Expanding opportunities for adult speech pathology clinical education in Queensland

Transcription

1 FINAL REPORT QUEENSLAND REGIONAL TRAINING NETWORK HEALTH DISCIPLINE GROUPS 2014 Expanding opportunities for adult speech pathology clinical education in Queensland Queensland Health Speech Pathology Clinical Education and Training Advisory Group Helen-Louise Usher Speech Pathology, Statewide Clinical Education and Training Program Manager Daisy D Isernia Chair, Speech Pathology Clinical Education and Training Advisory Group Gretchen Young Director, Young Futures This project was made possible by funding from the Commonwealth Department of Health, through the Department of Health Queensland Author: Executive Officer, QCETC Date: Page 1 of 1 Version: 2.0

2 1. CONTENT 2. ACKNOWLEDGEMENTS EXECUTIVE SUMMARY Introduction Outcomes achieved Recommendations PROJECT OVERVIEW Purpose Background Methodology Project advisory group Exploring the landscape Surveying issues and opportunities within the profession Developing strategies and an action plan Project Limitations OBJECTIVES AND OUTCOMES Objectives Outcomes The current adult speech pathology clinical education landscape Clinical education models and arrangements Clinical education arrangements within specific clinical contexts General findings Survey findings Survey respondents Variables influencing provision of clinical education Increasing/sustaining future possibilities of providing clinical education Motivations for providing clinical education Ideal clinical education arrangements Future likelihood of providing clinical education Conceptualising new approaches to expanding adult clinical education capacity Recommendations SUMMARY / CONCLUSION BIBLIOGRAPHY APPENDICES Online Survey Stakeholder matrix Page 2 of 37

3 2. ACKNOWLEDGEMENTS The Speech Pathology Clinical Advisory Group would like to thank and acknowledge the valuable support and generous contributions of those who have facilitated the successful completion of this project, including: The Project Advisory Group, which included contributions from: o Elizabeth Cardell, Chair Queensland Speech Pathology Clinical Education Collaborative and Head of Speech Pathology Program, Griffith University o Paul Carding, Professor of Speech Pathology, Australian Catholic University o Katherine Cooper, Clinical Education Liaison Manager, Audiology and Speech Pathology, University of Queensland o Marissa Corcoran, Statewide Clinical Education and Training Program Manager Workforce Training Portfolio, Speech Pathology, Queensland Health o Rebekah Dewberry, Director and Senior Speech Language Pathologist, Red Soup Speech Pathology o Daisy D Isernia, Chair Speech Pathology Clinical Education Training Advisory Group o Shelley Gapper, Clinical Education Support Officer, Gold Coast University Hospital o Breanne Hetherington, Senior Clinician Speech Language Pathology Department of Communities, Child Safety and Disability Services o Ronelle Hewetson, Clinical Education Support Officer, Queensland Health o Simone Howells, Clinical Education Coordinator, Griffith University o Lucy Hunter, Clinical Education Liaison Manager, Audiology and Speech Pathology, University of Queensland o Kate Jorgensen, Senior Speech Pathologist/Clinical Education Coordinator, St Andrew s War Memorial Hospital o Christine Lyons, Senior Advisor Professional Practice, Speech Pathology Australia o Heather Pedley, Speech Pathologist, Blue Care o Gai Rollings, Chair Leaders in Speech Pathology, Queensland Health o Helen-Louise Usher, Statewide Clinical Education and Training Program Manager Clinical Education Portfolio, Speech Pathology, Queensland Health o Lauren Wolf, Speech Pathologist, Blue Care The individual speech pathologists from diverse practice contexts who contributed their experiences, ideas and insights to the survey which have provided a critical platform to formulate this report s recommendations. Page 3 of 37

