Giving UK health professionals the skills to be excellent allies to internationally educated registrants

Effective communication is the lifeblood of healthcare. It’s the skill that underpins everything from delivering sensitive news to colleagues, supporting patients, resolving complaints, and building trust. However, many individuals struggle with initiating, sustaining, concluding, and following up on conversations. In the realm of healthcare education, simulation-based education (SBE) has emerged as a powerful tool to enhance communication skills. But to make the most of SBE, a structured communication skills framework is essential. While several such frameworks exist, we aimed to create a versatile, easily memorisable framework that could apply to a wide range of communication scenarios within SBE.

The building of STEPS: A framework for all conversations

Our journey began with a deep dive into existing communication skills frameworks, drawing insights from experts in communication skills, healthcare education, and SBE. SimComm wanted our framework to encompass the essential skills needed for every conversation, whether it’s between healthcare professionals and colleagues, patients, relatives, non-healthcare professionals, colleagues, or clients.

Through qualitative data analysis from sessions spanning five years, we identified key themes that formed the basis of our new framework:

  1. Why, When, Where, and How to Start a Conversation
  2. The Best Time for a Conversation
  3. Showing Empathy and Listening (Both Verbally and Nonverbally)
  4. Providing Support without Imposing Solutions
  5. Conducting a Sense Check After the Conversation

Two years ago, the STEPS framework was born. It has since been utilized by our facilitators in SBE to empower participants to confidently structure and engage in conversations.

Exploring the benefits of simulated placements

Capacity for Allied Health Professional (AHP) clinical placement is limited and has restricted the ability to grow the numbers in education to meet the needs of the workforce. The Covid -19 pandemic with its requirements for social distancing and PPE has compounded this issue. This means that ‘catch up’ capacity is required on top of the planned provision.

In addition, the NHS’s Long-Term Plan (LTP) and the subsequent People Plan signal the need for significant growth in numbers of AHPs for the workforce. This increase will significantly increase the number of placements required to deliver these numbers.

Practice is changing, the long called for shift to care closer to home also requires a shift in the location of placement education away from the acute NHS Trusts to more community, domiciliary and primary care settings. Whilst this shift has started more needs to be done to ensure sufficient capacity across a full range of setting. Covid-19 has necessitated a change in the models of delivery of care in order to manage workflow and keep people safe.

Education practice is also changing in the wake of advances in technology and simulation is becoming commonplace in the delivery of AHP degrees. Simulations are recognised as having value in preparing students effectively so that when they enter the clinical learning environment, they are better prepared and can consolidate their skills rather than start from scratch.

It is clear from all this that there is a need for an increased capacity in clinical placements and that radical change in how the placement is delivered is needed to respond to this need. The regulators of the AHP professions and the professional bodies have a role in setting out expectations of education providers in relation to practice placement.

 SimComm’s simulated placements:

SimComm Academy was approached by a podiatry undergraduate programme to assist in delivering a podiatry simulated placement for BSc and separately for MSc podiatry students for the academic year 2022/2023. The development of the simulated placement was a collaborative effort that spanned five weeks. Our team consisted of higher education institution (HEI) academics, subject specialists, and simulation-based educationalists. Together, we crafted six scenarios aligned with the Health and Care Professions Council (HCPC) Standards of Proficiency for Podiatrists, covering various aspects of the podiatry profession.

The simulated placement experience included both role play, where experienced actors took on the roles of simulated colleagues, patients, and relatives and facilitated learning, with skilled facilitators ensured a safe and immersive learning environment.

The focus areas of the simulated placements covered scope of practice and autonomous practice, professional judgment, culture, equality, diversity, and non-discriminatory practice, confidentiality and professionalism, teamwork, communication skills (both face-to-face and telephone), and safe practice environments.

The learning framework:

A communication skills framework served as the foundation of the entire learning experience, offering students a well-defined and structured approach to navigate their conversations and behaviours effectively. This framework provided them with a valuable toolkit to engage in discussions with patients, colleagues, and other stakeholders with confidence and empathy.

