A Simulated Placement: Using a Mixed-Reality Learning Environment for Social Work Field Education

ABSTRACT

COVID-19 presented fresh challenges for social work field education, requiring agile and innovative solutions. To address the scarcity of direct client-facing placements during the extended and unpredictable public health restrictions, Australian Catholic University (ACU) created the Simulated Placement Experience (SPE) for final-year students. The program immersed students into nine practice scenarios over a two-week (70-hour) intensive placement. Real-time feedback and reflective coaching sessions with a social work supervisor offered students enhanced learning and development opportunities applicable to multiple service settings and client presentations. The program was well received by participating final-year students, who highlighted that the experience enhanced their ability to perform and critically reflect on their direct practice skills. This article outlines the model and the initial evaluation of the pilot program using a Student Satisfaction of Simulation Survey tool. The findings of this evaluation reveal the potential for simulation to provide novel, valuable learning experiences to social work students for practice placements.

IMPLICATIONS

• COVID-19 restrictions presented an opportunity for social work field education programs to rethink the structure and nature of placement learning.

• Simulation-based learning provides social work students with enhanced learning and increased confidence as part of direct practice placements.

• There is scope to include supported simulation-based learning to enhance future social work field education programs; however, discipline-specific simulation standards and conceptual frameworks are needed.

KEYWORDS:

• Field Education
• Simulation
• Social Work Education
• Australia
• Practice Placements

Simulation is a novel approach to social work field education, building student skills, confidence, and reflective capabilities. While there is evidence of simulation pedagogies successfully used in social work education (Kourgiantakis et al., 2019), this article contributes to the limited social work knowledge and experience of simulation for placement. Sharing an overview of the Simulated Placement Experience (SPE), developed and delivered during the COVID-19 pandemic, this article reports on the unique use of mixed reality in social work field education in an Australian university (Jefferies et al., 2021). The pilot program evaluation illustrates the potential of simulation to provide students with valuable direct social work field education.

Social Work Field Education

Field education often has been considered a signature pedagogy of social work (Wayne et al., 2010). For a social work program to be accredited by the Australian Association of Social Work (AASW), training incorporates 1,000 h of field education in a minimum of two practice contexts (AASW, 2020). Field education aims to offer students rich experiences to integrate theory with practice through developing skills, confidence, and capacity for reflection (Wayne et al., 2010). For many students, field education provides them with the appropriate skills and knowledge for practice (Bogo et al., 2016; Muskat et al., 2011), confidence in their capabilities, and reflection on areas for development (Scholar et al., 2014).

Tertiary education has expanded in Australia, impacted by deregulation, allowing more students to enter social work programs (Hill et al., 2019). This growth has included social work courses, with accreditation growing from 42 to 84 across 31 universities (AASW, n.d). Compared with traditional models of field education, where students are placed with social workers as field educators, contemporary environments have reduced opportunities for students to be supervised by social workers directly (Cleak & Ines Zuchowski, 2020). Increased student numbers also have led to stress over the locations of placements, with contemporary models such as placing students in schools, university health clinics, work-based placements, overseas placements, or unfunded community organisations emerging (Cleak & Smith, 2012). The limited resources provided to potential workplace field educators also have impacted social workers’ capacity to supervise students (Bogo et al., 2016). For many students, their social work supervisor may be off-site, providing supervision on a weekly or fortnightly basis over their placement hours (Cleak & Smith, 2012). While the impacts of COVID-19 on the social work workforce is still not fully realised, pressures on agencies to provide placements was previously evident (Zuchowski, 2015).

Field Placement and the Development of Critical Reflective Practice

Social work graduates must display critical reflection skills as a core competency, allowing them to link academic knowledge to their own practice (Fook & Gardner, 2007). Critical reflection is a way for social workers to better understand the tacit norms that drive their choices, interventions, and practice. Embedding and engaging in critical reflection during field education can be important for questioning practices that imbed “technical rationality” where procedural approaches do not support the person-in-environment approach of social work (Dewey, 1933; Schon, 1983).

