Australian Occupational Therapy Journal (2015) 62, 13–20
doi: 10.1111/1440-1630.12165
Feature Article
Supporting new graduate professional development: A clinical learning framework Cate Fitzgerald,1 Alis Moores,2 Allison Coleman3 and Jennifer Fleming4 1 Statewide Clinical Education and Training Program, Metro South Hospital and Health Service, Brisbane, 2Ocupational Therapy Department, Townsville Hospital and Health Service, Townsville, 3School of Health and Rehabilitation Sciences, The University of Queensland, and 4The University of Queensland and Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
Background/aims: New graduate occupational therapists are required to competently deliver health-care practices within complex care environments. An occupational therapy clinical education programme within a large public sector health service sought to investigate methods to support new graduates in their clinical learning and professional development. Methods: Three cycles of an insider action research approach each using the steps of planning, action, critical observation and reflection were undertaken to investigate new graduate learning strategies, develop a learning framework and pilot its utility. Qualitative research methods were used to analyse data gathered during the action research cycles. Results: Action research identified variations in current practices to support new graduate learning and to the development of the Occupational Therapy Clinical Learning Framework (OTCLF). Investigation into the utility of the OTCLF revealed two themes associated with its implementation namely (i) contribution to learning goal development and (ii) compatibility with existing learning supports. Conclusions and significance of the study: The action research cycles aimed to review current practices to support new graduate learning. The learning framework developed encourages reflection to identify learning needs and the
Cate Fitzgerald MBA, BOccThy; Clinical Education Program Manager for Occupational Therapy. Alis Moores MSc Advanced Health Care Practice, BHsc (Hons) Occupational Therapy; Occupational Therapy Clinical Education Leader. Allison Coleman BHSc(OT); Clinic Manager – Occupational Therapy. Jennifer Fleming PhD; Associate Professor, Conjoint Associate Professor in Occupational Therapy. Correspondence: Ms Cate Fitzgerald, Allied Health Education Unit, Building 61, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Brisbane, Qld 4102, Australia. Email: [email protected] Accepted for publication 26 August 2014. © 2014 Occupational Therapy Australia
review, discussion of, and engagement in, goal setting and learning strategies. Preliminary evidence indicates that the OTCLF has potential as an approach to guide new graduate goal development supported by supervision. Future opportunity to implement a similar learning framework in other allied health professions was identified, enabling a continuation of the cyclical nature of enquiry, integral to this research approach within the workplace. KEY WORDS new graduate, professional education, reflective practice, supervision, mentoring.
Introduction The challenges facing new graduate occupational therapists as they transition from student to professional are well documented (Morley, 2006; Robertson & Griffiths, 2009). New graduates are required to demonstrate professional competence by having the relevant knowledge, skills and attitudes to perform the job while meeting expectations regarding management of caseloads and time efficiency (Occupational Therapy Australia, 2010a; Smith & Pilling, 2008). Complex health-care environments contribute to the demands on the new graduate workforce (Fortune, Ryan & Adamson, 2012; Smith & Pilling, 2008). Increasingly employees are seeking work ready graduates whose knowledge, skills and attitudes have an immediate effect on health-care provision (Fortune et al.; Mulholland & Derdall, 2004). Currently in Australia, an occupational therapist is considered to be a new graduate for two years of practice post-graduation. It is recognised that feelings of clinical competence continue to develop from six months to two years post-graduation (Hodgetts et al., 2007) and this is reported as the optimum time to assist new graduates to develop both clinical and professional skills vital to support their transition from student to practising professional (Smith & Pilling, 2008). Within
14 Queensland Health, a statewide public health system, new graduate occupational therapists are employed within facilities of 16 geographically dispersed Hospital and Health Services (HHSs). The new graduates receive support from local operational supervisors as well as from occupational therapy Clinical Education Support Officers (CESOs) located within each HHS. CESOs form part of the Queensland Health Occupational Therapy Clinical Education Program (OTCEP). In addition to building pre-entry student placement capacity, this programme provides support to the continuing professional education of occupational therapy graduates in reponse to the organisations commitment to safe, high quality clinical services (Blueprint for better healthcare in Queensland, 2013). Organisational restructuring and a renewed focus on clinical supervision, largely in response to consultations and actions of Health Workforce Australia (2011), provided the impetus for members of OTCEP to study recommended approaches to new graduate professional development. This paper reports on the process and findings of this study.
Methodology An insider action research methodology (Coghlan & Brannick, 2009) was chosen for this study as there was a desire to ensure any investigation was sensitive to existing new gradate support systems within a large, state wide public health-care service. Action research has been described as a collaborative approach to research in action whereby a scientific approach to study is applied to organisational issues (Coghlan & Brannick). Typically there are four steps to an action research cycle namely: (i) planning before action, (ii) taking action, (iii) critical observation, and (iv) reflection on the action (ZuberSkerritt, 2000). Insider action research enabled the investigation of workplace actions, the timely review of new concepts and the formulation of recommendations for future actions in a way that sustained the current new graduate support activity of the researchers and study participants. This action research study was completed in the three cycles, namely: (i) investigation into new graduate professional learning strategies; (ii) development of a learning framework; and (iii) pilot of the framework. In each of the three cycles the four steps of action research were followed and are reported on in this paper. Ethics approval was granted from the Queensland Health Central Human Research Ethics Committee at the Office of Health and Medical Research. Site specific ethics applications were approved by the individual Hospital and Health Service ethics committees.
Cycle 1: Investigation into current and recommended learning support strategies for occupational therapy new graduates Planning for this cycle involved exploration of how to gather required information from CESOs and the litera© 2014 Occupational Therapy Australia
