12Advancing Social Work Field Education in Healthcare

Patricia L. Samson, Janet McFarlane, Debra Samek, Hilary Nelson, and David B. Nicholas

Field education plays a critically important role in professional social work education. Yet in recent decades, the field of social work has been impacted by disciplinary and structural shifts affecting practice in healthcare settings. Healthcare social workers have grappled with greater workload demands amidst the continuing need to offer field education; the volume of available field placements has not kept pace with student interest and need. To address this challenge in our jurisdiction of Alberta, Canada, field placement efficiencies and innovations have been sought through collaborative efforts of healthcare social workers and university-based social work educators. Novel field education approaches have been developed and trialed in our region. This chapter highlights these innovations and their impact. We provide students with a general background on the role of social work in healthcare and how this influences field education opportunities, followed by a description of examples of innovation that have been locally implemented. You will gain an understanding of the complexities involved in this field of practice and how creative innovations are being implemented to support students in obtaining quality work-integrated learning opportunities in this milieu.

Social Work in Healthcare: Background and Context

Health, when envisioned broadly, includes social connection, spirituality, cultural considerations, financial stability, emotional well-being, and quality of life (Hutchison et al., 2011; Schrecker et al., 2010). While these activities are in line with the orientation of other healthcare professions, social workers introduce complementary skills and values through the pursuit of person-centered (or patient-centered) care (Canadian Association of Social Workers [CASW], 2005; National Association of Social Workers [NASW], 2008). Patient-centered care is a health-system term for person-centered care; care is focused on the patient/person as the priority. As such, social workers tend to shift from an expert voice to a recognition and honoring of the voice of the patient as a key tenet in their professional stance. This challenges the traditional medical model or reductionist orientations to healthcare. The traditional medical model of practice views physicians as the primary driver of care, from diagnosis to treatment planning and implementation (Anderson, 1995). It entails a hierarchical view of the team, where priority is usually given to medical practitioners (doctors, nurses, etc.) and the primary focus of care is on treating the acute illness/presenting medical issue (Anderson, 1995; Haegele & Hodge, 2016). In contrast, social work contextualizes the medical condition within consideration of the whole person to amplify patient voices and perspectives, and this approach is viewed as integral to quality care of patients.

It is recognized that there are gaps in contemporary healthcare, as one need only turn on the news to hear reports of the ‘crisis’ facing our Canadian healthcare system. According to Purnell et al. (2016), gaps include disparities and inequitable access to quality healthcare based on factors such as race, gender, ethnicity, level of social supports, geographic location, and income. The social determinants of health (SDH) encompass the underlying societal issues that contribute to/perpetuate disease, morbidity, and mortality rates across regions — locally, nationally, and internationally (World Health Organization [WHO], 2008). Socioeconomic factors significantly shape our understanding of the concepts of health and health equity (Braveman & Gottlieb, 2014); marginalized populations experience multifaceted gaps in relation to access and equity in the healthcare system. The noted gaps can be proactively addressed by hallmarks of social work practice, including person and family-centeredness and anti-oppressive practice. Social work roles in healthcare settings include support, system navigation, crisis management, mediation and conflict resolution, discharge planning, and advocacy (Beddoe, 2011; Craig & Muskat, 2013; Gibbons & Plath, 2009; Holliman et al., 2001; Judd & Sheffield, 2010). It is noteworthy that there is limited scholarship on the role of social work in healthcare over the last several years, largely due to the continual shifts in the scope of practice for interdisciplinary teams in the rapidly changing health context (Ashcroft et al., 2018). Social workers act as one of the most continuous healthcare providers on the multidisciplinary healthcare team by providing consistency and continuity of care throughout the patient journey, often advocating for unmet patient needs. There are systemic challenges for social workers in the healthcare system, including excessive workload demands and a hierarchical disciplinary structure (Beddoe, 2011; Whitehead, 2007). Healthcare staff, such as physicians or nurses, hold decision-making authority regarding care pathways (Mizrahi & Abramson, 2000), which risks social workers at times being viewed and treated as unequal partners (Beddoe, 2011; Keefe et al., 2009).

