Practice-based learning: main guidance
Practice placement national organisation and allocation
The approach to practice placement organisation and allocation is currently different across the four nations of the UK.
All UK nations
- The expectation of the RCSLT is that every SLT should offer a minimum of 25 days of practice-based learning per year per whole time equivalent (WTE) (pro rata), unless an explanation with a clear rationale can be provided. This recommendation applies across the UK, except in Northern Ireland, where specific central arrangements for placement allocation are in place.
- Students should not source their own practice placements, unless recommended by the HEI, as this can reduce parity and objectivity.
- Students should not have practice-based learning opportunities in clinical environments where they are working eg as an SLT assistant, or where they have secured future employment, as this can cause potential conflicts of interest.
- Practice placement providers will deliver on all offers, and provide alternatives when offers are redacted, where possible.
- It is helpful if practice placement offers in an area are overt and transparent. They may be discussed at HEI meetings, local managers groups and the Association of Speech and Language Therapists in Independent Practice (ASLTIP) forums.
- Even though the opportunity for telehealth placements does not restrict geographical distance for placements, the HEIs will maintain the principle, where possible, of seeking offers from their own area/locality. The geographical areas are broadly defined by the learning development agreement (LDA) and NHS trust boundaries.
- Where HEIs seek practice placements (onsite or via telehealth) outside their own area, it is requested that they contact the HEI in the area of the provider to discuss this collaboratively.
- Where speech and language therapy practices (NHS or independent) working remotely opt to link with an HEI that is not their closest geographically, there should be discussion and collaboration between the relevant HEIs.
- Where there is a collection of HEIs offering SLT programmes in a neighbouring geographical area – a collaborative working model is encouraged, to:
- prevent unhelpful competition in securing practice placements in the same geographical area
- share systems of planning, allocation and documentation where possible
- share clinical training for educators from both/all HEIs
- promote innovative practice in clinical education.
- Where HEIs are setting up new speech and language therapy courses, the expectation of the RCSLT is that they will demonstrate increased practice placement capacity.
- Speech and language therapy education in England is provided by a range of universities (HEIs) at undergraduate and postgraduate level. There is no direct commissioning of places from the Department of Health.
- HEIs work in collaboration with Health Education England (HEE) at a national and regional level.
- The learning development agreement (LDA) is an agreement, written by HEE, between NHS service providers and the education establishments. It offers a framework for the delivery of practice-based learning and teaching to support workforce development. It will be replaced by the new NHS Education Contract in April 2021, written by HEE; this will clarify responsibilities between the HEIs and all local service providers (including NHS, independent, voluntary and social care sectors).
- HEIs work in partnership with practice placement providers within their area to support and secure sufficient practice placement capacity.
- It is recommended that services and HEIs use electronic platforms for offers and allocations eg placement management programme (PMP), InPlace.
- Offers from practice placement providers are requested on an annual basis (generally).
- Confirmations of practice placements should be done in a timely way; ideally one month in advance of the practice placement starting, where possible.
- Since 2010, there have been allied health professions (AHP) practice-based learning partnership agreements in place between each Scottish university that runs pre-registration AHP programmes and each NHS board. These were previously known as practice placement agreements (PPA). These clarify an on-going commitment from each Scottish health board to provide a certain minimum amount of practice-based learning provision per profession each year. Each health board has an AHP practice placement group led by a practice education lead.
- Each practice-based learning partnership agreement has a stakeholder partnership statement, a generic agreement for all AHP groups and all organisations, and a schedule with profession specific details including the number of practice-based learning weeks that should be provided annually. NHS Education for Scotland facilitates the review of the Practice-based Learning partnership agreements between the HEIs and practice placement providers are updated at regular intervals to incorporate any policy changes and to consider changes to numbers of practice placements required. The agreement contains details of agreed mandatory training prior to practice placements and a robust cancellation policy.
- See the AHP practice education community practice placements resources for further information.
- Each HEI has links with SLTs practising in the independent and voluntary sector and these are arranged on an individual basis each year. The vast majority of clinical practice placements are provided in the NHS.
- Health Education and Information Wales (HEIW) currently commissions health funded training and bursary places for speech and language therapy students at Cardiff Metropolitan University.
- A tripartite agreement regarding practice placement provision exists between HEIW, Welsh health boards and the HEI.
- Practice placements are commissioned across seven health boards. Each health board has a local level agreement with the HEI, which agrees the provision and support of clinical practice placements in their region.
- A profession-specific practice education facilitator (PEF) is employed in each board. These posts are held by SLTs and are funded by commissioners, with employment/secondment contracts with the university. SLT training in Wales is fees funded, with agreement to work in Wales for two years post qualification. Practice placements are mostly offered by the NHS SLT teams and are sourced and supported by the PEFs. Additional non-NHS practice placements may also be used for practice-based learning, with a clinical practice placement agreement in place.
- Commissioners fund travel and accommodation for students on practice placement (means tested). Some practice placements require Welsh speaking students in order to meet the needs of the specific population.
- Practice placements are organised and allocated centrally by the Clinical Director at the HEI, in collaboration with the PEFs, and the health board/non-NHS practice placement provider.
- Five health and social care (HSC) trusts establish the parameters for practice placement provision for students at Ulster University.
- Tuition fees are paid by the Department of Health for all Northern Ireland students that have been resident in the country for three years prior to the course commencing and are EU applicants (excluding England, Scotland and Wales).
- A tripartite agreement exists between trusts, the HEI and the Department of Health. A practice education partnership committee safeguards best take up of practice placements. Practice placements are requested on a yearly basis and trust offers are guided by the number of students needing to be placed and the relative size of each trust.
- It is expected that all practice-based settings should offer placements. All practice placements are based in the HSC trusts.
Independent sector guidance for practice placements
Independent SLTs work in a wide range of contexts. It is acknowledged that the context will be a key factor when offering student practice placements.
Independent SLT roles may include:
- Sole practitioner working part time from home
- Sole practitioner working on fixed site, eg school, hospital, care home
- Sole practitioner working from premises, eg clinic
- Subcontractor working for clients at a range of sites
- Employee of a private practice or other multidisciplinary team
- Owner/manager of a private practice
This list is not exhaustive, and instead, attempts to explain the range of contexts that fall under the term independent practice. The term independent practice is used in the rest of this guidance to encompass all independent SLT contexts.
The RCSLT expectation is for independent practitioners to offer 25 days per whole time equivalent (WTE) (pro rata) student practice placements, where it is safe and reasonable to do so, as a professional responsibility.
Independent practitioners can claim tariff (as per local arrangements). See the tariff section for more information.
Insurance for students on practice placements in all settings is provided by the HEI. Independent practitioners need to work with the HEI regarding risk assessments.
In order to facilitate practice placements, there are a number of actions independent practitioners can take to support quality placements, and to link in with their local HEI:
- Liaise with other independent practitioners in the area to offer joint practice placement opportunities with an identified Lead Practice Educator. This may require an additional time commitment.
- Complete a risk assessment to identify any potential hazards and control measures when offering a practice placement, particularly in the case of lone working, or visiting client’s homes.
There are features of independent practice which make the working pattern and demands unique. These may include consideration that:
- SLTs often work from home so there isn’t a regular ‘base’ to access.