Field education can allow students to engage in critical reflection via supervision, but also by writing process recordings, critical incidents, and case notes with peers and supervisors (Knowles et al., 2006). The seminal work of Fook and Gardner (2007) suggested the opportunities available from critical reflection help develop new ideas and actions through the process of unsettling beliefs about social work practice. However, the stressors experienced in finding appropriate field education placements may reduce students’ perceived confidence in a range of skills, including critical reflection (Morley & Dunstan, 2013).

Simulation-Based Learning and Social Work

Simulation-based learning (SBL) describes various activities and mechanisms for learning. SBL activities generally share experiential and authentic learning elements, depicting situations, behaviours, processes, or environments outside of the learning space (Baek, 2009). SBL is “a dynamic process involving the creation of a hypothetical opportunity that incorporates an authentic representation of reality, facilitates active student engagement and integrates the complexities of practical and theoretical learning with opportunity for repetition, feedback, evaluation and reflection” (Bland et al., 2011, p. 668). It asks learners to actively respond while immersed in replicated practice contexts (Lateef, 2010) to test the learner’s ability to apply knowledge and skills and reflect on them (Lee et al., 2020). Simulation can be delivered through immersive technologies such as extended realities (virtual, augmented, and mixed realities supported through technology); however, SBL does not require these or any other specific technology as a pedagogy (Egonsdotter & Bengtsson, 2022; Kourgiantakis et al., 2020). For example, SBL is already embedded in existing social work programs through case studies and role-play activities (Logie et al., 2013); however, the use of immersive technology for SBL is less reported (Dodds et al., 2018), particularly in the Australian context (Jefferies et al., 2021).

The emerging literature on simulation in social work education highlights various student learning outcomes. In social work, SBL has been predominantly used for teaching direct practice skills (Bogo et al., 2014) rather than for macro practice (Huttar & BrintzenhofeSzoc, 2020). However, SBL has been used to develop critical reflection, self-awareness, and self-regulation (Kourgiantakis et al., 2019). SBL can reduce a student’s fear and anxiety about working with a particular client group or setting, allowing them to test their skills and emotions (MacFadden & Schoech, 2010), and can assist in reducing stigma concerning working within a range of settings and client groups (Hitchen, 2016). SBL can provide students with an opportunity to gain a sense of their role as a professional in the safety of a controlled learning environment (Dodds et al., 2018), and has been used to prepare students for placement learning (Phillips et al., 2018).

Simulation and Reflection

Best practice models of SBL highlight reflection as an essential phase of the simulation learning cycle (INACSL Standard Committee, 2016; Kourgiantakis et al., 2019; Ledger, 2020; Tortorelli et al., 2021). SBL encourages learning through experience (Kolb, 1984), allowing for transformational learning as new experiences are actively reinterpreted through reflection (Pagano & Roselle, 2009). Reflection as part of SBL can be an individual process or a shared experience, as activities can be recorded or watched with peers and educators simultaneously for assessment and discussion (Robertson, 2019). Reflection on SBL activities allows students to recognise their skills critically and accurately, giving educators a standardised context to assess students’ capabilities (Ledger & Fischetti, 2019).

The Simulated Placement Experience (SPE)

The use of simulation as field education in Australia was made possible through the AASW’s adoption of “Parameters for social work education during the COVID-19 pandemic” (AASW, 2020b), which for the first time, allowed simulation as placement hours. While the scarcity of client-facing social work placements drove the use of SBL reported on in this article, the existing evidence of the efficacy of simulation as placement hours from other disciplines such as occupational therapy, education, and nursing nurtured its development (Imms et al., 2018; Ledger & Fischetti, 2019; Sullivan et al., 2019).

The SBL ACU developed as a response to the additional challenges faced in field education during the 2020s COVID-19 restrictions the “Simulated Placement Experience” (SPE). The SPE used a mixed-reality augmented platform called SimLab^TM@Murdoch, where a social work supervisor supported small groups of five to six students through a series of nine simulated placement scenarios over a two-week intensive period (70 h).

The curriculum of the SPE was developed by the Field Education Lead (first author) from April 2020 to the program delivery in August 2020 (50 h of workload was allocated). The SPE required special permission for its use from the AASW as it was proposed before the “COVID parameters” (AASW, 2020b) were adopted. The development of the program involved reviewing several guides such as the NSW Health Education and Training Institute Simulation Guide (2015), International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice (2016), the work of Ledger on the use of SimLab^TM@Murdoch^., a rapid literature review of the use of simulation as placement from other disciplines, and SBL used in social work education more generally. The second author was consulted for their expertise in critical reflection frameworks.

