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The scope of this guidance 

This guidance is intended for all speech and language therapists (SLTs) and aims to establish the RCSLT’s position on placements for 2020-21.


In September 2019, work commenced on updating the Standards for Practice Based Learning (RCSLT, 2006), though this project was paused in March 2020 due to COVID-19. 

Due to the disruption to practice placement delivery (during COVID-19), this interim practice-based learning guidance has been developed to support adjustments to SLT practice placements, specifically for the academic year 2020-21

It will address the placement landscape and the pressure for, and disruption to, practice placements by providing information on:

  • Practice-based learning in context 
  • Key recommendations for placements 2020-21 
  • Overseas practice placements

Please also see

Telehealth placement guidance has also been developed to complement this practice-based learning guidance, which itself will provide information on:

  • Delivering telehealth placements
  • Roles and responsibilities during telehealth placements
  • Information governance and digital inclusion
  • Evidence-based practice

Both sets of guidelines offer general guidance and as such do not cover every instance and eventuality. Please discuss any specific questions with the relevant higher education institution (HEI).

Defining terminology 

 

Practice placement  

The period(s) of study undertaken by learners as a formal element of their speech and language therapy pre-registration training based within a working environment (including HEI-based clinics, as well as those outside the academic institution) (RCSLT, 2018)

During practice placements, students are assessed against learning outcomes set by the HEI for the placement. To pass the placement they must reach the competency level required for their level of learning, in line with the HCPC Standards of Proficiency (HCPC, 2014).

“Placements are essential to develop the skills and proficiencies necessary to be registered as an allied health professional with the HCPC.” 
(HEE, July 2020). 

Practice educator

A practice educator is a HCPC-registered SLT who supports learners in the workplace to develop their Standards of Proficiency (HCPC, 2014). 

The practice educator holds responsibility for signing off the student’s competency and assessment criteria, based upon the standards produced by the education provider and relevant professional body; although it is recognised that local models of delivery and assessment will apply (RCSLT, 2018).

Telehealth  

The RCSLT uses the WHO definition of telehealth: the “delivery of health care services, where patients and providers are separated by distance... (it) can contribute to achieving universal health coverage by improving access for patients to quality, cost-effective, health services wherever they may be” (World Health Organization, 2016). 

The RCSLT has developed additional and practical telehealth guidance

Telehealth placements  

Telehealth placements refer to student practice-based learning activity being carried out remotely. Telehealth is the context of the delivery of the practice placement, based on the mode of service delivery within the placement setting. The practice educator/student can be working remotely from a clinical site, university location, or from home. 

Please see the RCSLT telehealth placement webpages for further information.

Practice-based learning activities

All practice-based learning activities are intended to develop clinical and professional skills, and the application of theory to practice. 

Practice-based learning activities provide students with the opportunity to develop all the Standards of Proficiency (HCPC, 2014).

Direct client-centred care

Direct client-centred care refers to all practice-based learning that directly involves working with service users, carers, and members of the multi disciplinary team (MDT). 

Direct client-centred care provides students with the opportunity to develop Standards of Proficiency 8 and 9 which relate to communication and interpersonal skills (HCPC, 2014).  

 

Context

Practice-based learning 

The RCSLT views pre-registration learning as a collective agreement between academic HEI tutors, clinical practice educators and clinical managers to develop the transformative potential and transferable distinctive skill set of speech and language therapy learners. 

All practising SLTs have benefitted from placement experiences as students, and the RCSLT calls on every member of the profession to share this responsibility and to support placement opportunities for current student SLTs. As a skilled group of professionals, SLTs (both in the NHS and independent practice) are well placed to be creative, flexible and innovative in placement provision.
 
The RCSLT Standards for Practice Based Learning (RCSLT, 2006) currently provides guidance on clinical learning; however, this is currently being updated and is expected spring 2021. 

It will encompass all elements of practice-based learning and will therefore also supersede the following: 

There will be some key elements in the updated Standards for Practice Based Learning which are important to note, and have therefore been included here, ahead of the updated standards being published.

Practice-based learning in 2020-21

Following the declaration of the COVID-19 pandemic, in-person speech and language therapy student practice placements were withdrawn. In some regions of the UK, students were able to contribute to work in the NHS, as Health Education England (HEE) and Health Education and Improvement in Wales (HEWI) facilitated paid placements. 

HEIs have worked in partnership with some NHS, independent practice, and third sector colleagues to enable some students to engage in practice placements and practice-based learning activities via telehealth.  

The NHS is now in the recovery phase and paid practice placements have ended. There is an expectation from government authorities, including HEE, NHS Education for Scotland (NES) and HEWI, to transition back to standard placements. 

