Practice-based learning guidance: introduction

Context of this guidance: COVID-19

Practice placements were disrupted from March 2020, due to the start of the COVID-19 pandemic. As services have adapted to new ways of working, including telehealth, so practice-based learning has adapted too. All practice placements need to proceed in line with the most up to date local public health guidance, which may differ across the UK.

The RCSLT adheres to the current HCPC COVID-19 advice for employers, education providers and students. The HCPC supports flexibility within practice-based learning, while ensuring that standards of learners are maintained.

In line with HCPC guidance for education providers, the RCSLT acknowledges that flexibility may be required by higher education institutions (HEIs) to enable students to complete and pass placements, in order to progress to the next level, or receive their completed awards, where the required number of placement sessions has not been able to be met. RCSLT supports a pragmatic approach which may involve students being supported to achieve the necessary standards and competencies with fewer practice-based learning sessions. RCSLT supports the HCPC view that this is appropriate, as long as learners have met the relevant learning outcomes, and that the rationale for this decision can be evidenced by the HEI.

In-person practice placements should be taken up in alignment with risk assessments for staff, use of PPE and other local policies. PPE should be provided by the speech and language therapy service where possible, and students should be supported in the same way as all members of the workforce. HEIs and placement providers should integrate and adhere to the Council of Deans COVID-19 guidance. During the COVID-19 pandemic, students should complete local risk assessments to determine their eligibility to attend onsite placements.

Health Education England advice to the Allied Health Professions states that students on placement should have access to the same testing and vaccinations as NHS staff. This is also the case in Northern Ireland, Scotland and Wales. Any student at high risk of COVID-19 (eg Black, Asian and minority ethnic students, students who are immunosuppressed, those who are shielding etc) may be better suited to telehealth placements. This should be discussed with the student, the HEI and the placement provider, as appropriate.

At the time of publication (February 2021), the most up-to-date information regarding COVID-19 has been accessed and included in the guidance. However, we acknowledge that this is a rapidly changing situation so please refer to the relevant statutory bodies for the different nations:

• Council of Deans
• The Health and Care Professions Council (HCPC)
• Health Education England (HEE)
• NHS Education for Scotland (NES)
• Health Education and Improvement Wales
• Health and Social Care Northern Ireland (HSC)

Telehealth placements guidance

Telehealth placements guidance was published by RCSLT in September 2020 to complement the interim practice-based learning guidance for 2020-2021 and the telehealth placements guidance should continue to be used in conjunction with this 2021 RCSLT practice-based learning guidance.

The telehealth placement guidance provides information on:

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

The new RCSLT practice-based learning guidance, although thorough, does not cover every instance and eventuality. Please discuss any specific questions with the relevant higher education institution (HEI).

AHPs 2023

RCSLT are delighted to partner with our AHP colleagues to endorse a joint perspective on the principles of practice-based learning. A collaborative approach to inter-professional working is hugely important in practice, and engagement with shared principles for practice placements evidences this commitment from the earliest opportunity.

These principles reflect the RCSLT practice-based learning guidance in areas such as ensuring an inclusive and welcome learning environment on all practice placements, expecting flexible and supportive supervision for all learners, evaluating the impact of practice placements on learners and on SLT service delivery. The AHP principles of practice-based learning are aimed at learners, universities and practice educators, and promote the view that, together we are developing the future SLT workforce.

Aims and purpose of the guidance

The aim of this guidance is to ensure that SLT pre-registration practice-based learning is:

• successful in developing a future workforce of diverse and competent speech and language therapists.
• delivered in supportive and quality assured clinical teaching and learning environments.
• inclusive and supportive of the learning and stage of training of the student.
• sustainable and available to meet the demand of student numbers in higher education institutions (HEIs).
• a collaborative responsibility between SLTs in practice and HEIs.

This guidance is written from a perspective underpinned by collaboration between HEIs and SLTs in practice, who are committed to supporting the future SLT workforce.

It is written by members of the RCSLT from:

• Independent and NHS speech and language therapy services and
• HEIs delivering speech and language therapy training programmes.

This guidance aims to project a culture of ownership to, and collaboration with, the student body, as our future SLT colleagues. Personal pronouns are used, where appropriate, to demonstrate this principle. The term ‘student’ is used throughout to refer to both traditional learners and apprentices.

The purpose of this guidance is to support all SLTs in their roles as practice educators, placement coordinators, service managers and staff at HEIs, to provide high quality practice-based learning experiences for all pre-registration speech and language therapy students and apprentices.

The guidance is not aimed directly at student SLTs on pre-registration courses. HEIs will provide their own practice education policies for students, informed by the principles from this guidance.

