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Clinical Education Components for the Student

Original Editor - Angela Patterson

Top Contributors - Ewa Jaraczewska, Jess Bell and Kim Jackson  

Introduction

Clinical education or work-based placement is "the teaching and learning process that occurs in real-world organisational contexts with structured supervision and as a compulsory part of an academic programme with assigned learning outcomes".[1]

Clinical education provides students with experiences that enable them to learn practical skills.[2][3] During their clinical education, students apply the knowledge they gained in an academic setting to real-life situations with a range of patients. This article discusses the fundamentals of clinical education that relate directly to the student's clinical education experiences.

Practice Settings

Practice settings offer diverse and unique learning environments that prepare students for different career paths within their profession.[4] Rehabilitation students have opportunities to complete their clinical education in traditional and non-traditional clinical education settings. These settings provide a variety of learning experiences for the rehabilitation student.[5]

Traditional Practice Settings

Hospitals: acute care hospitals expose students to patients recovering from surgeries, acute injuries, or managing acute medical conditions, while inpatient acute rehabilitation hospitals focus on rehabilitation following strokes, spinal cord injuries, or other neurological conditions. Paediatric hospitals provide students with experience treating children with developmental disorders, injuries, or illnesses, while mental health hospitals treat and support people experiencing severe mental health issues or psychiatric crises.[5]

Outpatient clinics: orthopaedic clinics focus on musculoskeletal injuries and post-operative rehabilitation, while sports medicine clinics target sports-related injuries and performance enhancement. Neurological clinics specialise in conditions like stroke, Parkinson's, or multiple sclerosis, while paediatric clinics specialise in therapeutic services for children and adolescents with physical, developmental, or cognitive disabilities or injuries.[5]

Nursing homes (skilled nursing facilities and long-term care facilities): focus on rehabilitation for older persons recovering from surgeries or managing chronic conditions who require medical care and assistance with daily living activities.[5]

Home health care: offers students opportunities to visit patients in their homes and provide therapy. This service often provides care for patients recovering from injuries, illnesses or surgeries.[5]

Schools and educational institutions: provide opportunities for students to work with children and adolescents, focusing on physical, developmental, and cognitive disorders or disabilities.[5]

Community health centres: offer exposure to diverse patient populations with varying socioeconomic backgrounds, focusing on preventive care and chronic disease management.[5]

Industrial or workplace settings: provide students with exposure to ergonomic assessments, injury prevention programmes, and rehabilitation for work-related injuries.[5]

Non-Traditional Practice Settings

Workplace health programmes: students can gain experience in corporate wellness programmes or occupational health settings, assessing ergonomic hazards, promoting workplace safety, and providing rehabilitation services for employees recovering from work-related injuries or surgeries.[5]

Telehealth and virtual care:[6] with technological advancements, students may participate in telehealth initiatives where they conduct virtual assessments, provide remote consultations, and deliver therapeutic interventions under supervision. This setting allows students to learn about technology integration in healthcare delivery.[5] Students have reported that telehealth helped them develop their clinical reasoning and problem-solving skills and improved their resourcefulness and flexibility. Telehealth can facilitate effective communication "in ways different from face-to-face experiences."[7]

Sports and fitness facilities: physical therapy and athletic training students may work in sports clinics, fitness centres, or sports teams' facilities. They assist athletes with injury prevention, rehabilitation following sports injuries, and performance enhancement programmes.[5]

Research laboratories: students interested in research may conduct clinical research within academic institutions or healthcare organisations. They contribute to studies evaluating new treatments, therapeutic techniques, or outcome measures in rehabilitation and allied health.[5]

Hospice and palliative care settings: nursing, physical therapy, occupational therapy, and speech-language therapy students may participate in hospice and palliative care programmes. They provide comfort care, symptom management, and emotional support to patients with terminal illnesses and their families.[5]

Military or veteran health services: healthcare students may train in military healthcare facilities or Veteran Affairs (VA) hospitals, gaining experience in addressing unique health challenges faced by military personnel and veterans, such as combat-related injuries, PTSD, and traumatic brain injuries.[5]

International or global health experiences: some programmes offer opportunities for students to participate in healthcare missions or rotations abroad. They gain cross-cultural understanding, work with diverse patient populations, and contribute to healthcare initiatives in resource-limited settings.[5]

