Exploring alternative practice placement models: perspectives and experiences of learners and practice educators. A qualitative systematic review.

Exploring alternative practice placement models: perspectives and experiences of learners and practice educators. 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A qualitative systematic review. Amanda Deaves, Rebecca Matson, Edwina Rushe, David Edwards, Kate Trainor, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4867053/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Nov, 2024 Read the published version in BMC Medical Education → Version 1 posted 11 You are reading this latest preprint version Abstract Within physiotherapy and occupational therapy practice placements, there is a predominance of the one-to-one supervision model which creates limitations for placement capacity expansion. Alternative placement models must be considered to fulfil training requirements for these professions and ensure availability of future workforce. The aim of this review is to consider practice educators and learners’ experiences and perceptions of alternative placement models to inform future planning and adoption of these opportunities. This qualitative systematic review followed the Joanne Briggs Institute methodology. Six databases (CINAHL, MEDLINE, PubMed, Scopus, ERIC, PsycINFO), comprising the period January 2008 to December 2022, were comprehensively searched. Meta-aggregation was used to synthesise the findings of the included studies. A total of 16 articles were included within this review. The learner voice was represented in 18 categories aggregated to five synthesised findings: professional growth and development, personal and psychological adaptation, alliances within collaborative learning, educational and learning process, and managing professional relationships. The practice educator voice was represented in 14 categories aggregated into four synthesised findings: providing the right support; professional identity; peer relationships and levels of satisfaction. This review has identified many positive aspects related to skill development, personal growth and professional identity following the alternative placement experience. However, uncertainty and anxiety related to role, expectations and clarity within these environments were noted. This enhanced understanding of the perceptions and experiences of the learners and the practice educators can be incorporated to facilitate the development of appropriate support and guidance from the universities to address these challenges and increase satisfaction. Further adoption of the alternative placement models will have the potential to enable increased practice placement capacity for learners and offers a promising environment for healthcare education, proving learners with invaluable experiences and skills essential for their future careers. practice education alternative practice placement physiotherapy occupational therapy capacity Figures Figure 1 Background An essential requirement of professional registration for occupational therapy (OT) and physiotherapy (PT) learners, within the United Kingdom (UK), is to accrue 1000 hours of practical experience during training[ 1 , 2 ]. Within the UK, obtaining sufficient placement capacity to meet this requirement for both professions remains a significant issue[ 3 , 4 ]. The Allied Health workforce must expand to meet future health needs [ 5 – 7 ] and this drive for increased healthcare learner numbers has led to the exploration of alternative placement models[ 8 , 9 ]. The predominance of traditional one-to-one supervision models has created limitations for placement capacity expansion [ 10 ] and may limit breadth of future health care practitioner development[ 4 ]. For the purposes of this systematic review, alternative placements are defined as any placement model that does not follow the format of one learner per one practice educator. Whilst alternative placement models may provide opportunity for increased autonomy and self-direction, a number of challenges have been identified[ 4 , 11 ]. These include; increased physical space pressures, decreased service user engagement, reduced individual supervision, decreased role identity and alternative models often being instigated at short notice to meet demand rather than planned[ 4 , 11 ]. Currently, no existing qualitative systematic review has considered the alternative placement model experience for OT and PT learners. However, a mapping review considering practice education models for allied health and social care professionals[ 4 ]; a systematic review specific to peer learning and collaborative placement models for healthcare learners[ 12 ]; a scoping review relating to health profession learners [ 13 ] and a mixed methods literature review [ 9 ] have been conducted. These findings focused on the broader spectrums of allied health and social care professions, discussed a range of alternative placement models; and included both quantitative and qualitative methods within all previous studies. This qualitative systematic review will focus to OT and PT practice placements exclusively, to allow more detailed profession-specific consideration, due to the closely aligned working relationships and practices within the two professions. Adaptation of alternative placement models requires learner and practice educator “buy-in”, meaning evaluation factors resulting in a positive experience for both parties is crucial. Concerns regarding learner satisfaction with alternative placement models and the underlying reasons have been reported [ 4 ] and therefore consideration of factors that influence the quality of the experiences whilst ensuring expansion of capacity is essential. The objective of this review is to understand the experiences and perception of learners and practice educators in relation to alternative placement models. This will inform the development of future practice placement opportunities thereby addressing the placement capacity issues, optimisation of learning and increasing sustainability of practice education and workforce development. Research Question What are the experiences and perceptions of practice educators and learners, within physiotherapy and occupational therapy, participating in alternative practice placement models? Method The review followed the Joanne Briggs Institute (JBI) qualitative synthesis review approach[ 14 ]. This was selected for its established framework in synthesizing qualitative research enabling assessment of individual article quality and synthesized evidence strength. Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist was used to guide reporting of this review[ 15 ]. See Supplementary File 1. Search Strategy A systematic search was undertaken using six electronic databases (CINAHL, MEDLINE, PubMed, Scopus, ERIC, PsycINFO) January 2010 to December 2022. The search was limited to peer-reviewed studies, published in English, with reference lists of studies also hand-searched. A Boolean search strategy was used to search databases using relevant key terms and alternatives. Key search terms are fully detailed in Table 1. Table 1 Search terms Population Phenomena of interest Context Limits Student Learner Mentor Educator “Clinical educator” Physiotherap* “Physical therap*” “Occupational Therap*” Experience Evaluation View* Attitude* Perception* “Non-traditional” Blended Collaborative “2 to 1” “3 to 1” “4 to 1” Leadership Coaching “Split placement” “shared placement” “Role emerging” “Project placement” “TECS placement” “Peer learning” Placement “Practice learning” “Clinical education” “Clinical experience” “Clinical placement” 2010 to current (December 2022) English Language Rayyan software ( www.rayyan.ai ) was used to manage references, record decisions, and facilitate audit trail. Titles and abstracts were screened for eligibility by two independent researchers. If this screening failed to define suitability, full-text screening was undertaken. Studies that met inclusion criteria were retrieved and full-text articles were independently reviewed by both researchers. If there was disagreement between the two researchers, a discussion took place with a third researcher to reach agreement. Eligibility criteria and study selection The authors sought qualitative research including, but not limited to designs within phenomenology, grounded theory, ethnography, action research and interpretive analysis. Mixed-method studies with substantive qualitative components were included. The PICo approach (Population, Phenomena of Interest, Context) was used to determine search terms and identify relevant studies. Population: Studies reporting experiences of OT or PT learners and their practice educators. Phenomena of interest: studies which explored experiences, views, attitudes or perceptions of learners or practice educators participating in alternative practice placement models. Context: Alternative practice placement models were defined as the including any healthcare setting receiving an OT or PT learner implementing skills and behaviours aligned with their respective professions. This includes placements with face-to-face clinical practice experience and remote practice. All settings supporting learner education were included, namely Primary and Secondary care, Health and Social care, Private Practice and Voluntary organisations. Any placement not utilising one-to-one supervision models was also defined as an alternative placement. Critical appraisal of studies Two researchers independently undertook quality evaluation, with all disagreements resolved through discussion with a third researcher. The JBI Critical Appraisal Checklist [ 14 ] was used to evaluate methodological quality of included studies. Following critical appraisal, all studies scoring less than five on the checklist were excluded to enhance trustworthiness and ensure appropriate quality[ 16 ]. Data Extraction The JBI Qualitative data extraction tool [ 14 ] was utilised within Microsoft Excel. Methods, phenomena of interest, setting, participants, data analysis, cultural information, findings and illustrations were retrieved from the studies. Findings from the included studies were extracted using the meta-aggregation approach[ 14 ]. Two researchers independently reviewed the studies and identified relevant findings; considering both themes and metaphors. A finding is a verbatim extract of the authors analytic interpretation of their results[ 14 ]. The findings were identified by repeatedly re-reading the text. Each finding was accompanied by illustrations that were direct quotes from the participant voice. Each finding was quantified for credibility as per JBI process (unequivocal, credible and not supported)[ 17 ]. Levels of credibility were independently considered by the researchers. The third researcher compared the two independent data extraction results, with disagreements discussed and agreed prior to the finalisation of the data set. All unsupported findings and illustrations were removed from the final data set. Data Synthesis Data was synthesised using the three-step process outlined in the JBI manual[ 17 ]. To address the research questions, two subgroups were identified: learner voice and practice educator voice. The data synthesis within these subgroups were conducted by two pairs of researchers. Each researcher independently reviewed the data to identify categories of findings, with at least two or more similar findings per category. The meta synthesis involved aggregating these categories into synthesised findings. The two researchers per subgroup (learner voice and educator voice) met to discuss categorises and synthesis, cross checking results, discussing any differences with interpretation and agreeing final categories and synthesised findings. These final meta-aggregation synthesised findings were discussed and agreed by the researcher’s team. Results Results of the search and quality assessment. A total of 568 articles were identified from the six databases and 15 via citation searching. Duplicates were identified (n = 270) and removed resulting in 309 records being screened for relevance by title and abstract. In total, 47 full text articles were retrieved for review, of which 20 studies were included. The review and selection process has been recorded in Fig. 1 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses flow diagram[ 18 ]. In total, 20 studies met the inclusion criteria and were identified for quality appraisal using the JBI Checklist, shown in Table 2. Following critical appraisal, all studies scoring less than five on the checklist (n = 4) were excluded. Quality concerns included a lack of congruity in relation to philosophical perspective, methodology, research question and objectives, data collection methods and data analysis. Therefore, 16 studies were included for data extraction. Table 2: Critical appraisal scoring results Findings Characteristics of the studies All studies used a qualitative research design; methodological approaches and methods included Interpretative phenomenological analysis (n = 4)[ 19 – 22 ]; thematic analysis (n = 3)[ 23 – 25 ]; social constructivist thematic analyses (n = 3)[ 26 – 28 ]; grounded theory (n = 2)[ 29 , 30 ]; interpretive description (n = 2) [ 31 , 32 ]and action research (n = 2)[ 33 , 34 ]. Eight studies explored the views of the learners alone: OT (n = 7) [ 19 – 22 , 26 , 29 , 33 ]and PT (n = 1)[ 24 ]. Seven studies explored the views of both the learners and the practice educators; OT (n = 3)[ 27 , 31 , 34 ], PT (n = 3) [ 25 , 30 , 32 ]and both OT and PT (n = 1)[ 23 ]. One study reported the practice educator voice alone[ 28 ]. Geographical location of the studies included Ireland (n = 2)[ 23 , 26 ], UK (n = 7)[ 19 – 22 , 24 , 33 , 34 ], Australia (n = 3)[ 25 , 28 , 29 ], Canada (n = 2)[ 31 , 32 ], Switzerland (n = 1) [ 27 ]and USA (n = 1)[ 30 ]. The range of alternative placement include role emerging placements (REP) (n = 11)[ 19 – 22 , 24 , 26 , 27 , 31 – 34 ], project placements (n = 1)[ 29 ], 2:1, peer assisted learning and collaborative learning (n = 4)[ 23 , 25 , 28 , 30 ]. The study characteristics can be found in Table 3. Table 3: Characteristics of Included Studies Meta-synthesis of the findings Meta-synthesis of learner voice A total of 142 findings, classed as unequivocal or credible, were extracted from 15 articles about learner experience and aggregated into 18 categories based on the similarity of meanings. Five synthesised findings were developed from these categories: professional growth and development, personal and psychological adaptation, alliances within collaborative learning, educational and learning process, and managing professional relationships (Table 4). Table 4: Contribution of studies to meta-synthesis of learner’s voice. 1. Professional growth and development Professional growth and development centres around the learner building essential knowledge, skills, identity, values, and behaviours to become a competent professional. 1.1 Developing professional identity Alternative placement models enabled learners to better understand professional behaviours and values by articulating their role and identity as an OT[ 19 – 22 , 26 , 33 ]. I have learnt so much … the most on this placement; although it’s been the hardest and most challenging, I have learnt a lot about how I want to be as a therapist, and it’s really made me question everything. (Cardiff student, p200),[ 33 ]. 1.2 Development of professional skills Learners valued opportunities to become proficient in profession-specific skills and developed confidence[ 20 , 22 , 24 , 26 , 29 , 31 , 33 ]. “I found learning the project processes invaluable; documentation skills were useful and challenging. I enjoyed acting in a health promotion role, and it reinforced the benefits of using needs analysis to identify client/pt needs .… “ (student, p268),[ 29 ]. The role-emerging placement did give me the confidence to work. Because you are so independent in a role-emerging placement, and it really forces you to use your critical thinking skills and draw upon the knowledge that you have learned over two years in the occupational therapy programme. (Student OT 5, p 576),[ 31 ]. 1.3 Enabling the professional role The REP allowed learners to increase their understanding of their professional role via articulating this to others, utilising these professionally related skills within unique environments[ 24 , 26 , 31 ]. “Other healthcare professionals that are working there try to push you out of your remit of what you’re meant to be doing [...] I think maybe establishing that [your role] before and asking your placement educator “ (Participant 3, student, p4),[ 24 ]. 1.4 Person-centred care The individual was central to the learner’s decision-making and actions[ 19 , 20 , 24 , 27 , 31 ]. For me, [a highlight] was also the client-centeredness. We really assessed what the teacher needed and what was important to her. Then, we really set goals together and worked towards them. At the end we even were successful! (Andrea, p715),[ 27 ]. 1.5 Future Employability Learners expressed mixed views regarding the impact of alternative models in relation to future employability[ 20 , 24 ]. Working with the homeless in the future would be great; I’d love to do something like that, looking at different roles...health promotion would be really cool as well, I think. Occupational therapists could work really well in health promotion (Jayne, p47),[ 20 ]. We don’t know how employers are going to view physios doing role-emerging placements, and you don’t know what they’re going to think of that when they see that . (Participant 1, student, p7),[ 24 ]. 2. Personal and psychological adaptation This finding related to emotional challenges faced by learners during placements, including heightened anxiety and isolation. 2.1 Mixed emotions Challenges learners encountered during alternative placements led to both positive and negative emotions[ 20 , 24 , 26 , 29 ]. It has been such a roller coaster between loving and hating the placement! (Michelle, during the placement, p432),[ 26 ]. The feeling of being overwhelmed was familiar, and tiredness was induced by enhanced and diverse cognitive demands[ 20 , 24 , 26 , 29 ]. It just felt, felt very overwhelming and yeah there were a couple of days that week when I thought ‘this is too much, what have I done? (Sophie, p37),[ 20 ]. 2.2 Anxiety and isolation Feelings of anxiety and stress compared to peers on traditional placements were an area of concern[ 20 , 24 , 26 , 34 ]. “I was concerned with this placement, that obviously, being third year that, all my friends would have different, more specific placements, and my knowledge would kind of stay static. And I wouldn’t really learn that much from it, “ (student, p3),[ 24 ]. The isolation of working alone within placement areas without broader team support was expressed explicitly about REPs[ 20 , 24 ]. I really am out there on my own, that would be the only thing I would say, I felt a little bit out there on my own and thrown in, you know (student, p34),[ 20 ]. 2.3 Personal values and growth Despite challenges created by alternative placements, learners recognised and reflected upon individual personal growth[ 19 , 21 , 22 , 26 ]. ... it was kind of like a learning curve for myself as well’ cause my personal development, not just professional but me as a person [thinking] ‘yeah, I am grown up enough to do that sort of thing; I’m not little anymore (Jayne, p224),[ 21 ]. 2.4 Enhanced confidence Enhanced confidence among learners was expressed throughout multiple aspects of skills and practice-based categories[ 19 , 20 , 22 – 24 , 27 , 32 ]. ... I grew in my confidence of what I was doing, what actually OT is, how you could sort of implement interventions, how you can assess people. I grew practically like that but also ...just with my self-belief as well about my own abilities (Jayne p225),[ 19 ]. 