Good Practice in Australian Physiotherapy Education

In the undergraduate program at the University of Sydney, the Clinical and academic curricula are integrated with students undertaking clinical placements in Year 2, 3, 4. A good example of our integration is the Mentored Clinical placement which is undertaken in first semester of second year. Students attend clinical sites 1 day per week for seven weeks and are required to undertake workbook tasks. The assigned tasks are directly related to 3 academic units of study which are running concurrently in semester 1 of year 2. The three units of study are: Clinical Observation and Measurement, Professional Practice and Evidence Based Physiotherapy. The assessment of these three units of study reflects the integration of the clinical and academic curricula with the workbook tasks providing a component of the assessment in each of the three academic units of study.
The delivery of the academic units of study involve lecture and tutorial format utilising many forms of media including powerpoint, web based materials and digital photos and videos. The clinical components provide a series of practical tasks which need to be completed such as measurement of joint range and muscle strength while others involve observation and structured reflection.

The Community Health Practicum is a 5 week practicum in which the student explores areas of health need that have not been traditionally covered in physiotherapy programs, such as mental health, aged care, health promotion, sports coverage, obesity prevention and management. These areas reflect the changing health care needs of the Australian population and will ensure that graduates are well positioned to provide appropriate care in the changing health climate. For example, one community health practicum might involve 3 days per week in a nursing home and weekends covering weekend sports, such as school football or local netball teams.
This practicum offers less formal structure and greater diversity than traditional practicums and this will enable students to gain the generic skills of flexibility, time management and adapting to changing health care needs.
 
Students are required to generate independent learning contracts specific to the practicum. These learning contracts are developed and negotiated with practicum mentors. Students and practicum mentors work collaboratively to develop strategies to ensure attainment of the learning contract. In addition to assessment of physiotherapy clinical skills, students are required to reflect on the diversity of the practicum and provide evidence of the learning process.

As a part of initial introductory clinical placements in years 1 and 2, students complete Clinical Practice Workbooks. The workbooks are designed to enhance the clinical experience by encouraging student to seek out, perform and document specific structured tasks, and to reflect on their performance. Workbook activities require students to relate the clinical impairments documented in assessment tasks to the patients' quality of life assessed through discussions with patients. In addition, the workbooks encourage students to learn about the physiotherapist's work environment through tasks that require reflection on management and safety issues, manual handling, and equipment use. Clinical reasoning is enhanced through tasks that require the student to discuss observations from patient charts or interviews that are necessary for clinical decision-making. Students present a patient case to their peers following their first placement, and presentations are guided by their clinical workbook activities.

Physiotherapy students are allocated to one of the three general Clinical Schools of the Faculty on entry into year one of the physiotherapy course. Each Clinical School has an Associate Clinical Dean of Physiotherapy who is responsible for approximately 120 or one third of the undergraduate students. With the exception of 12 weeks of elective units and eight weeks in paediatric and gerontological physiotherapy all students spend their clinical education periods in their own Clinical Schools. This provides students with a university clinical base. Here they are well known by clinical and administrative staff, are supported by the infrastructure of the Clinical School and are familiar with the site environments and their requirements. In the Clinical School each student spends the equivalent of a week in each of the first two years, 18 weeks in year three and 12 weeks in year four.
An overview of the content and management of the clinical education components of the course is the responsibility of the Clinical Education Committee. The whole course is developed in conjunction with the clinicians who participate in discipline specific working groups. Course outcome, assessment, content and supporting teaching materials such as problem based learning triggers, manuals and multimedia are planned, developed and completed in these groups. The academic program is integrated within the clinical education program with appropriate teaching sessions occurring at the clinical sites. The clinicians have responsibility for continuous clinical assessment and the discipline specific and final clinical exams. Assessment reliability is established within the working groups.
The Associate Clinical Deans, with the support of their staff, the School of Physiotherapy's Clinical Coordinator and the undergraduate administrative team manage the clinical program. Junior clinical staff have management and content responsibility for the clinical education program in years one and two. They also act as mentors for students in years three and four. Senior clinicians oversee the clinical education program in these latter years.
An Associate Clinical Dean of Physiotherapy is a member of the School's Planning and Resources Committee and participates in senior academic staff selection. The Head of School participates in selection of Associate Clinical Deans. Clinical staff with significant educational responsibility are Fellows of the School of Physiotherapy and have full access to all University resources. In addition the University School of Physiotherapy runs general and site-specific inservice programs related to clinical education and in the specialist discipline areas. Clinical staff from the Clinical School teach elements of the academic program within the University.
The contained nature of the distribution of the students within the Clinical Schools enables the program's support by the International Student Support Program of the Faculty. As well as dedicated computers, telephone, fax and email the clinical education program is supported by 'Plexus' - an electronic data source for student timetables, assessment forms, information on clinical sites and clinical staff. It also includes notes on supervision and experiential learning for the clinicians.

Clinical Units are integrated into an academic course (subject) throughout the physiotherapy program. Prior to and following each clinical placement students discuss their clinical experiences with the supervisor of clinical education, the course convenor (following clinical unit) and a psychologist (following clinical unit).

Final year students in the School of Physiotherapy at Curtin University of Technology spend most of their year in clinical placements and are required to demonstrate that they meet the Australian professional competencies. Students receive both formative and summative feedback throughout the placement. Students who do not meet the competencies fail. A handful of students may meet most of the competencies, but have areas of weakness (usually in generic attributes) which are likely to impact on their performance in subsequent placements.
An Additional Development Form is completed by the Clinical educators for these students who then meet with the Clinical Program Coordinator to discuss the issues impacting on their performance. A management plan is designed to support their development of deficient competencies. Support may range from accessing specific counseling by the University services, provision of additional teaching support, strategies to overcome learning difficulties, accessing appropriate mentoring, reviewing lifestyle factors or identifying cross-cultural barriers to communication and performance.
 
A detailed plan of action outlining the issues, strategies used and additional suggestions to support learning are provided for both the student and the supervisors in the student's next clinical placement. Discussions with all parties ensure that students and supervisors are working together to assist the student to develop the required professional behaviours and competencies. Additional monitoring of student performance and supervisor support occurs during subsequent placements to ensure both parties' needs are met.
Provision of support facilitates students who are expected to take responsibility for their personal and professional development, and ensures that these students receive the appropriate assistance to achieve successful completion of the program.