Students need to spend 1,000 hours in settings that enhance their knowledge and practice. Gill Hitchcock and Gwyn Owen examine why the issue of student placements is a key one for the profession.
For physiotherapy students, practice-based learning makes up about of third of course time – a minimum of 1,000 hours each. The purpose is to develop an understanding of how physiotherapy meets the needs of a wide range of people and conditions, and students need to develop their competence and to be prepared to engage creatively – and critically – to generate evidence about the impact and value of physiotherapy services.
A CSP position paper states that, ‘Practice-based learning is a vital component of pre-registration physiotherapy education. It is the process through which students safely learn and develop within a physiotherapy practice environment or setting.’
While there appears to be a good range of NHS and other organisations willing to provide placements, there are challenges on the horizon. The CSP estimates that UK health services will need an additional 500 physiotherapists a year for the foreseeable future, just to keep pace with growing demand. More physio students, means more placements and that means students will be gaining experience in an increasingly wide range of settings, outside the traditional NHS.
Occupational health could be one of these experiences. Perhaps, like Jake Daws, with the Firefighters Charity, which provides physical and psychological support to firefighters from across the UK. Mr Daws, a 25-year-old MSc physio student at the University of Cumbria, spent six weeks with the charity and is upbeat about his experience. ‘They had access to some really incredible technology, such as anti-gravity treadmills and multiple hydrotherapy pools, which aren’t always available on the NHS. These facilities were used daily and clients reported very good feedback.’
Mr Daws says the charity takes referrals from occupational health settings around the UK and Ireland, and people can self-refer too. Any firefighter, active or retired, or relatives, could be eligible for rehab at the charity’s centres.
‘The clients were aged from 19 up to 75, with a range of conditions,’ he says. ‘Some were trauma-related, some had elective surgical procedures that hadn’t gone to plan and needed further rehab.
‘Because the clients had self-referred themselves for rehab, they were that much more committed and motivated to reaching their goals. And they typically spent between seven and 10 days in rehab there, compared to the NHS where people come and go very quickly.’
‘Even in seven days I felt I was able to really connect with patients and to try and understand their problems. I think they really appreciated you taking that time to listen to them and tailored their rehab programme, and physiotherapy specifically.’
It was eye opening, says Sarah Cowin of her eight-week practice-based placement with adults with learning disabilities. Sarah, aged 21 and a third-year physiotherapy student at Sheffield Hallam University, spent her ‘specialist’ placement at two-day centres in the north of England for people with Down syndrome, autism and other disabilities.
Ms Cowin joined multidisciplinary colleagues who helped people out of wheelchairs after they arrived at about 9am. They ensured they were comfortable, and helped them to engage in activities. She organised games such as throwing and catching a ball, or dance-type activities to get people moving and working their muscle groups. Sometimes these were collective activities, but Ms Cowin also designed activities for people who were more comfortable exercising alone.
‘The placement helped me to realise how many different people and disabilities you can work with as a physio, and how we can make such a difference. It’s an amazing profession to be going into.’
Philippa Miller, 23 and in her second year of a physiotherapy MSc at the University of Birmingham, has similar sentiments about her placement in the burns unit at Queen Elizabeth Hospital Birmingham. ‘I didn’t really have a clue about what physiotherapists could do for burns, other than mobility,’ she says. ‘There was so much more to burns that I realised, because you have the physical burn and the problems with inhalation injury. You also have to take into account the psychological aspect of having this type of injury.’
But when things work out well, they can provide valuable insights. For instance, Mr Daws says that because his firefighters placement enabled him to spend time with patients, it helped him to develop his communication skills. And he had to prioritise his own caseload, which, in effect, ‘sorted out’ his organisational skills.
The learning disabilities placement forced Ms Cowin to find new ways of communicating: ‘For those who had more profound disabilities, it was little things, such as tilting their head in a certain way to say yes, and moving their eyes to say they wanted a drink. It was just finding things like that, that I had never really thought of before.’
Mr Daws talks about being open and letting your educator, or any other member of staff, know if you are unsure about anything. And he recommends trying to contribute to the team as a whole: ‘I challenged a consultant about the lack of detail in their notes and that was picked up by my educator as a really positive thing to do,’ he says. ‘When it comes around to any note audit or Care Quality Commission inspection [in England], that will be picked up.’
What advice would these students give to others about getting the best out of a placement? Ms Miller says her top tip would be to make sure you prepare thoroughly, particularly for a specialist placement like a burns unit.
Ms Cowin agrees, and suggests getting in contact with your educator, or the team, ahead of a placement to find out as much as you can about the service and the people who deliver and receive it. fl
Students’ practice-based learning and your input
Practice-based learning is key to ensuring that we have the capacity to meet the changing needs of the patients and populations we work with. By providing opportunities for students to experience physiotherapy in a variety of settings, we will ensure the physiotherapy workforce can continue to lead and deliver new models of care and seize opportunities to take up new roles. If we fail to take collective responsibility to build capacity for practice-based learning, there’s a risk that our profession becomes stuck in the here and now a case of ‘sleep-walking into obscurity’.
As Jake, Philippa and Sarah’s experiences show, practice-based learning can occur in any environment or setting in which physiotherapy is delivered.
Changes to the design and delivery of physiotherapy services create a space for practice-based learning to evolve. As physiotherapy moves out of the hospital setting, the CSP has seen universities and clinical teams working together to establish placements in primary care, in workplaces, schools and sports clubs, in private practice, and in a variety of other community-based settings. The feedback from these developments shows that it’s not only students who benefit – practice-based learning has a positive impact for everyone involved: staff, the service and service users.
So if you’re not already feeling the benefit of practice-based learning in your practice and want to find out more, email me at email@example.com. We’re also keen to hear from members who are exploring ways of doing practice-based learning differently – by introducing new models of supervision or offering split placements, for example.
You’ll find information about the CSP’s approach to practice-based learning here. For information and resources to develop your capacity for practice based learning, please visit the ‘career development’ section in the CSP’s Learning Hub, which members can access via their CSP ePortfolio account.
Gwyn Owen, CSP professional adviser.
Gill Hitchcock and Gwyn Owen
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