I am increasingly involved in the preparation of allied health students (dietetics, occupational therapy, physiotherapy) for their clinical placements. 

Clinical placements are the real-world culmination of lots of hard work and learning for these groups of students. It is where they get to experience how the knowledge they’ve gained applies to real-world practice. They get to experience first-hand what it is like to work in their chosen profession. 

Now it isn’t totally clear whether it is possible, outside of administrative stuff, to prepare students for clinical placements. Many of us who did clinical placements remember them as being very challenging, but remember those challenges being part of the learning process. No-one could necessarily have prepared us better for them, outside of just good quality course material. 

That being said, we are experimenting with a few different approaches to giving students input, prior to the placement, that we think might help them get the most out of their placements. 

This includes:

1. Alerting students to the most common challenges faced during placement and some basic advice on how to address those challenges. 
2. Exploring methods for enhancing their placement experience.
3. Teaching behaviour change theory that they can use for themselves to develop good habits but also use with clients/patients they are working with.
4. Overview of basic self-care, coping and stress management strategies. 

Some of these ideas have been captured in documents we’ve prepared like the How To Prepare Yourself for Dietetics Placements guide. I am currently working on a revised version of our more generic How to Prepare Yourself Psychologically For Work Placements guide

Yesterday I was very lucky to spend an hour with a group of dietetics students who are 6-weeks into their first placement. Typically, I chat with students in the lead-up to placement so we end up talking about what they are anticipating and looking forward to. Catching up with students during their placement was a unique opportunity to get to hear about their experiences, right while it is happening. 

I asked the students to form small groups and answer two fairly simple questions:

What are you enjoying/liking about placement?

What are you finding challenging about placement?

The reported positives about clinical placements revolved around the chance to do clinical work and work with patients, getting to work with other professionals in the system, seeing the real world impact of their skills, rapid learning and the discovery that they had chosen the right career path. 

Reported challenges included time management, workload, financial stress, being emotionally drained, being graded, working with difficult patients and the downsides of short placements (e.g. not getting to see the outcomes for some patients, not enough time to get proficient in some areas). 

We talked about a few of these issues, but I don’t think I offered the students much in the way of useful advice. What I did notice however, which was very pleasing, was that the students were doing a lot of the heavy lifting in terms of supporting each other during the session. 

I could hear students sharing their experiences, giving validation to each other, acknowledging the challenges they were each facing and starting discussions around how to cope. 

The language of coping is helpful here. 

Coping refers to how one confronts and deals with responsibilities, problems, setbacks and challenges. 

When psychologists talk about coping, we often talk of different ‘coping strategies’. Coping strategies fall into categories reflecting what it is the coping strategy is attempting to do.

Common categories include:

Emotion-focused coping – includes strategies that seek to address the emotional impact of the problem/setback/challenge. An example might be a student who fills their evening with self-soothing strategies, knowing that the work day is going to be quite emotionally confronting. 

Problem-focused coping – includes strategies that seek to specifically address the cause(s) of the problems/setbacks/challenges. An example might be a student who organises a meeting with their placement supervisor to specifically discuss the negative feedback they have been given. 

Support-seeking – includes strategies that involve seeking out additional support from other people to help deal with the . An example might be a student who books an appointment to see a counsellor to discuss their placement experience. 

Meaning making – includes strategies that involve reflecting on the problem/setback/challenge and considering what meaning or personal growth we might be able to gain from it. An example might be a student that keeps a journal during placement and takes note of the things they found challenging and what they learned from it. 

Avoidant coping – includes strategies where we avoid thinking about or dealing with the problem/setback/challenge. This can work in the short-term, but doesn’t generally work well in the long-term. An example might be a student who uses drugs or alcohol to deal with the stress of the placement. 

 

As the groups chatted I could see support-seeking in action. Students were calling on each other to help them through a common experience. They were able to sympathise with each other because they were going through similar challenges. Small groups (e.g. 4-6 people) seemed optimal. This helped spread the responsibility of helping each other across a number of people. It also increases the likelihood that someone in the group has found a solution (or partial solution) to some of the challenges discussed. It provides variety of perspectives.  

After the session finished I wondered if It was possible that the structure I provided in the session helped facilitate those interactions but I suspect they would be easy to mimic outside of that session. 

So if you are about to head in a work or clinical placement situation, see if you can assemble a small group of your peers to meet once or twice during the placement period. Yes it might involve an out-of-hours session or some time on the weekend, but I would predict that the time would be well spent. Who better to know what you are going through than another student who is going through similar things? Coping with the challenges of placements might not require expert or professional assistance. It may in fact, be the ideal scenario for peer support and as students, you are best situated to make that happen.