HEIs need to recover practice placement hours which were lost during the COVID-19 outbreak and secure practice placement hours for all students for the academic year 2020-21. Planning is needed to safeguard practice placements in case of a second wave of COVID-19, or in case of any future local lockdowns. 

It is acknowledged that some services are still in furlough and re-deployment phases, and are transitioning back to in-person appointments. Whilst some SLTs are working clinically in person, many continue to function remotely. It is recognised that, where possible, practice placements will take place in person, but others will be delivered via telehealth. 

Practice educators can discuss flexibility around access to client venues, PPE and IT equipment, with the local HEI. 

All practice placements will proceed in line with the most up-to-date local public health guidance, which may differ across the UK.  

 

Key recommendations for placements 2020-21

Please find below the key recommendations for 2020-21 placements, all of which are explained in more detail throughout this guidance:

  • Practice placements will support a wide range of practice-based learning activities, to facilitate learners to meet their Standards of Proficiency (HCPC, 2014)
  • A minimum of 25% of practice-based learning should be direct client-centred care 
  • All SLTs should support 25 days of practice-based learning per year per whole time equivalent (wte) (pro rata), unless specific local arrangements are in place, i.e. in the devolved nations (see section on 'supporting students' for detail of Band 5s who are still working towards NQP competencies) 
  • Practice placement expansion is required for the sustainability of the workforce
  • HCPC guidance should be followed for overseas students 
  • Diversity and inclusion advice should be adhered to.

Practice-based learning requirements 

The HCPC Standard of Education and Training 5.2 states: “The structure, duration and range of practice-based learning must support the achievement of the learning outcomes and the standards of proficiency” (HCPC, 2017). 

Every practice placement must have learning outcomes defined by the HEI and the practice placement must provide the student with the opportunity to develop their clinical skills and meet the HCPC Standards of Proficiency for Speech and Language Therapists (HCPC, 2014). 

The RCSLT curriculum guidance for the pre-registration of speech and language therapists (2018) has defined the duration of overall placement hours. All students must achieve the mandatory 150 sessions of practice education; 100 of these sessions to be overseen by an SLT.

Additionally, the RCSLT suggests that practice placements should be spread across clinical areas:
 
  • adult (30 sessions)
  • child (30 sessions); and
  • the remainder reflecting local service delivery. 

The RCSLT acknowledges that during the 2020-21 transition period, some flexibility will be required to achieve practice placements.

We therefore suggest that:

  • Practice placements support a range of practice-based learning activities 
  • A minimum of 25% of a practice placement should be direct client-centred care, working with service users, carers, and the MDT
  • All practice-based learning activities support students developing their Standards of Proficiency (HCPC, 2014)
  • A balance of clinical experiences across client groups must be provided for all students over the duration of the programme 
  • Practice placements can take place in person, via telehealth, or as a hybrid of both

We suggest anybody at high-risk of COVID-19 (for example; BAME students, students who are immunosuppressed, those who are shielding, etc.) may be better suited to telehealth placements

Adaptations to these practice placement requirements can be supported for students with reasonable adjustment plans, via discussion with the HEI and relevant student support services.

 

Practice-based learning activities 

There are a range of practice-based learning activities which can be counted as practice placement in the 2020-21 academic year. 

Where practice-based learning activities are undertaken, there should be clearly defined outputs which link to Standards of Proficiency (HCPC, 2014) and form evidence of the student’s development. 

This is a template for practice-based learning activities with structured outputs, linked to the standards and including worked examples. 

The list below of practice-based learning activities is not exhaustive and services are encouraged to be creative and innovative in their placement offers.

Simulated learning environments

Simulation is a teaching and learning methodology which is well established in healthcare education. It offers a safe environment to focus on the learner’s needs, simulate the clinical environment and practice clinical skills (Hewat et al 2020).

There are various types of simulation (including part task trainers, mannequins, standardised patients) and environments (including in situ, dedicated clinical simulation suites). It is important to clearly define the intended learning outcomes for each simulation to ensure the appropriate type of simulation is selected and aligns to the student's level of learning (Alinier 2007).

A recent randomised control trial (RCT) carried out across a number of HEI speech pathology programmes in Australia reported that speech pathology students ”achieved a statistically equivalent level of competency when an average of 20% of their placement time was replaced with simulation-based learning, compared with students without a simulation component” (Hill et al, 2020). 

The RCSLT is discussing the possibility of providing more focused guidance on simulation in the future and is interested to hear about examples of good practice in this area.

