JCPSLP Vol 19 No 1 2017

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JCPSLP Volume 19, Number 1 2017 43
In context 1, these practices had been developed over
several years and were well established. Clinical educators
consciously modelled teamwork and trust in each other to
the students throughout the clinic.
We have complete trust in the other’s professional
judgement, teaching and learning judgement,
understanding of what the children need,
understanding of what the students need…and that’s
what [the students] say to us, isn’t it? “We watch you,
we see how you discuss things, the respect you have
for each other” (OT CE 1).
This trust extended to splitting responsibility for observing
students’ clinical sessions, so that both clinical educators
did not always need to be present. They further split
responsibility for reviewing the therapy plans generated by
student teams, so that each clinical educator provided
feedback on half of the interprofessional plans, thereby
reducing their workloads.
We are not [both] always present, there might be a
week go by when I haven’t seen a session with one
child, because I have been looking at sessions with
someone else. There is no sense from the students’
perspective that they are worried about that. (OT CE 1)
This was reflected in student responses, with 94% of
students in context 1 reporting they received appropriate
feedback and supervision. In context 2, 73% of students
reported they received adequate feedback. These CEs
reflected that, because they were new to working with each
other, they quickly learned throughout the placement to
include each other more when collaborating with students.
There was inconsistency in our feedback initially given
that we were new to working with each other. Our
feedback on session plans worked much better when
we discussed it before sending it to students. This
improved throughout the program as our relationship
grew (OT CE 2).
Overall, 93% of students indicated that they were satisfied
with the placement and it provided an environment
conducive to their learning. One student comment
exemplifies the variety of factors described above in
creating an overall positive learning experience.
I feel I learned more in this placement than I have in
any other. The knowledge shared by staff members
surrounding cultural sensitivity was informative and
their passion inspiring. I learned a lot about Indigenous
culture and also a lot about how to ensure activities
are culturally relevant. (OT student, group 3)
Discussion
This study sought to determine the practices and
processes which support the development of clinics in
Indigenous contexts. Data obtained from student surveys
revealed that overall, 94% of students in context 1 and
78.5% of students in context 2 felt they were more skilled in
working with Aboriginal and Torres Strait Islander clients as
a result of their practical experience. This difference
appeared to be due to the newer nature of context 2 and
the need to establish opportunities for more integrated
interprofessional practices. Students’ negative responses
were connected with university requirements, their stage of
learning (i.e., earlier year levels) and their concerns about
not learning specific clinical skills in this style of service
provision. In contrast, context 1 included final or near-final
year students and greater freedom to “take the pressure
developed skills in communicating effectively with
Indigenous colleagues and/or clients during their
placement. Importantly, students reflected not only on
Indigenous cultures but also the impact of their own culture
and societal positioning. “I realised how privileged I was to
be able to study and have opportunities to pursue my
dreams because of what my parents or my own society
have given me” (SLP Student group 2).
Client-centred practice
Clinical educators described assisting the students to focus
on the client as the centre of all their activities, rather than
evaluation of their own professional skills. They did this by
giving students more autonomy and constantly redirecting
them to consider how their planned therapy sessions would
impact on the children. “They switched from being a
student to focusing on the client and managing their
workload. It wasn’t like ‘you’re being assessed’; it’s about
what’s going to be best for our kids” (OT CE 1).
Student comments reflected this emphasis on client-
centred care, including the importance of informal
assessment processes. For instance, one student noted:
“I learnt a lot about how cultural differences should be
considered carefully in the planning and execution of
therapy. I considered this ‘discomfort’ with testing and
conducted all therapy or individual sessions informally” (SLP
student, group 2).
In contrast, in context 2, some students had difficulty
with this style of service provision because they were
focused on accruing placement hours and this affected the
appropriateness of their service provision.
[A couple of the students] were concerned their
hours would not count as they needed assessment
hours in particular. They were focused on testing
during the group sessions rather than supporting the
development of the children. (CE SLP 2)
Students were also expected to develop integrated goals
and reports on the children’s progress. Students reported
the benefits of working in this way.
Working in a strengths based approach with my
occupational therapy student made therapy so much
more holistic and motivating…and how much their
(OT) therapy plays a role in the goals I am trying to
achieve. (SLP student, group 2)
Clinical educators described their expectation that the
students move beyond their discipline-specific roles to
support the child’s needs. They also modelled being
comfortable to seek information from the other discipline
and work collaboratively to support their intervention goals
in therapy sessions.
When we see a child who has more OT needs than
speech pathology needs, we’ve gone “It’s the child
who’s the important part, so now you need to learn
more about OT, so you can assist”. (SLP CE 1)
When students embraced role expansion in this way, the
clinical educators reinforced their efforts and celebrated the
value of this expansion. “And we always give them such
positive feedback for that. When we have the speechie
there and they’re giving prompts for pencil grasp, for
posture, we’ve done our job” (OT CE 1).
Interprofessional leadership
The cultivation of this interprofessional client-centred
approach required leadership from the clinical educators to
model teamwork practices and create a teamwork culture.