McAllister, L & Nagarajan, S. V. (2015). Accreditation requirements in allied health education: Strengths, weaknesses and
missed opportunities. Journal of Teaching and Learning for Graduate Employability, 6(1), 2—24 2

Accreditation requirements in allied health education: Strengths,
weaknesses and missed opportunities

Lindy McAllister1, Srivalli Vilapakkam Nagarajan1

lindy.mcallister@sydney.edu.au; srivalli.nagarajan@sydney.edu.au

1The University of Sydney

Abstract

This paper reviews the accreditation requirements for six Allied Health (AH) degree programs
in Australia to understand the range of accreditation requirements and approaches, with a
particular focus on requirements around clinical education in AH education. Strengths of
current approaches and further requirements are identified. Of particular interest are those
areas where accreditation could better support educational goals and processes, including the
preparation of work ready graduates and the encouragement of the use of currently under-
utilized opportunities for preparing the AH workforce for future healthcare needs. The findings
suggest that the accreditation criteria perform well for the development of students’ conceptual
and procedural knowledge. However, there are several opportunities for improvement where
accreditation could better support preparation of graduates to meet current and future needs
of healthcare. These opportunities include increased emphasis on biopsychosocial
perspectives of health as healthcare models shift from hospital to community-based settings,
increased emphasis on development of interprofessional skills, encouragement of diverse
supervision models, explicitness about intentions and interpretations of accreditation
requirements, and increased employer representation on accreditation panels. Constraints on
universities’ uses of new educational approaches imposed by or arising from non-explicit
accreditation requirements are outlined. Arising from this analysis, a summary of
considerations for AH accreditation bodies is provided.

Keywords: Allied health, accreditation, curriculum, pedagogy, active learning clinical
placements, work readiness, health graduates.

Introduction

Accreditation of AH programs (also known as courses in Australia) plays a crucial role in
ensuring educational effectiveness, quality assurance and continuous improvement in higher
education. It is largely seen as an organised means by which universities demonstrate quality
education to students, universities, professional bodies, employer groups, the public and
government (Wergin, 2005; Dodd, 2004). Accreditation requires programs to demonstrate
achievement of clearly defined purposes and objectives related to the preparation of students
for practice, to demonstrate that adequate resources are available to achieve the program
objectives and to include reasonable quality assurance measures that will enable continuous
improvement (Fauser, 1992). The main objectives of accreditation are ensuring the quality of
programs and future graduates, and thereby protection of the public by ensuring that all health
graduates are able to provide safe and high quality healthcare for patients. Traditional models
of accreditation are compliance-driven (see for example Medical Radiation Practice Board of
Australia [2014]) and require documentation to evidence the professional capabilities of
graduates as described by the accrediting body, followed by site visits to clarify points of

mailto:lindy.mcallister@sydney.edu.au
mailto:srivalli.nagarajan@sydney.edu.au

uncertainty, collect additional evidence and triangulate data (evidence) from multiple sources
such as academics, students, clinical supervisors and employers. Other models (see for
example Australian Skills and Quality Authority course accreditation models [ASQA, 2013])
use a university-based internal systemic approach to quality assurance and continuous
improvement. In the past, accreditation often focused on educational inputs and resources, but
in recent times there has been a shift in this focus with an increased emphasis being placed
on student learning outcomes and attainment of competencies (Wergin, 2005; Speech
Pathology Australia, 2011). This shift in emphasis is linked to changes such as enhanced
curricular coherence (Health Workforce Australia, 2011), more efficient preparation of the
health workforce, and enhanced public accountability for investments in health professional
education (AHPRA, 2013; Australian Government, 2011). In addition to accreditation,
universities’ academic quality performance against the Higher Education Standards
Framework is also scrutinised by the Tertiary Education Quality and Standards Agency
(TEQSA) (TEQSA, 2014).

In Australia, AH pre-entry programs are developed by universities, based on professional
standards, competency statements, registration and accreditation requirements, as well as
university requirements and statements of graduate attributes. Programs are then accredited
by the relevant accrediting board or council of the Australian Health Practitioner Regulation
Agency (AHPRA) for registered professions (e.g. Australian Physiotherapy Council) or
professional associations for non-registered professions (e.g. Speech Pathology Australia)
against their professional standards, competencies and accreditation requirements to ensure
that all university programs meet the minimum standards and develop entry-level graduates
ready for professional practice. Accreditation standards developed by accrediting authorities
identify the essential knowledge, skills and attributes required for competent entry-level
practice in a specific profession. Accreditation standards may take an international perspective
to their accreditation standards (for example the World Federation for Occupational Therapists
(WFOT) (2002)) or give importance to local contexts of practice (for example Exercise and
Sports Science Australia (ESSA, 2012) or include both local and international perspectives.
For example, WFOT have developed minimum standards for the education of occupational
therapists worldwide so that upon successful completion of occupational therapy courses all
graduates will have comparable levels of skill, knowledge and ways of working. These
standards are used by the Occupational Therapy Board of Australia and particularized to the
national contexts for accreditation of occupational therapy programs in Australia.

A focus on both current and future workforce and patient needs should be at the core of any
accreditation. Consideration must be given to work readiness of graduates and their capacity
to work within complex systems with complex patients needing interprofessional (IP) care, and
deliver healthcare in both the community and hospitals (Health Workforce Australia, 2010a). A
shift from current perceptions about what a particular discipline does now to what they might
need to do in the future must occur. In preparing graduates, consideration must also be given
to new educational approaches which support the attainment of competence and quality while
ensuring the safety of graduates; for example, using simulation, role-emerging placements and
service learning, IP learning and IP supervision. However, in some cases these are not
allowed or are implicitly discouraged as part of clinical education deemed appropriate by
accreditation bodies (for example, see Table 2 ESSA requirements for clinical supervision of
exercise physiology students).

Given the changing needs for work ready graduates to be able to deliver healthcare in diverse
settings, and the availability of new educational approaches to preparing health graduates, the
purposes of this paper are to: a) review the accreditation requirements of AH professions
(particularly in relation to clinical education); b) consider whether these requirements support
the adoption of new educational technologies and approaches and c) investigate whether
accreditation requirements are aligned with workplace requirements for work ready health

graduates. Although accreditation documents increasingly reference professional standards
and competency documents, but these are often not explicitly included in accreditation
documentation. The focus of this paper is on accreditation documentation.

Method

A document analysis of current accreditation requirements for six AH professions in Australia
was conducted with a view to comparing the accreditation requirements across different AH
professions, particularly in relation to clinical/fieldwork education components of the programs.
While individual profession’s competency statements were not analysed, they were embedded
in the accreditation requirements of some professions. The AH professions included were:
Occupational Therapy (OT), Physiotherapy (PT), Speech Pathology (SP), Exercise Physiology
(EP), Medical Radiation Sciences (MRS) and Rehabilitation Counselling (RC). Table 1 lists the
accreditation documents that were analysed.

Table 1: List of Allied Health Accreditation Documents used for Analysis

Profession Document title Date/Authors/ Websites

OT Occupational Therapy Australia. (2011). Self-study
manual (revised) for accreditation of entry-level
occupational therapy education programs. (2nd
ed.). Fitzroy.
Occupational Therapy Australia. (2013, January).
Guidelines for Accreditation of Entry-Level
Occupational Therapy Programs. Fitzroy.

2013. Occupational Therapy
Australia.

http://www.otaus.com.au/about
/entry-level-program-
accreditation/accreditation-of-
entry-level-education-programs

SP Accreditation is based on two documents:
1. Speech Pathology Australia (2014).
Accreditation of Speech Pathology Degree
Programs. Melbourne, Australia: Speech Pathology
Association of Australia (SPA).

Accreditation of Speech
Pathology Degree Programs
(document available on request
to SPA)

http://www.speechpathologyau
stralia.org.au/professional-
standards-ps/university-
accreditation

EP Exercise and Sports Science Australia (ESSA)
(2012). National University Course Accreditation
Program: Policies, procedures and application form
for academic units applying for accreditation of a
course with Exercise & Sports Science Australia.

Exercise and Sports Science
Australia (ESSA) (2012).

http://www.essa.org.au/for-
universities/page1369-2/

PT Australian Physiotherapy Board: Accreditation of
entry level Physiotherapy programs – A manual for
Universities Australian Physiotherapy Council
(2006).

http://www.physiocouncil.com.a
u/accreditation

RC Rehabilitation Counselling Association of
Australasia (RCAA) Accreditation Manual for
Rehabilitation Counselling Education Programs
2012.

