Thinking differently

The CSP’s learning and development team has been looking at how to meet the challenge.

Covid-19 has turned everyone’s world upside-down and physiotherapy students are no exception. Placements stopped for almost all students and, as placement capacity was already under pressure, we now need to work together to try and regain those lost placement hours if we are to avoid delays in students graduating and a workforce crisis. 

Many people may think the CSP has strict guidance on placements and when and where they can happen. But that is far from true. Students should normally gain at least 1,000 hours of practical experience but when and where those placement hours are accrued is very flexible. We promote an outcome-based approach where students are encouraged to gain a breadth of experiences that supports the CSP’s learning and development principles and the HCPC’s standards of proficiency. There is no such thing as a ‘core placement’. Students are encouraged to gain a range of experiences and skills that represent the breadth of physiotherapy in both patient and non-patient facing environments.

Your entire team can support student supervision. Support workers, qualified physios at all levels, first contact physios, advanced practitioners, researchers and leaders can – and should – all contribute as part of their professional obligations. No physiotherapist or team is too specialist to take students.

And this is happening. Physiotherapists are showing their true colours: problem solving, adapting, innovating, seizing opportunities and making things happen. Over the next few pages, we will share examples of how some teams are working differently to offer placements, look at where placements can happen, and we challenge some of the thinking about what is a placement. 

Models of supervision

The CSP promotes the use of a variety of models of student supervision when facilitating practice based learning. Peer-assisted learning, learning within interprofessional teams, long-arm supervision and multiple student-to-educator models are encouraged and need to become part of normal practice and education. 

In the recent past, the traditional one-to-one supervision model has generally been the preferred method of education but we now need to think differently about all aspects of delivering healthcare. 

Many providers have been using alternative supervision models for years and have shown that students can benefit from them. It is imperative however, that students, educators and the wider team are supported appropriately. 

The University of East Anglia team is one example of successful implementation of an alternative supervision model in order to adapt their placements to pandemic constraints. 

Second year BSc physiotherapy students were scheduled to go out on placement from the end of April but, due to the restrictions, these placements could not go ahead. The physiotherapy team thought creatively to find a solution, and designed a six-week virtual placement experience to support 55 students. 

It included front loading teaching around telehealth alongside online learning for health coaching and motivational interviewing. Virtual case studies were assessed and treated remotely by small groups of students while they were observed and received feedback from the remaining students.

An integral part of the placement was the telehealth project. Here students engaged with their community during lockdown and carried out remote physical activity discussions. Interventions were recorded as evidence and students were required to clinically reason their approach. 

Dr Kelly Walker, associate professor of physiotherapy at UEA reports that the placement was successful in improving student communication skills and digital literacy as well as demonstrating effective peer learning.

A student says: ‘Having engaged with the six-week virtual placement, I now feel much more confident that I have to skills to be able to transfer my practice to telehealth which is really important based on how healthcare is expected to change in the future amid the Covid-19 pandemic.’ 

Support worker involvement 

Using the whole team to supervise students is not a new concept to some. Support workers Polly Hornby from Betsi Cadwaladr University Health Board and Paula Wheeler from the Liverpool Heart and Chest Hospital play key roles in the practice education of students within their trusts. 

Highlighting the capability of our fantastic support workforce, they are fully involved in the supervision process and support the students from the outset, helping set learning outcomes and creating plans to achieve them. This exposes students to the valuable skillset of a support worker and allows both an acknowledgement and appreciation of their clinical reasoning, communication, patient handling and person-centred skills. 

Understanding the importance of a quality learning experience, Paula acknowledges the different learning styles and needs of students, challenges their beliefs of stroke rehab being ‘too complex’ and helps to simplify clinical reasoning. She is able to support their clinical reasoning by ‘mentoring the students to break down the subjective into small pieces and put it together like a jigsaw to make a full picture’. 

Based in a community hospital ward setting, Polly reports that involving the support workforce in student learning ‘gives the students the opportunity to improve their skills in a less formal way’ and also ‘allows them to practice practical skills’. 

Placement initiatives: University of Huddersfield and Age-UK 

In conjunction with Age-UK Wakefield and ASPIRE, the University of Huddersfield created a student-led telehealth coaching service during the pandemic. THRIVE is designed to help older people who live on their own and whose health and wellbeing has been indirectly impacted by the pandemic. The student placement involves intensive training in a variety of areas including health coaching, exercise adherence, anxiety management and goal setting. The students all work in inter-professional pairs of occupational therapists and physiotherapists and all calls are closely supervised by academics from these professions. ‘The sessions centre around the goals that participants want to achieve,’ said Bethan Hebberd, who lectures in physiotherapy at the university and is one of the clinicians who have developed the project. ‘They might be feeling anxious or not sleeping very well or they feel they are not being very active. We will work through techniques around health coaching, relaxation and exercise to help them achieve their goals.’ 

She reports that the students have enjoyed learning how to use health coaching as well as working interprofessionally. This peer support has encouraged the development of different skill sets. 

A student says: ‘This is the most proactive placement that I have been on, I feel that I am fully in charge of my own learning and my own patient consultations.’ (Harrison Prudames third year physiotherapy) 

Placement initiatives: Royal Free Hospital, London – community paediatric physio team 

Irene Cologni is a paediatric physiotherapist. Her service’s shift onto virtual platforms prompted them to think laterally and create a valuable learning environment for Niamh Buttle, final year student at Brunel University. The whole team was involved in mentoring with Irene, monitoring learning through daily student-led self-reflections. She reported: ‘We have been trying to make this placement as similar as possible to a face-to-face one. We provided background information prior to every session, and reflected together after it. Niamh was asked to research and read information relevant for each session, lead sessions where appropriate, write SOAP notes, identify physiotherapy goals and draw up physiotherapy programmes in order to further develop her clinical reasoning skills. I also asked the student to work on a personal project, which entailed exploring a specific theme linked to the placement and presenting it to the team at the end of this journey’. 