If you have any further information or examples of simulation that you would be happy to share, please send it to info@rcslt.org

Case studies with/without video

To enable students to follow the service user journey from referral to discharge, engage in case history and information gathering discussions, complete assessments, plan and discuss interventions, thus developing clinical decision-making skills. 

Clinical and professional scenarios 

Clinical scenarios could involve referral decisions, discharge decisions or breaking bad news. Professional scenarios could involve caseload prioritisation, MDT working or legal and ethical issues.

Role play

This will involve students practicing and developing clinical skills with educators/peers.  

Expert service users and carers (SUC) 

These will involve real service users and carers who volunteer their time to support student learning; e.g. provide repeat case history opportunities, repeat assessment experiences, repeat intervention practice, and are an additional source of feedback.  

Project work 

For example: health promotion, making resources, life stories, developing training packages, carrying out audits. 

Attending CPD activities 

For example: workshops, webinars, enabling theory to practice development. 

These practice-based learning activities are a flexible approach to practice placement delivery. They can support students with different learning styles, in the same way that practice placements would usually (e.g. offering the opportunity to observe, then contribute, or practice via other activities before direct engagement with the service user, carer and MDT).

 

Direct client-centred care

All practice placements should include 25% direct client-centred care, as students need the opportunity to develop all their HCPC Standards of Proficiency. Standards 8 and 9 relate to communication and interpersonal skills and therefore cannot be fully achieved and assessed without direct clinical work. 

The recommended 25% is not a figure which can be supported by primary evidence, but reflects a realistic minimum amount of direct work needed to achieve the Standards of Proficiency, based on the experience of SLTs supporting practice placements during COVID-19. 

It is recognised that students being able to participate in direct clinical work may be a challenge within certain clinical populations and settings. This recommended balance of practice-based learning activities and direct client-centred care is intended to enable a realistic level of direct clinical activity, in all clinical settings and in the current circumstances.
 
However, exceptional circumstances may exist. If the minimum amount of direct clinical work cannot take place, then the student will need increased direct clinical work in their next practice placement. 

Direct client-centred work might include: 

  • One-to-one assessment and therapy sessions with a service user 
  • One-to-one work with a carer
  • Training sessions; e.g. parent training and coaching   
  • Work with the MDT; e.g. meetings, case conferences, ward rounds 
  • Groups; e.g. social skills groups, communication café style sessions 

Direct work can take place in person or remotely, reflecting the current mode of service delivery, though the following should be considered:

  • In-person practice placements should be taken up in alignment with risk assessments for staff, use of PPE and other local policies. For example: uniform requirements, and following COVID-19 guidance from NHS and other relevant public health bodies. HEIs and placement providers should integrate the Council of Dean’s guidance
  • Telehealth should adhere to the RCSLT telehealth and telehealth placement guidance.

 

Supporting students

The expectation of the RCSLT is that every SLT should aim to offer 25 days of practice education per year per wte (pro rata).

Please note: 

  • This is recommended guidance with the aim of supporting the sustainability of the future speech and language therapy workforce 
  • It is not mandated; however, it is intended that SLTs will respond to their professional responsibility and duty to support student learning.

Placement allocation 

There is a difference in the way practice placements are allocated across the four nations of the UK. Each of the UK nations will continue to work to their own practice placement allocation system, and will include telehealth placements, as appropriate.
 
England:

 

  • HEIs work in collaboration with HEE, at a national and regional level
  • HEIs work in partnership with placement providers within their area to ensure sufficient placement capacity 
  • If a placement is withdrawn, there is an expectation that an alternative placement will be offered 
  • Student numbers are based on placement capacity 
  • HEIs are currently working with HEE on placement expansion
Wales:

 

  • Health Education and Information Wales (HEIW) currently commission health funded training and bursary places for speech and language therapy, (this will continue into 2021/22) 
  • Students in receipt of a funded bursary place are expected to work in Wales for two-years, post-qualification 
  • First language Welsh is the chosen dialect in some geographical areas so it is preferred that students can speak Welsh, while HEIW commission some speech and language therapy places specifically for Welsh speakers
  • A tripartite agreement exists between HEIW, Welsh health boards and the HEI regarding placement provision
Scotland:

 

  • Placement offers are made in-line with the practice-based learning agreements which are established with each Health Board, via NHS Education Scotland (NES)
  • A robust placement cancellation policy exists
  • Student numbers are restricted by placement availability
  • Scottish HEIs and Health Boards have been engaging in NES-led “growing capacity” events and projects
Northern Ireland: 

 

  • Has five health and social care trusts who provide all of the placement for Ulster students
  • The department of health provides 28 funded places for students (it has been increased to this figure this upcoming year, for year one)
  • Tripartite agreement exists between trusts, HEI and Department of Health
  • HEI and trust partnership safeguards take up of placements

Practice placement offers in an area should be overt and transparent. Even though telehealth placements are not restricted by geographical distance, the HEIs will maintain the principle of seeking offers from their own area, to prevent unhelpful competition.