RCAA (document made
available via email to the
authors upon request)

MRS includes

Diagnostic
Radiography
(DR).

Medical Radiation Practice Board of Australia
(2013). Accreditation Standards: Medical radiation
practice December 2013.
Medical Radiation Practice Board of Australia
(2014). Medical radiation practice accreditation
guidance material March 2014.

http://www.medicalradiationpra
cticeboard.gov.au/Accreditation
.aspx

http://www.otaus.com.au/about/entry-level-program-accreditation/accreditation-of-entry-level-education-programs
http://www.otaus.com.au/about/entry-level-program-accreditation/accreditation-of-entry-level-education-programs
http://www.otaus.com.au/about/entry-level-program-accreditation/accreditation-of-entry-level-education-programs
http://www.otaus.com.au/about/entry-level-program-accreditation/accreditation-of-entry-level-education-programs
http://www.speechpathologyaustralia.org.au/professional-standards-ps/university-accreditation
http://www.speechpathologyaustralia.org.au/professional-standards-ps/university-accreditation
http://www.speechpathologyaustralia.org.au/professional-standards-ps/university-accreditation
http://www.speechpathologyaustralia.org.au/professional-standards-ps/university-accreditation
http://www.essa.org.au/for-universities/page1369-2/
http://www.essa.org.au/for-universities/page1369-2/
http://www.physiocouncil.com.au/accreditation
http://www.physiocouncil.com.au/accreditation
http://www.medicalradiationpracticeboard.gov.au/Accreditation.aspx
http://www.medicalradiationpracticeboard.gov.au/Accreditation.aspx
http://www.medicalradiationpracticeboard.gov.au/Accreditation.aspx

Comparison analysis

Table 2 summarises a comparison for each discipline of accreditation requirements for
program length, the minimum number of hours of clinical practice required of students,
categories in which experience should be obtained, supervisory requirements, prescribed
general/fieldwork teaching modes and educational methods, assessment tools used,
supervisor to student ratios for placements, and any other requirements related to placements.

Duration of Programs

AH programs range from three to four years duration for undergraduate and one to two years
for graduate entry masters programs. Some AH programs (e.g. SP, PT, OT and EP) are
delivered as four-year undergraduate or two-year graduate entry masters programs. Others
(e.g. RC) have a minimum of three years for undergraduate programs and a minimum of one
year full time for postgraduate programs. DR requires a minimum of three years for
undergraduate and two or two and a half years for graduate entry master programs.

Hours of clinical practice

Some AH professions specified the minimum number of hours of clinical placement with or
without any conditions while others did not prescribe minimum hours of placement or specify
any conditions. In professions such as OT, EP and RC accreditation guidelines specified the
minimum number of hours of clinical placement and any conditions were provided. For
example, 1000 hours of clinical practice are required in OT and it is also a requirement that
students spend those hours implementing an OT process or an aspect of OT process with or
for a real person. EP specified that only 50 hours out of the minimum 500 clinical hours could
be used for simulated activities; another 50 hours should involve exercise prescription and the
activities delivered by students are to be within the scope of practice of an accredited exercise
physiologist (AEP). In DR, PT and SP no specified number of hours of clinical practice was
mandated. In these programs the clinical placement hours required for students varied from
one university degree to another. For example, Health Workforce Australia (2014) shows that
the clinical education hours across the physiotherapy programs in Australia during 2012
ranged from 594 hours to 1470 hours with an overall average of hours being 1000 hours. No
specified minimum number of hours was provided for SP but students must be assessed as
competent at the point of graduation, against the competency-based occupational standards
(CBOS) (Speech Pathology Australia, 2011) for speech pathologists.

Categories in which experience should be obtained

Some AH professions specified the categories in which experience should be obtained and/or
minimum and maximum number of hours for each experience category. For example, OT, SP,
PT and EP requirements were very prescriptive. The type of prescription was however v
varied. OTs need to have clinical experience in a range of placements across the lifespan and
in rural/remote as well as metropolitan settings. SP, on the other hand, requires students to
obtain experience with both adult and paediatric caseloads in impairment categories of
language, speech, voice, fluency, swallowing and multi-modal communication for Units of
Competence 1-4 (assessment, analysis and interpretation, planning evidence-based speech
pathology practice and implementation of speech pathology practice), as well as experiences
to demonstrate competence in Units 5-7 (planning, providing and managing speech pathology
services, professional and supervisory practice and lifelong learning and reflective practice).

McAllister, L & Nagarajan, S. V. (2015). Accreditation requirements in allied health education: Strengths, weaknesses and missed opportunities. Journal of Teaching and Learning for Graduate
Employability, 6(1), 2—24 6

Discipline and
accrediting entity

Program
length

Hours
(hrs)of
clinical
practice

Categories experience
should be obtained in

Supervisory requirements Teaching modes and
educational methods for
Work Integrated Learning

Assessment
tools

Supervisor to student
ratios for placements

Occupational
Therapy

Occupational
Therapy Australia
and WFOT

4 years for
Bachelor
and 2 years
for
Graduate
Entry
Master
(GEM).

1000 hrs
minimum
(as prescribed
by
international
body WFOT)

Occupation and OT, body
structures and functions,
biomedicine, human and
social environment and
social perspectives of
health.

Must be supervised and assessed
by an OT with at least one year's
experience as an OT practitioner.
No requirement for supervisor to be
onsite.

Case studies, learning with
and from recipients of OT,
discussion, skills training,
assignments, reflective
exercises, projects, literature
review, experiential learning,
problem-based learning,
interprofessional learning,
lectures. Education practices
should address local
contexts and be informed by
international perspectives.

Assessment
tool in
Australian OT
programs:
Students
Practice
Evaluation
Form (SPEF-
Revised
Edition
Package
(SPEF-R,
2013)

Not stated.

Exercise and sports
sciences (includes
Exercise
Physiology)

Exercise and
Sports Science
Australia (ESSA)

Exercise
and Sports
Sciences :
3 years for
Bachelor.

Exercise
Physiology:
4 years for
Bachelor
and 2 years
for GEM
EP.

500 hrs
minimum

Apparently healthy (low
risk) clientele Minimum of
140 hrs in each of the
following categories:
Cardiopulmonary/
metabolic; Musculoskeletal/
Neuromuscular/
Neurological; Maximum of
80 hrs in Other clinical
health delivery.

Depends on type of placement;
Supervisor qualifications range
from qualified / degree trained in
Exercise Sciences/Physiology to
Certificate 4 in Personal Training
with ten years industry experience.

Suitable supervisors for apparently
healthy placements: An accredited
exercise physiologist (AEP); An
ESSA exercise science member
(ES) A degree qualified exercise
and sports science professional; A
personal trainer with a Certificate 4
in Fitness with a minimum of 10
years industry experience; A
degree qualified physical education
teacher; A bachelor degree
qualified/trained allied health
professional with experience in
exercise delivery (e.g.
physiotherapist); A state, national
and international level sports

Very prescriptive and
detailed (ESSA, 2012).

At least 60% of practicum
hours should be face to face
exercise delivery. Up to 35%
hours can be used for
preparation for exercise
services; up to 5% hours
can be used for
administration. For other
clinical health delivery area
there is no requirement for
apportioning hours into
these three categories.

Maximum of 50 clinical
hours (out of the 500 hours)
for simulated learning
activities conditional that 50
hours involves exercise
prescription and the
activities are within the

Not stated Clinical supervisor to
student ratios may be up
to 1:5 with the proviso that
there must be some 1:1
supervision of each
student at each
placement.

Table 2: A Comparison of AH Programs across Several Accreditation Requirements

McAllister, L & Nagarajan, S. V. (2015). Accreditation requirements in allied health education: Strengths, weaknesses and missed opportunities. Journal of Teaching and Learning for Graduate
Employability, 6(1), 2—24 7

Discipline and
accrediting entity

Program
length

Hours
(hrs)of
clinical
practice

Categories experience
should be obtained in

Supervisory requirements Teaching modes and
educational methods for
Work Integrated Learning

Assessment
tools

Supervisor to student
ratios for placements

coach; An Australian Strength and
Conditioning Association (ASCA)
level 2 or 3 coach.