- Client contact may not fall into standard business hours. Evening and weekend sessions are common.
- SLTs may work reduced hours, ie seeing 1-2 clients per week on average.
- SLTs main income is from direct client contact. Practice placement organisation needs to be sympathetic to this to avoid loss of income.
- Some areas of independent practice, eg medico-legal work, may be advanced and challenging, however students can still be involved with this. Educators can break down tasks into elements that are appropriate for a student to carry out, eg researching the evidence base to support an intervention.
This list is not exhaustive and attempts to explain the range of differences students may experience on practice placements in independent practice settings.
Where the SLT works hours such that the 25 days per year (pro rata) does not facilitate a practice placement, and they cannot join with other SLTs to form part of a placement, student learning can still be supported through offering:
- Work experience to prospective student SLTs, or those looking for experience outside of their HEI programme.
- Shadowing days as part of the HEI programme (where the HEI offers this to students).
- To undertake some teaching, assessment or application process support for the HEI programme.
It is understood that there may be financial implications involved in offering practice placements. Independent practitioners may choose to use practice placements to supplement their main business as an additional revenue source and to increase dosage for their clients, where the client is in agreement with this.
The differences between working in the NHS and independent practice should be explicitly discussed between the student, the HEI and the practice educator.
Additional considerations and requirements should include:
- Additional training and measures to support lone-working and working out of hours.
- An understanding of the variability of hours and locations, increased flexibility required and potential challenges of planning in advance.
- The need to orientate to more than one company/independent practitioner’s governance and procedures within the practice placement (where placements are offered jointly between different independent practitioners).
- Consideration of the reasonable adjustments that can and cannot be supported on an independent practitioner placement (this should be evaluated on a case-by-case basis).
- Access to ICT/resources.
HEIs are encouraged to support SLTs in independent practice in non-traditional ways to offer practice placements, for example:
- Offering out of hours or online practice educator training.
- Liaising with groups of independent practitioners to provide programme updates.
- Supporting independent practitioners who are offering a joint practice placement to collaborate and co-create the student learning environment, opportunities and assessment.
- Cascading placement updates directly to independent practitioners and also via ASLTIP for dissemination to members.
- Specifically discussing issues unique to independent practice with students to set clear expectations for roles and responsibilities.
Remote and digital working has facilitated the opportunity for independent practices to link with any HEI geographically. Where this happens, there should be discussion and a collaborative approach taken between the relevant HEIs.
It is helpful if HEIs have a link lecturer allocated to supporting practice placements in the independent sector.
Practice placement offers
The RCSLT supports a culture of continuous learning and improvement in the profession. This is enabled through continuing professional development (CPD) for all practising SLTs, and in the provision and planning for the future workforce.
Members of the RCSLT view the education of future members of the speech and language therapy workforce as a joint responsibility, shared between HCPC registered SLT service providers and HEIs, to ensure the sustainability and growth of the profession. As qualified SLTs, we all benefited from practice placement experiences as students, and it is essential that all SLTs now support practice placement opportunities for current students, where viable, to ensure the survival of our profession.
The expectation of the RCSLT is that all practising SLTs have a responsibility to engage in practice-based learning, irrespective of setting or banding. It is an integral part of the role of an SLT and is paramount to the future of our profession. The presence of student SLTs in all clinical settings needs to be considered the norm, not the exception (Gascoigne and Parker 2010).
Commitment to practice placements and support for the future workforce should be written into job descriptions, and accounted for at annual appraisal or through reflection or supervision processes. Time to support the future workforce should be ring-fenced both for placement coordinators and practice educators.
The RCSLT calls on all SLTs to share the responsibility for our future colleagues and to offer a minimum of 25 days of practice-based learning, per year, per whole time equivalent (pro rata). This recommendation applies across the UK, except in Northern Ireland, where specific central arrangements for practice placement allocation are in place.
The commitment to 25 days of practice education relates to time spent overseeing a student’s learning in the workplace. The practice educator does not need to be present with the student at all times. Where appropriate, students can work independently with clients, following planning with their practice educator and with opportunity to debrief afterwards.
Where peer or group practice placements are provided, these count as multiple days in terms of the practice educator offer, ie a peer placement for four days per week for three weeks equates to 24 days practice placement offered.
The view of the RCSLT, following national public consultation on this guidance, is that it is helpful to include a figure of 25 days per year (pro rata) in this guidance, to support service planning and to endorse the view of students being included as part of the workforce. The figure of 25 days is based on a formula derived from the number of practice placement sessions required (100 sessions per student overseen by an SLT) and the number of SLTs eligible to provide practice placements in the locality of the HEI.
If the offer of 25 days is not required by an HEI, they will inform local providers of their target figure.
A commitment to the offer of 25 days (pro rata) of practice-based learning should be evidenced by every practising speech and language therapist, where viable.
Days can be balanced across services eg if one SLT cannot offer 25 days, another in the service may be able to offer more.
If it is not possible for an SLT to offer 25 days, there should be a clear explanation.
Situations which are exceptions to the offer of 25 days might include:
- Where an SLT is new in post (ie for the first 6-12 months)
- Where services are managing significant numbers of vacancies or maternity/sick leaves
- Where clients do not consent to being seen by a student
- Where it is not financially viable; although the RCSLT expects demonstration of a commitment to SLT learners in other ways, if the full 25 day offer is not possible (see previous section for more information for SLTs in independent practice).
All areas of speech and language therapy practice are suitable for student practice-based learning, and should offer practice placements to all years of students. Discussion may take place between HEIs and practice educators to match student cohorts with the practice placements offered. There are no SLT roles that are considered too specialist, or too confidential, to support student learning. There is no gradation in the requirements for client confidentiality. For highly specialist areas of SLT practice, such as medico-legal work, SLTs can break down tasks and students can complete specific elements of client-centred care eg completing a literature review to support the effectiveness and dosage of a recommended intervention, for a medico-legal report. Practice settings can work with HEIs to discuss how competencies can be addressed in certain specialist settings.
Services that view students as assets create successful learning opportunities for students and can enhance service delivery for clients, for instance:
- Enabling SLTs to offer group therapy
- Providing additional therapy practice for clients
- Preparing resources
- Consulting the evidence base
A student can be an integral member of any team, adding value, bringing new skills and sharing knowledge from cutting-edge teaching.
Practice educators who have the overarching responsibility for a student’s learning on practice placement should be working at equivalent Bands 5-8 in statutory or independent/voluntary sectors.
Band 5 (or equivalent) SLTs working towards NQP competencies are encouraged and are ideally placed to contribute to student practice-based learning through supporting student learning alongside more experienced colleagues, through:
- placement induction
- engaging in presentations and tutorials with students
They should not take full responsibility for overseeing a student practice placement. They are asked to focus on their own development until they have gained their competencies and can then engage fully with student practice placements and offer 25 days (pro rata).
SLT leaders and managers (Band 7 and 8) may not hold clinical caseloads but are also encouraged to support student learning. Healthcare providers and educators need to facilitate leadership development in students from the very beginning of their healthcare careers: HEE Understanding and maximising leadership in pre-registration healthcare curricula: research report (PDF). Our colleagues in other allied health professions are leading the way with this and there are some excellent examples of students being able to learn about the profession, consider service wide issues and contribute to service delivery in new and innovative ways. For example, the Chartered Society of Physiotherapists hosted a practice placement where physiotherapy students worked on the recently published common placement assessment form.