Driving rehabilitation: students, typically occupational therapists, can work with their clinical instructors to assist individuals who have experienced injury or illness that affects their ability to drive safely, including assessing driving skills, recommending adaptations, and providing training.[5]

Animal-assisted therapy: students may be placed in a setting that incorporates animals (such as dogs or horses) into therapy sessions to achieve therapeutic goals, such as improving motor skills, social interaction, or emotional well-being.[5]

Simulation:[8] in simulated practice placements, the learning occurs using mannequins, actors, simulated environments, video or interactive computer packages. This practice has been used as a partial substitute for traditional placements within the physiotherapy and occupational therapy professions or as a complement placement with activities focusing on developing communication and counselling skills for audiology and speech pathology students.[9]

Service learning: students participate in community clinics, health fairs, or community education. They learn to apply their clinical skills, advocate for health promotion and collaborate with community partners.[10]

Clinical Experiences

The clinical experiences a student has depend on the practice setting, the population of patients, and the types of services that the clinical setting has available. Each setting provides unique opportunities for personal and professional development and hands-on learning:[5]

  • Direct patient care: involves performing evaluations and assessments under supervision, developing and implementing treatment plans and monitoring patient progress and modifying treatment interventions as needed.
  • Interdisciplinary collaboration: working alongside other healthcare professionals such as physicians, nurses, occupational therapists, and speech-language pathologists to provide comprehensive care.
  • Clinical reasoning and problem-solving: analysing patient cases, interpreting diagnostic tests, and making clinical decisions based on evidence-based practice and patient-centred care principles.
  • Professional development: opportunities to practise professional behaviours and ethics and develop effective communication skills with patients, families, and healthcare team members.
  • Specialty areas: exposure to specialised areas like wound care, cardiopulmonary rehabilitation, oncology rehabilitation, and pelvic health.

Length of the Clinical Experience

The length of the clinical experience and the number of clinical rotations a student completes varies. A minimum duration for practice education may be established by the institution that sets the standards for healthcare education. For example, the World Federation of Occupational Therapists expects students to complete at least one thousand hours of practice education.[11] The United Kingdom's Health and Care Professions Council (HCPC) does not, however, specify the length for practice education. It states that "the structure, environment and support provided for practice education must be sufficient to ensure learning outcomes are met."[12] The Accreditation Council for Occupational Therapy Education in the USA has recently published standards for "acceptable fieldwork experiences corresponding to different levels of education."[13] Finally, according to a study by Wolden et al.,[14] the optimal length of terminal full-time clinical education experiences (CEEs) among Doctor of Physical Therapy (DPT) programmes is 12.5 weeks.

Several adverse outcomes can occur if the clinical experience is too short, such as:[5]

  • insufficient skill development: students may not have enough time to adequately develop and refine their clinical skills, leaving them inadequately prepared for entry-level practice
  • limited diverse patient exposure: a shorter duration may reduce the variety of patient cases and conditions students encounter
  • incomplete learning cycle: students might not have the opportunity to see patients through their full course of treatment
  • inadequate assessment: clinical instructors may have difficulty accurately assessing student competence with limited time
  • insufficient clinical competence: students may struggle to apply classroom knowledge in real-world situations effectively and cannot achieve competency in clinical reasoning, decision-making, and evidence-based practice development
  • reduced cultural competence development: less time in diverse clinical settings could impact students' ability to work with varied patient populations
  • incomplete professional socialisation: students may not fully acclimate to the professional environment and culture
  • limited feedback and improvement: shorter durations provide less time for receiving feedback and implementing improvements, as there is a higher demand for the clinical instructor

Several positive outcomes can occur when the clinical experience is the optimal length, such as:[5]