After each debrief, students were encouraged to take a moment to process their experiences. This crucial step allowed them to delve deeper into the nuances of their interactions, enabling personal growth and a better understanding of the challenges and successes they encountered during the simulated placements.

In the immersive learning environment, all scenarios were crafted and presented in either forum theatre or fishbowl simulations. This approach ensured that all students shared the same space as the simulation, fostering a collective and inclusive learning atmosphere where they could observe, learn, and actively participate in discussions and scenarios. This hands-on engagement further enriched their learning and prepared them for real-world healthcare interactions.

Exploring large-scale simulated placements for BSc and MSc student

Clinical placements are a cornerstone of physiotherapy education, allowing students to gain valuable hands-on experience in healthcare settings. However, limited placement opportunities and evolving educational approaches have led to the emergence of large-scale simulated placements. In this blog post, we delve into the role of simulated placements, discussing their structure, impact, and most importantly, their sustainability for both BSc and MSc physiotherapy students.

Incorporating actors for realistic scenarios

Simulated clinical placements play a vital role in preparing physiotherapy students for real-world healthcare settings. One of the key elements that enhance the authenticity of these placements is the involvement of skilled actors who step into various roles, creating scenarios that closely mimic what students will encounter in their future careers.

The use of actors in simulated placements goes beyond mere role-play; it offers a lifelike representation of clinical situations. These actors are trained to portray patients with different conditions, backgrounds, and emotional states. They bring real-life complexities into the learning environment, allowing students to practice their skills in a context that closely resembles actual patient interactions.

The structure of simulated placements

Simulated clinical placements provide physiotherapy MSc and BSc students with a valuable, realistic learning experience, in a safe and supportive, facilitator-led environment. SimComm co-produced a placement programme for 80 BSc and 30 MSc undergraduate physiotherapy students .

Each student was provided with 40 simulated placement hours over one week, this was divided between hands on facilitated simulation, with follow-up synthesis and reflection of the learning outcomes. The facilitated sessions with actor role players centred around authentic scenarios which were level-matched and closely aligned with the HCPC Physiotherapy Standards of Proficiency (HCPC, 2018). The scenarios reflected the diverse society in which we live, with actors taking on roles of patients/relatives and colleagues, from a range of backgrounds, with differing demographics and characteristics, presenting in a broad range of situations. Students were able to reflect on their interactions, before, during and after the simulation; they received objective feedback from the actor, from the unique perspective of patient/relative or colleague, they received feedback from their peers and from the facilitator.

Beyond technical skills – nurturing effective communication

Simulated placements for paramedics are growing, with some organisations approaching these placements innovatively, focussing on combining undergraduate paramedic facilitation skills with peer reviewing skills (Wilford et al., 2022). Some higher education institutions (HEIs) focus on clinical skills with manikin scenario-simulations and virtual reality driven learning, others utilise actor-based simulations.

Effective communication skills are crucial for paramedics and simulated placements with real people provide an opportunity to practice these skills. Communication is not only a key proficiency for paramedics according to the Health and Care Professions Council (HCPC) (HCPC, 2018), but given paramedic’s responsibilities to patients and their relatives means that rehearsal of these skills should not be overlooked in preference to technical skill acquisition.

Communication and care in HCPC standards for paramedics

The HCPC Standards of Proficiency for Paramedics serve as a foundational guide for shaping competent and compassionate paramedic practice. Within these standards, there are specific mandates that underscore the importance of both technical excellence and effective communication.

Effective communication stands as a pillar of paramedic’s practice. Paramedics are expected to be skilled communicators, capable of conveying critical information to patients, their relatives, bystanders, and fellow healthcare professionals. This proficiency in communication is not limited to just verbal exchanges; it extends to non-verbal cues, active listening, and empathy.