Clinical placements for speech and language therapy - Part 3: The views of the practice educators and service managers

In this episode we talk to practice educators and service managers about the importance of placements to them and the profession:

• Tracey Day, Independent Speech and Language Therapist (SLT), paediatric, plus Practice educator
• Emma Ferris, Practice educator, plus SLT Lecturer and Academic Lead for Practice Education, University of East Anglia 
• Eleanor Douglas, SLT in the Adult Learning Disability team, NHS Lothian. Experienced as both Placement coordinator and as a Practice educator.  
• Carolyn Hawkes, Service Lead, West Edinburgh and supporting author on new guidance, and previous practice educator.

This is the third and final episode in a short series of podcasts in which we explore how placements are evolving, the impact of the pandemic, and how we hope to create more placements in the future to meet the needs of the profession.

The recently launched new guidance for practice-based learning can be found here (note that this is open access so non-members can see it too).

The interview is conducted by Jacques Strauss, freelance digital producer.

Please be aware that the views expressed are those of the guests and not the RCSLT.

Please do take a few moments to respond to our podcast survey: uk.surveymonkey.com/r/LG5HC3R

Transcript

Speaker Key:
 
H:            HOST
 
TD:         TRACEY DAY

EF:          EMMA FERRIS

ED:         ELEANOR DOUGLAS

CH:        CAROLYN HAWKES


- 0:00:00 - MUSIC PLAYS -

H - 0:00:07
Hi and welcome to another RCSLT podcast.  This is the third and final of a series in which we look at placements and how we can continue to develop more and better placement opportunities for SLTs.

Today, we are talking to practice educators to get their perspective on what works and what doesn't.  We have a diverse range of guests on the panel today, which should make it very interesting. 

The ongoing saga of our sound issues has not yet been resolved.  We're working on it.  I started by asking the guests to introduce themselves.

TD - 0:00:41
Hi, I'm Tracy Day, I'm a Paediatric Speech and Language Therapist of over 20 years’ experience, currently working independently in Lincolnshire as a sole trader in a paediatric practice.

EF - 0:00:57
Hello, name is Emma Ferris.  I'm one of the SLT lecturers and the academic lead for practice education for SLT at the University of East Anglia.  But I'm also the clinical director for an independent speech and language therapy company based in East Anglia, predominantly working with children and also young adults.

ED - 0:01:15
Hi, my name is Eleanor Douglas.  I work in Edinburgh for NHS Lothian.  I work in learning disabilities, and I work with a CAHMs learning disability team for the paediatric side of my job, and I work for an adult learning disability team, and I'm the practice placement coordinator.

CH - 0:01:32
I’m Carolyn Hawkes.  I'm a service lead in NHS Lothian, and I am overall responsible for all the coordinators within our organisation.  We have nearly ten different teams, and I coordinate all the coordinators who are responsible for the placements within Lothian.

H - 0:01:48
You've all been practice educators, and presumably you like doing it.  I wonder if you’d tell us... it might be your first one, it might be your fiftieth, but tell us a little bit more about your experience, starting with you, Tracey.

TD - 0:02:04
I've had a lot of experience with taking students over the years and tried to experiment with different models of doing that from an individual student up to small groups of students just to be able to develop the capacity for the placements as well as to find out more about the impact of that on my own clinical caseload.

EF - 0:02:31
I've been a practice educator since I was first allowed to be.  I've always been really interested in it and have enjoyed the experience of going from the old one-to-one Velcro model to starting to get little groups of students to think more creatively about it and obviously, more recently, being able to do much more project work with groups of up to eight and ten students doing something really different. 

It's been really exciting to see the shift over the last few years and be part of that.

H - 0:03:04
When you say the Velcro model, is that when someone basically shadows you and they don't move an inch from your side?

EF - 0:03:09
It’s like when they're so stuck to you and they are only with you as a clinician, but you have to warn them that you're going to the toilet, so they don't follow you in. 

Building that autonomy and a little bit more independence in what a placement looks like for a student has been really nice.

