Avoiding Common Physio Student Mistakes on Clinical Placement... Tips from a Practice Educator
- Physioing
- Mar 10
- 17 min read
Updated: Apr 24
As physio practice educators, we want our physio students to do their best on clinical placements. However, there's so much knowledge and what seems like so little time to pass it on!
Interestingly, we often see the same mistakes around preparation, timekeeping, lack of understanding of the setting and unfamiliarity with the clinical environment.
If you're looking to avoid some common pitfalls, you've come to the right place.
Preparation
Common mistakes:
Forgotten pens, paper, textbooks, uniform, etc.
Unfamiliar with CPAF.
Forgetting to book assessments & tutorials.
Incomplete goals, reflections & presentations.
Not researching or applying research.
Not asking for feedback.
Not utilising down time effectively.
Don't Forget your Pen, Badge, Notebook etc - You don't want to be remembered as the 'student who always forgot their pen'! A little bit of prep goes a long way towards how you come across to the rest of the team. There will be a lot of things to remember, so a small notebook in a pocket can be a lifesaver to jot things down. Remember not to write any patient or workplace sensitive information in it. Find out if there's anything specific you need like a stethoscope, or hydrotherapy kit and pack your bag the night before. If you've got room in your bag for a few pocketbook sized reference books, many students find these useful to refer to with questions and for studying if you've got any downtime.
Familiarise Yourself with the CPAF (Common Placement Assessment Form) - Once you're on your placement it can be easy to get caught up in the day-to-day routine, however, achieving some of the learning domains on the CPAF might require some special preparation and planning on your part. If you have time before starting placement, familiarise yourself with the CPAF learning domains and once you've started placement, think about how each domain can be achieved in the setting. With this approach you're more likely to be looking out for and creating opportunities to achieve the more obscure learning objectives earlier in your placement and avoid running out of time nearer the end.
Organise Assessments & Tutor Meetings Early - Get your halfway, final assessments and tutor meetings booked in the calendar early on before everyone gets too booked up. You'll benefit from having a clear idea of how long you've got before receiving your halfway and final marks. Surprisingly it's quite a common on busy placements for everyone to get stuck in and for halfway assessments to be forgotten and left until later in the placement. Unfortunately, this leaves minimal time to improve your performance and marks between the halfway and final assessment.
Set Relevant Goals in the First Few Days - Have a think about potential goals before you start the placement and in the first couple of days. This is also an area where if it's left too late, this can leave you short of time and result in missed opportunities to achieve higher marks. Make sure you follow your universities teachings on effective goal setting and ensure its relevant to the placement setting.
Write Regular Reflections - Help boost your marks and help your educators to get to know you by sharing regular reflections. It may feel uncomfortable at first, but getting these insights will help your educator tailor your learning experiences and help you zone in on areas you may want to focus on. A common mistake is to produce a few reflections and not act on what you have observed, or to produce regular reflections but not share them with your educators. For higher marks, we're looking for regular reflections, where it is clear to us that you've learnt from your observations and adapted your practice accordingly. Most universities have their preferred reflection models and the CPAF includes some reflection templates.
Produce a Quality Presentation - Although it's not everyone's favourite part of placement, always assume you'll be doing a presentation. Even if you have a relaxed setting that isn't too worried about a presentation, challenge yourself to do one. There are multiple benefits to this approach, firstly this is a good way to get used to presenting to smaller groups of people that you don't know well. Most workplaces run in service training, so presenting is often part of many physiotherapists' roles. Also, many physiotherapy interviews include a presentation element (especially from Band 6 level), so it's good practice for the future. Secondly, a well-researched and evidenced presentation is an ideal way to meet many of the learning domains, don't forget to email a copy to your educators and include your references. On the other hand, this is also a common area where students loose marks. If a placement is expecting a presentation and it's obvious it's been left to the last minute, your marks will reflect this. If you're feeling particularly nervous or anxious, it can help to include interactive elements such as quizzes, getting everyone out of their seats demonstrating exercises, or provide handouts so everyone is looking at those instead of you!
