Assessment Of Physiotherapy Practice Research Articles

The effect of self-assessment on student competence in physiotherapy clinical training: a randomized controlled trial

BackgroundSelf-assessment is a method that allows students to reflect on and critically evaluate their performance, increases students’ involvement in learning, and improves academic achievement. In physiotherapy (PT) education, clinical training is a crucial component, guided by clinical educators (CEs), who assess and provide feedback, fostering student development. Limited research has investigated the impact of self-assessment on PT clinical training outcomes. This study aims to assess the effect of mid-term self-assessment during PT clinical training on students’ competence and on level of agreement between students’ self-assessment and CEs’ assessment at the end of the training.Methods23 CEs and their 52 undergraduate PT students participated in the study. The students underwent eight weeks of clinical training in outpatient PT clinics in groups of two or three. For each group, one CE performed student assessment at the mid-term and the end of the training using the Assessment of Physiotherapy Practice (APP) form, an assessment tool used to evaluate clinical competence in PT clinical training. One student from each group was randomly assigned to join the intervention group (IG). These students completed a self-assessment process at the mid-term of the training. All students were asked to complete a self-assessment form at the end of the training.ResultsThe median CE’s evaluation score halfway through the training was 80 [50–96] and 91 [65–100] at the end of the training, with no significant differences between the two groups. The level of agreement between the student and CE’s evaluation at the end of the training was not significantly different between the groups (p = 0.05). It noted that students who scored themselves higher than their CEs tended to have lower APP scores than others, based on CEs’ assessment. These students were found to have less academic experience. Nevertheless, those from the IG improved significantly, based on the CE’s assessment, during the second half of the training, compared to the controls.ConclusionThe main finding of the present study is that student participation in self-assessment during PT clinical training is advantageous, mainly for individuals undergoing their initial clinical training and in the early stages of their academic studies.

Rating of physiotherapy student clinical performance in a paediatric setting: are assessors consistent in their rating of a simulated clinical student performance?

BackgroundDuring workplace-based clinical placements, best practice assessment states students should expect consistency between assessors rating their performance. To assist clinical educators (CEs) to provide consistent assessment of physiotherapy student performance, nine paediatric vignettes depicting various standards of simulated student performance, as assessed by the Assessment of Physiotherapy Practice (APP), were developed. The APP defines adequate on the global rating scale (GRS) as the minimally acceptable standard for an entry-level physiotherapist. The project aimed to evaluate consistency of paediatric physiotherapy educators assessing simulated student performance using the APP GRS.MethodsThree paediatric scenarios representing neurodevelopment across three age ranges, infant, toddler and adolescent, were developed and scripted that depicted a ‘not adequate’, ‘adequate’ and ‘good-excellent’ performance based on the APP GRS. An expert panel (n = 9) conducted face and content validation. Once agreement was reached for all scripts, each video was filmed. A purposive sample of physiotherapists providing paediatric clinical education in Australia were invited to participate in the study. Thirty-five CEs, with minimum 3-years clinical experience and had supervised a student within the past year, were sent three videos at four-week intervals. Videos depicted the same clinical scenario, however performance varied with each video. Participants rated the performance on the four categories: ‘not adequate’, ‘adequate’, ‘good’ and ‘excellent’ Consistency among raters was assessed using percentage agreement to establish reliability.ResultsThe vignettes were assessed a combined total of 59 times. Across scenarios, percentage agreement at the not adequate level was 100%. In contrast, the adequate scenarios for the Infant, Toddler and Adolescent video failed to meet the 75% agreement level. However, when combining adequate or good-excellent, percentage agreement was > 86%. The study demonstrated strong consensus when comparing not adequate to adequate or better performance. Importantly, no performance scripted as not adequate was passed by any assessor.ConclusionsExperienced educators demonstrate consistency in identifying not adequate from adequate or good-excellent performance when assessing a simulated student performance using the APP. Recommendation for practice: These validated video vignettes will be a valuable training tool to improve educator consistency when assessing student performance in paediatric physiotherapy.