Beddoe (2011) suggests that the history of social work in healthcare can be seen to locate social work as a “guest” in a system of care often dominated by medical practitioners. Keefe et al. (2009) put forth the notion that the role of the social worker should be more clearly defined, in work and in relation to others on the healthcare team. A history of mistrust and role confusion exists in the care delivery system (Craig & Muskat, 2013), which can create disciplinary isolation and an under-utilization of social workers (Ashcroft et al., 2018; Craig & Muskat, 2013). Greater understanding of the role and expertise of social work is warranted (Craig & Muskat, 2013).

There is tremendous value in the role of social work for addressing psychosocial needs and SDH barriers for those in need of care. Social work is integral to the health of Canadians and the overall healthcare system in terms of optimal patient experiences and outcomes. Social workers contribute detailed knowledge about community resources in assisting patients to navigate services (Holliman et al., 2001). Disciplinary preparation and values heighten care delivery through varying patient and system impacts such as improved quality of life and a reduction in readmission rates (Bronstein et al., 2015; Gibbons & Plath, 2009; Jencks et al., 2009; Keefe et al., 2009).

A review of the relevant literature identifies a range of areas of inquiry and a need for building capacity in social work healthcare delivery. Social work practice is highlighted as a key contributor to healthcare system improvement. The proven and potential initiatives in the scope of social work practice warrant capacity-building efforts to advance the role of social work amidst pressing resource gaps and other challenges to enhance the overall quality of healthcare practice.

Field Education in Social Work in Healthcare

Field education is integral to professional education. Practicums and service-learning opportunities within social work education are based on a learning paradigm founded on a student-centred approach rather than a hierarchical or utilitarian one (Barr & Tagg, 1995). The learning paradigm engenders collaborative learning spaces amidst and between students and instructors to cultivate student success. Teachers are facilitators (Barr & Tagg, 1995) in genuine learning environments and create safe spaces for students to navigate real-life scenarios from the practice context (Preez, 2012). Teaching and learning in social work involve a consolidative framework of theories, values, knowledge, and skills needed to support the development of professional competence for graduates (Larrison & Korr, 2013). These professions are built on a relational model, where relationships are central components to education and practice and exemplify notions of partnership and reciprocity in an authentic manner (Folgheraiter, 2007; Hartick-Doane & Varcoe, 2007).

Pedagogical approaches often employed in social work education are anchored in the practice theory of experiential learning and include problem-based learning (PBL), case-based learning (CBL), simulation, and practice-based activities including field practicums (Illingworth & Chelvanayagam, 2017) in the social work practice milieu. Kolb (1984) identifies four genres of experiential learning through which new knowledge, skills or attitudes are achieved, for example concrete experience, reflective observation, abstract conceptualization, and active experimentation. In this Kolb’s model of experiential learning, learning is detailed in a recurrent fashion by integrating thoughts, emotions, perceptions, and behaviour in ways that are persistently being recreated (Kolb, 1984). Problem-based learning and CBL deliver students real-life examples to work through in a practice context where students are encouraged to think critically and reflect on the learning experiences provided. Learning opportunities that afford these real-life experiences provide genuine learning spaces for students to integrate theory onto practice (Samson, 2018).

Ingraining the ability to work collaboratively in graduating professional social work students is one way to address the siloed approach to healthcare provision through engendering the necessary skills to navigate multi-professional teams in providing quality care (McLoughlin et al., 2018). Healthcare, when delivered by a collaborative interprofessional team, improves patient health outcomes, particularly for populations and individuals who are underserved or have complex social needs (McLoughlin et al., 2018). An interprofessional healthcare team holds diverse knowledge and skills that can lead to more effective and holistic client-centered services (Green & Johnson, 2015). Students who are involved in healthcare practicums have opportunities to work with professions from a range of disciplines, depending on the practicum context. In a hospital setting, students may attend interdisciplinary team meetings, liaise with community practitioners and agencies, work with nursing or physical/occupational therapists and the like in supporting patients in navigating the healthcare system. Students may also have opportunities to engage in family meetings and liaise with other community supports depending on the patient context in supporting treatment and recovery plans.