  • comprehensive skill development: students have sufficient time to develop and refine their clinical skills to a professional level
  • diverse patient exposure: an optimal duration allows students to encounter various patient populations, cases and conditions
  • complete learning cycle: students could follow patients through their entire course of treatment, understanding long-term outcomes
  • effective clinical competence: students can effectively apply classroom knowledge in real-world situations and achieve competency in clinical reasoning, decision-making, and evidence-based practice development
  • cultural competence development: students have time to work with diverse patient populations, enhancing their cultural awareness and skills
  • complete professional socialisation: students have time to fully acclimate to the professional environment, understanding workplace dynamics and expectations
  • iterative feedback and improvement: there is sufficient time for receiving feedback, implementing changes, and reassessing performance
  • thorough assessment: clinical instructors have enough time to accurately assess student competence across various domains
  • autonomy development: gradually, students could take on more responsibilities, preparing them for independent practice
  • research and evidence-based practice integration: students would have time to apply research to clinical practice
  • career path exploration: adequate time in various settings can help students identify their preferred areas of practice

Several adverse outcomes can occur if the clinical experience is too long, such as:

  • diminishing returns: additional time may not yield proportional gains in skills or knowledge after a certain point
  • student burnout / boredom: excessively long placements might lead to mental and physical fatigue, potentially reducing motivation and engagement
  • financial burden: extended unpaid internships could create additional financial stress for students
  • reduced exposure to different settings: time spent in one extended placement could limit opportunities to experience other clinical environments
  • dependency on clinical instructors: students might become overly reliant on their supervisors, hindering the development of independent decision-making skills
  • plateau in learning: after mastering basic skills, students might experience a plateau if not continuously challenged with new responsibilities
  • resource strain on clinical sites: hosting students for extended periods could strain the resources of healthcare facilities
  • delayed professional networking: spending too much time in one setting might limit opportunities to network across the field
  • overspecialisation: extended time in one area might lead to overspecialisation at the expense of broader skill development
  • stalled feedback and improvement: clinical instructors are not able to continually challenge the student and provide advanced skill development or feedback
  • lack of ongoing assessment: students may meet assessment benchmarks prior to the completion of the experience and clinical instructors would need to challenge the student beyond entry level competency

Student Activities During Clinical Education

A student's activities and responsibilities depend on the clinical setting, patient population, the stage of the student's education, and the specific goals of the clinical experience. These activities may include (1) patient care, (2) documentation, (3) clinical reasoning, (4) research and evidence-based practice, (5) inter-professional collaboration, (6) self-reflection and feedback, and (7) time management. This is only a general list of activities. Regardless of the skills the student is expected to meet or exceed during clinical education, they should all be directly related to the profession’s scope of practice. Please refer to examples provided by the American Speech and Hearing Association, World Federation of Physical Therapy Standards of Physical Therapy Practice, and Standards of Accreditation for The Orthotic/Prosthetic Training Residency Program.

Student Supervision During Clinical Education

All students completing clinical education require supervision.[15] This supervision should be provided by a clinical instructor trained in the same profession, and it should initially be direct and continuous, gradually transitioning to more indirect supervision. Clinical assessments and tools should be used to determine readiness for decreased supervision. At the beginning performance level, clinical supervision is required 100% of the time; at the advanced beginner level, 75-90% of the time; at the intermediate level, 50-75% of the time; at the advanced intermediate level, 25-50% of the time; and at entry level, 25% of the time. Performance beyond entry level requires no clinical supervision.[5]

Clinical Education Financial Considerations

Students must understand the financial implications of clinical placements. Clinical placements can be associated with high financial strain, increases student's accumulation of debt and impacting their health and well-being.[16] It is essential for students to consult their academic institution directly to obtain accurate, current information about any direct expenses related to their clinical education.[5] Direct costs associated with placement may include travel, parking, accommodation, uniforms, equipment, and liability insurance. Indirect expenses include lost income for students working part-time jobs and childcare for students with a family.[17]

However, some countries and programmes might provide financial support or payment to rehabilitation students during their clinical education. There may be:[5]

  • a policy of supporting higher education students
  • government-funded courses that offer living cost support for students during their studies, including clinical placements
  • clinical placements in rural, remote, and underserved areas that offer stipends or financial support to encourage students to gain experience in these areas
  • military programmes which pay for education, including paid clinical rotations, in exchange for service
  • government-sponsored programmes that provide stipends to students during their clinical education phases

It's important to note that payment or financial support is not universal and can depend on the programme, region, or specific circumstances. The amount and nature of support can vary widely. Additionally, many countries offer indirect financial support through scholarships, grants, or low-interest loans to help cover living expenses during unpaid clinical rotations.

