Experiential Placements : Dissemination and Stakeholder Engagement for Curriculum Planning Action to Prepare Future Pharmacy Professionals

Preparing graduates for the professions is increasingly recognised as involving a partnership approach to curriculum design, implementation and evaluation. Experiential placements play a critical role in developing discipline-specific knowledge and skills and also generic professional dispositions including relationships, communication, problem solving and creativity. This involves academics, workplace supervisors and students in being clear about the outcomes of the learning process and taking responsibility for various aspects. The ‘Experiential Placements in Pharmacy' research project was conducted during 2007 with the aim of documenting current practice in Australian university pharmacy school experiential placement programs. This paper describes collaborative work between researchers, university academics and practitioners to determine future directions for the project towards improved curriculum planning and developing graduated descriptors related to professional competency outcomes. We describe the approach used to disseminate research recommendations and to gain input into the project and give a brief outline of the eventual action which is being implemented to further improve curriculum planning for the experiential learning environment for Australian pharmacy students.


Background
Experiential placements are an essential component of university programs for building knowledge, skills and professional attitudes related to the workplace for the relevant profession.Other purposes of experiential placements are about using generic skills which have been developed at university; applying and developing classroom learning and theory in work settings; clarifying and determining career directions; establishing workforce contacts; and nurturing professional identity (Waters, 2001;Orrell, 2004).Therefore placements in general terms are important in supporting tertiary students in carrying out relevant tasks, in real environments, with actual clients.
In terms of curriculum design, experiential placements differ from the structured university context because learning opportunities vary from student to student.The experience is dependent on the particular site and on supervisor knowledge and skills.As highlighted in Kolb"s (1984) experiential learning model, the workplace context provides opportunities for concrete experience; review and reflection; the formation of abstract concepts and generalizations, as well as experimentation and application of new concepts.Therefore, new learning is related to personal experience and the quality of reflection, with students reflecting on the events occurring at the time, after the events and in regard to action for the future (Moon, 1999;Schon, 1983).However, while learning can occur merely by being in the environment, Vygotsky (1978) has highlighted the importance of scaffolding and planning for accelerated learning, using people, mentors and other resources within the actual context.Highlighting Vygotsky"s scaffolded learning approach within experiential placements, while the university usually provides a framework and some intended experiential placement goals linked to profession-driven outcomes, supervisors are also involved in planning and feedback.This includes scaffolding to develop the competencies which are aligned to professional entry requirements, and creating "authentic and meaningful learning experiences that enable the learner to acquire the knowledge, skills and attitudes as an outcome of professional practice situations: " …the preceptor is responsible for planning for the experience, increasing the learner"s awareness of the experience and providing feedback regarding the learner"s performance" (Littlefield, Haines, Harralson, Schwartz, Sheaffer, Zeolla & Flynn, 2004: 9).Therefore workplace supervisors, students, the professional and registration bodies, as well as university academics, have significant roles related to the curriculum design aspects and to the successful achievement of student learning outcomes.Despite this, curriculum design and implementation is often viewed as the domain of academics.Traditionally research about curriculum has been conducted by academics who may consult with students or the profession in the research process but without further involvement in determining decisions about future directions.
However, dissemination of educational research for action and sustained change is increasingly engaging stakeholders throughout the various stages of the research process.This includes students, academics and professional and registration representatives.In the context of work integrated learning work placements, this also involves supervisors.In regard to pharmacy experiential placements, an area of potentially significant importance is undergraduate students being provided with opportunities in workplace skill-building in preparation for the internship year and meeting competency standards.Despite this, little research has been undertaken around experiential placements and the outcomes of university pharmacy programs in preparing students for the profession.
In December 2006, an Australian Learning and Teaching Council (ALTC, formerly Carrick Institute) grant was awarded for the purpose of mapping objectives, teaching and learning activities, assessment and evaluation within experiential placements across Australian pharmacy schools, to identify areas for improvement and to develop quality indicators.
Research methods during 2007 included preliminary forums involving various stakeholder groups, literature review, contact with other professions, interviews with Australian university pharmacy schools, program mapping, and handbook analysis.Consultations in focus groups for professional/registration organisations, preceptors and students in each state and territory and nationally also occurred.
The 'Experiential Placements in Pharmacy' report indicates that across Australia there is a range of university pharmacy experiential placement structures with varied influences on curriculum outcomes.A range of experiential placement assessment tasks are being undertaken across various year levels of programs from different universities, and many are occurring with some consistency across locations, albeit with varying assessment approaches.Graduated descriptors related to competencies are evident in some placements and these are being supported with mechanisms for more consistent outcomes on a national level for university experiential placement programs.These aspects formed the basis of recommendations and other key issues outlined in the subsequent "Discussion and Options for Pharmacy Experiential Placements' paper, with stakeholders then providing feedback and strategies for future action through surveys and discussion forums.
While stakeholders are frequently involved in the process of collecting data for research and they are provided with access to the findings and reports, there has been little research into the dissemination processes.In particular there is little effort occurring in finding ways of more actively engaging stakeholders in future decision making.
The aim of this paper is to present the survey and discussion forum processes and stakeholder responses to the recommendations of the pharmacy experiential placement reports and to examine the strategic processes, benefits and potential issues in terms of building stakeholder engagement in curriculum planning and design.