4 3. EXECUTIVE SUMMARY 3.1. Introduction With a projected increase in Queensland speech pathology graduates from approximately 185 in 2013 to 270 in 2016, the demand for additional clinical education capacity is predicted to increase dramatically. Queensland Health currently provides the majority of adult clinical education for Queensland speech pathology students. However, having invested significantly in developing and implementing a range of innovative models to expand clinical education over the past six years, the public health system is reaching capacity and access to sufficient clinical education opportunities is reaching critical levels. The goal of this project was to identify strategies to increase capacity for adult clinical education within sectors beyond Queensland Health, including within other Government services, the not-for-profit sector, the aged care sector, private practice, and private hospitals. A Project Advisory Group including representatives from key stakeholder groups was established to oversee and guide the project. The project method included: researching examples of clinical education opportunities beyond the public health sector, surveying speech pathologists providing services to adults beyond the Queensland Health context to identify facilitators and barriers to expanding clinical education opportunities, and development of a set of recommendations to guide expansion of opportunities for adult clinical education through a workshop process with the Project Advisory Group Outcomes achieved The current adult speech pathology clinical education landscape Exploring the current clinical education context surfaced the following key findings: Traditional placement models predominate whereby 1:1, 2:1 and 1:2 student supervision by speech pathologists alone is provided, with minimal contributions to supervision through formalised peer supervision or supervision by other professions. Shared supervision within the one clinical team was recognised as a positive arrangements for students and clinical educators alike. Shared placements across services in one organisation or between two organisations was identified as a successful approach to increasing opportunities for a wider range of services to provide clinical education. Simulated learning is gaining momentum in all universities. Speech pathologists in private hospitals demonstrate interest and commitment to providing clinical education but identified issues at a hospital management level requiring consideration including impacts on revenue, patient consent, and lack of appreciation of the value students can bring to an organisation. There a range of models being used to provide clinical education in aged care facilities, however external support is required to provide the clinical supervision given current levels of allied health resources. In a time of transition for the disability sector, as the NDIS is developed and implemented, the current capacity of the Department of Communities, Child Safety and Disability Services is limited, despite the need to develop a workforce in this sector being high. A small number of private practitioners are positively and actively involved in providing clinical education and recognise a return to themselves and their business from doing so. Specific Page 4 of 37

5 issues to consider include establishing appropriate models for the private context, managing issues associated with paying clients, and ensuring optimal professional standards in the context of maintaining the profile of the speech pathologist s business. Diverse perspectives were evident regarding the framing of clinical education as opportunity and a positive experience for all stakeholders or a time consuming burden Survey findings The survey received 27 responses from speech pathologist who currently provide clinical education and 12 who do not. Key survey findings included: A wide range of variables influence the decision to contribute to clinical education, including but not limited to, organisational culture and policies, staff numbers and experience, caseload size and complexity, the administrative demands of clinical education, the desire to contribute to the profession, the quality of students, and the level of support from universities. Variables having the biggest impact on increasing the future contributions to clinical education included access to financial incentives, students being well prepared for the specific placement context, greater understanding from managers and colleagues of the benefits of taking students, access to resources, and support and guidance for clinical educators through universities, mentors and how to guides. The main motivators to contributing to clinical education included contributing to the development of students and the profession, speech pathologist s own professional satisfaction, maintaining a connection to universities, gaining knowledge of developments in clinical practice and building a workforce within the respondent s domain of practice. All but one respondent who currently provides clinical education indicated a definite or high likelihood of continuing to do so. Respondents who do not currently provide clinical education indicated varying degrees of likelihood of doing so in the future, but no respondents definitively said they would not. Perceptions of the ideal arrangement for providing clinical education were found to be as diverse as there are speech pathologists, organisational contexts and clinical domains. A wide range of concepts and issues were identified as requiring consideration, just a few examples included the fit between the placement model and the model of care of the service, building the knowledge base of the range of possible models, the need for clinical educators to have time without students, and issues of consent, fees and rebates for fee paying clients Conceptualising new approaches to expanding adult clinical education capacity At a workshop of the Project Advisory Group, Causal Layered Analysis (Inayatullah, n.d.) was used to surface new approaches to expanding adult clinical education capacity. The focus was on building appreciation of clinical education as a mutually beneficial endeavour for students, clinicians, service providers, universities and clients. With this as the focus, consideration was given to what this means for each of the stakeholders, which in turn, helped identification of systems and processes needed to work towards a broader appreciation of the mutually beneficial nature of clinical education. The project outcomes were used to inform development of the recommendations detailed below Recommendations The following recommendations were developed in collaboration with the Project Advisory Group and will be progressed by the Speech Pathology CETAG in collaboration with the Queensland Speech Pathology Clinical Education Collaborative. Page 5 of 37