H - 0:03:26
Eleanor, what are your experiences of placements?

ED - 0:03:30
I've also had students for many years in all the different jobs that I've had, although I’ve quite recently become the placement coordinator.  I must admit, I'm probably quite guilty of slightly dreading when students come and then when they're there, I really enjoy it, and it's really great, and I love having someone to talk to about all the cases and things.

As Emma said, it's been nice to think about different models of practice and different ways of doing things.  That has been good and has been affected by COVID but also before that, I think, we were starting to think more creatively about placements and how we would support them.

H - 0:04:08
Just to touch on this, and we're going to delve into this in more detail a little later on, but the sense of dread is that because there is workload that you're going to have to deal with?

ED - 0:04:18
Dread was maybe a slightly extreme word there!  I think it's just another thing to do, isn't it, that we're all really busy and it becomes another thing to do and another thing to plan for.  But actually, when you do it, it's always beneficial, and it's always been something that I actually enjoy.

CH - 0:04:35
A bit like Emma, I started taking students on placement as soon as I could, so pretty much I'd been working a year and then had my first student and realised I really enjoyed it and it added a lot to my skill set as a Speech and Language Therapist, but it was also quite good fun.

As my career’s evolved into being a coordinator and also a service manager, it's been really nice watching how placements have evolved.  But also I think it's fed my enthusiasm for making sure placements fit the current ways that we work.

H - 0:05:08
You guys have touched on this, but I think I'm going to ask this just as a separate and direct question, and Tracey you mentioned a bit in your first answer.   But why is it that you support placements?  I can tell you that some of the reaction is, is when people are told 25 days they go, wow, that is a big commitment for a year.  How do you do it?

TD - 0:05:29
As some of the other participants have alluded to, there is a real enjoyment in having something to offer to the future of the profession and of the workforce and being privileged and perhaps lucky to have a job that I myself love.  The opportunity to share that with somebody else who's got a vested interest is just very enjoyable.

In addition to that, it does contribute to your own professional development, you do learn new skills that you can apply with your caseload just as much as with the students.  It does allow fresh thinking into your practice.  Students come with a lot of creative ideas. 

I think the way they're questioning leads you, allows you to reflect in a way that you might not without somebody that's questioning the practice that you're doing.  It’s got multiple benefits.

H - 0:06:40
Emma, you've got a bit of a vested interest in taking placements because you're also at the university, but let's pretend that you were not at the university.  Why would you take placements?  What is it that you think your company gains from having students there?

EF - 0:06:55
Similar to what Tracey was saying, it is brilliant professional development for you as an educator, and that can actually be from having a really amazing student, and it can also be a huge professional development to have a student that struggles for whatever reason and being able to manage that.

Personally, I ended up being able to be relatively successful at different management roles because I had had the experience of having difficult conversations and understanding how to support somebody that was finding things difficult.  So I suppose there's a level of personal professional motivation from that point of view for our team. 

It also enables us to ensure the students know what it might be like to come and work with our team.  From an employment perspective, when we have vacancies coming up, we know that if we've made a really good impression on the student that we had, good news spreads fast, and that might help us with our vacancies.

The thing that always sticks with me is that I possibly wasn't the highflyer academic in my year.  I'm a much more practical person, and placements really showed me that I actually might be okay at being a Speech and Language Therapist outside of what my coursework marks were.  I had an amazing practice educator for my paediatric placement.

H - 0:08:20
The NHS obviously has an obligation to do a lot of placements because they are investing in the future of the profession.  But what is it you think that the NHS service gains from having placements?

ED - 0:08:34
I think we gain loads from having placements, actually.  I think it's really good.  There feels like there's a continuity of service, that we are contributing to people who are coming through and then come to work within the NHS.  It feels like it's all quite joined up.

I always, personally, feel a bit...  I love learning disabilities, and I like my adult learning disability job.  I want the students to like it too.  So, I feel a bit like I'm recruiting them and wanting to say, look how good this is, look at the breadth of what we do.