Apply Research - Another learning domain where students miss potential marks is forgetting to either carry out meaningful research or forgetting to share research and observations with their educators. Unfortunately, we can't give marks for anything we haven't seen or heard, even if you have been researching. As noted earlier, apart from a well evidenced presentation with referenced slides, support your evidence-based practice with research on a treatment method you have selected or researching common or rare conditions you have seen. Don't forget to send us emails of papers and articles and mention in your clinical reasoning any supporting research so it's evidenced and we can award you the marks. Your university will have provided you with electronic access to online journals and research, if you require additional materials the Physioing directory lists a variety of physio resources organised between specialism and treatment style.
Ask for Feedback - Yes it can be awkward, but it's a requirement of the CPAF to not only obtain feedback but demonstrate you've reflected upon it and improved your practice accordingly. Although it may be tempting to only get feedback before your halfway or final assessment, this doesn't help students achieve higher marks. Regular feedback will give you more opportunities to improve and can be a real confidence booster when you hear something positive. Don't forget to get a mix of feedback from not just your educators, but also the wider MDT, patients and their support system. Feedback doesn't always need to be formal or written, especially if you're in a busy setting. Asking a quick question after seeing a patient 'how was my handling?', 'did I leave enough time for treatment?' also counts. Include notes of your feedback in your reflections, what you have learnt and what you plan to do in the future as a result of the feedback. Be honest if you were disappointed with your feedback or performance. It's completely normal to take time and require practice when learning new things.
Use Downtime Effectively - Whilst you'll likely be on the go a lot, expect there to be times when your educators are busy writing notes, in meetings or you're required to work from home due to restricted staffing. Be prepared for these moments and have a plan of a few activities you can do, such as reading relevant textbooks or research, writing reflections, working on your presentation, preparing future treatment sessions or safely familiarising yourself with equipment. Ensure that your educator/s are aware of how you are using this time, they may even have suggestions of how you can best use this time, but being prepared shows that you're proactive.
Timekeeping
Common mistakes:
Losing track of time - missing appointments.
Running out of time on assessments.
Delaying patient discharges in inpatient settings.
Rely on your own Timekeeping Device - Time management is something we learn throughout our training and whilst educators appreciate this and provide extra time (dependent on your experience), physiotherapy is a time pressured job. For final year placements timings will likely be the same or similar to qualified staff, so it pays to get into good habits early on. Before you say it, nope, there are never enough reliable clocks around in a healthcare setting and beware the inevitable clock that is set to the wrong time! If in doubt, it's better to have your own way of checking the time. Make sure you have an infection control approved method (arms clear below the elbows), such as keeping your watch in your pocket, getting an extendable strap to put it on your upper arm or ankle or pinning a fob watch to your uniform.
Remember Meetings, Training Sessions & Other Anomalies - Sometimes it's easy to get caught up in what you're doing and lose track of time. Don't forget meetings, training sessions and anything else that may be different from a usual day. If you're in a setting with an electronic diary and have limited access to a laptop or computer, a small paper diary or notebook can be a very helpful. If you're ward based, consider whether you'll have enough time to start any physio sessions prior to meetings and training sessions. Have an idea of when you need to be finished, allowing time for safely leaving a patient, these are usually areas we underestimate when planning our time. If you're with a patient but due to attend a meeting and cannot safely leave them or find someone to take your place, don't worry, always stay with the patient and if possible, get a message to someone in the meeting, they will understand, we've all been there.
Community & Outpatient Time Management Tips - If you're in the community or outpatients and have got your own diary, or are sharing a diary with an educator, make sure you're aware of the time pressures of your day. How long are appointments, does this include time for note writing, completing referrals, booking follow ups or using exercise prescription software? If you're travelling to visit patients or between settings using your own transport, allow sufficient travel time for the journey, plus a little extra. Ensure you have a phone number for who you're visiting and phone numbers of your educator and placement. Whilst traffic, vehicle problems and getting lost, happen at some point to everyone in community roles, being sufficiently prepared will make it easier to manage and will reflect on you better if things go wrong. Regarding your own safety, always follow the settings procedures and policies for community visits, is there a system for signing out and in, are you aware of what to do in an emergency?
