royal perth hospital student training ward - Health Sciences - Curtin ...

REPORT
ROYAL PERTH HOSPITAL
STUDENT TRAINING WARD

REPORT
ROYAL PERTH HOSPITAL
STUDENT TRAINING WARD
I
n collaboration with Curtin University, Royal Perth
Hospital (RPH) played host to the first interprofessional
student training ward in the southern hemisphere. The
project was modelled on the highly successful training
wards that have operated in Europe for the past two
decades, which have demonstrated that students who
participate in such a learning experience:
gain an ability to collaborate effectively through an
increased understanding and appreciation of each
other’s profession;
develop their own professional competence and role in
the healthcare team;
develop efficient and effective practices in the
identification of the patient’s needs so as to plan,
implement and evaluate evidence based care;
understand the role of the patient in their care;
are highly attractive to employers; and
as new graduates, are more confident in their
interprofessional competencies whilst having an
appropriate level of confidence in their clinical skills.
Six beds within a 26–bed general medical ward provided the
setting for three consecutive 2-week clinical placements for
health science students from nursing, physiotherapy,
occupational therapy, social work, pharmacy and medicine.
The students were supervised five days a week on morning
shifts.
The ward provided an authentic, practice-based learning
environment where undergraduate students developed the
knowledge, skills and attitudes required for effective
patient-centred collaborative practice. The key focus was
the application of interprofessional education (IPE)
principles to the delivery of holistic patient care, with an
emphasis on teamwork during patient contact, handover
and discharge planning. The students were also required to
demonstrate an increased level of independence as they
undertook the ward duties as a team.
Facilitators from social work, physiotherapy, occupational
therapy, pharmacy and medicine were rostered on for part
of each day. A nursing facilitator was on the ward full time.
A consumer advocate visited the ward once per week to
listen to patients and to provide feedback to the students.
All students (except medicine) and the nurse facilitator
commenced each day at 0700 and began with handover
from the night shift nursing staff. The students then
completed the medication round and prepared patients for
breakfast. The medical students joined five members of the
student team at 0800 on the ward round whilst two
students remained on the ward to care for the patients.
Following the ward round students met with their
profession-specific facilitator (an RPH staff member from
their profession) to discuss each patient and to clarify the
profession-specific tasks the students were to undertake
that day. This also provided the opportunity for students to
request assistance with any task they felt they could not
undertake without profession-specific support/supervision.
Group planning meetings followed, led by a different
facilitator each day. For example, on Monday the medical
facilitator led the meeting while on Tuesday this was the
pharmacy facilitator.
Students then undertook further patient care activities,
including handover of the patients to the afternoon shift.
Other activities included professional development and
research. Each day ended with a half hour debrief led by
one of the staff facilitators.
Student Assessment
Student’s interprofessional capabilities were assessed
using a tool Curtin developed, the Interprofessional
Capability Assessment Tool (ICAT). This tool has a 4-point
Likert scale: unsatisfactory, satisfactory, developing and
outstanding with a rubric to describe each capability at
each level. Examples of the interprofessional capabilities
include the ability to:
communicate effectively in a respectful manner;
establish and maintain effective working relationships;
demonstrate confidence in understanding their own role
as well as others;
reflect on team structure, function and roles; and
participate in and lead team meetings.
Each student received both profession-specific supervision
and interprofessional supervision (supervision by staff from
a profession other than their own). As a result of this
shared model of supervision each student’s
interprofessional capabilities assessment was completed
by the nurse facilitator with input from the other
facilitators. Students were also required to rate themselves
using this tool. All students achieved a pass grade for their
interprofessional placement with most capabilities rated at
a satisfactory or outstanding level at the completion of
the placement. Comments were typified by the following
examples:-
“(Student) was an avid participant in team discussions
actively listening to her team members but always
offering constructive input from a social work point of
view.”
“(Student) ensures that patient safety is her number one
priority.”
In addition to the interprofessional capabilities assessment,
students were asked to provide feedback to their peers in
terms of their collaborative skills using a peer evaluation
tool Curtin developed. This asked students to rate
behaviours on a 5-point Likert scale from very poor to
excellent. The results are summarised in Table 1 (over).