Dissemination and Engagement for Change Theoretical Models
The objectives of the Australian Learning and Teaching Council (Carrick Institute) funding through the Australian Government Department of Education, Employment and Workplace Relations (DEEWR) include promotion of systemic change in Australian universities; developing mechanisms to identify good practice; and identifying future issues including facilitation of national approaches (Chalmers, 2006).
Research highlights the importance of university engagement, facilitated through dissemination with wider stakeholder groups to benefit students, communities and society at large, creating a public agenda for higher education (Weerts, 2007).
While dissemination in the past has been linked to raising awareness and transmission of information, the current focus is on action, with dissemination defined as: 'purposive goal-oriented communication of information or knowledge that is specific and potentially useable from one social system to another' (Louis & van Velzen, 1988).Therefore it is about dispersal of information in ways which promote use and help to drive educational change in organisations, systems and individuals.Social processes of consultation, collaboration and support for ongoing dissemination are emphasised (Carrick Institute, 2006).
The "knowledge use" model of dissemination involves capitalising on incentives for change including outside pressures and individual interests; providing useable knowledge; combining top down and bottom up approaches and actively constructing new ideas based on local practices: 'customising and personalising it for local use' (Louis & Dentler, 1988).The model involves stages of change which go beyond mere pre-awareness raising or awareness-raising and then meeting information-provision needs through flyers, CD ROMS and videos.Additionally the knowledge-use dissemination model involves stakeholders actively searching through websites, attending conferences and reading publications and being involved in decisions through longer workshops and then taking action and engaging in activities such as developing example plans (Froyd, 2001).This approach is linked to reflective practice and inquiry processes in which research knowledge is negotiated within the practitioner context.The spread of new ideas is sometimes supported by researchers who codify existing practice-based knowledge and then extend this through their own individual contribution (Schon, 1983;Carr & Kemmis, 1986).A community of learners approach is established, with the exchange of perspectives, materials, resources and interactive processes of implementation involved: 'Through exchange and implementation, researchers and stakeholders develop shared solutions to problems of mutual interest' (Hutchinson & Huberman, 1993).
The purpose of this paper is to report on a process for engaging academics, practitioners, students and other professional organisation stakeholders in relation to pharmacy experiential placements and to curriculum renewal on a national level.This has involved establishing initial forums prior to the research; engaging stakeholders in the research process consultation phase and then disseminating the results of the research and establishing action through additional workshops involving various stakeholder groups from across Australia.Through this process, their responses to the recommendations and issues raised in the report have been gauged and even more significantly, the various stakeholders have been involved in actively informing planning directions for future planning for experiential placements in pharmacy programs (Bartunek, Trullen, Bonet & Sauquet, 2003).This is important because the key issues and recommendations arising in the research are about curriculum design in terms of using a more comprehensive curriculum planning framework at the pre-placement, during placement and post-placement phases which involves the professional bodies, workplace supervisors and students as well as academics.Through involving all of these stakeholders in the future decision-making, including working collaboratively to design graduated descriptors related to the university graduate attributes and to the profession"s competencies, student learning can be better supported.