Considering Field Education in Social Work in Healthcare

Historical underfunding and limited infrastructure in healthcare have created challenges for field educator preparedness and in prioritizing practicums within social work teams. Along with these changes, increasing population challenges and complexities have confronted social workers in their daily work. Increased populations creating greater needs and changing community demographics have been reflected in healthcare, and the importance of social work in promoting health and well-being has been amplified. These changes, including in recent years the COVID-19 pandemic and its unmasking of societal resource challenges at community and societal levels, are requiring us to redefine and re-imagine the field education landscape. As an essential component of professional education to support students transitioning into professional careers, field practicums provide the venue where students apply theory onto practice (Bogo, 2015; Taylor Institute, 2022). Practicums are a mandatory part of the social work curriculum and are embedded in the accreditation standards set forth by the Canadian Association for Social Work Education (CASWE; 2017).

Students in field practicums are supervised by practice-based field instructors (FIs; Bogo, 2006), who provide mentorship and opportunities for students to partake in experiential learning. However, in a climate of continuing funding retrenchment, there are headwinds facing the delivery of healthcare-based field education. Reduced funding has contributed to the urgency for strong educational opportunities yet also constrains resources. In addition to shrinking placement options, FIs themselves face an increased workload and/or job losses in the current economic and political climates across Canada and other nations, amidst reorganization of human service and education delivery systems. These challenges in the field context do not bode well for creative, energized field education experiences for either FIs or students. Yet within such adversity, educators and FIs are invited to re-envision ways to support students in the practice milieu that optimally expose students to real-world experiences to aid in the development of needed practice skills. For the past several years in Alberta health-system social work leaders, social work educators and researchers, and students have been working together in a community-university partnership to generate new ideas and ways to better support students, both in practicum experiences and opportunities for future employment in the healthcare system upon graduation. Activities have included the development of Social Work in Health, a course that has seen educators and social work practitioners in the healthcare context co-teach students in the classroom; this provides an excellent venue for students to learn theory related to practice in the healthcare field and ways to bring it to life via employing the on-the-ground experience of social work practitioners. The learnings from this course can help ground students who may choose to pursue a health-based field practicum opportunity in the future.

The conventional field practicum approach of a single preceptor/field educator per student (comprising one student working solely with one field instructor throughout the entirety of the field placement) may no longer be viable for all students/field placements. Multiple factors have rendered this approach untenable as the only field education option, including an exponentially growing volume of social work trainees and schools across jurisdictions (including online programs) and a disconnect between classroom and field-based learning. Field practicum placement coordinators now place over 250 students/year in most Canadian social work programs in the face of dramatically reduced budgets that notably have been deeply felt in post-secondary educational institutions (Ayala et al., 2018). These financial constraints contribute to diminished field placement access and a reported disconnect of field experience/practice relative to classroom learning (Ayala et al., 2018; Samson et al., 2021). Of further demand in field education is the multifold increase in competing co-op programs. As of 2015, over 1,000 social work programs in Canada, in addition to other professional programs, such as nursing, occupational therapy and psychology, offer practica (Ayala et al., 2018). These programs compete for the same placements, especially in addiction and mental health; the net result is diminished capacity and availability of practicums (Ayala et al., 2018).

In response to these changes, including disciplinary and sectoral (healthcare) struggles, social work education in healthcare must adapt to offer effective, integrated education more efficiently for practice entry. A recent pilot of a rotational supervision practicum model was trialed at the Master of Social Work (MSW) level for a small cohort of students (Samson et al., 2021). This model involved students rotating through multiple fields of practice in the hospital setting, engaging in a new practice area every six weeks. This provided an opportunity for students to achieve broader exposure to the hospital-based healthcare system and to have experience working in a variety of departments, including the emergency room, gerontology, and oncology. While this model will be explored in more detail in the material that follows, it serves as a great example of creativity and innovation aimed at supporting students in developing entry-level social work practice skills. Innovation is a necessity for optimizing educational opportunity, enriching student experience and impact, and preparing students for healthcare practice. Novel approaches for field practicums are needed to adapt with the healthcare system in ways that are supported by and integrated into theoretical content taught in social work education.

Advancement of Field Education Training and Student Experience

Substantial advancement of field education in social work has emerged largely because of attempts to adapt and improve field education processes. Accordingly, new models are being trialed. The following section is focused on innovations that have been trialed to advance social work field education in healthcare. Multiple innovations are offered in the hope that these ideas may offer new insightsand options for student field placement advancement in other jurisdictions and contexts. New models and ideas to advance field education benefit students by potentially creating more practicum opportunities in the healthcare field more broadly. Rotational models can expand learning venues and strengthen capacity to bring on more FIs, hopefully generating more practicum opportunities for students. Providing students access to continuing education events and models for healthcare staff provides increased learning opportunities for students that are discipline specific to social work. Co-teaching among and between social work practitioners in the healthcare system and social work educators provides real-life expertise and learning moments for students that extend beyond theoretical conceptions and include application to practice in meaningful ways that can help support transformative learning for students in this milieu.