3. Alliances within collaborative learning This explores the challenges as well as the value of peer-assisted learning. 3.1 Challenges with Peer-assisted Learning Challenges included difficulties with navigating relationship dynamics, issues with independent marking, complexities in providing feedback to other learners and differences in learning styles[ 23 , 25 , 33 , 34 ]. I felt we were being marked very much as a pair. At the end it was reflected alright that I suppose that I was that little bit stronger maybe, or that bit better, but I don’t know even, if it could have been reflected more. (ST3PT; 2:1, p279),[ 23 ]. We got used to giving each other feedback, and now we still do that even though we don’t have to ... So, I guess sometimes you might think you don’t want to tell them offend them, but because we had to in the beginning now, we just keep giving each other feedback (student, FG2),[ 25 ]. 3.2 Value of peer-assisted learning Learners within REP pairs valued each other's support[ 22 , 24 – 26 , 30 , 31 , 33 , 34 ]. How I coped was…speaking with my fellow student (and). reflecting back on (those conversations). (Kathleen, p431),[ 26 ]. The collaborative learning models enabled peer-supportive conversations, enhancing each other’s practice. This debriefing process helped to reduce anxiety for learners. Peer supervision was great as well, being able to share our journey and how we were feeling. And if one of us was feeling low then the other one was able to pick you up. I think, to be honest, you actually do need two students. (Student 4, p572),[ 34 ]. 4. Educational and learning process This captured the learners' experiences of learning and supervision during placements. 4.1 Learning experience Learning progression was considered slow, with limited opportunities within the placement[ 23 , 27 ]. I have the feeling that the start was, for me, very much extended [slow], and nothing was concrete. (Kathrin, p714),[ 27 ]. “The only negative was that the caseload was so small because it was divided between us… you probably didn’t get as much contact with patients because of the 2:1 model…that was the one thing I suppose… was the setting suitable for a 2:1 model?” (ST10OT; 2:1, p280),[ 23 ]. The feeling of ‘belonging with the placement’ and the ability to ‘think for themselves’ was valued[ 21 , 24 , 27 , 29 , 34 ]. I really value the independent learning and being responsible for my own learning [...] whenever I’ve done that, I’ve shown my best qualities. (Participant 6, p5),[ 24 ]. 4.2 Theoretical frameworks OT learners within REPs indicated these placements provided solid opportunities for utilising theoretical frameworks[ 27 , 34 ]. We learned [about occupation-centred practice] theoretically, and yeah, we knew what it was, but this time, we really used it in practice and saw how the different steps [in the occupational therapy process] can be done and that they actually make sense and that they are needed. Yeah, it gave me this understanding, the practical side actually. (Elin, p714),[ 27 ]. 4.3 Learning process Learners valued learning tools and reflective activities embedded within the placement structure[ 22 , 23 , 25 , 27 , 32 ]. “It was more supervision, and even though it was probably a more pressurised situation, you do learn an awful lot from those sessions… “ (ST7PT; 2:1, p279),[ 23 ]. You want to mimic, to some extent, what your [clinical educator] is doing. To you, that’s the standard. If you can do what they do, then you’re going to be hopefully a good physio and get good marks. Early on, to know how to go see a patient, the process you do things, and where they put things when they’re getting patients up [out of bed]. I think all those things early on through demonstration are so critical (student, FG3),[ 25 ]. 4.4 Supervision process Within REPs, closer and more frequent supervision was preferred[ 24 – 26 , 29 , 30 , 32 – 34 ]. So I think it is very important to have that kind of support and have your supervisor in a senior capacity to just affirm what is right (that you are). on the right track. (Emily, p431),[ 26 ]. For me personally I think I much prefer having somebody with me; someone to guide me. I think I really miss that, actually. We were just thinking today about how much we have to explain because our practice educator hadn’t seen what we’ve done, and I find it really difficult to explain to somebody that hasn’t seen it, in words, expressing the meaning. (Student 4),[ 34 ]. 4.4 Learning environments and preparation REPs caused learners concerns regarding unfamiliar environments and client groups. However, these new environments were also perceived as valuable[ 20 , 26 , 32 , 33 ]. it made me realise how much you rely on the OT departments that are already set up, and that was, I suppose, probably quite a pivotal moment […] I sat here with all this information, and that was when I suppose it hit me, it was like because normally, you know, you might know that they might do cooking or they might do a skills learning or they might recommend they join this group or, but I just didn’t have any of that, and I was like well, great, but now what do I do with it? So, I had this kind of moment. (Student, p34),[ 20 ]. 5. Managing professional relationships Learners developed skills relating to maintaining and developing relationships and valuing teamwork. 5.1 Building relationships and teamwork The learners recognised that relationships required careful negotiation, and a sense of belonging and effective teamwork was valued alongside client relationships[ 22 , 26 , 30 , 31 ]. I was just part of the team, and I said to them at the end, ‘I’m really grateful ’cause you didn’t make me feel like a little student who didn’t have a clue; you just let me crack on; I was part of the team, I had a valued contribution. (Ella, p23),[ 22 ]. However, managing perceived hierarchy was challenging[ 29 , 32 ]. Working with team members with fixed attitudes, support of these members as long as they were asked not to participate. Delegating tasks, this was particularly difficult as student and an outsider to the org. Saying goodbye to the population, breaking attachments. (Student, p269),[ 29 ]. 5.2 Managing expectations The REP provoked concerns regarding expectations from clients, services, and the learners themselves. Some learners found the lack of clarity a challenge [ 33 ] and managing the expectations of the staff was particularly demanding[ 20 , 24 , 26 ]. What was mentally draining was trying to manage everyone’s expectations as well as doing something for myself and my own learning… (Ursla, p431),[ 26 ]. Meta-synthesis of the Practice Educator Voice A total of 49 findings were extracted from nine articles exploring the practice educator's voice. These findings were aggregated into 14 categories based on similarity of meaning. Four synthesised findings were developed from these categories: providing the right support, professional identity, peer relationships, and levels of satisfaction (Table 5). Table 5: Contribution of studies to meta-synthesis of Practice Educator’s voice. 1. Providing the right support This synthesised finding relates to the different approaches that alternative placement models may require to help ensure success. 1.1 Identifying the level of support Identifying the level of support means tailoring different styles and levels of support depending on learners' needs[ 25 , 27 , 28 , 30 , 33 ]. Some students were really good, took a lot of initiative and we didn’t have to ask a lot of questions at all. We had others that needed more prompting (educator, FG4).[ 25 ]. Some practice educators expressed the need for greater pastoral support for learners to allow for personal growth[ 27 , 30 , 33 ]. I think you have to create that safe space for both of those students so they share those fears and concerns (CI4 FG P2, p149),[ 30 ]. 1.2 Supervisor Feedback The variety and significance of supervisor feedback for the learner has been recognised by practice educators particularly the high value in relation to the assessment aspects[ 25 , 33 ]. [Students] want to know they’re doing well from their [educator] because they’re the ones that are going to assess them (educator, FG5),[ 25 ]. 1.3 Supervisor development Alternative placement models allowed supervisors to develop different skills and approaches, which benefited their professional development, however practice educators desired support for themselves[ 33 ]. at least one of the LAS [long-arm supervisors] needs to be experienced because I was also being supervised to a certain extent by the other LAS (Supervisor, p199),[ 33 ]. 1.4 Additional support structures Successful placements were related to the university's role in matching learners with placement settings, along with additional information related to learners needs and skill level[27, 28]. “It was good to be able to meet with the teachers before the students started their placement. It allowed to talk about what students experienced the last year and to talk about expectations and student learning.” (long-arm supervisor p715),[27]. 2. Professional identity Professional identity relates to challenges and facilitators of professional growth for learners as identified by the practice educators. 2.1 Clinical reasoning Clinical reasoning was enhanced within the alternative model, and this experience met learner’s expectations for practice, allowing a more client-centred approach[27, 34]. “On previous placements, the students were just told what to do and they just did it without thinking about it.” (Long arm supervisor, p570),[34]. “it seemed like their approach on the role-emerging placement was closer to really client-centred occupational therapy practice….” (long arm supervisor, p716),[27]. 2.2 Guiding process The practice educators perceived that clear clinical processes benefited the learners[27, 34]. This included a specific framework: the Occupational Therapy Intervention Process Model (OTIPM) [35, 36]to guide the learner’s approach and facilitate the develop of their reasoning to support the intervention[27, 34]. “By using the OTIPM to structure the approach of students it puts the brakes on…” (Long arm supervisor, p572),[34]. 2.3 Impact of Role Clarity Practice educators reflected that learners need guidance on the remit of their roles especially within REPs[27, 33]. “we need to be really much clearer about what we expect each person to do … about what level of supervision each person has” (Supervisor, p199),[33]. 2.4 Role expectations Practice educators experienced uncertainty regarding how much learners could do independently, without having full professional registration[27, 31]. “It was unclear at times how far you could proceed with the client, given the limitation that they are not occupational therapists; they are just students” (OT preceptor, p578),[31]. 3. Peer relationships Having more than one learner within a placement was both beneficial and challenging. 3.1 Peer working Peer working resulted in greater independence from practice educators, greater productivity, and greater confidence[23, 25, 28]. “If there are two students, they can bounce things off each other, and there is a lot of shared learning, so I always felt that it is better with 2 students.” (CE6PT; 2:1, p279),[23]. 3.2 Peer feedback Learners can develop skills delivering peer feedback; important for practice and reducing practice educator demands[25]. “If we’re skilling our students to give feedback to each other, I think it’s a good skill to have when they are coming to clinical practice. “ (Educator FG4, p89),[25]. 3.3 Independence Learners could become co-dependent and “didn’t want to be separated” [28](p125), and challenges were identified within placements without on-site supervision, but positive reflection was noted[27]. “They reflected how this might be similar to working as an occupational therapist after graduation and how it was a valuable learning experience” (Long arm supervisor, p715),[27]. 3.4 Collaborative working The placement model led to development of teamwork and professionalism, as learners were required to work together and adjust to the needs of others[25, 28, 30]. “The more experienced student was helping to lead and guide the more novice student. They learned to rely on each other, which was a great dynamic” (CL10 FG P1, p149),[30]. Some practice educators queried the rationale and evidence behind the peer-working approach[28]. “I want to know if there is actually research that is showing that it is an effective way of learning for students” (supervisor, p 127),[28]. 4. Levels of satisfaction This related to the differing demands and benefits that alternative placement models provide. 4.1 Satisfaction with the model The perceived benefits, influencing practice educators to consider alternative placements include reduced need for practice educator feedback and learner productivity, which decrease practice educator workload, along with unique opportunities that the alternative placement models can provide[25, 28, 32]. “These students [administered] ... 150 to 175 new assessments each. ... There was endless opportunity for learning with regards to patient history taking, documentation, collaboration, and communication with the interprofessional team… so many aspects of the placement that offered learning opportunities that do not exist in other placement settings.” (Clinical instructor, p282),[32]. 4.2 Dissatisfaction with the model Additional resource demands such as physical space, experiences and administration (including paperwork, preparation and time) could make practice educators reluctant to offer alternative placements[23, 25, 28, 30, 31, 34]. “I think from a preparation point of view, it’s a little bit more difficult to try to arrange the diary to facilitate two students” (CE5PT;2:1, p280),[23]. “One of the challenges was that it takes some time [for student occupational therapists] to integrate themselves. It is a bit more challenging for a role-emerging opportunity to maximise its potential.” (Educator, p578),[31]. Discussion Placement capacity is a recognised concern, yet consideration of the potential benefits that alternative practice education models could provide, has rarely been considered[ 4 ]. This systematic review seeks to understand the experience and perceptions of both practice educators and learners regarding these alternative models. This enhanced understanding of the experience could influence greater adoption of alternative placement models, thereby increasing training capacity and supporting the expansion of the workforce[ 8 ]. The practice placement environments play a crucial role in professional identity development, which is a cornerstone of practice. Professional identity is shaped through defining professional boundaries, multidisciplinary teamwork, and facilitation of safe and effective clinical practice for health professionals[ 37 ]. The key influencers in this development are the individuals themselves, the impact of relationships with clients and other professionals[ 38 ]. Our review found that REPs, in particular, supported learners to develop strong professional identity and perceived confidence in their abilities, a finding consistent within the research. These opportunities for professional growth have been highly valued by both learners and practice educators. However, role clarity and expectations were an area of concern for learners, similar to previous findings indicating that that careful organisation and planning is needed to prevent ‘false expectations’[ 39 ]. Our review has highlighted that addressing these issues with the learners prior to the start could provide the additional reassurance required as well as support them in understanding the potential scope of growth within these experiences. The development of proficient professional skills has been valued by both learners and practice educators. Learners were more focused on skill levels, whereas practice educators indicated that clinical reasoning, as a higher-level skill, could be enhanced within these alternative models. Learning environments that facilitate independent engagement in active critical analysis, thinking and learning processes around uncertainties allow clinical reasoning processes to develop[ 40 ]. The benefits of one placement model over another in developing these skills remains unconfirmed[ 13 ], however it is recognised that all placements provide skill development benefits to the learners[ 4 ]. The practice educators positively noted personal growth and professional development opportunities within these placements, therefore additional support provided by the university can facilitate the demand for these professional development opportunities[ 41 ]. The utilisation of alternative placement models may allow skills development for both parties due to increased focus on the analysis and reflective elements. A critical factor in ensuring the success of an alternative placement is the provision of appropriate support for both learners and practice educator. Confidence in the support provided, along with the need to adequately prepare all parties, is essential[ 12 ]. Our review suggested additional university support and guidance may be required to ensure a successful experience for stakeholders unfamiliar with alternative placement models. Consideration to the practice educator training provided by the universities and appropriate preparation of the learner regarding expectations has the potential to reduce anxieties from both parties. Practice educators identified experiencing barriers such as increased time demands, the challenges of supporting from a distance, and insufficient information about the placement model. The desire for continued and increased support from the universities has been reported within the literature[ 10 , 41 ]. This is a key area that needs to be addressed to enhance acceptance and adoption of alternative placements. Learners had mixed views regarding the success of alternative placements in relation to future employment. Within healthcare literature employability is often discussed in terms of skills and capabilities[ 42 ]. However, it is essential to consider the benefits of a flexible and changeable mindset that can better manage unpredictability and uncertainty within the changing landscapes of healthcare[ 43 ]. Due to the personal growth opportunities these alternative placements provide, it could be suggested these environments better prepare graduates for the challenges of the future employment market. To enhance the learner’s confidence in the placement model preparation activities, supervision and ongoing reflection may augment the positive mindset to embrace uncertainties whilst engaging in the deep learning experience. Our review findings identified the significance of psychological safety in ensuring the learner’s well-being and necessitates careful consideration when planning and supporting them within these environments. Psychological safety encompasses both intrapersonal and interpersonal factors[ 44 ]. The learners expressed a range of emotional responses. Consideration to emotional intelligence and resilience is essential to ensure educational safety where learners can fully engage within the experience without risk[ 45 ]. While REPs introduced notable stress and concern, our review found that the benefits include rewards of enhanced confidence and personal growth. This confidence impacts employability, enabling individuals to seek a broader range of career opportunities[ 46 ]. To ensure the successful adoption of these alternative placements consideration of how to support psychological safety, emotional intelligence and resilience within the placement structure must be considered. These activities can support greater learner understanding and preparation prior to and during these placements therefore reducing the potential psychological impact of uncertainty. Learning environments that provided