6 1. Establish mechanisms to carry out system-wide endeavours that optimise clinical education and bring efficiencies to the six universities providing clinical education, current and potential clinical educators and students. These functions could be fulfilled either by: a. allocation of specific functions to individual universities and establishment of coordination mechanisms, or b. establishment of a shared permanent or long term temporary role (minimum 5 years) funded across the six universities. Optimal outcomes would be achieved through option b. In the short term, option a. provides a means to begin realising the efficiencies and improved outcomes of coordinated functions. 2. Establish a comprehensive data set identifying the speech pathology workforce providing services to adults beyond the Queensland Health context. 3. Use the data set to distribute information and raise awareness of information relevant to providing clinical education 4. Use the data set to inform a systematic process whereby individual Queensland Health clinical educators and/or Clinical Education Support Officers proactively approach and discuss the role of clinical education with individual speech pathologists with whom they have a professional relationship, or are likely to, given their geographic proximity or related domains of practice. 5. Having fulfilled Recommendation 3 and Recommendation 4, where organisational policies present the first barrier to clinical education being provided, systematically work to understand the issues within and across organisations as the first step towards formulating resolutions to these issues. 6. Use a range of approaches to showcase good news stories from the different perspectives of each stakeholder group and representing different clinical practice domains. 7. Establish mechanisms to provide information and support to speech pathologists new to clinical education by experienced clinical educators working in similar practice contexts and/or clinical domains. 8. Establish mechanisms to support the preparation of clinical educators for prospective students and similarly the preparation of students for prospective placements, 9. Broaden representation on the Speech Pathology CETAG to include all key stakeholder groups, including student representatives, new graduate representatives and client representatives. 10. Identify currently available resources relevant to supporting the roles of speech pathology clinical educators and ensure widespread awareness of their availability. 11. Explore specific opportunities for expanding clinical education opportunities in the adult disability sector. 12. Explore specific opportunities for introducing clinical education opportunities in non- Queensland Health Government services, particularly in role emerging contexts, for example, correctional centres. Page 6 of 37

7 4. PROJECT OVERVIEW 4.1. Purpose The purpose of this project is to proactively identify strategies to reduce barriers to and build capacity for adult clinical education within sectors beyond Queensland Health Background It is a national requirement that all speech pathology graduates (both undergraduate and entry level masters) must demonstrate prescribed entry level competencies in both adult and paediatric service provision to be awarded a degree in speech pathology. University programs undergo accreditation from Speech Pathology Australia to ensure these competencies are being met. To this end, all speech pathology students must complete multiple adult and paediatric clinical education placements, culminating in a final adult placement and final paediatric placement. Students must be assessed at entry level by a clinical educator using the national clinical assessment tool, COMPASS. The Speech Pathology Clinical Education and Training Advisory Group (CETAG) was established in 2009 to guide clinical education and training initiatives across the higher education sector, other government agencies and the broader speech pathology profession within private and nongovernment sectors within Queensland via the Queensland Branch Chair of Speech Pathology Australia. Current Speech Pathology CETAG membership includes representation from Queensland Health, Speech Pathology Australia, Department of Communities, Education Queensland and the Queensland Speech Pathology Clinical Education Collaborative (QSPCEC), which includes representatives from all six universities in Queensland offering speech pathology programs. Speech Pathology CETAG also engages with the Speech Pathology Clinical Education Support Officer Network (SP CESO Network) which includes the Statewide Clinical Education Program Manager Speech Pathology, all Queensland Health speech pathology Clinical Education Support Officers, and a representative of QSPCEC. Speech Pathology CETAG and QSPCEC have identified that with an increase in student numbers within speech pathology programs in Queensland, access to sufficient quality adult clinical education experiences is reaching critical levels. The pressure for additional clinical education capacity is predicted to increase over next two years as the number of speech pathology graduates in Queensland is projected to increase from approximately 185 in 2013 to 270 in Queensland Health currently provides the majority of COMPASS -assessed adult clinical education experiences for Queensland speech pathology students. However, the public health system is reaching capacity for adult student placement. This is the case despite having successfully increased capacity since 2008 through significant effort and investment in implementing a range of innovative clinical education models, conducting research on alternative approaches to clinical education, and keeping statistics on student numbers, and uptake of placement offers. This scenario highlights the importance of working proactively with key stakeholders and education partners to identify strategies that reduce barriers to and build capacity for adult clinical education opportunities within sectors beyond Queensland Health. Additional contextual issues reinforcing the importance of building adult clinical education capacity and activity beyond Queensland Health include: changing community demographics, in particular an ageing population, changing models of care, including an emphasis on delivering services close to people s homes and within the community, and Page 7 of 37

8 changing funding models, including the introduction of the National Disability Insurance Scheme which will result in the majority of disability support services being provide in the nongovernment and private sector. This project, initiated and lead by Speech Pathology CETAG, was designed to respond to the imminent challenge of meeting the demand for adult clinical education in Queensland by identifying opportunities to expand adult speech pathology clinical placement options beyond Queensland Health, including within other Government services, the not for profit sector, the aged care sector, private practice, and private hospitals Methodology Project advisory group A project advisory group was established including representatives from: Queensland Health, including the Chair of SP CETAG, Statewide Program Manager for Clinical Education, and Clinical Education Support Officers) Australian Catholic University Griffith University University of Queensland Blue Care St Andrew s Memorial Hospital Speech Pathology Australia Red Soup Speech Pathology Three teleconferences and one face-to-face workshop were held with the Project Advisory Group Exploring the landscape Desk research and a number of phone conversations were conducted to inform development of a survey of speech pathologists who work with adults in contexts outside the Queensland public health system. This research focused on identifying documented examples of clinical education opportunities beyond the public health sector, including examples within and beyond the speech pathology profession and within and beyond Queensland. Information was sourced from: the Project Advisory Group projects with similar objectives funded by the Queensland Regional Training Network online resources and reports communication with speech pathology training programs across Australia communication with individual speech pathologists Surveying issues and opportunities within the profession The information identified at 3.3.2, above, was synthesised to identify: facilitators and barriers to expanding adult clinical education opportunities, mechanisms that successfully motivate contributions to expand adult clinical education opportunities, and factors influencing successful implementation of adult clinical education in new contexts. Page 8 of 37