Contexts and scenarios were selected based on common agency settings that offer placements to ACU. Simulation scenarios were determined through analysing reports on agency field education agreements that the university had developed over the past three years. Past survey findings of field educators, and student feedback on field education, also were reviewed. These highlighted areas that students and field educators identified for further student learning, such as critical reflection. The placement scenarios were designed to match individual avatars who represented clients of services or colleagues in the human services agency context. These scenarios included practice settings such as school-based social work, community mental health, child safety, community, youth, and group work. Scenarios were then sent to field placement supervisors who were agreeable to review them for feedback on relevance, accuracy, and real-world application.

The online mode of simulation was chosen due to the variety of COVID-19 restrictions impacting the multi-campus national university, addressing equivalency across campus experiences. Over each day of the SPE placement (10 days over two weeks), supported by a social work supervisor, students were required to attend an online briefing meeting, at least two interactive simulations, an individual coaching session, peer debriefing or group supervision, and complete written reflections. Students also provided one case note and one assessment report at the end of the two-week placement for review. The SPE (70 h) formed part of the student’s total placement hours (500 or 360 for students in a 3-placement program) and was completed as part of their other placement allocation (agency or project-based).

The SPE was intentionally designed to require a social work supervisor for 50 of the 70 h of placement for each group of six students. This was to ensure that students had access to their supervisor for most of the placement hours as it was a novel approach, and the uncertainty of COVID-19 restrictions had already impacted students. This broke down to a little over four hours per student per week for budgeting purposes, which was feasible given the need to ensure graduates met final placement learning outcomes.

The SPE was a unique simulated learning experience as it offered three important learning modes within a critically reflective framework. First, the program offered online, synchronous interaction with two forms of professional educators: interactors (professional actors behind the avatars) and a social work supervisor. The interactors animated avatars and were professional improvisation actors and puppeteers who controlled the movement, voice, and speech of simulated clients and a human services colleague in real time—thus being the “human in loop”. They were trained on each scenario, enabling them to provide students with controlled, standardised, and situated learning. Interactors also could give feedback on the students’ use of direct practice skills, such as engagement. The client groups represented by avatars included those from LGBTIQA + backgrounds with a range of cultural and racial markers, and were from differing age groups, including young children and older people. Students also were given an ethical dilemma involving a workplace colleague who was not their direct supervisor in one of the scenarios. The social work supervisor could role model and observe student interactions during the simulated activities and provide sustained online support throughout the placement. Second, students conducted asynchronous writing, such as written reflections, case notes, and reports that the social work supervisor reviewed. Finally, the SPE offered daily individual coaching and co-debriefing, as well as individual, peer, and group supervision opportunities supported by the social work supervisor, offering structured and unstructured opportunities for critical reflection. Figure 1 shows the reflective cycle of learning within the SPE.

Figure 1 The reflective model of learning in the SPE

Methods

Research Design

Individual student surveys, adapting the existing Satisfaction of Simulation Experience Scale (SSES) tool (Levett-Jones et al., 2011), were administered as students concluded their SPE. To evaluate the SPE, the tool was adapted to use relevant social work language and program specifics, such as the title of the social work supervisor (referred to as SWCE in the survey). The tool has 19 questions using a Likert scale that respondents rated according to their agreement of statements within three key areas of the simulation learning: debrief and reflection, practice reasoning, and direct practice learning. The scale ranged from one (strongly disagree) to a maximum of 5 (strongly agree). An additional open-text question was added, inviting respondents to offer any other feedback that they thought was relevant to their experience of the SPE. The survey was administered online via a secure Qualtrics link and was anonymous. Students were advised they their participation was voluntary and would not impact their final grades in field education. In total, 26 out of 32 students (81%) completed the survey.