I love it when you get somebody who's maybe not been to that kind of placement before and they say oh, no, I really enjoyed this, this looks really good.  I feel that we are selling our profession a little bit and showing the breadth of what we do.

CH - 0:09:17
It’s nice hearing Eleanor explain what she sees the advantages are to a service.  But actually, as a service manager, I see even more benefits of taking students on placements because I see the therapist developing their skills.

I think it's something Emma touched on but by a practice educator having students, they're learning supervisory skills that then will help them in their career as they progress.  They learn more about adult learning styles, they learn more about giving feedback, and all of those things are applicable to your work as a Speech and Language Therapist, but also as you then start to support newly qualified therapists as you become a more senior therapist.

The taking of a student is the beginning of a journey that a Speech and Language Therapist goes on throughout their entire career.  This is a job where we learn on every single day, we're learning something new.  Taking students I think just adds even more to that.

H - 0:10:13
If, for example, you were a service that was hugely stretched and under-resourced, would you still say that you should still take on placements?

CH - 0:10:30
Yes.  Every service is slightly different in the way they're structured, and we work within a large health board, so we have lots of different teams.  But we do try really hard to always offer placements, even in teams that are stretched, but it might be that other teams take over a few more of those placements if we're particularly struggling.

If you plan placements well and embrace some of the newer ideas of placements, so touching back on what Emma said about not being stuck at the hip, not being Velcro-ed with your student, as people used to feel they were in the past, you can see more advantages to what a student workforce can add to the team.

We've had lots of good examples recently of more project-based placements, where students have a really valuable role in doing some research in the clinical area, looking at the evidence-based practice, maybe designing some resources that perhaps the therapy team would have struggled to do on their own when they were busy doing their day job.

Students often have extremely good skills with data analysis, so they can really add to a quality improvement project, which means that they learn other skills that supplement the skills we've got in the team.

H - 0:11:49
I then asked Emma and Tracey, who are in private practice, how they dealt with the issue of student SLTs seeing paying patients.

TD - 0:11:57
It is hard, it does take a lot of careful thought but again, with a willingness to think differently and to take the blinkers off of that older traditional model.  There are ways that can make it very appealing for families that are paying for a service also.

Perhaps, it can be that the students could offer additional sessions over and above the sessions that the family would receive the direct support from myself.  It could be that the students could work much more on additional resources for a family or for a nursery or a school to go alongside the support that the child is receiving.

It could be that they could do some follow-up telephone consultations, especially at the moment where the face-to-face visits have to be so heavily risk-assessed, or some further parental training, parental support, that would go over and above the standard level of service that perhaps I, alone, would be able to provide.

H - 0:13:05
Generally, in your experience, have you met with resistance from parents when it's involved placements?

TD - 0:13:10
Not as much as you might assume.  I think, again, parents have a very, very practical, pragmatic understanding that we all have to learn.  So long as they get enough reassurance that the quality or quantity of the input for their child is not going to be detrimentally affected, they're very often on board.

EF - 0:13:38
Our service is possibly a little bit different in that the majority of our work is contracts with educational settings where they're bringing us in to see whomever in their setting needs us.  It operates in a much more typical caseload model from that point of view in a school or a post-16 environment.

The schools really value having students there.  They are very frequent supporters of teachers that are training, so they understand the process of needing to have placements and needing to have that hands-on experience.  Again, similarly to what Tracey was saying, getting something additional than they normally would. 

The time that we take out to offer supervision to those students is more than made up in the extra provision that the students can then provide to those students and learners in their settings.  It's also brilliant for them to feel more involved within the SLT profession as well and support us on another level.

It's not really been met with any hesitation from our settings once we can get over the issues around their governance and child protection.  We can meet all of their requirements that they have to have external visitors.

H - 0:14:56
Eleanor, not to be too blunt about it, but if you're in the NHS, you don't necessarily have a choice about how you're treated.  Is it the same situation where people are not necessarily resistant, you're not experiencing any resistance from patients or their carers or their family members about having young people, having students doing a chunk of treatment?