9 These findings informed the design of an online survey targeted at speech pathologists working with adults in contexts outside the Queensland public health system, regardless of whether they were currently providing clinical education or had ever provided clinical education in the past. The survey is presented in full in Appendix A Developing strategies and an action plan The Project Advisory Group came together for a single day workshop. The findings from and were presented. The workshop was then used to develop a set of recommendations to guide the expansion of opportunities for adult speech pathology clinical education Project Limitations Limitations on the method and outcomes of this project included the very tight timeline from project inception to project completion (5 September to 24 November 2014) and the extent of resources available. As a result, it was not possible to systematically or comprehensively identify the full range of placement arrangements and models currently being used within Queensland and across Australia. Similarly, the limited time available and lack of a data set defining the group of speech pathologists who work beyond Queensland Health meant that the distribution of the survey was dependent upon use of informal networks. Further, the window of opportunity for the survey was brief and consequently there was limited opportunity to build awareness across the speech pathology community to maximise the response rate. 5. OBJECTIVES AND OUTCOMES 5.1. Objectives The project objectives included: 1. Identify current issues and challenges, as well as barriers and enablers, to the provision of quality adult speech pathology clinical education experiences in sectors beyond Queensland Health. 2. Identify strategies to develop, implement and evaluate innovative models of clinical education to address the predicted shortfall of quality adult speech pathology clinical education experiences, particularly in sectors beyond Queensland Health. 3. Develop an action plan that demonstrates evidence and commitment to address the recommendations made in the report Outcomes The current adult speech pathology clinical education landscape Clinical education models and arrangements The following speech pathology clinical education models were identified as currently being used in different contexts across Australia: A range of supervisor to student ratios are used, however ratios of 1:1, 2:1 and 1:2 predominate, with ratios of 1:3 or more being rare, except in university clinics. Direct and indirect supervision predominates, although some examples of remote supervision utilising telephone, Skype TM, and teleconferencing do exist Page 9 of 37

10 Supervision by speech pathologists predominates, although examples exist where supervision is provided in combination by a) a non-speech pathologist and a speech pathologist, and b) a formalised peer supervision process and a speech pathologist. Although there are no documented standards in place regarding supervision by non-speech pathologists, universities approach this issue with caution given accreditation requirements Shared supervision within the one organisation was identified as being valuable for: Developing the skills of speech pathologists new to clinical education Enabling contributions to clinical education by part time speech pathologists Exposing students to diverse experiences and perspectives When a shared supervision approach is used, the value of using one primary supervisor and assessor was reinforced. Shared placements across services in the one organisation, or between two organisations were identified as being valuable for: Services with small numbers of speech pathologists Services with small and/or unpredictable caseloads Exposing students to diverse experiences and perspectives Placements facilitated through partnerships between universities and service providers, where the university provides clinical supervision within the service provider clinical contexts, were identified as being valuable for: Contexts where the speech pathology role is still emerging (e.g. aged care facilities, day respite centres, correctional centres) and organisational speech pathology staffing is limited or non-existent Building speech pathology practice within new organisations and clinical domains Simulated learning is gaining momentum in all universities to complement their current speech pathology clinical education programs. Client Tutor Programs involve pairing a student and an adult with acquired communication difficulties for a number of hours a week to develop a deep understanding of living with communication difficulties and the opportunity for the student to negotiate with their Client Tutor regarding their communication needs, and then assess, plan and implement a plan. Whilst this learning opportunity is not a COMPASS -assessed placement it is an important example with the potential to be further developed to meet the COMPASS assessment requirements Clinical education arrangements within specific clinical contexts When considering clinical education issues within private hospitals, the following factors were identified: A history of providing allied health services through contracted private practitioners, leading to the absence of a specific clinical education culture and in turn a lack of clinical education experience and confidence. A focus on not compromising revenue and an expectation of being funded to provide clinical education, particularly where this precedent has been established by other professions Diverse perspectives on consent processes required when asking paying patients to receive services from a student and the ethics of making this request at all. Page 10 of 37

