Occupational therapy student-led services in Australia:

Do we know what clients think?

Sijia Ding, Master of Occupational Therapy Student, University of Canberra

Dr Claire Pearce, Assistant Professor in Occupational Therapy, University of Canberra

Sijia is a second-year Master of Occupational Therapy student at the University of Canberra (UC) who recently completed an eight-week placement at a student-led clinic, which she found to be an enriching, fulfilling and rewarding learning experience. As part of her role at the University of Canberra, Claire helps facilitate placement experiences for students and had observed that student-led services provide a rich placement experience.

Professional practice education is central to development as an occupational therapist as it facilitates the integration of theory, knowledge, and professional reasoning within the clinical context to develop student competence (WFOT, 2016). Australian entry-level occupational therapy education programs meet the international benchmark set by the World Federation of Occupational Therapy (WFOT) of a minimum of 1,000 hours of clinical placements for entry to professional work practice (OTC, 2018; WFOT, 2016). However, ensuring sufficient quality placements for occupational therapy students is becoming increasingly challenging in Australia due to the rising number of occupational therapy education programs and the dramatic expansion of cohort sizes (Gustafsson et al., 2017). In addition, the range of practice contexts that occupational therapists are involved in has been growing, as reflected in the current Australian occupational therapy competency standards (OTBA, 2018). To address the changing nature of practice education needs, many studies called for actions to push the boundaries and develop innovative and sustainable approaches to manage the quantity and quality of Australian occupational therapy placement places (Gustafsson et al., 2017; Hamiliton et al., 2015).

Student-led services (SLS) are one of the innovative approaches to meeting the growing demand (Hamilton et al., 2015). SLSs are dedicated settings where students are intrinsically engaged in service delivery under professional supervision in a single or multiple discipline clinical environment (Broman et al., 2022). These are generally in the form of university-run health clinics (Moore et al., 2018) or community-based clinics (Wilbur et al., 2017; Rens & Joosten, 2014) but can be designed in a range of ways such as the Student-Led Group Model (Patterson et al., 2021; Patterson et al., 2017; Patterson et al., 2019; Pigott et al., 2021; Pigott et al., 2022) or student-run free clinics which are prevalent in the United States (Dhans, et al., 2015; Zachry et al., 2016)

The literature relating to the effectiveness of these services tends to focus on clinical outcomes and student and/or supervisor perceptions. But what do the clients who access these services think?

To begin to answer this question, the authors undertook a review of the literature with the aim of providing an overview of client perceptions of occupational therapy discipline specific SLSs in the Australian context. We found a paucity of literature relating to this subject, but we hope by presenting a summary of what we did find, we will encourage further discussion and research on this subject.

Our review was undertaken in November 2022 and at that time, we found just six articles that answered our question ‘What are client perceptions of occupational therapy student-led services in Australia?’–five peer-reviewed publications and one blog. From these papers we derived the following four themes:

1. Overall clients are satisfied with student-led services

Positive health outcomes, changes in occupational performance and rehabilitation needs being met through reduced waiting time (Rodger et al., 2011a), more therapy, greater consistency, intensity in service provision and additional opportunities for clients to practice skills (Patterson et al., 2019) all contributed to clients overall being satisfied with SLSs. In rural areas, a SLS provided previously difficult to access services (Sedgwick, 2020).

2. Student-led services provide a mutual learning experience

Mutual learning relationships made clients feel more equal with students and clients valued the opportunity to be supporting the student learning needs while having their own health needs addressed (Patterson et al., 2021; Pigott et al., 2021; Rodger et al., 2011a)

3. Students’ personal traits influence client perceptions

Clients reported students demonstrated enthusiasm, patience, dedication, motivation, willingness to listen and learn, and were friendly and encouraging, and this contributed to the overall positive regard for the SLS (Patterson et al., 2021; Pigott et al., 2021; Rodger et al., 2011a; Sedgewick, 2020).

4. Clients expressed a desire for adequate supervisor input

Clients prefer to have a qualified occupational therapist present during student interactions, even if it was just for some of the time (Patterson et al., 2021; Carrigan et al., 2001; Pigott et al., 2021).

Implications for practice

It is apparent that from a client point of view, SLSs contribute to positive client health outcomes and address community needs for occupational therapy services. This finding is potentially helpful for universities and practice education providers as it further reinforces that student-led clinics can be an alternative and effective approach to meet the increasing demand for both placements and services.

From a student point of view, knowing that personal traits are held in high regard by clients could assist students to be less anxious and more confident while delivering services. Students aren’t expected to know everything, but appropriate therapeutic use of self can impact the occupational therapy process and outcomes. Another theme that may be of interest to students is that the client’s sense of supporting student professional development was identified as an external motivator for clients’ active participation in therapy – a unique feature of SLSs. Mutual learning is unique to SLSs and is considered to foster mutually beneficial, powerbalanced, and collaborative therapeutic relationships.

We know that clinical educators are facing challenges in meeting supervision needs due to staffing and physical resources shortages and high workloads (Thomas et al., 2007). In SLSs, clinical educators need to balance a range of different needs including students’ needs for timely and routine feedback (Rodger et al., 2011b); students’ needs for the ‘just right’ challenge to gradually foster autonomy and independence (Rodger et al., 2013), and clients’ desire for adequate supervisor input. There exists the possibility of tensions between a supervisor’s capacity and the demand for clinical supervision in SLS settings, with supervisors facing multi-layered challenges in leveraging the needs of different stakeholders and a potential lack of organisational support.

The findings of our review further reinforce that student-led clinics can be an alternative and effective approach to meet the increasing placement demand. Future research is indicated to be undertaken in a wider range of settings to explore in more detail the specific themes identified through this review, including addressing the balance of supervisor workload with client expectations, alternative settings for SLSs and harnessing the mutual learning experience to provide a greater range of both service delivery models and student learning experiences.