Inpatient Time Management Tips - For inpatient settings, ensure you're aware of any time restrictions such as what time patients are awake and potentially ready to start physio sessions. Are there protected meal times? If there is an exercise space or gym, does it need pre-booking? Visiting times can be an ideal time for physio sessions if you're able to include visitors in a session, although some may prefer to keep this time free. Don't forget to check handovers so you're aware if anyone is potentially offsite for scans, appointments or is medically unfit for physio. For each patient you see, have a rough idea of how long the physio session will last and plan time for subjective and objective assessment, treatment, developing a plan, writing notes and completing any other paperwork and referrals.
Support Timely Patient Discharges (Inpatients) - Planning a patient discharge from hospital can be complex and involve a variety of disciplines and physios are very much involved in this process. It's an area that's easier to overlook or be sheltered from as a student, but demonstrating an awareness of discharge planning and gaining experience early in your career will be a standout point in interviews and prove valuable in your future career. Inpatient settings are measured on average stays and most patients will arrive with an estimated discharge date set by the multidisciplinary team (MDT). Keep an eye on patients expected discharge dates and up-to-date with any developments from the MDT. If a patient is declared medically fit for discharge, but has ongoing therapy needs, the pressure will be on the therapy team to support a safe and timely discharge from hospital. If you're delegated tasks or have responsibilities that are time critical for a patient discharge, such as procuring equipment, completing a stairs assessment or drafting discharge summaries, safely prioritise these. If you're unable to complete them in a timely manner, flag it up with the team, so patient discharges are not delayed.
Understanding the Service
Common mistakes:
Thinking about physio in isolation to the service.
Lack of understanding of MDT & hierarchy.
Avoiding leadership opportunities.
Not taking up opportunities to shadow.
Insufficiently prepared before assessing.
Not selecting appropriate assessments or treatments.
Understand how Physio fits into the Service - At uni when you're surrounded by everything physio, it can be a bit of a shock getting onto placement and encountering several other professions involved with the same patient. Clinical placements give you the chance to see the bigger picture and how physio fits into a healthcare service. Even in an MSK clinic where it may seem like physio are the sole profession involved, your patient may have already attended GP appointments, consultant clinics and arrived for post-operative rehab with notes from their surgeon. Consider an inpatient's journey through the hospital, they may have been admitted suddenly, moved wards multiple times, had a prolonged stay and currently unable to return home. As part of their healthcare team you have the opportunity to be a source of positivity, support and advocate for the best outcomes within the possibilities of the service. The CPAF includes learning domains related to advocating for patients, often there are chances for advocating in MDT meetings, in discussions with family and support networks and with other professions.
Know your MDT (Multidisciplinary Team) - Not all MDTs are made equally, in fact they are usually very specific to the setting. Check out the image below from Scottish Health and Social Care showing an example of an MDT for a care home resident.
With this in mind, it's worth getting an idea of which professions make up the MDT, who is around on which days and when there are MDT meetings. Be prepared to work with many other disciplines, adapt your communication style for your audience's physio knowledge and learn about other specialities. You may need to develop joint care plans and may work more closely with some professions than others, such as your occupational therapy colleagues. In an inpatient setting expect to be confused with a variety of different disciplines. It helps to know who everyone is so you can explain roles to patients and their support network and advise of when certain disciplines are likely to be on the wards. Confusingly there is no standardised uniform between hospital trusts. On your first day you'll discover who wears what style of uniform, if you're on a ward where everyone wears scrubs and very small name badges this can be especially confusing, don't worry if you're not sure who's who. If you don't have a name badge it's worth spending a few pounds on one so that you're more easily identifiable to everyone.