ED - 0:15:22
As good practice, we would still be seeking consent from the person or their carers that they're happy to have the student in as well.  It’s not generally a problem.  Sometimes it's difficult.  I've had a few very anxious people where they haven't wanted anybody else in.  It's not about it being a student, it's about how many people are working with them.

We're obviously explaining this as someone... we're working with adults with learning disabilities, so we're seeing this as someone learning to be a Speech and Language Therapist.  Sometimes I think they feel quite good that they're contributing to that.  That can actually be a positive.

Again, it’s seen as an added value thing rather than instead of.  You've also got a student as well.

H - 0:16:08
We then moved on to the question of what percentage of a placement needs to be clinical versus non-clinical that would still be relevant to a career as an SLT.  The current recommendation is that it must be a minimum of 25% clinical work.

CH - 0:16:22
I think Speech and Language Therapists have such a broad job with so many different aspects that that figure for direct contact had to be there in some way to ensure students got a good experience that helped them see so many different aspects of our work.

If you actually look at a typical day job of what a Speech and Language Therapist does, as if there was such a thing, a lot of that is not direct face-to-face contact with a client.  There may be training that you're giving, whether it's to a parent to a carer to a teacher; adult therapists would also be providing training.

It's helping people understand what a direct contact is – that we have a training role, that we have an assessment role, as well as delivering what people might think of as traditional therapy.

If we had looked honestly at a lot of placements that were provided, they weren't sitting all day every day with a client across the table from them, even in the days of feeling that they were with just one clinician all day long.  There still would have been aspects of phone calls and training and preparation and writing reports that happened.

The figure in the new guidance is really just to ensure that there is still recognition that that face-to-face work is so important in our field, and we don't want any students to go on placements where that's taken away completely.  But it's a really bare minimum.

If you actually look at the experiences that students have on a placement, it will involve little bits of project work, it will involve bits of face-to-face work, it will involve, nowadays, telehealth as well.  So there's a broad job that we've got.

H - 0:18:06
I guess what you're also saying then is that not having 100% clinical work is actually what proper preparation for the job is likely to be anyway.  You're not just going to be sitting with patients every single day for eight hours a day, which in and of itself sounds rather exhausting as well.

CH - 0:18:24
Absolutely, and that was sometimes what students didn't necessarily pick up on a placement.  If you cherry-picked the exact job that you gave them and made them feel they could sit across face-to-face from a client doing therapy every day, they'd be quite shocked when they went out into the real world and saw what our job involved and the planning, the organising of the timetables, especially if you were visiting lots of different places.

Clinically, I work within nurseries and mainstream schools, and the background of all of the organisation that's required; our job’s much more complicated than just sitting across from seeing a client face-to-face.

H - 0:19:04
Coming back to you, Tracey, you're unique in this group of people in that you're a sole trader.  Imagine if you were giving advice to another sole trader who hadn't done a placement yet, what would you say to them and how would you advise them to prepare?

TD - 0:19:20
In terms of how to prepare, there is no escaping that it does need… or a quality placement does need planning, and it does need some additional time invested in the student.  If that is done very well, it more than pays for itself in the return that you get from the students contributions.

H - 0:19:46
How much does the university support you in planning that placement?

TD - 0:19:52
There's a lot of support.  There's pre-placement training that I think is an annual requirement but in addition to that, there is a lot of documentation support, there's a lot of tutor-based support. 

Every student coming out has their own clinical advisor, who you can then link with as and when needed.  But the HEIs all have very strong placement-link tutors.  If you need it, it's there for you.

EF - 0:20:31
We do quite a lot of work to make sure the students that are with us get opportunities to join up together, even if they're not with each other during the day, so we coordinate it from that point of view.  I think the main thing is around knowing what your unique selling point of your team is.  As it's been said, we all secretly want to convert the students around to our professional field and our line of work.