C. FITZGERALD ET AL.
ture in order to focus on current and recommended learning support strategies for new graduates. Actions for this cycle were semi-structured interviews with all CESOs (n = 18) and a review of the literature. CESO interviews were conducted by telephone by one member of the research team. Five open-ended questions regarding the levels of support provided to new graduate occupational therapists were asked during telephone interviews, each of approximately 30 minutes duration. Conducting the interviews by telephone allowed for the interviewer to check the CESOs understanding of the questions and clarify their comments in context (Robson, 2011). Participant responses were recorded by note taking and then compiled and coded by a further two members of the research team. After further discussion the coded similarities or variations in CESO support actions for new graduate learning were further sorted into emerging themes with the aim of discovering any patterns in their actions (Howitt & Cramer, 2008). Critical observations from the review of interview responses identified similarities and variations in practice and the emergence of two key patterns of CESO support. There was variation in the time allocated to new graduate support and in the timing of that support (e.g. weekly or monthly or on an as needs basis). Different support methods were used by CESOs (telephone support, group meetings, tutorials) as well as a variety of planning tools. The methods used by CESOs to engage new graduates in professional learning also varied. CESOs were not consistent in the way they encouraged new graduates to incorporate their learning plan and actions into their mandated performance appraisal documentation managed by the local supervisors (Queensland Health, 2013). Similarities in CESO support actions were the assistance provided to the new graduate on reflection on learning needs, connection to available learning resources, provision of learning actions, recording of learning plans and feedback to supervisors. The key patterns of support emerging were the use of a learning plan and the linking of new graduates to the wide range of learning opportunities available. In some instances CESOs had developed their own tools and templates to assist new graduates to plan and record learning goals and actions. CESOs routinely directed new graduates to Queensland Health developed training packages, internal or external training opportunities that were profession specific or inter-professional and profession-endorsed reflection guides such as the Performance Record for the Australian Competency Standards for New Graduate Occupational Therapists (PRACSOT – Occupational Therapy Australia, 2010b). Critical observations from the literature review confirmed the importance of professional development in maximising therapeutic effectiveness as well as overall job satisfaction in occupational therapists (Seah, Mackenzie & Gamble, 2011). Supervision has been identified as critical in assisting the transition from student to
15
CLINICAL LEARNING FRAMEWORK
practitioner (Steenbergen & Mackenzie, 2004) with access to regular supervision and continued education being recommended (Hummell & Koelmeyer, 1999). Cusick, McIntosh and Santiago (2004) identified quality supervision as directly related to retention and the ability of new graduates to perform in their clinical roles. Programmes of support for new graduates have been developed and evaluated by authors aiming to identify key components to facilitate the transition process. Structured actions within such programmes have included linking new information to clinical experiences, providing planned experiences guided by a senior clinician, the development of a learning culture within the work place and the provision of mentoring (Butler & Felts, 2006; Santucci, 2004; Schoessler & Waldo, 2006). Support programmes which incorporate the development of critical thinking and reflective practice have been identified as making a positive contribution to new graduate learning with recommendations that reflective practice be incorporated into everyday work (Santucci; Smith & Pilling, 2008). There was strong support in the literature for encouraging new graduates to adopt reflective practices in order to learn from their experiences (Gibbs,1998). Reflective practice offers the opportunity for learners to be self directed in evaluating their strengths and weaknesses to identify learning needs (Mann, Gordon & MacLeod, 2009) and consequently seems a central component for professional development planning. The provision of supervision by experienced occupational therapists has been found to promote creativity and confidence as well as reflection (Morley, Rugg & Drew, 2007). Despite reflective practice being a common feature of health professional education, there is a lack of empirical evidence and limited resources to support its contribution to learning (Mann et al.). A systematic review on reflective practice (Mann et al.) identified mentoring and supervision as contributing to the success of reflective practice by providing a supportive learning environment suitable for this activity. Reflection on this action research cycle led to the identification of the need for increased consistency in the new graduate learning support provided by CESOs; the need for a process to routinely engage new graduates in learning goal development from reflective practice; and, the need for a tool for planning learning goals and actions. In addition CESO guidance to the wide range of available learning resources needed to be made explicit as it was evident from interview responses that CESOs valued their actions in linking new graduates to available learning resources. Consequently the idea for a learning framework evolved and became the focus for exploration in the next action research cycle.
Cycle 2: Development of a learning framework Planning for cycle 2 involved a review of the literature for an existing learning framework to meet the needs
identified in the reflections of the first cycle. An existing framework could not be found so the key elements of learning support for new graduates identified in cycle 1 were reflected upon once again and plans for the development of a learning framework commenced. Action for this cycle was the development of the Occupational Therapy Clinical Learning Framework (OTCLF see Figure 1) distilled from the information gathered in the first action research cycle and further explored with consideration to the existing new graduate supports available in local health services. The OTCLF is comprised of four cyclical components, namely (i) reflect, (ii) review, (iii) discuss and (iv) engage.
The occupational therapy clinical learning framework Reflect. Learners are encouraged to utilise a range of tools to guide reflection on their performance and identify clinical learning needs to contribute to their individual professional development. These may involve evaluating their level of ability in relation to key areas of practice identified in recognised competency frameworks such as the PRACSOT (Occupational Therapy Australia, 2010b). A range of reflective practice tools may also be used leading to the identification of leaning needs as a recognised outcome (Boud, 1985; Schon, 1984). The learning needs identified as a result of reflection can then be formulated into learning goals. Review. The identification of potential learning experiences or activities and a review of their relevance to prioritised learning goals form the focus of this component of the OTCLF. Discuss. The third component is an opportunity to discuss the activities undertaken during the reflection and review components with a supervisor, line manager and/ or colleague. The OTCLF assist the supervision process by providing tools to help the new graduate to prepare for discussions on professional development. Supervision also provides an appropriate forum for articulating reflections and regularly reviewing new graduate learning goals. Engage. The engage component identifies the importance of completion of a learning action as integral to the new graduate achieving individualised learning goals. After engaging in the planned learning action there is opportunity to re evaluate learning goals and consider whether the learning need has been met. The cycle of the framework may then recommence with further reflection and the subsequent setting of new learning goals to build on those previously achieved, or consideration to different areas of practice and associated learning needs. Critical observations during this action research cycle identified that the framework needed further support-
© 2014 Occupational Therapy Australia
16
C. FITZGERALD ET AL.
FIGURE 1: Occupational therapy clinical learning framework (OTCLF).
ing material to assist learners with its application in practice. To this end a range of resources were developed to guide use of the OTCLF, namely: ● Overview of the OTCLF: This document describes the purpose and key elements of the framework. ● Guide to reflection resources/tools: This document identifies reflective resources readily available to a new graduate. ● Individual Clinical Learning Plan (ICLP) template: This template assists new graduates to identify, prioritise and record learning goals as well as develop strategies to address goals within specified timeframes. ● Learning Opportunities Information Guide: This resource promotes a range of available learning opportunities provided within and external to the organisation. Reflection on this cycle led the researchers to surmise that the OTCLF had the potential to guide reflection on learning needs leading to the development of learning goals and learning actions within a continuous review cycle. The OTCLF promotes discussion of and engagement in actions for professional development. Its cyclical nature encourages the return to further reflection on learning needs as required. The need to pilot the framework emerged with the researchers wishing to investigate if the OTCLF is useful as a framework to support occupational therapy new graduates clinical learning and professional development. © 2014 Occupational Therapy Australia
Cycle 3: Pilot of the OTCLF The Planning for cycle 3 involved preparations for a small pilot study. Two online surveys were created to investigate new graduate clinical learning and professional development practices prior to and following a period of using the OTCLF. The use of survey questionnaires has been identified as an efficient way of collecting data over a large geographic area and as a practical method of enabling respondents to contribute their perspectives (Liamputtong, 2010). Two members of the research team each developed questions for three groups of stakeholders (CESOs, new graduate occupational therapists, and their supervisors) and brought these together for discussion and refinement prior to inclusion in the pre- and post-questionnaires. A combination of simple yes/no questions, multiple choice (with multiple response options) and a Likert five point rating scale were included to provide a variety of response options for participants in addition to the opportunity for participants to provide open-ended comments. The pre- and post-surveys included a total of five and thirteen questions respectively and took 5– 10 minutes to complete. Once designed the questionnaires were reviewed, refined and piloted by a third member of the research team to ensure clarity of questions, successful distribution of the survey, and security of data collected.
