Post-Registration IPL: Becoming a Paediatric Practitioner

doi:10.4236/ce.2012.326119

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Creative Education

2012. Vol.3, Special Issue, 802-806

Published Online October 2012 in SciRes (http://www.SciRP.org/journal/ce) http://dx.doi.org/10.4236/ce.2012.326119

802

Post-Registration IPL: Becoming a Paediatric Practitioner

“Virtually”

—NHS Education for Scotland & University of Nottingham AHP Paediatric

E-Learning Pilot Report

Sarah Westwat e r- Wo od1, Jane Reid1, Pauline Berine2, Grahame Pope3

1Division of Physiother a py Education, University of Nottingham, Nottingham, UK

2AHP National Lead for Children and Young People, Sco ttish Government, Edinbu rgh, Scotland

3Education Projects Manager (AHP), NHS Education for Scotland, Edinburgh, Scotland

Email: Sara h . Westwate[email protected]

Received September 10th, 2012; re vised October 8th, 2012; October 24th, 2012

Educational solutions for allied health professionals (AHP’s) need to stimulate problem-solving skills al-

though AHP’s seldom have the opportunity to develop these skills in a paediatric environment prior to

registration. Computer aided learning (CAL) has become an established educational option with a grow-

ing body of literature detailing positive CAL introduction within HC education across many disciplines.

NHS Education for Scotland (NES) scoping exercise identified a paucity of paediatric education at a pre

and post registration levels for all Allied Health Professionals (AHP’s), except speech and language

therapists. The question considered was would a reusable CAL (ReTool) be a useful tool in developing

inter-professional learning for AHP’s in paediatrics with potential to become a core part of induction for

new and aspirant paediatric AHP’s allowing flexibility in access (location & time). A pilot was completed

with a group of AHP’s (N12). ReTool was evaluated positively by users for usability (88.9% rated very

easy or easy). Working with children and young people requires the ability to work as part of a multi-

gency team and an ability to learn from one another therefore individuals were asked to comment on the

IPL opportunity of the project. They rated ReTool positively in facilitating joint working and decision

making for IPL (N10).

Keywords: Inter-Professional Learning; Reusable Computer Aided Learning

Introduction

An NHS Education for Scotland (NES) scoping exercise

identified a paucity of paediatric education at a pre-registration

level for Allied Health Professionals (AHPs), with the excep-

tion of speech and language therapists (NES, 2009). It also

found that at a post-registration level, AHPs had varied access

to education and a stakeholder consultation recognised the need

for a core learning resource that could be included at induction.

The small numbers and geographical distribution of clinicians

makes the delivery of inter-professional learning challenging

and the vulnerability of the patient group is problematic in de-

livering relevant learning opportunities. NES and the Physio-

therapy Division at University of Nottingham (UoN) entered

into a collaborative venture to identify whether a contextualised

Reusable e-Tool (ReTool) developed for undergraduate (UG)

physiotherapy education in paediatrics could be used as part of

a “virtual” paediatric induction programme for multi profes-

sional AHPs. The development and implementation of the Re-

Tool is published elsewhere (Westwater-Wood & Dennick,

2011).

The ReTool utilises a series of virtual case studies with em-

bedded multimedia and when evaluated with UG physiotherapy

students it was rated very highly for problem solving and clini-

cal reasoning skills (Westwater-Wood & Dennick, 2011). Four

separate learning tasks are delivered at weekly intervals to

stimulate clinical reasoning and problem solving in small group

discussion. It was proposed that ReTool may address some of

the issues identified for AHPs new to paediatrics with the po-

tential to become an integral part of the educational framework

for AHP paediatric induction in Scotland.

Methodology

In recruiting AHPs to the pilot it was important to reflect the

different settings that AHPs worked in across Scotland. There-

fore initial contact was made by NES AHP Education Projects

Manager to Paediatric AHP managers & AHP Directors across

urban and rural settings in Scotland via a circular e-mail. They

were asked if they would be willing for a member of their staff

to participate in the pilot and then to identify potential partici-

pants who would then be contacted by NES to give them more

information and to ascertain willingness to participate. This

method identified 15 AHPs willing to participate in the pilot

however due to timing of the pilot and other pressures 3 opted

not to be involved.