REPORT
Table 1: Summary of Peer Evaluations
Item Median Mean SD
% Rated
Good or
Excellent
Actively listens to the knowledge & opinions of other team members 5 4.69 0.510 97.6
Respects the competence & contribution of other professions to patient care 5 4.73 0.493 97.6
Effectively communicates own profession's role in a way that promotes positive
interaction
5 4.68 0.585 96.8
Effectively communicates knowledge in a way that promotes positive interaction 5 4.68 0.560 96.8
Works collaboratively with team members to provide safe, high quality patientcentered
care
5 4.69 0.568 97.6
Actively engages in team meetings 5 4.64 0.555 96.0
Actively engages in reflection on team structure, function & roles 5 4.56 0.542 97.6
NB – Median reported as primary central tendency when item data
is ordinal.
The table clearly shows that the students most frequently
rated their peers as good or excellent collaborators.
“He was really eager to learn about other professions as
well as share his knowledge.”
“(Student) appears confident in her role and knowledge,
resulting in clear communication with patients and team
members.”
Evaluation of the Placement
In keeping with the scholarly approach to our
interprofessional education initiatives, all stakeholders
involved in the training ward were invited to complete
quantitative and/or qualitative tools to measure the
outcomes of the experience.
showed statistically significant changes and large effect
sizes. The results are summarised in Table 2.
Students were asked to give a general rating on a 5-point
Likert scale of their pre and post placement knowledge of
their own as well as other professions, the patient’s role,
the importance of communication and their own comfort in
collaborating within the health care team. As you can see
from Figure 1 student’s knowledge of their own profession
and of the other professions increased dramatically
following this short but intense placement. Their knowledge
of the role of the patient in their own care and of the
importance of communication to patient safety and quality
also improved. All students reported feeling comfort in
collaborating with the other professions at the end of the
placement.
Figure 1: Summary of Students’ Post-Placement IPE Knowledge
Students
The quantitative tool used was the Interprofessional
Socialisation and Valuing Scale [ISVS] (King, Shaw &
Orchard, 2009). This tool has three subscales which
measure the students’ ability and comfort in working with
others and the value they place on this. A paired sample t
test was used to compare pre and post placement scores
for all 21 students who participated in the pilot. On
average, the students’ post placement ISVS scores were
19.55 points better than their pre placement scores. This
difference indicated a more positive attitude to
collaborative practice post placement and was statistically
significant with follow up analysis showing a large effect
size.
Three paired sample t tests were also used to compare the
difference of each of the three sub-scales of the ISVS before
and after the placement. A statistical correction was made
to account for the repeated t tests, and all three sub-factors
Table 2: Student ISVS Subscale Results
Subscales
Mean
change
Students were also asked to rate their overall experience on
a single item 5-point Likert scale ranging from 1 (very poor)
to 5 (excellent). Quantitative results indicated that 100% of
students rated this learning experience as good or excellent.
t df p d Effect Size
Ability to work with others 6.00 5.45 20

Quantitative comments revealed that:
Nineteen out of 20 students highlighted the knowledge of
the roles and responsibilities of other health professions
they had gained within the placement. One specific element
they found particularly useful was a greater understanding
of the assessments or skills specific to a particular
discipline. This was reinforced by staff who drew attention
to the increased understanding that students gained of the
roles and responsibilities of other healthcare professionals.
Responses from students concerning patient-centred care
emphasized that all the professions collaborated to provide
the best and most holistic care for the patient. In
considering the patient as an individual with wants and
needs at times conflict arose in addressing both of these.
Associated with this was the awareness that a large
number of these conflicts between patients’ needs and
wants were avoided or mitigated through effective
communication and rapport with the patient, something
that all student teams felt was particularly important.
Students reported that investing time and effort to develop
a good rapport with patients and keeping them involved
and informed in their treatment meant that the patients
were very motivated and cooperative. Comments included:
“All patients mentioned they felt more cared for and that
we were more thorough than on other wards. They felt
their needs were attended to more rapidly and that they
got benefit of all professions. Even when patients didn't
need certain things done, they could see the level of care
that others were getting and that reassured them.”
