FAQs: physiotherapy student placements in private practice – CPDANZ, October 2018
Please find below responses to questions physiotherapists frequently ask and a helpful guide about private practitioners as clinical educators. If you have further questions, please contact the University you are thinking of working with via the CPDANZ website.
Yes. There are no restrictions on private practitioners who are registered physiotherapists supervising students. This is a personal decision based on whether you feel you have the capacity to provide the environment and opportunities to support student learning.
Yes. Students are allowed to work with your clients as long as your client or the parent /guardian has provided informed consent for the student to be involved in their care. As the registered, treating physiotherapist you have full responsibility for all aspects of patient care and responsibility to ensure that the student receives a level of supervision that is appropriate for each element of patient care that they are involved with.
The registered treating physiotherapist has sole responsibility for the clinical care of the patient including responsibility for correct documentation and invoicing of third party funding bodies. These funding bodies include Medicare, NDIS, State and Federal Workers Compensation and Motor Vehicle Insurance bodies, DVA, private health insurers and others. Please note that restrictions may apply if students are providing a service for your client and they would like to claim a rebate for that interaction (see information below for details). Thus, billing practices for student services need to be considered. Note - there have been no changes in legislation underpinning restrictions. For further details, see the summary information collated by the APA. Please note that this advice is not the legal responsibility of the APA and is not a substitute for legal advice.
- Medicare: For claimable Medicare items (e.g. Chronic Disease Management program) – a registered physiotherapist who has a Medicare provider number (not a student) must work one on one with the client for at least 20 minutes of the session for the client to be eligible to claim a rebate. The student cannot work with the client on the same service that a rebate is being claimed for (See APA summary).
- NDIS: Students can provide services to NDIS participants provided they are under the supervision of a registered physiotherapist when delivering the services and the participant has agreed that the student can deliver specific aspects of support (NDIS further information).
- Motor vehicle (third party), DVA, Work Cover: Please see the information provided by the APA. The interpretation of whether students can be involved in services that are rebatable differs by the third party involved and may vary by entity and state. In general, students are often not able to provide services that are rebatable, but this varies.
- Private Health Insurance: For a private health insurance rebate to be claimed for physiotherapy, the person providing the treatment must be a qualified physiotherapist registered with the Physiotherapy Board of Australia.
If the client has access to other types of funding it should be confirmed with the funding provider whether the student can work with the client.
No, it is up to the practitioner to decide whether they feel they have the skills to supervise a student. Desirable skills include flexibility, support, approachability, clinical credibility, strong communication skills and ability to structure and organize effective learning opportunities. The level of student supervision and mentoring necessary may vary on the stage of learning or learning objectives and individual university requirements therefore a range of staff experience can be involved in the supervision of students. For example, some placements may range from observational to hands on practice experience. Please discuss this with the University clinical education Manager/Coordinator.
Most universities provide some form of training and support. The University placing the student will be able to advise you what training or experience you need prior to supervising a student and recommend appropriate training resources. University staff will guide and support you on how to supervise, educate and assess students on placement. Though training is not mandatory it is highly recommended and is a best practice quality indicator for clinical education. There are many avenues to access free training including online resources, webinars and face to face workshops. Information on assessment of students completing placements using the Assessment of Physiotherapy Practice – APP instrument can be sourced via http://www.appeducation.com.au/
Yes, it is essential that you gain the client’s informed consent and fully inform them of how the student will be involved in their therapy program. They also need to be informed that they can request to discontinue working with the student at any time and who they need to inform if they wish to discontinue their involvement with the student. It is recommended that this informed consent is documented whenever a student is involved with a client interaction during a placement in a private practice setting.
Yes. All students comply with legislation requirements related to working with children, and clients in aged care and disability services. Universities manage these mandatory requirements.
Yes. The University provides insurance which covers students on clinical placements. It is advisable to confirm with the University the details of the University’s insurance and who you need to contact if you have additional queries prior to agreeing to host the student placement.
