Clinical Collaboration in Learning and Teaching for Physiotherapy Occupational Therapy and Dental Undergraduates: Clinical Collaboration in Learning and Teaching for Physiotherapy Occupational Therapy and Dental Undergraduates Dinah Sweet and Chris Locke (SOHCS) John Sweet (School of Dentistry)


Overview: Overview Aims and relevance of project Investigative pre-study questionnaire Planning and methodology Results and evaluation Results/Discussion Conclusion Implications


Aims and Relevance: Aims and Relevance The purpose was to give the 3 different groups of students the opportunity to work together and learn from each other - Learning communities (Shapiro and Levine, 1999) To exchange information and share posture, ergonomic and oral health advice in a real workplace – Situated Learning (Lave and Wenger, 1991) To enhance the students’ communication skills and improve the quality of care for future patients – Integrative Learning, (Shulman, 2007)


Investigative pre-study questionnaire: Investigative pre-study questionnaire Initial exploration of feasibility of study by a questionnaire survey to assess student interest in inter-professional activity Also it was thought important to gauge the students perceptions of ‘good’ posture and how this impacts on working practice This pilot pursued the relevant themes on which to base main project These findings were presented at the World Interdisciplinary Congress of low back and neck pain in Barcelona, November 2007


Planning: Planning The themes were centered around good working posture, ergonomics of the total work situation and the ‘person centered’ approach Three inter-professional clinical sessions (one for each theme) were feasible with 12 students Logistical planning Identifying feedback methods – photography, videoing and focus groups Exchanging ideas between researchers at end of each session allowed ‘tweaking’ of plan


Methodology: Methodology Participants Environments – seminar room, dental work station and phantom head laboratory (a simulated working environment)


Slide7: Dental work station


Slide8: phantom head laboratory


Methodology (continued): Methodology (continued) Briefing sessions in seminar room – informal over lunch, setting the focus for each interaction.


Methodology (continued): Methodology (continued) Observation of encounter and their approach to each other in the different roles as - patient/client/student/peer/colleague Questionnaire and REBA assessment


Slide11: Observing working practice


Slide12: Clinical exchanges of information


Methodology (continued): Methodology (continued) De-briefing feedback and discussion (at work station first and then in seminar room)


Slide14: discussion at work station


Results/Evaluation: Results/Evaluation Students’ inter-professional learning interactions and experiences – “thought of whole task from an ergonomic perspective …..did quick search on line & found power point presentation on ergonomics specific to dentistry” “found it easier to learn from our peers” “really useful information, and fun!”


Results/Evaluation: Results/Evaluation Reflection and insight about themselves in practice and were able to contrast their working positions in the laboratory to their position at the dental work station Mutual respect of their colleagues


Results/Evaluation : Results/Evaluation Students’ approach to each other and person centeredness (implications of different theoretical perspectives - medical v social model) Challenges/reality of working practice Individual variables that impacted on working posture eg. height, left handed Students identified static working posture (repetitive strain injury)


Slide18: Challenges/reality of working practice


Limitations: Limitations Students hadn’t worked on live patients before Building work going on creating noise which impacted on video recording Dental work station occasionally too cluttered to take full picture of dental student’s working posture


Results/Discussion: Results/Discussion Opportunity to discuss different tools that could be used to improve working conditions Photographic evidence and its potential use in postural and ergonomic education – used as an instant feedback tool. REBA – useful objective tool


Slide21: Explaining and demonstrating to patient


Slide22: Improved communication following feedback


Results/Discussion: Results/Discussion Video recordings in the different areas – identified aspects of good practice in a real workplace situation and allowed the students to compare this setting with the laboratory setting – ‘Situated learning’


Results/Discussion: Results/Discussion Analysis of audio recordings from the focus groups – an interpretive qualitative approach, showed that the dental students valued the information exchange for their future work practice while the OT and Physiotherapy students experienced ergonomic challenges of a real working environment and enjoyed the opportunity of working together


Conclusion: Conclusion The study showed that this clinical situation produced a successful model for inter-professional learning identified a need for early ergonomic training for dental students identified how a small learning community of interdisciplinary health care students enhanced their understanding of working practice


Implications: Implications In this context the dental students will benefit from recommendations to incorporate more advice on ergonomics and good working postures into their undergraduate curriculum


Slide27: Suggestions for less time in laboratory but more at work station when starting, using each other as patients (practicing sterile handling, cleaning and giving prevention advice)


Implications: Implications The physiotherapy and OT students will benefit from recommendations that the experience of situated learning is included in their program All three student groups will benefit from working more with other disciplines to improve their quality of patient care and client centered approach


Wider Implications: Wider Implications Informing current and future implementation of IPL in the School of Health Care Studies (Cardiff University) Wider study now needed which evaluates many different IPL activities that have already taken place in order to get more evidence for its future continuation


Acknowledgements: Acknowledgements Funding for this project came from the Interdisciplinary/Inter-professional Collaboration in Learning and Teaching (IICLT) committee, Cardiff University Thanks to the students and staff who participated in this study


References: References Hignett S and McAtmney L (2000) Rapid Entire Body Assessment (REBA) in Applied Ergonomics 31. 201-205 http://www.carnegiefoundation.org/files/elibrary/integrative learning/index.htm Carnegie Foundation (2007) Shuman video – Integrative Learning http://siri.uvm.edu/ppt/dentalergo/sld001.htm Lave J and Wenger E (1991) Situated Learning, CUP, Cambridge Resnik L and Jensen G M (2003) Using Clinical outcomes to explore the theory of expert practice in Physical Therapy Phys Ther. 83:1090 – 1106 Sackett D , Strauss S, Richardson W et al (2000) How to practice and teach evidence based medicine Churchill Livingstone, London. Shapiro N and Levine J (1999) Creating Learning Communities. Jossey-Bass, San Francisco Sumsion T (1997) Client centred implications of evidence based practice in Physiotherapy 83.7