Resources

References

  1. ↑ Hay K. What is Quality Work-Integrated Learning? Social Work Tertiary Educator Perspectives 2020;21: 51–61.
  2. ↑ Momeni M, Asadi M, Shadin H, Noorian S, Senmar M. Self-efficacy of clinical performance in nursing students and its relationship with the motivation of field choice and clinical education status. BMC Med Educ. 2025 May 24;25(1):767.
  3. ↑ Reubenson A, Ng L, Lawton V, Nahon I, Terry R, Baldwin C, Blackford J, et al. The assessment of physiotherapy practice is a robust measure of entry-level physiotherapy standards: Reliability and validity evidence from a large, representative sample. PLoS One. 2025 Apr 18;20(4):e0321397.
  4. ↑ McBride LJ, Fitzgerald C, Costello C, Perkins K. Allied health pre-entry student clinical placement capacity: can it be sustained? Aust Health Rev. 2020 Feb;44(1):39-46.
  5. ↑ 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 Patterson A. Clinical Education Components for the Student Course. Plus, 2024.
  6. ↑ Anil K, Bird A, Bridgman K, Erickson S, Freeman J, McKinstry C, Robinson C, Abey S. Telehealth training and education for allied health professionals: a scoping review. Telemed Rep. 2025 Mar 19;6(1):76-90.
  7. ↑ Bacon R, Hopkins S, Georgousopoulou E, Nahon I, Hilly C, Millar C, Flynn A, Smillie L, Chapman S, Brown N. While allied health students prefer face-to-face clinical placement, telehealth can support competency development: results from a mixed-methods study. Front Med (Lausanne). 2023 May 15;10:1151980.
  8. ↑ Coleman J, Dhir J, Kobylianski J, Coughlan L, Law M, Pereira D, BeaversL. The use of simulation as a component of clinical education in health professional entry to practice programmes. Physiotherapy Canada. 2026;78(1):1-10.
  9. ↑ Rossiter L, Turk R, Judd B, Brentnall J, Grimmett C, Cowley E, McCormick K, Thackray D. Preparing allied health students for placement: a contrast of learning modalities for foundational skill development. BMC Med Educ. 2023 Mar 15;23(1):161.
  10. ↑ Smith SN, Crocker AF. Experiential learning in physical therapy education. Adv Med Educ Pract. 2017 Jun 28;8:427-433.
  11. ↑ Thomas Y, Penman M. World Federation of Occupational Therapists (WFOT) standard for 1000 hours of practice placement: informed by tradition or evidence? British Journal of Occupational Therapy 2018; 82(1). Available from https://journals.sagepub.com/doi/full/10.1177/0308022618788785 [last access 1.9.2024]
  12. ↑ Health and Care Professions Council (2017) Standards of education and training. Available at: https://www.hcpc-uk.org/globalassets/resources/standards/standards-of-education-and-training.pdf (accessed 1.9.2024).
  13. ↑ 2018 Accreditation Council for Occupational Therapy Education (ACOTE®) Standards and Interpretive Guide (effective July 31, 2020). August 2020 Interpretive Guide Version. Available from https://acoteonline.org/wp-content/uploads/2020/10/2018-ACOTE-Standards.pdf [last access 1.9.2024]
  14. ↑ Wolden M, Flom-Meland C, Gusman LN, Drevyn E, McCallum C. Determining the Optimal Length of Clinical Education Experiences: Surveying Doctor of Physical Therapy Academic and Clinical Faculty. J Phys Ther Educ. 2024 Sep 1;38(3):239-248.
  15. ↑ Sharma H, McDonald CE, Vaughan B, Bower KJ. Teaching clinical reasoning in gerontological physiotherapy: Experiences and perceptions of clinical supervisors. Physiother Theory Pract. 2025 Feb;41(2):351-361.
  16. ↑ Wray N, McCall L. Money matters students' perceptions of the costs associated with placements. Med Educ. 2007 Oct;41(10):975-81.
  17. ↑ Usher K, Fagan A, Brown JA, Mather C, Marlow A, Power T, van de Mortel T, West C, Hutchinson M, Zhao L, Terry V, Woods C, Lea J. The financial challenges for Australian nursing students attending placement-based work-integrated learning. Collegian 2022; 29 (2):154-160.
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