In the following sections, we detail some of these innovations, which include integrated rotational models, student-led communities of practice (CoP), student learning series, student and field educator orientations, promotion of rural or remote opportunities, and development of integrated classroom content, below.

Integrated Rotational Model

Although not new, the integrated rotational model may be a desirable alternative to traditional single instructor field placement models for students, FIs, and organizations. This approach offers an alternative to the traditional practicum model by replacing a student placed in a practicum with a single preceptor for its entirety. Rather, a group of students rotate from supervisor to supervisor, offering students exposure to a variety of social workers’ areas of expertise, styles of practice, and opportunities for the student to apply/practice skills gained in classroom and field learning. This approach arguably allows students to ascertain, develop, assimilate, and trial their emerging approach to practice in diverse contexts, and potentially enhances the application of theoretical learning from the classroom to the field (and vice versa). Different approaches to learning can be incorporated in this type of integrated model, such as CBL where students can perhaps follow a specific patient from one department to the next as they navigate their healthcare journey. This serves as a specific example of Kolb’s (1984) experiential learning theory and how it can be applied to practice through different strategies (i.e., CBL). Practice-based learning (learning that occurs in the field) provides students with hands-on, real-life experiences that help them learn how to apply theory in the practice context.

Despite these potential benefits, this approach has not been widely applied or tested in healthcare social work settings in Canada or internationally. However, preliminary literature and pilot work by this team are conveying the potential importance of considering this approach in healthcare field education. A few pilots have been conducted (Dawson et al., 2017; Muskat et al., 2017), including one done by this team (Samson et al., 2021). Moreover, this approach has been implemented within gerontological social work placements in the United States, yielding benefits for trainees who have gained greater opportunities and greater depth in classroom and field learning (Birkenmaier et al., 2012; Gough & Wilks, 2012). Within our western Canadian healthcare context, social workers have been trialing a variety of rotational practicum models, where learning activities are scaffolded—building upon one another—to support student learning in the field.

Emergent Outcomes from Rotational Field Education Approaches. Although more research is needed, and is indeed underway, findings to date are beginning to shape themes regarding benefits from rotational field placements for students and FIs. According to Samson et al. (2021), benefits to students include broadened exposure and experience; FIs benefit from greater collaboration across hospital sites and eased workload demands associated with shared field supervision and instruction. Critical to these gains in field education has been the innovative leadership of key stakeholders who collaborate in the development and implementation of new field models. This includes healthcare managers, field education leads, individual FIs, and faculty members. The next section of the chapter presents the benefits, key considerations, and limitations of the integrated rotational model for field supervisors and students.

Benefits to Field Supervisors

Rotational supervision models offer some advantages for FIs including:

• Reduces the time commitment for field placement supervisors and provide workload balance. For example, a rotational model allows for a division of labor between two or more supervisors.
• Prepares healthcare students for employment. Working between a variety of sites, programs, and/or portfolios uniquely prepares students for casual pool work and/or temporary assignments, which are common transition steps into the healthcare career path.
• Re-engages healthcare social work staff in student field education and their commitment to advancing the profession. Shorter supervisory time commitments and a collaborative supervision model that distributes the administrative and supervisory tasks can be more sustainable.
• Continuing Competency Program credits. Agreements between post-secondary institutions and social work professional organizations allow for a division of total continuing competency credits allocated for practicum supervisor placements among more than one supervisor, which could build FI capacity.

Benefits to Students

• Provides students with multiple supervisory perspectives to develop their own social work practice.
• Expands opportunities and organizational exposure.
• Provides an experience that mirrors the multiple roles and responsibilities of healthcare social workers.
• Increases opportunities to build a network of relationships and contacts within the organization, site, program and/or portfolios.
• Prepares students for entry level roles where social workers often work between multiple programs, units, sites, and/or portfolios.