Creating a Supportive Clinical Learning Environment for Physiotherapy Students: A Feasibility Study to Enhance Collaboration Between Students and Educators Using the ‘Everything DiSC’

Aim: To investigate if an intervention aimed at creating a supportive clinical learning environment (through shared debriefing of behaviour styles for physiotherapy students and their educators) can i) improve the clinical skills outcomes (grades) and ii) enhance the perceived quality of clinical education experiences for students and educators compared to placements without this intervention. Method: This quasi-experimental, non-equivalent groups, mixed methods study was conducted across two Australian universities and two public health sector settings. For the intervention group, Everything DiSC profiles and comparison reports were utilised to indicate differences and similarities in behaviour traits and this information was shared with students and clinical educators attending a 5-week placement. Written strategies were provided to enhance collaboration. For the comparison group, physiotherapy students attending usual clinical placements. Outcomes: Assessment of Physiotherapy Practice (APP) grades, Clinical Learning Environment Inventory (CLEI), Maastricht Teaching Evaluation, perspectives of clinical educators (obtained through focus groups). Results: At the completion of the 5-week placement, no significant differences between groups were found in APP grades, CLEI, or Maastricht scores. Focus groups (n=2) with clinical educators (n=12) revealed mostly positive perspectives on the utility of DiSC in the clinical education setting. Conclusion: Whilst sharing DiSC profiles and comparison reports between physiotherapy students and their clinical educators did not demonstrate significant benefits for students in terms of grades, positive outcomes regarding the collaboration between physiotherapy clinical educators and their students were reported by clinical educators.

The effect of standardized patients for physical therapy students on behaving and communicating as a professional: a systematic review

Background Previous systematic review and meta-analysis examining standardized patients (SPs) in Physical Therapy (PT) education yielded 14 articles describing 16 studies; 10 addressed professional behaviors (PB), and six reported providing SP feedback to students. Of those six studies, four were randomized controlled trials (RCTs) emphasizing SP feedback on clinical competencies. Only two studies examined PB or communication in PT students after receiving SP feedback. There appears to be a gap within the current literature to understand better SPs’ ability to impact PT students’ communication and PB as they prepare for clinical education. This systematic review aimed to synthesize and critically appraise the findings of empirical studies (qualitative or quantitative) evaluating the contribution of SPs on the student’s affective learning domain (professional behavior and/or communication) in PT entry-level education. Methods A systematic review was completed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Guidelines for Reporting Systematic Reviews on December 1, 2021, using the following electronic databases PubMed, Cochrane Central Register of Control Trials, CINAHL, ERIC, SCOPUS, and Web of Science. Article inclusion criteria: peer-reviewed, assess PT students, assess the affective learning domain, intervention using live, standardized patient learning experiences, and be written in the English language. Studies were excluded if they involved peer-role play as the (SP) or if the authors did not describe the SP process. The risk of bias was evaluated through the Critical Appraisal Skills Programme tool (CASP), given the heterogeneity of study types anticipated for this systematic review, and PEDro if the study design was a RCT. Results There were ten included studies in this review. Two studies were RCT designs that explored Immersive Simulation-Based Learning Experience (SBE) in the clinic’s impact on PB, and all used the Assessment of Physiotherapy Practice (AAP) outcome measure. The other seven studies examined SPs or SBE on PB within the classroom and had significant heterogeneity based on study design and outcomes reported. Discussion Summative results suggest that SP or SBE has some unique attributes, if applied in the clinical environment, may improve students’ PB and core values development, consistent with a PT practice. This systematic review may inform academic leadership and clinical educators in physical therapy education delivery. Integrating experiential and simulated learning experiences into a program may increase efficiency by allowing students to demonstrate clinical competence skills sooner. Limitations Heterogeneity of study design and reported outcomes limited the results and pooling of data.

Educating the educator: Evaluation of a standardised format, one-day clinical educator workshop on the assessment of physiotherapy student performance in clinical placement.