Suitable supervisors for
Cardiopulmonary/metabolic
/Musculoskeletal/Neuromuscular/
Neurological placements: An
accredited exercise physiologist
(AEP); An ESSA exercise Science
member (ES); A degree qualified
exercise physiologist; A bachelor
degree qualified/trained allied
health professional with experience
in exercise delivery (e.g.
physiotherapist, cardiac care nurse,
occupational therapist, doctor,
clinical nurse consultant,
osteopath). Some (greater than 2)
clinical hours in each category
must be supervised by an AEP
(Accredited Exercise Physiologist).
Flexibility in how 140 hours is spent
(for example, 50 hours with cardiac
nurse and 90 hours with AEP)

scope of practice of AEP
(accredited exercise
physiologist criteria)

Speech Pathology

Speech Pathology
Australia

4 years for
Bachelor
and 2 years
for GEM.

Not
specified. No
minimum hrs
requirement,
focus is on
attainment of
competency
as defined
by CBOS

Prescriptive:
Range of practice (for Child
and Adult) should cover 6
core areas and 4 principles.
Core areas: 1) Language 2)
Speech 3) Swallowing 4)
Voice 5) Fluency 6) Multi-
modal communication.
Principles:
Principle 1: In all work
contexts and decision-

Qualified SP required as a
supervisor.

Range of teaching modes
used; flexible teaching
modes with no prescribed
conditions; simulation/ off-
site experiences allowed;
problem-based PBL or Case
studies encouraged.
Assessment using case-
based and other exams,
exams, case studies,
essays, project work, and

Assessment
tool:
COMPASS

Not stated.

Table 2: A Comparison of AH Programs across Several Accreditation Requirements

McAllister, L & Nagarajan, S. V. (2015). Accreditation requirements in allied health education: Strengths, weaknesses and missed opportunities. Journal of Teaching and Learning for Graduate
Employability, 6(1), 2—24 8

Discipline and
accrediting entity

Program
length

Hours
(hrs)of
clinical
practice

Categories experience
should be obtained in

Supervisory requirements Teaching modes and
educational methods for
Work Integrated Learning

Assessment
tools

Supervisor to student
ratios for placements

making, the speech
pathologist must consider
the recommended
evidence base for the
speech pathology practice.
Principle 2:Speech
pathologists at entry-level
are not required to
demonstrate full
competence in areas of
complex clinical practice.
Principle 3: There are a
number of designated
areas within the range of
practice of speech
pathology that are
acknowledged as
advanced practice and
require further training
and/or workplace
credentialing in order for
the speech pathologist to
provide them. Principle 4:
Interprofessional practice is
a critical component of
competence for an entry-
level speech pathologist.

direct observation of work
with patients.

Physiotherapy

The Australian
Physiotherapy
Council

4 years for
Bachelor
and 2 years
for GEM.

No minimum
hrs
requirement
(used to be
850 hrs

Prescriptive:
3 core areas
musculoskeletal PT,
neurological PT, cardio
respiratory PT and a range
of settings and across the
life span. Further details in
Australian Physiotherapy
Council (2006).

Experienced clinical supervisors
/clinical supervision required. Not
necessary for a qualified PT to
supervise a PT student.

No prescribed modes. A
variety of assessment
modes is desirable including
practical tests, objective
structures clinical
examination (OSCE),
simulated skills and patients,
role play/ performance,
direct observation of work

Assessment
tool:
Assessment of
Physiotherapy
Practice (APP)
(Dalton et al.,
2009)

Not stated.

Table 2: A Comparison of AH Programs across Several Accreditation Requirements

McAllister, L & Nagarajan, S. V. (2015). Accreditation requirements in allied health education: Strengths, weaknesses and missed opportunities. Journal of Teaching and Learning for Graduate
Employability, 6(1), 2—24 9

Discipline and
accrediting entity

Program
length

Hours
(hrs)of
clinical
practice

Categories experience
should be obtained in

Supervisory requirements Teaching modes and
educational methods for
Work Integrated Learning

Assessment
tools

Supervisor to student
ratios for placements

with patients.

Medical Radiation
Sciences
Diagnostic
Radiography

Medical Radiation
Practice Board of
Australia (MRPBA)

For
Diagnostic
Radiograph
y 3 + 1 year
of
supervised
practice or 4
years for
Bachelor

2 +1 year of
supervised
practice or
2.5 years for
GEM

Not specified Not prescribed - General
guidelines provided in
MRPBA’S accreditation
document for DR
programs

Not stated.

Supervisors must hold a general
registration with MRPBA and have
radiation license (for example, in
NSW radiation license with NSW
EPA) to supervise students on
placements due to the nature of
radiation (risks) and that such
supervisors are onsite.

Also see Note 2.

Not prescribed. If
professional practice
placement undertaken is at
an international clinical site it
should be equivalent (not
defined) to those conducted
in Australia.

Not stated for
Diagnostic
Radiography

Not stated.

Rehabilitation
Counselling

The Rehabilitation
Counselling
Association of
Australasia (RCAA)

Min 3yrs full
time
Bachelor or
minimum 1
yr full time
GEM.

200 hrs
minimum

Should include minimum of
80 hrs in direct service
provision and direct client
contact as appropriate for
the program.
Student to receive
minimum one hour of
individual supervision each
week of their placement.

Not stated. General practice is that
the supervisor should be a qualified
Rehabilitation Counsellor.

Not detailed. Encourages
use of a variety of
approaches.

Not stated Not stated. General
practice is supervisor
should be qualified and be
available for direct
supervision at least ONE
hour per week of field
placement.

Table 2: A Comparison of AH Programs across Several Accreditation Requirements

PT also specifies core categories/caseload types (musculoskeletal, cardiopulmonary,
neurological) with a requirement that students should gain experience across the lifespan.
Like SP, the number of hours for each category was not specified. EP specified the
categories of healthy placements, cardiopulmonary/metabolic, musculoskeletal,
neuromuscular and neurological as well as the minimum and maximum number of hours
against each category. No such prescriptive requirements for DR and RC are stated. Table 3
provides a detailed comparison of non-direct client care learning activities that are explicitly
allowed as part of accreditation requirements.

Table 3: A Comparison of Non-direct Client Care Learning Activities Allowed
by Six Professions

Profession Minimum
hours for
placements

Minimum
hours of
face to
face
contact
with
client

Services
delivered
with or for a
real client
(eg, report
writing,
resource
development)

Simulation Educating others
(example, health
promotion,
carer/parent/
teacher/ other
professional
training)

IP
learning
or
practice

Y = Yes; N = No; NS = Prescription within minimum hours not stated

OT Y Y; Hours
NS

Y Y Y Y

EP Y Y; Hours
prescribed

Y Y Y N

SP N Y; Hours
NS

Y Y Y Y

MRS N Y; Hours
NS

Y Y NS NS

PT N Y; Hours
NS

Y NS NS NS

RC Y Y; Hours
NS

Y NS NS NS

Supervisor requirements

Requirements for supervisors varied across different AH professions in terms of supervisor
qualifications, number of years of experience, location of supervisor, and/or supervisor type
allowed for placement type. For example, EP had different supervisory requirements for
different categories of clinical and non-clinical practice. Supervisors for ‘healthy placements’,
focussed on providing clients with strength and conditioning training (e.g. at Australian
Institute of Sports or elite sports clubs) have a set of skills different from those supervisors in
clinical placements where patients are involved. Healthy placement supervisors may be: an
accredited exercise physiologist (AEP); an ESSA exercise science member; a degree
qualified exercise and sports science professional; a personal trainer with a Certificate 4 in
Fitness with a minimum of 10 years industry experience; a degree qualified physical
education teacher; a bachelor degree qualified/trained allied health professional with
experience in exercise delivery (e.g. physiotherapist); a state, national or international level
sports coach; an Australian Strength and Conditioning Association (ASCA) level 2 or 3
coach. The qualification requirements for AH clinical supervisors ranged from university
degree trained (for example OT, PT and SP) to a Certificate IV level (EP allowed supervisors
with Certificate IV in Personal Training and ten years’ experience for healthy

placements).The number of years of clinical experience required before people could
supervise students ranged from one year (e.g. OT) to ten years of experience (EP, for
healthy placement types) and others such as PT just specified ‘experienced supervisor’
without stating the number of years of experience. DR did not state any specific supervisor
qualification requirements. Requirements for an onsite supervisor were stated for some AH
professions but not others. OT criteria explicitly state that there is no requirement for the
fieldwork supervisor to be onsite. No reference is made to a requirement that fieldwork
supervisors have to be onsite in SP, EP, DR, RC and PT. Supervision of a student by
another AH professional was allowed in some AH professions (e.g. SP) if it was a generic or
an interprofessional education (IPE) placement. In role emerging placements in OT it is
acceptable to have a non-OT health professional work with a student onsite, with a
university-based OT educator to provide distance student supervision. EP allowed
supervisors from other AH professions for a selected component of the fieldwork but
required an accredited AEP to supervise some hours for each category of experience.

