A group of academic physiotherapists in Australia conducted a mixed-methods study including a nationwide survey and focus group interviews of 14 physiotherapy private practitioners who have hosted physiotherapy students on clinical placement.

The first author, Casey Peiris, answers some questions about the study.

 What were the two parts of your mixed-methods study?

In an attempt to capture as many opinions as possible, we conducted a nationwide survey of private practitioner physiotherapists who had supervised a student in the previous three years.

The online survey consisted of questions on private practice models and benefits, risks, costs, barriers to and enablers of hosting private practice student placements. 

To gain further insight, we conducted focus group interviews to explore private practitioners’ experiences. 

We then combined data from both sources to inform our results.

What do private practitioners perceive to be the benefits of hosting physiotherapy students on clinical placement?

Private practitioners identified that hosting students contributed to their professional development.

Participants said that having to think about and reflect on what they were doing and why they were doing it enhanced their knowledge and clinical reasoning skills. They also appreciated that students could provide extra services, care and attention to clients, especially for those with more complex needs.

For the practice and business as a whole, participants said that hosting students connected them with their local universities, providing access to experts and resources that they wouldn’t usually have. 

Hosting students also enhanced staff retention (for those who wanted something more) and aided new graduate recruitment.

What about the barriers, costs and risks?

Barriers varied greatly and depended on practitioner level of experience, their relationship with their local university and the variety of students they had supervised.

Overwhelmingly, however, the most frequently cited barriers were time and the financial costs associated with supervising students.

Time is money in private practice and participants reported that preparation time and supervision time contributed to a loss of productivity and subsequent financial costs.

However, one in five respondents reported no costs and some focus group participants said that hosting students could enhance efficiency.

Most survey respondents reported that third-party funding restrictions were a barrier because they limited the potential pool of clients that students could see. In some cases, they made it impracticable to host students.

What models of placement were used by the private practices that participated in the study?

Four in five survey respondents reported only hosting final-year students after they had completed a number of placements in other settings.

Nine in 10 could only host one student at a time, who was typically supervised by one or two practitioners.

Practitioners commonly described a graded exposure model of placement where students began with observation, then completed some shared care before progressing to a student-led model where students lead the consultation. This model was described as practical and safe because the supervisor could assess the student’s level of competency.

What support would private practitioners like to enable them to continue hosting students?

Predominantly, practitioners wanted financial incentives to host students.

While all agreed that university training and resources would help them be better supervisors, they were reluctant to take the time to engage in these.

They commented that they’d be more likely to engage if their time was reimbursed or if they were offered other incentives such as non-clinical education professional development.

Almost half of all respondents received remuneration from universities but it was perceived that it didn’t completely offset costs.

Developing good relationships with universities was also considered essential for successful clinical placements because it resulted in better communication and access to support and resources.

Where does research in this area need to move to now?

Considering national reports that state that the costs of running university health courses with clinical placements exceed the amount of funding received to run these courses, financial incentives alone will likely not be a viable or sustainable solution.

With this in mind, future research should focus on financial costs and outcomes of different models of placement delivery within private practice to determine the most feasible and cost-effective models for practitioners.

Future research should also consider non-financial incentives and contributions suggested by participants, including support from university clinical educators, access to university resources (eg, online journals), the provision of materials or online training to students on placement to provide practitioners with some downtime and access to free or subsidised professional development opportunities (not related to clinical education).

Associate Professor Casey Peiris holds a joint position between the Royal Melbourne Hospital and La Trobe University as the Head of Allied Health Research.
Casey has worked in private practice and clinical education and completed this work when she was chair of the Clinical Education Managers of Australia and New Zealand group.