structure and organisation via frameworks and experiential learning opportunities are highly valued. A guiding structure, such as the OTIPM[ 35 , 36 ], provided increased confidence and cohesion between expectations of learners and practice educators, and a framework to develop placement opportunities. In placement models demanding greater learner autonomy, like REP or 2:1 models, employing a framework to foster clinical reasoning is beneficial for professional socialisation and learning processes[ 47 ]. This enhances learners' confidence, unlike traditional placements where organisational or practice educator preferences typically dictate choices[ 48 ]. Peer learning and collaboration were considered beneficial from both the learners and the practice educator's perspectives within our review. This is consistent with previous findings that confidence and teamwork skills can be enhanced within all peer learning placement models[ 12 ]. However, concerns regarding the satisfaction of the learner and the practice educator have led to resistance related to the implementation of this model despite the educational benefits[ 11 ]. The nature of these peer relationships can be complex, leading to challenges within the placement environment[ 49 ]. Challenges identified included a range of cultural aspects such as unconscious biases, perceived epistemic authority and physical space[ 50 ]. These barriers and facilitators must be considered to ensure effective strategies are developed to maximise peer learning opportunities. The influence of the practice educator in the supervision process, and learner/educator relationship were especially evident within our review. Learners highly regard practice educators who build relationships, formulate active participation, and encourage learning via engagement within communities of practice, therefore recognising holistic and organisational contributions to the learner’s professional development[ 51 ]. Valued within placement experience is the ability to connect with practice educators and clients, building relationships highly cherished within the learner/educator dynamic, and supporting a successful placement[ 52 ]. These connections entail establishing trust, fostering active participation, and emphasising outcome-based learning[ 53 ]. To ensure the continued development and utilisation of these alternative models these positive relationships and connections must be nurtured for the benefit of all stakeholders. There was no clear consensus regarding overall satisfaction gained within alternative placement experience, with many factors influencing the views expressed. The barriers discussed such as patient contact time, physical space and workload have remained unchanged within recent literature[ 54 ]. Nevertheless, there were encouraging discussions related to increased learner autonomy, recognition of peer-learning benefits and increased environmental exposure, particularly when learners were seen as key team members. The sense of belonging, community of learning practice and role models are effective methods of supporting learning and increase satisfaction[ 41 , 55 ]. Alternative placements have the potential for these aspects to be developed and embraced. Our review has identified that to support the adoption of these alternative placements the benefits, challenges and expectations of these placements needs to be clarified for all stakeholder’s pre-placement by the university. There appear to be confusion or inaccuracies or uncertainty that are causing the challenges for both the practice educators and the learners. Addressing these concerns and highlighting the potential to develop higher level clinical reasoning skills and the enhancing employability possibilities might enhance the psychological well-being and allowing students to settle more in the placement. By understanding these perceptions and experiences the appropriate support and guidance can be developed by the universities to address these issues. Strengths and Limitations Utilisation of the JBI meta-aggregation process ensure a rigorous approach to the method. The adoption of this approach allowed for the combining of findings that is more than the sum of the individual findings aligned with that of meta-analysis[ 14 ]. The critical appraisal, standardised data extraction and synthesis approached allowed for a clear and robust processes to draw recommendations and conclusion related to the research question. Limitations within this qualitative review are related to challenges of identifying all relevant studies, due to the date range and grey literature search restrictions. The search was completed December 2022 and studies after this date have not been included. Only studies in English were included. All the research included were conducted pre the global COVID pandemic which may well have had an impact on the current experiences of learners and practice educators. Whilst 16 articles were included within the data for analysis, four data sets were from the same participants from a body of work from one authorship group. Eleven studies considered REP, 10 explored OT placements in comparison to four exploring PT placements: limiting the breadth of data available in terms of scope of participants and range of alternative practice placement models. This highlighted the lack of literature related to the scope of alternative placements within OT and PT and limits the generalisability of these findings beyond REP. The JBI process was followed to support the rigour in the extraction and aggregation of the findings however, the qualitative meta-synthesis involves individual interpretation and decision making. A team approach was utilised to ensure consensus was achieved, via repeatedly read and reading the articles, and discussion to ensure that the synthesised findings were grounded in the data. Future Research Future studies are required to explore the views within different alternative models to build on the understanding related to these experiences particularly within the physiotherapy profession in particular in relation to REP’s. Consideration of the employability factors related to the range of skills developed within the alternative placement models would enhance understanding related to the potential benefits. Focusing upon strategies and techniques to enhance these opportunities for learners, practice educators and organisations has the potential to facilitate increases in placement opportunity and capacity. Conclusion This review synthesised the experiences of learners and practice educators within alternative placement opportunities. Alternative placement models can present a positive environment to support the development of professional identity and personal growth, providing clear benefits in terms of clinical reasoning, professional skills and person-centred care. While they provide additional emotional challenges, consideration of psychological safety can then foster confidence and personal growth among learners. Peer-learning and collaboration strengthens these opportunities and contributes to skill enhancement. Additional support and guidance from the university, and the use of specific frameworks, was of particular value when utilising such models. The success of these models hinges on adequate support, preparation and ongoing guidance for both learners and practice educators. Recommendations include enhancing these support process to enhance the benefits, prevent uncertainty and support the psychological safety of the learner and practice educator. These findings emphasis the multifaceted nature of alternative placements in healthcare education and highlight the importance of addressing challenges to maximise the learner experience. Nonetheless, these models have the potential to enable increased practice placement capacity for learners. Overall, alternative placements offer a promising environment for healthcare education, proving learners with invaluable experiences and skills essential for their future careers. Abbreviations ENTREQ enhancing Transparency in Reporting the synthesis of qualitative research JBI Joanne Briggs Institute OT Occupational Therapist OTIPM Occupational Therapy Intervention Process Model PT Physiotherapist PICo Population, Phenomenon of Interest, Context REP Role Emerging Placement UK United Kingdom Declarations Ethics approval and consent to participate: Not applicable as this was a systematic review of previous published qualitative studies. Consent for publication: Not applicable Availability of data and materials: The datasets used and analysed during the current study are available from the corresponding author on reasonable request. Competing interests: The authors declare that they have no competing interests Funding: No funding was providing for this research. Authors' contributions: AD: Original idea, project management, Search strategy and data searching, screen and selection of included studies, data extraction, data analysis, primary author and manuscript production, editing and proof reading. RM: data extraction, data analysis, major contributor in writing the manuscript, editing and proof reading. ER: screen and selection of included studies, data extraction, data analysis, editing and proof reading. DE: development of search strategy, quality appraisal of the studies, data extraction, data analysis, editing and proof reading KT: quality appraisal of the studies, data extraction, data analysis, editing and proof reading JS: quality appraisal of the studies, data extraction, data analysis, editing and proof reading Acknowledgements: Jo Linforth and Dr Maria Moffatt provided internal peer review and proof reading of the material and contributed to the development of the final article. Acknowledgement Jo Linforth and Dr Maria Moffatt provided internal peer review and proof reading of the material and contributed to the development of the final article. References Minimum Standards for the Education of Occupational Therapists Revised. [ https://wfot.org/resources/new-minimum-standards-for-the-education-of-occupational-therapists-2016-e-copy] Accessed 16th October 2022. Accreditation of qualifying programmes in physiotherapy quality assurance processes. 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Tables Table 1: Search terms Population Phenomena of interest Context Limits Student Learner Mentor Educator “Clinical educator” Physiotherap* “Physical therap*” “Occupational Therap*” Experience Evaluation View* Attitude* Perception* “Non-traditional” Blended Collaborative “2 to 1” “3 to 1” “4 to 1” Leadership Coaching “Split placement” “shared placement” “Role emerging” “Project placement” “TECS placement” “Peer learning” Placement “Practice learning” “Clinical education” “Clinical experience” “Clinical placement” 2010 to current (December 2022) English Language Table 2: Quality Appraisal Scoring Results Authors / Year Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Is there congruity between the stated philosophical perspectives and the research methodology Is there congruity between the research methodology and the research question or objectives? Is there congruity between the research methodology and the methods used to collect data? Is there congruity between the research methodology and the representation and analysis of data? Is there congruity between the research methodology and the interpretation of results? Is there a statement locating the researcher culturally or theoretically? Is the influence of the researcher on the research, and vice- versa, addressed? Are participants, and their voices, adequately represented? Is the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by an appropriate body? Do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data? Scores 1 Alpine, Caldas, and Barrett, 2019 No No No No No No No Unclear No Yes 1.5 2 Barrett, Belton and Alpine, 2021 No No No No No No No Yes Yes Yes 3 3 Boniface, et al., 2012 Yes Yes Yes Unclear Yes No No Yes Yes Yes 7.5 4 Clarke, et al., 2014 Yes Yes Yes Yes Yes No No Yes Yes Yes 8 5 Clarke, et al., 2015 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 10 6 Clarke, et al., 2015a Yes Yes Yes Yes Yes No No Yes Yes Yes 8 7 Clarke, de Visser and Sadlo, 2019 Yes Yes Yes Yes Yes No No Yes Yes Yes 8 8 Dancza, et al., 2013 Yes Yes Yes Unclear Yes No Yes Yes Yes Yes 8.5 9 Dancza, Copley and Moran, 2019 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 10 10 Fortune, and McKinstry, 2012 Yes Yes Unclear Yes Yes No No Yes Yes Yes 7.5 11 Kaelin and Dancza, 2019 Yes Yes Yes Yes Yes Unclear Yes Yes Yes Yes 9.5 12 Kyte, Frank and Thomas, 2018 Yes Yes Yes Yes Yes No Yes Yes Yes Yes 9 13 Mattila and Dolhi, 2016 No No No No No No No Yes No Yes 2 14 O'Connor, Cahill, and McKay, 2012 Yes Yes Yes Yes Yes Unclear No Yes Yes Yes 8.5 15 O'Connor, Liston and O'Donnell, 2019 No No No No Unclear No No Yes Yes Yes 3.5 16 Price and Whiteside, 2016 Yes Yes Yes Yes Yes No No Yes Yes Yes 8 17 Sevenhuysen, et al., 2015 No Yes Unclear Yes Unclear No No Yes Yes Yes 6 18 Sharmin, et al., 2016 Yes Yes Yes Yes Yes No No Yes Yes Yes 8 19 Withers, et al., 2022 Yes Yes Yes Yes Yes Unclear Unclear Yes Yes Yes 9 20 Wolff-Burke, et al., 2022 Yes Yes Yes Yes Yes No No Yes Yes Yes 8 Table 3: Characteristics of Included studies Authors / Year Country / Culture Aims or Purpose of the Study Study Methodology / Method Phenomenon of interest Setting Participants Data analysis Boniface, et al., 2012 Setting is UK, but students are from UK and Poland / European Explore experiences of staff and students using pyramidal model of peer-assisted and long-arm supervisors in role-emerging practice placement Participatory Action Research / interviews Student and supervisors’ experiences of peer-assisted learning and long arm supervision Role emerging placements Two final year postgraduate diploma occupational therapy students from a UK university, two occupational therapy students from a Polish university, UK university staff (OTs) Reflexive TA (Braun and Clarke) Clarke, et al.,2014 Brighton- UK / UK Gain deeper understanding of occupational therapy students’ experience of role-emerging placements Phenomenological approach / interpretative phenomenological analysis / interviews Student experience of role emerging placements Role emerging placements. Five female MSc pre-registration occupational therapy students IPA Clarke, et al., 2015 UK (Brighton) / UK Explore the impact of role-emerging placements on professional practice and identity once graduated Phenomenological approach / Interpretative phenomenological analysis (IPA) / interviews Professional practice and identity Role emerging placement Five female MSc pre-registration occupational therapy graduates IPA Clarke, et al., 2015a Brighton – UK / UK Explore occupational therapy students’ experience of role-emerging placements Phenomenological approach / Interpretative phenomenological analysis / interviews How occupational therapy students experienced and ascribed meaning to their role-emerging placements. Role emerging placement Five OT students (pre-reg Masters) IPA Clarke, de Visser and Sadlo, 2019 Brighton – UK / UK To explore strategies used by students to cope on role-emerging placements Phenomenological / interpretative phenomenological analysis / semi-structured interviews how occupational therapy students cope with the challenges of undertaking a role-emerging placement. Role emerging placements Five female students (pre-reg MSc in OT) IPA Dancza, et al., 2013 Ireland and England / European To explore students’ perspectives of their learning in a variety of role-emerging placement settings Social constructionism / Interviews Learning experiences Role emerging placements 10 OT students Reflexive TA (Braun and Clarke) Dancza, Copley and Moran 2019 UK / UK Exploring the learning experiences of students (from both supervisor and student perspectives) during role-emerging placement. Action research methodology / reflective field notes, placement documentation and semi-structured interviews Exploration of the learning experiences of students, from both supervisor and student perspectives, over the duration of a role-emerging placement in schools, to contribute to our understanding of this important student learning process. Role emerging placement 14 students (OT), 5 on-site supervisors, 3 long arm supervisors, 1 researcher/ long arm supervisor Template analysis Fortune, and McKinstry, 2012 La Trobe University, Australia / Australia Exploring the perceptions of agency sponsors and students participating in a project placement. Grounded theory approach / open-ended, written questionnaires & interviews Value of project placements Project Placement - project occurs in place where OT services do not exist. 11 project sponsors, 11 final year OT masters students Adapted grounded theory approach with themes identified Kaelin and Dancza, 2019 Zurich – Switzerland / Switzerland Examine how occupational therapy students on role-emerging placements in school settings experience applying threshold concepts and how impacts onto placement Social constructivist paradigm / semi-structured focus group interviews Experience of applying threshold concepts Role emerging placements 13 female Swiss occupational therapy students, one long-arm supervisor for all student Template analysis Kyte, Frank and Thomas, 2018 UK (research conducted in University of Worcester) / UK Explore the experiences of physiotherapy students who had undertaken a role-emerging placement Qualitative / semi-structured focus groups Experiences of undergraduate physiotherapy students who had each undertaken a REP Role emerging placement Six physiotherapy students Thematic analysis O'Connor, Cahill, and McKay, 2012 Ireland / Ireland Compare experiences and perspective of clinical educators and students involved in 1:1 and 2:1 models of placement supervision and the learning opportunities available with both models Qualitative - descriptive approach / individual semi-structures interviews Perspectives of clinical educators and students (OT and PT) who had participated in both the 1:1 (one student supervised by one clinical educator) and 2:1 (two students supervised by one clinical educator) models of clinical education Clinical education (PT and OT) - 1:1 and 2:1 supervision model 24 students (OT and PT) and 29 educators Thematic content analysis Price, and Whiteside, 2016 Melbourne (Australia) / Australia Determine the experience of supervisors pre-and-post 2:1 supervision model experience Social constructivist theoretical perspective / focus group Supervisor experience in the trial of a new 2:1 supervision model (OT) Health service OT department Nine occupational therapy supervisors Thematic Analysis Sevenhuysen, et al., 2015 Australia / Australia To explore clinical placement experiences of students and clinical educators in paired peer-assisted learning model, compared to traditional paired teaching approach Qualitative study / focus groups Experiences of students and clinical educators in a paired student placement model incorporating facilitated peer-assisted learning (PAL) activities, compared to a traditional paired teaching approach Traditional paired model and a PAL paired model. 