17
CLINICAL LEARNING FRAMEWORK
The pre-survey asked participants to identify how they currently identified learning needs, goals and actions and engaged in clinical and professional learning. The post-survey explored participants experience of using the OTCLF and its associated guides to support learning and preparation for supervision. Copies of the surveys are available from the authors. The pre-survey also requested participants to enter a unique five digit identification code which would then be requested on the post-trial survey to enable matched responses. Ethics approval was granted by the Human Research Ethics Committee of Queensland Health and by each of the ethics committees of the participating health services. The actions engaged in for this cycle were the administration of the pre- and post-surveys to study participants and guided use of the OTCLF by CESOs with new graduates. Purposeful convenience sampling was used to recruit pilot participants. All new graduate occupational therapists employed by Queensland Health were invited to participate with seven new graduates agreeing from seven different HHSs. Once the seven new graduates were recruited, subsequent participation was invited from their seven designated supervisors and the seven CESOs linked to their HHS. As a result a total of 21 occupational therapists agreed to participate in the OTCLF pilot. After completing the online pre-survey, each participant was provided with the OTCLF and its associated resources. Participating CESOs were then requested to meet with each new graduate participant for one hour each month for six months. CESOs were requested to lead new graduate engagement with the OTCLF. They were encouraged to use the time with the new graduate to utilise recommended reflective tools, collaboratively identify learning needs, develop learning goals and identify suitable learning resources or opportunities. CESOs were also encouraged to meet with the new graduate supervisor at the commencement of the study to clarify supervision roles and timeframes while engaging with the OTCLF. At the end of the six month trial period, all 21 participants were forwarded the link to the online post-survey for completion. The post-survey asked the participants to indicate their experiences of using the OTCLF to support clinical learning and professional development and to prepare for and guide related discussions within supervision. Critical observations on the pilot of the OTCLF involved the analysis of participant responses to the surveys. A total of 32 surveys (pre and post) were received from 16 participants and were linked by the participant’s unique de-identified code. Of the 16 participants completing both pre- and post-surveys six were occupational therapy new graduates with either one (n = 3), or two (n = 3), years clinical experience, six were CESOs located in the HHS of the participating new graduate occupational therapist and four were identified as the primary
occupational therapy supervisor of a participating new graduate. Table 1 provides demographic information regarding the new graduate participants. Three members of the research team were provided with the 16 survey pairs in order to actively read and familiarise themselves with the data. The pre- and postpaired survey responses were collated into a spreadsheet format and the three researchers then analysed the paired responses noting key patterns. The researchers also identified themes from pre- and post-participant responses to open-ended questions (Braun & Clarke, 2006). Each of the three researchers produced initial patterns from the data, which were then organised into more meaningful codes through group discussion (Howitt & Cramer, 2008). All data extracts were linked to one of the nine codes identified by the group and the coded data was then sorted into potential themes. Through group discussion the three members of the research team reviewed the list of potential themes identified from the data and refined these into two main overarching themes: (i) Contribution to learning goal development and (ii) Compatibility with existing learning supports.
Contribution to learning goal development Pre-pilot survey responses from all participant groups revealed variability in the tools being used to identify
TABLE 1: Demographic characteristics of new graduate study participants Demographic characteristics
Pre-survey (N = 7)
Gender Male 0 Female 7 Age range 24 years and under 5 25–29 years 2 Years of experience as a new graduate First year since graduation 3 Second year since graduation 4 Clinical practice area Physical health 6 Mental health 0 Paediatrics 1 Work setting Acute/Subacute 5 Community 2 Geographical location Metropolitan area 4 Regional area 1 Rural area 2
Post-survey (N = 6)
0 6 5 1 3 3 5 0 1 4 2 4 1 1
© 2014 Occupational Therapy Australia
18
C. FITZGERALD ET AL.
and record learning goals. This variability extended to how learning goals and plans were discussed or acted upon during local supervision. One supervisor in a prepilot survey reported that that learning goals are ‘not actively brought to supervision’. This was supported by the CESO participants who reported that the lack of a consistent approach to goal development impacted on the clarity of the goals and learning actions for new graduate learning. In post-trial survey responses all new graduates reported that the OTCLF encouraged reflection on learning needs using tools such as the PRACSOT and this in turn guided their learning goal development. Both supervisors and new graduates in post-pilot surveys commented on greater clarity in learning goals derived from the time spent on reflection in the OTCLF. It was also identified that the OTCLF assisted new graduates to: Review and reevaluate these existing learning goals and identify other learning goals associated with (my) professional practice. (New Graduate)
The post-trial survey responses also identified increased consistency with recording learning goals and the learning goal template provided with the OTCLF was used as a planning document. The template was easy to understand/complete and also helped in feeling a sense of achievement when you completed a step towards your goals. (New Graduate)
We used the clinical learning plan template to structure my goals and guide how I was going to achieve them. (New Graduate)
Additionally, all supervisors reported the new graduates consistently brought documented learning goals and potential strategies to supervision for discussion. They also commented on the reduction in time spent in helping new graduates to reflect on learning needs and write goals.
Compatibility with existing learning supports All participant groups reported on the OTCLF’s positive contribution to established local supervision practices. In pre-pilot survey responses all participants reported their engagement in learning support practices primarily linked to local supervision and performance appraisal requirements. Queensland Health supervision practice includes the development of a supervision agreement and documented learning goals and outcomes within a mandated Performance Appraisal and Development (PAD) process (Queensland Health, 2013). Despite these existing processes for learning goal
© 2014 Occupational Therapy Australia
recording being available, the OTCLF and its learning goal template offered an approach to goal development welcomed by participants: Although I had goals documented in my PAD, I utilised the OTCLF template to set goals, identify objectives/actions to achieve the goals and identify when completed. I found this helpful in prioritising goals and it was easier to understand and to review during supervision meetings than my PAD. (New Graduate)
In post-survey responses new graduates specifically identified how the OTCLF enabled them to prepare for, structure and focus their local supervision time. I found the OTCLF assisted me in providing structure to my supervision. At the end of the pilot study, I was able to identify that I had achieved more out of my supervision. (New Graduate)
The OTCLF reportedly improved the content of supervision for one new graduate. As a new grad we often focus on acquisition of clinical skills and knowledge and we often don’t have the opportunity to work on interpersonal/ professional skills which the OTCLF assisted with. I believe my clinical practice has improved markedly due to being able to work on these interpersonal/professional skills through the OTCLF in conjunction with working on clinical skills during supervision (New Graduate).
New graduates reported positively on the frameworks emphasis on reflection supported through discussions with supervisor and mentors. They identified the value of the CESO as a mentor during the OTCLF pilot with the CESO role complementing existing supervisory practices. My CESO was motivating and assisted me to come up with goals and strategies to enhance my learning and tips and tricks to manage and get the most out of situations (New Graduate).
The new graduates and CESOs also reported positively on the linking to learning resources and opportunities during the REVIEW phase of the framework. This linking appeared to encourage investigation into resources available to support goal achievement. All CESO respondents indicated they would recommend the OTCLF for use by other professions to assist their new graduate professional goal development and achievement. Overall, participants viewed the OTCLF as a valuable framework with one supervisor noting there were ‘real benefits in the process’.
CLINICAL LEARNING FRAMEWORK
Reflections following the pilot led the researchers to conclude that the OTCLF could be successfully used by the CESO to support the professional development of new graduates. The researchers were encouraged by pilot participant responses on how the framework guided reflective practice, learning goal development and learning actions. Reflections on the potential of the framework to support a learner led approach to professional development identified the need for clearer implementation steps on how the OTCLF complements existing supervision practices. The researchers were conscious of the small sample size of the pilot as a major limitation and identified the need for cautious interpretation of the results.