Considerations in Delivering an Integrated Rotational Model

1. Optimizes student compatibility or fit within their role. A rotational placement is likely to appeal to a student who enjoys a fast-paced environment, adapts easily to change, and is comfortable in a shared supervision model. Rotational models require a student who is flexible, open to feedback, has a keen work ethic, and is eager to contribute feedback to the field supervisor team.
2. Standardized student orientation to the organization and discipline in addition to site-, unit-, program- and/or portfolio-specific orientation.
3. Standardization of field supervision roles and responsibilities across placements.
4. Development of student learning plans that includes alignment with rotational placement learning objectives across all placement experiences.

Limitations of an Integrated Rotational Model

• Short rotations can limit learning opportunities and provide insufficient time to thoroughly understand an area of practice.
• Rotations that take students to multiple geographic locations may pose challenges for them in locating their workspaces and limiting relational opportunities (with peers, supervisors, other members of the healthcare team., etc.) due to frequent changes.
• Integration seminars that support field practicums can vary widely in relation to student experiences. Seminars that serve primarily as debriefing sessions may not fully support bridging theory onto practice by in-depth exploration of clinical and practice issues that link to skill development. (Samson et al., 2021)

Overall, rotational models offer some unique learning opportunities for students who are interested in healthcare-based integrated learning opportunities. Important things to consider are being aware of what you need to feel prepared to enter this type of field education experience. Perhaps taking a Social Work in Health course, if one is available at your school, will help ground your expectations for this type of environment and provide a venue for you to become familiar with some of the language, policies, procedures, and patient issues you may encounter in this setting. Engaging in fulsome orientations to the practicum setting and clear communication with your FI and integration seminar instructor, are important considerations.

Social Work Student Community of Practice

The social work student (SWS) community of practice (CoP) is a peer-led initiative developed for students by students. The intent of the CoP is to provide a community of support and learning for Bachelor of Social Work (BSW) and MSW students in healthcare placements across Alberta. The CoP is structured with the collaborative learning circle principles of distributive leadership, collective wisdom, and group strengths to engage in meaningful group and individual development. Distributive leadership is a leadership model that shares power collaboratively among people rather than having a singular person in an authoritative position; it incorporates “collegial sharing of knowledge, practice and reflection” (Keppel et al., 2010, p. 166). Objectives of the social work studentCoP include networking opportunities, organization and resource navigation support, examination of the critical role social workers hold in healthcare, and peer-to-peer support.

Virtual meetings are held bi-weekly and are facilitated by a team of two students and a field supervisor. Each session has a theme identified by the collective as a priority practice topic. The sessions combine videos, practice reflection opportunities, exploration of and connection to the core clinical activities and competencies of healthcare social workers, and resource networking opportunities where students can build connections to and learn about community services, supports, etc. Participation is optional and attendance varies from session to session. Students are encouraged to discuss what they learn and questions that arise with their field supervisors on the session topics as a strategy to support scaffolded learning.

Student Learning Series

Within healthcare in Alberta, social workers have identified core clinical activities along with associated technical competencies intended to support clarity for the role of social workers in diverse healthcare settings and increase consistency in social work practice. Many of these core clinical activities and competencies are applied generically across programs, units, and portfolios. Standard education has been developed in relation to some core clinical activities and is available to social work students. To augment the available social-work-specific education, it made sense to begin developing additional education that would be available to all social work students within the province, regardless of program, supporting student orientation to the health context, skill development, education standardization, and the field supervisor’s workload.

The student learning series is an optional monthly webinar offering several topics, including social determinants of health, decision making capacity, grief and loss, social work and health care ethics, transitioning from student to employee, a harm reduction approach to practice, and a social work psychosocial assessment This complementary learning is in addition to mandatory organizational training that all students are required to complete prior to arriving at their placement. Mandatory training sessions are consistent with what new employees undertake: orientations to health and safety expectations, policies and procedures that govern practice in the organizational setting, etc. The webinars are intended to focus on social-work-specific skills and competencies development.

