Learning on clinical placements is an important part of a veterinary nurse's training in UK higher education. Students spend many months of their course undertaking such placements in veterinary practices. Placements complement lectures and practical sessions at university and also offer a number of benefits when compared with learning at a veterinary school's referral hospital. For example, cases at first opinion practices are more typical of those encountered by the majority of graduate veterinary nurses. The case load is more varied which provides greater opportunity for hands-on experience, and the lack of other students allows for more one-on-one instruction. Students often have a ‘base practice’ where they spend several placement blocks, improving their skills and increasing the range of duties performed over time. The Royal Veterinary College, University of London (RVC) offers several nursing courses including a Foundation Degree and a BSc in Veterinary Nursing. A BSc has also recently been launched in Hong Kong (HK) as part of a collaboration between the RVC and the Hong Kong Polytechnic University. In total, students at the RVC will spend at least 60 weeks (approximately half of the first 3 years of the course) in placements, with the first placement block occurring 4 months into the course; meaning that there is limited time to prepare students. The RVC staff and placement providers have recognized that there is a need to investigate ways to improve student preparation, the overall aim being to enable students to maximize the benefits of placement learning.
Placements, as a form of work-based learning (WBL), are part of several professions' undergraduate studies, for example human medicine (Dornan et al, 2007), nursing (Andrews et al, 2006) and social work (Maidment, 2003). Similar to veterinary nursing students, veterinary students also spend a significant amount of time on placements, known as Extramural Studies (EMS). The Royal College of Veterinary Surgeons (RCVS) requires 26 weeks to be completed during the clinical part of the course (Royal College of Veterinary Surgeons, 2011). Reports have shown that veterinary students and graduates consider EMS to be important for various aspects of their veterinary training including practical skills such as surgery (Fitzpatrick and Mellor, 2003) and non practical abilities such as interpersonal skills (Baguley, 2006). However, placement providers (qualified veterinarians, veterinary nurses and other practice staff), and veterinary students have reported a lack of preparation for placements to be an issue (Bell et al, 2010a), and this was also highlighted in the RCVS review on EMS (Royal College of Veterinary Surgeons, 2009). Similarly, other professions have also recognized the importance of preparation for clinical placement training (Maidment, 2003; Andrews et al, 2006; Williams et al, 2009).
Therefore, to assist veterinary students with placement preparation a Computer Aided Learning (CAL) program the ‘EMS Driving Licence’ was created (Bell et al, 2010a) as a collaborative project between The Royal (Dick) School of Veterinary Studies, Edinburgh and the RVC. The CAL constitutes sections including: ‘Introduction’, ‘Preparation’ (e.g. advice on what to take), ‘Working with People’ (practice staff and clients), ‘Professionalism’ (e.g. issues around confidentiality), ‘Tips’ (from veterinarians and other practice staff) and a list of answers to ‘Frequently Asked Questions’ (from students). A study then compared students who ‘had’ with those who ‘had not’ used the CAL before their first placement and feedback indicated that The EMS Driving Licence resulted in several benefits with veterinary students being more prepared, e.g. knowing what equipment to bring, being more likely to set learning objectives and more able to deal with difficult situations (Bell et al, 2010b).
The EMS Driving Licence has been included in the recommendations of the RCVS EMS Working Party (Royal College of Veterinary Surgeons, 2009). It is freely available on the internet (www.vet.ed.ac.uk/ems_driving_licence/) and is used by all UK veterinary schools and University College Dublin. Google Analytics indicates that the website received approximately 200 visits per month between January 2010 and January 2011. Several veterinary schools require students to submit their ‘EMS Driving Licence Certificate of Completion’ to the EMS office and some practices require students to present their certificate on arrival for a placement.
