Profile of clinical training placement stakeholders and models of clinical supervision and facilitation

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1 WA CLINICAL TRAINING NETWORK Profile of clinical training placement stakeholders and models of clinical supervision and facilitation 30 August 2013

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3 Our Vision: To positively impact people s lives by helping create better health services. Our Mission: To use our management consulting skills to provide expert advice and support to health funders, service providers and users.

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5 Table of contents Healthcare Management Advisors 1 Introduction BACKGROUND PROJECT AIMS SCOPE OF DISCIPLINE AND STAKEHOLDERS PROJECT METHODOLOGY PURPOSE AND STRUCTURE OF THE REPORT Overview of clinical placements CURRENT CLINICAL PLACEMENT REQUIREMENTS AND ACTIVITY LEVELS Aboriginal health Audiology Chiropractic Dentistry Dietetics Exercise physiology Medical laboratory science Medicine Midwifery Nursing Occupational therapy Optometry Oral health Orthoptics Orthotics and prosthetics Osteopathy Paramedicine Pharmacy Physiotherapy Podiatry Psychology Radiation Science Social work Speech pathology Overview of placement activity ENROLMENT CAPACITY AND PLACEMENT COMPETITION Aboriginal health worker Audiology Chiropractic Dentistry Dietetics Exercise Physiology Medical laboratory science Medicine Midwifery Nursing Occupational therapy Optometry, Orthoptics, Orthotics, Prosthetics, and Osteopathy Oral health Paramedicine Pharmacy Physiotherapy WA Clinical training network i

6 Podiatry Psychology Radiation Science Social Work Speech pathology Overview of enrolment capacity and levels of collaboration and competition Models of clinical supervision and facilitation TERMINOLOGY MODELS OF CLINICAL SUPERVISION AND FACILITATION Aboriginal health Audiology Chiropractic Dentistry Dietetics Exercise Physiology Medical laboratory science Medicine Midwifery Nursing Occupational therapy Optometry Oral health Orthoptics and osteopathy Orthotics and prosthetics Paramedicine Pharmacy Physiotherapy Podiatry Psychology Radiation Science Social Work Speech Pathology Overview of supervision and facilitation models INTERPROFESSIONAL AND MULTIPROFESSIONAL EDUCATION Interprofessional Education Multiprofessional education Opportunities and challenges with interprofessional and multiprofessional education Clinical placements in regional locations OVERVIEW OF EDUCATION AND PLACEMENTS IN REGIONAL AREAS Broome: key health services, educational courses and placement activity Bunbury: key health services, educational courses and placement activity Geraldton: key health services, educational courses and placement activity Narrogin: key health services, educational courses and placement activity Port Hedland: key health services, educational courses and placement activity REGIONAL BARRIERS AND ENABLERS TO PLACEMENT CAPACITY Key enablers to clinical placement capacity Key barriers to clinical placement capacity PRIORITIES IN STRENGTHENING PLACEMENT CAPACITY Barriers and enablers to building placement capacity and quality ENABLERS TO PLACEMENT ESTABLISHMENT AND CONTINUATION ACROSS THE DISCIPLINES ENABLERS THAT SUPPORT QUALITY PLACEMENTS AND EXPANSION OF CAPACITY BARRIERS AND CHALLENGES Barriers and challenges across the disciplines: education provider specific Barriers and challenges across the disciplines: host agencies specific WA Clinical training network Profile of clinical training placement stakeholders and models of clinical supervision and faci ii

7 5.3.3 Barriers and challenges specific to disciplines Key opportunities for the future OPPORTUNITIES ACROSS DISCIPLINES OPPORTUNITIES BY DISCIPLINE Aboriginal health Audiology Chiropractic Dentistry Dietetics Exercise physiology Medical laboratory science Medicine Midwifery Nursing Occupational therapy Optometry, orthoptics, orthotics, prosthetics and osteopathy Paramedicine Pharmacy Physiotherapy Podiatry Psychology Radiation science Social work Speech pathology FOCUS FOR THE FUTURE Current partnerships, groups, networks and committees ABORIGINAL HEALTH AUDIOLOGY CHIROPRACTIC DENTISTRY DIETETICS EXERCISE PHYSIOLOGY MEDICAL LABORATORY SCIENCE MEDICINE MIDWIFERY NURSING OCCUPATIONAL THERAPY PARAMEDCINE PHARMACY PHYSIOTHERAPY PODIATRY PSYCHOLOGY RADIATION SCIENCE SOCIAL WORK SPEECH PATHOLOGY Appendices APPENDIX A STAKEHOLDERS CONSULTED APPENDIX B REFERENCES WA Clinical training network iii

