Welcome to my next blog in the ‘So you want to be a physiotherapist…?’ series. In part 3 we introduced year 1 and I provided some key tips that will help you begin your physiotherapy studies.
This month I will be looking at placements, and the important role that they play not in only reaffirming your knowledge gained throughout your studies, but also will provide a great insight into clinical working and what you can expect as a qualified physiotherapist.
Although I have only discussed year 1 so far in my blog pieces, this blog will discuss your placements across your whole degree (years 1 – 3) and how the marking and expectations of you change over this time.
Universities will differ on when placements are allocated over the course of your 3 years. For me at King’s College I had 2 half day observational days in year one followed up one 6 week placement at the end, two 5 week placements in year 2 and then 3 five week placements in year 3.
However, no matter how your placements are organised, in the UK you have to complete a minimum of 1000 hours of clinical placements over the course of your 3 years to be able to complete your degree and apply to the HCPC. Most universities schedule over and above this (i.e 1056 hours) to account for any sick days or bank holidays.
Placements can be provided in a whole host of different areas, ranging from inpatients to outpatients, from critical care to community, but universities will attempt to make sure you have experience in all three fields of physiotherapy; musculoskeletal, neurology and cardiorespiratory.
Receiving Your Placement
You will be informed of your placement well in advance of when it is scheduled for. We received email notification informing us of our placement location, speciality, typical working pattern and who your clinical educator will be.
It is important that when you first receive your notification that you email your clinical educator to find out a little more about the placement. For example, what area of cardiorespiratory will you be working in? What is a typical working day? Do they have any pre-reading they recommend? Make sure that the email reads well and is professional throughout. Remember this is the first contact they make with you and you never get a second chance to make a good first impression.
Once you have been told what clinical area and speciality you will be working in for your placement, I strongly suggest that you go over your notes, examination techniques and further reading to bring that topic to the forefront. In my second blog I offered some resources that helped me over the three years and recommend you take a look at this, but there are lots out there that can help. Perhaps book a room with some colleagues and go over some practical examination techniques / role play etc.
Guidelines for Your Organisation / Governing Body
As physiotherapists in the UK we are required to adhere to both the HCPC Standards of Proficiency as well as Code of Members Professional Values and Behaviours.
As autonomous health care professionals, we are meant to be accountable for our actions and these guidelines provide a framework for how we should work. As you will be on placement in a clinical setting it is highly advisable that you go over these to refresh yourself.
Whilst placements are vitally important to obtain an insight into clinical working, it is also important to remember that you are being assessed against pre-set criteria. During my placements, I was marked on the following areas:
- Interpersonal Skills
- Treatment / Management
- Clinical Reasoning
On my first placement, each criteria was equally weighted towards the final overall mark. However, over the course of the next two years the weighting changed so the clinical reasoning and treatment aspects are more heavily weighted. While the other two topics are still important, clinical reasoning is a vital component as you move towards the latter years and for when you finally graduate and start working.
Your First Few Days
It is absolutely fine to be nervous when you first start your placement, everyone does, particularly on your first one but after the first few days you will start to feel more settled.
Typically, on your first day you will meet up with your clinical educator and you will go through health and safety information, log ins for any IT software plus a guide of where you will be working. Usually you will shadow your clinical educator over the first few days to gain an insight into how they work, document information and liaise with members of the team.
Every placement we were given a ‘placement pack’. Within this pack were feedback sheets from clinicians / patients plus a booklet where your goals and feedback are recorded.
It’s important that, before you start, you have a think about what your goals are for this placement – don’t make them too complicated and think of approximately 5. Goals that often encompass communication, documentation, exercise prescription and progression etc. are often ones to consider.
During the first few days of your placement, you will go through these goals goals with your clinical educator and make any alterations to them if necessary. Once agreed, these become your main goals over the duration and will be revisited at the end.
It is also worth discussing the grade that you wish to achieve on this placement. Of course, everyone wants to achieve the highest grade possible, but as you will come to learn different clinical educators will have different expectations in order for you to achieve this, so open and honest dialogue between the two is key. It is worth making a note of the key points mentioned in this discussion and refer to it occasionally to see whether or not you are achieving these tasks.
During your placement.
As already discussed, initially you will shadow your clinical educator to gain an insight into their assessment and treatment techniques as well as how a typical day operates and the systems they use. Over time your clinical educator will gradually let you take the lead with patients and in some instances, should they feel confident with your progress, will let you see patients by yourself to then discuss with them after about how you felt it went.
Your placement may also include running and participating in classes, working with other members of the multidisciplinary team, discharge planning and attending meetings to name a few. Some situations may put you out of your comfort zone but don’t worry, the more you do it the better you become and if there are things you are unsure of, ask your clinical educator, that’s what they are there for.
Physiotherapists are autonomous professionals and we are therefore held to account for any intervention we offer our patients. It is important that, throughout your placements and indeed the rest of your physiotherapy career that you continually reflect on your practice. There are some good reflective practice sheets available, one of which is offer by the CSP and can be found here. Not only will this highlight to your clinical educator that you are being proactive in your own learning, but these can also contribute towards your CPD folder. Try to aim for a couple of reflections minimum a week. As well as written reflections, discuss with your educator after a patient. What went well? What didn’t? What would you have done differently in that situation?
As physiotherapists, we are also responsible for keeping up to date with the latest evidence base. Your clinical educator will be impressed if you can explain an intervention that you performed based on the most recent NICE guidelines or systematic review, for example.
Half Way and Final Way
Half way during your placement you will sit down with your clinical educator and discuss your performance so far. You will revisit the initial goals that you set out and agreed at the beginning of the placement as well as going through the marking criteria. You should be given an idea at what level you are performing at for each criteria, and given advice about where you should improve on. Take note of this and ensure that you address these points in the second half of your placement.
On the other hand, don’t be afraid to address points that you feel you have accomplished but your clinical educator feels as though you haven’t, and give examples if you can.
At the end of your placement you will do the same, however this time you will be given your final mark and then, with your clinical educator, compile a list of action points to address on subsequent placements.
Do not be afraid to ask questions. This is SO important, as with so much going on, in an area that you are not particularly sure of, you are going to be unsure on several things. I was once told that, as a clinical educator, they would worry far more about someone who did not ask questions than someone who did. Talk to your clinical educator, other physiotherapists and members of the MDT, they are there to help you and not long ago they were in your shoes too!
I was also assigned a ‘link tutor’ from university, a member of staff who I could contact if I had any questions or concerns. Again, don’t be afraid to make contact should you need to.
Placements are a fantastic and essential way to transfer the theory learnt at university to actual patients who have a real pathology. Yes, you will be assessed and yes, your mark will count towards your degree, but do not lose sight of the real reason you are there and it’s to gain a small insight into the clinical working of a physiotherapist and to develop the skill of learning from your own practice.
You will not know everything, and you will be asking lots of questions. Physiotherapy is a lifelong learning process Whilst I was on placements I encountered numerous band 5 physiotherapists who were continually asking colleagues questions.
I hope you have found this blog useful and hopefully it will provide some preparation for your upcoming placements. Most importantly, enjoy yourself! Physiotherapy is a great profession and it’s good to gain an insight in the important role they play within the MDT.
Next month, we will continue our journey through the academic aspect of your degree and take a look at year 2. See you next time!