Supervision guidelines for physiotherapy

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:

• principles of supervision
• levels of supervision
• requirements and responsibilities of supervisors
• responsibilities of physiotherapists under supervision, and
• procedures, including assessment and reporting requirements.

These guidelines may be considered in a range of registration and notification matters resulting in supervision arrangements, including physiotherapists who:

• do not meet the Board’s Recency of practice standard (available on the registration standards page), that is, after an absence of five years
• have a condition on their registration or who have entered into an undertaking that requires supervision
• hold or are seeking a type of limited registration where supervision is a requirement of registration (e.g. overseas-trained physiotherapists)
• are working towards an endorsement, or
• are making a significant change to a different field or scope of practice¹.

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:

• supervision of students
• mentoring of new graduates or more junior practitioners
• performance review responsibilities of managers
• supervision for professional development or workplace-based revalidation
• situations where limited registration is required only to undertake Australian Physiotherapy Council (APC) clinical examinations and no physiotherapy practice is undertaken, or
• physiotherapists with limited registration for postgraduate study who are enrolled in an Australian postgraduate physiotherapy full-time or part-time program of study, and who undertake clinical placements that are organised by the tertiary education provider and who are not engaged in practice outside the program of study (note that physiotherapists meeting the Board’s limited registration standards who seek to work outside the postgraduate study program must adhere to supervision requirements for that work).

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:

1. It is the professional responsibility of each physiotherapist under supervision to work within the limits of their competence and to reflect upon and determine their own learning needs, including the requirements of the specific position in which the physiotherapist under supervision is proposing to work and the purpose of the supervision requirements.
2. For all physiotherapists under supervision, the type and level of supervision must be matched to individual needs, the level of risk associated with the position, the purpose of the supervision and the capabilities of the physiotherapist under supervision. Supervisory arrangements need to be modified over time, in keeping with progress achieved by the physiotherapist under supervision. Within parameters agreed by the Board, provision should also be made to accommodate a change of supervisor if this becomes necessary.
3. The supervisor and the physiotherapist under supervision need to agree on the duration and content of the supervised practice plan, including the period for review if this varies from the standard periods outlined in the ‘Levels of supervision’ section of these guidelines. The supervised practice plan is subject to approval by the Board, as it sees fit, prior to the start of supervised practice.
4. The onus is on the physiotherapist under supervision to ensure the agreed reporting requirements are met as per the supervised practice plan. However, the supervisor also has a responsibility to adhere to the agreement he or she enters into with the Board and to appropriately supervise the practice of the physiotherapist under supervision.

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:

• the purpose of supervision
• previous practice experience, qualifications, skills and attributes of the physiotherapist under supervision
• requirements of the position, as outlined in the position description provided with the application
• the level of risk associated with the purpose of supervision; the competence and suitability of the practitioner; and the position, location and availability of clinical and other relevant supports, or
• any specific requirements imposed either by the Board or by a third party (e.g. tribunal) under the National Law.

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:

1. Three months after the start of supervised practice, or as otherwise agreed by the Board (e.g. earlier if verification of a supervised practice plan is required, or later if supervised practice is not full-time).
2. Six months after the start of supervised practice.
3. To accompany an application for renewal of registration.
4. Six-monthly and on further renewal after the first renewal.
5. On completion of supervised practice.

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:

1. The supervisor must formally consent to act as a supervisor and must be approved by the Board. The supervisor must also be able to comply with the requirements of the supervised practice plan and agree to terms as outlined in the supervisor/physiotherapist under supervision agreements and undertakings.
2. The approved supervisor must not hold a position which is at a lower classification or remuneration level, or lesser responsibility, to that held by the physiotherapist under supervision.
3. As recommended in the Board’s Code of Conduct, good practice involves avoiding any potential for conflict of interest in the supervisory relationship, for example, by supervising someone who is a close relative or friend, or where there is another potential conflict of interest that could impede objectivity and/or interfere with the achievement of learning outcomes or relevant experience for the physiotherapist under supervision.⁴

Responsibilities of supervisors include:

1. Take reasonable steps to ensure that the physiotherapist under supervision is practising safely.
2. Provide clear direction and constructive feedback and be clear about how the supervisor can be contacted by the physiotherapist under supervision whenever he/she is practising.
3. Ensure that the physiotherapist under supervision is practising in accordance with the supervised practice plan and work arrangements approved by the Board, and report to the Board if this is not the case.
4. Ensure that the physiotherapist under supervision understands their legal responsibilities and the constraints within which they must operate; follows the ethical principles that apply to the profession; and acts in accordance with the directions of the supervisor.
5. Provide overseas-trained physiotherapists under supervision with an orientation or introduction to the Australian healthcare system and information on cultural competence.⁵
6. Understand the significance of supervision as a professional undertaking and commit to this role including regular, protected, scheduled time with the physiotherapist under supervision, which is free from interruptions and as required by the supervised practice plan.
7. Disclose to the Board any potential conflict of interest, such as a personal relationship or business relationship with the physiotherapist under supervision.⁶
8. Be accountable to the Board and provide honest, accurate and responsible reports in the approved form at determined intervals in the supervised practice plan.
9. Understand that the responsibility for determining the type and amount of supervision required within the framework of the supervised practice plan should be informed by the supervisor’s assessment of the physiotherapist under supervision.
10. Only delegate tasks that are appropriate to the role of those being supervised and that are within the scope of training, competence and capability of the physiotherapist under supervision.
11. Notify the Board immediately if:
    • the relationship with the physiotherapist under supervision deteriorates to a dysfunctional level
    • concerns that the clinical performance, conduct or health of the physiotherapist under supervision is placing the public at risk
    • the physiotherapist under supervision is not complying with conditions imposed, or undertakings accepted by the Board, or is in breach of any requirements on registration
    • the physiotherapist under supervision is not complying with the supervision requirements or there are any significant changes to those requirements, or
    • the supervisor is no longer able to provide the level of supervision that is required by the supervised practice plan.
      
