#35 – Clinical supervision and the challenges of early autonomy

In this episode we’re talking to Dr Danelle Hess. Danelle is a Lecturer in the Physiotherapy Department at the University of the Western Cape in Cape Town, South Africa. She did her PhD on the topic of developing clinical reasoning in undergraduate physiotherapy students, and has many years of experience as a clinical supervisor in resource-constrained environments.

We talk about the realities and demands faced by physiotherapy students during clinical placements in resource-limited environments like those described in South Africa, and compare them to the student experience in places like the UK.

The key points of this conversation include:

• the relatively limited contact time that supervisors have with students in SA, and how this means that students manage their own caseloads with minimal supervision.
• the complexity of cases, including gunshot wounds and poly-trauma in the SA context.
• how the lack of supervision and complexity of cases can lead to SA students developing coping mechanisms focused on survival rather than developing clinical reasoning.
• and how this raises concerns about mental health impacts, burnout, and attrition from the profession.

We also discuss some of the strategies employed by universities to provide supplemental learning support, mentoring, and counselling services to students grappling with challenging caseloads and complex patient scenarios. We cover the need to balance patient safety and care quality with the pedagogical need to expose students to diverse clinical presentations at an appropriate level. And we explore options for developing resilience and coping mechanisms in students to manage the emotional and psychological tolls of working in demanding healthcare settings.

This was an eye-opening conversation with plenty of opportunities to reflect on the challenges and opportunities of student autonomy on practice placement.

Additional resources

• Ahern, C., & O’Donnell, M. (2023). Are physiotherapy student-led services a suitable model of clinical education? – perceptions & experiences of physiotherapists, students & patients, a qualitative meta-synthesis. Physiotherapy Theory and Practice, 39(5), 963–978.
• Clouder, L., & Adefila, A. (2017). Empowerment of physiotherapy students on placement: The interplay between autonomy, risk, and responsibility. Physiotherapy Theory and Practice, 33(11), 859–868.
• Clouder, L., Jones, M., Mackintosh, S., & Adefila, A. (2022). Development of autonomy on placement: perceptions of physiotherapy students and educators in Australia and the United Kingdom. Physiotherapy Theory and Practice, 38(12), 2100–2110.
• Higgins, J. R. (2001). Educating for autonomy in practice : the experiences of undergraduate physiotherapy students. University of Sheffield.

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Danelle Hess is a Health Professions Educator based in South Africa. She currently works as a lecturer in Physiotherapy, guiding the research endeavours of postgraduate students and teaching subjects such as ethics and community-based rehabilitation at the undergraduate level within the physiotherapy curriculum.