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9 Acknowledgements Healthcare Management Advisors In undertaking this project HMA (Healthcare Management Advisors) has spoken with people from a wide range of organisations including educational providers and clinical placement providers across metropolitan Perth and the regional areas of Broome, Bunbury, Geraldton, Narrogin and Port Hedland. HMA has visited universities, vocational education training providers, registered training organisations as well as clinical educators, health professionals, community workers and managers. Settings for these visits has comprised: hospitals (public and private), community based health services, primary care services, government departments, Aboriginal and Community Controlled Health Organisations (ACCHOs), mental health services, aged and community care services, private practice, non-government organisations as well as discipline specific clinics run by educational providers or public health facilities. Additionally we have spoken with officers of the Department of Health and WA Country Health. HMA would like to thank all those who took part in our consultations. We greatly appreciated the time spent with us. We have endeavoured to capture the detail of the educational programs and the models of supervision and facilitation utilised by organisations as accurately as possible. We particularly appreciated the insights stakeholders had into: the enablers that support the provision of high quality clinical placements; the factors that have enabled the expansion of clinical placement capacity; and the opportunities to continue to strengthen clinical placement quality and capacity into the future. We trust this report will be useful in providing the Western Australia Clinical Training Network with: an overview of what is currently occurring in Western Australia across the 24 discipline areas examined; and useful information that will support future planning to strengthen clinical placement quality and capacity. HMA also wish to acknowledge the expertise of our associates who worked on this project: Dr Kristine Battye, Dr Catherine Sefton and Jan Veitch of KBC Australia, Associate Professor Tom Keating and Christine O Farrell. WA Clinical training network v

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11 Use of this report Healthcare Management Advisors This report presents the findings from the Profile of Clinical Training Placement Stakeholders and Models of Clinical Supervision and Facilitation Project, which was commissioned by the Western Australian Clinical Training Network (WA CTN). The project aimed to: (1) Identify and profile stakeholders engaged in clinical training placement activity, with a view to identifying the level and nature of student placement activity by profession, type of placement and health service provider type. (2) Identify models currently in place for the provision of clinical supervision and clinical facilitation by profession and to support interprofessional learning. (3) Identify enablers and opportunities to increase placement/enrolment capacity in the future by profession and type of placement. (4) Identify current partnerships, groups, networks and committees operating and their constituent membership, purpose and activity. This report seeks to assist the WA CTN set strategic directions to strengthen the quality of clinical placements and expand the capacity in the health and community sector to meet future demand for clinical placements. Whilst the focus of this report is on clinical placements, in setting priorities, the WA CTN will need to have regard to broader policy directions at a national and state level to strengthen health outcomes and strengthen workforce capacity. HMA has prepared two additional documents: (1) Discipline Summaries for each of the 24 discipline areas examined in the project. It is envisaged that these could be used to support discussion and planning at a discipline level. (2) Regional Area Summaries for each of the five regional areas visited. These could be used to support discussion and planning within regional areas as some strong themes emerged. HMA is also providing to WA CTN: (1) A list of champions or clinical/educational leaders in clinical placement development / expansion identified by stakeholders and in our consultation process. (2) The HMA stakeholder database containing contact details of people spoken with during the consultations. WA Clinical training network vii

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13 Executive Summary Healthcare Management Advisors The WA Clinical Training Network (WA CTN) was established to ensure that Western Australian (WA) health services and education and training providers are optimally positioned to offer quality clinical placements to health students, contributing to the development of a skilled and competent health workforce that will meet the needs of the WA community. At the inaugural meeting of the WA CTN, held in August 2012, one of the key themes to emerge was the need for enhanced collaboration between stakeholders. This project has been initiated in response to some of the issues identified at that meeting, specifically those relating to: communication between stakeholders involved in clinical training placements, and issues around supporting and developing clinical supervision and facilitation. Project aims The project aimed to: (1) Identify and profile stakeholders engaged in clinical training placement activity, with a view to identifying the level and nature of student placement activity by profession, type of placement and health service provider type. In gathering this information, HMA has sought to understand the differences in the profile of placements in rural and metropolitan areas, and identify the level and nature of interprofessional and innovative placement activity. (2) Identify models currently in place for the provision of clinical supervision and clinical facilitation by profession, and for interprofessional placements. This included identifying elements of good practice associated with quality placements and expanding placement capacity. (3) Identify enablers and opportunities to increase placement/enrolment capacity in the future by profession and type of placement. (4) Identify current partnerships, groups, networks and committees operating and their constituent membership, purpose and activity. This allows existing networks to be mapped and identify discipline areas where there may be a need for strengthening networks. Consultations were held with stakeholders involved in the provision of clinical placements in the following 24 discipline areas: Aboriginal Health Midwifery Paramedicine Audiology Nursing Pharmacy Chiropractic Occupational Therapy Physiotherapy Dentistry Optometry Podiatry Dietetics Oral Health Psychology Exercise Physiology Orthoptics Social Work Medical Laboratory Science Orthotics and Prosthetics Speech Pathology Medicine Osteopathy Radiation Science (incorporating sonography, radiography, nuclear medicine and radiation therapy) WA Clinical training network ix