Twelve AHPs were recruited which included physiothera-

pists, occupational therapists, speech and language therapists

and dieticians from 4 of the territorial health boards across NHS

Scotland. Participants included AHPs working in 2 children’s

hospitals, community paediatrics and there were 2 remote and

rural practitioners. It was postulated that it would be beneficial

to have a mixture of AHPs who were new to paediatrics and

also those who were more experienced, with the notion to op-

S. WESTWATER-WOOD ET AL.

timize varied experiences in supporting AHPs new to paediat-

rics through the induction period. The participants were allo-

cated to one of three groups and were allocated one of 2 case

studies. Two groups were allocated a child with Cerebral Palsy

and one group a case of developmental delay. One group com-

prised participants working in children’s hospitals solely and

the other 2 groups were a combination of hospital and commu-

nity to reflect the diverse nature of inter-professional learning

and working. The pilot ran for 4 weeks with four separate

learning tasks delivered each week via ReTool.

Each week the individual groups are presented with case in-

formation some which mimics aspects of real practice. So for

example there are multimedia elements such as video and audio.

These will only play once thus reproducing a telephone con-

versation or a time limited hi story taking se ssion with a patient .

Other resources are offered as a selection of 2 out of three items

so that the group have to discuss the potential usefulness and

reasoning for selecting one over the other. Again an example

might be “would you phone the patients school or review the

occupational therapists full report”, given that in real practice

time is pressurised. Participants were also expected to take part

in a weekly conference call with other members of their group

to discuss their reasoning for the choices and their hypothesis

development as they gained more details of the case. These

sessions were facilitated by the NES AHP Education Projects

Manager (JR).

Inclusion Criteria

 AHP working in paediatric services for all or part of the

time

 Internet access at home (due to the NHS firewall the mul-

timedia components of the resource were not accessible at

work)

 Agreement from managers that they could participate in the

pilot and would be able to negotiate time to work at home

Exclusion Criteria

 AHP not working in paediatric services

 No access to internet other than at work

 No agreement from manager

It is acknowledged that due to the recruitment methods and

the inclusion and exclusion criteria there could be an element of

bias which precluded other individuals taking part. However, it

was deemed that for a pilot study on usability of ReTool that

this was acceptable.

As this was a service educational development there was no

requirement for ethical approval.

The project was evaluated by users for usability and accessi-

bility via a bespoke questionnaire (open and closed questions)

with reflective accounts of learning and semi-structured discus-

sions to explore aspects of inter-professional learning and

clinical decision making. The bespoke questionnaire was based

upon the previous study (Westwater-Wood & Dennick, 2011)

which had demonstrated basic face validity. In line with the UG

version, pilot participants also submitted a report detailing their

findings for the case study with an action plan for the referrer.

The study findings therefore produced a mixture of qualitative

and questionnaire based quantitative data.

The timing for the pilot was opportunistic to avoid ReTool

being used by the UG students at the same time and also to fit

in with project timescales at NES. Although this might not be

ideal it did reflect practice and the difficulties releasing time for

education for clinicians.

Results

A total of 11 of the 12 AHPs recruited to the pilot completed

it. The individual who was unable to complete had to submit a

concurrent post-graduate assessment related to paediatrics at

this time and needed to prioritise this. For some questions only

10 AHPs provided answers.

Ten of the twelve participants completed the bespoke ques-

tionnaire. This was delivered online by Questback worldwide

(http://www.questback.com/) and eleven of the twelve partici-

pants completed reflective accounts. All twelve participants

participated in at least one of the semi-structured discussions

and one group where all 4 participants took part in each of the

weekly sessions; the other groups had one or two missing each

time due to annual leave or work pressures.