To gain varied experience, as part of their practice placement, students can also spend time with:
- SLT assistants (SLTAs)
- Newly qualified practitioner (NQP) Band 5 SLTs (working on their competencies)
- Colleagues from other health, education and care professions
HEI course providers should 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.
Practice educator training
Practice educator training is required before educators take responsibility for a student’s practice-based learning.
All practice educators can attend free practice educator training:
- Initial training as new practice educators
- NQP SLTs should usually have completed their NQP competencies, before they take a lead as a practice educator. NQP SLTs are encouraged to support student learning via observation etc but would not have responsibility for formal supervision or assessment of the student. They may wish to engage in practice educator training if they are supporting a student practice placement, although there is no requirement to do so, until they have gained all of their competencies and can take full responsibility as a practice educator.
- Follow up training for all educators should be taken every three years
- This may take the form of AHP training (with, and run by AHP colleagues) for some elements and SLT specific for others.
Training may be delivered face to face or via distance learning.
Scotland has a central AHP practice educator online training course.
Training may be HEI led or practice placement co-ordinator led with HEI Involvement.
Other sources to support practice educator training include National Clinical Education groups and conferences eg National Association of Educators in Practice (NAEP), or Clinical Education Research Journals eg Journal of Workplace Learning, Journal of Interprofessional Care.
Training must include how to support students from under-represented groups, and should highlight dealing with discrimination, racism and microaggression. Training should promote inclusion and diversity, and raise awareness with respect to unconscious bias. Training should also cover transparent and supportive processes for students to raise concerns about microaggression and bullying from practice educators, please see the RCSLT guidance on bullying.
Time to attend training should be protected and prioritised by practice educators and the service and be recognised as CPD.
- SLTs should commit to offering practice placements after having attended training.
- The RCSLT plans to provide web resources for content and ideas regarding practice educator training.
All trained practice educators should evidence progression of practice education skills in annual appraisals, or through CPD, reflection and supervision. These may be evidenced by attendance at courses, eg Health Education England professional development practice education e-learning for healthcare.
Within Scotland, practice educator training is coordinated by the universities with associated AHP programmes. The universities provide AHP practice educator preparation and update sessions and co-ordinate these across Scotland. The universities work closely together to provide similar content at their practice educator sessions. Practice placement quality is monitored using the Quality Standards for Practice Placements (QSPP) (NES 2008). The QSPP audit tool details a set of standards for all AHPs to monitor and improve their practice placements. There are separate sections for completion by the learner, practice educator, placement coordinator and organisations – both HEI and NHS. Details of all practice education initiatives can be found on the NES website.
SLTs can also join the AHP practice education community of practice.
Practice educators can participate in self and peer evaluation to facilitate their personal development as clinical teachers. Being a practice educator requires the same skill set as being an SLT – goal setting with students, planning how to achieve the goal, teaching the various components that lead to the goal, evaluating the steps towards the goal, giving feedback to the student on their development. This mirrors our work with clients; breaking down complex tasks into component parts and supporting learners to achieve them.
Practice-based learning models
As dynamic practitioners, members of RCSLT encourage and support practice-based learning opportunities that are aligned with changing models of care and service delivery, role configuration and developments in practice. Opportunities for practice education should contribute to the profession’s responsiveness to the changing population, client and service delivery needs. Practice placements need to be available across the employment sector (public, independent and voluntary) to reflect new and emerging practice settings.
Recent challenges to healthcare professions through the COVID-19 pandemic have accelerated the use of technology enabled care services (TECS), also called telehealth, telepractice, digital. Practice education may involve ‘in person’ or telehealth placements or a hybrid. Telehealth placements may be provided where both the practice educator and the student(s) are working from home, and link remotely for direct client-facing or other practice-based learning activities.
See the RCSLT telehealth placements guidance for specific information.
Exciting initiatives have led to the development of innovative models of practice-based learning opportunities for direct client-centred care. It is important to emphasise the flexibility and scope for originality in practice placement provision, for it to meet the needs of the service as well as the student.
These include the following:
- The need to support increasing numbers of learners on practice placement and to equip students with a broader range of employability skills eg collaboration, team work, leadership, supports the development of multiple supervision models of practice education (Walker et al 2013).
- RCSLT encourages all practice educators to offer paired practice placements, where possible.
- Group practice placements with three or more students with one educator, the effectiveness of multiple students to one educator is well documented (Martin et al, 2004; Lloyd et al, 2014).
- Creative models 4:1, 6:1, 8:1 ie four students with one educator, with project work and group tutorials by the practice educator and the HEI.
- Remote supervision, where the practice placement is offered digitally or via telehealth. The educator and student are not onsite in the same clinical setting at the same time. The educator offers a clear supervision framework with support for planning and debriefing via technology.
- ‘Long arm’ or distance supervision, where the practice educator does not work in the setting where the practice practice placement is offered. There is a non-SLT mentor in the setting. The practice educator will regularly plan and debrief with the student(s) to support their learning and skill development. The student will carry out sessions and activities independently. There are identified benefits to practice placements of this kind: students value autonomy (Sheepway et al, 2011) and they can demonstrate the positive outcomes of enhanced SLT provision eg by providing more regular therapy than is currently available. These practice placements will not suit every student and the HEI should decide on the appropriacy of these placements for specific students. Practice placements using this model of supervision may also be referred to as ‘role-emerging placements’.
- Peer mentoring, ie final year students supporting first year students on observation practice placements.
Practice education setting
- Client pathway practice placements which may be split between settings to provide a perspective of the patient journey eg acute ward to rehabilitation centre.
- Joined up practice placements between NHS and/or independent settings eg block placement involving two days per week in NHS and two days per week in independent setting.
- HEI in-house teaching clinics
- Interprofessional practice placements eg student SLTs and occupational therapy (OT) students shared between SLT and OT mentors in a special school; students being able to explain the rationale for their plans to other students helps them to refine their own understanding (Baxter, 2004).
- Leadership placements – where for example a student spends two days a week with a service manager and two days a week with an SLT in clinical practice.
- Conversation partner practice placements where students engage with service users to continue the work that an SLT has set up with a service user.
- Role-emerging placements – this is where SLT practice educators do not usually work in the setting but there is an identified benefit for clients. There is a non-SLT mentor in the setting, and students can be supported to work there, with a view to creating a case for an SLT role in that setting.
Where practice educators offer multiple student practice placement opportunities, this counts as multiple offers. All practice educators should offer 25 days per year (pro rata), ie two students on a 10 day block placement is recorded as 20 days offered. Practice educators can claim tariff per student.
Health Education England has produced a range of resources to support practice-based learning models.
Structure and supervision of practice-based learning
RCSLT specifies that SLT students need to accrue 150 sessions of practice-based learning (RCSLT curriculum guidance, 2018) over the duration (two, three or four years) of their pre-registration programme. This is the same for undergraduate and postgraduate routes, and for learners on apprenticeship programmes. A session equates to 3.75 hours based on Agenda for Change terms and conditions. Practice placement requirements are considered in terms of sessions (not hours) throughout this guidance to reflect the dynamic and flexible ways in which SLTs work.