Method
Initial discussion forums with national pharmacy student body representatives, specially-convened academic workshops and profession/registration sessions were used to initiate interest and develop networks for consultations regarding experiential placements in pharmacy.In the consultation research phase, a preliminary paper was circulated as a prompt for further discussion and information gathering.Following the gathering, compilation and analysis of consultation information and responses, a draft report which included three recommendations was prepared.Stakeholders were further engaged in the research process through using surveys (modified for different groups) and focused discussion forums as methodological approaches to gain responses to the report recommendations and to plan future action.
Essentially the survey involved free response questions related to the three recommendations and use of a five point Likert scale regarding various issues.This paper provides details of stakeholder response to the free response comment format for the three draft report recommendations.
The forums for specific stakeholder groups involved the national registration body, national pharmacy student group and academics and professional/registration organisation representatives who discussed the report findings, recommendations and future directions.Participants at the forums were invited to individually complete the survey.Collation and analysis using spreadsheets and manual processes occurred.In addition to the opportunity for individual response, forum attendees also responded to the Recommendations within discussion groups, recording their responses as a group and reporting back, with all verbal and documented comments from groups being collated and analysed.This paper reports on stakeholder dissemination and engagement processes, particularly in relation to their response through surveys and discussion forums to the Recommendations of the "Experiential Placements in Pharmacy" report.

Results
In regard to responses to the Recommendations from attendees at various discussion forums, twenty-two responses from representatives from a key professional body, and twenty-one responses to the survey from academics/professional body representatives attending a feedback forum, in addition to nineteen student responses.Focus group discussion comments were also received from 21 professional and academic participants in one session and from 19 students attending a national student forum.