Having observed the benefits of the EMS CAL for veterinary students, the original project team consulted with the RVC's veterinary nursing school (staff in UK and HK) and began the current project. The aim was to create an online tool containing advice from stakeholders (veterinary nurses, university staff and students) on preparation for nursing placements. The original EMS Driving Licence was developed with funding from the Higher Education Academy Subject Centre for Medicine, Dentistry and Veterinary Medicine (HEA MEDEV) and the Centre for Excellence in Professional Placement Learning (CEPPL). The current project was funded by the LIVE Development Fund (RVC).
Method
The ‘VN Online Clinical Placement Tool’ was based on the EMS Driving Licence and was developed in Adobe Flash. As several members of the project team were co-authors of the EMS Driving Licence CAL, it was possible to access and edit the original Flash file.
Stakeholder consultation
Three stakeholder groups were consulted to help develop the content of the nursing version: qualified veterinary nurses; university staff; and students. Interviews were conducted with three qualified veterinary nurses working in practices who have previously provided placements to RVC students. The nurses viewed the EMS Driving Licence and were asked to comment on the suitability of the content for a nursing version and identify any changes that were required. The nurses were also asked to identify specific issues particularly relevant for nursing students that were not addressed in the original CAL. RVC lecturers (one at the RVC, UK, and one at Hong Kong Polytechnic University, HK) also viewed the CAL and provided comments. Finally, a focus group was conducted with eight first year veterinary nursing students (who all had experience of undertaking a placement but had not viewed the EMS Driving Licence). They were asked to comment on the following points:
The focus group was audio recorded and transcribed.
Approval for the project was granted by the RVC's ethics committee and all students and qualified veterinary nurses involved in project activities (stakeholder consultation and evaluating the CAL) provided consent for their opinions to be used anonymously in development of the CAL and in publications.
Editing the Flash CAL Program
Several aspects of the original CAL were considered suitable for nursing students and were preserved. For example the main section headings (Figure 1) and the ability to print (or save) a personalized certificate of completion once all the pages in the CAL had been viewed.
Within each section, the content (text and pictures) were modified to ensure relevance to veterinary nurses and to address the points that arose during the stakeholder consultations. Several additions were suggested by the nurses in practice and RVC staff (UK and HK), e.g. expanding the advice on becoming part of the team, which was considered important as nursing students tend to remain in their placements longer than veterinary students. Analysis of the student focus group transcript identified issues and pieces of advice, which were incorporated into the CAL. An example was the students' opinions on the suitability of different dress codes: dress versus trousers, with buttoned or zipper shirt. After the first iteration of changes, the CAL was distributed to staff and project team members (three nurses and two veterinarians) for comments. Another iteration of changes to the program was then undertaken prior to evaluation. Figure 2 shows an example page from the CAL.
Evaluation of the VN Online Clinical Placement Tool
A group of five second year nursing students at the RVC evaluated the new CAL. For the first 30 minutes of the session, the students worked through the CAL individually in a computer room. The students were asked to make notes on the best aspects of the CAL and those aspects that could be improved, as well as answering two Likert scale questions. For the remaining 45 minutes, a facilitator (TK) led a focus group discussion on the usefulness of the CAL. The focus group was also recorded and transcribed. Thematic analysis was carried out on the transcript. The Likert scale data were analyzed using descriptive statistics (Excel).
The CAL was also re-sent to the three veterinary nurses in practice (who had been consulted earlier in the project) for their comments and approval.
Results
Evaluation of the VN Online Clinical Placement Tool Student feedback — qualitative data
Thematic analysis identified three major themes emerging from the focus group: positive aspects of the CAL; negative aspects; and areas for improvement. Table 1 indicates the sub-themes and example quotes from the students.