100 of the 150 sessions need to be overseen by an SLT, which can be:
- Onsite, where the SLT and student are in the same clinical setting at the same time
- Remote, where the service and/or the practice placement is offered by telehealth and the student and educator liaise digitally to plan, run sessions and debrief
- ‘Long arm’ or distance, via an SLT who does not work in the setting, but regularly plans and debriefs with the student and supports their learning and skill development
The 100 sessions may involve a combination of direct client-centred care and indirect practice-based learning activities, which facilitate learners to meet their standards of proficiency (HCPC, 2014).
50 of the 150 sessions can be overseen by other professionals in a range of clinically related activities and settings, eg education staff, health care staff, other AHPs, and clinical related learning activities that may take place within a HEI. Students may spend time in child care settings, schools, social care or other health-related contexts.
Insurance for students on practice placements in all settings is provided by the HEI.
The RCSLT has received funding for two projects from HEE. The first is to deliver entry-level dysphagia competencies in pre-registration HEI programmes across the UK, with implementation starting in September 2021 and the first cohort graduating in 2024. The second project is to identify/develop simulation based learning opportunities to complement the implementation of the entry-level dysphagia competencies. There may be changes to practice-based learning sessions as a result of these two projects and further consultation will be undertaken, and this guidance will be updated as appropriate and relevant.
Students are encouraged to take part in SLT related voluntary activity, where they are able to, but this is not included in practice placement sessions, as sessions need oversight and sign off by an educator. Volunteering is viewed positively by the RCSLT and can support employability. Evidence from volunteering sessions can be used in student portfolios.
Practice placements should be spread across clinical areas:
- Adult (30 sessions)
- Child (30 sessions)
- The remainder reflecting local service delivery needs
This refers to the 100 sessions overseen by an SLT, and reflects the minimum balance needed to qualify. The 50 sessions in other settings can be made up of any client group to allow more flexibility.
The balance of clinical experiences must be provided for all students over the duration of the programme and should be monitored by the HEI. For part time training routes, the clinical sessions need to match the full time routes.
Students should not be placed with SLT services where they are employed (eg as SLTAs) for practice-based learning opportunities. This could lead to potential conflicts of interest.
Ideally, there will be a period of clinical practice close to the end of the degree programme so that students have recent experience of practice placements when graduating.
Page 21 of the HCPC guidance on health, disability and becoming a health and care professional (2015) states that: “It is important to realise that students do not need to be able to do all types of practice placement to be able to show they meet all of the standards of proficiency needed before they can register with us”. Therefore, it can be appropriate to recognise that there may be some clinical settings that do not suit certain students, eg an acute hospital setting may be very challenging, for a variety of reasons, for some students, and they could acquire their adult focussed practice education sessions in rehabilitation contexts or through practice-based learning sessions with adults with learning disability.
Practice educators need to ensure that clients have consented to working with students on practice placements.
Insurance for students on practice placements in all settings is provided by the HEI.
Content of practice-based placements
100 sessions of practice-based learning need to be overseen by an SLT. This may be through direct client-centred care and a range of practice-based learning activities (see definitions). This flexible approach is welcomed by us all, as SLTs and HEIs, to enable practice educators to view practice education through a broader lens.
Over the duration of their programme, learners must have sufficient direct client-centred care opportunities to enable them to develop their HCPC standards of proficiency (2014). Standards of proficiency (SOPs) 8 and 9 refer to the development of communication and interpersonal skills with clients, which can only be achieved and assessed through direct client-centred care opportunities. Other standards of proficiency can be developed through a range of practice-based learning activities.
A minimum of 25% of practice-based learning sessions need to involve direct client-centred care. This needs to be planned and demonstrated for every practice placement. Where this has not been met, this needs to be balanced across other practice placement opportunities throughout the duration of the pre-registration programme. This 25% minimum needs to be accounted for by the practice educator and discussed with the HEI if it has not been possible to meet on the practice placement.
The recommended 25% is not a figure that 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.
Practice educators, can provide a combination of:
- Direct client-centred care (25% minimum) and
- Practice-based learning activities
Direct client-centred care
This refers to all practice-based learning that directly involves working with and impacts upon service users, carers and members of the multidisciplinary team (MDT). Direct work can take place in person or remotely, reflecting the current mode of service delivery. For more information, see the RCSLT telehealth placements guidance.
Direct client-centred work can include any work that has a direct impact on an actual client:
- One-to-one assessment and therapy sessions with a service user
- One-to-one work with a carer
- Writing reports, programmes and notes as part of a client’s episode of care
- Training sessions, eg parent training and coaching, staff training
- Work with the MDT, eg meetings, case conferences, ward rounds
- Groups, eg social skills groups, communication cafe style sessions
Practice-based learning activities
All practice-based learning activities are intended to develop clinical and professional skills, and the application of theory to practice, and are tasks that SLTs can support students to complete as part of their practice-based learning sessions.
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. Practice-based learning activities can take place in person or remotely. They can be a planned element of the practice placement and can also be used flexibly, eg when clients or educators need to cancel sessions. Practice-based learning activities support a flexible approach to practice placements. They can support students with different learning styles, in the same way that direct client-centred activity supports student learning.
Practice-based learning activities can be carried out by individual students or with peers, eg project work, audit, creating resources, life story work, reviewing and summarising the evidence base. These activities should be mutually beneficial to providers and to students ie supporting service delivery and development, and meeting student learning outcomes and development of their standards of proficiency (HCPC, 2014).
Download a template for practice-based learning activities (PDF) with structured outputs, linked to the standards and including worked examples.
The following list of practice-based learning activities is not exhaustive and services are encouraged to be creative and innovative in their thinking around other activities that can support SLT learners.
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 practice 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 these to firstname.lastname@example.org
Case studies with/without video
To enable students to follow the service user journey from request for assistance to end of episode of care, 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 requests for assistance/triage decisions, end of episode of care decisions or breaking bad news. Professional scenarios could involve caseload prioritisation, MDT working or legal and ethical issues.
This will involve students practising 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; eg provide repeat case history opportunities, repeat assessment experiences, repeat intervention practice, and are an additional source of feedback.
For example: health promotion, making resources such as screening tools, life stories, developing training packages, carrying out audits, quality improvement projects, collecting service user feedback, contributing to public health or prevention focussed initiatives.
Attending CPD activities
For example workshops, webinars, enabling theory to practice development.
Critical reflection is an important element of all practice-based learning opportunities. Applying the principles of critical reflection turns a task, action, event into a robust learning experience and provides opportunity for the development of independent critical enquiry skills. This needs to be built into the practice-based learning experience by the HEI and the practice educator has responsibility to develop this skill when working with students.
Roles and responsibilities of practice-based learning
Please see the RCSLT practice-based learning roles and responsibilities framework (Word) which indicates the key information about roles and responsibilities of students (including apprentices), practice educators, placement coordinators, service managers, practice learning facilitators and HEIs in relation to practice-based learning.
In addition to the roles and responsibilities indicated in the RCSLT practice-based learning roles and responsibilities framework, students, educators, coordinators and HEIs should consider the following guidelines.
