Placement models and approaches to supervision

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Placement models and approaches to supervision in clinical education

Clinical educators need to consider the range of placement options that are available when deciding to offer a clinical education placement. You need to think about your specific work context and decide what type of placement structure and approach is most appropriate.

Clinical education placements can vary in a number of ways including:

 (Mental Health Coordinating Council, 2013, p.14)

These variables are reflected in the different models of clinical education placements that are currently used in allied health. Brief summaries of some of the models used within allied health clinical education are provided below. Videos of clinical educators explaining how they have used some of these models are also included. There are some excellent 'fact sheets' and 'suggestion sheets' explaining the benefits and offering practical suggestions for applying different placement models available within the Clinical Placement Models section of the Clinical Educator's Resource Kit (OTPEC-Q, 2018).

There have been few comparative studies of the effectiveness of different models. Lekkas et al. (2007) systematically reviewed the available data and concluded that 'each model proffered strengths and weaknesses, which were unique to the model... There is currently no 'gold standard' model of clinical education' (p.19). When considering the various placement model options you need to think about the advantages and disadvantages of each option and evaluate whether you could successfully implement the model within your specific work context. Hybrid models are also possible where the variables overlap and aspects of different models are combined.

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Traditional model 

Also known as: one-to-one placement; apprenticeship model; mentorship; role-established placement

Key characteristics:

• one clinical educator supervising one student
• direct supervision by an on-site clinical educator from the same profession
• often limited to service delivery - practicing skills within an existing and well-defined role
• the most widely used model of clinical education placement
• students can benefit from the individual focus of the educator
• limited opportunity for collaborative or peer learning
• student is largely dependent on educator to facilitate learning
• some students prefer a traditional placement model at the later stages of the training to allow them to demonstrate autonomy
• some clinical educators prefer a traditional placement model in the early stages of training to allow closer supervision and promote modelling of skills and develop clinical reasoning
• management of the placement is less time consuming for the educator in comparison to other models
• one-on-one supervision limits each educator's capacity to offer placements.

Useful references: Lekkas et al. (2007); Sheepway, Lincoln & Togher (2011)

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Collaborative model

Also known as: paired/group supervision; two-to-one; co-operative model;  peer collaboration; multiple placement

Key characteristics:

• one clinical educator supervising more than one student
• usually a positive experience for both students and educators often resulting in higher clinical competence and increased satisfaction
• students often work together in pairs (at least initially)
• peer learning (where students learn from their peers) is emphasised
• peer learning works well when students are matched for experience and performance
• students are active participants and involved in discussion and feedback with their peer/s
• students feel supported by each other and are less dependent on the clinical educator
• students develop increased confidence and initiative and participate more
• students can practice skills and techniques with each other and ask each other questions
• students develop teamwork skills
• clinical educators need training to facilitate peer learning and collaboration
• there is sometimes negative competition or incompatibility (of personality/learning style) between students
• there is often less time available for individual student supervision and feedback
• there is a higher administrative burden on clinical educators (particularly to complete students assessments, review multiple sets of reports/documentation)
• requires appropriate space and resources and available clients.

Useful references: Briffa & Porter (2013); Rindflesch et al. (2009); Rodger et al. (2009); and Benefits of the collaborative student placement model and Tips for increasing efficiency using the collaborative placement model (OTPEC-Q, 2018).

In this video Sarah Jackson, physiotherapist with the Mount Isa Centre for Rural and Remote Health, describes a collaborative and multiple mentoring placement model.

 In this video Helen Bourne and Jayne Moyle describe the Central Queensland University student led clinic.

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Multiple mentoring

Also known as: shared supervision; team supervision; shared-responsibility; inter-agency placements

Key characteristics:

• a team of two or more clinical educators supervise a single student or a team of two or more students
• clinical educators may have a different practice focus or even different workplace (inter-agency)
• can combine a more traditional placement setting with a project placement or role-emerging placement experience
• students are exposed to a range of experiences and a range of practice approaches, skills and styles
• assist students to develop their own practice approach
• encourages students to be adaptable and understand that there is not necessarily one 'right' way to practice
• facilitates clinical reasoning skills of educators (explaining why they are doing things differently to another educator)
• can allow part-time staff to be involved in clinical education
• can allow inexperienced clinical educators to learn from more experienced educators and 'ease their way' into clinical education
• students can find it challenging to meet different educators expectations and can find the placement experience fragmented
• there is a reduced chance of student-educator conflict
• clinical educators need to work closely together and it helps if they have a good existing relationship
• clinical educators need to carefully plan the placement, organise how they are going to assess students and communicate with each other
• can result in increased productivity and enhanced client services as well as increased student competency.

Useful references: Copley & Nelson (2012); Nelson, Copley & Salama (2010); and Benefits of the multiple mentoring student placement model and Tips for greater efficiency using the multiple mentoring placement model (OTPEC-Q, 2018).

In the following videos two experienced clinical educators from different workplaces describe their experiences of sharing students with each other. In one setting the students are involved in a project placement while in the other it is a more traditional clinical setting. The educators offer some suggestion about what makes these placements successful.

 
 
In this video physiotherapist Megan Saunders describes how multiple mentoring works within Mobile Rehab, a private practice setting.

