Planning student placements in private practice settings

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Managing expectations for student placements in a private practice context

Planning and preparing for your placement are essential.  Ensure you have a clear understanding of the expectations of a clinical placement within your profession, refer to ‘Preparing for and Managing Clinical Placements’ and consider the following content for your private practice setting:

Understanding University Expectations

It is important that you contact your university partner(s) to establish a working relationship with the clinical placement coordinator.  This includes ensuring that you have clarity on :

• Placement requirements – Establish the placement duration, and whether weekend and home visit work is required. Determine the caseload, level and type of supervision, and student insurance requirements.
• Supervisor requirements – Establish the level of experience or supervisor training that is required and gain access to  university supervisor support tools and resources.
• Consent requirements – Establish the consent processes and documentation requirements  for students to provide care to the prospective clients/patients of the practice.
• Intellectual property requirements – Establish who owns the intellectual property for outputs that arise from a student clinical placement. 

Communicating Your Expectations

Every private practice setting is different. To ensure the placement is a positive experience for all involved, it is essential that your expectations are clear to both you and the student at the beginning of the placement. The student must understand that your practice is a business and your expectations of them, the staff/student/client  boundaries that have been put in place and why these are important, when you will be available to supervise/provide feedback, and how and when assessment will occur.

A Placement Profile, a document which summarises the placement expectations and experience, can facilitate clear and transparent communication of this information. Providing this information prior to the placement will set expectations early and facilitate conversations to ensure that the student understands the placement requirements.

Activity: Create a Placement Profile for your Placement

Please fill in the information under each heading using the information and questions as a guide.

Workload Considerations

Supervisors should consider how they will structure their workload to ensure an optimal balance between student learning and caseload completion.  You may find that in the first week/s of the placement, you will need more student-focused time for orientation, support, and direct supervision.  As the student progresses on placement, and increases their confidence and competence, there will be a shift in this balance, meaning that the student will require less direct supervision and support, while their productivity increases. Having an understanding of the student’s competence and confidence as well as the activities that are low in client risk, will identify opportunities where you can provide direct client care while the student undertakes other activities, For example:

• Students may be able to independently gather assessment data, including the client history, at the same time as you are providing interventions to other clients.
• Students may be able to independently provide education or an intervention session to clients, allowing you to manage more complex clients.

Financial Considerations

Financial considerations will be unique for each private practice and the types of services they provide.  Some examples of financial considerations include:

• Client fees (e.g. whether a subsidised fee will be applied for clients seen by a student)
• Third party payments (e.g. whether payments are affected when a student is providing the service)
• Costs for equipment and supplies (incurred by the student on placement)

Allowing the student an opportunity to understand or be exposed to these aspects of private practice can be a valuable learning experience.

Not all professions have defined guidelines on the financial implications of hosting a student placement in the private practice context.  It is therefore important that relevant state/territory legislation on private health insurance is understood and clear expectations are established with your  university partners, client, third party payer on:

• the nature of fees for student led occasions of service
• the level of practitioner input if the occasion of service qualifies for a private health insurance rebate
• whether private health insurance companies pay for student delivered therapy services
• the consent and documentation required

Some universities operate student led clinics.  It may be useful to contact the university placement or clinic coordinator to discuss  the processes they use for the management of private patients.

Legal and Ethical Considerations

Legal and ethical considerations with student placements in private practice include:

• Student supervisors should be familiar with the conditions of insurance cover by universities for :
  1. Student public liability
  2. Professional Indemnity
  3. Workers Compensation/Personal Accident Insurance
• You should provide orientation to workplace health and safety policies and processes in the practice environment for any site the student is attending
• The competence of the student should be determined before they conduct an assessment or provide a service to a client
• Always check carefully the student’s documentation or written reports prior to signing
• Check the student’s level of understanding of directions given regarding performance of an intervention or procedure prior to their execution
• Work with the university placement coordinator to establish processes on travel and or home visits that may be required as part of the placement
• For client interactions:
  • Provide clear student identification, and require the student to introduce themselves as a student
  • Develop a written consent form for client/third party consent for student delivered intervention
  • Ensure the level of student involvement is clearly explained to the client/third party
  • Obtain client consent for the student to assess and or provide an intervention, and establish documentation processes to record this

Intellectual Property Considerations

• Provide students with explicit guidelines on access to information and copying of resources specific to and developed for your private practice
• Consider developing a site-specific written and signed confidentiality agreement between you, the practitioner and the student regarding the appropriate  use of confidential information and intellectual property
• Identify university policies on intellectual property and how to protect your IP rights. The Occupational Therapy Practice Education Collaborative - Queensland has provided information on confidentiality and intellectual property for students

Student placement models in a private practice context

Different student placement models exist in private practice due to the differences in practice settings, including the wide range/variety of caseloads. It is important that each private practice develop a model that is most appropriate to that setting, its owners, and their staff (including the supervisor) taking into consideration the level of the student.  Models may include one or multiple supervisors, students and workplaces. Models may need to be combined to provide an appropriate casemix/caseload which can fluctuate in many private practice settings.

When deciding upon a model, review other models already in existence and ascertain if some or all of that model would work in your circumstance. Remember, there can be flexibility, and this can be discussed with the University Placement Coordinator. Shared placement models, with another provider (not necessarily a private practice) in your area, can be developed to provide students with diverse learning experiences to meet their learning outcomes.

University placement coordinators and/or Student led clinic coordinators could be contacted to review the placement model/s adopted in your setting and the approaches to manage fluctuations in workload, e.g., providing students with opportunities to be involved in administrative projects such as marketing, updating client resources, observing other professionals in private practice; or pairing a traditional placement model with a project based placement model). Irrespective of the model used, it should be clearly documented in the Placement Profile.

Examples of Clinical Education Models Currently Being Used In A Private Practice Setting

In this video, Megan Saunders from Mobile Rehab describes the model they use in their setting - Sharing the placement with another educator from the same site.

References:

Please Note: References remain valid until superseded by later research. The resources referenced here are regularly reviewed and are considered current and relevant to the topics presented.

• University of British Colombia – Department of Physical Therapy (2019) Private Practice Toolkit:  https://physicaltherapy.med.ubc.ca/clinical-education/clinical-educator-professional-development/private-practice-toolkit/