- When the practice educator and the student are both confident that the student is competent to work with clients autonomously, students should take opportunities to plan and deliver client-facing sessions independently. A graded approach towards this is key – supported by structured observation, modelling and coaching by the practice educator, and will involve clear planning and debrief sessions.
- Students with additional needs are strongly encouraged to share plans to support their learning on practice placements with practice educators, so that they may benefit from additional support on practice placement.
- Students on peer or group practice placements need to recognise their responsibility towards their peer(s), work cooperatively and collaboratively, and take shared responsibility for the activities in which they are jointly engaged.
- All UK practice educators will be HCPC registered.
- Where a student has more than one educator in a practice placement setting, there should be a lead practice educator, identified to the HEI and the student. This educator has the responsibility to coordinate feedback from other educators and to share the feedback and placement outcome with the student.
- Additional liaison from the HEI may be required if educators span different services ie NHS and independent practitioner; there should be a lead educator in each service. Learner assessments may be completed separately but may complement each other and collaboration between educators is recommended. If a skill is not achieved in one setting by a student, but is achieved in another, a discussion between educators and the HEI is recommended and a decision made re whether the student can pass that competence.
- On a multiple supervision model practice placement (where there is more than one student with one practice educator), practice educators should offer individual feedback to the students.
- All students should receive regular written feedback from practice educators. This is best practice throughout the placement and is essential at key points during the practice placement, eg at mid point and at the end of the placement. Some HEIs have specific guidance as to the regularity of written feedback.
- Students on remote or ‘long arm’ practice placements need educators to observe some of their clinical sessions to give clear and specific feedback to support the development of their clinical skills.
Service placement co-ordinator role
NB: This relates to settings where an SLT is allocated the role of practice-based learning coordinator within a service; for independent sole practitioners this will not be a differentiated role.
- Placement coordinators need protected time for this role as part of their job plans and have a key role in supporting staff to offer practice placements.
- They should ensure that all staff are aware of their roles and responsibilities in relation to student education.
- They should have the opportunity to host a student slot at staff meetings and have a pivotal role in liaising with the HEI and the clinical staff team, keeping information updated in both directions.
- In Wales, the profession specific practice education facilitators (PEFS) undertake the role of placement coordinator.
- In Northern Ireland this role is not formalised.
Service manager role in relation to practice-based learning
For independent sole practitioners this will not be a separate role.
- Service managers (public and private sector) have a responsibility to ensure all eligible staff offer student practice placements, unless a rationale to opt out has been explained.
- Service managers are best placed to explore with teams who feel unable to offer their quota of student practice placements, how they might support practice-based learning in other ways, to contribute to the development of the future workforce.
- Service managers, as part of their workforce planning, can ensure that students are included and can be useful in supporting service delivery.
- Service managers in the NHS should ensure that Learning Development Agreements (currently under revision) are in place at Trust level with the HEIs (in England).
Practice education facilitators/practice learning facilitators/practice education leads (PEF/PLF/PEL)
This is an additional role related to practice-based learning across England and Wales, which is aimed at practice placement quality monitoring for non-medical professionals.
- PEFs are funded through NHS Trusts in England. The number of these posts in an organisation is determined by the learning development agreement (LDA) and the number of students. PEFs aim to lead on the learning opportunities in the service and work with the HEIs to co-design and review the development of mentors.
- In Wales, there are seven profession specific PEFs who support practice-based learning within Wales. They are based within Health Boards, and are funded by Health Education and Improvement Wales (HEIW). The PEFs have employment or secondment contracts with the university. They are employed for two days per week, and support with quality assurance and management of practice placements.
- In Scotland, a similar role is undertaken by the Practice Education Leads in each Health Board funded by NHS Education Scotland (NES).
- In Northern Ireland each Trust has a placement lead who works closely with the HEI and supports the management of practice placements. This role is not funded.
- There should be transparency from the HEI re student numbers recruited each year.
- HEI tutors and practice educators should liaise throughout the practice placement; the style of contact (email or onsite/remote visit) and timing will vary depending on the length of the practice placement.
- Most HEIs will offer contact at the midpoint of the practice placement to discuss the student’s progress.
- There must be an agreed process in place between the HEI, the practice educator and the student, where there are concerns about the student’s progress. The aim is always to enable the student to complete and pass the practice placement. The support will include a three-way collaborative discussion between the HEI tutor, the student and the practice educator, with clear written actions for all to take forwards, to work towards a successful practice placement.
Diversity and inclusion in practice placements
The RCSLT is committed to equality, inclusion and creating better lives for all, in accordance with the duties under the Equality Act 2010 (which applies to England, Scotland and Wales) and the equality legislation in Northern Ireland. Northern Ireland does not have a single legislation, instead it retains different pieces of equality legislation, which can all be found on the Equality Commission website and relate to all points in this section of the guidance.
RCSLT is fully committed to:
- Eliminating unlawful discrimination, harassment, and victimisation.
- Advancing equality of opportunity between people who share a protected characteristic and people who do not.
- Fostering good relations between people who share a protected characteristic and people who do not.
The Equality Act 2010, and relevant Northern Ireland legislation, covers the protected characteristics:
- Gender reassignment
- Marriage and civil partnership
- Pregnancy and maternity
- Religion and belief
- Sexual orientation
HEIs and all practice placement providers are required to comply with relevant equality and diversity legislation for their nation, ensuring that equality and diversity is embraced. HEIs and practice educators are bound by the same legislation and are expected to treat student SLTs, service users and all other professionals with dignity and respect at all times.
The lack of diversity in the speech and language therapy profession has had a profound impact on those who do not fit the stereotypical mould of a SLT. A workforce which reflects a diverse client base can deliver better services as it is more likely to understand the needs of the population it serves.
Students from under-represented groups face many inequalities in the classroom and on practice placement. HEIs and practice educators should have an understanding of unconscious bias and how this may affect their students and be willing to have open conversations about how they can create a more inclusive and supportive learning environment. Racism can be overt or can be unconsciously demonstrated by fellow students, tutors, practice educators and clients.
HEIs and practice educators need to establish inclusive environments that promote best practice equality policies. All practice educators need to be culturally aware and culturally competent, including understanding issues relating to a range of minority groups; for example, Black, Asian and minority ethnic, LGBTQ+, and persons with disabilities.
HEIs and practice educators must consider the experiences of under-represented students and how a culture of unconscious bias can impact on their wellbeing, academic and practice placement performance. Opportunities for open, safe discussion need to be embedded throughout the practice placement, where students can learn and share experiences without fear of being penalised.
- Create a space and forum where students can speak about their experiences on practice placement openly
- Be more proactive to tackle discrimination and unconscious bias
Support practice educators to have an understanding of unconscious bias and how this may affect their practice on placements
- Have clear and overt pathways for students to report discrimination, harassment, or microaggression.
Students need to be enabled to raise concerns and discuss situations where they have not felt supported on practice placements. There must be a transparent and safe process in place at the HEI, for students to raise and escalate any concerns regarding diversity and inclusion while on practice placements.
Students need to be provided with information about the actions that may happen if they report concern on practice placements. This needs to be student-focussed support and students need to know that concerns will be acknowledged, taken seriously and that their practice placement outcome will not be affected by raising a concern.