Improving Learning Design: Recommendation One
In the research conducted through national consultation with stakeholders and handbook analysis, while there were many positive comments about experiential placement programs, there were some key areas for improvement cited.These related to the need for greater goal clarity; scaffolding at the pre-placement, during placement and post-placement stages and the importance of building student and preceptor skills in reflection and feedback in the learning process.A more systematic approach to planning for experiential placements was highlighted as an area for future development.
On the basis of this, the first recommendation for the research report related to establishing collaborative action research workshops to develop a repository of experiential placement learning and assessment tasks.This focuses on using an educational template and comprehensive planning model linked to clearly identified outcomes.
In the stakeholder forums about this recommendation, over 95% positive responses were received.Significant support aspects were raised relating to national consistency directions, efficiency and avoiding duplication; continuity through university to pre-registration and registration phases; professional development collaborative benefits; increased clarity of outcomes and support for preceptors and students.Participants from the national professional body organisation particularly noted the advantages given the trends towards more nationally consistent approaches and students especially valued the clarity of outcomes and support aspects.
Table 1 provides examples of comments reflecting some of these positive views.'This would be beneficial to assist a more even expectation of the experiential learning, particularly with the movement of students interstate to complete their pre-registration training' (National professional organisation) 'This will help to create across the board assessment tasks that are similar which will be beneficial to students, preceptors and universities' (student) 'National guidelines will enforce a standard of placement action…the same standards can then be published and all will know exactly what is expected.Feedback allows for improvement which will be professionally beneficial' (student) Efficiency and avoiding duplication and PD collaborative benefits 'Would cut down on workload by sharing'(National professional organisation) 'Good idea as it allows a resource which contains models for assessment tasks based on collaborative research available to universities/preceptors to use and implement' (student) 'I think anything that assists the lecturers to become better at what they do, that increases the resources by pooling and provides better quality placements for students should happen definitely' (student) Continuity from university 'Need to consider continuum into pre-registration' (Academic) Increased clarity of outcomes and support 'This would be very useful.It would allow the outcomes desired for experiential placements to be more clearly identified' (Academic) 'Any such move would allow the upskilling across the range of those involved and most particularly students and preceptors (who are particularly short in support and short in opportunity to train and be educated') (National professional organisation) 'Availability of clear set guides for preceptors are fundamental if the student is to get clear comparative assessment and consistency in their experiential placements' (National professional organisation) stakeholders will give experiential placement more direction and will result in far more competent graduates and registered pharmacists' (Student) '…the same standards can then be published and all will know exactly what is expected.Feedback allows for improvement which will be professionally beneficial' (Student) Table 1 specific comments of interest to this paper are: "This will help to create across the board assessment tasks that are similar which will be beneficial to students, preceptors and universities" (student); "Good idea as it allows a resource which contains models for assessment tasks based on collaborative research available to universities/preceptors to use and implement" (student); and "This would be very useful.It would allow the outcomes desired for experiential placements to be more clearly identified" (Academic).
These comments are relevant to this paper because they support the research recommendations and the importance of curriculum design involving clear outcomes and assessment tasks, with expectations being outlined and aligned for students, supervisor and academics and with all stakeholders consulted in developing an overall framework.
Within this generally supportive context and considering the variety of programs which currently exist across Australian pharmacy programs (some of which were specifically developed to meet local situations), the importance of retaining flexibility was also emphasised: It would be important that this depository provides feedback and an avenue for benchmarking but would not be prescriptive.Sites should adopt information to suit particular courses and outcomes sought (Academic).Some specific issues needing consideration were also raised in regard to continual updating of repository tasks; intellectual property aspects and willingness to share; funding and implementation complexities and the importance of involvement of all groups of stakeholders.Survey comments typifying some of these aspects are as follows: I have concerns about 1) updating tasks to remain relevant 2) Relevance across courses 3) possible changes to competencies that will affect presentation (Academic)

Each contributing party must reveal the same amount of IP (intellectual property), otherwise there will be an imbalance between schools and an unfair advantage for new schools. Must be agreement to acknowledge sources of borrowed material (Academic)
Generally in favour but issues relating to willingness of institutions sharing ideas/tasks (are) probably greater than you anticipate and under whose auspices would it operate and ongoing funding importance to (the) project (National professional organisation) In student surveys, some cautionary comments were made about the importance of national approaches containing flexibility: The template must be broad…If the template is too specific and fixed it may deter some potential preceptors (Student).
Focused discussion sessions for all stakeholder groups were overwhelmingly positive.The national professional/academic forum especially valued the collaborative professional development opportunities involved.Intellectual property concerns were seen to be overcome through pharmacy academics in attendance each providing some current tasks in relation to a particular pre-agreed learning activity/assessment aspect.They could then workshop together using a collaboratively-developed comprehensive planning model template.Follow-up up work and trialling by some institutions and support with publication and dissemination of the repository product could then occur within a key professional website.
Student discussions were also very positive, with students highlighting the importance of their involvement and feedback in the central repository tasks process.