Understanding the Hierarchy - For inpatient settings understand how the ward is run, including the hierarchy of nursing staff, who is the charge nurse, the lead consultant, who reports to who and when doctor and consultant rounds are. For both inpatient and outpatient settings find out when specialist clinics are running in case you're supporting these or need to refer patients for a review. Ensure you understand the hierarchy of the physio team, what are the different responsibilities between the band 5, 6, 7, and higher roles. Are some roles fully clinical or non-clinical and others a mix? If your team is supported by therapy assistants, you'll be required to delegate work as appropriate for their banding and role competencies, note levels of autonomy differ between different bands 3 and 4. Don't forget as a student you'll be required to have a qualified physio countersign any notes, make sure you have these ready for countersigning promptly if you can.
Step Up to Leadership Opportunities - One area that crops up with regards to improving potential marks, is leadership opportunities. It comes as a bit of surprise to some students that leadership and delegation are on the CPAF when you may feel new and inexperienced in comparison to others. However, being part of a team, working for and with others and delegating is all part of a qualified physiotherapist's role. As a student, as well as respecting the team hierarchy, you'll also have opportunities to step into positions where you'll be representing the physio team, perhaps at MDT meetings, when talking to a patients support network and you'll likely delegate work to colleagues who support the physio team. It's ok to feel uncomfortable or anxious, observe those around you and how they manage these situations for some helpful pointers. They were likely just as nervous once.
Embrace Shadowing Opportunities - Another area that can be a bit intimidating but definitely worth getting out of your comfort zone for is shadowing. Shadowing is a great way to learn about the MDT, other roles and professions and expand your knowledge. Physio is a small world and the more potential colleagues you can meet before you're qualified, the more opportunities may present themselves when you're job hunting. Common shadowing opportunities often include observing surgeries, attending specialist clinics, working with specialist equipment and swapping ward locations for community visits and vice versa. Mentioning unique or specialist shadowing opportunities when applying for jobs can also help make you stand out from other similarly experienced candidates.
Learn Regularly Used Techniques - Be prepared to research and learn assessment and treatment techniques regularly used by the service, that you may have little or no experience with. Universities don't have the time or equipment to teach everything, clinical placements are there to provide real life practical experience. Note, even settings in the same specialism often favour different techniques and equipment (.e.g. NHS MSK and private MSK). Where some students come unstuck is selecting the wrong assessments or treatment styles for the setting. If it's specifically a neuro, respiratory or an MSK setting, start off with using the right type of assessment. Most services have some specifics you'll need to include in your assessments such as outcome measures or templates, all placements will likely do things a little differently. Treatment techniques can vary significantly between settings, you may be studying post-operative protocols, specific manual therapy techniques, running telehealth clinics, using specialist equipment, running a rehab group, expanding your exercise knowledge or inventing an obstacle course that incorporates all of a young child's prescribed exercises! That really is the beauty of physio, it's so varied. Whilst it's good to stick to what we know, as educators it's great to hear about new techniques and research from others in the field. If there's something you've learnt from university or other placements that you'd like to introduce, such as an outcome measure or technique, don't feel like you can't bring this up with your educator and clinically reason the potential benefits.
Prepare Before Seeing Your Patient - Take a moment to pause before collecting or visiting your patient and check if you've done enough to prepare. Ideally you want to be in a position where you can avoid loosing time and going back and forth getting extra supplies/equipment. Have an idea of why you're seeing them and what type of assessment and possibly treatment you might use. Consider if you'll need extra staff such as a therapy assistant with you, or if you could conduct a joint assessment with another profession. As a bare minimum, always check patient notes, their nursing observations (if applicable), if a patient is medically fit for physio and if there any restrictions. If there's anything you're unsure about ask therapy and medical teams first, no question is a silly question when it comes to patient safety. Sometimes a quick check to make sure the patient is where you expect them to be before you start preparing can be useful, in case you discover after all the prep time that they're off site for the afternoon!
Familiar with the Environment
Common mistakes:
Overwhelmed by clinical environment.
