The Broken Hill University Department of Rural Health (BH UDRH) operates a successful multidisciplinary rural clinical placement program in far western New South Wales. 1 However, until recently, the development of allied health programs had been constrained by the region's limited access to allied health services and their capacity to support students. There are few placement opportunities nationally across the UDRH network for allied health disciplines such as speech pathology (22 students in 2008/2009 J. Ramsay, pers. comm., 2010).In Broken Hill, local primary school teachers and parents had raised concerns about the lack of paediatric speech pathology services and the impact this was having on educational attainment. We proposed a novel solution using a clinical education model 2 structured around student-run clinics 3 in the primary schools. The development relied on non-traditional partnerships with school education, a commitment by speech pathologists from the Area Health Service to allocate time for clinical supervision and work by BH UDRH staff to engage academic partners from a feeder university, recruit students and manage the placements. Participants, methods and resultsThe program was piloted in 2009 and three groups of final year students (17 students) completed a fieldwork placement during 2010. The six-week placements were scheduled for school terms 1, 2 and 3, and each included orientation and three days of structured teaching on cross cultural education, primary health care principles, preparation for fieldwork and professional resilience.Students worked in pairs running clinics at local primary schools supervised by local speech pathologists. Clinical activity varied with each placement. The first group of the year focused on screening kindergarten children while subsequent rotations screened other children referred by parents or teachers. The students delivered speech pathology interventions for children with straightforward problems, assisted speech pathologists in complex cases and referred to associated services if required. They also provided teacher and parent education. Each consultation was documented on a standard form, reviewed by the speech pathologist and filed in school records. The supervising speech pathologist referred children for ongoing treatment or further assessment to the speech pathology service as required.Individual student needs were closely monitored and tailored levels of clinical and non-clinical supervision/ support developed to enhance participant experiences. Students also participated in the local inter-professional learning program.The curriculum requirements for the placement were determined and monitored by academic staff from the Faculty of Health Sciences, University of Sydney and delivered collaboratively on-site.A total of 231 primary school aged children, including 167 from kindergarten (93% of enrolments) were assessed in 2010. Fifty-eight per cent of kindergarten children had a speech pathology intervention. Furthermore, the number of new referrals on...
Introduction:The current and future health needs of the population pose challenges for healthcare services, which face increased pressure for service provision, and for universities educating graduates to meet this clinical demand. One aspect influencing allied health (AH) clinician willingness to offer student placements is the perceptions of impact on patient activity levels and clinician time. This systematic review synthesises the evidence quantifying student impact on AH patient activity, clinician time and productivity.Methods: Searches of peer-reviewed literature published since 1990 were conducted in Medline, CINAHL, Scopus and EMBASE and supplemented by other sources. Selected studies reported clinician-recorded patient activity and/or time participating in services provided by nutrition and dietetics, occupational therapy, physiotherapy and speech pathology, with and without students present. Studies meeting eligibility criteria (n = 23) were rated using the McMaster Guidelines for Critical Review Form: Quantitative Studies. Effect size calculations and meta-analysis were planned if sufficient studies reported similar outcome measures. Results:Seventeen studies contributed to four meta-analyses: patient activity levels, direct clinical time, clinical billed units and direct time per patient. Pooled results were neutral or favoured increases in activity or time during student placements. Methodological variation and research quality inhibited more comprehensive analysis.
There was no significant difference in overall clinical time used, nor patient activity or productivity whether clinicians were supervising students or not. Further research is required within SLP services.
Several studies have demonstrated good understanding of comparatives by 3‐ and 4‐year‐olds. We suggest that this result is artifactual and arises because testers have used tasks where the child can successfully respond to sentences such as ‘the A is bigger than the B’ simply by understanding ‘the A is big’. We tested 80 children aged from 4 to 7 years using a task where the child could not succeed simply by responding to the first half of the sentence, and found that the majority of 4‐ and 5‐year‐olds did not understand comparatives. Children's errors were not random but showed that they used two basic strategies to interpret sentences: a non‐linguistic strategy of selecting the largest objects, and a linguistic strategy of assigning the adjective to the first noun. It is not until 6 or 7 years of age that most children reliably respond correctly to comparatives. Even this may be an overestimate of understanding, since children of this age are quite unable to appreciate that a comparative construction using a nonsense adjective implies a contrast between the two nouns, although they can handle simpler sentences using nonsense adjectives quite adequately.
Qualitative studies have described clinician perspectives on student placements. These studies highlight likely contributors to placement shortages, but little is documented in speech pathology (SP). This article describes SP clinician perceptions of student impact/s on their clinical and other work tasks, stress levels and time management, and explores factors that may contribute to these perceptions of their experience. Interpretive description was selected to analyse public health sector SP clinician online survey responses. Open-ended questions explored clinician perceptions of student impact on specified components of their work as well as any other aspects clinicians identified. Thirty-four SP clinicians with varying caseloads and experience levels responded. Clinicians perceived that students can positively or negatively impact their clinical and non-clinical activities. Many also identified negative impacts on their stress levels. Some commented on differing impacts for patients and other colleagues. Collective themes of Clinician, Supervision Practices, Workplace, and Student are presented in a model of potential influences on the experience of student impact. SP clinicians perceived that experience of student impact is varied and complex. Influences are likely to be multi-factorial and further research is needed in a range of contexts to guide clinicians, managers and universities in supporting SP student clinical placements.
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