It is important to discuss expectations of client engagement with the University involved. Placements are undertaken by students at different stages of their program and the level of supervision that is required will vary considerably. The level of supervision will also depend on the complexity of the patient’s condition, the complexity of the task and the supervisor’s ongoing assessment and judgment of the individual student’s capability. When students are in their final year or later stages of their program, active engagement (mostly hands on) occurs with students so they are able to develop the skills necessary to conduct a client interview, assessment, plan and implement management strategies, progressed across the placement, all under the guidance and supervision of the supervising practitioner. Students typically start with some observation/ education opportunities, and less complex clients. Responsibility is progressed throughout the placement. In the early stages students can provide client education, demonstration of exercises and gym programs, supervise client programs, assist with and lead groups, create and use a client education resource, and engage in post treatment planning as some ideas. There may be some placements that are only observational or provided for students at earlier stages of their programs and Universities will discuss the goals of the student placement with you.
Practices use a variety of models when they take students on clinical placement. Some take one student at a time; others elect to take a pair depending on the size and staffing of a practice and capacity of staff. Having a pair of students can provide good learning outcomes and support for students using a peer-assisted learning model where students have the opportunity to learn together and from each other. Practices may take students ranging from once up to 8 times or more per year, depending on practice capacity. Final year student placements usually occur in 5-week blocks at set times from January – November. There is usually a key staff member who is the primary clinical educator and contact person for the student and University, however students can have more than one clinician providing supervision/clinical education and this can broaden the exposure of the students to a variety of clinical skills.
There is variability in models and most aspects of placements. We have found that the models can be broadly summarised under the following four examples -
- Student led: The practitioner initially assesses/triages their clients to build a client list for a student. The student provides additional client sessions free or at a reduced cost to the client. The student may start with a few patients and observation, and build over time as they progress through the placement.
- Shared care: The student does components of assessments and treatments with/for practitioners. The client session is shared from the start, with the student engagement with the client increasing over time.
- Shared care progressing to student led: Student gradually manages the session over the placement with the later weeks mostly student led (fully supervised). This may start as observation with a client and progress from there.
- Student clinic: A private practice actively utilises the whole year and sources students from a number of universities to enable a continuous stream of patients to see students. This tends to be larger providers who have worked out a model that works for them. The type of ways students engage with clients will vary, but they may progress as per option 3.
Inherent in all these examples is an option to include a clinical reasoning model as part of the placement, where students do not have as much hands on contact with clients, but still work through a structured clinical reasoning tool (provided by the University) and discuss with the clinician to check their clinical reasoning and build their knowledge. Universities can provide guidelines and discuss the expectations for the number and type of client interactions to expect over time for this type of placement.
Contact hours need to be discussed with the University involved. There is usually flexibility in how to manage student time on placement. For block placements students are usually expected to be on placement for approximately 30-38 hours / week. Note however, that students are not expected to engage with clients or the educator for all this time. Students will be expected to use some of their placement time to prepare for clients, complete any paperwork, reflect on their work and may have other tasks to do set by the University. There is flexibility – not all placements need to look the same! If you require students to attend their placement outside of usual business hours (e.g. evenings, weekend/special sporting events), the University should be notified prior to the placement commencing and sessions may need to be negotiated with the student’s availability as students may have outside responsibilities to manage.
The casemix of clients is usually discussed with the University involved, so that all parties have similar expectations about the type of experience students will gain. Examples of clients that engage with students on placements include: self-funded clients (e.g. not Chronic Disease Management clients), existing clients whose cover has run out, clients that may have cover but have extra sessions with students not related to a rebatable claim, sporting teams and groups.
Universities provide support to supervisors in a number of ways, depending on the needs of the supervisor and student. This is often phone calls / emails / online / site visits and will depend on the University as to what their processes are. We strongly recommend supervising practitioners contact the University to discuss any student issues as early as possible and to consider appropriate strategies.
Top 10 reasons for supervising students in private practice!
- Develop and recruit future employees
- Improve client satisfaction - most clients report positive feedback from being involved in the student learning experience
- Stay current – learn what the students are learning
- Establish a relationship with University programs – clinical educators may be entitled to University library access, formal affiliation status with the University, and access to resources / professional development
- Raise the status of your practice
- Expand your skillset - develop your educator, mentoring and supervisory skills
- Give your staff more options in their career pathway and provide variety in their daily practice
- Raise the bar and standards of your practice
- Enhance your clinical skills by teaching someone else
- Share your expertise with future physiotherapists and leave a legacy!