Clinical supervisor to student ratios

Requirements for clinical supervisor to student ratios are specified for some AH professions.
For example, EP criteria state that the clinical supervisor to student ratio may be up to 1:5
with the condition that there must be some 1:1 supervision of each student at each
placement. Other professions do not state a ratio.

Teaching methodologies and modes of educational delivery

Consideration in accreditation documents of teaching methodologies (case studies, problem
based learning, simulation etc.) and educational modes (face to face or via internet) ranges
from being minimal (e.g. DR allowed for flexible teaching modes with no prescribed
conditions) to detailed and prescribed requirements (e.g. EP stated that at least 60 per cent
of practicum hours should be face to face exercise delivery). Some accreditation documents
encourage a flexible approach to the use of teaching and learning modes; for example, OT
and SP encourage use of a variety of teaching methods such as case studies, projects,
interprofessional learning activities to build competence. Others prescribe the maximum
number of hours allowed using certain education modes. For example, EP criteria prescribe
that a maximum of 50 hours out of the required 500 clinical hours is allowed for simulated
learning activities. Although there is increased acceptance that some learning activities could
be simulated (Hill, 2012), support for inclusion of simulation is not yet explicitly stated in
some accreditation documents (e.g. PT).

Assessment methods and modes

References to a range of assessment methods and modes are seen in the accreditation
documents. For example, PT encourages use of a variety of assessment modes including
practical tests, objective structured clinical examination (OSCE), simulated skills and
patients and role play/ performance. PT, SP and OT use validated and reliable, standardised
assessments, based on direct observation of student clinical performance: the APP
(Assessment of Physiotherapy Practice) (Dalton, Keating & Davidson, 2009), COMPASS
(Competency Assessment in Speech Pathology - Revised 2011) (McAllister, Lincoln,
Ferguson & McAllister, 2011) and the SPEF-R (Students Practice Evaluation Form) (SPEF-
R, 2013) respectively. These assessment tools are used in each program in Australia.
Standardised assessment tools are in development for DR (Kilgour, 2011) and EP. Other AH
professions (e.g. RC) do not yet have standardized or national assessments.

Strengths of AH accreditation standards

There is acknowledgment in AH that both academic and practice settings are important and
each have a role in student learning. There is clear recognition that learning occurs both

inside and outside university. Competency standards detailed in the accreditation documents
capture the conceptual knowledge that all AH graduates in a discipline are expected to
know. They also capture the requirements for procedural knowledge and skills development
such as the ability to adhere to occupation-specific procedures in a health practice setting.
Universities use professional competencies and accreditation standards to develop learning
goals and demonstrate that such goals are mapped to their AH curriculum requirements and
used to guide assessment of student learning outcomes. There is also increased emphasis
in some professions on problem-solving skills leading to shifts towards problem-based
education (e.g. Occupational Therapy Australia (2011)) and reflective practice (e.g. Speech
Pathology Australia (2011) CBOS Unit 7 on lifelong learning and reflective practice).

Accreditation standards and processes provide a means for achieving minimum standards
across universities offering AH programs. If the standards are clear in terms of the outcomes
that are desired in graduates then they should be useful for programs to frame up their
curriculum and demonstrate how they develop the competencies and the outcomes that are
required. Accreditation also requires universities to define, collect, analyse and provide
evidence of student learning and achievement thus giving student learning outcomes a
central focus in quality assurance (Wergin, 2005). Engagement with accreditation processes
allows universities to evidence student learning and achievement. Some AH standards also
take into account the international minimum standards for education programs (e.g. OT) thus
ensuring that Australian competency standards for AH professionals are comparable to
international standards for AH professionals, and that graduates will be recognised
internationally.

In AH professions where minimum professional standards do not exist, accreditation
standards serve as the minimum standards for that profession. They can be used to define
the standards of performance that a) the public can expect when they use an AH service or
interact with an AH professional or b) health employers and workplaces can expect when
they recruit an AH professional. AH graduates from accredited university programs are able
to register with their profession’s Registration Board (or professional association for
unregistered professions) because they can demonstrate achievement of core competencies
consistent with entry level requirements for AH professionals.

Weaknesses and missed opportunities in AH accreditation standards

There are several areas of weaknesses and missed opportunities in AH accreditation
standards. This discussion is presented under two headings: the first relates to work
readiness of AH graduates and the second relates to constraints in the adoption of new
educational approaches available to universities.

Work readiness of AH graduates

AH accreditation requirements aim to ensure that all AH university programs meet the
minimum standards and develop entry-level graduates who are well prepared for work.
However, employers suggest that new health graduates are not work-ready (Garling, 2008;
NSW Ministry of Health, 2011). Skill deficiencies cited by employers include a lack of
communication skills, interpersonal skills, problem solving abilities, and understanding of
business practice (Walker, Young, Pang, Fullarton, Costa & Dunning, 2013). Employer
comments as reported by Walker et al., (2013, p.118-119) include: 1) They might be brilliant,
academic, clinical people but if you can't communicate then it's a bit of a waste of time; 2)
She works in a team but I think she doesn't get that a team works with each other; 3) If
they're not understanding what's policy and procedure, then what else are they missing?; 4)
It is the hierarchical areas that really get the grads kind of worried so they feel like they can't
go to anybody because they're on the bottom of the pack. These views have serious
implications for accreditation, university preparation, workplace supervision and support
(Health Workforce Australia, 2010a), capacity to meet the demand for collaborative models

of healthcare (National Health and Hospitals Reform Commission, 2009), and health
professionals’ workforce satisfaction, performance and retention (Walker et al., 2013).

It may be that some AH accreditation requirements are out of step with current workplace
requirements for new AH graduates and are grounded in old approaches to education (e.g.
placement in hospitals when healthcare is moving to primary healthcare and community-
based care). There appear to be mismatches in employer, university and professional
expectations about preparedness of new AH graduates for practice. For example, health
employers expect new graduates to have active learning skills, to proactively seek and
manage learning opportunities in the workplace. However, this agentic learning style (Billett,
2009) cannot be fostered in overly prescriptive placement learning environments. Past
studies have identified stressful transitions, negative workplace experiences and inability to
cope with workplace challenges for new health graduates (Kelly & Ahern, 2009; Newton &
McKenna, 2007; Walker et al., 2012; Deary, Watson & Hogston, 2003). Increased dialogue
between employers, universities and accrediting bodies may reduce mismatches in
expectations. It is suggested that there is a shared responsibility amongst accreditation
bodies, employers and universities to ensure that graduates are able to cope with such
challenges when they enter the workforce and a means to achieve that is through flexibility
to prepare students to be active learners.

It is our recommendation that all AH accreditation panels include employers on their teams.
There is some employer representation on university-based degree external advisory
committees (comprised of academics, employers, clinicians, student representatives and
perhaps also service users) that develop and monitor curriculum. While academics’
perspectives are important for the development of accreditation standards, inclusion of
employers and service users may add value by increasing the understanding of the
contemporary practice needs and employer work readiness expectations of new AH
graduates.

Preparing AH graduates for future practice needs

There is a shift in progress in healthcare services from hospital-based settings to
community-based settings with increasing awareness of the need to address chronic
diseases (WHO, 2008) and manage chronic conditions (Rodger, Webb, Devitt, Gilbert,
Wrightson & McMeeken, 2008). An increase in Australia’s ageing population combined with
lifestyle factors such as smoking, increased levels of alcohol intake and sedentary
behaviours and occupations are likely to increase the prevalence of chronic conditions such
as diabetes, cardiovascular disease and musculoskeletal conditions resulting in an
unprecedented demand on our chronic care services. NSW Treasury papers provide
estimates that by 2020 chronic disease is expected to account for over 80 per cent of the
total burden of disease in Australia (NSW Government, 2008). Such forecasts have
implications for workforce preparation.