24 physiotherapy students and 12 clinical educators. Thematic Analysis Sharmin, et al., 2016 Southern Ontario, Canada / Canada To explore the benefits and challenges of engaging student occupational therapists in HIV service organisations through role-emerging placements. Interpretive description / interviews Benefits and challenges of role-emerging placements of student occupational therapists in HIV service organisations Role emerging placements Five student occupational therapists (5), (2) staff members from the HIV service organisations (3) and an off-site occupational therapy preceptor (1) - total of 11 Content analysis Withers, et al., 2022 Ontario (Canada) / Canada To understand the experiences of students, clinical instructors, health care providers and patient in role-emerging placement and identify barriers and facilitators. Interpretive description ­y / semi-structured interviews Experiences and perspectives of a role emerging placement in an emergency department role-emerging placement 51 participants (6 PT students, 1 clinical instructor, 15 nurses, 12 physi­cians, and 17 patients) Thematic analysis in an interpretive description Wolff-Burke, et al., 2022 USA - West Virginia / USA Examine the perspectives on processes that occur in students and clinical educators throughout CCLE and to expand on factors that influence a successful CCLE Grounded Theory / surveys and focus groups / journals and focus groups Clinical collaborative learning experience (CCLE) - factors perceived in influencing the success of this, examination of the processes that make this successful Clinical collaborative learning experience (multiple students paired with one clinical instructor) 29 DPT students and 18 Clinical Instructors Grounded Theory approach / Thematic analysis Tables 4 and 5 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Supplementryfile1ENTREQQualstudy.docx Table4Contributionofstudiestometasynthesisoflearnervoice.docx Table5Contributionofstudiestometasynthesisofpracticeeducatorvoice.docx Cite Share Download PDF Status: Published Journal Publication published 18 Nov, 2024 Read the published version in BMC Medical Education → Version 1 posted Editorial decision: Revision requested 13 Sep, 2024 Reviews received at journal 01 Sep, 2024 Reviewers agreed at journal 28 Aug, 2024 Reviews received at journal 26 Aug, 2024 Reviewers agreed at journal 25 Aug, 2024 Reviewers agreed at journal 21 Aug, 2024 Reviewers invited by journal 19 Aug, 2024 Editor invited by journal 16 Aug, 2024 Editor assigned by journal 14 Aug, 2024 Submission checks completed at journal 14 Aug, 2024 First submitted to journal 06 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4867053","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":349846324,"identity":"5d0269b0-2eb3-4d7a-a860-7d57eaf07f70","order_by":0,"name":"Amanda 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Liverpool","correspondingAuthor":false,"prefix":"","firstName":"Rebecca","middleName":"","lastName":"Matson","suffix":""},{"id":349846326,"identity":"9c4c4a85-9bf4-4a9f-9bdd-6e6794c91c8c","order_by":2,"name":"Edwina Rushe","email":"","orcid":"","institution":"University of Ulster","correspondingAuthor":false,"prefix":"","firstName":"Edwina","middleName":"","lastName":"Rushe","suffix":""},{"id":349846327,"identity":"811f95fa-8f08-41ae-a62c-07cb274a9b95","order_by":3,"name":"David Edwards","email":"","orcid":"","institution":"University of Liverpool","correspondingAuthor":false,"prefix":"","firstName":"David","middleName":"","lastName":"Edwards","suffix":""},{"id":349846328,"identity":"d0fac25f-e721-4fe4-bc02-f650e3c6e9ca","order_by":4,"name":"Kate Trainor","email":"","orcid":"","institution":"University of Liverpool","correspondingAuthor":false,"prefix":"","firstName":"Kate","middleName":"","lastName":"Trainor","suffix":""},{"id":349846329,"identity":"d681f67f-6ecf-4bbd-8222-180696a0bc8b","order_by":5,"name":"Joanne Seddon","email":"","orcid":"","institution":"University of Liverpool","correspondingAuthor":false,"prefix":"","firstName":"Joanne","middleName":"","lastName":"Seddon","suffix":""}],"badges":[],"createdAt":"2024-08-06 08:55:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4867053/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4867053/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12909-024-06323-z","type":"published","date":"2024-11-18T15:57:14+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":64305477,"identity":"4eb0a628-a016-49cf-8aab-f803be32cec6","added_by":"auto","created_at":"2024-09-11 12:45:27","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":52265,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-4867053/v1/ddc691f8292b4a45ea85c7b9.png"},{"id":69834822,"identity":"fa918d67-bf9f-4087-85d5-469cfb379001","added_by":"auto","created_at":"2024-11-25 16:09:09","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1260898,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4867053/v1/2c0384a4-9557-4a34-a133-76e3a5237831.pdf"},{"id":64305479,"identity":"448e8394-3ab4-4b6a-b3f6-246653f2517e","added_by":"auto","created_at":"2024-09-11 12:45:28","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26853,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementryfile1ENTREQQualstudy.docx","url":"https://assets-eu.researchsquare.com/files/rs-4867053/v1/6e19f3de6d08051ae0e58d1c.docx"},{"id":64305481,"identity":"b3a5a995-718d-4416-92db-8bec85af1525","added_by":"auto","created_at":"2024-09-11 12:45:28","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":27452,"visible":true,"origin":"","legend":"","description":"","filename":"Table4Contributionofstudiestometasynthesisoflearnervoice.docx","url":"https://assets-eu.researchsquare.com/files/rs-4867053/v1/91e7b424cab1ee1fc0b85b03.docx"},{"id":64305478,"identity":"2222ded5-2349-4196-9be7-8fd9dea83044","added_by":"auto","created_at":"2024-09-11 12:45:27","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":24985,"visible":true,"origin":"","legend":"","description":"","filename":"Table5Contributionofstudiestometasynthesisofpracticeeducatorvoice.docx","url":"https://assets-eu.researchsquare.com/files/rs-4867053/v1/12a96708ad71460ddb39121c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Exploring alternative practice placement models: perspectives and experiences of learners and practice educators. A qualitative systematic review.","fulltext":[{"header":"Background","content":"\u003cp\u003eAn essential requirement of professional registration for occupational therapy (OT) and physiotherapy (PT) learners, within the United Kingdom (UK), is to accrue 1000 hours of practical experience during training[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Within the UK, obtaining sufficient placement capacity to meet this requirement for both professions remains a significant issue[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The Allied Health workforce must expand to meet future health needs [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] and this drive for increased healthcare learner numbers has led to the exploration of alternative placement models[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe predominance of traditional one-to-one supervision models has created limitations for placement capacity expansion [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] and may limit breadth of future health care practitioner development[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. For the purposes of this systematic review, alternative placements are defined as any placement model that does not follow the format of one learner per one practice educator.\u003c/p\u003e \u003cp\u003eWhilst alternative placement models may provide opportunity for increased autonomy and self-direction, a number of challenges have been identified[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. These include; increased physical space pressures, decreased service user engagement, reduced individual supervision, decreased role identity and alternative models often being instigated at short notice to meet demand rather than planned[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCurrently, no existing qualitative systematic review has considered the alternative placement model experience for OT and PT learners. However, a mapping review considering practice education models for allied health and social care professionals[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]; a systematic review specific to peer learning and collaborative placement models for healthcare learners[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]; a scoping review relating to health profession learners [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and a mixed methods literature review [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] have been conducted. These findings focused on the broader spectrums of allied health and social care professions, discussed a range of alternative placement models; and included both quantitative and qualitative methods within all previous studies.\u003c/p\u003e \u003cp\u003eThis qualitative systematic review will focus to OT and PT practice placements exclusively, to allow more detailed profession-specific consideration, due to the closely aligned working relationships and practices within the two professions. Adaptation of alternative placement models requires learner and practice educator \u0026ldquo;buy-in\u0026rdquo;, meaning evaluation factors resulting in a positive experience for both parties is crucial. Concerns regarding learner satisfaction with alternative placement models and the underlying reasons have been reported [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and therefore consideration of factors that influence the quality of the experiences whilst ensuring expansion of capacity is essential.\u003c/p\u003e \u003cp\u003eThe objective of this review is to understand the experiences and perception of learners and practice educators in relation to alternative placement models. This will inform the development of future practice placement opportunities thereby addressing the placement capacity issues, optimisation of learning and increasing sustainability of practice education and workforce development.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eResearch Question\u003c/strong\u003e \u003cp\u003eWhat are the experiences and perceptions of practice educators and learners, within physiotherapy and occupational therapy, participating in alternative practice placement models?\u003c/p\u003e \u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThe review followed the Joanne Briggs Institute (JBI) qualitative synthesis review approach[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This was selected for its established framework in synthesizing qualitative research enabling assessment of individual article quality and synthesized evidence strength. Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist was used to guide reporting of this review[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. See Supplementary File 1.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSearch Strategy\u003c/h2\u003e \u003cp\u003eA systematic search was undertaken using six electronic databases (CINAHL, MEDLINE, PubMed, Scopus, ERIC, PsycINFO) January 2010 to December 2022. The search was limited to peer-reviewed studies, published in English, with reference lists of studies also hand-searched. A Boolean search strategy was used to search databases using relevant key terms and alternatives. Key search terms are fully detailed in Table\u0026nbsp;1.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSearch terms\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePopulation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePhenomena of interest\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eContext\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLimits\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003cp\u003eLearner\u003c/p\u003e \u003cp\u003eMentor\u003c/p\u003e \u003cp\u003eEducator\u003c/p\u003e \u003cp\u003e\u0026ldquo;Clinical educator\u0026rdquo;\u003c/p\u003e \u003cp\u003ePhysiotherap*\u003c/p\u003e \u003cp\u003e\u0026ldquo;Physical therap*\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Occupational Therap*\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eExperience\u003c/p\u003e \u003cp\u003eEvaluation\u003c/p\u003e \u003cp\u003eView*\u003c/p\u003e \u003cp\u003eAttitude*\u003c/p\u003e \u003cp\u003ePerception*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026ldquo;Non-traditional\u0026rdquo;\u003c/p\u003e \u003cp\u003eBlended\u003c/p\u003e \u003cp\u003eCollaborative\u003c/p\u003e \u003cp\u003e\u0026ldquo;2 to 1\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;3 to 1\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;4 to 1\u0026rdquo;\u003c/p\u003e \u003cp\u003eLeadership\u003c/p\u003e \u003cp\u003eCoaching\u003c/p\u003e \u003cp\u003e\u0026ldquo;Split placement\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;shared placement\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Role emerging\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Project placement\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;TECS placement\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Peer learning\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePlacement\u003c/p\u003e \u003cp\u003e\u0026ldquo;Practice learning\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Clinical education\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Clinical experience\u0026rdquo;\u003c/p\u003e \u003cp\u003e\u0026ldquo;Clinical placement\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2010 to current (December 2022)\u003c/p\u003e \u003cp\u003eEnglish Language\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eRayyan software (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ewww.rayyan.ai\u003c/span\u003e\u003cspan address=\"http://www.rayyan.ai\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e) was used to manage references, record decisions, and facilitate audit trail. Titles and abstracts were screened for eligibility by two independent researchers. If this screening failed to define suitability, full-text screening was undertaken. Studies that met inclusion criteria were retrieved and full-text articles were independently reviewed by both researchers. If there was disagreement between the two researchers, a discussion took place with a third researcher to reach agreement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eEligibility criteria and study selection\u003c/h2\u003e \u003cp\u003eThe authors sought qualitative research including, but not limited to designs within phenomenology, grounded theory, ethnography, action research and interpretive analysis. Mixed-method studies with substantive qualitative components were included. The PICo approach (Population, Phenomena of Interest, Context) was used to determine search terms and identify relevant studies.\u003c/p\u003e \u003cp\u003ePopulation: Studies reporting experiences of OT or PT learners and their practice educators.\u003c/p\u003e \u003cp\u003ePhenomena of interest: studies which explored experiences, views, attitudes or perceptions of learners or practice educators participating in alternative practice placement models.\u003c/p\u003e \u003cp\u003eContext: Alternative practice placement models were defined as the including any healthcare setting receiving an OT or PT learner implementing skills and behaviours aligned with their respective professions. This includes placements with face-to-face clinical practice experience and remote practice. All settings supporting learner education were included, namely Primary and Secondary care, Health and Social care, Private Practice and Voluntary organisations. Any placement not utilising one-to-one supervision models was also defined as an alternative placement.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eCritical appraisal of studies\u003c/h2\u003e \u003cp\u003eTwo researchers independently undertook quality evaluation, with all disagreements resolved through discussion with a third researcher. The JBI Critical Appraisal Checklist [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] was used to evaluate methodological quality of included studies. Following critical appraisal, all studies scoring less than five on the checklist were excluded to enhance trustworthiness and ensure appropriate quality[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData Extraction\u003c/h2\u003e \u003cp\u003eThe JBI Qualitative data extraction tool [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] was utilised within Microsoft Excel. Methods, phenomena of interest, setting, participants, data analysis, cultural information, findings and illustrations were retrieved from the studies.\u003c/p\u003e \u003cp\u003eFindings from the included studies were extracted using the meta-aggregation approach[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Two researchers independently reviewed the studies and identified relevant findings; considering both themes and metaphors. A finding is a verbatim extract of the authors analytic interpretation of their results[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The findings were identified by repeatedly re-reading the text. Each finding was accompanied by illustrations that were direct quotes from the participant voice.\u003c/p\u003e \u003cp\u003eEach finding was quantified for credibility as per JBI process (unequivocal, credible and not supported)[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Levels of credibility were independently considered by the researchers. The third researcher compared the two independent data extraction results, with disagreements discussed and agreed prior to the finalisation of the data set. All unsupported findings and illustrations were removed from the final data set.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eData Synthesis\u003c/h2\u003e \u003cp\u003eData was synthesised using the three-step process outlined in the JBI manual[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. To address the research questions, two subgroups were identified: learner voice and practice educator voice. The data synthesis within these subgroups were conducted by two pairs of researchers. Each researcher independently reviewed the data to identify categories of findings, with at least two or more similar findings per category. The meta synthesis involved aggregating these categories into synthesised findings. The two researchers per subgroup (learner voice and educator voice) met to discuss categorises and synthesis, cross checking results, discussing any differences with interpretation and agreeing final categories and synthesised findings. These final meta-aggregation synthesised findings were discussed and agreed by the researcher\u0026rsquo;s team.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eResults of the search and quality assessment.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA total of 568 articles were identified from the six databases and 15 via citation searching. Duplicates were identified (n\u0026thinsp;=\u0026thinsp;270) and removed resulting in 309 records being screened for relevance by title and abstract. In total, 47 full text articles were retrieved for review, of which 20 studies were included. The review and selection process has been recorded in Fig.\u0026nbsp;1 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses flow diagram[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn total, 20 studies met the inclusion criteria and were identified for quality appraisal using the JBI Checklist, shown in Table\u0026nbsp;2. Following critical appraisal, all studies scoring less than five on the checklist (n\u0026thinsp;=\u0026thinsp;4) were excluded. Quality concerns included a lack of congruity in relation to philosophical perspective, methodology, research question and objectives, data collection methods and data analysis. Therefore, 16 studies were included for data extraction.