Where there is an exceptional reason for placing a student ‘out of area’, there will be prior contact with the local HEI to agree the arrangement. 

 

Rationale for 25 days

In England, most HEIs work to a fair share allocation agreement in partnership with local placement providers. This is based on a formula derived from the number of placements required (150 sessions per student), and the number of SLTs eligible to provide practice placements in the locality of the HEI.

The number of placement days requested by HEIs in the past few years has varied. Due to the expansion of student numbers and speech and language therapy programmes, the RCSLT suggests that all SLTs aim to offer 25 days to meet current placement capacity requirements. 

The request for 25 days can be re-calculated locally according to the need of the HEI. If a HEI does not require 25 days practice placement provision per educator, then educators are asked to offer this practice placement capacity to another HEI. 

Flexibility in the approach to the 25 days may also be agreed in partnership between service providers and HEIs, if, for example, services are managing maternity leave, sick leave, staff shortages, etc. However, to meet the requirement for practice placements due to COVID-19, and to sustain the workforce, it is essential that all services and individuals aim to meet their placement quota.

Who provides practice education

Practice educators who have the overarching responsibility for a student’s learning on placement should be working at equivalent Band 5-8 in the NHS or independent sector. All practice educators will have completed educator training with the relevant HEI.

In addition we suggest that you consider the following:

 

  • Band 5 SLTs who have completed their NQP competencies may take full responsibility for a student practice placement.
  • NQP Band 5 SLTs who are still completing their competencies may be involved in offering observation opportunities or supporting students alongside more senior SLT colleagues. 
  • Service managers who do not hold a clinical caseload may be able to offer practice-based education sessions for students; e.g. on service delivery models.
  • No area of SLT service delivery is considered too specialist to offer student practice placements. 
  • A student can be an integral part of any team, adding value, bringing new skills and sharing knowledge from cutting-edge teaching.

HEI course providers should endeavour to consider all speech and language therapy services as potential practice placement opportunities and offer SLTs the support they need to become practice educators and work with learners in their services.

Where SLTs are unable to provide 25 days per wte (pro rata), a clear rationale should be provided

Fulfilling student supervision

The commitment to 25 days of practice education relates to time spent overseeing a student’s learning in the workplace.

We suggest that you consider the following:

  • The practice educator does not need to supervise the student at all times. 
  • Where appropriate, students can work independently with clients, having been briefed by their educator, and with opportunity to feedback afterwards. 
  • Students can engage in a range of practice-based learning activities to help them develop in line with the Standards of Proficiency (HCPC, 2014). 
  • Some activities can be carried out independently, or with peers; e.g. project work, audit, creating resources, life story work, reviewing and summarising evidence-based practice. 

To gain a varied experience, as part of their practice placement, students can also spend time with:

  • SLT Assistants (SLTAs)
  • NQP Band 5s (working on their competencies); and
  • colleagues from other health, education and care professions. 

 

Placement expansion 

Pre COVID-19, there were national concerns across many of the allied health professions (AHPs) concerning practice placement capacity and the sustainability of a growing AHP workforce. 

The senior AHPs were working with the National Health Education Agencies and the Council of Deans of Health to develop plans for expansion of practice placement capacity. 

Practice placement expansion work is required to ensure that practice placements take place, for the sustainability of the future speech and language therapy workforce.

There are many practice placement expansion ideas, including:

  • Multiple supervision models
  • Practice placements reflecting the current workplace (e.g. 24/7, 7/7)
  • Innovative virtual and simulation practice placement opportunities
  • Role emerging practice placements
  • New learning environments that reflect modern healthcare and educational practices (e.g. telehealth)
  • New and innovative approaches, including those emerging as a result of the COVID-19 response

HEIs and placement providers should work together to develop innovative practice placement expansion ideas.

Overseas practice placements

Overseas (or international) practice placements are permitted by the HCPC and RCSLT as long as providers are able to maintain the same standards of quality, for both practice educator and settings, as they would for any UK-based placements. 

Providers must meet the HCPC Standards of Education and Training SET 5 Practice Based Learning.

The HCPC requires that where practice educators are not HCPC registered, providers must be able to explain their decision and how they make sure that they are appropriate to carry out this role, including how their experience, qualifications and training are relevant to the practice-based learning they are involved in.

For more information, please see HCPC Standards of education and training guidance (linked above).