This guidance should be read in conjunction with the RCSLT practice-based learning roles and responsibilities framework (Word), which states the joint responsibility and expectations of the roles of the student SLT or apprentice, the practice educator, the placement co-ordinator in the practice placement setting, the service manager and the HEI. The presentation of the framework as a table demonstrates the collaborative nature of practice-based learning. This framework is aimed at everyone involved in speech and language therapy practice-based learning, including the students themselves.

This guidance replaces:

• The RCSLT national standards for practice-based learning (2006)
• The RCSLT position paper – the provision of clinical placements: stakeholder roles and responsibilities (2003)

This guidance relates to the four nations of the UK, including the crown dependencies. Where there are differences in provision, organisation or expectations across the devolved nations, these are specifically indicated.

This guidance relates to all speech and language therapy service providers: NHS-based, education-based, social care-based, and SLTs in independent or voluntary sector service provision roles.

Third sector colleagues should use the most appropriate and relevant guidance from the varying sections – in some sections, the guidance for independent settings may be more relevant, in other sections the guidance for statutory organisations may be more appropriate.

Definitions

Refer to this page for the RCSLT’s definitions of key terms used throughout the guidance.

Degree apprentice

A degree apprentice in speech and language therapy is an employee who is studying towards an undergraduate or postgraduate degree in speech and language therapy as part of their apprenticeship.

Direct client-centred care (related to practice-based learning)

Direct client-centred care, in this context, refers to all practice-based learning that directly involves working with, or work that impacts on service users, carers and members of the multidisciplinary team. This may be carried out onsite (in a range of clinical settings) or via telehealth. Direct client-centred care provides students with the opportunity to develop standards of proficiency eight and nine (HCPC, 2014) which relate to communication and interpersonal skills. The other standards of proficiency (SOPs) may be developed through practice-based learning activities which do not directly involve client care.

Learning development agreement (LDA)

This is an agreement in England between NHS service providers and the education establishments. It is an established framework for the delivery of practice learning and teaching to support workforce development. It will be replaced by a new NHS Education Contract in April 2021, which will be applicable across multiple providers, including HEIs, NHS, independent, voluntary and social care.

‘Long arm’ or distance supervision

This refers to supervision of the student SLT, where the SLT practice educator does not work in the setting where the practice placement is offered and there is a non-SLT mentor in the setting. The SLT practice educator will regularly plan and debrief with the student to support their learning and skill development. The student will carry out sessions and activities independently. Practice placements using this model of supervision may also be referred to as role-emerging placements.

Onsite supervision

This refers to practice placements where the practice educator and the student are in the same clinical setting. The student may or may not carry out sessions and activities independently.

Placement coordinator

This relates to settings where an SLT (or other AHP) is allocated the role of placement coordinator within a service. This role involves supporting and coordinating practice-based learning within the service. The RCSLT supports the position of placement coordinators having protected time in their job plans for this role.

Placement provider

The term ‘placement provider’ refers to the staff in a clinical setting who are offering the practice-based learning opportunity. It may be used to refer to an organisational level (where appropriate) and can include the differentiated roles of the practice educator, the placement coordinator and the service manager (where appropriate), or it may refer to a sole practitioner. This guidance acknowledges that in sole practitioner independent settings, the multiple roles (placement coordinator, practice educator and service manager) may all be carried out by one individual.

Practice-based learning

This is a collective agreement between HEI tutors, clinical practice educators and clinical service managers to develop the transferable and distinctive skill set of speech and language therapy learners. Practice-based learning may involve a combination of direct client-centred care and practice-based learning activities which do not involve direct client care. Different models of practice-based learning present different opportunities and can have equivalent value in supporting student learning. Practice-based learning may include onsite and/or telehealth clinical learning environments.

Practice-based learning activities

All practice-based learning activities are intended to develop clinical and professional skills, and the application of theory to practice. These activities do not directly involve client care. They provide students with the opportunity to develop their standards of proficiency (HCPC, 2014) in the same way that direct client-centred care does, and can constitute practice-based learning sessions. They can be supported by practice educators in clinical practice placement sessions.

Practice educator (PE)

A practice educator is a registered SLT who supports student SLTs in clinical learning environments. They facilitate practice education alongside clinical and academic colleagues. In addition, the practice educator holds responsibility for signing off competency and assessment criteria, based upon the standards produced by the education provider and relevant professional body. It is recognised that local models of delivery and assessment will apply. It is the practice educator who holds responsibility for ensuring that the contributing elements of a practice placement cover the relevant learning outcomes necessary for the learner, where possible. The terms placement educator, clinical teacher, clinician may all be used to refer to the PE. It is the responsibility of the HEI to ensure that students have the opportunity to work towards all learning outcomes on the variety of practice placements offered, across the duration of the pre-registration programme.