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;2: Critical appraisal scoring results\u003c/b\u003e \u003c/p\u003e\n\u003ch3\u003eFindings\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the studies\u003c/h2\u003e \u003cp\u003eAll studies used a qualitative research design; methodological approaches and methods included Interpretative phenomenological analysis (n\u0026thinsp;=\u0026thinsp;4)[\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]; thematic analysis (n\u0026thinsp;=\u0026thinsp;3)[\u003cspan additionalcitationids=\"CR24\" citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]; social constructivist thematic analyses (n\u0026thinsp;=\u0026thinsp;3)[\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]; grounded theory (n\u0026thinsp;=\u0026thinsp;2)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]; interpretive description (n\u0026thinsp;=\u0026thinsp;2) [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]and action research (n\u0026thinsp;=\u0026thinsp;2)[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEight studies explored the views of the learners alone: OT (n\u0026thinsp;=\u0026thinsp;7) [\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]and PT (n\u0026thinsp;=\u0026thinsp;1)[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Seven studies explored the views of both the learners and the practice educators; OT (n\u0026thinsp;=\u0026thinsp;3)[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], PT (n\u0026thinsp;=\u0026thinsp;3) [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]and both OT and PT (n\u0026thinsp;=\u0026thinsp;1)[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. One study reported the practice educator voice alone[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGeographical location of the studies included Ireland (n\u0026thinsp;=\u0026thinsp;2)[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], UK (n\u0026thinsp;=\u0026thinsp;7)[\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], Australia (n\u0026thinsp;=\u0026thinsp;3)[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], Canada (n\u0026thinsp;=\u0026thinsp;2)[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], Switzerland (n\u0026thinsp;=\u0026thinsp;1) [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]and USA (n\u0026thinsp;=\u0026thinsp;1)[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe range of alternative placement include role emerging placements (REP) (n\u0026thinsp;=\u0026thinsp;11)[\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], project placements (n\u0026thinsp;=\u0026thinsp;1)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], 2:1, peer assisted learning and collaborative learning (n\u0026thinsp;=\u0026thinsp;4)[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The study characteristics can be found in Table\u0026nbsp;3.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;3: Characteristics of Included Studies\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eMeta-synthesis of the findings\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003eMeta-synthesis of learner voice\u003c/h2\u003e \u003cp\u003eA total of 142 findings, classed as unequivocal or credible, were extracted from 15 articles about learner experience and aggregated into 18 categories based on the similarity of meanings.\u003c/p\u003e \u003cp\u003eFive synthesised findings were developed from these categories: professional growth and development, personal and psychological adaptation, alliances within collaborative learning, educational and learning process, and managing professional relationships (Table\u0026nbsp;4).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;4: Contribution of studies to meta-synthesis of learner\u0026rsquo;s voice.\u003c/b\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e1. Professional growth and development\u003c/h2\u003e \u003cp\u003eProfessional growth and development centres around the learner building essential knowledge, skills, identity, values, and behaviours to become a competent professional.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Developing professional identity\u003c/h2\u003e \u003cp\u003eAlternative placement models enabled learners to better understand professional behaviours and values by articulating their role and identity as an OT[\u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI have learnt so much \u0026hellip; the most on this placement; although it\u0026rsquo;s been the hardest and most challenging, I have learnt a lot about how I want to be as a therapist, and it\u0026rsquo;s really made me question everything.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Cardiff student, p200),[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Development of professional skills\u003c/h2\u003e \u003cp\u003eLearners valued opportunities to become proficient in profession-specific skills and developed confidence[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I found learning the project processes invaluable; documentation skills were useful and challenging. I enjoyed acting in a health promotion role, and it reinforced the benefits of using needs analysis to identify client/pt needs\u003c/em\u003e.\u0026hellip; \u0026ldquo;\u003c/p\u003e \u003cp\u003e(student, p268),[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe role-emerging placement did give me the confidence to work. Because you are so independent in a role-emerging placement, and it really forces you to use your critical thinking skills and draw upon the knowledge that you have learned over two years in the occupational therapy programme.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Student OT 5, p 576),[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e1.3 Enabling the professional role\u003c/h2\u003e \u003cp\u003eThe REP allowed learners to increase their understanding of their professional role via articulating this to others, utilising these professionally related skills within unique environments[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Other healthcare professionals that are working there try to push you out of your remit of what you\u0026rsquo;re meant to be doing [...] I think maybe establishing that [your role] before and asking your placement educator \u0026ldquo;\u003c/em\u003e \u003c/p\u003e \u003cp\u003e(Participant 3, student, p4),[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e1.4 Person-centred care\u003c/h2\u003e \u003cp\u003eThe individual was central to the learner\u0026rsquo;s decision-making and actions[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFor me, [a highlight] was also the client-centeredness. We really assessed what the teacher needed and what was important to her. Then, we really set goals together and worked towards them. At the end we even were successful!\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Andrea, p715),[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e1.5 Future Employability\u003c/h2\u003e \u003cp\u003eLearners expressed mixed views regarding the impact of alternative models in relation to future employability[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWorking with the homeless in the future would be great; I\u0026rsquo;d love to do something like that, looking at different roles...health promotion would be really cool as well, I think. Occupational therapists could work really well in health promotion\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Jayne, p47),[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe don\u0026rsquo;t know how employers are going to view physios doing role-emerging placements, and you don\u0026rsquo;t know what they\u0026rsquo;re going to think of that when they see that .\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Participant 1, student, p7),[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e2. Personal and psychological adaptation\u003c/h2\u003e \u003cp\u003eThis finding related to emotional challenges faced by learners during placements, including heightened anxiety and isolation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Mixed emotions\u003c/h2\u003e \u003cp\u003eChallenges learners encountered during alternative placements led to both positive and negative emotions[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIt has been such a roller coaster between loving and hating the placement!\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Michelle, during the placement, p432),[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe feeling of being overwhelmed was familiar, and tiredness was induced by enhanced and diverse cognitive demands[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eIt just felt, felt very overwhelming and yeah there were a couple of days that week when I thought \u0026lsquo;this is too much, what have I done?\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Sophie, p37),[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Anxiety and isolation\u003c/h2\u003e \u003cp\u003eFeelings of anxiety and stress compared to peers on traditional placements were an area of concern[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I was concerned with this placement, that obviously, being third year that, all my friends would have different, more specific placements, and my knowledge would kind of stay static. And I wouldn\u0026rsquo;t really learn that much from it, \u0026ldquo;\u003c/em\u003e \u003c/p\u003e \u003cp\u003e(student, p3),[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe isolation of working alone within placement areas without broader team support was expressed explicitly about REPs[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI really am out there on my own, that would be the only thing I would say, I felt a little bit out there on my own and thrown in, you know\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(student, p34),[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Personal values and growth\u003c/h2\u003e \u003cp\u003eDespite challenges created by alternative placements, learners recognised and reflected upon individual personal growth[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e... it was kind of like a learning curve for myself as well\u0026rsquo; cause my personal development, not just professional but me as a person [thinking] \u0026lsquo;yeah, I am grown up enough to do that sort of thing; I\u0026rsquo;m not little anymore\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Jayne, p224),[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e2.4 Enhanced confidence\u003c/h2\u003e \u003cp\u003eEnhanced confidence among learners was expressed throughout multiple aspects of skills and practice-based categories[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e... I grew in my confidence of what I was doing, what actually OT is, how you could sort of implement interventions, how you can assess people. I grew practically like that but also ...just with my self-belief as well about my own abilities\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Jayne p225),[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e3. Alliances within collaborative learning\u003c/h2\u003e \u003cp\u003eThis explores the challenges as well as the value of peer-assisted learning.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003e3.1 Challenges with Peer-assisted Learning\u003c/h2\u003e \u003cp\u003eChallenges included difficulties with navigating relationship dynamics, issues with independent marking, complexities in providing feedback to other learners and differences in learning styles[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI felt we were being marked very much as a pair. At the end it was reflected alright that I suppose that I was that little bit stronger maybe, or that bit better, but I don\u0026rsquo;t know even, if it could have been reflected more.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(ST3PT; 2:1, p279),[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe got used to giving each other feedback, and now we still do that even though we don\u0026rsquo;t have to ... So, I guess sometimes you might think you don\u0026rsquo;t want to tell them offend them, but because we had to in the beginning now, we just keep giving each other feedback\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(student, FG2),[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003e3.2 Value of peer-assisted learning\u003c/h2\u003e \u003cp\u003eLearners within REP pairs valued each other's support[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eHow I coped was\u0026hellip;speaking with my fellow student (and). reflecting back on (those conversations).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Kathleen, p431),[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe collaborative learning models enabled peer-supportive conversations, enhancing each other\u0026rsquo;s practice. This debriefing process helped to reduce anxiety for learners.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003ePeer supervision was great as well, being able to share our journey and how we were feeling. And if one of us was feeling low then the other one was able to pick you up. I think, to be honest, you actually do need two students.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Student 4, p572),[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003e4. Educational and learning process\u003c/h2\u003e \u003cp\u003eThis captured the learners' experiences of learning and supervision during placements.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Learning experience\u003c/h2\u003e \u003cp\u003eLearning progression was considered slow, with limited opportunities within the placement[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI have the feeling that the start was, for me, very much extended [slow], and nothing was concrete.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Kathrin, p714),[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The only negative was that the caseload was so small because it was divided between us\u0026hellip; you probably didn\u0026rsquo;t get as much contact with patients because of the 2:1 model\u0026hellip;that was the one thing I suppose\u0026hellip; was the setting suitable for a 2:1 model?\u0026rdquo;\u003c/em\u003e \u003c/p\u003e \u003cp\u003e(ST10OT; 2:1, p280),[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe feeling of \u0026lsquo;belonging with the placement\u0026rsquo; and the ability to \u0026lsquo;think for themselves\u0026rsquo; was valued[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI really value the independent learning and being responsible for my own learning [...] whenever I\u0026rsquo;ve done that, I\u0026rsquo;ve shown my best qualities.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Participant 6, p5),[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Theoretical frameworks\u003c/h2\u003e \u003cp\u003eOT learners within REPs indicated these placements provided solid opportunities for utilising theoretical frameworks[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWe learned [about occupation-centred practice] theoretically, and yeah, we knew what it was, but this time, we really used it in practice and saw how the different steps [in the occupational therapy process] can be done and that they actually make sense and that they are needed. Yeah, it gave me this understanding, the practical side actually.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Elin, p714),[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e4.3 Learning process\u003c/h3\u003e\n\u003cp\u003eLearners valued learning tools and reflective activities embedded within the placement structure[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;It was more supervision, and even though it was probably a more pressurised situation, you do learn an awful lot from those sessions\u0026hellip; \u0026ldquo;\u003c/em\u003e \u003c/p\u003e \u003cp\u003e(ST7PT; 2:1, p279),[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eYou want to mimic, to some extent, what your [clinical educator] is doing. To you, that\u0026rsquo;s the standard. If you can do what they do, then you\u0026rsquo;re going to be hopefully a good physio and get good marks. Early on, to know how to go see a patient, the process you do things, and where they put things when they\u0026rsquo;re getting patients up [out of bed]. I think all those things early on through demonstration are so critical\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(student, FG3),[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Supervision process\u003c/h2\u003e \u003cp\u003eWithin REPs, closer and more frequent supervision was preferred[\u003cspan additionalcitationids=\"CR25\" citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan additionalcitationids=\"CR33\" citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSo I think it is very important to have that kind of support and have your supervisor in a senior capacity to just affirm what is right (that you are). on the right track.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Emily, p431),[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eFor me personally I think I much prefer having somebody with me; someone to guide me. I think I really miss that, actually. We were just thinking today about how much we have to explain because our practice educator hadn\u0026rsquo;t seen what we\u0026rsquo;ve done, and I find it really difficult to explain to somebody that hasn\u0026rsquo;t seen it, in words, expressing the meaning.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Student 4),[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Learning environments and preparation\u003c/h2\u003e \u003cp\u003eREPs caused learners concerns regarding unfamiliar environments and client groups. However, these new environments were also perceived as valuable[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eit made me realise how much you rely on the OT departments that are already set up, and that was, I suppose, probably quite a pivotal moment [\u0026hellip;] I sat here with all this information, and that was when I suppose it hit me, it was like because normally, you know, you might know that they might do cooking or they might do a skills learning or they might recommend they join this group or, but I just didn\u0026rsquo;t have any of that, and I was like well, great, but now what do I do with it? So, I had this kind of moment.\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Student, p34),[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003e5. Managing professional relationships\u003c/h2\u003e \u003cp\u003eLearners developed skills relating to maintaining and developing relationships and valuing teamwork.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003e5.1 Building relationships and teamwork\u003c/h2\u003e \u003cp\u003eThe learners recognised that relationships required careful negotiation, and a sense of belonging and effective teamwork was valued alongside client relationships[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI was just part of the team, and I said to them at the end, \u0026lsquo;I\u0026rsquo;m really grateful \u0026rsquo;cause you didn\u0026rsquo;t make me feel like a little student who didn\u0026rsquo;t have a clue; you just let me crack on; I was part of the team, I had a valued contribution.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Ella, p23),[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, managing perceived hierarchy was challenging[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWorking with team members with fixed attitudes, support of these members as long as they were asked not to participate. Delegating tasks, this was particularly difficult as student and an outsider to the org. Saying goodbye to the population, breaking attachments.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Student, p269),[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003e5.2 Managing expectations\u003c/h3\u003e\n\u003cp\u003eThe REP provoked concerns regarding expectations from clients, services, and the learners themselves. Some learners found the lack of clarity a challenge [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] and managing the expectations of the staff was particularly demanding[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eWhat was mentally draining was trying to manage everyone\u0026rsquo;s expectations as well as doing something for myself and my own learning\u0026hellip;\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Ursla, p431),[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eMeta-synthesis of the Practice Educator Voice\u003c/h3\u003e\n\u003cp\u003eA total of 49 findings were extracted from nine articles exploring the practice educator's voice. These findings were aggregated into 14 categories based on similarity of meaning. Four synthesised findings were developed from these categories: providing the right support, professional identity, peer relationships, and levels of satisfaction (Table\u0026nbsp;5).