JCPSLP Vol 23 No 3

Creative clinical education

Featured researcher Dr Elizabeth Bourne

Liz, I understand you have completed some very interesting research into the experience of clinical educators. What was that research about? Clinical education is really important for the students, but it also can have benefits for the clinical educators (CEs). Placements can be seen as hard work or stressful for CEs and so some clinicians are reluctant to take students on. I wanted to find out what their experiences as CEs were, and also find their secrets to success. There are lots of ways you could measure success, and in the past a lot of research was about things like the number of patients/ clients seen, enhancing productivity. I also think it’s also really important for long-term sustainability that the placement works well for the CEs personally. So I thought a good positive outcome would be if CEs weren’t any more stressed than normal, that is, without students present. So I was looking at how they set things up, what factors were in place so that placements didn’t add any extra stress to their existing work challenges. I believe you used an innovative research method called QCA. Can you explain to us what QCA is and why you chose this method? I knew that the way to make things less stressful for CEs wasn’t going to be something simple. Many of us in universities have been trying to make things better for CEs and workplaces over the years. I think what makes it tricky is what’s termed “complexity” (for more information on this see, for example, Bleakley & Cleland, 2015). There are many facets to this but if you just think about a placement and how many people or situations are in play: we’ve got the CEs themselves, maybe extra CEs, we’ve got students, patients/clients, and maybe other colleagues or other professions in the workplace as well. So there are all those relationships between all those people which are continually changing, and because everyone’s unique and adapting to each other it’s a bit unpredictable about how they combine. I needed a technique that could factor all of that change in. A lot of the other methods need to keep something stable and I couldn’t keep very much stable in the dynamic context of clinical education. I chose QCA as my method of data analysis. QCA stands for qualitative comparative analysis (Ragin, 2000). It’s a research method that helps you address those questions where there are multiple things going on. It actually came out of political sciences but it’s used in health research as well (as starting point, see Cristancho et al., 2019; Thompson et al., 2016). It involves some mathematical kinds of things, but also some qualitative things like coding. I came across it because I was fortunate to have Dr Kate Short as one of my PhD supervisors and she was using QCA to look at factors in

child language development (see for example Shortet al., 2019). So it’s kind of a mix of your qual and your quant and a bit of everything. What does that actually look like? Yes, you’re right. It’s actually in the literature that people can’t decide whether it’s a mixed method or qualitative. To use QCA you need to focus on what’s called “a case”. In my study, the cases were the CEs and I needed to think about what factors might be relevant to the outcome that CEs weren’t any more stressed than they were when they didn’t have students on placement. In a previous study I’d developed a more general model of factors that seemed to influence the CEs’ experiences during placements (Bourne et al., 2020). I had data from CEs before, during and after a placement, which I thought I could use for this study. I knew things like the caseload they had, how many students they’d supervised before, how many students and CEs were involved, how they described the challenges they faced, and how their workplace supported them (or not). I also knew whether the students had passed placement or not. So after going through my data, I used another framework (Demand control support model, see Johnson & Hall, 1988) to identify from all of those things, factors that might be important for a CE not to be stressed. And in the end, we narrowed it down to seven factors which are shown in the key box in the Figure 1 which summarises my key findings. What were your key findings or your conclusions from your research? I had 32 CEs and they had a range of experience as a clinician, from only being a couple of years out to very experienced, and just over half of them had two to five years’ experience as a CE. Most of them were in acute hospitals seeing adult patients. Collectively those 32 CEs supervised 67 students in my data collection period, so some of them were taking more than one student, mostly in block placements. I had fairly much a 50/50 split between intermediate level and advanced level placements—those that are going for near entry level or entry level on COMPASS ® . The students were a mix of undergraduate and masters’ level. When we asked CEs after the placement, 17 out of the 32 said that their stress level was no different with students present, or at worst, maybe slightly more stressed than usual. The others were reporting increased stress and I had nine who said “I’m just stressed all the time”, with or without students. What I wanted to know was what those 17 were doing so it was positive for them. When we used QCA to look at the factors, we actually found ten different paths, with differing combinations of

Dr Elizabeth Bourne

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JCPSLP Volume 23, Number 3 2021

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