14 Overview of clinical placements The content, structure and hours required for clinical placement required by universities and VET providers differs significantly across the disciplines examined in this report. The design of each discipline s clinical placement activity is almost always underpinned by the accreditation and competency requirements of the appropriate professional board or association. Clinical training placements for undergraduate and postgraduate students take place in a diverse range of settings including hospitals (public and private), community based health services, primary care services, Aboriginal Community Controlled Health Organisations (ACCHOs), mental health services, aged and community care services, private practice, and non-government organisations as well as discipline specific clinics run by educational providers or public health facilities. In particular it was noted that: (1) The Australian Health Practitioner Regulation Agency (AHPRA) only requires registration of students and professionals in 14 discipline areas, namely: Aboriginal health workers, chiropractic, dentistry, medicine, medical radiation practice, midwifery, nursing, occupational therapy, osteopathy, optometry, oral health, pharmacy, physiotherapy, podiatry and psychology (where students must apply to the professional association for provisional registration). (2) A few disciplines require graduates to undertake an internship year before they are able to apply for general registration to practice, notably medicine and pharmacy. On successful completion of their internship year, graduates are able to apply for general registration. (3) A number of disciplines applied models of placement where the student is employed whilst studying. This occurs for Aboriginal Health Workers, some midwifery courses, paramedicine and sonography. (4) A few courses require and/or support placements in rural areas most notably: medicine, dentistry, occupational therapy, medical imaging and physiotherapy. Many disciplines were supportive of rural placements. However, a few discipline areas said they did not use placements in rural areas as it was particularly difficult to find supervisors in regional areas. (5) Some courses have large volumes of students and specific setting requirements for students, most particularly nursing and medicine. Additionally, there were a number of disciplines for which no courses exist within WA: nuclear medicine, optometry, orthoptics, orthotics and prosthetics, osteopathy and radiation therapy. Some interstate universities are working with health services within WA at present to support clinical placement and some are interested in doing so in the future. Enrolment capacity and competition for placement Enrolment capacity in courses across the disciplines varied significantly. Some educational providers have capped the numbers of students they take for a range of reasons including: available funding, costs associated with delivering the course, strategic directions of the education provider, industry input, level of workforce demand, lack of clinical placements available and the inability of training facilities to accommodate additional student numbers. However, other courses have the capacity to accommodate increases in the number of students and clear growth strategies. The level of collaboration differs between discipline areas at present and appears dependent on individual program coordinators motivation, the desire for equity of placement opportunities, and the level of competition for placements facing a particular discipline area. Collaboration between university program coordinators has also occurred in response to WA Clinical training network x

15 requests from services that host students. Stakeholders said that competition for placement opportunities occurs both within and between disciplines and is influenced by: student numbers, the placement model, the length of placement, the availability of practitioners to supervise, and reliance on traditional services such as hospitals. The discipline areas facing greatest challenges in securing placements at present include: medicine, midwifery, nursing, psychology, exercise physiology, medical laboratory, medical imaging, paramedicine and radiation therapy. Models of clinical supervision and facilitation Across the different disciplines there was a range of supervision models in place. Some disciplines predominantly utilise a one to one supervision model, whilst other models involve having one supervisor to a number of students. Disciplines employing the one to one supervisor to student model include: Aboriginal health worker, audiology, exercise physiology, paramedicine, pharmacy, podiatry, psychology, sonography, nuclear medicine, social work and speech pathology. Some of the disciplines use a peer placement model where a supervisor(s) supports students attending in pairs (providing peer support to each other.) These disciplines include dietetics, occupational therapy and speech pathology. A number of disciplines have models of supervision involving one supervisor to a number of students (often varying from 1:2 to 1:10 in the disciplines examined). The discipline areas using these models include: chiropractic, dentistry (after an initial period), midwifery, nursing, occupational therapy, oral health and physiotherapy. In medical laboratory science, medical imaging and radiation therapy and some pharmacy placements the models of placement involve two or more supervisors for each student. Often student supervision was shared amongst a small group of supervisors when: the placement was over many weeks or months, supervising staff worked part time and there was a need for full time supervision, the model of supervision was intense or complex, or the students were required to rotate across different work areas. The majority of models incorporated a senior staff member taking responsibility for facilitating the placements, liaising with the universities and orientating and supporting students whilst on placement. There was a lot of interest across the professions in developing interprofessional competencies. With increasing numbers of older people and those living with chronic conditions, good practice requires multidisciplinary and interdisciplinary care. Developing student s competencies in working with other health professionals is essential. Health Workforce Australia has played a key role in supporting the development of these innovative models. Whilst there is a lot of support for these models, there are still a number of challenges related to their operation that need to be addressed before they are introduced more widely. Clinical placements in regional locations Five regional centres were visited: Broome, Bunbury, Geraldton, Narrogin and Port Hedland. Each of the five regions has unique characteristics, challenges and strengths that influence their ability to provide quality clinical placements. However there were a number of recurrent themes that arose in discussion related to building placement capacity and quality. Key strengths and enablers in maintaining and increasing capacity of clinical placements across regional and remote settings included: WA Clinical training network xi

