The structure or nature of the placement

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 Adapting the structure or nature of the clinical education placement for an Indigenous context

Selecting the most appropriate style of placement experience can enhance the benefits of clinical education working with Aboriginal and Torres Strait Islander people. The traditional one student with one clinician model might not be the most suitable or useful model within this context. Some of the challenges might also be more easily addressed using a non-traditional placement model.

The structure of placement needs to be carefully considered:

• Length of placement: You might prefer to only take students for longer placements.
• for example, longer placements (e.g., 10 weeks) might ensure students have time to develop relationships, cultural awareness and communication skills, and become part of the interprofessional team;

• Shared supervision: You might find it helpful to share the clinical education responsibilities with another educator (from the same or another profession) within your own or with another workplace/agency. Shared supervision:
• Can help ensure students have a range of experiences and they can benefit from the range of educator input. Partnering with another service provider might address concerns about ensuring the student has some less complex client experiences or that they will have a higher number of ‘hands-on’ clinical practice hours.
• Can also mean that you do not have the student with you all the time and you could structure your workload around your educator responsibilities (e.g., if you have ‘outreach’ trips and the student cannot go with you, or if you have a certain client where a student’s presence might jeopardise the relationship).
• Can help you limit the impact of the additional time you will need to spend with the student (e.g., if you know the student is with you for two days each week, it might be easier to block out time on those days to focus on your clinical educator role).

• Collaborative model: You might find that having more than one student on placement at the same time is particularly useful in an Indigenous context. Students might find it beneficial working together to help each other develop the necessary skills. They might also value having another student’s support to talk through their experiences and developing understanding. This might alleviate the student’s need to spend as much time working these things through with you.

• Multiple mentoring placements: where a team of clinical educators supervise a team of students
• Can often suit the 'team approach' used in most Indigenous health contexts.
• Allows students to experience a range of approaches to practice and styles of communication and interaction with Aboriginal and Torres Strait Islander people.

• Interprofessional Education: Working in Indigenous health services usually requires a multidisciplinary approach. This can extend to offering interprofessional education where students from a range of disciplines work together. There can also be educators from different disciplines providing feedback and supervision to the students. This service model can effectively facilitate ‘holistic’ and client-centred practice and demonstrate to students flexible, collaborative, culturally-appropriate and contextualised services.

• Role-Emerging Placement: with external or off-site discipline-specific supervision can demonstrate a need and demand for ongoing services working with Aboriginal and Torres Strait Islander people.

• Student-led Clinics: can increase opportunities for student placements as well as increasing the services offered to clients.

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Some examples of how different placement models can work in an Indigenous context

Project Placements

Project placements are commonly used in occupational therapy placements working within an Indigenous context but can be useful across other allied health professions also:

• Projects can be developed to address needs specific to your workplace - for example, setting up education or prevention programs, creating resources, promote or evaluate an aspect of service.
• The projects can be developed collaboratively by the students (working independently or in pairs/groups) and the workplace during the clinical education placement.
• Project work can be used as one component of a placement - for example, students can undertake projects while the clinical educator is on outreach and would prefer not to, or is unable to, take the student with the them, or alternatively as part of an inter-agency shared supervision model.

Project placements have been used successfully at the Institute for Urban Indigenous Health to develop, trial, and evaluate programs. In this video Dr Alison Nelson describes some of the project placements they have offered.

Queensland Health's 'Deadly Ears Program' also offer project placements to students. Jodie Booth, a Senior Occupational Therapist and experienced clinical educator explains how the placements work in this video.

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Multiple mentoring placements

A multiple mentoring model of placement has also been used at the Institute for Urban Indigenous Health. A team of students might spend a day of each week with a different clinical educator which allows them to experience:

• a range of approaches to practice and styles of communication and interaction with Aboriginal and Torres Strait Islander people.
• a range of supervision styles and expectations.
  
  

In the following three 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 in an Indigenous health program, while in the other it is a more traditional clinical setting. The students are also involved in a community engagement placement run in an Indigenous kindergarten and the two clinical educators share the supervision in this setting. The educators offer some suggestion about what makes these placements successful.

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Interprofessional Education

Speech pathology and occupational therapy students from The University of Queensland experience inter-professional learning on placement at the Murri School, an urban Aboriginal and Torres Strait Islander School in Brisbane. The students experience ‘a service delivery model built on mutual learning, collaboration and understanding and respect of cultural difference. [...] A clinical educator from each profession [is] integral to a well-coordinated approach and has enabled opportunities to share supervision and to model inter-professional clinical skills’ (Davidson, Hill & Nelson, 2013, p.70).

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Student-led Clinics

A student-led clinic at the Institute for Urban Indigenous Health was the starting point for the ‘Work It Out’ program. ‘Work It Out’ is an inter-professional education and exercise program for Aboriginal and Torres Strait Islander clients diagnosed or at risk of a chronic disease. It is an example of the establishment of a new service through a student placement.  The health service staff had identified that there was a need for rehabilitation services and the program was developed in partnership with a private gym. Once the service was established and positively evaluated the program expanded and is now run by a team of dedicated allied health staff. Students from medicine, nursing, occupational therapy, exercise physiology, pharmacy and psychology deliver educational content and assist in exercise supervision, monitoring clients’ health status and making recommendations within their scope of practice and level of experience. (Nelson, Shannon & Carson, 2013, p.31).