Following concerns being raised, appropriate actions will be discussed and agreed with students. HEIs should work with practice educators, placement co-ordinators and service managers, as appropriate, to identify HR policies and procedures to inform action and support for any students who raise issues about any form of discrimination including racism, unconscious bias, microaggression and bullying during their practice placements.
Students should be given the same level of protection as staff on employment contracts within services. For more information, visit the RCSLT diversity, inclusion and anti-racism pages.
Practice educators need to be equipped to support students from under-represented backgrounds. HEIs should include cultural awareness, disability awareness, diversity and inclusion and unconscious bias discussions as part of practice educator training. Practice educators need to be able to deal with this, where discrimination or harassment towards students arises from clients too.
It is the HEIs responsibility to support practice educators to adapt practice placements to adhere to reasonable adjustment plans.
We need the diversity of cultures and backgrounds to be celebrated and increased in the speech and language therapy profession (RCSLT towards a diverse profession, 2019).
HEIs and practice educators can address issues around diversity through:
- Creating specific networks that support under-represented groups
- Addressing barriers to access and progression of SLT professionals in HEIs
- Understanding the impact that the mismatch effect can have on students
- Continuing open dialogue about how to create opportunities for SLTs and students from diverse backgrounds
- Creating mentor networks for Black, Asian and minority ethnic students, students with disabilities and/or LGBTQ+ students to support with any potential mismatch of educators and students
The student SLT population is much less ethnically diverse than the student population as a whole. In the 2018-19 academic year 3% of student admissions were from a Black background, 8% were Asian, and white students accounted for 75% (HESA and RCSLT, 2018). Statistics indicate that undergraduate and postgraduate speech and language therapy courses have broadly similar ethnicity profiles and these numbers have slowly increased since 2014 (HESA, 2018).
This guidance uses the term BAME to refer to those who are Black, Asian and minority ethnic. We are however aware that the term BAME may be outdated and uncomfortable for some, but currently this is the term used widely in literature, by government bodies and the media. In the future, as society continues to develop and becomes more equal, we hope to have inclusive, appropriate terminology that is representative of all individual groups in our society.
Research suggests that speech and language therapy students from BAME backgrounds are slightly more likely to leave the course before completion than their white counterparts, although we should be cautious about these figures due to the small numbers of students involved (HESA and RCSLT, 2018). Despite this, there needs to be suitable disaggregation within the broad BAME category. This group consists of a range of individuals from various ethnic, cultural and socio-economic backgrounds, who all have different experiences and needs as speech and language therapy students.
Anti-racism needs to be explicitly discussed in practice educator training.
HEIs and practice educators should actively refer to RCSLT resources regarding Black Lives Matter and use the reading lists.
Please see RCSLT guidance on raising concerns about racism.
In the 2017-18 academic year, only 18% of speech and language therapy students declared a disability. Many challenges and barriers remain with recent studies highlighting that despite HEIs adhering to the “social model of disability”, a number of institutions perceive the disabled person as a “problem” to be solved. On the whole, students who report a disability have lower degree results and are less likely to be in employment after graduation than non-disabled students (Higher Education Statistics Agency (HESA), 2018).
There is limited research specifically looking into the experiences of student SLTs with disabilities, much of the research that is widely available is based on the experiences of other AHP students eg nurses, physiotherapists. In order to better understand and facilitate for the needs of student SLTs with disabilities, there needs to be more engagement around the topic.
HEI staff and practice educators should be equipped with the tools to effectively support students who have a disability. Student support services should provide information to HEI staff, in the form of a reasonable adjustment plan (RAP), which needs to be taken into account for practice placements.
This may include adjustments to support students, such as:
- Different practice placement format or timing, eg increased breaks
- Access to the practice placement, eg considering reduced travel time
- Use of specific equipment to support the student on practice placement eg voice recognition software
- Specific methods of feedback, eg written bullet points
HEI staff should support students to share information, from the student’s adjustment plan, with practice educators, that will facilitate the success of the practice placement. Students do not have to disclose information to practice educators if they are not comfortable doing so. Adjustments can successfully be put in place without personal disclosure.
Treating students fairly may not equate to treating them the same. The Equality and Human Rights Commission (EHRC) guidance provides further information.
Sensitivity is required to the needs of the student with a disability on practice placement, and the possibilities for adjustment within the practice placement setting.
HEIs will have specific policies with reference to supporting students with disabilities. These will be specific to the HEI and may differ, based on local knowledge.
Students may require support from educators and HEIs where clients display prejudicial and offensive behaviours as a result of conditions such as a brain injury, and additional preparation and support may be required. Students should be aware of the system of support within the HEI and feel comfortable to access this.
It is not the place of practice educators to judge whether students with disabilities should be training to be SLTs. Educators should be supported by HEIs (who are in turn scaffolded by student support services), to make positive adjustments, rather than focussing on needs, and should adhere to the HCPC guidance on becoming a health and care professional.
Gender, gender identity and sexual orientation
The speech and language therapy male student admission rate fell from 4.1% in 2017-18 to 3.4% for the 2018-19 academic year. Currently 3% of the SLT workforce identifies as male (HCPC, 2019). Greenwood et al (2010) highlighted that the profession is mostly made up of “white women”. A possible explanation for this under-representation is due to the poor awareness and understanding of the profession.
Male students report negative experiences resulting from being a minority gender in the classroom and on practice placements, as they struggle with feeling isolated in a predominantly female setting (Beagan et al, 2018).
Many students face discrimination, exclusion and barriers at university because of being LGBTQ+. Research suggests that experiences of being a sexual minority influences a number of beliefs about which occupations are accessible and chosen (Jackson, 1995). Many students from this heterogeneous group report negative experiences, derogatory remarks and exclusion by other students and even staff (Balsam, 2010). A high number of LGBTQ+ students do not feel safe enough to disclose their gender identity and/or sexual orientation, which could impact on their experience of university and practice placements.
Reasonable adjustments on practice placements
As SLTs in HEIs and practice education settings, we are legally obliged under the Equality Act 2010, and relevant legislation in Northern Ireland, to make appropriate reasonable adjustments for students with disabilities; these usually include identified physical, learning and mental health concerns.
HEI disability advisors can support students in disclosing issues and arranging adjustments to degree programmes and with practice educators.
Students have a responsibility to make the HEI and the practice educator aware of the required adjustments in advance of starting the practice placement. Students do not need to disclose issues to practice educators but may still request the adjustments are put in place. Students have the choice to decide whether they want reasonable adjustments to be put in place in practice education settings. They should be encouraged to do so by the HEI. The HEI is unable to share information about the student’s needs without the student’s consent to do so.
If students have needs that fall outside of the Equality Act (2010) or equivalent legislation in Northern Ireland, they can still request adjustments to support their learning, through a learning support discussion.
Where students do want adjustments to be put in place, they should contact the practice education setting prior to the start of the practice placement to discuss the adjustments required. A student may request that the HEI supports this process and discussion.
HEIs should consider and discuss with a student whether a certain practice placement might exacerbate their health condition, and make appropriate decisions jointly with the student. Settings should support reasonable adjustments where possible. Information should be shared in a timely manner to facilitate the setting up of the adjustments prior to the practice placement.
