Government bodies across the UK, through the production of health and wellbeing strategies are highlighting the need to increase the use of digital-enabled care within healthcare and wider systems. A growing number of dietetic services are being supported digitally to deliver care to service users.
Although digital-enabled care can improve services and make them more sustainable, it has the potential to create a skills gap in the workforce. Offering some digital Practice-based Learning to learners during their training means they can develop the skills they need to manage remote service user care platforms and other digital appliances. This benefits both service user and dietetic teams.
The following sections give descriptions of digital approaches that can be used for Practice-based Learning:
Simulation
Dietetic education is increasingly supported by technology alongside conventional and learning experiences. Learners can explore knowledge and skills and practice application of these in a low-risk environment. It is now possible to create effective and efficient clinicians via simulated Practice-based Learning opportunities alongside other opportunities. This is reflected in the BDA curriculum which states simulation can be used for up to 350 Practice-based Learning hours.
Simulation is a teaching and learning methodology which is well established in healthcare education. It is described as “a technique (not or a tool, or technology) to replace, augment or amplify reality with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world, in an interactive fashion” (Gaba 2004). It offers a safe environment to focus on the learner’s needs, simulate the clinical environment and practice clinical skills (Hewat et al, 2020) allowing for repetition, feedback, evaluation and reflection.
There are various types of simulation (including part task trainers, mannequins, service users) and environments (including in situ, dedicated clinical simulation suites). It is important to clearly define the intended learning outcomes for each simulation to ensure the appropriate type of simulation is selected and aligns to the learner’s level of learning (Alinier, 2007).
Examples of simulation include:
- Video-based learning
- Role-playing interactions: This will involve learners practising and developing clinical skills with educators/peers
- scenarios where learners or others act as the person receiving dietetic services
- scenarios using professionally trained actors, and the use of high-fidelity manikins
- Peer Enhanced e-Placement (PEEP) using electronic platforms for virtual caseloads.
See the Health Education England webpages on simulation and the Health Eduacation and Improvement Wales.
Benefits include:
Technology Enabled Care Services (TECS)
Recent challenges to healthcare professions through the COVID-19 pandemic have accelerated the use of technology enabled care services (TECS), also called telehealth, telepractice or digital. Practice education may involve ‘in person’ or telehealth PBL or a hybrid. Telehealth PBL may be provided where both the practice educator and the learner(s) are working from home, and link remotely for direct client-facing or other Practice-based Learning activities.
TECS refers to the use of telehealth, telecare, telemedicine, telecoaching and self-care in providing care for patients with long term conditions that is convenient, accessible and cost-effective. [NHS England, 2020]
Technology enabled care Practice-based Learning (virtual placements) involve delivering care where the service user is not in the same room as the clinician. The learners may be in a clinic with a practice educator, at home delivering care either via a virtual platform or over the telephone.
Microsoft Teams offers an ideal platform to support TEC Practice-based Learning. You can video call the learner and have all the functionality of Teams at your disposal for the duration of the call. Service users (patients) can be called in using audio on Teams if you have an associated direct dial.
Alternatively, you can use any mobile phone and set up conference call via the phone so that the learner and service users are on the same call as you. This way you can hear the learner however you are unable to see them at the same time, you are also unable to use message prompts using this method.
Learners can be supported to deliver group training sessions on a virtual platform, service users can be given links to join the virtual session and learners can practice their IT skills at facilitating a virtual session and delivering one.
Examples of TECS include:
- NearMe and Attend anywhere technology
Benefits to the learner
- Develops communication capabilities e.g. telephone etiquette, being more explicit when giving and receiving feedback, resource development etc.
- Increased access to healthcare.
- Elimination of travel time.
- More privacy, less stigma.
Read our 4 to 1 TECS student training model case study.
Applications (apps)
This is described as an application, especially as downloaded by a user to a mobile device. Educational learning apps are designed to be engaging and enjoyable for learners. Knowledge augmentation, tailored learning experiences, improved engagement, access to online study material, ease of communication, and, most significantly, remote access are all advantages of a learning app.
Points to consider
- The method chosen should be determined by the learning outcomes and be used effectively and proportionately to support learning and assessment.
- Whatever the method chosen, it should be determined by the learning outcomes and be used effectively and proportionately to support learning and assessment.
- At present the number of hours that are allocated to TECS will vary between HEI settings. The BDA stipulates that if simulation is only being used as part of the 350 hours criteria in a clinical setting, this should not exceed 175 hours in order to ensure that learners maintain some face-to-face contact as part of their whole 1000 hours of Practice-based Learning. If TECS is used in a variety of clinical and non-clinical settings the 175 hours may well be exceeded [but assurance is sought that the 175 hours of face-to-face contact is maintained for the clinical setting component].
- For both simulation and TECS the relevant governance and data protection systems need to be in place but this has not posed any barriers to operating these systems. As dietetic services will use these methods going forward to deliver care, learners using them on Practice-based Learning is beneficial and positive, so that it will not come as a shock when in practice following graduation. It is a skill they can offer to make them more attractive employees.
- Information Governance: It remains standard that HEIs are responsible for ensuring learners have completed the appropriate mandatory training before attending Practice-based Learning. Practice educators are responsible for the induction of learners to the local policies and procedures. Specific consideration of local implementation in the telehealth context will be required, including safeguarding and information governance. Requirements for consent to treatment from a learner and associated information governance do not change in relation to the telehealth service delivery method. Where learners are providing telehealth services using their personal devices and/or from their home, the education provider should ensure professional and local governance is applied.
- Learners should prepare for telehealth Practice-based Learning in the same way as an in-person Practice-based Learning. Additionally, learners should contact their practice educator in advance of the first day to ask for information regarding the online platform details, which they should test before starting Practice-based Learning.