Demograp hic Informatio n

The participants were asked to state how long they had been

qualified and how long they had worked in paediatrics and the

table outlines this information. One of the participants was

moderately new to paediatrics (1 - 2 years) but had been quail-

fied for more than 5 years (Table 1).

The following results are reported in relation to each other to

combine into themes the 3 elements:

 Bespoke questionnaire

 Reflective accounts

 Semi-structured discussions

Learning Styles

Individuals were asked to rank the ways they learnt most e f-

fectively. Not unsurprisingly for mainly practical AHPs the

majority 70% (n = 7) felt that a practical session was most ef-

fective but with the exception of 1 individual no-one ranked a

web-based workbook as one of their 3 most effective learning

modes. However 83.3% (n = 5) stated that they were confident

computer users and would “prefer to access activities via the

web rather than a book, journal or library”.

This question was free text to allow individuals to express

their own thoughts and samples of these are displayed below.

However the themes were:

 Different formats of learning; audio, video, text

 Inter-professional Learning

 Learning more about particular conditions

Things enjoyed most about ReTool (n = 10).

For example:

“I enjoyed interacting with therapists from different profes-

sions.”

“Very practical application, build a report through using the

tool rather than writing an essa y. ”

Table 1.

Duration of post graduate qualitfication and experience.

Length of time Post Qualificatio n

% (n = 10) Working in Paedia trics

% (n = 10)

Less than a year 0 40

1 - 2 years 10 30

2 - 5 years 70 20

More than 5 years 20 10

S. WESTWATER-WOOD ET AL.

“It was enjoyable learning in a new and different way.”

“Interesting insight into other allied health disciplines” “Ex-

cellent resources e.g. video of assessments and telephone con-

versations.”

“Opportunity to talk with others about process”

“Hearing other professionals perspectives on case studies and

being forced to think holistically”

“Learning more about CP and reading relevant research arti-

cles”

“Good way to work through the thought process of subjec-

tive and objective assessment”

It was interesting to note the value individuals placed upon

accessing contemporary knowledge via research articles and the

benefits they perceived in the opportunity to discuss with col-

leagues. The impression is given that this is perhaps not com-

mon practice and may indicate a need for further education and

support.

Things enjoyed least about ReTool (n = 10)

This question was also free text to allow individuals to ex-

press their own thoughts and samples of these are displayed

below. The themes were:

 Inability to access all the resources at work

 Only being able to view a resource once

 Time; waiting for others to join in tasks and occasionally

lack of group involvement

 Time; coincided with summer holidays for some

For example;

The tensions around group dynamics reflect issues which

arise from time to time in all team working. Thus this aspect is

not viewed as necessarily negative in use of such a tool. The

feedback from the pilot participants particularly around dislik-

ing being “made to choose” reflects UoN experience with stu-

dents (Westwater-Wood & Dennick, 2011). Individuals feel

that they might be losing something or lack confidence to jus-

tify their clinical reasoning out loud to the multi-professional

group. Again these decisions around optimising time by rea-

soning choices are a valuable experience for real practice. To

have the opportunity to hear and present reasoning for these

choices is core to reflective practice and developing expertise

(Schon, 1991).

Usability

The ReT ool was evalua ted by users fo r usability . Nine of the

twelve participants provided feedback and rated it positively

with 88.9% agreeing that overall usability was easy or very

easy (Table 2). This is in keeping with the UG pilot where

overall usability was also rated highly (Westwater-Wood &

Dennick, 2011).

AHPs New to Paediatrics

As was discussed previously it was not possible nor felt en-

tirely appropriate to only have AHPs who were new to paediat-

rics participating in this pilot. However it was essential to as-

certain the appropriateness of the ReTool for AHPs who will be

new to paediatrics.

Nine individuals responded to the questions about elements

of task, facilitation, IPL and the discussion forum with results

being very positive on a 5 point rating scale. With 5 being

strongly agree (Table 3).