It is very important to support reasonable adjustments. However, it is sometimes not possible to manage this in practice. If a practice education setting cannot reasonably put the required adjustment in place, then an alternative practice placement setting should be sourced.
Nuanced and individual discussions will need to take place between the HEI and the student, in respect of reasonable adjustment plans and the availability of practice placements.
Where reasonable adjustments have been put in place at the start of the practice placement and need to be altered as the practice placement progresses, any party (student, HEI, practice educator) can request a triumvirate meeting to adapt the reasonable adjustments.
Where students miss practice placement sessions due to ill health (related to a pre-existing condition or otherwise), sessions need to be made up (in line with the 150 sessions guidance). Nuanced decisions may be made in discussion with the student, the HEI and the educator if the required competence has already been established.
Recording learner progress
Practice placement grading can be pass/fail or graded numerically by practice educators, dependent upon the HEI requirements. Practice placement assessments are not standardised across HEIs, diversity should be recognised and parity is sourced through the HCPC and RCSLT accreditation of the HEI programmes.
Practice educators should be familiar with the documentation of the HEI. Where HEIs are geographically close and regularly share practice areas, there should be collaboration between HEIs with respect to shared practice placement documentation to support efficiency and clarity for the educators.
Competency based assessments are welcomed and can identify exactly what competence the student has achieved ie ‘gathers information, records accurate observations, and can assimilate and discuss information’ rather than a task list eg ‘can take a case history’ (McAllister et al 2010).
Practice placement documentation should include:
- A place for the student to record their learning objectives
- A place for the practice educator to indicate progress towards the objectives and to give feedback (strengths and needs)
- A place for the student to indicate how they will implement feedback and work towards new goals
Practice educators and HEIs should keep in close contact if there are concerns about a student’s progress or wellbeing; this must be documented and shared with the student as early as possible during the practice placement. Written documentation from the practice educator needs to be explicit to support the student in knowing what they need to do to improve.
Students who are at a borderline pass should not pass if there are concerns about their ability to progress to the next level. A failed practice placement indicates that a student needs more opportunity and practice to reach the standard for this level. This will ultimately support the student to become a stronger SLT.
Students should be notified as early as possible, and ideally by the mid way point of the practice placement, if they are at risk of failing the placement. It is good practice for HEI tutors to contact students and practice educators at the midpoint of the practice placement to check that all is going as planned.
Where a student fails a practice placement, a resit placement will be offered. This may be a full resit of the same length and (usually) the same client group as the failed placement. This will enable the student to gain the additional support and time on practice placement required to acquire the competency needed to move to the next level.
Sometimes adapted additional or resit opportunities are appropriate where students have failed on very specific competencies, and may be provided through a shorter time period or a different approach eg structured learning activities which will target theory to practice. Sometimes these can be provided by the HEI.
Where students are attending resit practice placements, practice educators will be made aware that this is a resit practice placement.
There are mechanisms within HEIs to support students applying for extenuating circumstances in relation to failed practice placements.
HEIs will devise options for students who fail practice placements; regulations are individual to HEIs. Contained awards may be available, in exceptional circumstances, for students who complete the academic modules of a degree, but do not successfully complete practice placements. In this case, students will not be able to apply to HCPC for registration to practice as a speech and language therapist.
What does a quality practice placement look like?
In alignment with the responsibilities of students, practice educators and HEIs, outlined in the RCSLT practice-based learning roles and responsibilities framework 2021 (Word), quality practice placements will provide the following support and guidance for speech and language therapy learners.
Students will complete all (NHS approved) mandatory training as required by the HEI, prior to the practice placement starting. Some practice placement settings may require students to complete additional mandatory or induction training at the start of the practice placement. Students should be made aware of and adhere to all local trust and service policies, eg lone working.
Quality practice placements will:
- Support students with appropriate access to IT equipment, activations and logins at the start of or prior to the practice placement
- Send a comprehensive induction pack about the clinical setting, to the student, prior to the practice placement starting
- Invest in a positive supervisor-student relationship, which is supportive, encouraging and develops the student’s confidence
- Allow students time to discuss their goals and learning styles with the practice educator at the start of the practice placement and to review this at the mid point
- Provide opportunities for students to observe their practice educators working. Students will benefit from demonstration, modelling, coaching etc to support their skill development
- Support and guide students to plan clinical sessions and give constructive feedback on plans
- Provide clinical teaching which augments or enhances the HEI teaching, and which facilitates the student to apply theory to practice
- Provide opportunities for practice educators to observe students carrying out clinical sessions, so that the educator can provide specific and supportive feedback to the student
- Provide time for students to reflect on sessions and then to debrief with their practice educators
- Support students to carry out sessions independently when both they and their practice educator are confident about this
- Support students to write clinical case notes and reports. Every entry should be reviewed and countersigned by the practice educator
- Provide regular specific, supportive feedback on all aspects of the student’s progress, to facilitate their learning and skill development
- Not demonstrate microaggression or bullying of students. Students should be supported to engage in transparent processes with the HEI, to share any concerns about microaggression on practice placements. Practice educators need to respond to any concerns raised, and to discuss this with the HEI and their line manager, where appropriate. Services should have relevant policies and procedures in place to manage bullying situations in line with the Equality Act 2010 or equivalent legislation in Northern Ireland. For more information, see the RCSLT bullying guidance.
Quality practice placement monitoring and evaluation
The Health and Care Professions Council (HCPC) requires practice placements to be monitored and evaluated to ensure quality standards are met. Practice placement quality is monitored by evaluations completed by students, and by the practice educator. These should be reviewed regularly by the HEI team and any significant concerns should be escalated to the governing or regulatory body, ie HCPC, Health Education England (HEE) or equivalent as appropriate.
Electronic platforms such as the national practice assessment record and evaluation (PARE) host a profile and evaluation for each practice placement provider. Audit of the profile and evaluations is carried out by the practice placement co-ordinator and the HEI, and also the practice learning facilitator (PLF), where possible. Any concerns or areas for development, following audit or review of student evaluations, should be followed up and action plans put in place. Student surveys post-placement are a reliable and valid measure of practice placement quality, especially when longitudinal data is collected (McAllister et al, 2018).
Practice placement quality can be monitored through the HEE professional development framework.
Practice Educators in Scotland can find additional guidance in the NES Quality Standards for Practice Placements Audit Tool Section 2: Standards for individuals supporting students in the workplace (PDF).
There must be a clear process in place for students to raise any concerns regarding diversity and inclusion or microaggression. HEIs should work with practice educators, placement co-ordinators and service managers, as appropriate, to identify HR policies and procedures to inform action and support for any students who raise issues about any form of discrimination including racism, unconscious bias, microaggression and bullying during their practice placements.
For further information, see the RCSLT bullying guidance.
Service user involvement in practice placement steering groups at HEIs is an excellent way of supporting quality practice placements.
Tariff for practice placements
Information relating to the tariff changes annually and the relevant links should be followed for accurate information.
To support consistent and transparent healthcare education funding across England, Health Education England has published a new NHS Education Funding Guide that outlines the sources of funding that contribute to the education and training of healthcare professional roles.