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable\u0026nbsp;5: Contribution of studies to meta-synthesis of Practice Educator\u0026rsquo;s voice.\u003c/b\u003e \u003c/p\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003e1. Providing the right support\u003c/h2\u003e \u003cp\u003eThis synthesised finding relates to the different approaches that alternative placement models may require to help ensure success.\u003c/p\u003e \u003cdiv id=\"Sec38\" class=\"Section3\"\u003e \u003ch2\u003e1.1 Identifying the level of support\u003c/h2\u003e \u003cp\u003eIdentifying the level of support means tailoring different styles and levels of support depending on learners' needs[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eSome students were really good, took a lot of initiative and we didn\u0026rsquo;t have to ask a lot of questions at all. We had others that needed more prompting\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(educator, FG4).[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSome practice educators expressed the need for greater pastoral support for learners to allow for personal growth[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eI think you have to create that safe space for both of those students so they share those fears and concerns\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(CI4 FG P2, p149),[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec39\" class=\"Section2\"\u003e \u003ch2\u003e1.2 Supervisor Feedback\u003c/h2\u003e \u003cp\u003eThe variety and significance of supervisor feedback for the learner has been recognised by practice educators particularly the high value in relation to the assessment aspects[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e[Students] want to know they\u0026rsquo;re doing well from their [educator] because they\u0026rsquo;re the ones that are going to assess them\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(educator, FG5),[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec40\" class=\"Section3\"\u003e \u003ch2\u003e1.3 Supervisor development\u003c/h2\u003e \u003cp\u003eAlternative placement models allowed supervisors to develop different skills and approaches, which benefited their professional development, however practice educators desired support for themselves[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eat least one of the LAS [long-arm supervisors] needs to be experienced because I was also being supervised to a certain extent by the other LAS\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e(Supervisor, p199),[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cem\u003e1.4\u0026nbsp;Additional support structures\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSuccessful placements were related to the university\u0026apos;s role in matching learners with placement settings, along with additional information related to learners needs and skill level[27, 28]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It was good to be able to meet with the teachers before the students started their placement. It allowed to talk about what students experienced the last year and to talk about expectations and student learning.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(long-arm supervisor p715),[27]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.\u0026nbsp; \u0026nbsp;Professional identity\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eProfessional identity relates to challenges and facilitators of professional growth for learners as identified by the practice educators.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.1\u0026nbsp;Clinical reasoning\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eClinical reasoning was enhanced within the alternative model, and this experience met learner\u0026rsquo;s expectations for practice, allowing a more client-centred approach[27, 34]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;On previous placements, the students were just told what to do and they just did it without thinking about it.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(Long arm supervisor, p570),[34]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;it seemed like their approach on the role-emerging placement was closer to really client-centred occupational therapy practice\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(long arm supervisor, p716),[27]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.2\u0026nbsp;Guiding process\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe practice educators perceived that clear clinical processes benefited the learners[27, 34]. This included a specific framework: the Occupational Therapy Intervention Process Model (OTIPM)\u0026nbsp;[35, 36]to guide the learner\u0026rsquo;s approach and facilitate the develop of their reasoning to support the intervention[27, 34]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;By using the OTIPM to structure the approach of students it puts the brakes on\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(Long arm supervisor, p572),[34]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.3\u0026nbsp;Impact of Role Clarity\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePractice educators reflected that learners need guidance on the remit of their roles especially within REPs[27, 33].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;we need to be really much clearer about what we expect each person to do \u0026hellip; about what level of supervision each person has\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(Supervisor, p199),[33]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e2.4\u0026nbsp;Role expectations\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePractice educators experienced uncertainty regarding how much learners could do independently, without having full professional registration[27, 31].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;It was unclear at times how far you could proceed with the client, given the\u0026nbsp;\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003elimitation that they are not occupational therapists; they are just students\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(OT preceptor, p578),[31]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.\u0026nbsp; \u0026nbsp;Peer relationships\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHaving more than one learner within a placement was both beneficial and challenging.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.1\u0026nbsp;Peer working\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePeer working resulted in greater independence from practice educators, greater productivity, and greater confidence[23, 25, 28].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;If there are two students, they can bounce things off each other, and there is a lot of shared learning, so I always felt that it is better with 2 students.\u0026rdquo;\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(CE6PT; 2:1, p279),[23]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.2\u0026nbsp;Peer feedback\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLearners can develop skills delivering peer feedback; important for practice and reducing practice educator demands[25]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;If we\u0026rsquo;re skilling our students to give feedback to each other, I think it\u0026rsquo;s a good skill to have when they are coming to clinical practice. \u0026ldquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(Educator FG4, p89),[25]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.3\u0026nbsp;Independence\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLearners could become co-dependent and \u0026ldquo;didn\u0026rsquo;t want to be separated\u0026rdquo;\u0026nbsp;[28](p125), and challenges were identified within placements without on-site supervision, but positive reflection was noted[27]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;They reflected how this might be similar to working as an occupational therapist after graduation and how it was a valuable learning experience\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(Long arm supervisor, p715),[27]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e3.4\u0026nbsp;Collaborative working\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe placement model led to development of teamwork and professionalism, as learners were required to work together and adjust to the needs of others[25, 28, 30].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The more experienced student was helping to lead and guide the more novice student. They learned to rely on each other, which was a great dynamic\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(CL10 FG P1, p149),[30]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSome practice educators queried the rationale and evidence behind the peer-working approach[28]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I want to know if there is actually research that is showing that it is an effective way of learning for students\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(supervisor, p 127),[28].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e4.\u0026nbsp; \u0026nbsp;Levels of satisfaction\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis related to the differing demands and benefits that alternative placement models provide.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.1\u0026nbsp;Satisfaction with the model\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe perceived benefits, influencing practice educators to consider alternative placements include reduced need for practice educator feedback and learner productivity, which decrease practice educator workload, along with unique opportunities that the alternative placement models can provide[25, 28, 32]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;These students [administered] ... 150 to 175 new assessments each. ... There was endless opportunity for learning with regards to patient history taking, documentation, collaboration, and communication with the interprofessional team\u0026hellip; so many aspects of the placement that offered learning opportunities that do not exist in other placement settings.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(Clinical instructor, p282),[32]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e4.2\u0026nbsp;Dissatisfaction with the model\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditional resource demands such as physical space, experiences and administration (including paperwork, preparation and time) could make practice educators reluctant to offer alternative placements[23, 25, 28, 30, 31, 34]. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I think from a preparation point of view, it\u0026rsquo;s a little bit more difficult to try to\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003earrange the diary to facilitate two students\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(CE5PT;2:1, p280),[23]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;One of the challenges was that it takes some time [for student occupational therapists] to integrate themselves. It is a bit more challenging for a role-emerging opportunity to maximise its potential.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e(Educator, p578),[31]. \u0026nbsp;\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePlacement capacity is a recognised concern, yet consideration of the potential benefits that alternative practice education models could provide, has rarely been considered[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This systematic review seeks to understand the experience and perceptions of both practice educators and learners regarding these alternative models. This enhanced understanding of the experience could influence greater adoption of alternative placement models, thereby increasing training capacity and supporting the expansion of the workforce[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe practice placement environments play a crucial role in professional identity development, which is a cornerstone of practice. Professional identity is shaped through defining professional boundaries, multidisciplinary teamwork, and facilitation of safe and effective clinical practice for health professionals[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The key influencers in this development are the individuals themselves, the impact of relationships with clients and other professionals[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Our review found that REPs, in particular, supported learners to develop strong professional identity and perceived confidence in their abilities, a finding consistent within the research. These opportunities for professional growth have been highly valued by both learners and practice educators. However, role clarity and expectations were an area of concern for learners, similar to previous findings indicating that that careful organisation and planning is needed to prevent \u0026lsquo;false expectations\u0026rsquo;[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Our review has highlighted that addressing these issues with the learners prior to the start could provide the additional reassurance required as well as support them in understanding the potential scope of growth within these experiences.\u003c/p\u003e \u003cp\u003eThe development of proficient professional skills has been valued by both learners and practice educators. Learners were more focused on skill levels, whereas practice educators indicated that clinical reasoning, as a higher-level skill, could be enhanced within these alternative models. Learning environments that facilitate independent engagement in active critical analysis, thinking and learning processes around uncertainties allow clinical reasoning processes to develop[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. The benefits of one placement model over another in developing these skills remains unconfirmed[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], however it is recognised that all placements provide skill development benefits to the learners[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The practice educators positively noted personal growth and professional development opportunities within these placements, therefore additional support provided by the university can facilitate the demand for these professional development opportunities[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. The utilisation of alternative placement models may allow skills development for both parties due to increased focus on the analysis and reflective elements.\u003c/p\u003e \u003cp\u003eA critical factor in ensuring the success of an alternative placement is the provision of appropriate support for both learners and practice educator. Confidence in the support provided, along with the need to adequately prepare all parties, is essential[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Our review suggested additional university support and guidance may be required to ensure a successful experience for stakeholders unfamiliar with alternative placement models. Consideration to the practice educator training provided by the universities and appropriate preparation of the learner regarding expectations has the potential to reduce anxieties from both parties. Practice educators identified experiencing barriers such as increased time demands, the challenges of supporting from a distance, and insufficient information about the placement model. The desire for continued and increased support from the universities has been reported within the literature[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. This is a key area that needs to be addressed to enhance acceptance and adoption of alternative placements.\u003c/p\u003e \u003cp\u003eLearners had mixed views regarding the success of alternative placements in relation to future employment. Within healthcare literature employability is often discussed in terms of skills and capabilities[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. However, it is essential to consider the benefits of a flexible and changeable mindset that can better manage unpredictability and uncertainty within the changing landscapes of healthcare[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Due to the personal growth opportunities these alternative placements provide, it could be suggested these environments better prepare graduates for the challenges of the future employment market. To enhance the learner\u0026rsquo;s confidence in the placement model preparation activities, supervision and ongoing reflection may augment the positive mindset to embrace uncertainties whilst engaging in the deep learning experience.\u003c/p\u003e \u003cp\u003eOur review findings identified the significance of psychological safety in ensuring the learner\u0026rsquo;s well-being and necessitates careful consideration when planning and supporting them within these environments. Psychological safety encompasses both intrapersonal and interpersonal factors[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. The learners expressed a range of emotional responses. Consideration to emotional intelligence and resilience is essential to ensure educational safety where learners can fully engage within the experience without risk[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. While REPs introduced notable stress and concern, our review found that the benefits include rewards of enhanced confidence and personal growth. This confidence impacts employability, enabling individuals to seek a broader range of career opportunities[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. To ensure the successful adoption of these alternative placements consideration of how to support psychological safety, emotional intelligence and resilience within the placement structure must be considered. These activities can support greater learner understanding and preparation prior to and during these placements therefore reducing the potential psychological impact of uncertainty.\u003c/p\u003e \u003cp\u003eLearning environments that provided structure and organisation via frameworks and experiential learning opportunities are highly valued. A guiding structure, such as the OTIPM[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], provided increased confidence and cohesion between expectations of learners and practice educators, and a framework to develop placement opportunities. In placement models demanding greater learner autonomy, like REP or 2:1 models, employing a framework to foster clinical reasoning is beneficial for professional socialisation and learning processes[\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. This enhances learners' confidence, unlike traditional placements where organisational or practice educator preferences typically dictate choices[\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e Peer learning and collaboration were considered beneficial from both the learners and the practice educator's perspectives within our review. This is consistent with previous findings that confidence and teamwork skills can be enhanced within all peer learning placement models[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, concerns regarding the satisfaction of the learner and the practice educator have led to resistance related to the implementation of this model despite the educational benefits[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The nature of these peer relationships can be complex, leading to challenges within the placement environment[\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Challenges identified included a range of cultural aspects such as unconscious biases, perceived epistemic authority and physical space[\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. These barriers and facilitators must be considered to ensure effective strategies are developed to maximise peer learning opportunities.