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These guidelines for supervision have been developed by the Physiotherapy Board of Australia (the Board) under section 39 of the Health Practitioner Regulation National Law (the National Law), as in force in each state and territory.
The relevant sections of the National Law are set out in Appendix 1.
Guidelines approved by a National Board may be used as evidence of what constitutes appropriate professional conduct or practice for physiotherapy in proceedings under the National Law, or a law of a co-regulatory jurisdiction, against a health practitioner.
Consumers of physiotherapy services have the right to expect delivery of safe, competent and contemporary services at all times, including when care is being provided under supervisory arrangements.
Appropriate supervision provides assurance to the Board and the community that a registrant’s practice is safe and not putting the public at risk. Further, it provides a framework that facilitates progressive development of the competence and skills required of a practitioner for general registration or registration without conditions.
These guidelines include the principles the Board considers central to safe and effective supervision.
Physiotherapists with limited registration or with conditions or undertakings attached to their registration may be required to work under supervision. They may be directed by the Board to work with guidance and support from a supervisor to develop a level of competence required for general registration, or to address a conduct, performance or health issue that has been assessed as impacting on safe and/or appropriate practice.
Supervision requirements may be different for each practitioner. Supervision needs to be tailored to address the reason why supervision is required, as well as the particular circumstances, experience and learning needs of the physiotherapist under supervision. Arrangements should be flexible to accommodate individual capabilities, diverse settings and complexity of workloads. Supervision should be provided at different levels to address the different supervision requirements of individuals.
These guidelines set out the:
These guidelines may be considered in a range of registration and notification matters resulting in supervision arrangements, including physiotherapists who:
Supervision requirements related to performance, conduct or health matters may be determined by the Board or another entity, such as a panel or tribunal.
These guidelines apply to both the physiotherapist providing the supervision and the physiotherapist under supervision.
These guidelines are not intended to cover:
See Appendix 2 for a summary of which registration applicants must comply with these supervision guidelines.
The Board is committed to ensuring that physiotherapists under supervision are provided with adequate support. For this reason, if a supervisor proposes to supervise more than three physiotherapists concurrently, the Board may seek assurance that the supervisor has the capacity for this responsibility and can provide appropriate supports.
Back-up plans should also be considered in the event that a supervisor is unexpectedly not available to provide supervision. This would normally be the nomination of a second physiotherapist who meets the requirements described in the ‘Definitions’ section of these guidelines, and who is approved by the Board.
1For example, physiotherapists moving back into a clinical role from a non-clinical role.
Practice means any role, whether remunerated or not, in which the individual uses his or her skills and knowledge as a health practitioner in the profession. For the purposes of the registration standard on recency of practice, practice is not restricted to the provision of direct clinical care. It also includes: working in a direct non-clinical relationship with clients; working in management, administration, education, research, advisory, regulatory or policy development roles; and any other roles that impact on the safe, effective delivery of services in the profession and/or uses the individual’s professional skills.
Supervision, for the purposes of these guidelines, incorporates elements of direction and guidance. It is a formal process of professional support and learning which enables a physiotherapist under supervision to develop knowledge and competence, assume responsibility for their own practice, and enhance public protection and safety. Supervision may be direct, indirect or remote, according to the nature or context in which practice is being supervised.
Direct supervision is where the supervisor is physically present on the premises when the physiotherapist under supervision provides clinical care, to observe and work with the physiotherapist under supervision.
Indirect supervision is where the supervisor is easily contactable and is available when needed to observe and discuss clinical management with the physiotherapist under supervision in the presence of the patient/client.
Remote supervision is where the supervisor is contactable to discuss clinical activities, but is not on the premises or required to directly observe or participate in the clinical management.
Mentoring is considered, in the context of a re-entry plan, as a relationship in which the mentor facilitates the personal and professional growth and development of another practitioner (the mentee). Mentoring may
also be relevant where a practitioner is changing their scope of practice. The mentor assists with career development and guides the mentee through professional networks. The mentor relationship is considered by the Board to be less formal than that of a supervisor role. However, there are elements of mentoring in supervision arrangements.
Supervisor is a health practitioner with current general registration who has agreed to assess and monitor a physiotherapist undertaking supervised practice and report to the Board about the performance of the physiotherapist under supervision and who, in the opinion of the Board, is suitably qualified and experienced (usually a minimum of three years’ experience). The registration of a supervisor should not be subject to conditions or undertakings that would impact on their ability to effectively supervise the physiotherapist under supervision. Only in exceptional circumstances would a health practitioner who is not a physiotherapist be considered as a supervisor.
Physiotherapist under supervision is a physiotherapist holding limited registration, or registration with conditions or undertakings that requires supervision and who is practising under the direction and oversight of a supervisor to meet the objectives of a supervised practice plan.
Competency assessment is an assessment undertaken by a supervisor of a physiotherapist under supervision. Where the supervised practice is clinical in nature, this assessment would usually be undertaken using the Assessment of Physiotherapy Practice (APP) Instrument (Dalton M, Keating J, Davidson M 2009)2, a tool based on the Australian Standards for Physiotherapy (Australian Physiotherapy Council 2006)3. The Board retains discretion to require alternative methods of assessment. A competency assessment can be used to justify, or inform any amendment to, supervised practice plans and is usually included in supervision reports. The minimum level of competence expected at the end of the period of supervision is that of an entry-level practitioner capable of meeting professional standards as set out in the Australian Standards for Physiotherapy.