Our analysis of the accreditation documents shows that required educational goals and
clinical placement types do not reflect this increasing focus on chronic disease and primary
healthcare. During the consultation processes for the development of HWA’s national
strategic frameworks, healthcare providers indicated that health professional education is not
keeping pace with the changing models and place of care (National Health Workforce
Taskforce, 2009). Currently much of the focus of health professional preparation is on acute
care, hospital-based settings and in-patients. Some of this focus is driven by accreditation
requirements; some of it is driven by practitioner beliefs about the types of clinical
placements that students require to meet accreditation requirements. For example, in
seeking to expand the range of available clinical placement sites, some university
physiotherapy programs (Blackford, McAllister & Alison, personal communication 2013) have
met resistance from physiotherapists in aged care sites who insist that some placement
types for example, rehabilitation can only be obtained in hospitals even though appropriate

patients live in aged care facilities and are in need of services. While this is probably not the
intent of accreditation documents, requirements are variably interpreted by different
stakeholder groups. We suggest that accreditation bodies consider making it explicit in
accreditation documents that experience in chronic care is required, and that categories of
clinical experience they require students to obtain (e.g. musculo-skeletal, cardio-pulmonary
for PT) can be met through placements in diverse settings, not just from hospitals, and in
collaboration with professional associations and universities, develop strategies to educate
stakeholders about options and flexibility in meeting requirements, . This will provide clarity
for university placement coordinators and for external clinical supervisors and facility staff.

The Australian Government’s health priorities (NHMRC, 2013) acknowledge that ageing,
chronic disease, and mental health are major challenges for the healthcare systems in
Australia. To effectively deliver care for chronic diseases and conditions and primary
adoption of a bio-psychosocial model of healthcare, such as that embodied in International
Classification of Functioning, Disability and Health Framework (ICF) (WHO, 2013), which
provides a holistic view of health based on biological, individual and social perspectives. A
bio-psychosocial perspective on health and wellbeing, contrasts with the medical model
which focuses on illness (NHMRC, 2013; WHO, 2013). These two differing models are
variously reflected in curricula and accreditation standards in the AH professions. DR and
PT, for example, predominantly reflect medical models and/or science perspectives of
healthcare, in contrast to professions such as OT, SP, and RC which include a social
perspective of healthcare. The technical requirements for the AH professions are well
addressed in accreditation criteria but some AH professions appear not to emphasise the
development of AH student knowledge and skills that address social dimensions of health.
For example, Tinning, Jenkins, Collins, Rossi and Brancato (2012) argue that Exercise
Science has suffered from its science-focussed approach to curriculum development which
has led to insufficient engagement with issues that foster development of students’
understanding of social aspects of health and factors leading to chronic conditions. It is
important that all AH curriculum and standards take into account a holistic view of health
based on biological, individual and social perspectives. Such an approach is necessary to
ensure adequate preparation of health graduates to the meet both the current and future
healthcare needs (Australian Government, 2011a).

Development of interprofessional practice skills

All health graduates are required to work in interprofessional teams. One of the key action
objectives of the Health Workforce Innovation and Reform Strategic Framework for Action
2011-2015 (HWA, 2011) is to develop an adaptable health workforce that can support team
based and collaborative models of care. Several authors have discussed the need for
graduates to engage in interprofessional learning (Humphries & Hean, 2004) and
collaborative practice, particularly given the changing nature of healthcare (Rodger et al.,
2008). Yet there is no direct requirement in some AH professions’ accreditation criteria
regarding development of such skills. Supervisors from different professions bring different
perspectives and capacities to develop students’ knowledge, reasoning and generic skills
development during clinical education. A requirement for profession specific supervision to a
student may restrict opportunities for enhanced student learning and generic and IP skills
development. These issues are discussed in detail in the next section on prescriptiveness.
As evident in Table 2, some AH accreditation documents are silent about pedagogically
sound models of education and do not explicitly encourage models of placement that will
support the type of learning needed for graduates’ workplaces using learning within teams,
peer learning and learning through feedback and reflection.

Adoption of new educational approaches

Prescriptiveness

A range of new educational approaches is now available to universities that can enhance
student learning and alleviate some of the pressure experienced with placement shortages
(Health Workforce Australia, 2013). However, prescriptiveness in some accreditation
requirements impedes the adoption of these approaches as well as innovation in
placements. While it is acknowledged that students need experience with a diversity of
placement and patient types, being overly prescriptive about the type and location of
placement limits opportunities to tap the potential of placements in non-traditional sites,
service learning and role emerging placements, all of which are highly relevant to the
preparation of graduates for primary healthcare and chronic disease management (Thomas,
Penman & Williamson, 2005). In addition, overly prescriptive placement requirements can
lead to an increase in demand for specific types of learning experiences during placements
that students must undertake prior to graduation. Rodger et al. (2008) also warn that if
access to a prescribed area in which experience must be gained becomes problematic (for
example, insufficient hospital based placements for rehabilitation clients) this makes it
difficult for students to complete prescriptive placement requirements and graduate.
Prescriptiveness about placement and patient types denies what we know about the
generalisability and transferability of knowledge and skills. For example, Sheepway, Lincoln
and McAllister (2014) studied the development of student competence in speech language
pathology degree students and found that their competencies developed over a one year
period of clinical placements irrespective of placement type or context or intensity of
placement (daily versus block mode) thus indicating that there was a possible transfer of
learning occurring between placement types.

Prescriptiveness regarding number of hours for placement types is also problematic for
several reasons. First, it assumes that upon completion of the required number of hours
students will have gained the required competencies and ignores the generalisability and
transferability of knowledge and skills that can occur between placements. Second, it shifts
emphasis from the quality of the placement experiences, supervision and clinical
performance assessment, to quantity and the completion of required, but sometimes
arbitrary number of, possibly low quality, hours. Wimmers, Schmidt and Splinter (2006)
studied the professional performance of medical students across 14 hospital placement sites
and concluded that the volume of experience was found to be less important for students’
clinical competence development in comparison with repetition of experiences and quality of
supervision provided during placement experiences. Holmes, Bossers, Polatajko, Drynan,
Gallagher, O’Sullivan and Denney (2010) studied the competency development in Canadian
OT students who undertook placements during their studies to determine if the evidence
supports the 1000 hours of placement prescribed by WFOT. They found that student
competencies increased with each placement and that entry-level status is achieved by the
majority of students in most of the competencies. However, their studies found that student
competencies in areas such as clinical reasoning, practice knowledge and facilitating change
were not achieved at 1000 hours. The focus for accreditation should be more clearly on
outputs (learning outcomes and competencies) rather than on inputs (specific placement
types and experiences with patients). This would open up not only more diverse types of
placements, but also recognise the contributions of other learning experiences which build
knowledge and skills needed for practice. A shift away from prescriptiveness regarding
patient types, placement locations, and requirements of hours for specific placement types
also provides the flexibility required for consideration of new and innovative models of
supervision.

Accreditation requirements that prescribe the levels of experience of clinical supervisors
(number of years of industry experience) and/or mandate only same-profession supervision
may limit utilisation of interprofessional placement opportunities, access to supervision

expertise outside of specific professions and does not support utilisation of peer learning
opportunities that interprofessional placements can provide. These limitations have
implications for achievement of rich student learning outcomes particularly in relation to the
development of students’ knowledge and understanding of perspectives of other health
professions, communication and interprofessional team work skills. An evidence-based
approach to supervision requirements that considers the requisite skills for supervision,
which may not equate to years of clinical experience or same-profession supervision only,
and which encourages opportunities for students to develop capacity to learn with and from
peers, reflection and clinical reasoning skills, is essential to ensure achievement of student
learning outcomes and good quality supervision. Prescriptions for face-to-face supervision
modes and hours restrict the use of modern technologies and underestimate the powerful
learning experiences such technologies can support. Generation Y learns in different ways
to past generations of learners and hence new modes of teaching that are suited for this
generation of learners is key to achieving student engagement and interest (Penman,
Donnelly & Drynan, 2010; Jones, McKenzie & Wong, 2010).