Not hands on with washing, dressing, etc.
Unsafe or unsuitable manual handling.
Not adapting communication styles.
Get Familiar with Clinical Settings - Clinical environments can be overwhelming and overstimulating places when you're not used to them. There's often limited space, noise, bright lights, equipment, people and lots of safety and cleanliness requirements. It's understandable that getting used to the environment can detract from thinking about your studies. Your first priority is always safety, where is the crash trolley kept, where are the emergency call bells, what to do in an emergency, in outpatient clinics are you supported by an onsite acute hospital or should you call an ambulance? Remember your basics like brakes on beds and plinths, keeping walkways free of cables and equipment and keep call bells and bed tables in easy reach of patients and leave patients safely positioned. Your induction should cover all the equipment you'll be using, where it's stored and provide you with relevant training. Beds, wheelchairs, hoists, specialist seating and stand aids often differ between settings, even experienced professionals will spend time familiarising themselves in a new setting, so if there's anything you're unsure of ask the team. If you're feeling particularly overwhelmed, many students have found it beneficial to take on some casual care, therapy assistant or heath care assistant work. If this isn't possible, don't stress it all becomes easier with practice and time.
Assist with Personal Care, Washing and Dressing - This one is often debated in physio circles. Although it may not always be considered a requirement of your role (although I have worked in many physio roles where it was), in reality, with staffing issues in the NHS, there will be times when you'll need to help maintain a patients comfort and dignity and do a quick toilet trip, a pad change or provide specialist handling to support having a shower or getting dressed. Don't forget a lot of mobilising patients on wards is with the aim of getting to and from the toilet, often using equipment or mobility aids and specialist handling. Patients may need help with wiping and their clothing, it pays to know how to do this quickly and effectively. As a student, expect to learn about and work with other professions who do carry out day-to-day personal care, washing and dressing. In these instances, you will be required to help out, so use these opportunities to learn as much as you can about assisting quickly and safely. Often where students struggle with timing regarding washing, dressing and personal care, being quick and confident can make all the difference. Bonus points for being able to put socks and shoes on quickly, expert level for fitting an orthotic in a shoe!
Use Appropriate Therapeutic & Manual Handling Techniques - With therapeutic and manual handling there's a couple of areas that are commonly mentioned as requiring improvement. Firstly, being too supportive, where your patient isn't being challenged or doing enough for themselves. Or secondly, providing too little support and not being in contact with the patient whilst their mobilising or exercising and compromising safety. Yes, these two statements do contradict each other and as a physio it will be your job to clinically reason and assess what level of support is appropriate, depending on who you're seeing. You'll find this develops naturally as you become more experienced. On your first day, find out from the team how hands on they are, observe any techniques you're unfamiliar with and ask for training if you don't feel confident. If you're working in pairs or teams, make sure you know your role, such as following closely with a wheelchair or providing seating balance support on a plinth. Ensure your hand placement for supporting mobility compliments that of anyone else also supporting the patient. A special note about passively testing movements, ensure you are taking the full weight of the limb you are testing, it should feel heavy. If the patient is joining in in anyway, then it has become an active movement.
Adapt Communication Styles for your Audience - This is where empathy really pays off, having fantastic physio knowledge doesn't translate into being a fantastic physio if you can't communicate with and educate a variety of audiences (medical, family, other professions, adult and paediatric patients, etc). When communicating, remember your audience, are they likely to understand any medical terminology or descriptions? Consider additional needs, cognition and hearing. If you have no prior experience working with those affected by dementia I'd highly recommend completing an online dementia education course. Where possible demonstrate exercises with your patients, if you're struggling to get the message across, practise instructing family and friends.
In Conclusion...
As educators we want to bring out the best in you and it can be tough as a physio student adapting to the clinical environment whilst being assessed. Hopefully this article has provided a heads up and highlighted some areas where mistakes commonly occur and how these can be avoided:
Wishing all the future physios the best of luck on your clinical placements.
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