Discussion The action research cycles reported on in this paper arose from the need to review existing practices for engaging new graduates in learning and professional development. Consideration of established new graduate learning support methods was seen as essential and drove the use of an insider action research approach (Coghlan & Brannick, 2009). Reflection on outcomes of the first action research cycle highlighted the need to provide a more consistent approach for guiding new graduate reflection on learning needs and achievement of learning goals including the need for supported linking to reflective tools and learning resources. Information gathered from the literature review in this cycle identified key strategies for new graduate learning support with an emphasis on reflective practice and supervision clearly evident in the literature. While greater consistency in the approach used by CESOs emerged as a need, it became clear that flexibility in the implementation of any methods to support learning was required. This flexibility would cater for the needs of new graduates and CESOs working in the geographically dispersed and diversely resourced health service locations. The first action research cycle provided key information informing the second research cycle where the OTCLF was distilled. The OTCLF promotes reflection on capability and competence utilising profession-endorsed tools designed for this purpose such as the PRACSOT (Occupational Therapy Australia, 2010b). This reflective process forms the foundation to learning goal development that new graduate participants in the pilot study found beneficial. The OTCLF and its associated resources guide the new graduate to a range of potential learning strategies while encouraging dialogue with mentors and supervisors. This approach acknowledges the importance of supervision for promoting reflective practice and identifying learning actions aiming to strengthen the match between the skills of the new graduate and the needs of the health-care environment (Mann et al., 2009; Seah et al., 2011). All pilot study participants in the third action research cycle reported that use of the OTCLF
19 complemented and contributed positively to existing supervision practices including the organisation’s PAD process. The researchers acknowledge that the small sample size of participants in the pilot was a major limitation warranting cautious review of its outcomes. It was interesting to note that the variability in the methods used by new graduates to reflect upon, record and respond to learning needs and goals reported by CESOs in the first action research cycle was also noted by new graduates and their supervisors in the pilot of the OTCLF within the third action research cycle. The insider action research approach used in this study provided the researchers with the opportunity to not only reflect on observations from each cycle but to reflect on critical observations from all of the cycles in an ongoing way. This enabled attention to new graduate support actions by CESOs as the programme developed through the time frame of the action research cycles and is seen as a strength of the insider action research method used. CESO contribution to new graduate learning was of interest to the researchers. Feedback from new graduate participants in the OTCLF pilot identified the CESOs as motivators for engagement in learning, supporting the value of positive mentors for professional learning (Tryssenaar & Perkins, 2001). Once again, given the small sample size and the insider nature of the action research, it is unclear whether participants were biased towards positive reporting of the benefits of the OTCLF and CESO involvement. The contribution of the CESO in facilitating new graduate engagement with the framework and providing profession specific support to reflect on and develop learning goals and actions was not clearly appraised in the pilot research undertaken. The issue of whether or not the OTCLF requires CESO support to its implementation was not tested and warrants further investigation as this would provide information on how the framework stands alone as a tool to benefit the outcomes of supervision practices commonly used in the organisation. This further research would also provide insights into how the framework could be used independently by new graduates or their supervisors to guide professional development. The six month time frame of the pilot within the third action research cycle was too short to identify any longer term benefits of the frameworks recommended components. However, the framework was reported as a cue to noticing goal achievement with one new graduate commenting ‘the tools highlighted my massive learning throughout the OTCLF’. The researchers welcomed feedback on the resources to be used alongside the OTCLF such as the Overview of the OTCLF document. The need to review the OTCLF resources to provide greater clarity for its use have been addressed with the resources modified in response to feedback from the pilot survey responses. Further research in action is planned in response to participants of the pilot reporting they would recommend the OTCLF to other allied health professions. © 2014 Occupational Therapy Australia
20
Conclusion This paper has reported on three action research cycles initially arising from a desire to review new graduate support from dedicated occupational therapy clinical education support officers. The insider action research approach led to the identification of recommended support practices, the development of a learning framework and associated resources for use, and a small pilot study to discern the utility of the framework. Action research was welcomed as a method of enquiry as it enabled exploration, action and critical reflection while continuing to develop activity in the study area. As is the nature of action research the reported cycles have identified future actions and research opportunities. Future developments are intended to further profession specific and inter-professional dialogue aimed at improving the support to new graduate learning to meet workplace demands.
References Blueprint for better healthcare in Queensland (2013). State of Queensland (Queensland Health). Retrieved 24 March, 2014, from http://www.health.qld.gov.au/blueprint Boud, D. J. (1985). Reflection: Turning experience into learning. London: Kogan Page. Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. Butler, M. R. & Felts, J. (2006). Tool kit for the staff mentor: Strategies for improving retention. The Journal of Continuing Education in Nursing, 37, 210. Coghlan, D. & Brannick, T. (2009). Doing action research in your own organisation. London: Sage. Cusick, A., McIntosh, D. & Santiago, L. (2004). New graduate therapists in acute care hospitals: Priorities, problems and strategies for departmental action. Australian Occupational Therapy Journal, 51, 174–184. Fortune, T., Ryan, S. & Adamson, L. (2012). Transition to practice in supercomplex environments: Are occupational therapy graduates adequately prepared? Australian Occupational Therapy Journal, 60, 217–220. Gibbs, G. (1998). Learning by doing: A guide to teaching and learning methods. Oxford: Further education Unit, Oxford Polytechnic. Health Workforce Australia (2011). Clinical supervision support program. Retrieved 24 March, 2014, from http://www.hwa.gov.au/our-work/build-capacity/clinicalsupervision-support-program Hodgetts, S., Hollis, V., Triska, O., Dennis, S., Madill, H. & Taylor, E. (2007). Occupational therapy students’ and graduates’ satisfaction with professional education and preparedness for practice. Canadian Journal of Occupational Therapy, 74, 148–160. Howitt, D. & Cramer, D. (2008). Introduction to research methods in psychology (2nd ed.). Harlow Essex: Pearson. Hummell, J. & Koelmeyer, L. (1999). New graduates: Perceptions of their first occupational therapy position. The British Journal of Occupational Therapy, 62, 351–358.
© 2014 Occupational Therapy Australia
C. FITZGERALD ET AL.
Liamputtong, P. (2010). Research methods in health: Foundations for evidence- based practice. South Melbourne: Oxford University Press. Mann, K., Gordon, J. & MacLeod, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Science Education, 14, 595–621. Morley, M. (2006). Moving from student to new practitioner: The transitional experience. The British Journal of Occupational Therapy, 69, 231–233. Morley, M., Rugg, S. & Drew, J. (2007). Before preceptorship: New occupational therapists’ expectations of practice and experience of supervision. The British Journal of Occupational Therapy, 70, 243–253. Mulholland, S. & Derdall, M. (2004). Exploring what employers seek when hiring occupational therapists. Canadian Journal of Occupational Therapy, 71, 223–229. Occupational Therapy Australia (2010a). Australian minimum competency standards for new graduate occupational therapists. Melbourne, Victoria: Occupational Therapy Australia. Occupational Therapy Australia (2010b). Performance Record for the Australian Competency Standards for New Gradaute Occupatioanal Therapists (PRACSOT). Melbourne, Victoria: Occupational Therapy Australia. Queensland Health (2013) Perfomance appraisal and development policy. Retrieved 24 March, 2014, from http:// www.health.qld.gov.au/qhpolicy/docs/pol/qh-pol-189. pdf Robertson, L. J. & Griffiths, S. (2009). Graduates’ reflections on their preparation for practice. British Journal of Occupational Therapy, 72, 125–132. Robson, C. (2011). Real world research (3rd ed.). Chichester: Wiley & Sons. Santucci, J. (2004). Facilitating the transition into nursing practice: Concepts and strategies for mentoring new graduates. Journal for Nurses in Staff Development, 20, 274–284. Schoessler, M. & Waldo, M. (2006). Organisational infrastructure to support development of newly graduated nurses. Journal for Nurses in Professional Development, 22, 286–293. Schon, D. (1984). The Reflective Practitioner: How professionals think in action. New York: Basic Books Inc. Seah, C. H., Mackenzie, L. & Gamble, J. (2011). Transition of graduates of the master of occupational therapy to practice. Australian Occupational Therapy Journal, 58, 103–110. Smith, R. & Pilling, S. (2008). Supporting the transition from student to professional – A case study in allied health. Australian Health Review, 32, 134–138. Steenbergen, K. & Mackenzie, L. (2004). Professional support in rural New South Wales: Perceptions of new graduate occupational therapists. Australian Journal of Rural Health, 12, 160–165. Tryssenaar, J. & Perkins, J. (2001). From student to therapist: Exploring the first year of practice. The American Journal of Occupational Therapy, 55, 19–27. Zuber-Skerritt, O. (2000). A generic model for action learning and action research programs within organizations. Action Learning and Action Research Journal, 5, 41.