Simulation

In real clinical settings clinicians must prioritise a patient-centred approach over learner-
centred. Simulation enables a priority focus on student learning needs without compromising
patient-safety or workplace productivity (Maran & Glavin, 2003). Health Workforce Australia
(2010b) states that Simulated Learning Environments (SLE) provide a flexible alternative to
traditional placement models, expand clinical placement capacity and have a positive impact
on student learning during clinical supervision. They report widespread willingness amongst
university education providers to consider SLEs for aspects of their programs of study.
Repetition of simulation experiences until demonstration of mastery and use of contrasting
cases can improve learning outcomes (Cook, Erwin & Triola, 2010). A recent US study
conducted by the National Council of State Boards for Nursing (NCSBN, 2014) investigated
the effectiveness of simulation as an alternative to traditional clinical placement program in a
final year nursing program. Approximately 50 per cent of clinical placement time was
replaced by a simulation based curriculum. The study found that simulation programs were
just as effective as traditional clinical placements programs at preparing nursing students for
professional nursing work. The evidence base for simulation in AH is growing. Watson et al.
(2012) concluded that PT students’ achievement of clinical competencies was as good in
simulated learning groups as in traditional placement groups. Hill (2012) studied the use of
standardised patients (or actors) in the clinical education of speech pathology students at an
Australian University SP program and found that standardised patients can support the
development of foundation clinical competencies in SP students. Nationwide studies in
progress for PT and in preparation for OT and SP will further add to the evidence base.

Blackford, McAllister and Alison (paper under review) studied the impact of replacement of
the first week of a five week physiotherapy clinical placement with a simulated learning
experience using standardised patients and found that SLE significantly increased students’
confidence to apply their professional and clinical skills. Further, simulated patients have
been shown to enhance learner experience as well as address the problem of placement
shortages (Howard, Blackmer & Markowski, 2006; Blackstock et al., 2013). Simulation has a
role to play in clinical education and should be encouraged (explicitly) in AH accreditation
documents.

Role emerging and service learning placements

Some AH professions (e.g. DR, PT) still place students primarily in occupation-specific
placement sites. Other professions such as OT encourage role-emerging placements in non-
traditional settings. Some studies in OT have shown that non-traditional placements and
role-emerging placements assist with the development of students’ reflection and clinical
reasoning skills (Overton, Clarke & Thomas, 2009; Thew, Hargreaves & Cronin-Davis,

2008). Relatively few professions use service learning placements, in which students
(typically in teams) engage in activities that address community identified needs together
with structured opportunities intentionally designed to promote student learning and
development (Jacoby & Associates, 1996). Service learning placements are valued for their
capacity to develop interprofessional and generic competencies. While service learning is
well established in North America, various barriers, including accreditation requirements
have sometimes limited its adoption in Australia. Role-emerging and service learning
placements need to be given more consideration in all AH professions both to increase
placement capacity and to address generic skills development and work readiness of
graduates.

Tele-supervision

Tele-health delivery of services to patients is well established and effective (Theodoros et
al., 2006; Russell, 2004). Tele-supervision has the potential to tap into remote placements,
utilise the supervision expertise of part-time clinical supervisors and support new supervisors
both in rural and urban placement sites. Tele-supervision is not yet widely used but with
increasing placement shortages, untapped potential placements as mentioned above,
excessive clinician workloads, and difficulty in finding willing supervisors it is essential to
develop innovative ways of using fieldwork supervision expertise. While face-to-face or direct
supervision is needed for many placement experiences due to reasons such as patient
safety, indirect or tele--supervision may still be appropriate for many placement types
providing services to low risk patients. Some recent studies have shown the benefits of
mobile technologies during clinical training (Vyas, Albright, Walker, Zachariah & Lee, 2010;
Lee, Albright, O’Leary, Terkla & Wilson, 2008) to support the education and training of the
health workforce and using such technologies to reach underserved communities. Hall
(2013) discusses the results from a PT pilot project that explored the effectiveness of video
calling using Skype in clinical education. The results showed that tele-supervision was a cost
and time effective means of communication with students during their clinical education
experiences and provided several opportunities for students to develop partnerships with
clinical education academic coordinators and for academic and clinical supervisors to
develop partnerships beyond local areas and into rural and regional areas.

Tele-supervision models can also be used to support remote supervisors and hence
increase supervisor capacity, providing a win-win for students, universities and clinical
supervisors. The evidence base is growing that tele-supervision has similar outcomes or nil
negative impact on students’ capacity to develop and demonstrate competence in
comparison with traditional models of supervision. It is timely for AH accreditation documents
to encourage tele-supervision explicitly where appropriate.

Multiple Student Placements

A missed opportunity in the AH accreditation documents is the encouragement of
supervision models that have multiple students on placements at one time. It is
acknowledged that some 1:1 supervision will still be required in high risk contexts (medically
unstable patients, dangerous situations) but in our experience of requesting placements for
thousands of students each year, some professions (and some clinicians irrespective of
profession) cling to the traditional 1:1 model in the belief that this provides the best learning
for students. There is no evidence to support this belief. There is evidence to support that
2:1 and 3:1 models in clinical supervision are as effective as the traditional 1:1 model of
supervision (Lekkas et al., 2007; Ladyshewskey, 1995). Rindflesch et al. (2009) found that
3:1 or 4:1 models also produced learning outcomes in OT and PT students which were at
least as good as 1:1 models. A comparison study of the three models of placement in OT
found that the 2:1 model offered more opportunities for peer support and enhanced quality of
the educational experiences through peer learning (Baldry Currens, 2010; Martin, Morris,

Moore, Sadlo & Crouch, 2004; Bristow & Hagler, 1997). Such approaches to supervision
also address placement shortages encountered by many AH faculties.

Summary of considerations

Based on a review and comparison of accreditation documents for six AH professions in
Australia, summarised in Tables 2 and 3, this paper has identified a number of areas for
improvement, consideration and further dialogue. Accrediting bodies, universities and health
industry stakeholders are encouraged to collaborate to ensure that accreditation
requirements are aligned with workplace requirements for work ready health graduates. In
particular, consideration needs to be given to making explicit in accreditation documents the
following:

 A holistic view of healthcare by inclusion of bio-psychosocial perspectives in all AH
programs.

 A balanced approach to the development of technical profession-specific skills, and
generic and interprofessional skills.

 Encouragement of flexible approaches to the facilitation of student learning during
placements using a combination of modes including use of modern portable
information and communication technologies (i.e., tele-supervision) that is fit for the
purpose and ensures patient and learner safety.

 Encouragement for the use of non-traditional and role emerging placements where
appropriate.

 Encouragement for the use of simulation in clinical education where appropriate.

 Flexibility in patient types and settings to meet requirements for ‘patient types’ to be
seen by students.

 Encouragement of supervision models that have multiple students on placements at
a time and multiple supervisors sharing student supervision.

 A need for employers to sit on accreditation panels to ensure workplace needs for
work ready graduates are considered.

Accreditation documentation that explicitly allowed for flexibility in achievement of work
ready graduates would enable universities to work with placement sites and clinical
supervisors to increase placement numbers, improve quality, more efficiently achieve
desired learning outcomes and meet employers’ demands for work ready graduates.

Conclusion

This paper analysed the accreditation documents for six Australian AH professions with a
view to comparing the accreditation requirements using common criteria such as number of
hours of clinical practice for students, patient types and caseload categories in which
experience should be obtained, supervisory requirements, academic hours inputs,
prescribed placement teaching modes and educational methods, and clinical supervisor staff
to student ratios. The focus was primarily on the clinical placement requirements. The
findings show that the accreditation criteria and standards perform well for the development
of students’ conceptual and procedural knowledge. However there are several areas for
improvement such as the preparation of graduates to meet current and future needs of
healthcare, a focus on biopsychosocial perspectives of health as healthcare models shift
from hospital to community-based settings, addressing the gaps in interpretation and
intentions of accreditation requirements, the development of AH students’ active learning

capabilities, the encouragement of supervision approaches that are pedagogically sound, an
increased emphasis on the development of interprofessional skills, and increased employer
representation on accreditation panels. Finally, a summary of the points for consideration by
AH accreditation bodies is provided. It is acknowledged that our discussion focused heavily
on the missed opportunities in accreditation rather than the self-evident strengths of
accreditation. Our aim in this paper was to initiate debate around how changing accreditation
requirements might enable the adoption of educational approaches that would better meet
future workforce needs.

References

ASQA (2013). Australian Skills and Quality Authority. Retrieved from
http://www.asqa.gov.au/course-accreditation/accreditation-with-asqa/accreditation-with-asqa.html

Australian Government (2011). Budget 2011-2012: Investing in Australia’s regions.
Retrieved from
http://www.budget.gov.au/20112012/content/glossy/regional/html/regional_overview_12.htm

Australian Government (2011a). Closing the gap: Prime Minister’s Report 2011. Retrieved
from
http://www.dss.gov.au/our-responsibilities/indigenous-australians/publications-articles/closing-
the-gap/closing-the-gap-prime-ministers-report-2011

AHPRA (2013). Australian Health Practitioner and Regulation Agency. Retrieved from
http://www.ahpra.gov.au

Australian Physiotherapy Council (2006). Australian standards for physiotherapy. Canberra,
Australia: Australian Physiotherapy Council.