Student Sample

Thirty-two students participated in the SPE. All were in their final year of placement, including 22 postgraduate (MSWQ) and ten undergraduate (BSW) students. In total, eight groups ran between August and December 2020. Due to the resource intensiveness of the program, the SPE was not offered to all students. After assessment by field education staff, the SPE was provided to those negatively impacted by COVID-19 (placement pause) or when a student could not be placed with sufficient direct client practice to address graduate learning outcomes.

Students were informed that this program was developed to respond to the COVID-19 disruptions and cancellations to many direct placements, so their feedback would be collected throughout the program informally and formally at the end via a group discussion and an individual survey. The outcomes from the group discussions impacted minor changes to the program through its delivery (changes to the timing of activities or assessment). This article reports on the findings from the individual student survey completed at the end of a student’s SPE.

Due to time constraints and the prioritisation of placement allocations during COVID-19, ethics approval was sought and approved by ACU’s HREC as a waiver after the program conclusion to report findings more widely. However, students were informed during their participation in the program that it would be evaluated to assess its potential use for future field education students.

Findings

The pilot evaluation findings are reported in two parts: descriptive statistics from the SSES tool (Levett-Jones et al., 2011) and thematic analysis (Braun & Clarke, 2021) from open-ended questions on the survey.

The SSES tool elicited that overall, students felt that the SPE was a positive learning experience. Students found the social work supervisor (the SWCE) valuable in developing their practice skills. Students experienced the SWCE role as the program design intended, with students feeling strongly that the SWCE allowed them to reflect on and be witnessed in their direct practice (Qs one to nine). The highest-rated response was to Q 4, where 92% strongly agreed that debriefing and coaching allowed them to ask questions, highlighting the critical role of the SWCE. The simulations also strongly contributed to students’ ability to apply, test, and reflect on direct practice skills (Qs 10 to 19). Ninety-six per cent of students either agreed (15%) or strongly agreed (81%), that it was a valuable learning experience. It is worth noting that the respondent (4%) who scored at the lower end of the scale consistently for all SSES questions offered positive feedback in the open-text question and requested more time in the simulations, creating the assumption that they did not use the scale correctly (Table 1).

Table 1 SSES Questions and Percentage Responses

SSES Question	Strong Disagree	Disagree	Unsure	Agree	Strongly Agree
1. The SWCE provided constructive criticism during the debriefing and coaching	4%			11%	85%
2. The SWCE summarised important issues during the debriefing and coaching	4%			8%	88%
3. I had the opportunity to reflect on and discuss my practice during the debriefing and coaching	4%			8%	88%
4. The debriefing and coaching provided an opportunity to ask questions	4%			4%	92%
5. The SWCE provided feedback that helped me to develop my direct practice skills	4%			15%	81%
6. Reflecting on and discussing the simulation enhanced my learning	4%			11%	85%
7. The SWCE’s questions helped me to learn		4%		19%	77%
8. I received feedback during the debriefing and coaching that helped me to learn	4%			11%	85%
9. The SWCE made me feel comfortable and at ease during the debriefing		4%		11%	85%
10. The simulations developed my practice reasoning skills		4%		19%	77%
11. The simulations developed my decision-making ability		4%		32%	64%
12. The simulations enabled me to demonstrate my practice skills	4%	4%		11%	81%
13. The simulations helped me to recognise the client’s needs		4%		23%	73%
14. This was a valuable learning experience	4%			15%	81%
15. The simulation caused me to reflect on my direct practice ability		4%		27%	69%
16. The simulation tested my direct practice ability	4%		4%	11%	81%
17. The simulation helped me to apply what I learned from my social work studies		4%	4%	8%	84%
18. In general, my 2nd attempt at the simulation was better than my first		4%	4%	8%	84%
19. The simulation helped me to recognise my practice strengths and weaknesses		4%	4%	4%	88%

Analysis of the open-text responses generated three themes: building skills and confidence in emerging practice, building a safe space for reflection, and simulation as a valuable placement learning experience.

Building Skills and Confidence in Emerging Practice

As indicated in the SSES (Qs 10 to 19) in Table 1, students in this study found simulation built their practice skills and confidence. For some, SPE provided the ability to practice skills with simulated clients differing from themselves, which allowed them to better understand how they might work with those from diverse cultures, genders, sexual orientations, and age groups. One student stated that SPE allowed them to engage in “supervision and mentoring to critique and discuss the issues and skills I have displayed within client simulations. It felt real to me”. Reflecting the SSES ratings, the SWCE role was seen as integral to building skills: “With simulation the supervisor is present to see how you engage with clients and therefore provides valuable feedback on the engagement with clients which often does not happen in placement.”