What can they get out of our placement with our team that they maybe wouldn't get being with a different team, be that a different type of team or another independent team so that they really get the flavour of what it actually is that they would be walking into as newly qualified?  And so trying to weave that into the placement as well, giving them opportunities to be more involved with the team.

H - 0:21:20
Carolyn, just coming to you, a slightly different question.  Obviously, this has now been raised a lot that there is a shortage of placements.  My understanding is that’s a UK issue. 

In terms of the solution, is the NHS at capacity in terms of the number of placements that it can do and how we're looking to the independent sector to make up for that shortfall of placements?  Or do we think the NHS could do more?  And who is making that decision?

CH - 0:21:50
It's a really interesting question because I think it can be quite variable.  We're a health board that has a university within our patch, so we are very close to saying that we are at capacity, we would be struggling to offer too many more placements.  But there would be other health boards that are not offering as many placements.  Even within the NHS it's variable depending on your geography.

There are untapped places within the NHS that could probably provide more placements too, as well as then looking at independent as another growing area that can provide more placements.  Each of the four nations has a slightly different way of doing it, which will help in different ways. 

Certainly, from my perspective, within Scotland, we actually now have what are called practice-based learning agreements that do set out what the NHS will be providing and to try and make sure that each health board is offering what it needs to offer to meet the future workforce.

Sharing of good practice is really needed right now so that everybody can understand and learn from each other what these new placements can look like.  They’re not maybe as challenging as people think.  They're maybe not always as time consuming as people think.  If you plan it properly, there is actually a really good way of using students as part of the workforce in a team. 

The beauty of adding in blended learning and telehealth, it maybe opens up opportunities that weren't there before.  Thinking of the geography of Scotland, Highlands and Islands where there’s not very many therapists up there, it's a huge rural area, they could maybe also contribute in different ways that they weren't able to before.

It's quite an exciting time, I think, and the new RCSLT Guidance coming out now, it’s just the right time to give people ideas and inspiration.

H - 0:23:54
An issue that has come up before is placements in highly specialist areas, such as head and neck cancers and cleft palates, and whether there was an opportunity to create more placements in these areas where traditionally these specialisms accepted fewer students SLTs.

EF - 0:24:10
Can I speak as a previous cleft palate specialist?!  I think it's twofold.  One is that it is too clinically complex, and so the students might struggle to be able to do some of the assessment or clinical decision making, but as educators it's our job to break it down to a level that the student can then take on. 

If there is really complicated physiology or anatomy happening, maybe we just tell them the answer to that bit, and we leave the rest of it and we break it down to a level that is then appropriate for them to do that clinical reasoning.  They can also maybe work alongside a more experienced therapist instead of being given a client to work with.  It's a much more collaborative approach that you have with that student. 

I think the other element of the reticence sometimes is around student resilience.  I know definitely we have some really amazing placement settings that offer placements but do make it really clear that it needs to be a student that will cope within that environment and seeing some quite challenging things emotionally, maybe some challenging behaviour, more specifically in some of our secure settings, and actually that's fine.

You can go back to your HEI and say, we want to offer placements, these are the things that you just need to be aware of that are specific to our team, so that we can match up students appropriately.   Some students thrive in areas like that and other students we know, possibly, are going to find that too challenging, and it would be unkind and unfair to expect them to do really well in that setting.

It's a little bit of matchmaking that needs to happen, and a conversation that needs to be opened up.  But I don't think there is any setting that is too specialist or too scary for a student to go into.  Some just need to be managed and thought about a little bit more.

H - 0:26:13
Starting with you, Tracey, we should talk about placements and the pandemic, how it affected placements but with a view to the fact that we think things are going to be under control, hopefully, in about six months.  How do you think placements possibly are going to change going forward?

TD - 0:26:30
Again, another really interesting question.  The pandemic forced us into a situation where we had to very rapidly, very drastically re-think so much about our clinical practice, let alone providing an education for students in that context.  However, I do think that there are so many really positive things to come out of that.