“Having a combined assessment meant that the patient
didn't have to repeat themselves many times to different
disciplines.”
“I feel the patients also gained a greater insight into the
different professions and could see that we were working
together to provide the highest quality patient centred
care.”
“The STW was great for me and I hope it continues for a
long time.”
“I had an immensely enjoyable time, discovering other
professions, meeting the other students and sharing time
with them. I would not hesitate to recommend the
opportunity to anyone!!!”
“I loved this experience and wish I had more of it during
my clinical placements.”
Students highlighted the value and importance of
collaboration in this placement, with many emphasising
that effective communication was particularly important.
As a subcategory to this some students stressed that it
was important to ask for help when needed. This was again
supported by staff who drew attention to the benefits of
effective communication. When students compared this
experience to other placements that had taken place with
differing professions, they remarked that in the training
ward the different professions really worked as a team and
communicated equally with each other.
When asked about the skills they could transfer to other
environments, students commented that the knowledge of
roles and responsibilities gained both within and between
professions, together with the understanding of what was
involved in the operation of a general medical ward, was
invaluable. They felt that this knowledge would be
applicable to some extent regardless of where they practice.
Staff
Staff completed a qualitative and quantitative survey, pre
and post placement, and attended an interview at the
conclusion of the pilots. Eighty per cent of staff rated their
overall experience in the ward as good or excellent.
They were asked to rate a number of items designed to
measure their attitude and ability with regards to IPE
facilitation on a 5-point Likert scale (1 = very poor to 5 =
excellent), Descriptive analysis showed that following the
placements, most staff were very motivated and confident
to facilitate IPE. Their knowledge of strategies, ability to
provide feedback and to model interprofessional practice
varied from average to excellent. A summary of this is
provided in Table 3. Comments included:-
“From the facilitator’s perspective, I have thoroughly
enjoyed being involved in the STW experience. I hope the
STW becomes a sustainable program as I see it being
very beneficial to students in preparing them for the ‘real
world’.”
“By training students in an ‘ideal’ environment and
encouraging multidisciplinary team collaboration and
understanding, the organisation will benefit, as a better
service will be provided to consumers when the students
graduate & enter the workforce.”
“Patients received the comprehensive input of the whole
team & often reported they felt more understood &
listened to.”
“Students were able to relate practice to theory in earlier
stages. Even doctors were able to have hands on with
direct patient care.”
“Medically speaking, our workload was reduced as the
students were efficient and completed all tasks.”
“Staff resources are not stretched as there are more
hands on deck.”
“This STW is an excellent and fantastic learning
opportunity for all students. I highly recommend it.”
Table 3: Summary of IPE Staff Attitudes and Abilities
Item Median Mean SD % Rated
Good or
Excellent
% rated
Average
% Rated
Poor or
Very Poor
Motivation to facilitate interprofessional education 4.0 4.07 .730 78.6 21.4 0
Confidence to facilitate interprofessional education 4.0 4.00 .679 78.6 21.4 0
Knowledge of strategies to facilitate interprofessional
education
Ability to provide appropriate feedback to students from
different professions
Ability to model collaborative practice (interprofessional
practice)
4.0 3.75 .700 64.3 35.7 0
4.0 3.86 .770 64.3 35.7 0
4.0 3.85 .770 64.3 35.7 0

REPORT
Patients and/or Carers
The consumer advocate on the student training ward
interviewed the patients each week and provided feedback
on this to the students along with a written report to staff.
Formal patient satisfaction surveys were also provided
consisting of questions about their experience with both
staff and students on the ward. Ratings were on a 5-point
Likert from very dissatisfied to very satisfied. Fourteen
completed surveys were analysed and revealed that the
vast majority of patients were happy with the care they
received as indicated in Table 4.