The variety of scenarios and client groups offered to students via the SPE also allowed them to develop new skills and knowledge for practice. Another student stated: “The different scenarios gave me the opportunity to apply skills that my placement did not offer such as a de-escalating a client, boundary setting, conflict resolution, group work.” Others felt the SPE allowed for rapid learning over a two-week period, facilitating this student to “revisit my social work skills and I have gained new skills regarding social work engagement and assessment”. This reiteration of skills also was reported by others: “I was able to confirm the skills I have and hone them even further. The SPE also helped me identify multiple learning areas for my future practice.”

Recognising their current abilities and capacity to develop new skills led many students to report increased confidence. Some relayed the importance of identifying their strengths and weaknesses via the SPE, reflecting responses from Q19 where 88% strongly agreed the simulations helped them recognise practice strengths and weaknesses. One student reflected that the program led to “a significant boost to my confidence and my identity as a social worker”. Another student, felt that simulation filled gaps in their learning alongside their perceived confidence and abilities:

“I feel confident now to engage in face-to-face interactions with clients as this was something I was not able to do whilst on my previous placements. Having the videos recorded also allowed me to be able to watch myself in practice and see what worked and what didn’t, and I found that to be so helpful. Overall, simulation I believe has shaped me into a better, more aware social worker and has given me so much more confidence.”

These findings suggest that the SPE was a valuable mechanism for students to reflect and apply existing skills or gain further ones, enabling them to feel more confident.

Building a Safe Space for Reflection

The process of engaging in simulated activity, reflecting upon it and seeking feedback was well received by students in this pilot. Students felt the SPE allowed them to expand their reflective capabilities. As indicted in the SESS ratings for questions Q3 and Q6 on reflection, the role of the SWCE clearly allowed students to extend their reflective capabilities with 88% and 85% strongly agreeing with the survey statements respectively.

Daily sessions allowed students the opportunity to meet with their peers and SWCE. As highlighted in the SESS rating (Q4), these meetings allowed students to ask questions, building reflective skills: “The daily coaching sessions, debriefing, peer supervisions and individual supervisions were a great opportunity to reflect, discuss and develop skills needed in social work practice.” Because the simulations could be performed by students more than once, new opportunities emerged for students to try different approaches. This created a positive feedback loop: “We received constructive feedback and I liked that you received the feedback and then could apply [it] into the second attempt.” For others the ability to repeat an activity also was considered useful:

“The opportunity to do the same scenario twice allowed us to try things with our practice that we may not be comfortable enough to do in real life. This means that although the second time may not end up being better it was still a valuable learning experience.”

The ability to reflect, take on feedback, and retry tasks within the SPE was considered a high point of the student experience. The ability to try something without the risk of harming a vulnerable client or fear of being seen as incompetent allowed many students to engage in a deep process of learning and reflection.

Simulation as a Valuable Placement Learning Experience

Students from this pilot noted that the SPE should become a mandatory field education component. Though the SSES did not specifically ask a question on this topic, 15 students suggested in open text responses that the SPE should be offered in social work programs. Of concern were responses that compared the SPE to students’ previous experiences of field education. All students were final-year MSWQ and BSW students and had all been on placement prior to COVID-19 impacts. Comments such as: “It was a great experience and an opportunity I never had both in theory and placement”, and “many students do not get the opportunity to have direct placements where they can interact with clients” speak to the quality of learning experiences as perceived by students themselves.

Discussion

SBL has previously been used successfully in preparing students for placements (Phillips et al., 2018) and, as discovered in the SPE, offers rich and transformative learning as placement itself. SBL activities such as the SPE present students with learning opportunities to trial new ideas (Kourgiantakis et al., 2020) and take risks without consequence to service users (Egonsdotter & Bengtsson, 2022), which are important steps in increasing student confidence.