Student Orientation Guide

Small, innovative student field education projects, such as the ones outlined in this chapter, can quickly and efficiently begin to create positive momentum and change for students in the healthcare practicum. Engagement in project work can aid students in their learning, growth, and development as they transition from students to emerging social work practitioners. Shifting the overall context from crisis to sustainability for social work student placements will take time and a coordinated approach. Partnering with post-secondary institutions, regulatory colleges, and internal organizational departments are key to developing sustainable models, both in the healthcare context and beyond. However, structural change is only one component, and there are multiple opportunities for small, micro change to create momentum for larger change. In addition to projects already outlined, the Student Survival Guide illustrates the immediate and secondary impact that small-scale projects can have.

The Student Survival Guide is a student-led project that was adapted from social work student orientation materials developed by healthcare social workers. The guide brings together social-work-specific learning topics and resources identified as foundational to student orientation and learning from both staff and student perspectives. The guide highlights the needed utility of the document and clearly aligns with the orientation and learning priorities of other organizational departments, such as the student placement team, human resources, and the organization’s workforce planning goals. Due to the momentum generated, the stage was set to embark on larger organizational discussions to align this work and partner on the development of organization-wide student orientation and learning pathways across the local healthcare spectrum. Small “just do it” projects can be the momentum that drives bigger change.

Orientation Development for Social Work in Healthcare Trainees and Field Instructors

Further innovation has been focused on student orientation. The collaborative effort of university faculty members and health-based social workers resulted in the development and delivery of a healthcare field education orientation for students at the start of the semester, as well as ongoing training on core social work topics throughout practicum field instruction. The intent of the student orientation is to support students in navigating a healthcare practicum from the lens of lived experience from students who have gone through practicums in this setting. This orientation is a work-in-progress that is evolving as subsequent cohorts of students engage in health-based practicums. Generally, topic areas covered include networking; training; workshops and knowledge building; essentials for communication, professional practice, and the role of allied health in health care; supervision topic areas; building a sense of community among students; and examining healthcare as a potential career path.

Training for students includes extensive workshops on clinical ethics, decision-making and capacity, and financial assessment. For FIs, a healthcare-focused orientation is offered with a workshop on how to teach critical thinking. This training offers “on-the-ground” practice guidance in the aim of engaging, informing, and supporting field instructors; streamlining student field-based training; and optimizing student and field supervisor experience. Quarterly three-hour sessions have been offered, and evaluation has determined strong endorsement of these capacity-building sessions, with particular benefit identified by students; feedback shows strong support for these sessions from students due to increased knowledge, awareness, and clinical intervention skills these opportunities afford.

Promoting Rural and Remote Field Education Opportunities

Students interested in rural practice were offered the opportunity to participate in a rural cohort practicum experience. In rural settings, there are often interested FIs but limited numbers of students interested in, or able to take advantage of, rural placement opportunities. Barriers such as housing, additional financial burden, and isolation were identified and mitigated through partnerships with Alberta Health Services (AHS) housing, recruitment, rural operational leaders, and a funder agency, the Rural Health Professions Action Plan (RhPAP). This field education opportunity has offered diverse learning experiences, including heightened provincial social work training modules on topics such as decision-making and ethics, and has deepened field education experiences for students, which have, in turn, augmented FI training requirements. Additionally, through work with the RhPAP, students have been oriented into the local community to address the potential experience of loneliness and isolation and to strengthen their knowledge of the community and available resources and services. This opportunity for rich placement experiences has proactively addressed recruitment needs particular to rural communities.

As a broader recruitment strategy, this field education approach is directly linked to job opportunities for social workers in healthcare within rural regions upon graduation. Future opportunities exist to expand this approach for social work students both as a discipline-specific cohort, but also as an interdisciplinary cohort. For this approach to be successful and ultimately scaled up and spread, consideration will need to be given to the scheduling of placements within a semester (possibility of block placements) and a method of instructional delivery for concurrent courses and integrative seminars will need to be developed.

Developing Classroom Content in Tandem with Field Education Advancements

Advancing innovation in field education takes a team effort between stakeholders in social work education, including academics and researchers; facilitators in the field education office and healthcare settings; practicing social worker leaders; and most importantly, students. Over the last several years, we have sought to deeply reflect on the degree of complementarity of our university BSW-level social work in healthcare training in the classroom to assess its fit with field needs and the field education offered. To that end, we have examined integral elements for successful healthcare practice; hence, key learning objectives and pedagogical approaches. Building from key learnings emerging from our work, we have redeveloped (and are continuing to redefine) social work classroom education to better complement key needs and learnings in the field context. The Social Work in Health course addresses the practice of social work in healthcare, reflecting the healthcare needs of Canada’s population. It provides an overview of the structure of the healthcare system, the SDH, and the role of the social work profession in this context. Key concepts pertinent to healthcare are explored in this course including interprofessional teams, patient-centered care, care transitions, advanced care planning, ethical decision-making, assessment, intervention, documentation, continuous quality improvement and the skills required for social work efficacy. The course serves as a foundation to support entry-level practice for students new to this field, which can be built upon in the real-life context of practice when students commence field learning.