It was also important to consider whether the learning out-

comes set for the pilot would meet the requirements of AHP’s

Table 2.

ReTool usa bi lity ranking (N9).

Rating Overall

usability

(n = 9)

Videos

usability

(n = 9)

Audio

usability

(n = 9)

Document

usability

(n = 9)

Very difficult0% 0% 0% 0%

Difficult 0% 0% 11.1% 0%

Acceptable 11.1% 11.1% 0% 0%

Easy 77.8% 55.6% 44.4% 44.4%

Very easy 11.1% 33.3% 44.4% 55.6%

Table 3.

Task, IPL elements and L earning outcome achievement.

Task, IPL elements (n = 9) Mean

The tasks are set at the right level 4.00

Facilitation sessions are useful 3.78

Tasks are a useful way to fac i lit ate IPL 4.00

Discussion forum is a useful wa y to explore clinical

decision making 3.67

Learning o u tcome (n = 10 ) Mean

Develop kn owledge and understanding of a specific

paediatric pathology 4.00

Develop cl in ically prov ok ed proble m solving skills and

confiden ce me an 3.40

Develop cl in ical reas o ning in rega rd to the m anagement

of a paediatric condition 3.60

new to paediatrics. Ten individuals responded to this question

with results being very positive (Table 3) again on a 5 point

scale with 5 being strongly agree. The mean value has been

used to report these findings (Bandolier, 2010).

Inter-Professional Learning

In working with children and young people a core skill is the

ability to work as part of a multi-agency team, learning with

and from each other. Individuals were therefore asked to com-

ment on IPL as part of the pilot and also in general; ten indi-

viduals completed this section and rated the experience posi-

tively in this skill (Table 4).

The reflective reports elicited comments on the topic of IPL

with a theme around valuing the opportunity to discuss with

other professions for example:

“I felt that the multi-professional approach was useful in de-

veloping MDT working because, through the discussion forum

decisions were reasoned by members of the group”

“Learned more about how OTs & SLTs structure an assess-

ment with a paediatric patient and what wording they use/don’t

so better able to communicate with them”

“Excellent forum for discussion with other health profes-

sionals—allowing for understanding of different approaches to

treatment”

This appears to reflect the MDT demands of case manage-

ment in paediatrics. It supports the notion that individuals want

804

S. WESTWATER-WOOD ET AL.

Table 4.

Use in IPL (n = 10).

Question Mean

Useful to work with oth er health care professional s in a

group 4.20

Gained knowl edge about another p r ofessional during pilot 3.40

Learning in this wa y could facilita te joint working and

decision making 3.50

Would prefer to work with uni-professional group 2.20

to learn together which is found within the literature around

learning being facilitated with peers or near peers (Daniels,

1996; Evans & Cuffe et al., 2009).

Future Recommendation

Finally the participants were asked whether they would rec-

ommend the ReTool as a learning resource. The results were

overwhelmingly positiv e (Table 5).

User identified Limitation

Although this appears to be generally a very positive re-

sponse to this pilot by participants a theme which emerged over

several aspects and not one question was that the time required

was more than expected with a need to be more directing in the

level of commitment for all group members.

For example:

“the nature of the time commitment of the tool lends itself to

those who are not facing the time pressures of a demanding

job”

“I found it difficult working in the group and felt that not all

members of the group were committed to the pilot”

Discussion

Although some participants highlighted the need to be more

directive and to agree from the outset times and commitments

to log in and to contribute to the discussions. Overall this was a

minor theme. It may be explained by the period during which

the project ran as unfortunately several individuals had holidays

during this time. It might be that other group members could

have summarised or provided an update of what had gone on in

their absence. This is perhaps indicative of the need for AHPs

to engage in more inter-professional learning to enhance cohe-

sion around the learning experience as a team. MDT group

learning should be a core learning component, such as in this

project, of all teamwork. The more evident positive perceptions

of the experience were around opportunities to develop MDT

communication skills and understanding of professional roles

stimulated by the ReTool driving discussion around choices

and justifying individual reasoning.