Background: In Queensland, Australia, physiotherapy students on clinical placements are assessed using the Assessment of Physiotherapy Practice (APP) instrument, by physiotherapists who do not necessarily have a background in education and assessment. Professional development to assist quality assessment processes is currently provided in a variety of formats ranging from online resources to facilitated workshops. However, limited evidence exists regarding best practice methods to support the ongoing training of physiotherapy clinical educators. The aim of this study was to: i) determine if a one-day clinical education workshop can change the perceived knowledge, skills and attributes and overall confidence in ability to undertake a standardised assessment of student performance on clinical placement and; ii) identify if the training format used in the one-day workshop was perceived to be effective in assisting participants with improving their understanding and use of the APP. Methods: Participants attended a single day face-to-face workshop which consisted of standardised content, practical simulated activities and a process of calibrating participants understanding of the assessment standards when applying the APP instrument. Pre and post workshops surveys were administered to participants of the workshop on the day and later analysed using related samples Wilcoxon Signed rank tests to explore pre to post differences in knowledge, skills, attributes, and confidence. Results: Data from 109 clinical educator participants (mean age: 30.25 years) who attended the one-day face-to-face workshop was analysed (79 females; 30 males). After attending the workshop, participants self-reported significantly improved knowledge, skills, attributes, and confidence regarding clinical assessment of physiotherapy students. Additionally, after attending the one-day workshop, clinical educators perceived themselves to be appropriately skilled to undertake a standardised process of assessment when using the APP to indicate a physiotherapy student’s clinical performance. Conclusions: The findings from the current study demonstrate that a one-day face-to-face workshop is perceived by clinical educators to be effective for calibrating their understanding and application of the APP instrument to assess physiotherapy students against national entry-level physiotherapy standards.

An investigation of the predictive validity of selection tools on performance in physiotherapy training in Australia

ObjectivesDespite a large body of research on selection in medical education, very little is conducted in other health professions. This study investigated the predictive validity of multiple selection tools on academic and clinical performance outcomes of undergraduate physiotherapy students. DesignA retrospective observational study. SettingUndergraduate physiotherapy program in Australia. Participants497 undergraduate physiotherapy students across seven entry cohorts. Including students directly from secondary school (n=381) and with prior tertiary study (n=116). Main outcome measuresAcademic performance as measured by written examinations. Clinical performance, measured by Objective Structured Clinical Examinations (OSCEs) during on-campus units and the Assessment of Physiotherapy Practice (APP) for off-campus clinical placements. Predictor variables included selection tools (academic achievement, interview, aptitude test) and demographic variables (age, gender). ResultsSelection interview was a positive predictor of OSCEs and final year clinical performance in direct school leaver participants. Academic achievement scores from selection positively predicted written examinations scores. ConclusionClinical and academic performance were predicted by tools measuring different domains at selection. Assessing broadly across academic and non-academic domains at selection can be valuable in identifying applicants who will be able to meet the range of outcomes for course completion and subsequent registration in the physiotherapy profession.

Responding to emerging needs: Development of adapted performance indicators for physiotherapy student assessment in telehealth

Clinical placements in 2020 have been significantly impacted by the COVID-19 global pandemic. Ensuring that effective clinical placement opportunities continue during this time remains the priority of the Clinical Education Managers Australia and New Zealand (CEMANZ). Supporting educators to assess student competency when service delivery models are altered to embrace telehealth services, has been integral to achieving this. Telehealth has been widely adopted to maintain services and contact with patients during the pandemic. Physiotherapy clinical educators voiced concern about the applicability of the Assessment of Physiotherapy Practice (APP) tool in this emerging learning environment and sought guidance from University Clinical Education Managers. This paper describes representative consensus across Universities regarding use of the Assessment of Physiotherapy Practice (APP) tool and the development of adapted APP performance indicators for use in telehealth. Clinical educators can use these adapted performance indicators to guide assessment of student competency for students completing placements in a telehealth setting.

Students achieve comparable performance scores for clinical placements in public and private sectors: a longitudinal observational study.

Does student clinical performance differ according to healthcare sector? Does student clinical performance at Macquarie University differ from other Australian graduate entry-level programs? A longitudinal observational study with comparison to national data. A total of 284 physiotherapy students from Macquarie University. Each student's clinical performance was evaluated by a clinical educator using the Assessment of Physiotherapy Practice (APP) tool at the end of four 5-week clinical placements. Four measures of clinical performance were analysed: Total APP score, Employability Skills, Clinical Skills and a global rating of performance. A between-group difference in the APP results of 5% was nominated a priori as large enough to be considered important. Of the 1,136 placements, 533 (47%) were undertaken in the private sector. Among their four placements, 99% of students had at least one private sector placement and 70% had two or more private sector placements. There were negligible differences between private and public sector placements in Total APP scores (MD 0%, 95% CI-1 to 1), Employability Skills scores (MD 2% higher in the public sector, 95% CI 1 to 3) and Clinical Skills scores (MD 1% higher in the private sector, 95% CI-1 to 3). On the global rating of performance, 88% of placements in each sector were rated as being either good or excellent. Students in the private sector were 9% (95% CI 3 to 14) more likely to be rated as excellent compared with the public sector. There were negligible differences in clinical performance between the Macquarie University and other Australian graduate-entry students. Macquarie University's practice of increasing private sector participation in clinical education had no adverse effects on student clinical performance, and it is likely to be beneficial in better preparing students for work in the private sector.