Copyright of Australian Occupational Therapy Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
doi: 10.1111/1440-1630.12165
Feature Article
Supporting new graduate professional development: A clinical learning framework Cate Fitzgerald,1 Alis Moores,2 Allison Coleman3 and Jennifer Fleming4 1 Statewide Clinical Education and Training Program, Metro South Hospital and Health Service, Brisbane, 2Ocupational Therapy Department, Townsville Hospital and Health Service, Townsville, 3School of Health and Rehabilitation Sciences, The University of Queensland, and 4The University of Queensland and Princess Alexandra Hospital, Metro South Hospital and Health Service, Brisbane, Queensland, Australia
Background/aims: New graduate occupational therapists are required to competently deliver health-care practices within complex care environments. An occupational therapy clinical education programme within a large public sector health service sought to investigate methods to support new graduates in their clinical learning and professional development. Methods: Three cycles of an insider action research approach each using the steps of planning, action, critical observation and reflection were undertaken to investigate new graduate learning strategies, develop a learning framework and pilot its utility. Qualitative research methods were used to analyse data gathered during the action research cycles. Results: Action research identified variations in current practices to support new graduate learning and to the development of the Occupational Therapy Clinical Learning Framework (OTCLF). Investigation into the utility of the OTCLF revealed two themes associated with its implementation namely (i) contribution to learning goal development and (ii) compatibility with existing learning supports. Conclusions and significance of the study: The action research cycles aimed to review current practices to support new graduate learning. The learning framework developed encourages reflection to identify learning needs and the
Cate Fitzgerald MBA, BOccThy; Clinical Education Program Manager for Occupational Therapy. Alis Moores MSc Advanced Health Care Practice, BHsc (Hons) Occupational Therapy; Occupational Therapy Clinical Education Leader. Allison Coleman BHSc(OT); Clinic Manager – Occupational Therapy. Jennifer Fleming PhD; Associate Professor, Conjoint Associate Professor in Occupational Therapy. Correspondence: Ms Cate Fitzgerald, Allied Health Education Unit, Building 61, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Brisbane, Qld 4102, Australia. Email: [email protected] Accepted for publication 26 August 2014. © 2014 Occupational Therapy Australia
review, discussion of, and engagement in, goal setting and learning strategies. Preliminary evidence indicates that the OTCLF has potential as an approach to guide new graduate goal development supported by supervision. Future opportunity to implement a similar learning framework in other allied health professions was identified, enabling a continuation of the cyclical nature of enquiry, integral to this research approach within the workplace. KEY WORDS new graduate, professional education, reflective practice, supervision, mentoring.
Introduction The challenges facing new graduate occupational therapists as they transition from student to professional are well documented (Morley, 2006; Robertson & Griffiths, 2009). New graduates are required to demonstrate professional competence by having the relevant knowledge, skills and attitudes to perform the job while meeting expectations regarding management of caseloads and time efficiency (Occupational Therapy Australia, 2010a; Smith & Pilling, 2008). Complex health-care environments contribute to the demands on the new graduate workforce (Fortune, Ryan & Adamson, 2012; Smith & Pilling, 2008). Increasingly employees are seeking work ready graduates whose knowledge, skills and attitudes have an immediate effect on health-care provision (Fortune et al.; Mulholland & Derdall, 2004). Currently in Australia, an occupational therapist is considered to be a new graduate for two years of practice post-graduation. It is recognised that feelings of clinical competence continue to develop from six months to two years post-graduation (Hodgetts et al., 2007) and this is reported as the optimum time to assist new graduates to develop both clinical and professional skills vital to support their transition from student to practising professional (Smith & Pilling, 2008). Within
14 Queensland Health, a statewide public health system, new graduate occupational therapists are employed within facilities of 16 geographically dispersed Hospital and Health Services (HHSs). The new graduates receive support from local operational supervisors as well as from occupational therapy Clinical Education Support Officers (CESOs) located within each HHS. CESOs form part of the Queensland Health Occupational Therapy Clinical Education Program (OTCEP). In addition to building pre-entry student placement capacity, this programme provides support to the continuing professional education of occupational therapy graduates in reponse to the organisations commitment to safe, high quality clinical services (Blueprint for better healthcare in Queensland, 2013). Organisational restructuring and a renewed focus on clinical supervision, largely in response to consultations and actions of Health Workforce Australia (2011), provided the impetus for members of OTCEP to study recommended approaches to new graduate professional development. This paper reports on the process and findings of this study.
Methodology An insider action research methodology (Coghlan & Brannick, 2009) was chosen for this study as there was a desire to ensure any investigation was sensitive to existing new gradate support systems within a large, state wide public health-care service. Action research has been described as a collaborative approach to research in action whereby a scientific approach to study is applied to organisational issues (Coghlan & Brannick). Typically there are four steps to an action research cycle namely: (i) planning before action, (ii) taking action, (iii) critical observation, and (iv) reflection on the action (ZuberSkerritt, 2000). Insider action research enabled the investigation of workplace actions, the timely review of new concepts and the formulation of recommendations for future actions in a way that sustained the current new graduate support activity of the researchers and study participants. This action research study was completed in the three cycles, namely: (i) investigation into new graduate professional learning strategies; (ii) development of a learning framework; and (iii) pilot of the framework. In each of the three cycles the four steps of action research were followed and are reported on in this paper. Ethics approval was granted from the Queensland Health Central Human Research Ethics Committee at the Office of Health and Medical Research. Site specific ethics applications were approved by the individual Hospital and Health Service ethics committees.
Cycle 1: Investigation into current and recommended learning support strategies for occupational therapy new graduates Planning for this cycle involved exploration of how to gather required information from CESOs and the litera© 2014 Occupational Therapy Australia