16 the quality of the placement offered; desire to attract health professionals to the region; funding from Health Workforce Australia to establish Interprofessional Education (IPE) programs; scholarships to undertake rural placements (such as John Flynn Scholarships, and those supported by the Combined Universities Centre for Rural Health, Services for Australian Remote and Rural Allied Health and the WA Country Health Service); attractiveness of the region to students; individual motivation of the supervisors; accommodation and student resources in place: and remuneration provided to some clinical supervisors, services or departments. Key barriers to the expansion of student clinical and field placement capacity across regional and remote settings included: the availability and cost of student accommodation; insufficient space in facilities to host students; lack of staff with required competencies to provide supervision; length and model of clinical placement; social and community isolation; and cancellation of placements with insufficient notice to organise replacements. Priorities identified in strengthening placement capacity in regional locations include: (1) Strategies that support regional areas to grow their own health workforce. (2) Improving access to accommodation and transport. (3) Establishing coordinator roles to support placements within regions. The Rural Clinical School model was considered to be effective and there was support for this model being expanded / applied to other disciplines. Enablers to building placement capacity and quality Stakeholders were asked about enablers to building placement capacity and quality. A number of key themes arose pertaining to enablers of clinical placement establishment and continuation across disciplines. These included: (1) Organisational and management support for supervision and a culture of teaching, including recognition of the role of supervisor within their setting. (2) Systems and structures that require all staff to play roles in supporting clinical placements and availability of professional develop opportunities to strengthen their competencies in supervising students. (3) A sense of partnership between educational institutions and hosting agencies. (4) Recruitment practices of the agencies. (5) Individual motivation of the supervisors. (6) Provision of a university supervisor / facilitator / field placement liaison officer that provides practical support. (7) Educational providers commitment to maintaining good working relationships with agencies and their supervisors. (8) Capacity to provide students sufficiently skilled/trained to deal with placement complexity. (9) Sufficient staff available to provide supervision. WA Clinical training network xii

17 (10) Good coordination between education providers. (11) Having students in the agency who make a valued contribution. (12) An ongoing connection to the university environment and resources. (13) Strong linkages with past graduates. (14) Funding from Health Workforce Australia. A number of key themes arose relating to enablers that support quality placements for students and the expansion of placement capacity. These included: (1) A strong workforce development objective beyond the immediate objective of providing placements. (2) Robust models of supervision and facilitation. (3) Good orientation and training manuals and resources for students and supervisors. (4) Consistent approaches to assessment frameworks including generic handbooks. (5) Tools that support preceptors/supervisors monitor student attainment of competencies and educational provider support when student performance issues arise. (6) Clinical placement networks. (7) Supervisor training and other professional development opportunities provided by the educational provider. (8) Development of career pathways and opportunities for staff interested in teaching. (9) Proactivity and innovation of discipline program coordinator. Barriers to building placement capacity and quality During consultations some barriers were reported across the education and health sectors, whilst others were specific to disciplines. Barriers and challenges identified across the disciplines specific to education providers include: (1) Ongoing challenges of sourcing and maintaining placements. (2) Challenge of providing incentives to hosting agencies and supervisors. (3) Competition for placement opportunities from other education providers. (4) Access to appropriate staff to supervise. (5) Attractiveness of sites and quality of placement experience for the student. (6) Difficulty engaging private practitioners as supervisors. Barriers and challenges identified across the disciplines specific to host agencies include: (1) A lack of physical space including rooms, offices, desks, computers and secure storage. (2) Length and model of placement. (3) Inability of staff to manage the demands of the supervision in conjunction with their ongoing workload. (4) Lack of recognition for the role of supervisor. (5) Inequitable funding for some disciplines to cover the costs of supervising students. (6) Organisational and administrative instability. Some of the barriers and challenges surrounding clinical placement are discipline specific. Barriers for specific disciplines are presented in detail in Chapter 5: Barriers and enablers to building placement capacity and quality. WA Clinical training network xiii

