JCPSLP Vol 19 No 1 March 2017

student participants agreed that it was important to receive a comprehensive orientation for the placement. In context 1, this orientation had evolved over time to include a cultural and community orientation from Indigenous board members in the school and 100% of students felt they received an adequate orientation for the placement. Students from context 2 also received a cultural and placement-specific orientation and they generally agreed that the orientation was adequate but 10.5% indicated they were either unsure or did not feel they had an adequate orientation. One student commented: “I feel that the orientation to this placement gave little speech related information and unfortunately the speech CE was not able to attend the orientation” (SLP student, group 3). The need for clear expectations for interprofessional contact was expressed by both student and CE participants. CE responses indicated the importance of students having face-to-face time with each other outside of the clinic. In context 1, students were given a structured schedule on their first day that detailed their interactions with the clients as well as each other, including preparation and debriefing meetings. Students were expected to commit to a weekly two-hour meeting outside the clinic day. We will negotiate it until everybody agrees before we leave…it’s too easy to go, when one says that time doesn’t suit me, “Well OK, maybe you can catch up later on”, and then that student doesn’t have the IP experience that we’re after, so we keep going until we get a good compromise. (OT CE 1) In contrast, a CE in context 2 commented: We strongly encouraged this [the students to meet outside clinic time] but did not make it compulsory. We did reiterate the importance of checking with the team before sending session plans through, although we could tell that this hadn’t always been done. (OT CE 2) The process of establishing teams between OT and SLP students was also conducted in an explicit manner with the importance of being physically together highlighted so that each pair of students began to consider themselves as a team from the beginning. “Within the first hours they are put into their pairs, I mean physically put into their pairs, sitting together, so from the get-go when they are getting their caseloads they are already thinking as one” (SLP CE 1). Students came to appreciate the importance of these meetings: “Initially I was resentful of attending so many feedback and planning sessions, however throughout I really appreciated the feedback and planning sessions as I believe this really enhanced my learning and collaboration with other students” (OT student, group 3). In terms of more formal communication, students were given the clear expectation that all their interactions with the clinical educators and professional development needed to happen as a team. “So if you want to talk to us about a client, you come as a pair” (SLP CE 1). In context 2, students in one location had made an effort to communicate outside the clinic and this resulted in them being more prepared and organised, knowing their allocated roles, and working more effectively with the children. In the other location, where this student communication had been limited, students struggled with working as a team. It was also seen as important to incorporate structures and processes which facilitated a safe learning environment, particularly in exploring students’ roles and

practices with Aboriginal and Torres Strait Islander children. In context 1, students engaged in a weekly journal club as part of their clinic day. “In our journal club, we had a lot of focus on issues they needed to consider working with children from Indigenous backgrounds” (SLP CE 1). “I think people felt safe to share their feelings and their observations [in debriefing sessions]” (OT CE 1). Students also reported positive outcomes from the journal club. “A lot of it was on cultural and community aspects that speech and OT can contribute … it was quite good to bring that to awareness” (SLP student, group 1). In context 2, some students met for tutorials and debriefing at the host Institute where they were able to interact with Indigenous staff: “the lunches and morning teas with the Institute gave a really positive feel for working in an Aboriginal and Torres Strait Islander Health service” (OT Student, group 3). Another student commented: “I never felt uncomfortable to ask questions and was always given feedback when needed” (OT Student, group 3). However, in one clinic, students had difficulty attending the tutorials because of their university timetable and this restricted their learning of culturally responsive practice. [The tutorials and debriefing] helped students to be more in tune with expectations, have more opportunity to discuss their clinical reasoning, so they were just more immersed in the organisation’s style of practice. The students [in the other clinic] did not have this experience because they couldn’t fit [the tutorials] into their schedule. The SLP students had to rush off to get to a uni lecture before the [client] session had even ended. (OT CE 2) Overall, 93% of students indicated that their appreciation and knowledge of Indigenous cultures and their awareness of the health issues faced by Indigenous people had increased as a result of their placement. The importance of relationships Responses from students and CEs reflected the importance of relationships with a variety of stakeholders involved in service delivery. It was important to ensure that clinical educators had developed a relationship with staff in the practice context over a period of time. This provided a solid basis for the clinical educators to introduce students into the context. We’ve gradually built our own relationships with the principal, with the prep teacher and the year one teacher…we’ve spent quite a lot of time trying to cement those relationships within the environment. [Now] we’re accepted there and feel more comfortable and we’ve established those bonds. (OT CE 1) Developing relationships was more difficult in context 2 where the service was new. CEs in this context commented that they had not had time to form connections with other health staff at the clinics before running the programs. Students were encouraged to spend time building relationships with the staff in the practice contexts and it was made clear that this was an important use of their time. As a student, they would probably not do that without our encouraging and nurturing because they’d be on the product, you know, “I’ve got to complete this assessment…” We did give them a lot of reassurance that it was OK [to spend the time]. (OT CE 1) Student responses reflected that they had learnt these skills over time, with 89% of students indicating they felt they had

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JCPSLP Volume 19, Number 1 2017

Journal of Clinical Practice in Speech-Language Pathology