| Main theme | Sub-theme | No. of comments | Example quote |
|---|---|---|---|
| Positive | Specific points within the sections | 17 | I thought [the Tips Section] was all quite helpful, it was basically about busying yourself when you are standing there doing nothing, because not only does that give a bad impression, but you are not learning anything |
| Beneficial (general) | 4 | I wish we had something like this because I went in at the deep end, badly | |
| Presentation | 2 | I thought that the speech bubbles… kind of lighten it up a bit | |
| Negative | Text animation | 5 | I was being distracted from what I was reading, because the next sentence was coming up |
| Boring/repetitive | 3 | It's literally pressing ‘next’, there is no actual interaction with the program | |
| Too basic | 3 | It would definitely be useful for first practice. But I think it's still quite basic | |
| Grammar/clarity of sentences | 3 | There is one slide, and it ends with the word ‘with’ … and you think that it is going to carry onto the next slide, but it just finishes | |
| Improvements | Specific points within the sections | 27 | I think in the professionalism bit… how to answer a phone at reception, manner sort of thing |
| More media/interaction | 4 | You don't know you've gone onto the next section, so either a video or something to break it up, or maybe like multiple choice questions |
Student feedback — quantitative
The results of the Likert questions can be seen in Table 2, whereby a value of 1 indicates strong disagreement with the statement and 5 indicates strong agreement.
| Statement | Minimum | Mode | Maximum |
|---|---|---|---|
| The VN Online Clinical Placement Tool (CAL) has useful information for a veterinary nurse's first placement | 4 | 5 | 5 |
| I would recommend the VN Clinical Placement Tool (CAL) to other students prior to their first placement | 2 | 4 | 5 |
Veterinary nurses in practice feedback
Feedback from the three veterinary nurses in practice was positive, indicating the CAL was appropriate to students' needs. Some example quotes can be seen below:
‘This is fantastic, exactly what is needed.’ [VN1] ‘I have looked through the Prep Tool and it seems to cover everything I can think of.’ [VN2] ‘It is hard for them to reach the right balance of being confident but not seeming to be a ‘know it all’. They really need to try to just be themselves and relax and this Prep Tool will help them do that.’ [VN2] ‘The information on nails, hair and uniform was very good and well put, plus it needed to be said.’ [VN3] ‘The list of what to do when it is quiet was good as one of the biggest problems is finding jobs when it's quiet.’ [VN3]
The nurses all agreed that they would use the CAL with future students.
The VN Online Clinical Placement Tool
Final edits were made to the CAL based on the second student focus group. For example, mistakes in the text were corrected, videos were recorded and inserted to introduce each section, and an editable set of notes was included to download and accompany the CAL. The CAL is available online at www.live.ac.uk/vn_placement
Conclusions
A CAL has been created to assist veterinary nursing students from the UK and HK in their preparation for placements. The development involved an iterative process including consultation with key stakeholders — qualified nurses in practice, staff at the RVC (UK and HK) and veterinary nursing students.
The CAL has received positive feedback from staff, nurses in practice and students, indicating that it provides useful information for students preparing for their first placement. Several suggestions for improvements were implemented but, due to issues such as project time and cost, as well as the desire to keep the program relatively short and succinct, not all changes were feasible. The VN Online Clinical Placement Tool is freely available online, which means that placement providers and staff can direct students to the website and ask them to present their ‘Certifcate of completion’ on their first day of a placement if they wish.
The feedback from veterinary nursing students for this CAL was largely similar to the feedback from the veterinary students on the EMS Driving Licence (Bell et al, 2010a), for example, the sections on body language and the frequently asked questions (e.g. ‘What should I do if a client asks me a question while the vet is out of the room’) were commended. Several slides of the original CAL did not require extensive editing, which demonstrates the similarity in advice for veterinary and nursing students. Examples of the common advice range from ‘don't forget your lunch’ to ‘what you should do if you don't know the answer to a question’, and may be generalized to other courses that include work placements, indicating the potential to extend the CAL further. Future initiatives of the project team could therefore include modifying the CAL for other veterinary placements such as preclinical EMS or collaborating with other placement providers to create additional versions.
The EMS Driving Licence and the VN Online Clinical Placement Tool CALs, provide students with access to information provided by staff and qualified veterinarians and nurses on preparing for placements. Online delivery facilitates use by students while at university, at home or on placements. By following the advice in the CAL, the students should be better prepared, and get the most out of the valuable learning opportunities provided on placements.