18 Opportunities across disciplines Common opportunities to strengthen or expand clinical placements identified in consultations with stakeholders include: (1) Formal recognition of supervisors/preceptors: Across a number of professions, universities and health services spoke of the importance of good quality placements. To a large extent, enthusiastic supervisors/preceptors who go out of their way to provide a positive learning experience for students are at the core of good quality placements. A number of professions spoke of the importance of ensuring appropriate professional recognition is given to those undertaking these roles. (2) Credentialing of preceptors/supervisors: Some disciplines spoke of significant variations in the quality of placements, based on the interest of the supervisor, their clinical expertise and their skills in supervising/preceptoring students. Some stakeholders suggested consideration be given to accrediting training programs and credentialing preceptors/supervisors (such as those to be introduced from July 2013 for psychology). (3) Interprofessional learning: A number of stakeholders saw opportunities for strengthening interprofessional learning opportunities for students in the final year including: chiropractic, pharmacy, and speech pathology. (4) Consideration of simulation: The opportunity for simulated learning activities to fulfil specific competencies normally acquired through clinical placement produced divergent responses. Some of the university representatives could see value in simulation to achieve certain task based competencies whereas others were less positive. Almost all disciplines considered that simulation was an important learning and teaching method that can enhance rather than replace clinical placement activity. Irrespective of stakeholder views, at present the accreditation requirements of many disciplines do not allow for simulation to replace clinical placement activity. (5) Greater collaboration and coordination within disciplines: Some of the disciplines work collaboratively to identify and approach host agencies and coordinate the allocation of placements. Others have common assessment frameworks that are utilised by all educational providers. In anticipation of increased demand for clinical placement opportunities and recognition of the administrative onus placed on hosting agencies, there is value in greater collaboration between educational providers within discipline areas to increase capacity and manage competition for placements. (6) New hospitals and health services recognise and incorporate sufficient space for students into their design and construction. Spaces for students to work, for teaching to occur and interprofessional education needs to be incorporated into the design of facilities. (7) Regular review of workforce demand: To ensure that students undertaking a program have reasonable employment opportunities at graduation, education providers need to continue assessing workforce demand for their disciplines and capping enrolment numbers when appropriate. (8) Continuation of Health Workforce Australia funding focused on increasing capacity of services to host students and enabling a dedicated coordinator to manage the increasing numbers and support a quality clinical placement experience. (9) Exploring methods of overcoming barriers to rural placement: The cost of accommodation and transport are major barriers to students undertaking clinical placement in regional areas at present. It is not clear how this issue can be definitively addressed. However, options may include the expansion of rural placement scholarships within WA, the introduction of rural incentives similar to those offered in other states or improved promotion of rural placement within some disciplines, greater flexibility in WA Clinical training network xiv

19 placement models, and exploration of partnerships in rural areas to coordinate all available accommodation. (10) A strategy to build on and around the already established Rural Clinical School infrastructure to support and enhance clinical placement opportunities in regional areas for students of all disciplines. The general concept of having training, mentoring, a resource centre, collegiate support and accommodation resource base for nursing and allied health students as well as medical students during training placements was acknowledged by many stakeholders to be attractive, especially in opening up more placement opportunities in the north west regions where the current logistics and costs are unaffordable. Future strategic directions Key themes to be considered in future approaches to strengthen capacity and quality of clinical placements include: (1) Continued support for collaborative approaches: it was apparent that disciplines that collaborated tended to have greater success in addressing the challenges facing them. Discipline areas that are collaborative in nature: (a) (b) (c) (d) (e) (f) (g) have educational providers working together with host agencies to address issues; minimise competition by alignment of the placement calendars; approach host agencies in a coordinated way to minimise duplication of effort; ensure allocations of placements are equitable; utilise common assessment frameworks and guides; identify problems emerging and develop solutions to address these issues together; and share information about how they approach supervision to ensure consistency and foster learning. (2) Support the development of new approaches to supervision: A wide range of placement approaches are being applied across the discipline areas. However, there is a need to increase awareness of the different models that can be utilised to supervise students to expand capacity. Models that should be considered include: (a) (b) (c) (d) (e) increased and better use of telehealth/videoconferencing/ipad and tablet technology to enable remote supervision; joint supervision arrangements that support students to work across a range of settings/organisations. Services may not have the capacity to support a student by themselves. However, if they rotate a student across settings/organisations it may be possible; engagement of recently retired/semi-retired clinicians to provide clinical supervision; hybrid supervision models where a range of senior clinicians support students in a remote setting and remote/visiting supervision is provided by a discipline specific remote/visiting supervisors; using public and private visiting specialists to contribute to training in areas where they provide specialist visiting services; and WA Clinical training network xv

20 (f) utilising specialist registrars undertaking regional rotations and/or outreach services to supervise junior doctors. (3) Support and recognition of supervisors/preceptors: Clinical supervisors, facilitators and preceptors are the backbone of the clinical placement system. Many clinicians supervising students on clinical placements do so on top of their already busy work role. It is important that increased recognition is given for the work they do and that time is allocated to allow them to supervise students. There is also a need to ensure there is ready access to professional development and networking opportunities. (4) Funding to support clinical placements: Health Workforce Australia funding has been instrumental in supporting innovations such as interprofessional education and the expansion of clinical placements in regional areas. To continue to innovate, there is a need to have the resources available to support the development of models. For most health services, whether they are public or private there needs to be recognition of the costs associated with taking students and some recompense that allows for clinical positions to be backfilled. (5) Focusing on addressing issues facing rural placement: which may include flexible models of supervision, continued Health Workforce Australia funding, shared accommodation resources or explorations of new accommodation options. Rural scholarships and incentives are also critical in ensuring students are able to afford to undertake placement in non-metropolitan settings. The Rural Clinical School provides a strong model of clinical education facilitation that could be adopted by other disciplines with sufficient funding and resources. (6) Importance of improving efficiency: Placement opportunities not being undertaken or cancelled with little notice was a key concern in discipline areas where there was a high level of competition. To address this there is a need for sophisticated tools and models of placement to support the efficient and effective management of high volumes of students who need to complete a range of specified placements. (7) Facility design: A major barrier to supporting placements across many disciplines was having the capacity to accommodate students. Future master planning for new hospitals and health services need to ensure clinical placement requirements are considered. Current partnerships, groups, networks and committees Stakeholders are involved in partnerships, groups, networks and committees at varying levels of formality or intensity. A high level overview of the current partnerships, groups, networks and committees operating related to clinical placements for each of the disciplines consulted with is provided in the final chapter. WA Clinical training network xvi