The RCSLT recommends that practice educators who support overseas practice placements are:

  • HCPC registered; 
  • UK trained and registered with the professional body within a country that has a mutual recognition agreement with the RCSLT; or 
  • trained and registered within a country that has a mutual recognition agreement with the RCSLT.

Practice placements are permitted in other circumstances, however, you must be able to explain your rationale. For example: due to COVID-19, some HEIs are reporting that international students have returned to their home countries overseas and have queried the option of students sourcing and engaging in practice placements at home. 

International practice placements cannot form the majority of a student’s practice placement experience, the majority of a student’s practice placement experience should take place within the UK.

Diversity and inclusion 

The update to the Standards for Practice Based Learning (currently underway and expected spring 2021), will further emphasise diversity and inclusion. Key advice will include: 

  • All educators need to be culturally aware and culturally competent, including on issues relating to a range of minority groups; for example, Black, Asian, and Minority Ethnic (BAME), LGBTQ+, and persons with disabilities.
  • Educators need to have an understanding of unconscious bias and how this may affect their practice.
  • There may be a mismatch of educators and students, and a mentor network for students from BAME backgrounds should be created.

For further information on the RCSLT’s diversity and anti-racism work, please visit our diversity, inclusion and anti-racism webpages

Resources

RCSLT resources:

Additional resources:

References

Alinier, G. (2007) A typology of educationally focused medical simulation tools. Medical Teacher, 29:8, e243-e250, DOI:10.1080/01421590701551185

Equality Act (2010) Available at: https://www.legislation.gov.uk/ukpga/2010/15/section/92 <accessed on 10 September 2020>

Health and Care Professions Council (2014) Standards of Proficiency. Speech and language therapists. Available at: https://www.hcpc-uk.org/globalassets/resources/standards/standards-of-proficiency---speech-and-language-therapists.pdf?v=637018072470000000 <accessed on 10 September 2020>

Health and Care Professions Council (2016) Standards of performance, conduct and ethics. Available at: https://www.hcpc-uk.org/globalassets/resources/standards/standards-of-conduct-performance-and-ethics.pdf?v=637171211260000000 <accessed on 10 September 2020>

Health and Care Professions Council (2017) Standards of education and training guidance. Available at: https://www.hcpc-uk.org/globalassets/resources/guidance/standards-of-education-and-training-guidance.pdf?v=637106444300000000 <accessed on 10 September 2020>

Health Education England (2018) Professional development framework for educators. Available at: https://london.hee.nhs.uk/sites/default/files/professional_development_framework_for_educators_2018.pdf <accessed on 10 September 2020>

Health Education England (2020) AHP Placements FAQs - 1 July 2020. Available at: https://www.hee.nhs.uk/sites/default/files/documents/AHP%20placement%20FAQs%20-%2006-07-20.pdf <accessed on 10 September 2020>

Health Education England (2020) Coronavirus (COVID-19) information for AHPs Available at: https://www.hee.nhs.uk/coronavirus-covid-19/coronavirus-covid-19-information-ahps <accessed on 10 September 2020>

Hewat, S., Penman, A., Davidson, B., Baldac, S., Howells, S., Walters, J., Purcell, A., Cardell, E., McCabe, P., Caird, E., Ward, E. and Hill, A.E. (2020) A framework to support the development of quality simulation-based-learning programmes in speech-language pathology. International Journal of Language and Communication Disorders. Vol 0. No O, 1-14 <accessed on 10 September 2020>

Hill, A. E., Ward, E., Heard, R., McAllister, S., McCabe, P., Penman, A., Caird, E., Aldridge, D., Baldac, S., Cardell, E., Davenport, R., Davidson, B., Hewat, S., Howells, S., Purcell, A. & Walters, J. (2020) Simulation can replace part of speech-language pathology placement time: A randomised controlled trial. International Journal of Speech-Language Pathology. DOI:10.1080/17549507.2020.1722238

RCSLT (2006) RCSLT National standards for practice-based learning. Available at: https://www.rcslt.org/-/media/Project/RCSLT/rcslt-he-national-standards-practice-based-learning-Jan2006.pdf <accessed on 10 September 2020>

RCSLT (2018) Curriculum guidance for the pre-registration education of speech and language therapists. Available at: https://www.rcslt.org/-/media/Project/RCSLT/curriculum-guidance-2018.pdf <accessed on 10 September 2020>

RCSLT (2020) Telehealth guidance. Available at: https://www.rcslt.org/members/delivering-quality-services/telehealth/telehealth-guidance <accessed on 10 September 2020>

RCSLT (2020) Telehealth placement guidance. Available at: https://www.rcslt.org/members/lifelong-learning/telehealth-placements <accessed on 10 September 2020>