In England, the NMET (non-medical placement tariff) is paid by Health Education England (HEE) to practice placement providers to offset the costs of supporting learners in clinical practice.
Tariff is available to NHS and independent practitioners in England. Visit GOV.UK for education and training tariff guidance and prices for the 2020 to 2021 financial year.
The tariff is part of the learning development agreement, which is the agreement between HEIs and local service providers with respect to practice placement provision, this is currently being updated and will be replaced by the new NHS Education Contract in April 2021. See HEE’s frequently asked questions for the latest information on this development to date.
Where a practice educator offers a multiple student practice placement, the tariff is multiplied by the number of students supported on the practice placement.
The tariff is accessed directly by NHS trusts or via the HEI for independent practitioners.
Health Education and Improvement Wales (HEIW) do not pay a tariff for practice placements and therefore no placement provided for the NHS commissioned course in Wales has a tariff attached.
There is no tariff paid to practice placement providers in Scotland.
In Northern Ireland trusts are paid a student tariff from the Department of Health based on the number of AHP practice education sessions that they have provided that year.
The SLT apprenticeship standard and end-point assessment (EPA) in England has been approved, which means that universities and employers are now able to work together to develop pre-registration apprenticeship routes for speech and language therapy . One university (as of February 2021) has announced it will be offering the apprenticeship route and we hope others will follow.
An SLT degree apprenticeship is where an employee is studying towards a pre-registration SLT degree alongside working in a speech and language therapy service as a speech and language therapy assistant (SLTA). The apprenticeship can be offered as a level 6 (equivalent to bachelor’s) or a level 7 (equivalent to master’s) pre-registration degree, the same as for the traditional speech and language therapy learner route.
Apprentices are required by the Government to spend a minimum of 20% of their time in formal ‘off the job’ training – for SLTs this will normally be time spent at university on academic learning. In addition to this, apprentices will also need to undertake practice placements in the same way as other students.
Apprenticeship practice-based learning needs to reflect the breadth of UK speech and language therapy practice, ie with all clients of all ages, and to include a wide range of social, health, justice and education settings.
In relation to practice-based learning, the apprentice takes the same role as the traditional student learner, as indicated in the RCSLT practice-based learning roles and responsibilities framework 2021 (Word).
Practice-based learning as part of the apprenticeship model will meet the same standards as for traditional models of speech and language therapy pre-registration qualification. The role of the HEI, practice educator and the apprentice, in this context, are parable to those set out in the roles and responsibilities framework, in terms of support for the learner before, during and after the practice placement.
Apprentices will need to achieve 150 sessions of supervised practice-based learning before presenting for their end-point assessment. 100 of the 150 sessions must be overseen by a qualified SLT. One session is equivalent to approximately 3.75 hours, based on Agenda for Change terms. Practice placement requirements are considered in terms of sessions (not hours) throughout this guidance to reflect the dynamic and flexible ways in which SLTs work.
The requirement to experience practice placement sessions in both adult and paediatric settings applies to apprentices: 30 adult sessions, 30 child sessions and the remainder to reflect local service delivery needs. This refers to the 100 sessions overseen by an SLT, and reflects the minimum balance needed to qualify. The 50 sessions in other settings can be made up of any client group to allow more flexibility. Apprentices should have the same diversity of learning experiences as learners on traditional routes.
In order for the apprentice to gain breadth and depth of learning, their 150 practice-based learning sessions should be carried out in venues different from their own employment setting. In line with nursing and other AHP apprentice programmes, apprentices may remain with their own employer for one of their practice placements but this must be in a different area and under different supervision from their usual job role. This is aimed at avoiding conflicts of interest and to endorse the principle that apprentices need the opportunity for objective assessment on practice placement.
Practice placement sessions need to be recorded by the apprentice, signed by the practice educator and monitored by the HEI. The SLTs providing the supervision and feedback to the apprentice need to take responsibility for signing off the apprentice’s competencies, as they would for a traditional learner.
As with practice placements on traditional pre-registration programmes, sessions may involve direct client-centred care and practice-based learning activities overseen by an SLT.
Apprentices in practice-based learning need access to regular supervision with structured feedback, to support their clinical decision making. Their practice-based learning opportunities need to be differentiated from their paid roles eg as an SLTA. It is important that apprentices are viewed as learners and as student SLTs working towards competencies (HCPC SOPs).
Consideration needs to be given to the practice educator/line manager differentiation for apprentices.
Speech and language therapy practice placement providers need to consider the potential impact of apprenticeship placements on traditional practice placement offers, and are encouraged to discuss this with the relevant HEI.
There needs to be an adequate number of appropriately qualified and experienced SLT staff involved in practice-based learning, to support practice placements for apprentices.
The availability of the apprenticeship programme is controlled and funded by the Government, and because it is a devolved policy matter, it is differentiated in each of the four nations. RCSLT does not have control over this. At present the apprenticeship programme is only available in England.
The Governments in the devolved nations are taking a different approach to how they use apprenticeship funding. They support the traditional degrees by providing funding or commissioning the courses directly. In England, this does not happen and student loans are available to fund degree programmes. The RCSLT apprenticeships guidance gives further information.
Practice educators working with apprentices should adhere to all relevant information in these guidelines in the same way as for traditional pre-registration students.
Overseas practice placements
In 2020-21, in response to COVID-19, HCPC and RCSLT agreed that overseas (or international) practice placements can be permitted for UK students, 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 practice 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 to the HEI and ensure that they are appropriate to carry out this role, including how their experience, qualifications and training are relevant to practice-based learning.
For more information, please see the HCPC standards of education and training.
The RCSLT recommends that practice educators who support overseas practice placements are:
- HCPC registered; or
- 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, practice placement providers must be able to explain their rationale. 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.
Expanding practice placement capacity
Speech and language therapy has been recognised as a profession in shortage by the Migration Advisory Committee and the Government has added it to the list of shortage professions. There have been increasing concerns across all of the allied health professions (AHPs) regarding practice placement capacity and the sustainability of the growing AHP workforce.
Senior AHPs have been working with the National Health Education Agencies and the Council of Deans of Health to develop plans for expansion of practice placement capacity. HEE has provided funding to support practice placement expansion in England and RCSLT awaits the outcomes and evaluation of these projects.
There are many practice placement expansion ideas, including:
- Multiple supervision models
- Practice placements reflecting the current workplace (eg 24/7, 7/7)
- Innovative virtual and simulation practice placement opportunities
- Role-emerging placements
- New learning environments that reflect modern healthcare and educational practices (eg telehealth)
- Leadership placements
- Research placements
- Education placements
- Social care placements
- New and innovative approaches, including those emerging as a result of the COVID-19 response
HEIs and practice placement providers should work together to develop innovative practice placement expansion ideas.
Health Education England (HEE)
HEE provides a number of resources to promote placement expansion and innovation, including information on alternative supervision models, on-site clinics, role-emerging placements, technology enhanced care services (TECS) and simulation. HEE is developing an AHP learning placement exchange platform to share best practice or innovation around expanding placement capacity and improving quality.
Placement expansion and innovation campaign
Visit our campaign page to learn about the RCSLT’s campaign to address the shortage of placements for speech and language therapy students.