      Note: Documented evidence should be provided if relevant and available.
      
      
12. Understand the requirement that a physiotherapist under supervision must notify the Board in writing within seven calendar days if a supervisor is no longer able to discharge his or her duties; report on whether an approved back-up supervisor can assume supervisory responsibilities; and immediately cease practice if a supervisor cannot fulfil his/her responsibilities and back-up options are not available.

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:

1. at the outset and in conjunction with the supervisor, establish their learning needs, the context relevant to the need for supervision and any other issues that may impact on an effective supervisory arrangement
2. if trained overseas, participate in an orientation or introduction to the Australian healthcare system and be informed on cultural competence
3. take joint responsibility for establishing a schedule of regular meetings with the supervisor and make all reasonable efforts within their control to ensure that these meetings take place
4. be adequately prepared for meetings with their supervisor
5. participate in assessments conducted by the supervisor to assist in determining future supervision needs and progress
6. recognise the limits of their professional competence and seek guidance and assistance, and follow directions and instructions from their supervisor as required
7. familiarise themselves and comply with regulatory, professional and other legal responsibilities applicable to their practice
8. advise their supervisor immediately of any issues or clinical incidents during the period of supervision which could have an adverse impact
9. reflect on and respond to feedback
10. inform the Board and supervisor if the conditions or requirements of their supervision are not being met, or if the relationship with the supervisor becomes dysfunctional, and
11. notify the Board in writing within seven calendar days if a supervisor is no longer able to discharge his or her duties; report on whether an approved back-up supervisor can assume supervisory responsibilities; and immediately cease practice if a supervisor cannot fulfil his/her responsibilities and back-up options are not available.

When supervision is a registration requirement, the following procedures apply.

Before commencement of supervised practice

The prospective supervisor and physiotherapist under supervision must provide to the Board for its consideration:

• Contact details and signed agreements and undertakings. See Appendix 3: Form A – Supervision agreement.
• A supervised practice plan setting out objectives, levels, type and amount of supervision proposed, and how the supervision is to occur. See Appendix 4: Form B – Supervised practice plan template.
• Any other applicable documentation (e.g. registration application, APC interim certificate, position description).

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.

Assessment and reporting requirements

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:

• Three months after commencement of supervised practice, or as otherwise agreed by the Board, e.g. earlier if verification of a supervised practice plan is required, or later if supervised practice is not full-time.
• Six months after the start of supervised practice.
• To accompany an application for renewal of registration.
• Six-monthly and on further renewal after the first renewal.
• On completion of supervised practice.

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.

Changes in supervisory arrangements

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:

• notify the Board in writing of intent to change supervisors no less than seven calendar days before the proposed date of change, or within seven calendar days of any unexpected supervisor changes (e.g. due to illness)
• submit proposed new supervision arrangements to the Board for consideration, including name and contact details of proposed new supervisor(s), new signed agreements and undertakings, and new supervised practice plan, and
• provide to the proposed new supervisor(s) copies of:
  • previous supervisor undertakings
  • supervised practice plan(s), and
  • supervision report(s).

• Australian Standards for Physiotherapy. Australian Physiotherapy Council. July 2006.
  
  
• Assessment of Physiotherapy Practice Instrument. Dalton M., Keating J., Davidson M. (2009, March).
  
  
• Development of the Assessment of Physiotherapy Practice (APP): A standardised and valid approach to assessment of clinical competence in physiotherapy. [Australian Learning and Teaching Council (ALTC) Final report PP6-28]. Brisbane: Griffith University. Support for the original work was provided by the Australian Learning and Teaching Council Ltd, an initiative of the Australian Government Department of Education, Employment and Workplace Relations.

General provisions

Division 3 Registration standards and codes and guidelines

39 Codes and guidelines

A National Board may develop and approve codes and guidelines—

1. to provide guidance to the health practitioners it registers; and
2. about other matters relevant to the exercise of its functions.

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.

40 Consultation about registration standards, codes and guidelines

1. If a National Board develops a registration standard or a code or guideline, it must ensure there is wide-ranging consultation about its content.
2. A contravention of subsection (1) does not invalidate a registration standard, code or guideline.
3. The following must be published on a National Board’s website—
   1. a registration standard developed by the Board and approved by the Ministerial Council;
   2. a code or guideline approved by the National Board.
4. An approved registration standard or a code or guideline takes effect—
   1. on the day it is published on the National Board’s website; or
   2. if a later day is stated in the registration standard, code or guideline, on that day.

41 Use of registration standards, codes or guidelines in disciplinary proceedings

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.

Specific provisions

Provisions of the National Law that refer to supervised practice are sections 35, 62, 66, 68, 69, 178, 191, 196, 237 and 271.

Required

Possibly required

Not required

• Supervision agreement - Form A (77.4 KB,PDF), Word version (342 KB, DOC)

• Supervised practice plan - Form B (82.2 KB,PDF), Word version (384 KB,DOC)

• Supervision report (including competency assessment using the APP tool) - Form C (81.0 KB,PDF), Word version (345 KB,DOC)

• Appendix 6 - Examples to assist with use of the APP tool (293 KB,DOCX)

• Alternative supervision report (where approved by the Board) - Form D (69.9 KB, PDF), Word version (332 KB,DOC)