C. FITZGERALD ET AL.
ture in order to focus on current and recommended learning support strategies for new graduates. Actions for this cycle were semi-structured interviews with all CESOs (n = 18) and a review of the literature. CESO interviews were conducted by telephone by one member of the research team. Five open-ended questions regarding the levels of support provided to new graduate occupational therapists were asked during telephone interviews, each of approximately 30 minutes duration. Conducting the interviews by telephone allowed for the interviewer to check the CESOs understanding of the questions and clarify their comments in context (Robson, 2011). Participant responses were recorded by note taking and then compiled and coded by a further two members of the research team. After further discussion the coded similarities or variations in CESO support actions for new graduate learning were further sorted into emerging themes with the aim of discovering any patterns in their actions (Howitt & Cramer, 2008). Critical observations from the review of interview responses identified similarities and variations in practice and the emergence of two key patterns of CESO support. There was variation in the time allocated to new graduate support and in the timing of that support (e.g. weekly or monthly or on an as needs basis). Different support methods were used by CESOs (telephone support, group meetings, tutorials) as well as a variety of planning tools. The methods used by CESOs to engage new graduates in professional learning also varied. CESOs were not consistent in the way they encouraged new graduates to incorporate their learning plan and actions into their mandated performance appraisal documentation managed by the local supervisors (Queensland Health, 2013). Similarities in CESO support actions were the assistance provided to the new graduate on reflection on learning needs, connection to available learning resources, provision of learning actions, recording of learning plans and feedback to supervisors. The key patterns of support emerging were the use of a learning plan and the linking of new graduates to the wide range of learning opportunities available. In some instances CESOs had developed their own tools and templates to assist new graduates to plan and record learning goals and actions. CESOs routinely directed new graduates to Queensland Health developed training packages, internal or external training opportunities that were profession specific or inter-professional and profession-endorsed reflection guides such as the Performance Record for the Australian Competency Standards for New Graduate Occupational Therapists (PRACSOT – Occupational Therapy Australia, 2010b). Critical observations from the literature review confirmed the importance of professional development in maximising therapeutic effectiveness as well as overall job satisfaction in occupational therapists (Seah, Mackenzie & Gamble, 2011). Supervision has been identified as critical in assisting the transition from student to
15
CLINICAL LEARNING FRAMEWORK
practitioner (Steenbergen & Mackenzie, 2004) with access to regular supervision and continued education being recommended (Hummell & Koelmeyer, 1999). Cusick, McIntosh and Santiago (2004) identified quality supervision as directly related to retention and the ability of new graduates to perform in their clinical roles. Programmes of support for new graduates have been developed and evaluated by authors aiming to identify key components to facilitate the transition process. Structured actions within such programmes have included linking new information to clinical experiences, providing planned experiences guided by a senior clinician, the development of a learning culture within the work place and the provision of mentoring (Butler & Felts, 2006; Santucci, 2004; Schoessler & Waldo, 2006). Support programmes which incorporate the development of critical thinking and reflective practice have been identified as making a positive contribution to new graduate learning with recommendations that reflective practice be incorporated into everyday work (Santucci; Smith & Pilling, 2008). There was strong support in the literature for encouraging new graduates to adopt reflective practices in order to learn from their experiences (Gibbs,1998). Reflective practice offers the opportunity for learners to be self directed in evaluating their strengths and weaknesses to identify learning needs (Mann, Gordon & MacLeod, 2009) and consequently seems a central component for professional development planning. The provision of supervision by experienced occupational therapists has been found to promote creativity and confidence as well as reflection (Morley, Rugg & Drew, 2007). Despite reflective practice being a common feature of health professional education, there is a lack of empirical evidence and limited resources to support its contribution to learning (Mann et al.). A systematic review on reflective practice (Mann et al.) identified mentoring and supervision as contributing to the success of reflective practice by providing a supportive learning environment suitable for this activity. Reflection on this action research cycle led to the identification of the need for increased consistency in the new graduate learning support provided by CESOs; the need for a process to routinely engage new graduates in learning goal development from reflective practice; and, the need for a tool for planning learning goals and actions. In addition CESO guidance to the wide range of available learning resources needed to be made explicit as it was evident from interview responses that CESOs valued their actions in linking new graduates to available learning resources. Consequently the idea for a learning framework evolved and became the focus for exploration in the next action research cycle.
Cycle 2: Development of a learning framework Planning for cycle 2 involved a review of the literature for an existing learning framework to meet the needs
identified in the reflections of the first cycle. An existing framework could not be found so the key elements of learning support for new graduates identified in cycle 1 were reflected upon once again and plans for the development of a learning framework commenced. Action for this cycle was the development of the Occupational Therapy Clinical Learning Framework (OTCLF see Figure 1) distilled from the information gathered in the first action research cycle and further explored with consideration to the existing new graduate supports available in local health services. The OTCLF is comprised of four cyclical components, namely (i) reflect, (ii) review, (iii) discuss and (iv) engage.
The occupational therapy clinical learning framework Reflect. Learners are encouraged to utilise a range of tools to guide reflection on their performance and identify clinical learning needs to contribute to their individual professional development. These may involve evaluating their level of ability in relation to key areas of practice identified in recognised competency frameworks such as the PRACSOT (Occupational Therapy Australia, 2010b). A range of reflective practice tools may also be used leading to the identification of leaning needs as a recognised outcome (Boud, 1985; Schon, 1984). The learning needs identified as a result of reflection can then be formulated into learning goals. Review. The identification of potential learning experiences or activities and a review of their relevance to prioritised learning goals form the focus of this component of the OTCLF. Discuss. The third component is an opportunity to discuss the activities undertaken during the reflection and review components with a supervisor, line manager and/ or colleague. The OTCLF assist the supervision process by providing tools to help the new graduate to prepare for discussions on professional development. Supervision also provides an appropriate forum for articulating reflections and regularly reviewing new graduate learning goals. Engage. The engage component identifies the importance of completion of a learning action as integral to the new graduate achieving individualised learning goals. After engaging in the planned learning action there is opportunity to re evaluate learning goals and consider whether the learning need has been met. The cycle of the framework may then recommence with further reflection and the subsequent setting of new learning goals to build on those previously achieved, or consideration to different areas of practice and associated learning needs. Critical observations during this action research cycle identified that the framework needed further support-
© 2014 Occupational Therapy Australia
16
C. FITZGERALD ET AL.
FIGURE 1: Occupational therapy clinical learning framework (OTCLF).
ing material to assist learners with its application in practice. To this end a range of resources were developed to guide use of the OTCLF, namely: ● Overview of the OTCLF: This document describes the purpose and key elements of the framework. ● Guide to reflection resources/tools: This document identifies reflective resources readily available to a new graduate. ● Individual Clinical Learning Plan (ICLP) template: This template assists new graduates to identify, prioritise and record learning goals as well as develop strategies to address goals within specified timeframes. ● Learning Opportunities Information Guide: This resource promotes a range of available learning opportunities provided within and external to the organisation. Reflection on this cycle led the researchers to surmise that the OTCLF had the potential to guide reflection on learning needs leading to the development of learning goals and learning actions within a continuous review cycle. The OTCLF promotes discussion of and engagement in actions for professional development. Its cyclical nature encourages the return to further reflection on learning needs as required. The need to pilot the framework emerged with the researchers wishing to investigate if the OTCLF is useful as a framework to support occupational therapy new graduates clinical learning and professional development. © 2014 Occupational Therapy Australia
Cycle 3: Pilot of the OTCLF The Planning for cycle 3 involved preparations for a small pilot study. Two online surveys were created to investigate new graduate clinical learning and professional development practices prior to and following a period of using the OTCLF. The use of survey questionnaires has been identified as an efficient way of collecting data over a large geographic area and as a practical method of enabling respondents to contribute their perspectives (Liamputtong, 2010). Two members of the research team each developed questions for three groups of stakeholders (CESOs, new graduate occupational therapists, and their supervisors) and brought these together for discussion and refinement prior to inclusion in the pre- and post-questionnaires. A combination of simple yes/no questions, multiple choice (with multiple response options) and a Likert five point rating scale were included to provide a variety of response options for participants in addition to the opportunity for participants to provide open-ended comments. The pre- and post-surveys included a total of five and thirteen questions respectively and took 5– 10 minutes to complete. Once designed the questionnaires were reviewed, refined and piloted by a third member of the research team to ensure clarity of questions, successful distribution of the survey, and security of data collected.
