Adverse health events associated with clinical placement: A systematic review

Abstract

Objective

Clinical placement is a fundamental aspect of student learning and skill development across healthcare disciplines. However, participation in clinical placements can also present significant risk to students. This systematic literature review sought to examine the range of risks and hazards encountered by students across healthcare disciplines during their clinical placements.

Design

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines were utilised in conducting this exploratory systematic review.

Data sources

The CINAHL Complete, Medline Complete, and PsycINFO databases were searched. Reference lists of eligible records obtained via database searching were screened, and a supplementary key author search was conducted. Research published between 2013 and 2018 and conducted in the context of comparative international healthcare systems was the focus of this study.

Review methods

Study titles and abstracts were screened, and the full text of potentially relevant records was perused. Records meeting key eligibility criteria by addressing risk posed to students in healthcare disciplines within a clinical placement context were included in the final synthesis.

Results

The search identified 46 eligible records. The literature highlighted the worrying trend that students, most notably in the nursing discipline, can be exposed to a wide range of risks and adverse health events during clinical placement.

Conclusions

As risks in unpredictable clinical environments cannot be eradicated, this review demonstrated a critical need for educative action to enable students to competently and confidently manage risks, and to reduce occurrence of adverse health events.

Introduction

Students across healthcare participate in clinical placement, often as a compulsory element of their professional training. Clinical placement is widely acknowledged as a fundamental aspect of learning and professional development for students undertaking tertiary education in a healthcare discipline. Placement enables students to integrate theoretical knowledge with clinical practice and to develop skills and competencies in an applied context (Levett-Jones et al., 2006; Yiend et al., 2016). During clinical placement, students are introduced to the professional practices, values, and ethics of their field, scaffolding their future work as a healthcare clinician (Yiend et al., 2016). Formative clinical experiences can also impact long-term career aspirations (Boyd-Turner et al., 2016; McCall et al., 2009).

Simultaneously, the myriad of challenges associated with clinical placement across international healthcare are increasingly being acknowledged (Taylor et al., 2017; Department of Health and Human Services, 2017; Driver, 2013; McBride et al., 2015; Council of Ontario Universities, 2013; Smith et al., 2016). In addition to organisational challenges, such as a paucity of appropriate placements and supervisors, and restricted learning opportunities (Scott et al., 2011; Healthcare Management Advisors, 2014), clinical placement presents a range of risks to students across the healthcare industry (Department of Health, 2011; Taylor et al., 2017). Notably, preliminary research has indicated that students can be directly exposed to violence, sexual harassment, and verbal abuse whilst on placement (Sheen et al., 2012; McManamny et al., 2013). These findings indicate a need for increased emphasis on risk management strategies to protect students within clinical placement contexts.

The literature examining risks to students on clinical placement is complex. Healthcare training and education operates within rapidly changing landscapes. A broad array of placement-related issues has been explored from multiple perspectives (i.e. universities, placement providers, supervisors, clinical staff, and students) and across many healthcare disciplines. Clarity around this topic is also marred by differing terminologies used across research to describe the concepts of ‘clinical placement’, ‘supervision’, and ‘risk’. To the authors' knowledge, systematic review of research examining the risks faced by students completing clinical placement, has not yet been undertaken. Given the importance of assuring student safety and competency, clinical placement stakeholders would benefit from a clear conceptualisation of key challenges presented to students during their training. This would enable the development of training models designed to equip students to competently and confidently manage any risks presenting during placement. As a first step, a research review is needed to explore and summarise the breadth of placement problems, hazards, and risks raised in the literature.

The objective of the current study was to address this gap in the literature by exploring the range of risks and hazards encountered by students across healthcare disciplines during clinical placement. To best capture placement-related risks arising in the current educational climate, all literature published from 2013 and onwards was examined.