Students reporting on the SPE noted that their skills were witnessed, building confidence in their practice, despite making mistakes during the simulated scenarios (Lee et al., 2020). Within Lee and others’ (2020) study, students who completed the survey noted limited scope in which to apply their university learning in previous placements whilst the ability to work with diverse simulated clients in a broader range of practice contexts gave students further opportunity to put their knowledge into practice. Simulation as placement cannot replace in-agency learning. Still, it can supplement contexts that student placements cannot reach, such as those deemed too risky for students or clients by universities or agencies (Jefferies et al., 2022). For simulation to be considered as placement, diverse programs must be implemented so that students can develop confidence in various settings.

The immersive nature of the SPE allowed for deeper student reflection on practice skills, professional development, and social work identity. While there are known limitations to reflective tasks (Knowles et al., 2006), the SPE presented students with the opportunity to reflect in and on action in a shortened cycle. While the simulations and technology offered a controlled learning environment, the SWCE’s role was integral in guiding and supporting critical reflection. Field educators play a crucial role in supporting students to link theory to practice (Cleak & Smith, 2012). However, with pressures on placements, many field educators are limited in the time they can directly supervise students (Hill et al., 2019). In the SPE, the role of the SWCE gave full attention to the student, offering safe and supportive supervision (Newcomb, 2022). As the simulations allowed for the SWCE to be present during simulated scenarios, the student could authentically reflect on practice witnessed and validated by the SWCE. Direct supervision remains critical in supporting student learning during simulated placement or within other existing placement models. For simulation to be considered for placement, a strong model of supervision, such as the cycle used in this pilot study, is essential to support student learning.

The “COVID-19 parameters” (AASW, 2020b) used during 2020–21 allowed for the limited use of simulation as placement for the first time in Australia. Few universities could pivot to using simulation for placement, and many had limited capacity to do so (Jefferies et al., 2021). The study by Jefferies and others (2021) on the use of simulation as placement during the COVID-19 parameters (AASW, 2020b) found that many universities lacked existing mechanisms and resources for simulation in social work programs, as well as the expertise of simulation itself. With no “social work specific” simulation guidelines, frameworks or standards to draw upon, such as the ones used to create the SPE from other disciplines, social work’s capacity to build expertise and to advocate for specific resourcing remains limited. As found in this pilot, simulation offers students opportunities that current models of placement may not be able to, such as sustained supervision, intensive support of critical reflection, the safety to make mistakes, and a broader variety of practice scenarios in which they can extend their skills and develop confidence. Although the SPE used novel, mixed-reality technology, SPE was presented through videoconferencing software frequently used in universities. However, for social work to embed simulation pedagogies into field education, further development of simulation in Australian social work education settings is required.

Limitations

The examination of a mixed-reality placement pilot in social work field education provided rich and deep data with limitations. The sample size was small, located in one university and only ran for one semester, limiting the applicability of the study to further settings. The program reported on in this article was only able to be run in 2020, as a subsequent request to the accrediting body to run the program in 2021 was approved with additional conditions, changing the nature of the program outlined in this article. This experience highlights the difficulties of running such an innovation within the current Australian field education requirements. The long-term impacts of this program were not able to be examined; however, this model of simulation offers exciting alternatives for social work field education.

Conclusion

The challenges to field education predated COVID-19. However, the pandemic has created new concerns that universities must address creatively. If social work hopes to continue to grow, not just in size but in the development of capable and diverse graduates, new models of field placement need to be considered with renewed urgency. As we look to reimagine field education, there is potentially an ongoing place for simulation in social work placements. The success of the SPE pilot program detailed in this article highlights the use of simulation as being integral to the learning process in field education units. As an emerging pedagogy in social work field education, developing discipline-specific simulation guidelines and standards could enrich social work education in Australia.

Acknowledgements

The first author wishes to thank the social work supervisors and field education staff who were generous, open, and supportive of this initiative, as well as Murdoch University SimLab@Murdoch™ staff, and the Australian Catholic University, Faculty of Health Simulation Lead in 2020 who supported this pilot program. Thank you to the students who were open to participating in this pilot during a very stressful year of study, and to the AASW for approving this program offering.

Disclosure Statement

No potential conflict of interest was reported by the author(s).