17
CLINICAL LEARNING FRAMEWORK
The pre-survey asked participants to identify how they currently identified learning needs, goals and actions and engaged in clinical and professional learning. The post-survey explored participants experience of using the OTCLF and its associated guides to support learning and preparation for supervision. Copies of the surveys are available from the authors. The pre-survey also requested participants to enter a unique five digit identification code which would then be requested on the post-trial survey to enable matched responses. Ethics approval was granted by the Human Research Ethics Committee of Queensland Health and by each of the ethics committees of the participating health services. The actions engaged in for this cycle were the administration of the pre- and post-surveys to study participants and guided use of the OTCLF by CESOs with new graduates. Purposeful convenience sampling was used to recruit pilot participants. All new graduate occupational therapists employed by Queensland Health were invited to participate with seven new graduates agreeing from seven different HHSs. Once the seven new graduates were recruited, subsequent participation was invited from their seven designated supervisors and the seven CESOs linked to their HHS. As a result a total of 21 occupational therapists agreed to participate in the OTCLF pilot. After completing the online pre-survey, each participant was provided with the OTCLF and its associated resources. Participating CESOs were then requested to meet with each new graduate participant for one hour each month for six months. CESOs were requested to lead new graduate engagement with the OTCLF. They were encouraged to use the time with the new graduate to utilise recommended reflective tools, collaboratively identify learning needs, develop learning goals and identify suitable learning resources or opportunities. CESOs were also encouraged to meet with the new graduate supervisor at the commencement of the study to clarify supervision roles and timeframes while engaging with the OTCLF. At the end of the six month trial period, all 21 participants were forwarded the link to the online post-survey for completion. The post-survey asked the participants to indicate their experiences of using the OTCLF to support clinical learning and professional development and to prepare for and guide related discussions within supervision. Critical observations on the pilot of the OTCLF involved the analysis of participant responses to the surveys. A total of 32 surveys (pre and post) were received from 16 participants and were linked by the participant’s unique de-identified code. Of the 16 participants completing both pre- and post-surveys six were occupational therapy new graduates with either one (n = 3), or two (n = 3), years clinical experience, six were CESOs located in the HHS of the participating new graduate occupational therapist and four were identified as the primary
occupational therapy supervisor of a participating new graduate. Table 1 provides demographic information regarding the new graduate participants. Three members of the research team were provided with the 16 survey pairs in order to actively read and familiarise themselves with the data. The pre- and postpaired survey responses were collated into a spreadsheet format and the three researchers then analysed the paired responses noting key patterns. The researchers also identified themes from pre- and post-participant responses to open-ended questions (Braun & Clarke, 2006). Each of the three researchers produced initial patterns from the data, which were then organised into more meaningful codes through group discussion (Howitt & Cramer, 2008). All data extracts were linked to one of the nine codes identified by the group and the coded data was then sorted into potential themes. Through group discussion the three members of the research team reviewed the list of potential themes identified from the data and refined these into two main overarching themes: (i) Contribution to learning goal development and (ii) Compatibility with existing learning supports.
Contribution to learning goal development Pre-pilot survey responses from all participant groups revealed variability in the tools being used to identify
TABLE 1: Demographic characteristics of new graduate study participants Demographic characteristics
Pre-survey (N = 7)
Gender Male 0 Female 7 Age range 24 years and under 5 25–29 years 2 Years of experience as a new graduate First year since graduation 3 Second year since graduation 4 Clinical practice area Physical health 6 Mental health 0 Paediatrics 1 Work setting Acute/Subacute 5 Community 2 Geographical location Metropolitan area 4 Regional area 1 Rural area 2
Post-survey (N = 6)
0 6 5 1 3 3 5 0 1 4 2 4 1 1
© 2014 Occupational Therapy Australia
18
C. FITZGERALD ET AL.
and record learning goals. This variability extended to how learning goals and plans were discussed or acted upon during local supervision. One supervisor in a prepilot survey reported that that learning goals are ‘not actively brought to supervision’. This was supported by the CESO participants who reported that the lack of a consistent approach to goal development impacted on the clarity of the goals and learning actions for new graduate learning. In post-trial survey responses all new graduates reported that the OTCLF encouraged reflection on learning needs using tools such as the PRACSOT and this in turn guided their learning goal development. Both supervisors and new graduates in post-pilot surveys commented on greater clarity in learning goals derived from the time spent on reflection in the OTCLF. It was also identified that the OTCLF assisted new graduates to: Review and reevaluate these existing learning goals and identify other learning goals associated with (my) professional practice. (New Graduate)
The post-trial survey responses also identified increased consistency with recording learning goals and the learning goal template provided with the OTCLF was used as a planning document. The template was easy to understand/complete and also helped in feeling a sense of achievement when you completed a step towards your goals. (New Graduate)
We used the clinical learning plan template to structure my goals and guide how I was going to achieve them. (New Graduate)
Additionally, all supervisors reported the new graduates consistently brought documented learning goals and potential strategies to supervision for discussion. They also commented on the reduction in time spent in helping new graduates to reflect on learning needs and write goals.
Compatibility with existing learning supports All participant groups reported on the OTCLF’s positive contribution to established local supervision practices. In pre-pilot survey responses all participants reported their engagement in learning support practices primarily linked to local supervision and performance appraisal requirements. Queensland Health supervision practice includes the development of a supervision agreement and documented learning goals and outcomes within a mandated Performance Appraisal and Development (PAD) process (Queensland Health, 2013). Despite these existing processes for learning goal
© 2014 Occupational Therapy Australia
recording being available, the OTCLF and its learning goal template offered an approach to goal development welcomed by participants: Although I had goals documented in my PAD, I utilised the OTCLF template to set goals, identify objectives/actions to achieve the goals and identify when completed. I found this helpful in prioritising goals and it was easier to understand and to review during supervision meetings than my PAD. (New Graduate)
In post-survey responses new graduates specifically identified how the OTCLF enabled them to prepare for, structure and focus their local supervision time. I found the OTCLF assisted me in providing structure to my supervision. At the end of the pilot study, I was able to identify that I had achieved more out of my supervision. (New Graduate)
The OTCLF reportedly improved the content of supervision for one new graduate. As a new grad we often focus on acquisition of clinical skills and knowledge and we often don’t have the opportunity to work on interpersonal/ professional skills which the OTCLF assisted with. I believe my clinical practice has improved markedly due to being able to work on these interpersonal/professional skills through the OTCLF in conjunction with working on clinical skills during supervision (New Graduate).
New graduates reported positively on the frameworks emphasis on reflection supported through discussions with supervisor and mentors. They identified the value of the CESO as a mentor during the OTCLF pilot with the CESO role complementing existing supervisory practices. My CESO was motivating and assisted me to come up with goals and strategies to enhance my learning and tips and tricks to manage and get the most out of situations (New Graduate).
The new graduates and CESOs also reported positively on the linking to learning resources and opportunities during the REVIEW phase of the framework. This linking appeared to encourage investigation into resources available to support goal achievement. All CESO respondents indicated they would recommend the OTCLF for use by other professions to assist their new graduate professional goal development and achievement. Overall, participants viewed the OTCLF as a valuable framework with one supervisor noting there were ‘real benefits in the process’.
CLINICAL LEARNING FRAMEWORK
Reflections following the pilot led the researchers to conclude that the OTCLF could be successfully used by the CESO to support the professional development of new graduates. The researchers were encouraged by pilot participant responses on how the framework guided reflective practice, learning goal development and learning actions. Reflections on the potential of the framework to support a learner led approach to professional development identified the need for clearer implementation steps on how the OTCLF complements existing supervision practices. The researchers were conscious of the small sample size of the pilot as a major limitation and identified the need for cautious interpretation of the results.