Improving Learning Design: Recommendation Two
The pharmacy experiential placements research mapping in university schools, handbook analysis and stakeholder consultation feedback highlighted a range of assessment models including norm-referenced, criterion-related and other approaches.Handbook analysis focused on final year handbooks and tasks such as orals, workbook exercises and preceptor feedback regarding generic and/or occupation-specific competencies.
While there are implicit links to the pharmacy competencies of the profession and some universityspecific requirements regarding graduate attributes, these were generally not explicitly identified.The role of preceptors/supervisors in the provision of marks which contribute to university processes varied with university pharmacy schools.However, the significant issues raised, particularly by students was the importance of explicit feedback highlighting areas of strength and those aspects needing further development.
Therefore the second recommendation proposed national collaborative stakeholder work to develop standardised developmental descriptors related to competencies and providing a more consistent set of outcomes from university experiential placement programs at the novice and advanced beginner levels.
In the discussion forums and survey about the recommendations, positive responses were received from all stakeholder groups.Support was provided in terms of the preceptor training opportunities and the notion of clear graduated descriptors including continuity from university to pre-registration and competencies of the profession.

Examples of positive comments included:
Agreebenefit to all experienced preceptors in providing guidance and supported by preceptor education and training (National professional organisation) Could not recommend support for such a move more strongly.The linkage between undergraduate education, graduate training and registration needs much greater clarity (National professional organisation) Agree, this is once again important to the profession.If students are aware of the competencies early on they will work towards the learning process and also further development to sustain and enhance competence (National professional organisation) Descriptors are also an urgent need.Collaboration will help foster later participation through ownership (National professional organisation) Having developmental descriptors as described earlier will bring pharmacy as a degree up to the same experiential placement learning level as other professions being taught at universities today.This is important as pharmacy should not get left behind…having the descriptors based on competencies needed to become a pharmacist is essential to produce graduates comfortable in the workplace (Student) Good recommendation.It would be beneficial to rate our graduates from novice to advanced levels.A single descriptor i.e' a component' implies a single level of achievement and that is never the case (Academic) While the Recommendation was overwhelmingly supported, cautions regarding the need for flexibility to accommodate the variety of pharmacy experiential programs, maintaining simplicity and the importance of links to other degree components were aspects raised by some respondents: This could be challenging and should not be in isolation of other components of the degree.Placements have different objectives; some are stand-alone, others are integrated with didactic components (Academic) A general framework of descriptors based on evidence is a good idea.It should be flexible enough to adapt to any program but not used to compare students 'quality' or 'standards' between schools (Academic) We must be careful not to be too restrictive.University pharmacy courses are indeed pretty varied -such individuality must not be curtailed (Academic) Valuablebut needs to not be complicated for in-practice use (National professional organisation) Discussion forums were overwhelmingly positive about this recommendation and respondents believed clear outcomes using developmental graduated descriptors were a preliminary step in any new developments and collaborative work to improve experiential placements and overall curriculum design.The notion of a continuum from "novice" to "advanced beginner" received a positive response from all stakeholder groups as appropriate for university pharmacy placements.Associated graduated descriptors were supported, with "competent" then being achieved within pre-registration processes.As with issues raised in the survey responses, consideration of different types of placements was raised as an aspect needing discussion and the importance of making links to current graduate outcomes.

Improving Learning Design: Recommendation Three
The national consultation research with stakeholders highlighted quality indicators for successful experiential placements focused on preceptors, students, universities, placement sites and overall environment and application at the pre-placement, during placement and post-placement phases.While there were many positive models from pharmacy schools, there were certainly some areas which were identified as benefiting from more comprehensive preparation of students and preceptors for placement experiences including clearer goals and ensuring students have the necessary pre-requisite skills to undertake learning and assessment tasks.During the placement, negotiation of expectations and tasks between preceptors and students was cited as providing additional support and more explicit feedback.Debriefing and systematic evaluation of pharmacy experiential placements and reviewing current programs and providing some generalised and/or specific feedback to preceptors (as appropriate) was also highlighted.
Therefore, the third report recommendation proposed collaborative work with stakeholders regarding quality experiential placement success indicators in relation to pre-placement, during placement and post-placement aspects.
This recommendation created a wider range of survey responses as a future direction in the follow-up discussion forum and surveys.However there were generally positive comments about the usefulness of quality indicators information, links to training and the importance of balance of university expectations of placements and preceptor ability and desire to continue in this role:

Quality indicators are an essential component of placements to enhance the validity of assessment and address the needs of accreditation bodies (Academic)
This recommendation is valuable as it takes into account times before and after the placement..It also acknowledges the need for debriefing with all parties to help with future improvements (Student) Great idea.There is a lot of ambiguity surrounding what students should actually be doing and achieving on placements and this would give success indicators to each aspect of the placement from beforehand to after it's completed (Student) However, there were also individual survey responses especially from academics that quality indicators are very subjective.In some of the surveys and in some discussion forums, there were concerns expressed by academics about over-surveying of stakeholders, with those having this view believing that information on quality indicators is already available from previous surveys.There were also individual concerns expressed regarding university programs being overly-influenced by the profession and the desirability of payment of preceptors was questioned.
Students in discussion forums were enthusiastic about a quality indicators survey.They suggested that students be informed about it prior to a placement, with survey completion post-placement thereby providing more focused responses and with preceptors being surveyed pre and post placement.

Discussion
Survey responses and discussion forum sessions indicated that the "Experiential Placements in Pharmacy" report"s three recommendations were generally highly supported by academics, professional/registration organisation representatives and students.Generally all stakeholder groups were positive about Recommendation One and establishing a central repository of tasks.The response was similar for Recommendation Two in developing graduated descriptors as well as for Recommendation Three regarding quality indicators, although there were some cautions.
For example, concerns of some academics about Recommendation One central repository and intellectual property issues were discussed within their forum.Senior representatives from pharmacy programs in Australia proposed some additional detail regarding processes which involved attendees at central repository workshops bringing samples of a pre-agreed learning or assessment task and collaboratively reworking the activity using a template, thereby devising a new task.This proposal was believed to overcome intellectual property issues.Through the discussion forum, workshop attendees (from professional/registration, academic, preceptor and student background) also proposed that the website dissemination process outlined in the recommendation could provide the opportunity for stakeholder feedback on the task, thereby ensuring a quality control mechanism.These workshop stakeholder discussions also proposed using a professional body"s annual conference to continue the central repository workshop and this was subsequently agreed to by the organisation concerned.
Resulting from the stakeholder feedback processes, stakeholders were able to influence the report recommendations.Subsequently, this resulted in a successful application to the Australian Learning and Teaching Council for additional funding to enable the three recommendations to be implemented.A key aspect of the funded project being implemented is the development of the experiential placement central online repository, with a website containing an educational template created.In a workshop trial, stakeholders have worked collaboratively on specific tasks and they are using the template to re-work their own ideas and materials collaboratively, with positive written response to the processes involved.Other workshops involving various stakeholder groups are under development.
The educational template for the central online repository involves background and explicit outcomes related to the professions" competencies, learning activities for pre-placement, during placement and post-placement phases and documentation of explicit criteria for assessment tasks.Evaluation of the placement and feedback survey on the online task repository for completion by students, preceptors and professional organisation representatives and academics is available.
Through providing accessible models of comprehensively-planned curriculum material which are linked to outcomes, and using collaborative workshop processes, it is anticipated that other high quality experiential placement tasks will be devised.In addition, there will be a greater understanding developed by various stakeholder groups about their role in scaffolding learning for student success.
Additionally, as introduced earlier (Hutchinson & Huberman, 1993), through intensive collaborative workshops focused on the website education template, a community of learners approach is being adopted.This involves the exchange of perspectives, materials and resources and involves sharing of problems of mutual interest.
A concluding comment from one workshop attendee captures the impact of academic, professional organisation, student and practitioner collaboration in terms of pharmacy experiential placements: "Knowledge sharing will serve to benefit all stakeholders, students, pharmacist preceptors, academics and ultimately the community".

Table 1 :
Themes and Sample Comments regarding Recommendation 1