Supervised practice plan is a plan that is agreed between the supervisor and physiotherapist under supervision and is approved by the Board. It sets out the objectives, level, type and amount of supervision required, and how the supervision is to occur. It should reflect a balance between the need for supervision, the current level of training, competence and scope of practice of the physiotherapist under supervision, and the position in which the physiotherapist under supervision will be practising. The Board may require a competency assessment at an agreed time after commencement of supervision to justify a supervised practice plan. Supervisors may also propose amendments to a supervised practice plan after the start of supervision, where change is justified.
Supervision report is a document detailing progress against the supervised practice plan and incorporates a competency assessment using the APP tool, unless otherwise agreed by the Board. Supervision reports include information about whether or not the elements of the supervised practice plan are being achieved and, if not, measures to address them. Also included are any emerging issues and changes in supervisory arrangements, including changes in level of supervision over time. Supervision reports are to be submitted to the Board at agreed intervals. Additional supervision reports may be required where there are changes in circumstances or concerns about the physiotherapist under supervision.
2The Assessment of Physiotherapy Practice Instrument is available on the University of British Columbia website.
3See the Australian Physiotherapy Council website. This document provides a benchmark for the knowledge, skills and attributes of a safe and effective entry-level physiotherapist.
Consistent with the objectives of the National Law, the Board expects adherence to the following principles in all supervisory arrangements:
Note: Progression from limited to general registration may only be achieved by meeting the Board’s standards for general registration, which may include assessment by an external authority such as the APC.
The four levels of supervision described in Table 1 (see below) are designed to assist the physiotherapist under supervision to practise safely.
The starting level of supervision required will depend upon a number of factors that may include:
Individual supervised practice plans should set out the proposed starting level of supervision and expected progressions. Competency assessments using the APP tool would usually verify that the starting level is appropriate and inform changes in the level of supervision. Levels of supervision, both starting and progressions, remain subject to Board approval.
Competency assessments form part of the supervision reports unless otherwise agreed by the Board. If concerns are raised in supervision reports, or directly by the supervisor, the supervised practice plan may need to be amended. The Board or the supervisor may, at any time, exercise discretion to ask for/provide a report.
Unless otherwise mandated by the Board, or another entity such as a panel or tribunal, supervision reports are to be submitted to the Board at the following intervals:
Note: Not all physiotherapists under supervision will need to progress through all four levels of supervision (see Table 1) to attain general registration or registration without conditions, and some may not be expected to, or be capable of, progressing to level 4 supervision.
Requirements of supervisors:
Responsibilities of supervisors include:
4Physiotherapy Board of Australia. Code of Conduct.
5Physiotherapy Board of Australia. Orientation to Australian Healthcare System.
6A personal relationship or business relationship between the physiotherapist under supervision and supervisor is not condoned, but will be considered in the context of the matter under consideration by the Board.
Physiotherapists under supervision must:
When supervision is a registration requirement, the following procedures apply.
The prospective supervisor and physiotherapist under supervision must provide to the Board for its consideration:
The Board may exercise its discretion in requiring different levels of supervision to those proposed in the supervised practice plan and make any other amendments to the plan as it sees fit.
It is expected that supervisors will monitor and assess physiotherapists under supervision on an ongoing basis.
The APP tool is to be used to assess competence in clinical practice in a consistent and objective manner, and is included in supervision reports, unless otherwise agreed by the Board. See Appendix 5: Form C – Supervision report template (including competency assessment using APP tool) and Appendix 6: Examples to assist with use of the APP tool.
When the Board determines that a competency assessment using the APP tool is not applicable, an alternative supervision report format is available, e.g. supervision for a specific issue rather than general competence or non-clinical situations. See Appendix 7: Form D – Alternative supervision report template.
Supervision reports on the progress of physiotherapists under supervision must be legible and submitted to the Board and meet the reporting requirements of the Board or other entity such as a panel or tribunal.
Unless otherwise mandated by the Board or another entity such as a panel or tribunal, supervision reports are to be submitted to the Board at the following intervals:
While reporting requirements are determined on approval of the supervised practice plan prior to the start of supervised practice, the Board may, at any time, exercise discretion about the frequency and structure of a report and the need for assessment.
A supervisor may also, at any time, provide a verbal report to the Board if there are immediate concerns.
A physiotherapist under supervision must not practise without a supervisor approved by the Board. It is recommended that when supervision is initially proposed, a back-up supervisor (supervisor 2) be nominated for Board approval so that in the event that the initial supervisor (supervisor 1) is no longer able to discharge his or her duties, supervisor 2 can assume supervisory responsibilities. If supervisor 2 is unable to assume supervisory responsibilities, or if there is an unexpected need to change both supervisors, the physiotherapist under supervision must cease practice immediately. Only in exceptional circumstances would a health practitioner who is not a physiotherapist be considered as a supervisor, e.g. as a back-up for temporary situations or in very remote locations.
The physiotherapist under supervision must:
Supervisors and physiotherapists under supervision should refer to the supervision flowchart for a diagrammatic representation of the procedures. See Appendix 8: Supervision flowchart.
A National Board may develop and approve codes and guidelines—
Example. A National Board may develop guidelines about the advertising of regulated health services by health practitioners registered by the Board or other persons for the purposes of section 133.
An approved registration standard for a health profession, or a code or guideline approved by a National Board, is admissible in proceedings under this Law or a law of a co-regulatory jurisdiction against a health practitioner registered by the Board as evidence of what constitutes appropriate professional conduct or practice for the health profession.
Provisions of the National Law that refer to supervised practice are sections 35, 62, 66, 68, 69, 178, 191, 196, 237 and 271.