Practice learning facilitator (PLF), practice education facilitator (PEF) or practice education leads (PEL)

These are roles usually funded by the NHS, to support practice-based learning, and liaison between HEIs and practice placement settings.

Practice placement

This is the period of study undertaken by learners as a formal element of their speech and language therapy pre-registration training, based within a working and learning environment, including HEI based clinics, as well as those outside of the academic institution – see RCSLT curriculum guidance 2021 (PDF). During practice placements, students are assessed against learning outcomes set by the HEI for the practice placement. To pass the practice 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.”
(Health Education England, July 2020).

Remote supervision

This refers to supervision where the service and/or the practice placement is offered by telehealth. The educator and student are not onsite in the same clinical setting at the same time. The practice educator and student can plan and debrief together, via technology, and the student may or may not carry out sessions and activities independently.

Role-emerging placements

These are practice placements where an SLT does not work in the setting, but supports a student on practice placement there. There is a non-SLT mentor in the setting. The SLT, as practice educator, plans and debriefs with the student regularly and will observe some sessions to provide feedback to the student. This model may provide evidence for the need for SLT provision in the setting, and may lead to the development of an SLT provision. For more information see our information on role-emerging placements: building capacity and developing skills of independence in student learning (PDF).

Service user

A broad term to refer to those who access (or have accessed) the services of SLTs (directly or indirectly), and those who have a caring responsibility for people who access (or have accessed) the services of SLT; sometimes also known as ‘experts by experience’. This term may include the family and carers of the service user, or other multidisciplinary colleagues, in some contexts. Different settings use different terms to refer to the service user, eg in schools, the service user is usually known as ‘the child’, in hospitals, it is usually ‘the patient’, and, in some settings ‘the client’.

Student

This is a learner, registered with an HEI on an speech and language therapy  pre-registration degree programme. This may be at bachelor or master’s level.

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 being carried out remotely. The practice educator/student can be working remotely from a clinical site, university location or from home. They are also referred to as remote, virtual, digital or TECS (technology enhanced care services) practice placements. They may involve direct client-centred care or practice-based learning activities. See the RCSLT telehealth placements webpages for further information.

Key requirements

The key requirements are explained in more detail throughout this guidance.

• Students are our future colleagues and speech and language therapy workforce. As practising SLTs, we have a duty to provide them with excellent clinical learning opportunities to support, inspire and enable them to serve our clients in the best way they can, and to future-proof our profession.
• To gain validation higher education institutions (HEIs) must adhere to the HCPC standards of education and training (SET) in their pre-registration programmes. The HCPC SET 5.2 states: “The structure, duration and range of practice-based learning must support the achievement of the learning outcomes and standards of proficiency”.
• 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 SLTs.
• The 2021 RCSLT curriculum guidance (PDF) for the pre-registration of speech and language therapists defines the duration of overall placement hours.
• All students must achieve the mandatory 150 sessions of practice education across the duration of their pre-registration training.
  • 100 sessions must be overseen by an SLT, but the SLT does not need to be present with the student at all times.
  • 50 sessions can be completed through clinically related activities.
  • Of the 100 sessions overseen by an SLT, 30 should be in adult settings, 30 in child settings and the remainder should reflect local service delivery needs.
• A session equates to approximately 3.75 hours (as per 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.
• Practice placements can be provided through a combination of direct client-centred care and a range of practice-based learning activities to facilitate learners to meet their standards of proficiency (HCPC, 2014) to qualify as SLTs. A minimum of 25% of all practice placements (as part of the 100 sessions across the duration of the pre-registration training) should involve direct client-centred care. Direct client-centred care relates to any elements of speech and language therapy work that have direct impact on an actual client.
• Diversity and inclusion must be at the forefront of all of our work with students on practice placements. Cultural competence and awareness of unconscious bias must be addressed in practice educator training.
• Practice placements should be supportive of learners. Processes to raise concerns, where students do not feel supported, must be made explicit by HEIs and practice placement providers.
• Adaptations to practice placement requirements can be supported for students with reasonable adjustment plans, via discussion with the HEI and relevant student support services.

Key recommendations

Key recommendations are explained in more detail throughout this guidance.