Our collaborative team, which includes those from academic, field, and student perspectives, continues to seek opportunities to find synergies to further advance social work in healthcare. A key learning from early pilot projects is the need for field, students, and faculty members to work closely together in co-creating opportunities and new ideas for continually moving forward. The power of us emerges as we work and think holistically together on these concepts — university, field, field education, student life, classroom learning, research, and teaching and learning — rather than isolated in our silos. This has and will continue to move us further forward in thinking about new ideas to address the emerging crises in accessing field education, and importantly, guide us as we seek to move to a more seamless educational pathway into social work in healthcare. Throughout our journey, this process has reflected our collective quest to address the questions of how we can better invite and inspire students into healthcare-based social work and how we can prepare them for this career and support them educationally in the field. Other examples of field innovation could be explored and shared; however, these samples we have shared here are possible innovation. Reflections in Moving Forward: Key Issues to Consider in Advancing Field Education

At the core of our collaborative work in healthcare to support field education, this work is a process of re-envisioning opportunities and ways of delivering field education given current financial, political, etc. realities. Steps for moving forward in improving social work education in our jurisdiction have required collectively moving forward together. Our experience invites the continuing development of strong partnerships as innovation requires trust and collaboration between the field and the academy. The following is a list of some key considerations that can guide field education development through systematic change. Important elements include clarity of mandate and aims, consideration of options and the activities needed to advance those options, reflection on the fit of options with students’ interest and professional goals, balance of what is needed in the field and what optimizes student learning and growth (a key is not just making the placement the best learning opportunity possible for a given student, but also the sustainability of the placement options), consideration of field instructors’ supervisory needs and fit of a given model or approach, recalibration of student learning contracts to fit for other ways of orchestrating placements.

This may require a different template and orientation in conveying and determining field placement success (e.g., language from “client” to “participant,” or “team member” to “partner”), Strong communication in clearly discerning, aiming for, and communicating expectations, and Being bold and creative. Think about how placements can offer a “win/win” outcome, for example, student learning and what is viable given the pressures on field instructors in busy field practice environments.

Our preliminary work on advancing field education in healthcare has shown us that long-term commitment is productive; indeed, it has been generative and team-building to us as group of social workers in the field and academia. Striving for innovation in field education in healthcare is a work in progress — perhaps that work is never complete! Yet as a team working together, new ideas can be birthed and trialed — ideas that may lead to more options and opportunities. From our experience, the effort to work together for innovative change is pressing and critically important to the advancement and recruitment within social work in healthcare, particularly given the critical importance of the field practicum in social work education.

Questions to Consider When Choosing Social Work in Healthcare

As a social work student (or as future or current social worker) in healthcare, you have unique insights that can contribute to the development and evaluation of this field context. We would like to end this chapter with some questions to consider. These questions invite you to consider your engagement with healthcare social work and develop ideas for social work field education.

1. What excites you about social work in healthcare as a career opportunity?
2. What personal and professional strengths do you have that would benefit social work in healthcare?
3. What supports, resources or networking opportunities would help you grow and thrive in this area of social work?
4. What opportunities are available at your university for collaborative work?
5. Are there any changes to social work education that you think would complement skill development for practice readiness?
6. Do you have any innovative ideas, and what could you do to help implement them?

Resources

Samson, P., Nicholas, D., Jones, C., Hilsen, L., Samek, D., Mielke, K., Holtzman, S., Walley, B., Manas, M., & Deol, M. (2020, July 15-19). Contributing to the global agenda: Building social work capacity in healthcare [Workshop]. The International Federation of Social Workers (IFSW) Conference — The 2020 to 2030 Social Work Global Agenda: Co-Building Social Transformation (virtual international conference venue). https://www.youtube.com/watch?v=t1KdOAcox00

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