The importance of clinical placements in emerging models of practice
Students can be a catalyst for change.
If we wish to see physiotherapists working in emerging models of care or developing satisfying careers in out-of-the-way places, then we must provide our students with opportunities that sow the seeds for change.
One training program that is attempting to address the gaps in care for individuals living in rural communities that require rehabilitation is the Northern and Rural Cohort (NRC) of the UBC Masters of Physical Therapy (MPT) program. The NRC has a mandate to increase recruitment and retention of PTs in northern and rural regions through clinical education. This provincially funded program supports 20 MPT students in completing the majority of their clinical education in a variety of practice settings in northern and rural communities.
Based on the literature in the area of rural recruitment, the NRC selects students with a rural background and attributes associated with leadership and community leadership. The NRC are guided in the development of competencies associated with rural practice, including understanding Aboriginal health, providing culturally safe care, and interprofessional collaborative practice. In an effort to address the gaps in care that commonly exist in rural areas, students are also exposed to innovative models of health service delivery such as remote community outreach, telehealth, and rural primary health care. To offer these clinical educational opportunities for students, UBC has developed a number of initiatives in partnership with the health authority and First Nations communities in Northern B.C.
Combining the face-to-face interaction with video telehealth engages students in a new perspective on the potential reach of the profession and possibly influences how they shape their own future practice.
E-health opportunities on clinical placement
In more remote regions, physiotherapists frequently provide outreach to communities; however, one of the challenges of itinerant work has been the continuity necessary for the provision of effective physiotherapy services (1) and for sustaining relationships for culturally safe care (2). The advent of technologies such as high fidelity video and electronic medical records allow health care providers to connect with patients and onsite health care regardless of location.
In partnership with Carrier Sekani Family Services and the Aboriginal Family Practice Residency program at UBC, the NRC has developed a clinical placement for MPT students to travel with a physiotherapist, family physician and resident to remote First Nations communities to provide primary health care and physiotherapy services, and then to follow up with patients via telehealth once the team has left the community.
While in the community, students have the opportunity to see the negative effects on health that isolation and racial segregation can cause, and to experience the positive effects of a strong culture and healthy traditional practices on health and well-being. Students are welcomed into the community by elders and members who recognize the power of educating future health care professionals about Aboriginal health and culturally safe practice.
Time in the community allows for relationships to be established and for hands-on assessments and treatments to be carried out—the foundations of conducting follow-up by telehealth when we leave the community. Telehealth also offers an opportunity for the team to connect with specialists in urban areas for consultations, bringing a different dimension to the concept of collaborative practice.
Frequently, when we are in remote communities, we are asked by the rheumatologist to conduct a telehealth session and ‘be their hands’ performing joint counts and guiding the patient through the consult. Initially students question how such a hands-on profession as physiotherapy can utilize telehealth, however it quickly becomes apparent that a physiotherapist’s second most important tool is their eyes.
E-health (in this case, telehealth and electronic medical records) effectively reduces the geographical barrier associated with care for rural and remote communities by bridging the gap not only between physiotherapist and patient, but also between health care providers to facilitate patient-centred care.
Combining the face-to-face interaction with video telehealth engages students in a new perspective on the potential reach of the profession (3) and possibly influences how they shape their own future practice.
Emilie Whittemore was the first student to embark on this innovative placement:
“I am very excited to be a part of this groundbreaking project and to participate in a cultural exchange with First Nations communities, and to be a part of directing the future of rural and remote health care. This has been a remarkable and inspiring experience!”
Clinical placements in primary health care
Another model of service delivery that is frequently talked about is the role of physiotherapists in primary health care (PHC); however, there are scant opportunities for students to experience PHC during their training.
In an effort to provide students with clinical education using a primary
health care approach as well as increase rehabilitation services in an underserviced remote community, the NRC established an interprofessional student-led clinic. The Prince Rupert Interprofessional Student-led Model (PRISM) Clinic uses a population health approach to integrated primary health care along the continuum of care with the aim of improving the function and mobility of residents in the coastal community.
Teams of Masters of Occupational Therapy (MOT) and MPT students see patients in the hospital or community and follow them through their health care journey, eventually ensuring the patient reaches their potential for participation at home and in the community. In addition to addressing the reason for referral, students focus on modifying the patient’s level of risk to prevent further injury or disability.
Regardless of primary impairment, patients are assessed for risk of falls, decreased functional mobility andcapacity for independent living, social isolation or decreased participation in society, and chronic conditions that may place the patient at risk in the future. Students learn how the determinants of health intersect in a rural community, and ways in which physiotherapy can address issues upstream.
Rural communities offer students a rich learning environment due to the collaborative nature of practice with health care professionals in close proximity and the complexity and variety of caseloads. (4) Exposing students to the generalist nature of rural practice and the primary health care approach to care builds a spectrum of skills and knowledge that students take forward in the development of their careers.
“What has been most rewarding, however is the progress that you are able to see week to week in the members of the community who truly appreciate your time and dedication. It is amazing the difference one can make in just five weeks. What a unique experience and environment to develop the tools needed as a new grad!” Charlene Copeland MPT student 2014
The physiotherapy profession must embrace the evolving nature of health care that includes technology and changing roles and develop new models of practice. Students are primed to assist us in envisioning the future of the profession. To do so, we must provide opportunities for our students to explore and push the margins of our practice.
So, if you are a physiotherapist working in a non-traditional or emerging area of practice, consider mentoring a student and inspiring them to take their career in new direction. Known as role-emerging placements, the academic coordinator of clinical education at your local physiotherapy training program would be pleased to discuss how to make the placement work for you and be a positive learning experience for the student.
As Davies, Hanna and Cott (5) noted, hosting a student on placement “keeps you on your toes” and benefits your own practice, but it may also be the catalyst that shapes the future of physiotherapy service delivery and the profession.
Republished from Physiotherapy Practice