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Role-emerging placements

Also known as: non-traditional placements

Key characteristics:

• clinical education placement offered in a setting where services are not usually or currently available but where there is potential for a role to be established
• the students explore the possibilities and then establish the provision of a professional role within that setting in liaison with other professionals within the setting
• provides an opportunity to partner with community organisations
• students can also evaluate the need for service provision within a setting
• direct supervision is usually provided by a staff member from a different profession
• additional unidisciplinary professional supervision is provided by a clinical educator working within another service or from the university (this might be direct face to face supervision or indirectly by phone or videoconferencing)
• students raise the profile of their profession and the potential for services within the setting
• students are involved in educating others within the setting about the role which can be challenging for students with poor knowledge of the role themselves
• broadens students' understanding of their professional role and helps students understand the broad diversity of roles within their profession
• enhances students' independence, clinical reasoning, communication, advocacy and self-directed learning skills
• paired or groups of students feel more supported when working together in a role-emerging placement
• students are often concerned about the lack of opportunity to develop core clinical skills
• requires clear expectations to be communicated to students
• students need to understand the placement structure and purpose and know how to access direction, feedback and supervision from both their unidisciplinary and onsite supervisors
• works well when a split inter-agency placement between a more traditional setting and a role-emerging one

Useful references: Fieldhouse & Fedden (2009); Overton, Clark & Thomas (2009); Rodger et al. (2009); and Benefits of role-emerging placements and How to set up and manage a role-emerging placement (OTPEC-Q, 2018)

In the following three videos Professor Lindy McAllister explains how role-emerging placements work and gives an example of a role-emerging placement in Broken Hill.

In this video Antoinette Fitzgerald, an Advanced (Clinical Specialist) Occupational Therapist with Queensland Health's Child Development Program, explains how community engagement has been achieved through clinical education placements. A student placement model within a kindergarten for Aboriginal and Torres Strait Islander children has allowed relationships to develop and build the capacity of the kindergarten staff to identify and encourage children who need to access allied health services.

In this video Professor Barbara Dodd describes an innovative clinical education placement structure for a rural community where students have established services that would not otherwise have been available.

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Project placements

Also known as: non-traditional placements; macro-strategy placements; community development projects; public health placements

Key characteristics:

• project placements can occur within traditional clinical or non-traditional settings
• individuals or groups of students complete a specific project in close liaison with staff within the setting
• common projects are often focused on quality assurance; health promotion; service development; capacity building; and/or community engagement
• supervision can be from a clinical educator within the organisation or from a university staff member
• there is usually a project sponsor from within the organisation that explains the project brief and assists the student/s identify the parameters and scope of the project
• students can be involved in planning, implementing and evaluating services or resources
• develops students' critical thinking, problem solving, autonomy, self-directed learning, communication, interprofessional and clinical reasoning skills
• helps students understand the broader practice context and the policy, economic, political and other factors that are often significant
• most effective when students have already developed a range of clinical skills in other placements
• can demonstrate to students the importance of evidence-based practice and the role of research
• clinical educators need to be available to support and monitor students as well as facilitate reflective practice and collaboration.

Useful references: Fortune & McKinstry (2012); Overton, Clarke & Thomas (2009);  Benefits of project-focused placements and How to set up and manage a project-focused placement (OTPEC-Q, 2018).

Jodie Booth, Senior Occupational Therapist with Queensland Health's Deadly Ears program, describes in this video how project placements have been successfully offered within their service.

Project placements are also offered within the Institute for Urban Indigenous Health. Dr Alison Nelson explains how these placements are run in this video.

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References

Briffa, C. & Porter, J. (2013) A systematic review of the collaborative clinical education model to inform speech-language pathology practice. International Journal of Speech-Language Pathology, 1-11.

Copley, J. & Nelson, A. (2012). Practice educator perspectives of multiple mentoring in diverse clinical settings. British Journal of Occupational Therapy, 75, 456-462.

Fieldhouse, J. & Fedden, T. (2009). Exploring the learning process on a role-emerging practice placement: a qualitative study. British Journal of Occupational Therapy, 72, 302-307.

Fortune, T. & McKinstry, C. (2012). Project-based fieldwork: Perspectives of graduate entry students and project sponsors. Australian Occupational Therapy Journal, 59, 265-275.

Lekkas, P. et al. (2007). No model of clinical education for physiotherapy students is superior to another: a systematic review. Australian Journal of Physiotherapy, 53, 19-28.

Nelson, A., Copley, J. & Salama, R. (2010). Occupational therapy students’ perceptions of the multiple mentoring model of clinical supervision.  Focus on health professional education, 11, 1427.

O'Connor, A., Cahill, M., and McKay, E. (2012). Revisiting 1:1 and 2:1 clinical placement models: student and clinical educator perspectives. Australian Occupational Therapy Journal, 59(4), 276-83.

Overton, A., Clark, M., & Thomas, Y. (2009). A review of non-traditional occupational therapy practice placement education: a focus on role-emerging and project placements. British Journal of Occupational Therapy, 72, 294-301.

Queensland Occupational Therapy Fieldwork Collaborative (2007). Clinical Placement Models. within the Clinical Educator's Resource Kit.

Rindflesch, A. et al. (2009). Collaborative model of clinical education in physical and occupational therapy at the mayo Clinic. Journal of Allied Health, 38, 132-143.

Rodger, S., Thomas, Y., Holley, S., Springfield, E., Edwards, A., Broadbridge, J., Greber, C., McBryde, C., Banks, R., & Hawkins, R. (2009). Increasing the occupational therapy mental health workforce through innovative practice education: a pilot project. Australian Occupational Therapy Journal, 56, 409-417.

Sheepway, L., Lincoln, M. & Togher, L. (2011). An international study of clinical education practices in speech-language pathology. International Journal of Speech-Language Pathology, 13(2), 174–185.