JCPSLP Vol 23 No 3

a sense of thinking and practising as developing SLPs and to learn, as reflected here: To de-centre and adapt to making someone else the priority, unlike at uni. where everything revolves around them and their needs. On a normal placement the priority and focus are the clients and the reality is that the students’ learning has to fit around. Balancing the ability of CSLE, in its more “low-stakes” environment where time and repetition of skills practice can create more confident students, against the clinical reality of providing time-limited compassionate and effective patient care, is interesting to consider. The former learning environment provides critical “exposure” (as discussed by Hancock et al., 2020) and can result in a perceived reduction of student anxiety and stress with a reported elevation of students’ confidence levels. UPEs reflected on the rich and novel opportunities for students to learn from this departure from traditional transmission models of clinical education and training, explaining that, “to work through a case from the initial referral through to intervention is not an experience they would typically experience in their ‘real’ placements.” It is not uncommon for UPEs to receive student feedback on the strangeness or unrealistic nature of simulated or experiential learning (Stoneham & Feltham, 2009), especially role-play. We have used actors as simulated patients in other clinical simulated (role-play) workshops and found, as Kneebone et al. (2016) suggest, they capture the essence of clinical encounters and support students to develop the relationship of care. Therefore, managing students’ expectations of exactly which skills and knowledge they are able to draw upon in any learning context is critical to success (Trede & Smith, 2014). Perhaps a spectrum of realism needs to be acknowledged requiring different skills, knowledge and opportunities at the various stages of placement learning. Having made the transition to full online learning via video platform six months previously, most students had learnt to successfully engage with the technology for academic work and teletherapy, but perhaps not with clinical work, with one UPE noting that: one student appeared briefly for the 9am meet up and then failed to join in with any of the subsequent meetings scheduled. She sent a message via the online platform to the effect that her internet wasn’t working that day. This reflection perhaps indicated the conflict for the student around the need to continue developing her SLP professional skills and to problem-solve and engage as in the “live” clinical placement. An additional factor noted in the reflections by some UPEs concerned the transatlantic difference in some areas of SLP practice. The advantages, however, of working with clients from different cultural backgrounds and in global SLP practice afforded critical discussions across the placement groups. While there is no doubt that Simucase® (Ondo et al., 2020) offers high-quality video material with supporting case details, the differences in approaches and practices of EBP needed to be explicitly considered with the students as part of the learning experience (McCurtin & Carter, 2015). Finally, another challenge to the notion of realism were the restrictions placed on clinical decision-making which can, as stated above, be noted and discussed with students, with a UPE stating that:

We are coming to the clinical decision-making process (on Simucase) second-hand, ie following someone else’s thinking. All UPEs differ in terms of the knowledge and expertise they bring (i.e. E3BP) and there is typically no definitive ‘correct’ approach in a given case. The assessment data and so on in the simulation, are not necessarily optimal given the evidence base or what you would have selected

yourself. Rationale is not necessarily provided. Perspective 2: Identity, roles and relationships

The “vexed question” of identity (Clegg, 2008, p. 329) is of central importance in the context of clinical education at all levels, and is much discussed in the literature as a result. Professional identity is a complex and nuanced arena, arguably more faithfully conceived of in multitudes than a dichotomy between, in this instance, academic versus placement (clinical) educator. Professional identity formation, then, as an inherently non-linear phenomenon perhaps appropriately reflects the “messy realities” (Bleakley & Cleland, 2015, p. 81) of both health, education and their intersections as experienced by UPEs in this context. In a health care education context, much of the literature focuses on the move from clinical educator/practitioner to academic (see Hughes, 2013), and a perceived value hierarchy in favour of clinical practice (Fisher, 2005). However, much less evidence exists for the challenges and opportunities of being a practice educator for your own university students—effectively, a reverse process, moving from academic lecturer to clinical practitioner (see Bentley & Pegram, 2003 for a discussion from the perspective of nursing). This issue was raised explicitly by over half of the UPEs involved in their reflections. One UPE reflected on the benefits from her point of view of this dualism noting that: “as lecturers we bring knowledge of good pedagogy and our experience of guiding student observations and scaffolding learning, as clinicians, we bring our clinical experience to the task and first-hand experience of the clinical decision-making process”. Another noted a circularity within the two roles, “you know exactly what content you have taught in lectures ... having the role of [U]PE gives you more insight into the relevance of your teaching materials on this clinical topic ... so it helps you to develop as a lecturer”. Considerations of perceived worth were also explored, with discussion of security, value and credibility, itself a “slippery concept” (Molloy & Bearman, 2019, p. 3), all being raised by different participants. The tensions described by Molloy and Bearman (2019) around potentially mismatched perceptions of credibility between people were highlighted in the following observation: could I be a credible practice educator in the eyes of my students? What would that look like, how would I know and how could a trusted space be established between us to allow for honest discussions of not only their experience of working through the simulated case, but their experience of me As explored in Davies et al. (2019), an appreciation of the complexities of the role of a UPE on placement was reflected in the consideration of the multiple elements within the role “as lecturer, personal development tutor or [U]PE? How do I perceive it and possibly more importantly, how did the students?”. However, maintaining a distinction between

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JCPSLP Volume 23, Number 3 2021

Journal of Clinical Practice in Speech-Language Pathology