Appendix 4: Summary of visit to Anglia Ruskin University
Summary of visit to Anglia Ruskin University on 12 May: Note by the Clerk
1.Anglia Ruskin University and the Council of Deans of Health invited the Committee, as part of their inquiry into the sustainability of the public services workforce, to visit the Chelmsford campus of Anglia Ruskin University. Specifically, the Committee visited the Faculty of Health, Education, Medicine and Social Care (HEMS) to view training facilities that incorporate simulated learning.
Presentations
2.The Committee were greeted by representatives from the university and from the Council of Deans of Health, who then provided a presentation giving an overview of the university, of which some relevant points are outlined below:
- 25% of the student body are international students.
- Health, education, medicine and social care (HEMS) courses account for 38% of undergraduate students at ARU.
- The stated vision of the faculty is to be responsive to national policy and partnership. Key priorities are to be collaborative, inclusive, and for students to be “co-creators” of their learning.
- Retention at Anglia Ruskin and in the HEMS faculty in particular is high - which they put down to academic support.
Simulated learning/simulation-based learning
3.Paul Driver, Director of Simulated Learning gave an overview of simulated learning, which he called “simulation-based learning”. This encompasses any practical learning which is not in a real-world situation. Simulated learning could encompass volunteer actors, virtual reality (high fidelity) or models such as full body dummies or model arms on which to practise taking blood (low fidelity).
4.The aim of simulation-based learning is to capture elements of the real world in a way that promotes learning. He said that it could sometimes be superior to placement-based learning: it was safer, feedback could be delivered immediately (with benefits for information retention), and more competencies could be practised.
5.Some points raised were:
- Simulated learning is not cheap. (Approximately £0.5m per simulated learning lab.) There is also a substantial time cost for designing and using simulated settings.
- Simulated learning complements placements for students, rather than replacing them. Swift development was necessary during the pandemic. The priority now is to expand the evidence base on how effective simulated learning is. This may help in expanding the potential–currently profession specific regulators limit the number of hours of experience that can be in simulated settings. There is some debate over simulated learning, and different views over how much it can be used. ARU felt it was important not to revert to placement-only ways of learning, but that the relevant regulation needed to be right to enhance and support simulated learning.
- Simulated learning can teach specific skills or scenarios that may never occur during a “real” placement. For example, a patient falling off an operating table is a “never event”, so people will rarely see it during placement. Simulated learning can teach it.
- Developing relationships between different disciplines was recognised as important; professionals must recognise the perspective of all those involved in a service users care. ARU has leads in each faculty for interdisciplinary learning, and some projects are underway to get professional groups talking to one another. This includes seminars which present one scenario to a number of different professions. Another was a virtual placement which was filmed in every room of a service users home: allowing students to see all that person’s needs.
6.The Committee were introduced to “Hemsville”, a “virtual community” which is built on local authority data. This, the Committee were told, allows students to see macro factors such as the environment, and then to enter into a home to see the micro. Information was provided which allowed them to see behaviours from all perspectives. For example; demonstration of hoarding behaviour would be provided alongside the information that that service user was grieving. The platform would then show what services were accessible to the service user. This platform was animated, with the ability to map handwriting samples (including unintelligible prescriptions), and faces. An added benefit of learning with this “virtual community” was that it enhanced students’ digital literacy.
Visit around the facilities
7.The Committee visited several low-fidelity simulation labs. The nurse who was teaching described the use of models as “closing the theory-practise gap”. This included:
- A lab where nursing students were using models arms (attached to “blood”-bags) to practise venipuncture and canulation.346 These are skills that nurses will need in practise, and which are likely soon to be needed pre-qualification.
- Models which used sound to demonstrate to students what crackled breathing sounded like, before they had to recognise it on a ward.
- Rooms with dummies/models on trolleys. One reported difficulty for students on placement is that they do not know where to stand, and how to not get in the way of care. These simulations allowed them to practise such practicalities.
- A mock-up of a home, with all its “things to bump into”, which was used for training paramedics. This allowed them to practise in a realistic setting: “do what you can do, but with added pressures”–for example, CPR cannot be delivered on a bed.
- The Committee were shown a primary school classroom setting used to practise teaching in situ.
- The Committee were shown a room where cadavers were kept; for use in anatomy classes. We were told that groups of students operated on and dissected these cadavers to self-direct their learning, in contrast to some other teaching methods, where a teacher would operate and the students watch.
- A class of students learning to perform intimate examinations using wearable breasts (different sizes, skin tones, shapes), and simulated gynaecological scanners.
8.Committee Members tried on Virtual Reality headsets, which are also used to train students.
Meeting with Nursing, Midwifery, and Allied Health students
9.The Committee then met with a selection of students (all women), including several who were studying to be Operating Department Practitioners. Comments were made about the cliff-edge felt when moving from study to placement: “I’ve never been in a theatre”, “they expect us to know so much”. This had been significantly worsened due to the pandemic which had reduced placement opportunities in hospital and access to the university’s simulation facilities.
10.There was unanimous agreement that the simulation facilities were extremely helpful, particularly when complementary to placements. Students felt that they provided an advantage over students who had learned in a more traditional way as they were able to practise certain skills until they had developed muscle memory: “It’s easier to sign off on our competencies”.
11.When the Operating Department Practitioners (ODPs) were asked how they had come to choose that course, the answers were revealing:
- One mature student had been warned away from becoming a doctor on the basis of her sex and class.
- One had been told she couldn’t be a midwife because she had no NHS experience.
- All the students had come across the role of ODPs somewhat accidentally. All had wanted to do something in the health/care field but had not heard of the role of ODPs. One student previously worked in a hospital and had asked colleagues after wondering for some time, and one had met an ARU student ambassador.
Additional points of interest
12.A perception of snobbery and protectionism within professions was raised several times–always along with the need to escape this. There were some examples of where progress had been made:
- Some paediatric nurses are given a veto on whether a patient could be discharged. This was to ensure that the healthcare team thought not only of the medical situation but of the wider social context affecting that child.
- Nurses now need to be “prescriber ready”.
Enhancing collaboration across professions could include placements in different settings (for example having a paramedic training in a GPs surgery) but there were concerns around whether regulators would approve of this.
13.The Committee met a Physician Associate, who was supervising a class. This is a relatively new position, which encompasses many of the tasks a GP would perform, but which does not have “prescribing power”. She was keen that Physician Associates be given this power as a common-sense measure. She was also asked how long it would take her to qualify as a GP. There is no fast-track: she would have to retrain from the beginning of the six-year course.
14.ARU felt it was hard to demonstrate the impact they had on the way health care providers operated. They outlined several ways they tried to impact on provision: by having providers involved in the teaching, by giving feedback to providers through quality teams, and by building trust and strong relationships. The feedback from students was an important tool here.
15.Universities can be seen as “gateways” or “gatekeepers” to careers, and “gatekeeping” may decrease diversity in the future workforce. There was acknowledgement that universities need to work with students to find ways to meet entry requirements for their courses. (ARU provided an alternative for the standard maths qualification). Efforts were also underway to make the student population representative of the community–including sending student ambassadors into schools.