11 Varying opinions across clinicians and hospital management regarding the cost-benefit to the organisation, clients, and staff from providing clinical education. Challenges providing a complete clinical experience where there are low and unpredictable patient numbers in a small hospital. Where the option for supervision by staff speech pathologists is ruled out or limited, in some locations university supervisors provide supervision. The administrative burden of student agreements was indicated to be unnecessarily high for some universities compared to others. A number of approaches to providing clinical education in aged care facilities were identified, including: Use of university supervisor, with a staff speech pathologist defining student roles and caseloads In the absence of a staff speech pathologist, clinical education is supervised by an onsite or remote university speech pathologist and/or on site non-speech pathology supervisor. Students conduct a needs analysis, review residents, provide relevant intervention and staff training. In the absence of a staff speech pathologist, a multidisciplinary in-reach service is provided. Provision of clinical education for adults with a disability through the Department of Communities, Child Safety and Disability are being affected by: Major system changes due to the soon to be introduced NDIS which is currently limiting capacity, at a time when workforce development is important. Loss of experienced staff resulting in the remaining experienced staff supervising a greater proportion of new graduates, thus reducing clinical education capacity. Recognition of the need for significant growth in the workforce of appropriately skilled speech pathologists in the disability sector when the NDIS commences in mid Experience suggesting that adult disability clinical education provided in traditional 1:1 supervision models are experienced as very demanding for students. However, there is limited published research or reports on different approaches to clinical education in the adult disability context. Currently, clinical education by private practitioners is not widespread. However, important findings were identified through communication with three practitioners and online reports: Private practitioners providing clinical education were very positive and deliberate regarding their decision to contribute to clinical education. Private practitioners noted that providing clinical education reduced isolation, satisfied their desire to contribute to others, gave them new ideas, supported their development and career progression opportunities, and contributed to their business through students completing quality improvement projects, and supported recruitment prospects. Private practitioners were more inclined to take final year students, but also indicated that observation placements were viable. Supervision is provided both directly and indirectly. Student to supervisor ratios included 1:1, 2:1 and 1:2. The need for guidance to establish optimal clinical education processes was identified, including approaches to managing the issues of client fees, and more specifically issues associated with clients receiving services through private health insurance, worker s compensation and other insurance arrangements. Page 11 of 37

12 General findings A number of more general issues were also identified, including: Diverse perspectives on whether providing clinical education to students presents an opportunity or burden. The presence of pockets of innovative clinical education practices beyond the public health context, but a significant need to scale this up across the service system. The need for clinical education models to meet the needs of the community, the service provider, students, supervisors, universities, and the profession. The needs for clinical education arrangements to be flexible and responsive to the clinical site. The value of external support to the service providing clinical education. The significant financial investment in clinical education by the Federal Government over recent years possibly has significant consequences for future willingness to contribute in an environment where funding is likely to be significantly reduced Survey findings Survey respondents Of the 53 respondents to the survey, 39 were eligible to contribute (i.e., work with adults in contexts outside the Queensland public health system). 27 of the 39 respondents were current providers of adult clinical education 16 of these 27 respondents completed all of the core content questions of the survey. Individual respondents were from diverse organisational contexts: 5 Government disability 3 private not-for-profit hospital 3 private practice multidisciplinary team 2 not-for-profit health community 2 private practice speech pathology only 1 Government hospital 1 Government health community 1 private for-profit hospital 1 university clinical education 12 of the 39 respondents were not current providers of adult clinical education 10 of these 12 respondents completed all of the core content questions of the survey. The organisational contexts of the individual respondents included: 8 private practice speech pathology only 2 private for-profit hospital 1 private not-for-profit hospital 1 not-for-profit community Variables influencing provision of clinical education When asked to identify the variables that influence decisions about providing clinical education, the following factors were identified: Financial lack of financial incentives; cost to private practice; Organisational culture policies supportive of clinical education; organisational recognition of students as an asset to providing evidence based practice; Staffing numbers, extent of individual experience since graduating; Page 12 of 37