Some aspects not captured by the participant evaluation but

noted by the facilitator and project team were the need to use

terminology that was applicable for all AHPs or have a glossary

of terminology e.g. subjective and objective assessment was not

a term that SLTs used. It was also noted that there needed to be

more attention to the regionalist nature of policies, legislation

and agencies available to enhance an individual’s learning. For

example some content was England and Wales specific with

Table 5.

For what would the ReTool be recommended (n = 9).

Prompt Yes %No %

Experienced AHPs new to pae diatrics 100%

Students on pla c eme nt 70% 30%

New graduates 90% 10%

Returners to paediatrics 77.8%22.2%

Returners w ho have not previously worked

in paediatrics 90% 10%

some referenced services not in existence in Scotland i.e. Scot-

land has a visiting teacher service rather than Portage.

For the pilot it was important for participants to have internet

access at home because of the inability to access the multi-

media resources through the NHS firewall. Although this was

acceptable for a pilot it would be a major area that would need

addressed going forward. Otherwise there could be issues

around equality and diversity if individuals could not access a

key induction resource. Other platforms and the potential for

any NHS closed system to have a parallel system for educa-

tional content isolated from the required very robust firewalls

for patient content are options.

The feedback from the participants regarding choice and IPL

are very important. The need to articulate clinical reasoning as

part of a team is challenging and was integral in the conception

of the development of ReTool; and the findings are supported

in the literature and previous evaluations of the UoN UG pro-

gramme. However, the strength in the ReTool format is that not

only does it enhance IPL but because individuals need to com-

pile a profession specific report they are also learning uni-pro-

fessional elements. Both of these factors were identified in the

NES 2009 scoping report as being essential in the development

of a core resource for AHPs working within paediatric services.

Although there was some debate about the length of time the

programme should be accessed over in general 4 - 6 weeks is

probably the preferred length. This gives individuals time to

absorb and consolidate learning, to access reading materials

relevant to the case studies and to analyse and discuss these. In

a recent study conducted in NHS Scotland (unpublished) clini-

cians reported that once in practice they lost skills in being able

to access evidence and critically appraise it. The wide literature

on implementing evidence based practice echoes a gap between

published literature and implementation, which is similar to

these AHP clinicians experience (Haynes & Haines, 1998;

Restas, 2000; Schreiber & Stern, 2005,). The nature of ReTool

enables clinicians to maintain these skills in a safe environment

with support of peer IP colleagues. This pilot users experiences

are in step with the recommendations from the systematic re-

view by Barr et al. (2005) in that they are positive, are collabo-

rative and support development of capability.

Limitations

The main limitation of this pilot is the lack of long term fol-

low up. Occasions of inter-professional discussion, any changes

in amount or use of MDT goals, intervention program and

support of AHP recommendations might be considered in an

audit cycle. AHPs’ own perceptions of changes in their own

S. WESTWATER-WOOD ET AL.

806

clinical practice would also be appropriate to consider in any

further investigat io n.

Conclusion

The collaboration between UoN and NHS Education Scot-

land has been very positive. The contextualised e-tool program

ReTool was successfully implemented and evaluated for the

needs of inter-professional professional development in the

field of paediatrics. Clinical reasoning and solution options

from different AHPs were shared within multi professional

groups and demonstrated the low desire for paediatric AHPs to

work in uni-professional groups but to be aware of the balance

in the size of larger groups and the dynamics therein. The Re-

Tool should be incorporated into the induction component of

the education framework for AHPs working with children and

young people. To achieve this, the issues identified around

glossary, referencing and learning relating to the needs of AHPs

in Scotland and the barrier of the NHS firewall need to be con-

sidered. In addition to meeting the learning needs of individ-

ual’s access to ReTool will also provide evidence for individu-

als to meet the requirements of the NHS Knowledge and Skills

framework (Department of Health, 2004).

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