Undergraduate Student Experience During COVID-19

March’s blog was written by Amanda Bolderston and Kim Meeking.

The COVID-19 pandemic has affected the delivery of undergraduate education, both for university-based coursework (including exams) and clinical placements. We asked diagnostic and therapeutic radiography students on Twitter to tell us what the experience has been like for them. We posted a tweet from the @MedRadJClub account with a link to a Google form and after a week we had 23 replies from 4 countries (UK, Canada, Ghana and Malta) The main themes of the responses have been summarised in this blog.

Part One: The University Experience

We first asked about learning experiences at university (lectures, exams, coursework etc.) All students had shifted to learning online (e.g. through Zoom or Microsoft Teams) and many saw positive elements to this. Online learning was seen as more flexible and efficient for some. On-demand videos could be watched in the student’s own time or re-watched if needed. Travel time was less, and some students appreciated having more control of their work and timelines:

“With my lectures being pre-recorded it has given me the opportunity to get lectures done earlier than in the timetable, which gives me more time to revise.“

Support and flexibility from universities was appreciated. Students mentioned laptops being supplied, exams being changed to open book or courses being graded without exams which suited people who suffer from exam anxiety. Finally, some students mentioned faculty support has been invaluable:

“Having the choice of a virtual chat during difficult times has had a positive impact on many students.“

There were many more comments detailing negative experiences, or problems with online learning. Students missed the support from fellow students and faculty, both socially and in learning situations. Having to be extremely self-motivated was a challenge and some felt that they didn’t learn best online and needed face to face teaching and support. Some felt that peers who didn’t fully participate impacted the learning of others and that (for example) group work was more difficult online:

“Students will often log into lectures to get a tick for attendance and turn the volume down and go back to sleep/watch TV. When it comes to ‘breakout rooms’, many will stay silent or leave to avoid speaking on a mic.“

There were comments about “screen fatigue” and technical issues that can hinder learning. Some people mentioned privacy issues with online learning and difficulties balancing children at home or living with others:

“I have a large family, so having exams at home was a very stressful event for me, as all throughout the duration of an exam, I was praying that they keep silence.“

Finally, there were numerous comments about variability in the quality of materials used and the readiness of teaching faculty to teach online.

“Online lectures are not as good as they should be, tutors don’t understand or make poor use of technology, the technology platform isn’t designed for a healthcare course and much of the content delivered is often of mediocre standard. Interaction with material has dropped, attendance has dropped…“

A few people felt that universities would take advantage of the shift to online learning and provide less value for money. However, some expressed that faculty were also learning and needed support.

Part Two: The Clinical Environment

Although most students had experienced delays in accessing clinical teaching/placements the comments in this section were generally more positive. One person commented that “clinical has been less impacted compared to academic”. An overriding concern was that of diminishing time to achieve competencies or complete assignments in the clinical environment (or a possible delay in graduation). One student called for a change in the traditional way of clinical evaluation:

“Some competencies have had to be deferred piling on yet more pressure on students, some of us have competencies for year 1 that we will feasibly not have signed off until we’re third year … Progression through the course needs to be based on safety and clinical skill/knowledge, how someone can be deemed competent to be a third year doing “third year-type work” when they haven’t actually passed first year due to deferring one or two competencies? This makes a mockery of the competency system and shows how much work needs to be done to improve the way students are assessed on placement moving to a more sustainable (and sensible) model such as continuous assessment. End-point or staging type assessments are outdated“

Some clinical tutors have been providing support remotely, but many students mentioned that clinical staff (radiographers or medical radiation technologists) have stepped up and provided additional support and learning opportunities:

“Perhaps the best change introduced is the 'extra sessions' which are delivered by radiographers to a small group of 2-3 students at a time (taking them away from the department if 2 students are both timetabled on a single machine) and delivering a sort of seminar - covering things such as difficult scenarios, first-day chats, IR(ME)R, anatomy refreshers etc.“

Thankfully many students said they felt safe and have been included in staff screening and access to PPE, although getting used to working and learning in PPE has been challenging. There was also a sense of appreciation, both for the learning opportunities available and for resilience learned during the pandemic:

"It has provided us with a lot of learning opportunities and has put us in the ‘worst’ situation, which helps us get through the easier aspects of placement in the future. We have been able to learn and work through an entire pandemic, I personally don’t think it could get worse than that.“

Changes made in the clinical environment to accommodate physical distancing and safety have included staggered start times and/or study days as well as access to study space, lockers or staff rooms.