13 Personal interest in providing clinical; Caseload size; variability of caseload size across the year; complexity/appropriateness of caseload for undergraduates (palliative care, challenging behaviour); match of organisational capacity to clinical education requirements; Placement type required/possible duration; shared/interagency; sessional, part-time, fulltime; opportunity for non-student time; option to accommodate variable hours; Supervisor option for a supervisor to be provided by university Administrative extent of university paperwork; extent and quality of organisation and communication by university; Supervision options need for confirmation that providing a proportion of supervision indirectly and/or remotely is acceptable; Resources current workload; space; clinical resources, such as assessments and computers; administrative resources; Private patients perspectives on the appropriateness of students working with clients who are paying for services Mobile service difficulties when a client declines student involvement; need for student transport Student quality language and literacy skills; theoretical knowledge; willingness to invest in fulfilling clinical education requirements out of hours; level of motivation student expectation to be passed; University support level of support to fail students; Awareness that private practitioners can provide clinical education; Contributing to the profession; and Professional development mutual learning Increasing/sustaining future possibilities of providing clinical education When asked to select variables from a list that would have a significant impact on increasing/sustaining the future possibility of the respondent contributing to clinical education in their current role, Table 1 presents the responses that predominated for those who currently provide clinical education and those who do not currently provide clinical education. Table 1. Survey Q. 21 From the list provided, identify each variable that would have a significant impact on increasing/sustaining the future possibility of you contributing to clinical education in your current role. Provide clinical education (n = 16 ) Do not provide clinical education (n = 11) Students being well prepared for the domain and context e.g. disability, aged care, private practice, not-for-profit (n=12, 75%) Access to university library resources (n=11, 69%) Professional development opportunities for novice CEs (n=10, 63%) Opportunities for part-time and/or shared/interagency models (n=9, 56%) Financial incentives (n=9, 56%) Access to university titles reflecting involvement in CE (n=8, 50%) Opportunities for part-time and/or shared/interagency models (n=8, 73%) Students being well prepared for the domain and context e.g. disability, aged care, private practice, not-for-profit (n=8, 73%) Formal and regular support from a clinical education facilitator for the CE (n=8, 73%) Support from a network of CEs from similar contexts (n=7, 64%) Assistance to identify a model best suited to my clinical context (6, 55%) Formal and regular support for student from a CE facilitator for the student (n=6, 55%) Opportunities to screen students prior to placements (n=8, 50%) Access to university library resources (n=6, 55%) Page 13 of 37

14 Note: Every option presented (see Q. 21, Appendix A) was selected by at least one respondent. When asked to specify the three variables likely to have the biggest impact on increasing the future possibility of contributing to clinical education in their current role, the responses presented in Table 2 were identified. Table 2. Survey Q. 22 Which 3 variables would have the biggest impact on increasing the future possibility of you contributing to clinical education in your current role? Provide clinical education (n=16 ) Financial incentives (n=8, 50%) Do not provide clinical education (n=11) Formal and regular support from a CE facilitator for the CE Assistance to implement a model from a colleague who has successfully implemented a similar model in a similar context/ How to resources for different clinical placement models and/or clinical contexts (n=8, 73%) Students being well prepared for the domain and context e.g. disability, aged care, private practice, not-for-profit (n=5, 31%) Financial incentives (n=7, 64%) Greater understanding from my managers and colleagues of the benefits of taking students (n=4, 25%) All items were selected Resource support e.g. loan laptops; loan assessments (n=3, 27%) Not selected: Professional development opportunities for novice CEs; Professional development opportunities for experienced CEs Professional development opportunities clinical Opportunities to participate in research Access to university titles reflecting involvement in CE Opportunities to contribute to CE planning within universities Comments from respondents included: Private SP is a service to paying customers. The student must be professional and not risk the company s professional reputation. [We d need] increased supports to help the clinical educator maintain efficiency while inducting a student. [I need] a thorough understanding of the expectations of a clinical supervisor Motivations for providing clinical education When asked to select variables from a list that would motivate the respondent contribute to or continue contributing to clinical education in the future, the following responses predominated for those who currently provide clinical education and those who do not currently provide clinical education. Page 14 of 37