21 Abbreviations Healthcare Management Advisors AASW ACCHO AEP APAC APHRA CEC CPD CTN ESSA GP HMA HWA IPE MBS NGO NUCAP NZ OT RACF RPH SPEF-R VET WA WA CTN WOFT Australian Association of Social Workers Aboriginal Community Controlled Health Organisations Accredited Exercise Physiologist Australian Psychological Accreditation Council Australian Health Practitioner Regulation Agency Clinical Education Coordinator Continuing professional development Clinical Training Network Exercise and Sports Science Australia General Practitioner Healthcare Management Advisors Pty Ltd Health Workforce Australia Inter professional Education Medicare Benefit Schedule Non-Government Organisation National University Course Accreditation Program New Zealand Occupational Therapy Residential Aged Care Facilities Royal Perth Hospital Student Practice Evaluation Form-Revised Vocational Education Training Western Australia Western Australia Clinical Training Network World Federation of Occupational Therapist WA Clinical training network xvii

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23 1 Introduction 1.1 BACKGROUND Clinical training placements occur in a diverse range of settings, which include: hospitals (public and private), community based health services, primary health care services, Aboriginal Community Controlled Health Organisations (ACCHOs), mental health services, aged care services, community services, private practice, non-government organisations (NGOs), and discipline specific clinics run by education providers. The Western Australian Clinical Training Network (WA CTN) was established to ensure that Western Australian (WA) health services and education and training providers are optimally positioned to offer quality clinical placements to health students. This will in turn contribute to the development of a skilled and competent health workforce that will meet the needs of the WA community. Although it is early days for the Network, stakeholders have shown a strong interest in working together to make the WA CTN a success. At the inaugural meeting of the WA CTN, held in August 2012, one of the key themes to emerge was the need for enhanced collaboration between stakeholders. This project has been initiated in response to some of the issues identified at that meeting, specifically those relating to: communication between stakeholders involved in clinical training placements; and issues around supporting and developing clinical supervision and facilitation. The WA CTN Steering Group engaged HMA (Healthcare Management Advisors) to undertake extensive stakeholder consultations, focussing on: identifying and profiling clinical training placement stakeholders in WA; and identifying models of clinical supervision and facilitation currently applied in WA. This WA CTN project was funded by Health Workforce Australia (HWA) as an Australian Government initiative. 1.2 PROJECT AIMS The project aimed to: (1) Identify and profile stakeholders engaged in clinical training placement activity, with a view to identifying the level and nature of student placement activity by profession, type of placement and health service provider type. In gathering this information, HMA has sought to understand the differences in the profile of placements in rural and metropolitan areas, and identify the level and nature of interprofessional and innovative placement activity. (2) Identify models currently in place for the provision of clinical supervision and clinical facilitation by profession, and for interprofessional placements. This included identifying elements of good practice associated with quality placements and expanding placement capacity. WA Clinical training network 1

24 (3) Identify enablers and opportunities to increase placement/enrolment capacity in the future by profession and type of placement. (4) Identify current partnerships, groups, networks and committees operating and their constituent membership, purpose and activity. This allows existing networks to be mapped and identify discipline areas where there may be a need for strengthening networks. 1.3 SCOPE OF DISCIPLINE AND STAKEHOLDERS Consultations were held with a range of stakeholders involved in the provision of clinical university, vocational education and training (VET) and Registered Training Organisation (RTO) placements in the following 24 discipline areas: Aboriginal Health Midwifery Paramedicine Audiology Nursing Pharmacy Chiropractic Occupational Therapy Physiotherapy Dentistry Optometry Podiatry Dietetics Oral Health Psychology Exercise Physiology Orthoptics Social Work Medical Laboratory Science Orthotics and Prosthetics Speech Pathology Medicine Osteopathy Radiation Science (incorporating sonography, radiography, nuclear medicine and radiation therapy) The identification of appropriate stakeholders has been undertaken through a range of diverse methods. These included: reviewing the WA CTN contact list; Steering Committee recommendations; suggestions by WA Country Health regional directors and university program senior staff; and suggestions made by health sector and universities contacts via an online survey. A full list of stakeholders consulted throughout the project is provided in Appendix A. 1.4 PROJECT METHODOLOGY The project involved the following stages. Stage 1 Project initiation: The objective of this stage was to initiate the project and confirm the approach to be taken. Stage 2 Develop a consultation framework: A consultation framework was developed that guided the consultation process with education providers and health services. This stage included the development and dissemination of an online survey to stakeholders to identify stakeholders where good practice placements were occurring. Stage 3 Undertake consultations: HMA scheduled and undertook consultations with a range of educational providers, health and community services including NGOs and ACCHOs in metropolitan Perth and five regional areas: Broome, Bunbury, Geraldton, Narrogin and Port Hedland. WA Clinical training network 2