The Assessment of Physiotherapy Practice tool provides informative assessments of clinical and professional dimensions of student performance in undergraduate placements: a longitudinal validity and reliability study.

Do one or two factors best represent clinical performance scores obtained via the Assessment of Physiotherapy Practice (APP) and what is the nature of their characterisation? To what extent are the same number of factors and their interpretation, and item scaling captured equally over time and across contexts (eg, clinical subdisciplines) for assessments of clinical performance via the APP? Archival and longitudinal study of undergraduate students' clinical performances for each of four final-year clinical placements. A total of 561 undergraduate physiotherapy students from one Australian university who were enrolled to complete their final-year clinical placements between 2014 and2017. Clinical educators' assessments of student performance across seven key domains of clinical practice: professional behaviour, communication, assessment, analysis and planning, intervention, evidence-based practice and risk management. Factor analyses supported the superiority of a two-factor representation of the APP, including dimensions characterised by professional and clinical domains, when compared with a unidimensional structure of an overarching 'clinical performance' factor. It was also found that the two-factor representation and item scaling was consistent across four clinical placements covering typical areas of physiotherapy practice. In other words, the same constructs are being assessed equally well across context and time. The APP is the nationally adopted assessment tool that is used to evaluate clinical competence to practise as a physiotherapist in Australia and New Zealand. These findings provide new evidence for an updated scoring protocol in which clinical factors are distinguished from professional competencies.

The effect of replacing 1\xa0week of content teaching with an intensive simulation-based learning activity on physiotherapy student clinical placement performance

BackgroundSimulation-based learning (SBL) activities are increasingly used to replace or supplement clinical placements for physiotherapy students. There is limited literature evaluating SBL activities that replace on-campus teaching, and to our knowledge, no studies evaluate the role of SBL in counteracting the negative impact of delay between content teaching and clinical placements. The aims of this study were to (i) determine the effect on clinical placement performance of replacing 1 week of content teaching with a SBL activity and (ii) determine if a delay between content teaching and clinical placement impacted clinical placement performance.MethodsThis study is a retrospective cohort study. Participants included students in the first two clinical placements of a graduate-entry, masters-level program. Six hundred twenty-nine student placements were analysed—285 clinical placements where students undertook a 20-h SBL activity immediately prior to clinical placement were compared with 344 placements where students received traditional content. Of the placements where students received the SBL, 147 occurred immediately following content teaching and 138 had a delay of at least 5 weeks. Performance on clinical placement was assessed using the Assessment of Physiotherapy Practice (APP).ResultsThere was a significant main effect of SBL with higher APP marks for the experimental group (3.12/4, SD = 0.25 vs 3.01/4, SD = 0.22), and post hoc analysis indicated marks were significantly higher for all seven areas of assessment. Students whose placements immediately followed content teaching performed better on mid-placement APP marks in two areas of assessment (analysis and planning, and intervention) compared to students for whom there was a delay. There were no statistically significant differences in relation to delay for end of placement APP marks.ConclusionReplacing 1 week of classroom teaching with a targeted, SBL activity immediately before placement significantly improved student performance on that clinical placement. A negative impact of delay was found on mid-placement, but not the end of placement APPs. Findings of improved performance when replacing a week of content teaching with a targeted SBL activity, and poorer performance on mid-placement marks with a delay between content teaching and clinical placement, may have implications for curriculum design.

Physiotherapy students\u2019 DiSC behaviour styles can be used to predict the likelihood of success in clinical placements