Table 4: Summary of patient survey
All students commence each shift at the same time
Reduced external commitments such as days students
are required to be at university as these detracted both
from the learning experience and the team’s ability to
function effectively
Inclusion of an extra medical student to reduce the
workload and allow them to be present for more of the
group activities (Note: It was also pointed out that one
very useful experience that the medical students gained
from this placement was learning to deal with being
overwhelmed, as this reflected their practice in real life)
Patient Survey Question Median Mode SD
% Rated
Satisfied or
Very satisfied
How would you rate your overall experience in the student training ward 5 4.50 .674 91.7
The students were courteous and treated you with respect. 4 4.38 .506 100
How well the students communicated with you. 5 4.54 .660 92.7
Promptness in students responding to your requests 4.50 4.31 .855 84.6
How well the students kept you informed. 4 4.31 .751 76.9
The effort made by the students to include you in decisions about your care 5 4.46 .776 84.6
Time the students spent with you 4 4.38 .650 92.3
Communication between the students regarding your care 4 4.23 .765 84.6
Communication between the staff and the students regarding your care 4 4.31 .751 84.6
Effort made by the students to involve your family in your care. 4.50 4.56 .527 100
Respect shown by the students for your emotional/spiritual needs 4 4.50 .527 100
Students showed concern for your privacy 4 4.45 .522 100
Your overall rating of care provided to you at Royal Perth Hospital 5 4.58 .669 91.7
Patient feedback included comments such as:-
“… one patient I was speaking to yesterday (name
removed) said that she’s been in and out of hospital
quite a bit and this was the best experience she’d had
and she’d never felt so comforted …”
“The student training ward is an extremely good way to
train students.”
“All students should go through the same training.”
Recommendations for the Future
A number of suggestions for improvement were made by
staff and students including:
More detailed training for staff including those external
to the ward
Varied shifts so students are exposed to both morning
and afternoon shift responsibilities
Placement on different wards in order to provide
exposure to a wider range of medical needs
Additional professions where appropriate be included in
the team
An increased focus on interprofessional rather than
profession specific or nursing tasks
Less (or at least more flexibility with) meetings and
breaks
Improved system for student feedback to the facilitators
A pool of facilitators, as well as the necessity for
rotations with break periods, both for recovery and to
provide time to reflect on their own performance as
facilitators.
Conclusion
The Curtin-RPH Student Training Ward was a very
successful initiative with feedback from staff, students and
clients being overwhelmingly positive. Both quantitative
and qualitative analysis revealed there were significant
changes in the students’ ability and comfort in working in
collaboration with the team, knowledge of their own and
other professions’ roles and responsibilities, and
understanding of the importance of patient-centred care. A
great deal of time and effort was required to get the
initiative started, with documentation of the project, the
partnership between the university and the hospital, the
risks and the evaluation process. Once the first students
arrived, the ward ran very smoothly.
The success of the STW has sparked interest by staff on
other wards who are keen to run a similar student training
model, and the hospital is currently exploring funding
options for the ward so that it is sustainable into the
future. The Western Australian Department of Health have
also expressed interest in rolling out student training
wards in other metropolitan and rural sites.

Authors and Acknowledgements
This report was compiled by Margo Brewer and Diane Franklin
(Curtin University), with comments from Ted Stewart-Wynne
(RPH), and research assistance from Lorenz Wolf (Curtin
University).
The Student Training Ward was made possible due to the
input of the RPH staff Alison Lockhart, Claire-Louise DaRe,
Doreen Demos, Seng Khee Gan, Michael McComish, Deanka
Preston, Peter Smith, Robyn Kerr and Yan Peng), students
(Alastair Jamison, Amy Fussell, Amy Rushton, Cheryl Weng,
Chris McErvale, Courtney Royston, David McGillivray, Fiona
Tydde, Jennifer Allan, Jessica Milne, Julie Smith, Jun Yan Lin,
Michael Hewson, Nora Ihdayhid, Ranita Siru, Seyhan Catan,
Thuy Tran, Wladimir Jakimowicz, Zin Mar Naing, Darius
Arjomand and Kym Moiler), consumer advocate (Jenny John),
Curtin staff (Sue White, Ciara Bambrick, Valerie Sollis, Robyn
Martin, Nigel Gribble, Peter Robinson, Emma Lawrence) and
patients involved.
December 2010
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