maintaining open communication and recognizing the potential of the model for all involved is crucial. Reflecting back on her experiences, Laura reported:
In my first year in this position, I supervised nine students in total (four students for the first placement, two for the middle, and three for the final placement). Looking back on the placement with the first group of year III students, there were times where I felt overwhelmed. Fortunately, throughout the year, the university proved to be a reliable and valuable support and we kept in touch with weekly phone calls. Towards the end of the second week of the first placement, I discussed my concerns with the university about not being able to spend enough time with the students demonstrating and role modeling, and observing their performance. I was reassured that I did not have to observe everything they were doing all of the time, and during weekly supervision sessions I would expect them to provide me with evidence of what they had been doing. I came to the conclusion that I needed to let go of my attachment to the traditional model of student placements, and work with the reality of this placement. I focused on the positives, particularly the degree of learning that was taking place and the increased student confidence that was evident when a positive outcome was achieved. This was not easy, and I continued to grapple with the collaborative model of supervision during the remainder of that first placement. The second placement was easier and although they were second year students and this was their first major placement, both of the students were highly motivated and flourished in this setting. By the final placement, even though I was feeling somewhat tired and the students were similarly fatigued, I was feeling much more comfortable with the model.
Laura's report points to a possible weakness in the Martin et al. (2004) study, in which they did not differentiate between therapists who were novices in using a collaborative fieldwork model and those who had more experience. As with most aspects of practice learning takes effort, but the pay-off is decreasing effort and increasing confidence in actions.
In our experience, implementing a collaborative fieldwork model in a residential service for older people had benefits for all parties as detailed below.
The students' feedback indicated that they valued the opportunity to work with a wide range of patients in this setting. They welcomed having freedom to develop their own style of practice without a therapist watching over them. Furthermore, they appreciated opportunities to work closely with other members of the team, to develop and implement innovative interventions. Most importantly, they appreciated the support they were able to give each other.
The students' presence had a noticeable impact on the hospital. They brought energy and enthusiasm, and many new ideas for interventions and changes to the environment to enable the patients' participation in occupations. The additional occupational therapy presence and input provided by the students had a significant impact on the patients, their families, ward staff and at a management level. The ward staff reported that they appreciated the extra contact the patients received and when there were less than four students, the wards which went without a student were sorely disappointed.
The occupational therapist
Having the students helped me to build my relationships with the nursing staff, as they saw more of what occupational therapy had to offer. As for my concerns about safety and whether the students would learn what they needed to, these proved unfounded and if anything, they had more opportunities to develop skills and confidence due to the autonomy they were given. In terms of preparing the students for graduation, it was as close an experience as possible to the real world and they responded well. Overall, working with the students using the collaborative model was a great experience. I grew both personally and professionally, ward staff were very positive and appreciative, the patients received a greater level of occupational therapy input and attention, the organisation was encouraged to undertake a major environmental enhancement to increase the patients' opportunities to participate in occupation, and the students had an abundance of learning opportunities.
The evidence presented, and Laura's reflections on implementing a collaborative model in practice, support the use of this model in New Zealand. Arguably this approach may not work in every practice environment for every therapist, but the stated benefits in the development of self directed, reflective and critical practitioners is evident. Organisations also benefit from increased occupational therapy input, and the profession achieves a higher profile. There is little evidence as to the benefits of using a collaborative model of supervision in New Zealand, but as its use becomes more widespread, the authors anticipate research that will explore the benefits to organisations, fieldwork educators and students. The findings of this case study indicate that students graduate with an enhanced ability to be self directed, to critically evaluate and reflect on practice, and to be goal directed.
1. A collaborative model of supervision has benefits for the supervising therapist and the organisation as well as students.
2. A collaborative model of supervision increases students' autonomy, and enhances learning, skills, and confidence in the practice environment.
3. Careful preparation and planning ensures a successful placement for all concerned.
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Brenda Flood, MScOT, DipOT
Department of Occupational Science and Therapy
Laura Haslam, PGCert, BSc(Hons)OT
Senior Occupational Therapist,
Canterbury District Health Board
Associate Professor Clare Hocking, PhD
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|Title Annotation:||FEATURE ARTICLE|
|Author:||Flood, Brenda; Haslam, Laura; Hocking, Clare|
|Publication:||New Zealand Journal of Occupational Therapy|
|Date:||Mar 1, 2010|
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