Integrating academic and clinical training - exploring opportunities and innovations

Background: Clinical practice placements are integral to health professional education including the profession of dietetics. They provide experiential learning opportunities with feedback from clinical educators, opportunities to reflect and to continue to improve clinical and professional skills. However, clinical placements are becoming more challenging due to increasing costs, patient complexity and turnover and overall placement shortages with novice students perceived as requiring more intensive supervision. Aim: This research aimed to identify gaps in skills and attributes in health professional students for the clinical environment and explore classroom and hospital-based experiential learning activities to maximise the preparedness and performance of students in the clinical setting; with a focus on the dietetic profession. Method: The research includes six different studies utilising an overall mixed and multi-methods framework. A systematic literature review to identify professional skill gaps of newly graduated health professionals was supplemented by qualitative investigations and thematic analysis of focus groups to gather dietetic clinical educators’ perceptions of students commencing their first clinical placements. Malnutrition screening in hospitals was explored in depth by two mixed methods studies utilising surveys, focus groups, interviews and audits. Another mixed methods study investigated placement-based malnutrition screening as a learning task for pre-clinical students utilising focus groups and questionnaires. The effectiveness of using simulated patients to improve communication skills in pre- clinical dietetics students was researched quantitatively and analysed with parametric and non-parametric tests. Results: Newly graduated health professionals often lack skills such as communication, teamwork, flexibility and reflection with challenges associated with the teaching and assessment of these professional competencies. There are unique challenges when supervising students from culturally and linguistically diverse backgrounds, and there is a need to address the variation in expectations between and within the clinical educator group, students and the university. Clinical educators also reported that student supervision impacts on their time and clinical workloads. Staff time was identified as a common factor influencing a range of both clinical and student- learning outcomes including screening rates of malnutrition by nurses, the optimal choice of malnutrition screening tools in hospital practice; and the usefulness of utilising simulated patients to teach communication skills. A teaching and learning program where students perform malnutrition screening as a pre-clinical learning activity improved student confidence and has potential to save considerable staff time. Using simulated patients to enhance placement readiness showed significant skill improvement however is time, cost and resource-intensive. Conclusions: The range of skills required for students to be optimally prepared for clinical placements and future practice include both professional and clinical competencies. Clinical educators supervise students in an increasingly strained healthcare environment, while universities are under pressure to deliver economical teaching approaches producing competent and employable graduates. Costs need to be analysed when evaluating the benefits of existing teaching methods and instigating future innovations. Authentic and clinically relevant teaching and learning activities such as patient risk screening can constructively impact student learning, and have the potential to benefit organisations. Identifying and implementing learning activities that have positive student and patient outcomes show promise in addressing clinical placement shortages while strengthening engagement between academic and clinical practice placement domains.