\u003c/p\u003e \u003cp\u003e The influence of the practice educator in the supervision process, and learner/educator relationship were especially evident within our review. Learners highly regard practice educators who build relationships, formulate active participation, and encourage learning via engagement within communities of practice, therefore recognising holistic and organisational contributions to the learner\u0026rsquo;s professional development[\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Valued within placement experience is the ability to connect with practice educators and clients, building relationships highly cherished within the learner/educator dynamic, and supporting a successful placement[\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. These connections entail establishing trust, fostering active participation, and emphasising outcome-based learning[\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. To ensure the continued development and utilisation of these alternative models these positive relationships and connections must be nurtured for the benefit of all stakeholders.\u003c/p\u003e \u003cp\u003eThere was no clear consensus regarding overall satisfaction gained within alternative placement experience, with many factors influencing the views expressed. The barriers discussed such as patient contact time, physical space and workload have remained unchanged within recent literature[\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Nevertheless, there were encouraging discussions related to increased learner autonomy, recognition of peer-learning benefits and increased environmental exposure, particularly when learners were seen as key team members. The sense of belonging, community of learning practice and role models are effective methods of supporting learning and increase satisfaction[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Alternative placements have the potential for these aspects to be developed and embraced.\u003c/p\u003e \u003cp\u003e Our review has identified that to support the adoption of these alternative placements the benefits, challenges and expectations of these placements needs to be clarified for all stakeholder\u0026rsquo;s pre-placement by the university. There appear to be confusion or inaccuracies or uncertainty that are causing the challenges for both the practice educators and the learners. Addressing these concerns and highlighting the potential to develop higher level clinical reasoning skills and the enhancing employability possibilities might enhance the psychological well-being and allowing students to settle more in the placement. By understanding these perceptions and experiences the appropriate support and guidance can be developed by the universities to address these issues.\u003c/p\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cp\u003eUtilisation of the JBI meta-aggregation process ensure a rigorous approach to the method. The adoption of this approach allowed for the combining of findings that is more than the sum of the individual findings aligned with that of meta-analysis[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The critical appraisal, standardised data extraction and synthesis approached allowed for a clear and robust processes to draw recommendations and conclusion related to the research question.\u003c/p\u003e \u003cp\u003eLimitations within this qualitative review are related to challenges of identifying all relevant studies, due to the date range and grey literature search restrictions. The search was completed December 2022 and studies after this date have not been included. Only studies in English were included. All the research included were conducted pre the global COVID pandemic which may well have had an impact on the current experiences of learners and practice educators.\u003c/p\u003e \u003cp\u003eWhilst 16 articles were included within the data for analysis, four data sets were from the same participants from a body of work from one authorship group. Eleven studies considered REP, 10 explored OT placements in comparison to four exploring PT placements: limiting the breadth of data available in terms of scope of participants and range of alternative practice placement models. This highlighted the lack of literature related to the scope of alternative placements within OT and PT and limits the generalisability of these findings beyond REP.\u003c/p\u003e \u003cp\u003eThe JBI process was followed to support the rigour in the extraction and aggregation of the findings however, the qualitative meta-synthesis involves individual interpretation and decision making. A team approach was utilised to ensure consensus was achieved, via repeatedly read and reading the articles, and discussion to ensure that the synthesised findings were grounded in the data.\u003c/p\u003e\n\u003ch3\u003eFuture Research\u003c/h3\u003e\n\u003cp\u003eFuture studies are required to explore the views within different alternative models to build on the understanding related to these experiences particularly within the physiotherapy profession in particular in relation to REP\u0026rsquo;s. Consideration of the employability factors related to the range of skills developed within the alternative placement models would enhance understanding related to the potential benefits. Focusing upon strategies and techniques to enhance these opportunities for learners, practice educators and organisations has the potential to facilitate increases in placement opportunity and capacity.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis review synthesised the experiences of learners and practice educators within alternative placement opportunities. Alternative placement models can present a positive environment to support the development of professional identity and personal growth, providing clear benefits in terms of clinical reasoning, professional skills and person-centred care. While they provide additional emotional challenges, consideration of psychological safety can then foster confidence and personal growth among learners. Peer-learning and collaboration strengthens these opportunities and contributes to skill enhancement. Additional support and guidance from the university, and the use of specific frameworks, was of particular value when utilising such models. The success of these models hinges on adequate support, preparation and ongoing guidance for both learners and practice educators. Recommendations include enhancing these support process to enhance the benefits, prevent uncertainty and support the psychological safety of the learner and practice educator. These findings emphasis the multifaceted nature of alternative placements in healthcare education and highlight the importance of addressing challenges to maximise the learner experience. Nonetheless, these models have the potential to enable increased practice placement capacity for learners. Overall, alternative placements offer a promising environment for healthcare education, proving learners with invaluable experiences and skills essential for their future careers.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eENTREQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eenhancing Transparency in Reporting the synthesis of qualitative research\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eJBI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eJoanne Briggs Institute\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOccupational Therapist\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eOTIPM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOccupational Therapy Intervention Process Model\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePhysiotherapist\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePICo\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePopulation, Phenomenon of Interest, Context\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eREP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRole Emerging Placement\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eUK\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eUnited Kingdom\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate: Not applicable as this was a systematic review of previous published qualitative studies.\u003c/p\u003e\n\u003cp\u003eConsent for publication: Not applicable\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials: The datasets used and analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eCompeting interests: The authors declare that they have no competing interests\u003c/p\u003e\n\u003cp\u003eFunding: No funding was providing for this research.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026apos; contributions:\u003c/p\u003e\n\u003cp\u003eAD: Original idea, project management, Search strategy and data searching, screen and selection of included studies, data extraction, data analysis, primary author and manuscript production, editing and proof reading.\u003c/p\u003e\n\u003cp\u003eRM: data extraction, data analysis, major contributor in writing the manuscript, editing and proof reading.\u003c/p\u003e\n\u003cp\u003eER: screen and selection of included studies, data extraction, data analysis, editing and proof reading.\u003c/p\u003e\n\u003cp\u003eDE: development of search strategy, quality appraisal of the studies, data extraction, data analysis, editing and proof reading\u003c/p\u003e\n\u003cp\u003eKT: quality appraisal of the studies, data extraction, data analysis, editing and proof reading\u003c/p\u003e\n\u003cp\u003eJS: quality appraisal of the studies, data extraction, data analysis, editing and proof reading\u003c/p\u003e\n\u003cp\u003eAcknowledgements: Jo Linforth and Dr Maria Moffatt provided internal peer review and proof reading of the material and contributed to the development of the final article.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eJo Linforth and Dr Maria Moffatt provided internal peer review and proof reading of the material and contributed to the development of the final article.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMinimum Standards for the Education of Occupational Therapists Revised. 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Physiotherapy students' experiences of working with people with dementia during their clinical placements: a qualitative study. Physiother Theory Pract. 2023;39(4):794\u0026ndash;802.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCassidy E, Norris M, Williams A. What does it take to graduate? A qualitative exploration of the perceptions of successful physiotherapy graduates from one university in the UK. Physiother Theory Pract. 2020;36(2):316\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSellberg M, Halvarsson A, Nygren-Bonnier M, Palmgren PJ, M\u0026ouml;ller R. Relationships matter: a qualitative study of physiotherapy students' experiences of their first clinical placement. Phys Therapy Reviews. 2022;27(6):477\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarber JRG, Park SE, Jensen K, Marshall H, McDonald P, McKinley RK, Randles H, Alberti H. Facilitators and barriers to teaching undergraduate medical students in general practice. Med Educ. 2019;53(8):778\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJack K, Hamshire C, Chambers A. The influence of role models in undergraduate nurse education. J Clin Nurs. 2017;26(23\u0026ndash;24):4707\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Search terms\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.96078431372549%\"\u003e\n \u003cp\u003ePopulation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.235294117647058%\"\u003e\n \u003cp\u003ePhenomena of interest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"40.78431372549019%\" colspan=\"2\"\u003e\n \u003cp\u003eContext\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.019607843137255%\"\u003e\n \u003cp\u003eLimits\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"21.96078431372549%\" valign=\"top\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003cp\u003eLearner\u003c/p\u003e\n \u003cp\u003eMentor\u003c/p\u003e\n \u003cp\u003eEducator\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u0026ldquo;Clinical educator\u0026rdquo;\u003c/p\u003e\n \u003cp\u003ePhysiotherap*\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Physical therap*\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Occupational Therap*\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.235294117647058%\" valign=\"top\"\u003e\n \u003cp\u003eExperience\u003c/p\u003e\n \u003cp\u003eEvaluation\u003c/p\u003e\n \u003cp\u003eView*\u003c/p\u003e\n \u003cp\u003eAttitude*\u003c/p\u003e\n \u003cp\u003ePerception*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.980392156862745%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026ldquo;Non-traditional\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eBlended\u003c/p\u003e\n \u003cp\u003eCollaborative\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;2 to 1\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u0026ldquo;3 to 1\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;4 to 1\u0026rdquo;\u003c/p\u003e\n \u003cp\u003eLeadership\u003c/p\u003e\n \u003cp\u003eCoaching\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Split placement\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;shared placement\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Role emerging\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Project placement\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;TECS placement\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Peer learning\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.80392156862745%\" valign=\"top\"\u003e\n \u003cp\u003ePlacement\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Practice learning\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Clinical education\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Clinical experience\u0026rdquo;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;Clinical placement\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.019607843137255%\" valign=\"top\"\u003e\n \u003cp\u003e2010 to current (December 2022)\u003c/p\u003e\n \u003cp\u003eEnglish Language\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2: Quality Appraisal Scoring Results\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eAuthors / Year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eQ1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eQ2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eQ3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eQ4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eQ5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eQ6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eQ7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eQ8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eQ9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eQ10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eIs there congruity between the stated philosophical perspectives and the research methodology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eIs there congruity between the research methodology and the research question or objectives?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eIs there congruity between the research methodology and the methods used to collect data?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eIs there congruity between the research methodology and the representation and analysis of data?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eIs there congruity between the research methodology and the interpretation of results?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eIs there a statement locating the researcher culturally or theoretically?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eIs the influence of the researcher on the research, and vice- versa, addressed?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eAre participants, and their voices, adequately represented?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eIs the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by an appropriate body?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eDo the conclusions drawn in the research report flow from the analysis, or interpretation, of the data?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eScores\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eAlpine, Caldas, and Barrett, 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eUnclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eBarrett, Belton and Alpine, 2021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eBoniface, et al., 2012\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eUnclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eClarke, et al., 2014\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eClarke, et al., 2015\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eClarke, et al., 2015a\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eClarke, de Visser and Sadlo, 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eDancza, et al., 2013\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eUnclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eDancza, Copley and Moran, 2019\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eFortune, and McKinstry, 2012\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eUnclear\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e7.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eKaelin and Dancza, 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eUnclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e9.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eKyte, Frank and Thomas, 2018\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eMattila and Dolhi, 2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eO\u0026apos;Connor, Cahill, and McKay, 2012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eUnclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e8.