BackgroundBehaviour can be defined as the internally coordinated responses (actions or inactions) of whole living organisms (individuals or groups) to internal and/or external stimuli, excluding responses more easily understood as developmental changes. Unlike personality traits, that are thought to be biologically consistent, behaviour, through the application of cognition and reasoning is open to change across time and circumstance, although most humans will display preferred ways of behaving. The objective of this study was to: i) identify the behaviour styles of physiotherapy students and investigate if there is a relationship (predictive or otherwise) between students’ unique behaviour patterns and their clinical placement grades and; ii) examine if this relationship differs when student’s in a Master’s level program as well as student’s in a Bachelor’s level program are explored separately.MethodsThis cross-sectional study with 132 (F = 78, M = 54) physiotherapy students was conducted across two Australian university settings. Measures included Everything DiSC Workplace profile, Assessment of Physiotherapy Practice (APP).ResultsPhysiotherapy students (n = 133) profiled the following ways: Dominance (D) style n = 20 (15%), Influence (i) style n = 33 (25%), Steadiness (S) style n = 36 (27%) and Conscientiousness (C) n = 44 (33%). Students with the individual DiSC styles of i and Conscientiousness / Steadiness (CS) were in the lowest APP quartile for clinical grades and the D style was in the highest quartile. Binary logistic regressions revealed students with an i DiSC style had 3.96 times higher odds, and students with a CS DiSC style had 4.34 times higher odds, of failing a clinical placement. When explored independently, the same trend remained for Master’s level students. Bachelor’s level students with DiSC styles of S and C had failed placements, however these styles were not significantly associated with failure (DiSC S Style: Exp(B) 1.667, p = 0.713 (CI: 0.109 to 25.433), DiSC C Style: Exp(B) 11.00, p = 0.097 (CI: 0.646 to 187.166)).ConclusionPhysiotherapy students with DiSC styles i and CS appear to be more likely to fail physiotherapy clinical placements. Further research with larger undergraduate samples is required to establish if relations differ for undergraduate versus postgraduate students.

Establishing the Reliability of a Tool for Assessing Israeli Physical Therapy Students' Clinical Performance

Introduction. The evaluation of students' abilities in the clinical setting requires the use of a valid and reliable assessment tool. The assessment tool currently used for this purpose in all physical therapy (PT) undergraduate programs in Israel has never been evaluated for these parameters. This study aimed to find an established assessment tool, translate it into Hebrew, and determine the inter-rater reliability of the translated version and whether it could be a viable substitute for the currently used assessment tool. Review of the Literature. Revealed that the Assessment of Physiotherapy Practice (APP) is an established, valid, and reliable assessment tool. Subjects. Assessors: 21 clinical educators; assessed: 30 undergraduate PT students. Methods. The APP was translated into Hebrew using the translation–retranslation method. Clinical educators were briefly trained to use the APP before the study. Following 8 weeks of clinical practice in an assigned outpatient clinic, each student was assessed by 2 clinical educators, each of whom used both the APP and the currently used assessment tool. Intraclass correlation coefficient (ICC) was used to measure the inter-rater reliability of the APP. Cronbach's alpha was used to measure the internal consistency of the sections of the APP. Percentage of agreement between assessors was measured for each item. Results. The ICC for the total APP was 0.88 (95% confidence interval: 0.77–0.94). The internal consistency of APP sections ranged from 0.65 to 0.93 Cronbach's alpha. Exact agreement between assessors on 12 of the 20 items was identical in 63% or more occasions. Discussion and Conclusion. The ICC for the total score on the Hebrew APP was similar to that of the original APP, and the percentage of agreement among assessors was slightly lower than that of the original version. The latter may be due to the educators' limited experience with this assessment tool. The inter-rater reliability and validity of the Hebrew APP established it as a good substitute for the currently used assessment tool.

Effectiveness of high fidelity simulation versus low fidelity simulation on practical/clinical skill development in pre-registration physiotherapy students: a systematic review.