15 Table 3. Survey Q. 23 From the list provided, identify each variable that would motivate you to contribute to/continue contributing to clinical education in the future. Provide clinical education (n=16 ) Contributing to the development of my profession (n=14, 88%) Contributing to the development of students (n=13, 81%) Contributing to my professional satisfaction (n=11, 69%) Maintaining a connection to universities (n=10, 63%) Fulfilling an obligation to the profession (n=8, 50%) Do not provide clinical education (n=10) Gaining knowledge of developments in clinical practice (n=8, 80%) Building a workforce with clinical skills in my domain of practice (n=7, 70%) Contributing to my professional satisfaction (n=7, 70%) Contributing to the development of my profession (n=7, 70%) Contributing to the development of students (n=7, 70%) Fulfilling an obligation to students (n=7, 44%) Fulfilling an obligation to the profession (n=7, 70%) Building a workforce with clinical skills in my domain of practice (n=7, 44%) Gaining knowledge of developments in clinical theory (n=6, 60%) Gaining knowledge of developments in clinical practice (n=5, 31%) Maintaining a connection to universities (n=6, 60%) Note: Every option presented (see Q. 23, Appendix A) was selected by at least one respondent. When asked to specify the three variables likely to have the biggest impact on motivating contributing to clinical education in their current role, the responses presented in Table 4 were identified. Table 4. Survey Q. 24 Which 3 variables would have the biggest impact on your motivation to contribute to clinical education in your current role? Provide clinical education (n=16 ) Contributing to the development of students (n=7, 44%) Contributing to the development of my profession (n=5, 31%) Contributing to my professional satisfaction (n=5, 31%) Maintaining a connection to universities (n=4, 25%) Building a workforce with clinical skills in my domain of practice (n=4, 25%) Not selected: Developing immediate potential recruitment opportunities for my organisation; Fulfilling an obligation to my organisation. Do not provide clinical education (n=10) Contributing to the development of my profession (n=5, 50%) Gaining knowledge of developments in clinical practice (n=5, 50%) Building a workforce with clinical skills in my domain of practice (n=4, 40%) Contributing to my professional satisfaction (n=3, 30%) Not selected: Building the profile of my organisation; Expanding the perspectives of my organisation; Fulfilling an obligation to my organisation; Developing immediate potential recruitment opportunities for my organisation. Page 15 of 37

16 Comments from respondents included: The responsibility to give back and teach the budding speech pathologist. A student who is genuinely committed to learning and making a difference to clients. [The opportunity for] mutual learning. Building a workforce of competent clinicians. The ability to shape and model speech pathology practices and standards Ideal clinical education arrangements Perceptions of the ideal arrangement for providing clinical education are as diverse as there are speech pathologists, organisational contexts and clinical domains. From the survey responses, a wide range of concepts and issues were identified as requiring consideration. These included: Ensuring a good fit between the placement model and length and the service s model of care. Need for broadening knowledge of and skills to provide diverse clinical education models. Allowance for time without students (e.g. part-time, 4 days, 5 short days). Interest in paired clinical education arrangements for peer learning and support and to reduce some demands on the clinical educator. Interest in shared supervision to develop the skills of novice clinical educators and to enable part-time speech pathologists to supervise. Interest in part-time interagency clinical education for small not-for-profits and private practitioners. Use of a university supervisor within a non-queensland Health facility. Issues of consent, fees and rebates for private clients. Generalist clinical education opportunities within private practices in metropolitan areas. Access to financial incentives and/or reimbursement of expenses The administrative burden of clinical education management. Adequacy of space. Access to resources, in particular assessments. Student access transport to enable attendance at different places on different days. Comments from respondents included: One student works better for the supervisors as it is quite a complex area that we work in and not all of our clients can been seen by students so the supervisors still have their own caseload. But, having a second student might provide them with some peer support. Ideally a student is here 4 days per week. This gives the CE one day per week to plan and catch up on other jobs that need to be done. Four days allows the student to have a good grasp of the structure of the organisation, and really be immersed in the learning environment. A placement where a student or students are here for consecutive days so that they can observe changes in patients, build rapport and witness patients achieving goals. My caseload has such a high and fast turnover that coming one day a week would likely mean seeing different patients every time. Ideal arrangements would be one student for no more than 6 weeks as I only work during school terms. Two students would be too much work. I would be happy to work in conjunction with another service. One to two days/week would be the maximum I could provide and probably half days as I often have regular patients booked in for therapy but other times have to visit private hospitals and nursing homes. Four days per week with supervision shared between two colleagues. Page 16 of 37

17 Future likelihood of providing clinical education Table 5 presents the likelihood of respondents providing clinical education in the future. All but one current clinical educator indicated a definite or high likelihood of providing clinical education in the future. Eight of the ten respondents not currently providing clinical education indicated a definite, or a high likelihood, or a possible intent to provide clinical education in the future. Table 5. Survey Q. 25 Within your current role, how likely are you to contribute to adult speech pathology clinical education in the future? Provide clinical education (n=16 ) Do not provide clinical education (n=10) Definitely 9 (56%) 1 (10%) Highly likely 6 (38%) 2 (20%) Possibly 0 5 (50%) Probably not 0 2 (20%) Highly unlikely 0 0 Definitely not 1 (6%) Conceptualising new approaches to expanding adult clinical education capacity The project workshop was used to conceptualise new approaches to expanding adult clinical education capacity. Causal layered analysis (CLA) (Inayatullah, n.d.) was used to guide this process. CLA is based on the premise that the way issues are framed strongly influences how they are understood, and therefore limits the perceived scope of possible change. (Scenarios for Sustainability, n.d.). As shown in Figure 1 on the following page, CLA provides a framework to explore an issue at four different levels, and in turn identify a set of solutions corresponding to each level. Page 17 of 37

