Less hands-on, more clinical reasoning


Despite the COVID-19 pandemic disrupting the continuity of education, private practices hosting students for their clinical placement is still achievable and just as important—and the learning opportunities run both ways. 

For the next generation of physiotherapists to be able to graduate, and to allow them the best education they can have in private practice, requires an unprecedented approach, a blend of online and social- distanced consultations, mixed with less hands-on work and more clinical reasoning.

The combination of these factors relies on the practice, patients, location-specific restrictions as well as the students themselves.

Peter Steggall, Specialist Musculoskeletal Physiotherapist (as awarded by the Australian College of Physiotherapists in 2018), is one physiotherapist who hosted a student for their clinical placement throughout Victoria’s first wave of the coronavirus.

Peter says it was a challenging experience, partly because of the concerns around safety.

‘The safety of the clients, safety for yourself and, of course, the safety of the student. You want to make sure that everyone was okay,’ he says.

‘Then the worry was about if we were really adding value add to the training of the student. Can they get benefit out of having a placement like that?

'But then we had a fourth-year student who wouldn’t be able to graduate this year if they hadn’t completed their allotted education. So we just went for it.’

This kind of placement may not work for every student or every clinic.

In the tumultuous times that we are experiencing at the moment, individual needs, learning styles, teaching capabilities and resources need to be taken into account before hosting a student.

As the second wave hits Victoria hard at the time of writing, and with no way to know how long work-from-home orders will be in place or how the virus may spread nationwide, new and innovative ways of running private practices are now the norm.

‘I think it would be dependent somewhat on the quality of the student and their ability to engage,' Peter says.

'I work with the Australian Catholic University and I teach in the first-year and second-year programs. I had experience earlier this year with teaching online, and teaching practical classes online, with the students there.’

With the university’s approval, Peter was able to host a student in the clinic where he works. Peter and the other practice physiotherapists managed the student’s placement in a number of ways.

‘We would present the patient history to the student the day before the booked consultation. The student would be encouraged to prepare what assessment they might like to do, and what they might like to ask the patient.’

During the consultation the student would sit in a separate room with access the patient notes, and watch the consultation via video link.

‘We tried to get the student thinking about the patient, about clinical reasoning and progression of treatment. In some cases, we were able to allow the student to assist with patient management in the larger gym space.

'So in this way we were still able to have some patient–student clinical interaction. This was done in accordance with social-distancing guidelines at the time,’ Peter says.

There are some benefits to limited access to patients.

As Peter found, ‘one of the hardest skills to learn, and develop, as a student and as a young graduate physiotherapist is clinical reasoning.’

He says that when teaching online, ‘you really are forcing the student to do clinical reasoning. Because they can only observe, and aren’t able to touch the patient, there is nothing else to go on apart from the student’s own knowledge-base.

'From there it’s up to the student to try and explore what the possibilities are.

‘So I felt that when you limit that opportunity for them to be hands-on, they had to use other components of their skillset—and perhaps, hopefully, develop much better skills in terms of clinical reasoning than they would otherwise have achieved.’

There are positives that have come from being forced to change up the more traditional ways in which clinical placements are done.

The emphasis on clinical reasoning for one, ensuring that the student undertaking placement has to use the knowledge they have learned in the past three to four years (or equivalent) of study. 

But the student has not been the only one to benefit from this experience.

Peter says ‘it was a great learning experience for all of us, not just the student, because it forced us to take a more active role in the growing field of digital physiotherapy.’

Because of lockdowns, practices had to learn how to work around telehealth. Peter says ‘there were some patients happy to have telehealth consultations, and others that weren’t.

’Being confident with videoconferencing software and having to learn alongside a student undertaking placement is an excellent way to build connections and allow the student to be active in the clinic beyond manual therapy.

‘The online platform experience has resulted in us having our staff meetings online through the same platform,’ Peter says. 

‘Social distancing has had each of the physiotherapists in their own treatment room presenting case studies and training to their colleagues. This forced us to get into the habit of videoconferencing, and we found that if this can work with a student, it can work with our own education.

The student, the clinicians and practice as a whole have benefited in some way from this challenge to conventional private practice.’

‘Having to think more and not simply relying on being hands-on, which is going to be the future of physiotherapy in terms of telehealth, the clinicians of the future are going to have to be quite skilled at that. So in some ways you’re really better preparing them for the future of physiotherapy.’

>> Keep up to date at australian.physio/covid19.


Health providers who treat older veterans and their families now have access to two new booklets and a series of eight training webinars published by the Department of Veterans’ Affairs.

Available for download or in hardcopy format are two new booklets: ‘A veteran’s guide to living independently—accessing DVA services’ and ‘A veteran’s guide to moving into an aged care home—accessing DVA services’.

There is also a series of eight webinars available for viewing that cover the same topics. Each webinar is around 30 minutes and packed with information on each aged care program or service.

To access the resources visit tinyurl.com/y3whnesr.


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