The objective of this review is to evaluate the effectiveness of high fidelity simulation (HFS) versus low fidelity simulation (LFS) on practical/clinical skill development in pre-registration physiotherapy students. Evidence suggests that improved skill development in university can reduce anxiety in practice, improving performance of skills and overall learning at clinical placement for health professions students. However, evidence indicates that the clinical environment is most effective for learning. As a result, there has been increased interest in the use of HFS where students can test knowledge and skills in an increasingly self-directed way. No previous reviews on the effectiveness of HFS on skill development in physiotherapy students were identified. Experimental and quasi-experimental studies comparing HFS (simulated person, manikin, virtual simulation, video case-studies) to LFS (peer role-play, paper-based case-studies) in pre-registration physiotherapy education were included. Primary outcomes were objective measures of skills performance; secondary outcomes were students' perceptions of the impact of simulation on learning measured using quantitative outcomes. A three-step search strategy was employed. Following an initial search of MEDLINE and CINAHL and analysis of text words, MEDLINE, CINAHL, ERIC, AMED, EThOS and Google Scholar were searched in November 2017. Reference lists of studies included at critical appraisal stage were hand-searched. Studies published in English from 1978 onwards were included. Title/abstract screening, critical appraisal and data extraction were conducted by two independent reviewers; conflicts were resolved by discussion. Meta-analysis was not possible due to heterogeneity; therefore, results were presented in narrative form. Three randomized controlled trials (RCT) and three quasi-experimental studies (310 participants) were included. They were conducted in the USA and Australia, and evaluated standardized patients (people who take on the role of a real patient), near-peers, computerized manikins and virtual simulation in pre-registration Bachelor of Science (Honors), Master of Science and Doctor of Physiotherapy students. One RCT was considered high quality, with the remainder moderate quality. The findings related to five main areas: i) In terms of motor skills performance, an increased number of safety fails were found with HFS (HFS = 13.5% safety fails, HFS plus video feedback = 15.4% safety fails, control [LFS] = 8.1% safety fails); ii) In terms of clinical performance, the Assessment of Physiotherapy Practice (APP) tool indicated no significant improvement in mean APP scores at week 6 of clinical placement (HFS mean APP score = 60.7 [9.1], control mean APP score = 58.7 [8.4]; P = 0.35); iii) In terms of self-efficacy, only one of two studies showed a statistically significant difference with HFS, as measured by the Acute Care Confidence Survey (P = 0.001); however, became non-significant once students were on clinical placement (P = 0.328); iv) Students did not perceive a significant difference in their communication skills with HFS, as measured on a visual analogue scale (simulation = 9.05 [1.27]; control 8.75 [1.2]; P = 0.482); and v) In terms of general perceptions, students were significantly more positive about HFS for increasing awareness of safety issues (P = 0.002), patients' emotional status (P = 0.002), handling skills (P < 0.0001) and ability to provide instructions to patients (P < 0.0001). Currently, there is no high quality evidence that HFS improves motor skill performance in pre-registration physiotherapy students. There is a small amount of moderate-quality evidence it may improve students' perception of their self-efficacy but no evidence that it improves communication skills. However, a lack of studies and variation in outcome measures meant that meta-analysis was not possible. At present, no recommendations can be made regarding the use of HFS to improve skill performance in this population.

Rating of physiotherapy student clinical performance: is it possible to gain assessor consistency?

BackgroundReliable interpretation of the Assessment of Physiotherapy Practice (APP) tool is necessary for consistent assessment of physiotherapy students in the clinical setting. However, since the APP was implemented, no study has reassessed how consistently a student performance is evaluated against the threshold standards. Therefore, the primary aim of this study was to determine the consistency among physiotherapy educators when assessing a student performance using the APP tool.MethodsPhysiotherapists (n = 153) from Australia with a minimum 3 years clinical experience and who had supervised a physiotherapy student within the past 12-months were recruited. Three levels of performance (not adequate, adequate, good/excellent) were scripted and filmed across outpatient musculoskeletal, neurorehabilitation, cardiorespiratory and inpatient musculoskeletal. In the initial phase of the study, scripts were written by academic staff and reviewed by an expert panel (n = 8) to ensure face and content validity as well as clinical relevance prior to filming. In the second phase of the study, pilot testing of the vignettes was performed by clinical academics (n = 16) from Australian universities to confirm the validity of each vignette. In the final phase, study participants reviewed one randomly allocated vignette, in their nominated clinical area and rated the student performance including a rationale for their decision. Participants were blinded to the performance level. Percentage agreement between participants was calculated for each vignette with an a priori percentage agreement of 75% considered acceptable.ResultsConsensus among educators across all areas was observed when assessing a performance at either the ‘not adequate’ (97%) or the ‘good/excellent’ level (89%). When assessing a student at the ‘adequate’ level, consensus reduced to 43%. Similarly, consensus amongst the ‘not adequate’ and ‘good/excellent’ ranged from 83 to 100% across each clinical area; while agreement was between 33 and 46% for the ‘adequate’ level. Percent agreement between clinical educators was 89% when differentiating ‘not adequate’ from ‘adequate’ or better.ConclusionConsistency is achievable for ‘not adequate’ and ‘good/excellent’ performances, although, variability exists at an adequate level. Consistency remained when differentiating an ‘adequate’ or better from a ‘not adequate’ performance.