Certainly, in my own experience, working in quite rural Lincolnshire at quite a distance from the most local university, it actually facilitated access to more students to more placement time because we did it remotely.  Whereas, prior to that, we would have expected the students to do the travelling, to do the commuting.   

Without having been forced into thinking differently, I guess we never did think differently about that.  Certainly, from an access point of view, I think it's something that can really quite fundamentally change the landscape of how placements can be offered.

H - 0:27:43
Eleanor, I'm just going to jump to you then.  Firstly, how did it affect your practice because I imagine that would be a challenging area to do virtually, or not, and then how did that affect placements?

ED - 0:27:53
It definitely was a challenging area to do virtually.  I think we’ve been surprised in that we can probably do more than we might have originally thought we could do, using telehealth and remote placements and also using sometimes a more consultative approach rather than direct one-to-one things.  We've looked at that again.

There are things that we can't wait to get back to doing face-to-face with because obviously a lot of our clients are not going to be able to manage video calls and remote things at all.  Having students come in, we all felt quite new to a lot of that, and they were quite new to it, so there was a bit of figuring out a lot of stuff together.

I've had very inventive students who’ve got really good ways of doing assessment via telehealth that I hadn’t quite sussed out.  Also, they tend to have considerably better IT skills than I have, so that was really useful as well.  We were thinking differently about our practice and then that has just been thinking differently about how students support that as well.  The two things have gone together.

CH - 0:29:02
I think that the opportunity of blended placements gives us all a huge opportunity moving forward.  We touched a little bit earlier about some areas sometimes thinking they were too specialist, their job was too different, and having to work out how to adapt placements. 

The fact that you can have a blended placement actually means students can join different clinicians for different aspects and in large organisations, perhaps different teams for different things, which brings efficiency to the service and to the placement but can also give a better-quality placement to a student.

We're having big discussions with our local university about timetabling and what does that actually mean moving forward for when placements can happen when students have to be on campus and when students can be out and about.  We've always had challenges of accommodation and how many students could come out on accommodation. 

We've also always had a challenge where if a student was on placement and people just did not turn up for their appointment, the student almost felt they'd wasted that opportunity.  If it is only a blended placement and they just haven't clicked into something, the student can do something else and maybe join that session at a later date when the family joins into a virtual session again. 

It’s really just making us think radically quite differently now but added an awful lot more flexibility to what a placement could be.  Speech Language Therapists have always been quite creative and flexible.  It's actually quite positive moving forward that I think we'll be good at doing that within placements, and it'll be really interesting to get students’ feedback as these new placements evolve.

Working together with students and working together, perhaps educators with universities, we can have a really positive impact on what a placement is going to look like in the next year or two.  I think it could still keep evolving.

EF - 0:30:58
I think it's been a time of real introspection for us as a profession, and that includes placements.  Even just the guidance being written was an opportunity to really sit and think, what are we actually wanting students to be able to get out of the clinical placement?  What do they need to be able to have the opportunity to do that supplements their learning at the university?

I think we had almost got into a habit of a one-size fits all, this is what a placement should look like, and there's a huge level of diversification that's come out of this process that actually, one-size doesn't fit all.   We can be really good at gearing it towards our skillsets within teams and our clinical specialties and what we're like as an organisation, and that's still really good.

We've understood now the core baseline that we expect placements to be able to offer, and that can be interpreted in any number of different ways and be really solution-focused towards that team.

H - 0:32:10
A big thank you to everyone who agreed to take part in this podcast.  If you are an independent practitioner and are thinking about becoming a practice educator, start by reading the guidance and then get in touch with your local university or [inaudible 0:32:23], and there is a Clinical Excellence network for practice educators.  

As always, please do reach out to RCSLT who will be happy to help with whatever you need.  If you're in the NHS and you think you'd like to offer more placements, talk to your service manager, and maybe go to them with a plan on how you'd like to manage these new kinds of placements.  

The consensus seems to be that it's a great opportunity for everyone involved and essential for maintaining the future of the profession.  Until next time, keep safe.

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