18 Figure 1. Causal Layered Analysis Using the CLA framework to integrate the project findings and consider new opportunities for expanding adult clinical education opportunities, the following perspectives, detailed in Figure 2, were identified. Figure 2. Causal Layered Analysis of speech pathology clinical education Page 18 of 37

19 Recommendations The perspectives identified above were used to inform development of the following recommendations. The recommendations will be progressed by the Speech Pathology CETAG in collaboration with the Queensland Speech Pathology Clinical Education Collaborative. 1. Establish mechanisms to carry out system-wide endeavours that optimise clinical education and bring efficiencies to the six universities providing clinical education, current and potential clinical educators and students. Examples of possible functions include: a. establish and maintain a data set of practicing speech pathologists that is used to optimise awareness of and engagement with issues relevant to clinical education using a range of communication modes b. promote the role of clinical education to current students, new graduates and experienced clinicians c. create a single entry point for potential clinical educators to explore the nature of the role and models of clinical education optimal for their context d. management of information sharing, mentoring, and networking between potential, novice and experienced clinical educators e. establish and facilitate a network of clinical education champions f. communicate positive stories of clinical education from all perspectives to the speech pathology professional community g. identify the systemic change opportunities arising from individual experiences, both positive and negative h. streamline processes for stakeholders i. refine processes of incentive and appreciation, including library access, academic titles, acknowledgement and appreciation These functions could be fulfilled either by: a. allocation of specific functions to individual universities and establishment of coordination mechanisms, or b. establishment of a shared permanent or long term temporary role (minimum 5 years) funded across the six universities. Optimal outcomes would be achieved through option b. In the short term, option a. provides a means to begin realising the efficiencies and improved outcomes of coordinated functions. 2. Establish a comprehensive data set identifying the speech pathology workforce providing services to adults beyond the Queensland Health context, including but not limited to speech pathologists working in the following contexts: a. private hospitals (for-profit and not-for-profit) b. private practices c. not-for-profit organisations d. residential aged care facilities e. day respite centres f. Government services beyond the Queensland Health context 3. Use the data set to distribute information and raise awareness of information relevant to providing clinical education, including for: a. flexible clinical education arrangements, b. diverse ways to contribute to clinical education including project placements, observation placements, sessional placements and block placements, and c. training and resources relevant to clinical education. Page 19 of 37

20 This process should ensure comprehensive coverage of each of the service contexts identified in Recommendation Use the data set to inform a systematic process whereby individual Queensland Health clinical educators and/or Clinical Education Support Officers proactively approach and discuss the role of clinical education with individual speech pathologists with whom they have a professional relationship, or are likely to, given their geographic proximity or related domains of practice. 5. Having fulfilled Recommendation 3 and Recommendation 4, where organisational policies present the first barrier to clinical education being provided, systematically work to understand the issues within and across organisations as the first step towards formulating resolutions to these issues. 6. Use a range of approaches to showcase good news stories from the different perspectives of each stakeholder group and representing different clinical practice domains, including but not limited to: a. establishing a private page on an appropriate social media platform focussed on speech pathology clinical education, and b. publishing a bi-monthly stories in Speech Pathology Australia s Speak Out magazine and/or Queensland e-news, profiling different perspectives on the clinical education experiences of speech pathologists from diverse clinical practice contexts, students, clients, organisational management etc. 7. Establish mechanisms to provide information and support to speech pathologists new to clinical education by experienced clinical educators working in similar practice contexts and/or clinical domains, including but not limited to: a. experienced clinical educators willing to provide general information and insights to speech pathologists considering contributing to clinical education b. experienced clinical educators willing to establish a formal mentor relationship with speech pathologists new to clinical education c. establishing a network of clinical educators from similar contexts 8. Establish mechanisms to support the preparation of clinical educators for prospective students and similarly the preparation of students for prospective placements, including but not limited to: a. providing a standardised mechanism for students to provide clinical educators with information pertinent to their upcoming placement prior to its commencement (e.g. past placement experiences, current knowledge base relevant to the placement, personal learning style, perceived strengths relevant to the placement, concerns about the placement whether related to experience, knowledge of personal circumstances etc.) b. providing a standardised mechanism for clinical educators to provide prospective students with information pertinent to their upcoming placement prior to its commencement (e.g. likely supervision style and processes; expectations of the student; standard information about the operation of the clinic, including daily/weekly routines, base knowledge required at placement commencement, extent of student roles, multidisciplinary interactions etc.) c. provision of information to students in written or seminar form regarding issues unique to specific clinical education contexts (e.g. private practice, disability, residential aged care facilities etc.) Page 20 of 37