Undergraduate Grade-point Average as a Selection Criterion for a Postgraduate Entry-level Physiotherapy Program

Aim: Undergraduate GPA (UGPA) is commonly used to select students into postgraduate physiotherapy programs. The aim of this study was to explore the relationships between UGPA and the academic and clinical performance of postgraduate entry-level physiotherapy students. Method: A retrospective cohort study of students from four cohorts (2010-2013) of a postgraduate entry-level physiotherapy program. UGPA, average pre-clinical coursework marks and clinical performance scores were investigated. Clinical performance was measured by the Assessment of Physiotherapy Practice. Normality tests, descriptive analysis and correlations between variables were calculated. Participants were then grouped according to UGPA and a one-way ANOVA was performed to determine differences in clinical or coursework performance between groups. Results: Data from 121 students were analysed. There were no significant relationships identified between UGPA and pre-clinical coursework or clinical performance scores. There were no significant differences in academic or clinical performance between groups when students were classified by UGPA. Conclusion: These findings indicate a need to reconsider the use of UGPA as a sole selection criterion and supports the inclusion of other criteria to select students into competitive programs. Minimum UGPA entry requirements for postgraduate physiotherapy programs should be reviewed to ensure all suitable applicants are eligible for admission.

Performance in Simulation Is Associated With Clinical Practice Performance in Physical Therapist Students

Introduction. Simulation-based clinical education is often adopted before clinical practice to provide health professional students with practice in a safe environment. The simulated environment is often presumed to replicate clinical practice, but performance in these settings is likely to be different. Simulation may be able to determine student clinical competency before clinical practice. However, there is little research comparing health professional student performance in simulation followed by clinical practice. The aim of the study was to determine whether there was an association between the performance of physical therapist students in simulation and clinical practice and whether aspects of simulation performance could predict subsequent clinical performance. Methods. We measured clinical performance of 148 graduate entry-level master physical therapist students using the Assessment of Physiotherapy Practice (APP) tool (n = 296) at the end of 2 weeks of simulation and subsequent 3 weeks of clinical practice. Assessments were conducted by clinical educators. Data were analyzed using Pearson correlation and multiple regression with backward elimination for exploring predictors of clinical performance. Results. A significant association was found between student performance in simulation and clinical practice (r = .40, P &lt; .001). Two domains of practice of the APP in simulation assessments, “analysis and planning” and “risk assessment,” were found to be predictive of student performance in subsequent clinical practice. Discussion and Conclusion. The association between physical therapist student performance in simulation and clinical practice adds support for simulation assessments being used to determine subsequent clinical practice performance. Educators may consider focusing on learner development in the domains of practice of “analysis and planning” and “risk assessment” in simulation as a way of assisting physical therapist student preparation for clinical practice and facilitating more effective implementation of simulation-based education practices.

The influence of a full-time, immersive simulation-based clinical placement on physiotherapy student confidence during the transition to clinical practice

BackgroundNovice students may have limited learning opportunities during their early exposure to complex clinical environments, due to the priorities of patient care. Immersive, high-fidelity simulation provides an opportunity for physiotherapy students to be exposed to relatively complex scenarios in a safe learning environment before transitioning to the clinical setting. The present study evaluated the influence of immersive simulation on student confidence and competence.MethodsSixty penultimate year physiotherapy students completed an 18-day full-time immersive simulation placement. The placement involved students spending 6 days working in each of three core practice areas (cardiopulmonary, musculoskeletal, neurological) in which they interacted with simulated patients portrayed by professional role-play actors. The patient scenarios were developed by groups of expert practitioners and incorporated full documentary and imaging information. Students completed a questionnaire to evaluate their confidence in the clinical environment at the start and completion of each 6-day rotation. Their clinical competence was evaluated at the end of each 6-day rotation using the Assessment of Physiotherapy Practice (APP) tool. In a secondary analysis, the clinical competence of this cohort was evaluated in comparison to a matched cohort of students from the same year group that had not completed an immersive simulation placement.ResultsStudent confidence improved significantly in each 6-day rotation (p < 0.001); however, it reduced again at the commencement of the next rotation, and there was no cumulative improvement in confidence over the 18-day placement (p = 0.22). Students who had completed the immersive simulation placement achieved higher APP (p < 0.001) scores in an evaluation of their competence to practice during their subsequent clinical placement.ConclusionImmersive simulation provides a beneficial learning environment to enable physiotherapy students to transition from university-based education to working in the clinical environment.