Discussion The action research cycles reported on in this paper arose from the need to review existing practices for engaging new graduates in learning and professional development. Consideration of established new graduate learning support methods was seen as essential and drove the use of an insider action research approach (Coghlan & Brannick, 2009). Reflection on outcomes of the first action research cycle highlighted the need to provide a more consistent approach for guiding new graduate reflection on learning needs and achievement of learning goals including the need for supported linking to reflective tools and learning resources. Information gathered from the literature review in this cycle identified key strategies for new graduate learning support with an emphasis on reflective practice and supervision clearly evident in the literature. While greater consistency in the approach used by CESOs emerged as a need, it became clear that flexibility in the implementation of any methods to support learning was required. This flexibility would cater for the needs of new graduates and CESOs working in the geographically dispersed and diversely resourced health service locations. The first action research cycle provided key information informing the second research cycle where the OTCLF was distilled. The OTCLF promotes reflection on capability and competence utilising profession-endorsed tools designed for this purpose such as the PRACSOT (Occupational Therapy Australia, 2010b). This reflective process forms the foundation to learning goal development that new graduate participants in the pilot study found beneficial. The OTCLF and its associated resources guide the new graduate to a range of potential learning strategies while encouraging dialogue with mentors and supervisors. This approach acknowledges the importance of supervision for promoting reflective practice and identifying learning actions aiming to strengthen the match between the skills of the new graduate and the needs of the health-care environment (Mann et al., 2009; Seah et al., 2011). All pilot study participants in the third action research cycle reported that use of the OTCLF
19 complemented and contributed positively to existing supervision practices including the organisation’s PAD process. The researchers acknowledge that the small sample size of participants in the pilot was a major limitation warranting cautious review of its outcomes. It was interesting to note that the variability in the methods used by new graduates to reflect upon, record and respond to learning needs and goals reported by CESOs in the first action research cycle was also noted by new graduates and their supervisors in the pilot of the OTCLF within the third action research cycle. The insider action research approach used in this study provided the researchers with the opportunity to not only reflect on observations from each cycle but to reflect on critical observations from all of the cycles in an ongoing way. This enabled attention to new graduate support actions by CESOs as the programme developed through the time frame of the action research cycles and is seen as a strength of the insider action research method used. CESO contribution to new graduate learning was of interest to the researchers. Feedback from new graduate participants in the OTCLF pilot identified the CESOs as motivators for engagement in learning, supporting the value of positive mentors for professional learning (Tryssenaar & Perkins, 2001). Once again, given the small sample size and the insider nature of the action research, it is unclear whether participants were biased towards positive reporting of the benefits of the OTCLF and CESO involvement. The contribution of the CESO in facilitating new graduate engagement with the framework and providing profession specific support to reflect on and develop learning goals and actions was not clearly appraised in the pilot research undertaken. The issue of whether or not the OTCLF requires CESO support to its implementation was not tested and warrants further investigation as this would provide information on how the framework stands alone as a tool to benefit the outcomes of supervision practices commonly used in the organisation. This further research would also provide insights into how the framework could be used independently by new graduates or their supervisors to guide professional development. The six month time frame of the pilot within the third action research cycle was too short to identify any longer term benefits of the frameworks recommended components. However, the framework was reported as a cue to noticing goal achievement with one new graduate commenting ‘the tools highlighted my massive learning throughout the OTCLF’. The researchers welcomed feedback on the resources to be used alongside the OTCLF such as the Overview of the OTCLF document. The need to review the OTCLF resources to provide greater clarity for its use have been addressed with the resources modified in response to feedback from the pilot survey responses. Further research in action is planned in response to participants of the pilot reporting they would recommend the OTCLF to other allied health professions. © 2014 Occupational Therapy Australia
20
Conclusion This paper has reported on three action research cycles initially arising from a desire to review new graduate support from dedicated occupational therapy clinical education support officers. The insider action research approach led to the identification of recommended support practices, the development of a learning framework and associated resources for use, and a small pilot study to discern the utility of the framework. Action research was welcomed as a method of enquiry as it enabled exploration, action and critical reflection while continuing to develop activity in the study area. As is the nature of action research the reported cycles have identified future actions and research opportunities. Future developments are intended to further profession specific and inter-professional dialogue aimed at improving the support to new graduate learning to meet workplace demands.
References Blueprint for better healthcare in Queensland (2013). State of Queensland (Queensland Health). Retrieved 24 March, 2014, from http://www.health.qld.gov.au/blueprint Boud, D. J. (1985). Reflection: Turning experience into learning. London: Kogan Page. Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101. Butler, M. R. & Felts, J. (2006). Tool kit for the staff mentor: Strategies for improving retention. The Journal of Continuing Education in Nursing, 37, 210. Coghlan, D. & Brannick, T. (2009). Doing action research in your own organisation. London: Sage. Cusick, A., McIntosh, D. & Santiago, L. (2004). New graduate therapists in acute care hospitals: Priorities, problems and strategies for departmental action. Australian Occupational Therapy Journal, 51, 174–184. Fortune, T., Ryan, S. & Adamson, L. (2012). Transition to practice in supercomplex environments: Are occupational therapy graduates adequately prepared? Australian Occupational Therapy Journal, 60, 217–220. Gibbs, G. (1998). Learning by doing: A guide to teaching and learning methods. Oxford: Further education Unit, Oxford Polytechnic. Health Workforce Australia (2011). Clinical supervision support program. Retrieved 24 March, 2014, from http://www.hwa.gov.au/our-work/build-capacity/clinicalsupervision-support-program Hodgetts, S., Hollis, V., Triska, O., Dennis, S., Madill, H. & Taylor, E. (2007). Occupational therapy students’ and graduates’ satisfaction with professional education and preparedness for practice. Canadian Journal of Occupational Therapy, 74, 148–160. Howitt, D. & Cramer, D. (2008). Introduction to research methods in psychology (2nd ed.). Harlow Essex: Pearson. Hummell, J. & Koelmeyer, L. (1999). New graduates: Perceptions of their first occupational therapy position. The British Journal of Occupational Therapy, 62, 351–358.
© 2014 Occupational Therapy Australia
C. FITZGERALD ET AL.
Liamputtong, P. (2010). Research methods in health: Foundations for evidence- based practice. South Melbourne: Oxford University Press. Mann, K., Gordon, J. & MacLeod, A. (2009). Reflection and reflective practice in health professions education: A systematic review. Advances in Health Science Education, 14, 595–621. Morley, M. (2006). Moving from student to new practitioner: The transitional experience. The British Journal of Occupational Therapy, 69, 231–233. Morley, M., Rugg, S. & Drew, J. (2007). Before preceptorship: New occupational therapists’ expectations of practice and experience of supervision. The British Journal of Occupational Therapy, 70, 243–253. Mulholland, S. & Derdall, M. (2004). Exploring what employers seek when hiring occupational therapists. Canadian Journal of Occupational Therapy, 71, 223–229. Occupational Therapy Australia (2010a). Australian minimum competency standards for new graduate occupational therapists. Melbourne, Victoria: Occupational Therapy Australia. Occupational Therapy Australia (2010b). Performance Record for the Australian Competency Standards for New Gradaute Occupatioanal Therapists (PRACSOT). Melbourne, Victoria: Occupational Therapy Australia. Queensland Health (2013) Perfomance appraisal and development policy. Retrieved 24 March, 2014, from http:// www.health.qld.gov.au/qhpolicy/docs/pol/qh-pol-189. pdf Robertson, L. J. & Griffiths, S. (2009). Graduates’ reflections on their preparation for practice. British Journal of Occupational Therapy, 72, 125–132. Robson, C. (2011). Real world research (3rd ed.). Chichester: Wiley & Sons. Santucci, J. (2004). Facilitating the transition into nursing practice: Concepts and strategies for mentoring new graduates. Journal for Nurses in Staff Development, 20, 274–284. Schoessler, M. & Waldo, M. (2006). Organisational infrastructure to support development of newly graduated nurses. Journal for Nurses in Professional Development, 22, 286–293. Schon, D. (1984). The Reflective Practitioner: How professionals think in action. New York: Basic Books Inc. Seah, C. H., Mackenzie, L. & Gamble, J. (2011). Transition of graduates of the master of occupational therapy to practice. Australian Occupational Therapy Journal, 58, 103–110. Smith, R. & Pilling, S. (2008). Supporting the transition from student to professional – A case study in allied health. Australian Health Review, 32, 134–138. Steenbergen, K. & Mackenzie, L. (2004). Professional support in rural New South Wales: Perceptions of new graduate occupational therapists. Australian Journal of Rural Health, 12, 160–165. Tryssenaar, J. & Perkins, J. (2001). From student to therapist: Exploring the first year of practice. The American Journal of Occupational Therapy, 55, 19–27. Zuber-Skerritt, O. (2000). A generic model for action learning and action research programs within organizations. Action Learning and Action Research Journal, 5, 41.
Copyright of Australian Occupational Therapy Journal is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