In some cases, patient numbers in clinics have dropped, and some patient groups have been unavailable (for example, brachytherapy access has been limited for radiation therapy students). However there have also been unexpected opportunities:

“I don’t think I would have had the chance to do as many portable chest x-rays pre-covid that’s for sure!“

Finally, some students mentioned that they had a better awareness of the difficulties faced by patients (e.g. having to come alone for appointments) as well as a better grasp of patient communication:

“I feel that covid has made me more aware of my communication with patients - facing difficulties with masks and extra patient anxiety involved etc.“

Conclusion

It’s clear that students have faced many challenges and uncertainties in the last year and will continue to do so. MedRadJClub would like to thank the students whose honest responses have helped illustrate how COVID-19 has impacted undergraduate learning. Although comments have been anonymized, several students left their names, so we’d like to mention Astrid, Andie, Samantha, Samuel, Kathryn, Sahar, Vanessa, Lauren, Keith, Charli, Izzy, Millicent, Anne, Clara and Rebecca.

Are sonographers advanced practitioners?

To continue this month’s discussion on advanced practice, we have a blog from the sonography perspective written by Jacquie Torrington. Jacquie is a radiographer sonographer and specialised in women’s health ultrasound before joining City University (London) as a lecturer in medical ultrasound in 2016. She is currently Joint Interim Programme Director of the course and leads the obstetric and gynaecological ultrasound and professional skills modules.

I would like to pick up on the disparity between the general understanding of the term advanced practice and reality on the ground.  This comes with the caveat that my research was carried out in 2017 so may be out of date in some respects. My experience from teaching trainee sonographers from across London and the South East does suggest that many of the findings are still current.

My project was a survey of sonographers’ opinions of their level of practice evaluated against the Society of Radiographers advanced practitioner accreditation criteria. The survey questions were designed around the SCoR definition of the advanced practitioner level of the SCoR four tier career framework¹ and responses were evaluated against the SCoR definition of advanced practice. 

As Bev and Martine stated in their post, the underlying premise of advanced practice is that the practitioner is working at expert practitioner level and has advanced in their role to undertake elements of leadership, education and evidence based practice.  This differs slightly from the SCoR 2017 accreditation criteria which requires research to be evidenced as opposed to evidence based practice.  (At this point I am tempted to be distracted and write about the overuse / inaccurate use of the term evidence based practice – maybe that could be a future discussion?!)

In my survey the term expert clinical practice was not defined because the survey questions were based on the information on application for accreditation available on the SCoR website which requires that the individual applying for accreditation as an advanced practitioner provides details of their practice and is supported in their definition of themselves as expert by the testimony of two attestors who work with them².  Effectively the practice of an individual applying for accreditation is defined in the context of the usual practice of their department.  In the survey and in accreditation applications this may lead to discrepancies in assessment of expertise as inevitably some sonographers will work in departments where they experience a wide range of examinations with highly expert practitioners while others will be employed in small departments with little variation in work. 

Of the 149 responses received from UK sonographers, 10 fulfilled all three functions, making them eligible for SCoR advanced practitioner accreditation at the time.

This made an interesting contrast with the 44 survey respondents claiming to hold SCoR advanced practitioner accreditation.  When I checked with the SCoR I found that at the time (December 2017) one sonographer held accreditation and two were going through reaccreditation.   Of the respondents, were in the process of applying for advanced or consultant accreditation and 1 was considering accreditation.

The thematic analysis of the open questions suggested that the term advance practice and the scope of activities within the pillars of advanced practice are poorly understood and that role extension into new areas of clinical practice is routinely termed advanced practice, and in many cases, the extension of the clinical role into sonography is defined as advanced practice.

There are five jobs advertised as sonographer advanced practitioner roles on NHS jobs this week (w/c 22.02.21).  The content of the JDs varies widely from exclusively clinical to some elements of advanced practice, none of the JDs meets professional body or the multiprofessional framework³ requirements for advanced practice.

Without a good working definition of expert clinical practice, advanced practice is difficult to define from the outset.  The variation in terminology used to define advanced practice seems to be a major barrier to understanding and creation of advanced practice roles.  If advanced practice is not well understood it does not seem likely that the benefits to services, patients, and staff of creating the roles will be understood either. 

References:

1. Society and College of Radiographers: 2010. Education and Professional Developments Strategy: New Directions.
2. Society and College of Radiographers: 2021. Advanced Practitioner Accreditation.
3. Health Education England. Multi-professional framework for advanced clinical practice in England. 2017.