Enhancing patient education skills of physiotherapy students in a clinical education setting

Introduction: Effective patient education is a fundamental aspect of healthcare provision, which requires the use of effective clinical and communication skills. Simulation approaches using group discussion and feedback are effective for clinical and communication skills training in healthcare students. The purpose of this study was to investigate such an approach in improving physiotherapy students’ patient education skills and self-efficacy in a clinical education setting. Methods: A simulated learning activity consisting of a case study and structured role play with feedback and discussion was developed for use during the first week of final‑year musculoskeletal physiotherapy clinical placements. Student self-efficacy in relation to patient education was evaluated before and after, and compared using non-parametric statistical tests. Student performance of patient education was contrasted to that of previous cohorts. Student and clinical educator perception of the intervention was also evaluated with descriptive statistics and qualitative framework analysis. Results: Twenty-four students took part in the study. Student self-efficacy significantly improved following the intervention ( p < 0.01). Although performance scores were not significantly higher than those of previous cohorts, all students within the current study passed the assessment of physiotherapy practice, which contrasts to previous cohorts. The intervention was well received by students, and themes relating to importance of patient education, improved quality and increased engagement in patient education were generated from clinical educator and student qualitative data. Conclusion: Within physiotherapy clinical placement settings, a small group learning intervention using case studies, simulation, facilitated feedback and discussion provides an effective and well-received approach to patient education skills training.

Investigating a Physiotherapy Clinical Simulation Assessment Tool Using The Delphi Approach

Purpose: Simulation in physiotherapy education is increasing, but a standardised assessment tool for student performance in simulation has not been developed. The Assessment of Physiotherapy Practice (APP) is a validated tool for student performance in the clinical workplace, and has been used recently for simulation despite its relevance for this context being unknown. The purpose of the study was to gain consensus about which APP items should be included in a tool to assess physiotherapy students’ performance in simulation. The relevance of items was considered for both single patient encounters, and longitudinal (multiple) encounters. Methods: An online Delphi approach used a custom designed survey. A purposive sample of physiotherapists with simulation experience was recruited via email. Two rounds were undertaken with consensus being reached when at least 80% of the panel agreed on inclusion or exclusion of an item. Results: Twenty participants responded in the first round and fourteen in the second (70% retention). For longitudinal simulations, all APP items reached consensus in the first round. For single patient simulation encounters, consensus was not reached in the first round for the following items: commitment to learning (61%), teamwork (76%) and discharge planning (72%). In the second round, consensus for ‘teamwork’ remained the only item below eighty percent agreement (78.6%). Conclusions: The APP was deemed to be an appropriate measure for longitudinal clinical simulations, and with the exclusion of teamwork, for a single patient simulation encounter.

The validity of a professional competence tool for physiotherapy students in simulation-based clinical education: a Rasch analysis.

BackgroundDespite the recent widespread adoption of simulation in clinical education in physiotherapy, there is a lack of validated tools for assessment in this setting. The Assessment of Physiotherapy Practice (APP) is a comprehensive tool used in clinical placement settings in Australia to measure professional competence of physiotherapy students. The aim of the study was to evaluate the validity of the APP for student assessment in simulation settings.MethodsA total of 1260 APPs were collected, 971 from students in simulation and 289 from students in clinical placements. Rasch analysis was used to examine the construct validity of the APP tool in three different simulation assessment formats: longitudinal assessment over 1 week of simulation; longitudinal assessment over 2 weeks; and a short-form (25 min) assessment of a single simulation scenario. Comparison with APPs from 5 week clinical placements in hospital and clinic-based settings were also conducted.ResultsThe APP demonstrated acceptable fit to the expectations of the Rasch model for the 1 and 2 week clinical simulations, exhibiting unidimensional properties that were able to distinguish different levels of student performance. For the short-form simulation, nine of the 20 items recorded greater than 25 % of scores as ‘not-assessed’ by clinical educators which impacted on the suitability of the APP tool in this simulation format.ConclusionThe APP was a valid assessment tool when used in longitudinal simulation formats. A revised APP may be required for assessment in short-form simulation scenarios.Electronic supplementary materialThe online version of this article (doi:10.1186/s12909-016-0718-x) contains supplementary material, which is available to authorized users.