• The RCSLT calls on all practising SLTs to share the responsibility for supporting the future workforce, and to offer a minimum of 25 days of practice-based learning per year per whole time equivalent (pro rata). This does not apply in Northern Ireland, where there is an alternative allocation model.
• All areas of speech and language therapy clinical practice are appropriate to support student practice placements. This includes SLTs at all bands (or equivalent) of the profession including leadership and managerial roles, and also includes consideration of how SLT assistants can support student practice placements as part of a wider team. No speech and language therapy setting is considered too specialist to support student practice-based learning.
• Peer placements should be offered where possible. This can be counted as double, in terms of educator offers, ie working with two students for two full weeks equates to 20 days of an SLT’s practice-based learning offer.
• Practice educators should attend educator training after gaining their NQP competencies and subsequently every three years.
• A commitment to practice-based learning should be demonstrated by all SLTs at annual appraisal or through reflection and supervision processes.
• Practice placements should be quality assured through transparent evaluation processes and practice placement settings should be audited every two years.
• Practice placements can take place in person, via telehealth or as a hybrid of both. There are a range of supervision models that are acceptable.
• Practice placement expansion is required for the sustainability of the workforce.
• This guidance should be read in conjunction with the RCSLT practice-based learning roles and responsibilities framework (Word) which sets out the roles and responsibilities of those involved in practice-based learning, including the students themselves.

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 as SLTs, we will respond to our professional responsibility and duty to support student learning.

Background to SLT practice-based learning

Practice-based learning is a fundamental and indispensable element of training to become an SLT. It is the application of knowledge and skills, with service users and carers, in clinical learning environments.

Practice-based learning provides the opportunity for learners to:

• Apply theoretical knowledge in client-centred contexts
.
• Develop clinical awareness and understanding
.
• Learn and practice interpersonal and therapeutic skills.
• Embed the critical skills of reflection and self-evaluation.
• Work effectively with both service users and colleagues.

Practice placements provide experience of related health, social and educational provision for people with communication and eating, drinking and swallowing difficulties, as well as consideration of wider organisational and management issues. The provision of a range of practice placement opportunities during SLT training, is therefore a crucial element in the development of competent clinicians who are prepared for the workplace.

The Health and Care Professions Council (HCPC) is the regulatory body which approves SLT pre-registration courses, and as part of this, assesses HEI systems and processes for acquiring and quality assuring practice-based learning opportunities. The HCPC makes accreditation visits to HEI qualifying speech and language therapy programmes and scrutinise the timing, length and assessment of practice-based learning, as well as the level of training and support for practice educators, against the HCPC standards of education and training and the HCPC standards of proficiency. Practice placement providers should adhere to these guidelines to meet the HCPC requirements.

Prior to 2020 and the additional challenges of COVID-19, there were existing difficulties in securing sufficient practice placements to support student numbers. Some speech and language therapy settings historically have never offered practice-based learning opportunities. COVID-19 thrust the profession into crisis, with respect to cancellation of all practice-based learning opportunities. This has led to great innovation, exciting developments in service delivery, and the opportunity to review and strengthen RCSLT’s approach to practice-based learning, with the aim of securing the future of our profession.

The benefits of practice-based learning

There are clearly evidenced benefits of practice-based learning (Sokkar et al, 2019).

For the service user

• Students can share new ideas and up-to-date evidence-informed approaches that improve patient care.
• Practice placements can offer increased dosage of intervention for clients (both in NHS and in independent practice) leading to better outcomes and attainment of client goals.
• Service users frequently report that they want to ‘give something back’, and value their role in the education of students.

For the practice educator

• Supporting students is an important way for SLTs to demonstrate their continuing professional development (CPD).
• SLTs develop their leadership skills through working with students, increasing opportunities for their own progression.
• SLTs develop their clinical teaching skills.
• SLTs develop their reflective practice skills, alongside their students.
• SLTs can access cutting edge research and teaching via their students, and stay up to date in their own practice.
• Supporting practice placements can enhance service delivery eg a student can take a case history with one client while the SLT works with another client.
• Engaging in practice-based learning enhances workforce capacity to support additional and different service delivery models eg groups, increased therapy sessions, training programmes.
• Students can be given time to complete projects eg literature reviews, making resources, developing podcasts, completing audits, supporting waiting list initiatives, these are all activities which enhance service delivery and provide valuable learning.
• Students may be able to support some of the SLT work that cannot always be prioritised by SLTs, this can be factored into workforce planning.

For the speech and language therapy service

• Engaging in practice-based learning can support recruitment; students value practice placement experience highly and there is evidence to show that it influences their career choices regarding both the clinical practice area, geographical location and the organisation in which they choose to work (Jones-Berry, 2018). The national picture highlights some difficulty in recruitment to band 5 posts in certain areas; increasing student practice placements in these areas will support this. The Health Education England RePAIR project (2018) evidences the benefits of supporting practice-based learning and this facilitates recruitment into services.
• Students can support service improvement initiatives; can increase service delivery and can be an additional resource to develop new areas of practice.
• Regularly involving students in client care aligns with the clinical governance agenda – providing practice placements is a way to support quality and enhance client care in a compassionate way.
• Demonstrating a regular and sustained commitment to practice-based learning promotes an ethos of dynamic service development and organisational learning.
• Students may offer to volunteer for the service following a positive practice placement opportunity.

Continue to the main guidance