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eO\u0026apos;Connor, Liston and O\u0026apos;Donnell, 2019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eUnclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003ePrice and Whiteside, 2016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eSevenhuysen, et al., 2015 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eUnclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eUnclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eSharmin, et al., 2016\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eWithers, et al., 2022\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eUnclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eUnclear\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"3.125%\" valign=\"top\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eWolff-Burke, et al., 2022\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.291666666666667%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"4.166666666666667%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3: Characteristics of Included studies\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAuthors / Year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eCountry / Culture\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eAims or Purpose of the Study\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eStudy Methodology / Method\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePhenomenon of interest\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eSetting\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eBoniface, et al., 2012 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eSetting is UK, but students are from UK and Poland / European\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eExplore experiences of staff and students using pyramidal model of peer-assisted and long-arm supervisors in role-emerging practice placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eParticipatory Action Research / interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eStudent and supervisors\u0026rsquo; experiences of peer-assisted learning and long arm supervision\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eRole emerging placements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eTwo final year postgraduate diploma occupational therapy students from a UK university, two occupational therapy students from a Polish university, UK university staff (OTs)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eReflexive TA (Braun and Clarke)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eClarke, et al.,2014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eBrighton- UK / UK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eGain deeper understanding of occupational therapy students\u0026rsquo; experience of role-emerging placements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003ePhenomenological approach / interpretative phenomenological analysis / interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eStudent experience of role emerging placements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eRole emerging placements. \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eFive female MSc pre-registration occupational therapy students\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eIPA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eClarke, et al., 2015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eUK (Brighton) / UK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eExplore the impact of role-emerging placements on professional practice and identity once graduated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003ePhenomenological approach / Interpretative phenomenological analysis (IPA) / interviews\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eProfessional practice and identity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eRole emerging placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eFive female MSc pre-registration occupational therapy graduates\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eIPA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eClarke, et al., 2015a\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eBrighton \u0026ndash; UK / UK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eExplore occupational therapy students\u0026rsquo; experience of role-emerging placements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003ePhenomenological approach / Interpretative phenomenological analysis / interviews\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eHow occupational therapy students experienced and ascribed meaning to their role-emerging placements.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eRole emerging placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eFive OT students (pre-reg Masters)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eIPA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eClarke, de Visser and Sadlo, 2019\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eBrighton \u0026ndash; UK / UK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eTo explore strategies used by students to cope on role-emerging placements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003ePhenomenological / interpretative phenomenological analysis / semi-structured interviews\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003ehow occupational therapy students cope with the challenges of undertaking a role-emerging placement.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eRole emerging placements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eFive female students (pre-reg MSc in OT)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eIPA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eDancza, et al., 2013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eIreland and England / European\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eTo explore students\u0026rsquo; perspectives of their learning in a variety of role-emerging placement settings\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eSocial constructionism / Interviews\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eLearning experiences\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eRole emerging placements\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e10 OT students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eReflexive TA (Braun and Clarke)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eDancza, Copley and Moran 2019\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eUK / UK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eExploring the learning experiences of students (from both supervisor and student perspectives) during role-emerging placement.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eAction research methodology / reflective field notes, placement documentation and semi-structured interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eExploration of the learning experiences of students, from both supervisor and student perspectives, over the duration of a role-emerging placement in schools, to contribute to our understanding of this important student learning process.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eRole emerging placement\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e14 students (OT), 5 on-site supervisors, 3 long arm supervisors, 1 researcher/ long arm supervisor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eTemplate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eFortune, and McKinstry, 2012 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eLa Trobe University, Australia / Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eExploring the perceptions of agency sponsors and students participating in a project placement.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eGrounded theory approach / open-ended, written questionnaires \u0026amp; interviews\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eValue of project placements\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eProject Placement - project occurs in place where OT services do not exist.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e11 project sponsors, 11 final year OT masters students\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eAdapted grounded theory approach with themes identified\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eKaelin and Dancza, 2019\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eZurich \u0026ndash; Switzerland / Switzerland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eExamine how occupational therapy students on role-emerging placements in school settings experience applying threshold concepts and how impacts onto placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eSocial constructivist paradigm / semi-structured focus group interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eExperience of applying threshold concepts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eRole emerging placements\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e13 female Swiss occupational therapy students, one long-arm supervisor for all student\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eTemplate analysis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eKyte, Frank and Thomas, 2018\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eUK (research conducted in University of Worcester) / UK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eExplore the experiences of physiotherapy students who had undertaken a role-emerging placement\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eQualitative / semi-structured focus groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eExperiences of undergraduate physiotherapy students who had each undertaken a REP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eRole emerging placement\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eSix physiotherapy students\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eThematic analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eO\u0026apos;Connor, Cahill, and McKay, 2012\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eIreland / Ireland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eCompare experiences and perspective of clinical educators and students involved in 1:1 and 2:1 models of placement supervision and the learning opportunities available with both models\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eQualitative - descriptive approach / individual semi-structures interviews\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003ePerspectives of clinical educators and students (OT and PT) who had participated in both the 1:1 (one student supervised by one clinical educator) and 2:1 (two students supervised by one clinical educator) models of clinical education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eClinical education (PT and OT) - 1:1 and 2:1 supervision model\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e24 students (OT and PT) and 29 educators\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eThematic content analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003ePrice, and Whiteside, 2016\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eMelbourne (Australia) / Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eDetermine the experience of supervisors pre-and-post 2:1 supervision model experience\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eSocial constructivist theoretical perspective / focus group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eSupervisor experience in the trial of a new 2:1 supervision model (OT)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eHealth service OT department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eNine occupational therapy supervisors\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eThematic Analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eSevenhuysen, et al., 2015 \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eAustralia / Australia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eTo explore clinical placement experiences of students and clinical educators in paired peer-assisted learning model, compared to traditional paired teaching approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eQualitative study / focus groups\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eExperiences of students and clinical educators in a paired student placement model incorporating facilitated peer-assisted learning (PAL) activities, compared to a traditional paired teaching approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eTraditional paired model and a PAL paired model.\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e24 physiotherapy students and 12 clinical educators.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eThematic Analysis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eSharmin, et al., 2016\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eSouthern Ontario, Canada / Canada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eTo explore the benefits and challenges of engaging student occupational therapists in HIV service organisations through role-emerging placements.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eInterpretive description / interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eBenefits and challenges of role-emerging placements of student occupational therapists in HIV service organisations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eRole emerging placements\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eFive student occupational therapists (5), (2) staff members from the HIV service organisations (3) and an off-site occupational therapy preceptor (1) - total of 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eContent analysis\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eWithers, et al., 2022 \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eOntario (Canada) / Canada\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eTo understand the experiences of students, clinical instructors, health care providers and patient in role-emerging placement and identify barriers and facilitators.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eInterpretive description \u0026shy;y / semi-structured interviews\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eExperiences and perspectives of a role emerging placement in an emergency department\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003erole-emerging placement\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e51 participants (6 PT students, 1 clinical instructor, 15 nurses, 12 physi\u0026shy;cians, and 17 patients)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eThematic analysis in an interpretive description\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eWolff-Burke, et al., 2022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eUSA - West Virginia / USA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eExamine the perspectives on processes that occur in students and clinical educators throughout CCLE and to expand on factors that influence a successful CCLE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.625%\" valign=\"top\"\u003e\n \u003cp\u003eGrounded Theory / surveys and focus groups / journals and focus groups\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.541666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eClinical collaborative learning experience (CCLE) - factors perceived in influencing the success of this, examination of the processes that make this successful\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003eClinical collaborative learning experience (multiple students paired with one clinical instructor)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"12.5%\" valign=\"top\"\u003e\n \u003cp\u003e29 DPT students and 18 Clinical Instructors \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.416666666666666%\" valign=\"top\"\u003e\n \u003cp\u003eGrounded Theory approach / Thematic analysis\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTables 4 and 5 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"practice education, alternative practice placement, physiotherapy, occupational therapy, capacity","lastPublishedDoi":"10.21203/rs.3.rs-4867053/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4867053/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWithin physiotherapy and occupational therapy practice placements, there is a predominance of the one-to-one supervision model which creates limitations for placement capacity expansion. Alternative placement models must be considered to fulfil training requirements for these professions and ensure availability of future workforce. The aim of this review is to consider practice educators and learners\u0026rsquo; experiences and perceptions of alternative placement models to inform future planning and adoption of these opportunities.\u003c/p\u003e \u003cp\u003eThis qualitative systematic review followed the Joanne Briggs Institute methodology. Six databases (CINAHL, MEDLINE, PubMed, Scopus, ERIC, PsycINFO), comprising the period January 2008 to December 2022, were comprehensively searched. Meta-aggregation was used to synthesise the findings of the included studies.\u003c/p\u003e \u003cp\u003eA total of 16 articles were included within this review. The learner voice was represented in 18 categories aggregated to five synthesised findings: professional growth and development, personal and psychological adaptation, alliances within collaborative learning, educational and learning process, and managing professional relationships. The practice educator voice was represented in 14 categories aggregated into four synthesised findings: providing the right support; professional identity; peer relationships and levels of satisfaction.\u003c/p\u003e \u003cp\u003eThis review has identified many positive aspects related to skill development, personal growth and professional identity following the alternative placement experience. However, uncertainty and anxiety related to role, expectations and clarity within these environments were noted. This enhanced understanding of the perceptions and experiences of the learners and the practice educators can be incorporated to facilitate the development of appropriate support and guidance from the universities to address these challenges and increase satisfaction. Further adoption of the alternative placement models will have the potential to enable increased practice placement capacity for learners and offers a promising environment for healthcare education, proving learners with invaluable experiences and skills essential for their future careers.\u003c/p\u003e","manuscriptTitle":"Exploring alternative practice placement models: perspectives and experiences of learners and practice educators. A qualitative systematic review.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-11 12:45:23","doi":"10.21203/rs.3.rs-4867053/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-13T04:23:07+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-01T08:49:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"120902084059102254849471330383088552580","date":"2024-08-28T07:10:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-08-26T07:17:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"334697698896859518697582380847434678945","date":"2024-08-26T02:10:13+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"148185546141621442489632414861729075850","date":"2024-08-22T03:57:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-08-19T08:37:05+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-08-16T05:15:04+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-14T14:12:28+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-14T14:10:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Medical Education","date":"2024-08-06T08:53:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-medical-education","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"meed","sideBox":"Learn more about [BMC Medical Education](http://bmcmededuc.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/meed/default.aspx","title":"BMC Medical Education","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2891c72b-f65c-4493-bc9d-c78f6952333e","owner":[],"postedDate":"September 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-25T16:00:12+00:00","versionOfRecord":{"articleIdentity":"rs-4867053","link":"https://doi.org/10.1186/s12909-024-06323-z","journal":{"identity":"bmc-medical-education","isVorOnly":false,"title":"BMC Medical Education"},"publishedOn":"2024-11-18 15:57:14","publishedOnDateReadable":"November 18th, 2024"},"versionCreatedAt":"2024-09-11 12:45:23","video":"","vorDoi":"10.1186/s12909-024-06323-z","vorDoiUrl":"https://doi.org/10.1186/s12909-024-06323-z","workflowStages":[]},"version":"v1","identity":"rs-4867053","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4867053","identity":"rs-4867053","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}