A student says: ‘My final clinical placement has been a thoroughly enjoyable experience which has developed my skillset immensely and furthered my knowledge of the world of paediatrics. Thanks to the incredible team I have been working with, I have now completed my clinical hours and can apply for HCPC registration.’ 

Whole team supervision 

Supervision of a student on placement is often undertaken by one experienced physiotherapist (commonly a band 6) in a team. The topic of ‘shared supervision’ has been discussed in numerous Frontline articles. However, there are still not many examples of lower and higher-level banded roles supporting students or team models. The HCPC Standards of Proficiency, the CSP Code of Professional Values and Behaviours, and the CSP Quality Assurance Standards (Standard 3.3: Members actively engage with supporting students’ practice education and the development of their professional socialisation) support the fact that it is a shared responsibility to educate students, regardless of banding or role.

An article in July’s Frontline highlighted that ‘supporting students and learners is everyone’s business’, (while acknowledging that a registered professional must have overall accountability), drawing attention, for instance, to the benefits that could be gained from time spent with support workers. 

Connect Health has successfully demonstrated a team supervision approach, giving the students an opportunity to work with different team members. The Connect Health virtual student placement initiative has seen more than 100 student placements completed since May.  

They devised a placement structure with three different core elements that could all be completed from the students’ own homes: 

• Remote consultations. Students shadow and co-deliver patient care with clinical staff by either phone or video. This offers a much wider diversity of both clinics and clinicians including physiotherapy, occupational health services, advanced practice clinics, rheumatology consultants and psychology. Shadowing these clinics virtually rather than in person allowed larger access to learning, some sessions having over 20 students observing. 
• Virtual group rehabilitation. Students plan and deliver virtual group rehabilitation, exercise and education sessions to patients and the public via social media platforms including Facebook Live. 
• Access to a virtual student learning academy. Students have access to more than 400 clinicians and a broad range of educational resources. This includes daily CPD sessions delivered by senior clinicians as well as online learning materials. 

The initiative has been a resounding hit with students, patients and educational institutions alike. Consultant physiotherapist Matthew Wyatt reported that the energy and engagement from the students and clinicians had been a big success as had the resources created by the students that can be used going forwards. 

Connect Health have created a virtual guide to help others set up virtual student placements 

A student says: ‘I’ve been really impressed and just generally really enjoyed the whole experience – a huge learning opportunity in many aspects and lots of benefits that I would never have had with a conventional placement.’ 

Placement settings 

Student learning can happen in lots of different environments. With some creative thinking we can not only expand placement capacity that is very much needed but also develop rich learning opportunities for our future workforce. 

• Never before have physiotherapists worked in such a diverse range of settings, as the profession is responsive to the rapidly changing healthcare environment. The shift into the community, primary care, occupational health, private and rehab settings as well as leadership and research posts has enabled physiotherapists to grow as a workforce, develop new roles and influence services. While quality placements are typically provided in the more familiar environments, there is opportunity to widen access and diversity with more learning opportunities in others. What’s important is providing a range of experience that will equip students for a future beyond 2050. 
• New ways of working. Working in different ways and with an ageing and more medically complex population, a broad range of skills is needed including assessment and diagnosis, behaviour change approaches, patient education, working in integrated multi-disciplinary teams, using healthcare technologies, evaluating value and influencing change. The shift to virtual consultations at pace during the pandemic highlights a new way of working that will be integral to physiotherapy practice going forward. Exposure to these skills as a student could unlock amazing learning potential. No service is too specialist or caseload too complex for quality student learning - the key is identifying and unlocking the learning opportunities. 
• Placements DO NOT have to be patient-facing. Students can have placements in non-clinical settings and these hours can count towards their required placement hours. A range of experiences that support students to meet the required standards of proficiency is crucial. Physiotherapists working in leadership, research and policy-based settings can offer an invaluable learning environment and assist students meeting this standards. Students can contribute to evidence-based practice, inform service improvement, understand policy and develop key leadership skills, and see the wider role of physiotherapy. This opportunity is two-fold as the placement provider gains a valuable student voice to their work.  

Working together with experts in practice education, the CSP has developed a common placement assessment form (CPAF), which offers a standardised approach, irrespective of university, as well as parity in learning outcomes that are applicable to all settings – whether patient facing or not. Watch this space.  If you’re currently thinking innovatively and providing student placements, we would love to hear from you to find out more and share great practice. Send us details: learninganddevelopment@csp.org.uk 

Our top tips 

• Creative thinking is key – be open minded to change and different models of student placements n Think about what you and your team can offer students, not what you can’t 
• Consider what learning opportunities there are in your practice setting 
• Involve the whole team and make students part of this 
• Consider what students can add to your service 
• Let’s widen access to non-patient facing environments and the learning opportunities this could bring 
• Act now – it may not be perfect first time, this is a great opportunity for us all to learn together alongside the student 

If you’re currently thinking innovatively and providing student placements, we would love to hear from you to find out more and share great practice. Send us details at learninganddevelopment@csp.org.uk