25 Stage 4 Prepare a final report: findings were summarised into a final report (this document). 1.5 PURPOSE AND STRUCTURE OF THE REPORT The chapters of this report are structured in line with the project aims: (1) Chapter 2 provides information pertaining to Aim 1: Profiling the stakeholders engaged in clinical training placement activity with a view to understanding the level and nature of student placement activity by profession, type of placement and health service provider type. (2) Chapter 3 provides discussion relevant to Aim 2: Description of the clinical supervision and clinical facilitation models in place by profession, interprofessional learning placements. The chapter also identifies the elements of good practice associated with quality placements and expanding placement capacity. (3) Chapter 4 gives an overview of clinical placements in regional locations: Identifying key barriers and enablers that support clinical placement activity and opportunities to improve placement quality and/or placement capacity. (4) Chapters 5 and 6 present information specific to Aim 3: Identifying the key enablers and opportunities to increase placement/enrolment capacity in the future by profession and type of placement. (5) Chapter 7 provides information pertaining to Aim 4: Profiling current partnerships, groups, networks and committees operating and their constituent membership, purpose and activity. (6) Chapter 8 contains the appendices: Appendix A details the stakeholders consulted throughout the project. Appendix B provides a list of references. WA Clinical training network 3

26 2 Overview of clinical placements This chapter provides an overview of: current clinical placement requirements, placement demand, activity levels at the sites visited, educational provider s enrolment capacity and the level of competition amongst providers to secure placements. 2.1 CURRENT CLINICAL PLACEMENT REQUIREMENTS AND ACTIVITY LEVELS In this section, clinical placement requirements and activity levels identified within the scope of the project for each of the disciplines are presented. Please note: At the time this project commenced, universities were in the midst of preparing data relating to the number of students undertaking placements for Health Workforce Australia (HWA). As a consequence, HMA was asked to seek only high level information about the number of students undertaking each course and/or placements. Commentary on each discipline is presented in alphabetical order Aboriginal health The Community Services and Health Industry Skills Council has responsibility for oversight of the Aboriginal and/or Torres Strait Islander Health Worker qualifications and competency standards to ensure they are current and relevant to existing and emerging job roles. The final qualifications are currently under review. The Aboriginal and Torres Strait Islander Health Practice Board of Australia requires Aboriginal Health Workers intending to practice as Aboriginal and Torres Strait Islander Health Practitioners to be registered. However, those workers who are not required by their employer to use the title Aboriginal and Torres Strait Islander Health Practitioner, Aboriginal Health Practitioner or Torres Strait Islander Health Practitioner, are not required to be registered, and can continue to work using their current titles (for example, Aboriginal Health Worker, Drug and Alcohol Worker and Mental Health Worker). The approach taken to the training of Aboriginal Health Workers is quite different to all other courses HMA examined in this project. Generally, health services recruit an Aboriginal Health Worker from their local community and as an employee they are then enrolled in a Certificate III or IV Aboriginal Health Worker course and released for blocks of time to undertake studies. Marr Mooditj Training provides Certificate III, IV and Diploma of Aboriginal and Torres Strait Islander Primary Health Care courses. In the Certificate III course two weeks of observation placements are required. For the Certificate IV, three placements of two to three weeks are required. Generally, the experiential practice occurs in the work setting under the supervision of a Senior Aboriginal Health Worker. The courses are offered in a two week block release format. Students alternate between attending theoretical classes at Marr Mooditj Training. WA Clinical training network 4