Baldry Currens, J. (2010). Preparing for learning together in fieldwork education practice
settings. In L. McAllister, M. Paterson, J. Higgs, & C. Bithell (Eds.), Innovations in allied
health fieldwork education: A critical appraisal (pp.309-318). Rotterdam, Netherlands:
Sense Publishers.

Billett, S. (2009). Realising the educational worth of integrating work experiences in higher
education. Studies in Higher Education, 34(7), 827–843.

Blackstock, F., Watson, K., Morris, N., Jones, A., Wright, A., McMeeken, J.M., … & Jull, G.A.
(2013). Simulation can contribute a part of cardiorespiratory physiotherapy clinical
education. Two randomized trials. Simulation in Healthcare-Journal of the Society for
Simulation in Healthcare, 8(1), 32–42.

Blackford, J., McAllister, L., & Alison, J. (under review). Simulated learning in the
clinical education of novice physiotherapy students. International Journal of Practice-
based Learning in Health and Social Care.

Bristow, D. & Hagler, P, (1997). Comparison of individual physical therapists' productivity to
that of combined physical therapist-student pairs. Physiotherapy, 83(10), 16–23.

Cook, D.A., Erwin, P.J., & Triola, M.M. (2010). Computerized virtual patients in health
professions education: A systematic review and meta-analysis. Academic Medicine, 85
(10), 1589–1602.

Dalton M., Keating, J., & Davidson M. (2009). Development of the assessment of
physiotherapy practice (APP): A standardised and valid approach to assessment of
clinical competence in physiotherapy: Final report. Canberra: Australian Learning and
Teaching Council (ALTC), pp. 6–28. Retrieved from
http://www.olt.gov.au/resource-development-clinical-assessment-griffith-2009

Deary I. J., Watson, R., & Hogston, R. (2003). A longitudinal cohort study of burnout and
attrition in nursing students. Journal of Advanced Nursing, 43, 71–81.

Dodd, A. (2004). Accreditation as a catalyst for institutional effectiveness. New Directions
for Institutional Research, 123, 13–25.

ESSA (2012). National university course accreditation program: Policies, procedures and
application form for academic units applying for accreditation of a course with Exercise
& Sports Science Australia. Retrieved from http://www.essa.org.au/for-
universities/page1369-2/

Fauser, J. J. (1992) Accreditation of allied health education: Assessing for educational

http://www.asqa.gov.au/course-accreditation/accreditation-with-asqa/accreditation-with-asqa.html
http://www.budget.gov.au/20112012/content/glossy/regional/html/regional_overview_12.htm
http://www.dss.gov.au/our-responsibilities/indigenous-australians/publications-articles/closing-the-gap/closing-the-gap-prime-ministers-report-2011
http://www.dss.gov.au/our-responsibilities/indigenous-australians/publications-articles/closing-the-gap/closing-the-gap-prime-ministers-report-2011
http://www.ahpra.gov.au/
http://www.ncbi.nlm.nih.gov/pubmed?term=Blackstock%20FC%5BAuthor%5D&cauthor=true&cauthor_uid=23250189
http://www.ncbi.nlm.nih.gov/pubmed?term=Watson%20KM%5BAuthor%5D&cauthor=true&cauthor_uid=23250189
http://www.ncbi.nlm.nih.gov/pubmed?term=Morris%20NR%5BAuthor%5D&cauthor=true&cauthor_uid=23250189
http://www.ncbi.nlm.nih.gov/pubmed?term=Jones%20A%5BAuthor%5D&cauthor=true&cauthor_uid=23250189
http://www.ncbi.nlm.nih.gov/pubmed?term=Wright%20A%5BAuthor%5D&cauthor=true&cauthor_uid=23250189
http://www.ncbi.nlm.nih.gov/pubmed?term=McMeeken%20JM%5BAuthor%5D&cauthor=true&cauthor_uid=23250189
http://www.ncbi.nlm.nih.gov/pubmed?term=Jull%20GA%5BAuthor%5D&cauthor=true&cauthor_uid=23250189
http://www.olt.gov.au/resource-development-clinical-assessment-griffith-2009
http://www.essa.org.au/for-universities/page1369-2/
http://www.essa.org.au/for-universities/page1369-2/

effectiveness. JAMA, 268(9), 1123–1126.

Garling, P. (2008). Final report of the special commission of inquiry: Acute care services in
NSW public hospitals, 2008 – Overview. State of NSW through the Special
Commission of Inquiry: Acute Care Services in New South Wales Public Hospitals.

Hall, C. A. (2013). What’s all the ‘Hype’ about Skype? The effectiveness of video calling in
clinical education. Journal of Physical Therapy Education, 27(1), 77–93.

Health Workforce Australia. (2010a). National health workforce planning and research
collaboration 2010: Workload measures for AH professionals: Final Report. Adelaide,
Health Workforce Australia.

Health Workforce Australia (2010b). Use of simulated learning environments in professional
entry level curricula of selected professions in Australia, December 2010.

Health Workforce Australia (2011). Information, analysis and planning. Retrieved from
http://www.hwa.gov.au/work-programs/information-analysis-and-planning

Health Workforce Australia (2013). Clinical training reform. Retrieved from
https://www.hwa.gov.au/work-programs/clinical-training-reform

Health Workforce Australia (2014). Clinical training profile: Physiotherapy. Retrieved from
http://www.hwa.gov.au/sites/default/files/HWA_Clinical%20Training%20Profile_Physiotherapy_L
R.pdf

Hill, A. (2012). The use of standardised patients in the clinical education of speech pathology
students. PhD Thesis. The University of Queensland, Brisbane. Retrieved from
http://espace.library.uq.edu.au/view/UQ:284212

Holmes, J. D., Bossers, A. M., Polatajko, H. J., Drynan, D. P., Gallagher, M.B., O’Sullivan, C.
M., & Denney, J. L. (2010). 1000 fieldwork hours: Analysis of multisite evidence.
Canadian Journal of Occupational Therapy, 77, 135–143. doi: 10.2182/cjot.2010.77.3.2

Haywood, L. M., Blackmer, B., & Markowski, A. (2006). Standardised patients and
communities of practice: A realistic strategy for integrating the core values in a physical
therapist education program. Journal of Physical Therapy Education, 20(2), 29–37.

Humphries, D. & Hean, S. (2004). Educating the future workforce: Building the evidence
about interprofessional learning. Journal of Health Services Research Policy, 9 (1), 24–
27.

Jacoby, B. & Associates (1996). Service-learning in higher education: Concepts and
practices. San Francisco: Jossey-Bass.

Jones, L. E., McKenzie, M., & Wong, M. S. (2010). The use of videoconference technology:
Creating innovative and interactive fieldwork education experiences. In L. McAllister, M.
Paterson, J. Higgs, & C. Bithell (Eds.), Innovations in allied health fieldwork education:
A critical appraisal (pp.167-178). Rotterdam, Netherlands: Sense Publishers.

Kelly, J. & Ahern, K. (2009) Preparing nurses for practice: A phenomenological study of the
new graduate in Australia. Journal of Clinical Nursing, 18, 910–918.

Kilgour, A. (2011). Assessment of competency in radiography students - a new approach.
Radiographer: The Official Journal of the Australian Institute of Radiography, 58(3), 32–
37.

Ladyshewskey, R. (1995). Enhancing service productivity in acute care inpatient settings
using collaborative clinical education model. Physical Therapy, 75 (6), 53–63.

Lee, M.Y., Albright, S.A., O’Leary, L., Terkla, D. G., & Wilson, N. (2008). Expanding the
reach of health sciences education and empowering others: The OpenCourseWare
initiative at Tufts University. Medical Teacher, 30(2), 159–163.

http://www.hwa.gov.au/work-programs/information-analysis-and-planning
https://www.hwa.gov.au/work-programs/clinical-training-reform
http://www.hwa.gov.au/sites/default/files/HWA_Clinical%20Training%20Profile_Physiotherapy_LR.pdf
http://www.hwa.gov.au/sites/default/files/HWA_Clinical%20Training%20Profile_Physiotherapy_LR.pdf
http://espace.library.uq.edu.au/view/UQ:284212

Lekkas, P., Larsen, T., Kumar, S., Grimmer, K., Nyland, L., Chipcase, L., …& Finch, J.
(2007). No model of clinical education for physiotherapy students is superior to another:
A systematic review. Australian Journal of Physiotherapy, 53, 19–28.

