Nursing studies

Clinical placements: online options for learning during COVID-19 and beyond

How an e-placement model can keep nurse education on track with virtual caseloads and live assessments

The e-placement model that enables students to manage a virtual caseload and undertake live online assessments

Picture: iStock

Placement capacity problems for preregistration health and social care students have been compounded by the COVID-19 pandemic, with many hours lost due to placement suspensions.

When face-to-face placements were suspended for occupational therapy students at the University of East Anglia, we had to respond urgently by exploring virtual alternatives that would enable students to continue with their learning and achieve their desired placement outcomes.

Peer-enhanced e-placements – the PEEP model

This led to the development of the Peer Enhanced e-Placement (PEEP) model. With professional placement standards and learning outcomes at the heart of its design, PEEP is delivered online using a virtual learning environment.

The model was designed for occupational therapy students in the second year of their degree, and created, delivered and evaluated throughout April and May at the height of the first wave of the pandemic. It has since received significant interest from UK and international health and social care placement teams, including nursing, and organisations including Health Education England.

During the three-week placement, occupational therapy students managed a virtual patient caseload. Problems were identified through live online immersive assessments, goal setting, treatment planning and evaluation.

The cohort of 36 students was divided into smaller peer groups. Friendship groups were avoided to encourage the group formation process, with students later reporting this approach meant they felt like a multidisciplinary team.

Watch: Education Alchemists: Peer Enhanced E-Placement PEEP



Positive evaluations of the programme

Deploying the usual placement supervision and feedback processes, along with learning outcomes, individual learning contracts and assessment paperwork, ensured the design was robust, consistent and familiar for the students. An e-handbook was created with space for students to provide evidence of their learning and structured reflections.

Students’ evaluation of the PEEP model confirmed much rich learning, particularly from the live immersive sessions, the peer group work and being able to challenge their peers’ decision-making, and the development of in-depth professional reasoning.

Students reported increased confidence in professional reasoning, which they can take forward in future face-to-face placements.

Applying the model to placements across healthcare

The opportunities afforded by well-designed online learning have been reported widely in the education literature by pedagogical specialist Gilly Salmon, an expert in digital and blended learning.

I have been working with Professor Salmon to advance the PEEP model beyond occupational therapy, customising it for individual professional placement contexts. We have received significant interest from UK and international health and social care placement teams and organisations, including Health Education England.

Since May, we have been developing and implementing a three-stage PEEP acquisition package, enabling higher education staff and/or clinical placement teams to adopt and adapt the model for their local professional and placement needs.

The three-stage PEEP acquisition package

How PEEP works in nurse education

To date, more than 100 staff representing 15 different professions and fields have completed a PEEP acquisition package with us. This includes physiotherapy, speech and language therapy, dietetics, diagnostic radiography, optometry, podiatry, social work, and nursing and midwifery colleagues from academia and clinical practice.

Feedback has been overwhelmingly positive, with reports that the model easily enables local customisation and adoption to address students’ placement learning requirements.

‘Although I created the PEEP as an innovative solution to an emergency in occupational therapy learning, it has now been developed into a model of value outside this area, including in nursing’

A recent workshop included teams from acute, community, mental health and children’s nursing, and midwives from a large NHS trust. As well as focusing on their own clinical areas, some members of the group plan to co-create a PEEP across different clinical specialties.

The children’s and mental health nursing teams intend to design and deliver their PEEP collaboratively with the midwifery teams, to provide students with a breadth of experience focused on an intervention with a young person and their parent that spans the clinical areas.

Feedback from nurses who have completed the PEEP acquisition workshops has been positive:

  • ‘This is a really interesting concept. I can see it working as a complement to traditional (community) nursing placements’ – primary care nurse
  • ‘It offers a lot of scope to provide experience across all fields of nursing, following the patient’s journey and also for shared learning across the different healthcare professions’ – acute adult nurse
  • ‘Being able to link into subject specialists offers an in depth and richer experience ’ – acute adult nurse

Customising the model to local requirements

Examples of customisation of the PEEP model include the role play live immersive sessions being replaced with simulation or a live link to patients in a clinic. Others have found that PEEP exposes students to clinical areas not usually enabled by geographical locations and offers a whole journey approach for patient management in the acute, rehabilitation and community phases of intervention. Others, such as paramedics, have favoured a scenario approach.

A range of implementation structures have also been explored to offer alternatives to the like-for-like block placement used in the original PEEP, including a hub-and-spoke model and a combination of PEEP and shortened face-to-face placements.

PEEP alternative implementation structures

  • Hybrid model – Shortened face-to-face placement with a PEEP at the beginning or at the end
  • Hybrid model for larger cohorts – Cohort split into two smaller groups. One undertakes a shortened face-to-face placement first, followed by a PEEP; the other does this in reverse
  • Hub and spoke – Shortened hub face-to-face placement, then a PEEP spoke
  • Tandem – PEEP for half the week, academic programme delivery for half the week

Peer learning, collaboration and a chance to reflect

Although I created the PEEP as an innovative solution to an emergency in occupational therapy learning, it has now been developed into a model of value outside this area, including in nursing.

When built around the Nursing and Midwifery Council standards for education, PEEP can support nursing students in meeting the programme outcomes and standards of proficiency for their placements.

‘A PEEP not only offers insurance against placement disruptions caused by the pandemic, but also against any ongoing placement capacity issues post COVID-19’

PEEP is underpinned by Professor Salmon’s five stages of learning, a well-established and evidence-based theory of online teaching and learning, and is proving to be a valuable, pedagogically and professionally robust placement model for any health or social care student.

It offers a highly purposeful student experience, with peer learning group formation, in-depth group work, collaboration and discussions, strong theory to practice links, shared and individual reviews and reflections, and practice in digital working and learning – all focused on supporting placement learning outcomes.

We are confident that a PEEP not only offers insurance against placement disruptions caused by the pandemic, but also against any ongoing capacity issues post COVID-19, with emergent benefits for well-designed, online digital experiences.

Find out more about PEEP and what it can offer your students on the Education Alchemists website, or by contacting me at

Lisa Taylor is associate professor in occupational therapy and associate dean for employability at the University of East Anglia and creator of the Peer Enhanced e-Placement (PEEP) model