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4. CHAPTER FOUR

4.1 Interviews with programme leaders in HEIs

There are 10 HEIs in England offering pre-registration radiotherapy education: Birmingham City University, City University London, University of Hertfordshire, Kingston and St Georges University of London, Liverpool University, London South Bank University, Portsmouth University, Sheffield Hallam University, University Campus Suffolk and University of the West of England.

The total number of commissions is reported as 364, with the range being 20 – 65 per year. All providers offer a BSc (Hons), three  offer a Postgraduate Diploma and one offers an MSc programme. The number of placement providers is reported to be 51, and this figure includes some placements that are shared by two HEIs.

4.2 Interview schedule

The interview schedule was developed in discussion with the Steering Group following the audit visits. Its purpose was to validate the findings and gain the perspective of education providers on aspects of the emerging issues reflected in the analysis and conclusions in 3.2 and 3.3 above.

The schedule was piloted with one HEI and no changes were made as a result. The remaining interviews took place in the week beginning 17th September 2012.  (See Appendix 4 for a copy of the interview schedule).

4.3 Findings and analysis

The existence of a Service Level Agreement between HEIs and their placement providers was clarified. In all cases there is an agreement but it is at a high level, either between the Strategic Health Authority and NHS Trusts through a Learning and Development Agreement Placement Learning Annex or an overarching Placement Management Partnership document than contains within it a specific annex that defines the relationship between the HEI and its placement providers. This is signed off at Chief Executive level. In only two HEIs is there reported to be a signed agreement at the level of the university department and the specific provider trusts.

The number of students placed is generally a matter for negotiation around baseline figures with custom and practice and the need for goodwill on both sides cited as important factors. Often, it is the responsibility of the university placement coordinator to agree the numbers with education leads in centres or the service manager. In one case it was reported that numbers are agreed at a tri-partite meeting between service managers, the university department and the strategic health authority. While most HEIs state that they are struggling with placement capacity at the present level of commissions, no problems were reported in two interviews.

Relationships with placement providers are described as good in the majority of instances and, in one case, outstanding. Those interviewed believe that they work in partnership with their providers and could outline the structures and university roles in place to support this constructive dialogue. Dialogue takes place at all levels of the partnership. Weaker partnerships are attributed to specific pressures in centres leading to disengagement and variations in the perceived quality of placement learning for students. Examples were given of non-attendance at meetings and of individuals exacerbating rather than ameliorating difficult situations. A lack of appreciation by radiotherapy centre staff of the need to adhere to university processes for resolving student issues was also noted. Where relationships are improving, this is often owing to a change of personnel. Where placements are shared, this tends to place greater strain on the partnership. 

Having a centre-based practice educator in post is considered crucial to ensuring the quality of the partnership and student welfare and education. Where they exist, these roles are funded variously, sometimes by the university, sometimes by the SHA and sometimes by the department. This is largely an historical arrangement and, where it depends on the centre budget and the support of the manager, the role is not secure.

HEIs were asked about how placement quality is monitored and assured, in particular, the processes for dealing with any problems that may arise. All have formal processes for the audit of placements, which are linked to university quality systems and the requirements of the Health and Care Professions Council (HCPC). When problems with placement suitability or experience occur these are addressed with either the practice educator or service manager, depending on severity.

All but one of the HEIs have a formal ‘cause for concern’ process or equivalent thatcentres use to raise any specific concerns about a student’s performance or conduct. This links ultimately to the Student Fitness to Practice procedures.  The outstanding HEI uses a traffic light system for identifying students who are giving cause for concern.

Selection of students is managed within university admissions procedures and interviewing practices are diverse. In eight HEIs all students are interviewed, although in two of these the decision to begin interviewing is relatively recent. One HEI does not interview applicants for the BSc (Hons) programme and another interviews only those applicants who have non-standard entry qualifications. All universities seek the involvement of clinical staff in the interviewing process, although it was pointed out that engagement is sometimes difficult to sustain. It is evident that the student profile is more diverse than ever before. The range of abilities and personal circumstances is wider and students’ expectations have changed in line with broader societal changes, which are focused more on the primacy of the individual and their needs.

Suitability for a career in radiotherapy is mainly judged through personal statements and questioning at interview, often with a scoring system to increase objectivity. Techniques used include written assessments, group interviews, presentations and use of scenarios. Innovations reported include service user involvement and the involvement of existing students in the interview process. One respondent referred positively to a values assessment that is used for selecting nursing students. Some interviewees pointed out that students may be coached for interviews and that personal statements may not be the work of the student. The value of interviewing for suitability as is currently undertaken is debatable and controversial.

According to protocol, all prospective students should undertake a clinical visit either prior to interview or before being offered a place. The format of these visits varies and their value to students is doubtful, although the use of a clinical visit report form is increasing. Difficulties with arranging prior experience to support students with making the right decision are acknowledged and the question of how to ensure suitability remains significant, both for prospective students and the profession.

Arrangements for student support and assessment described in the audit are confirmed by HEI respondents. There is a variety of practices and little consistency.

The timing of the first placement is variable and controversial, ranging from 5 weeks to 8 months after students enroll on the programme. The length of placement varies from one week to 14 weeks. Pre-clinical preparation activities are embedded in academic programmes, often with involvement from clinical staff, and VERT™ is used for the development of practical skills. Respondents believe that students are well prepared theoretically and professionally. Attention is also given to communication skills, team working and mandatory training. One HEI involves service users in assisting with preparing students for placement.

Finally, interviewees were asked about how academic staff kept themselves up to date and apprised of changes to clinical services. Most responded that that this occurred through updates at routine meetings and CPD activities. Few academic staff work in clinical practice although one HEI reported that a week’s work for all staff had been implemented during this year and that staff had benefitted.

4.4 Conclusions

The findings support those of the audit and suggest that there is a shared understanding of the factors that contribute to student attrition. Aside from local service level agreements, multi-level organisational systems and processes are in place to manage the partnerships. The role of practice educator, where it exists, is significant in maintaining good relationships.

The way in which student numbers per placement provider is agreed requires a more structured approach. Placement capacity is at its limits and there will be overcrowding in many placement sites when attrition is reduced unless new approaches are developed. This may have the perverse effect of making retention more difficult.

Selection procedures vary and the value of interviewing in relation to suitability assessment needs to be debated and developed further. The ways in which students are prepared for their placements appear comprehensive and robust yet the ‘reality shock’ of daily work in the radiotherapy centre is evident.

The diverse profile of student cohorts and their expectations is problematic. It is observed that some practitioners do not understand or accept societal changes and their effects on the learning needs of students, who require a more personalised approach. In clinical centres, patients have primacy and there is a conflict of interest that sometimes means that students’ needs have to take second place. Better management  of the expectations of both students and staff is essential.

There is no consistent view of mentoring and assessment. As demonstrated in the centre audit, there is no consensus about terminology or process, although there is a prevailing view that, in order to be objective about clinical assessment, this process should be separate from mentoring. This dilemma has been the subject of considerable debate in nursing for many years. A compelling body of evidence has been built up about how the two roles are perceived and enabled by appropriate education and training of mentors.10,11

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