Maran, N. & Glavin, R. (2003). Low-to high-fidelity simulation – a continuum of medical
education?. Medical Education, 37(1), 22–28.

Martin, M., Morris, J., Moore, A., Sadlo, G., & Crouch, V. (2004). Evaluating practice
education models in occupational therapy: Comparing 1:1, 2:1 and 3:1 placements. The
British Journal of Occupational Therapy, 67, 192-200.

McAllister S., Lincoln, M., Ferguson, A., & McAllister, L. (2011). COMPASS® (Competency
assessment in speech pathology) assessment and resource manual. Melbourne:
Speech Pathology Australia.

Medical Radiation Practice Board of Australia (2014). Medical radiation practice
accreditation guidance material. Australian Health Practitioner and Regulation Agency
(AHPRA). Retrieved from http://www.medicalradiationpracticeboard.gov.au/Accreditation.aspx

National Health Workforce Taskforce (2009). Clinical training governance and organisation.
New South Wales: Health Education and Training Institute.

National Health and Hospitals Reform Commission. (2009). A healthier future for all
Australians: Final report. Canberra: Australian Government.

NCSBN (2014). NCSBN National simulation study: A longitudinal, randomised controlled
study replacing clinical hours with simulation in prelicensure nursing education. National
Council of State Boards of Nursing.

Newton, J. & McKenna, L. (2007). The transitional journey through the graduate year: A
focus group study. International Journal of Nursing Studies, 44(7), 1231–1237.

NHMRC (2013). National Health and Medical Research Council (NHMRC) and Other
Australian Government Priorities. Retrieved from
http://www.nhmrc.gov.au/grants/research-funding-statistics-and-data/nhmrc-priorities

NSW Ministry of Health. (2011). Health professionals workforce plan taskforce: Discussion
paper to inform and support the NSW government's Health Professionals Workforce
Plan, Sydney: NSW Government.

NSW Government. (2008). Budget estimates 2008-09 – NSW Treasury. Retrieved from
http://www.treasury.nsw.gov.au/budget_papers/Budget_Papers_2008-09/bp3/2008-
09_budget_paper_3

Occupational Therapy Australia. (2011). Self study manual (revised) for accreditation of
entry-level occupational therapy education programs. (2nd ed.). Fitzroy: Occupational
Therapy Australia Programme Accreditation Committee.

Occupational Therapy Australia (2013). Response to the occupational therapy council
consultation on the accreditation standards, February 2013. Retrieved from
http://otcouncil.com.au/wp-content/uploads/2012/09/OTA-feedback-to-OTC-on-accred-stds.pdf

Overton, A., Clark, M., & Thomas, Y. (2009). A review of non-traditional occupational therapy
practice placement education: A focus on role emerging and project placements. British
Journal of Occupational Therapy, 72, 294–301.

Penman, M., Donnelly, C., & Drynan, D. (2010). Using information and communication
technology in fieldwork education: Issues and possibilities. In L. McAllister, M. Paterson,
J. Higgs, & C. Bithell, (Eds.), Innovations in allied health fieldwork education: A critical
appraisal. Rotterdam, Netherlands: Sense Publishers, pp.167–178.

Rindflesch, A. B., Dunfee, H. J., Cieslak, K. R., Eischen, S. L., Trenary, T., Calley, D. Q., &

http://www.medicalradiationpracticeboard.gov.au/Accreditation.aspx
http://www.nhmrc.gov.au/grants/research-funding-statistics-and-data/nhmrc-priorities
http://www.treasury.nsw.gov.au/budget_papers/Budget_Papers_2008-09/bp3/2008-09_budget_paper_3
http://www.treasury.nsw.gov.au/budget_papers/Budget_Papers_2008-09/bp3/2008-09_budget_paper_3
http://otcouncil.com.au/wp-content/uploads/2012/09/OTA-feedback-to-OTC-on-accred-stds.pdf

Heinle, D. K. (2009). Collaborative model of clinical education in physical and
occupational therapy at the Mayo clinic. Journal of Allied Health, 38(3), 132–142.

Rodger, S., Webb, G., Devitt, L., Gilbert, J., Wrightson, P., & McMeeken, J. (2008). Clinical
education and practice placements in the allied health professions: An international
perspective. Journal of Allied Health, 37, 53–62.

Russell, T. (2004). Establishing the efficacy of telemedicine as a clinical tool for
physiotherapists: From systems design to randomised controlled trial. PhD Thesis. The
University of Queensland, Brisbane.

Sheepway, L., Lincoln, M., & McAllister, S. (2014) Impact of placement type on the
development of clinical competency in speech–language pathology students.
International Journal of Language and Communication and Disorders, 49(2), 189–203.

Speech Pathology Australia (2011). Competency based occupational standards (C-BOS) for
speech pathologist: Entry level. Revised 2011. Melbourne, Australia: The Speech
Pathology Association of Australia Limited.

Speech Pathology Australia (2014). Accreditation of speech pathology degree programs.
Melbourne, Australia: The Speech Pathology Association of Australia Limited.

SPEF-R (2013). Student practice evaluation form (SPEF-Revised Edition Package).
Retrieved from http://www.uq.edu.au/spef/

TEQSA (2014). Higher Education Standards Framework. Retrieved from
http://www.teqsa.gov.au/higher-education-standards-framework

Theodoros, D. G., Constantinescu, G., Russell, T., Ward, E. C., Wilson, S. J., & Wootton, R.
(2006). Treating the speech disorder in Parkinson’s disease online. Journal of
Telemedicine and Telecare, 12, Supplement 3, 88–91.

Thew, M., Hargreaves, A., & Cronin-Davis, J. (2008). An evaluation of a role-emerging
practice placement model for a full cohort of occupational therapy students. British
Journal of Occupational Therapy, 71, 348–353.

Thomas, Y., Penman, M., & Williamson, P. (2005). Australian and New Zealand fieldwork:
Charting the territory for future practice. Australian Occupational Therapy Journal, 52,
78–81.

Tinning, R., Jenkins, D., Collins, J., Rossi, T., & Brancato, T. (2012) Major practicum as a
learning site for exercise science professionals: A pilot study. European Physical
Education Review, 18(2), 239–244.

Vyas, R., Albright, S., Walker, D., Zachariah, A., & Lee, M.Y. (2010). Clinical training in
remote sites using mobile technology: An India-USA partnership. Distance Education,
31(2), 211–226.

Walker, A., Yong, M., Pang, L., Fullarton, C., Costa, B., & Dunning, A. M. T. (2013). Work
readiness of graduate health professionals. Nurse Education Today, 33, 116–122.
doi: 10.1016/j.nedt.2012.01.007

Watson, K., Wright, A., Morris, N., McMeeken., J., Rivett, D., Blackstock, F., … Jull, G.
(2012). Can simulation replace part of clinical time? Two parallel randomised controlled
trials. Medical Education, 46(7), 657–667.

Wergin, J F. (2005). Higher education: Waking up to the importance of accreditation.
Change, (3), 35–41. Retrieved from
http://go.galegroup.com/ps/i.do?id=GALE%7CA132680056&v=2.1&u=usyd&it=r&p=EAIM&sw=w

WFOT (2002). World Federation of Occupational Therapists: Minimum standards for the
education of occupational therapists. Retrieved from www.wfot.org

http://www.uq.edu.au/spef/
http://www.teqsa.gov.au/higher-education-standards-framework
http://go.galegroup.com/ps/i.do?id=GALE%7CA132680056&v=2.1&u=usyd&it=r&p=EAIM&sw=w
http://www.wfot.org/

WHO (2013). International classification of functioning, disability and health (ICF). Retrieved
from http://www.who.int/classifications/icf/en/

WHO (2008). The World Health Report 2008: Primary health care: Now more than ever.
World Health Organization. Retrieved from http://www.who.int/whr/2008/whr08_en.pdf

Wimmers, P.F., Schmidt, H.G., & Splinter, T.A. (2006). Influence of clerkship experiences
on clinical competence. Medical Education, 40(5), 450–458.

http://www.who.int/classifications/icf/en/
http://www.who.int/whr/2008/whr08_en.pdf