27 The Aboriginal Health Council of Western Australia provides Certificate III and IV Aboriginal and Torres Strait Primary Health Care courses in Perth and provides training on behalf of Wirraka Maya Health Service as required. Most students complete Certificate III before moving on to Certificate IV and undertake placements in the health service they work in, although they may be required to work in a different area of their organisation. Kimberley Aboriginal Medical Services Council (KAMSC) provides courses in Aboriginal and Torres Strait Islander Primary Health Care from Certificate III to Advanced Diploma level. Students are recruited from the Kimberley region and trained to work in KAMSC member organisations. 1 Placements occur in the towns from which the students live. Table 2.1 provides the level of placement activity occurring at the sites visited. Table 2.1: Aboriginal Health Worker student placement activity Health Service Type Name of Health Service Approx. number of students each year ACCHO Derbarl Yerrigan Health Service 8 students ACCHO Broome Regional Aboriginal Medical Service 4 students (BRAMS) ACCHO Geraldton Regional Aboriginal Medical Service 1 at a time for 2-6 weeks placement numbers per year vary- generally local students ACCHO Wirraka Maya Health Service, Port Hedland Aboriginal Health Service Narrogin Community Health Service 1 recent graduate and 1 new trainee. Mental Health Primary Mental Health Service Narrogin 2 students Audiology Audiology Australia is the governing body currently responsible for registration of Audiologist in Australia and accrediting courses. Audiology Australia requires students to complete at least 200 hours of clinical placement of which at least 100 hours must be direct adult client contact and at least 30 hours direct paediatric client contact. The other hours can consist of indirect client contact. The University of Western Australia is the only university in WA offering an audiology course and one of only five programs in Australia. Approximately 30 students undertake the course, with a new intake of students commencing every two years. The Master in Clinical Audiology is a two year postgraduate degree. Students are required to complete 500 hours of clinical placement and demonstrate competency. Eighty to ninety per cent of all clinical placements must be undertaken under a 1:1 supervision model. There is no requirement for students to complete a rural placement as it is hard to find suitable supervisors and no funding is available to support a rural program. Currently there are 30 students enrolled in the course at the University of Western Australia. The university make arrangements with a range of health services to take students on clinical placements and many students attend the same health services several times throughout their course. Placements occur in a range of settings including: Australian Hearing, public hospitals, community health, private practice and specialised hearing schools. Table 2.2 provides an overview of the level of placement activity at the sites visited. Table 2.2: Audiology student placement activity Health Service Type Name of Health Service Number of students taken each year Public hospital Royal Perth Hospital 34 total students completing their final year in seven week placement 100 first year day placements NGO Telethon Speech and Hearing 30 students a year 1 day per week( students may complete multiple days) NGO Ear Science Institute of Australia 30 Students will attend 4 days within 2 year course Will have some students for 2 week placement blocks between Year 1 Year 2 WA Clinical training network 5

28 2.1.3 Chiropractic The Chiropractic Board of Australia is responsible for the registration of chiropractors and chiropractic students. Only students who have studied accredited courses are eligible to apply to the Chiropractic Board of Australia for professional registration. Prior to commencing clinical placements, educational providers need to ensure their students are registered with the Chiropractic Board of Australia. The Council Chiropractic Education Australasia Inc. formally accredits all chiropractic education courses and specifies the standards relating to clinical placements. 2 Murdoch University is the only university in WA delivering a chiropractic course. Students graduate with a joint degree of Bachelor Science and Bachelor of Chiropractics. Approximately 47 students are studying the course at present. Students must undertake a total of 46 weeks of clinical placements. Within this time they are expected to undertake 400 treatments and/or see 50 new clients which equates to close to 800 hours of clinical placements. The majority of placements are undertaken in the chiropractic clinic established on campus by the university. Additionally, students undertake placements at a number of outreach clinics established and supervised by university clinical staff. The outreach clinics are based in a number of NGOs which provide services to clients with more complex needs including: St Patrick s Community Support Centre (which helps people who are homeless, needy and disadvantaged), South Ottey Family and Neighbourhood Centre (which focusses on providing services to the local Aboriginal community) and Palmerston Farm (which supports people facing issues with alcohol and drug use). There are currently 47 students undertaking placements at the chiropractic clinic. The university also facilitates additional opportunities for students to undertake health screening assessments at cultural events such as music festivals and annual rural outreach clinics are delivered in Aboriginal and rural communities. Informally, some students facilitate overseas placements Dentistry The Australian Dental Council is the authority responsible for accrediting education providers and programs of study for the dental profession in Australia. Dental students must achieve set competencies for accreditation rather than specific hours undertaking clinical practice. The Dental Board of Australia is responsible for the registration of dentists and dental students. Only students who have studied accredited courses are eligible to apply to the Dental Board of Australia for professional registration. Prior to commencing clinical placements, educational providers need to ensure their students are registered with the Dental Board of Australia. The University of Western Australia is the only university in the State to offer a dentistry program. The undergraduate program of the School of Dentistry, the Bachelor of Dental Science degree, is being phased out from 2013 (final students to graduate 2016) and has been replaced with the Doctor of Dental Medicine (DMD). The DMD is a four year full time degree and its first graduate intake commenced in There are 56 students undertaking this course. All DMD applicants must have achieved at least a bachelor degree prior to commencing the program. The Oral Health Centre of WA (OHCWA) provides the most significant placement activity to dentistry students. The OHCWA is funded through a contract between The University of Western Australia and the WA Department of Health for provision of: clinical dentistry to eligible members of the public; and practical dental training linked with the courses provided by the university. WA Clinical training network 6

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