Clinical Education Experiences Research Articles

An innovative clinical interprofessional education experience to advance knowledge and skill in communication with aphasic patients: A randomized controlled pilot study

BackgroundBecause of its impact on communication, aphasia increases patients’ risk for poor healthcare outcomes. Healthcare teams should be equipped to effectively serve this population. PurposeThe primary aim was to pilot the effectiveness of an aphasia communication.partner training program for healthcare students by examining changes in knowledge and behavior. A secondary aim assessed learners' understanding of other healthcare professionals’ roles and responsibilities. MethodStudents in pharmacy, physician assistant, and occupational therapy were randomly assigned to experimental or control groups. The former participated in didactic training with speech-language pathology students and mentored interactions with aphasic patients. Both groups completed pre-/post-training knowledge assessments and participated in semi-structured patient interactions. DiscussionThe clinical IPE experience resulted in statistically significant differences in aphasia knowledge and associated behaviors. Additionally, learners’ understanding of healthcare professions improved. ConclusionsClinical IPE experiences are effective at improving clinical communication skills and increasing knowledge of language-impaired populations.

Determining the Optimal Length of Clinical Education Experiences: Surveying Doctor of Physical Therapy Academic and Clinical Faculty.

There is wide variability in the length of full-time clinical education experiences (CEEs) among Doctor of Physical Therapy (DPT) programs. We investigated academic and clinical faculty perspectives on the optimal length and level of agreement on the length, timing, and offering of full-time CEEs. A survey assessing perspectives on the optimal length and level of agreement for the length, timing, and offering of full-time CEEs was completed by 100 academic and 240 clinical faculty. Differences between academic and clinical faculty responses on the optimal length and level of agreement were assessed with a 2-sample test of proportions and 2-sample t-test. Participants believed that the length of full-time CEEs (in weeks) should be single CEE 10.6 (SD 2.3); first CEE 7.8 (SD 2.1); terminal CEE 12.5 (SD 5.4); integrated CEE 9.6 (SD 1.9); and total CEEs 37.2 (SD 6.9). There were significant differences (MD = -3.0; 95% confidence interval [CI] -4.6 to -1.6) between academic and clinical faculty perspectives for the total length of CEEs. No significant differences between academic and clinical faculty perspectives for the length of single, first, terminal, or integrated CEEs. There were significant differences between academic and clinical faculty perspectives for the optimal length of inpatient (MD = 1.1; 95% CI 0.6-1.6) and specialty (MD = 0.8; 95% CI 0.2-1.3) settings. There were significant differences between academic and clinical faculty level of agreement for 8 of 15 items. There was consistency between academic and clinical faculty regarding the perceived optimal length of full-time CEEs. Academic and clinical faculty perspectives for the optimal length of terminal full-time CEEs (12.5 weeks) were different than those for the national average (21.8 weeks) length of terminal full-time CEEs. Our study provides evidence to support DPT programs' clinical education curriculum decisions regarding the length of full-time CEEs to optimize students learning and maturation.

Professional quality of life and organizational support: a survey of physical therapists with experience as clinical instructors

Purpose: The purpose of this study was to determine the professional quality of life (ProQoL) of physical therapists (PTs) with experience as a clinical instructor and identify factors associated with compassion satisfaction, burnout, and secondary traumatic stress. Methods: This study used a cross-sectional design and survey methodology. Participants were clinician PTs who have been clinical instructors, and completed an online survey that included the ProQoL scale, the eight-item Survey of Perceived Organizational Support, and demographics. Results: Of the 259 participants who completed the survey, the majority experienced average to high levels of compassion satisfaction and low levels of burnout and secondary traumatic stress. Chi-square tests of independence indicated high ratings of compassion satisfaction were associated with the uppermost years licensed as a PT, years of clinical teaching experience, and age. Participants aged 26–35 or with less than 5 years of clinical instruction experience correlated with low ratings of compassion satisfaction. Participants with more than 25 years of experience as PTs correlated with low ratings of burnout. High levels of compassion satisfaction were associated with high levels of perceived organizational support. Conclusion: Findings may assist clinical sites and site coordinators of clinical education in selecting and training clinical instructors.

Use of a SimBox, a Video-Augmented, Newborn Resuscitation Simulation for Prehospital Providers to Measure Clinical Performance and Educational Experience.

Few studies have described the current clinical practices, adherence to guidelines, and outcomes of newborn resuscitations attended by emergency medical services (EMS). SimBox, a novel, video-augmented simulation, was used to describe the adherence of prehospital providers to Neonatal Resuscitation Program guidelines, to measure satisfaction with the simulation intervention, and to describe the self-reported improvement in knowledge, skills, and attitudes after the simulation. A prospective observational cohort study of EMS providers was designed and conducted using SimBox, an open-access simulation platform, and facilitated by EMS educators. Clinical performance measures were collected using a five-item checklist. Simulation satisfaction measures were collected through net promoter scores. Learners' demographics, and self-reported knowledge, skills, and attitudes were measured using a retrospective survey of 25 questions. In total, 33 facilitator and 55 learner surveys were collected across Connecticut, Colorado, and Alaska between July 2021 and September 2022. At least one deviation from clinical guidelines occurred in 22/30 (73.3%) of the sessions, with 10/30 (33.3%) teams inappropriately performing chest compressions, 5/31 (16.1%) teams not warming, drying, stimulating, and suctioning the newborn, and 7/31 (22.6%) teams not performing positive pressure ventilation correctly. Lastly, 10/30 (33.3%) teams administered an incorrect dose of dextrose-containing fluids. Very high levels of satisfaction were reported with net promoter scores of 97 and 82 out of 100 for the facilitator and learner surveys, respectively. Finally, all 55/55 (100%) of the learners strongly or somewhat agreed that the simulation improved their knowledge, teamwork, communication, and psychomotor skills. In this cohort of prehospital providers, clinical management decisions during a newborn resuscitation simulation often deviated from the gold-standard, newborn resuscitation guidelines. Free, online, open-access simulation resources like SimBox can be used to identify and measure practice deviations from standardized resuscitation protocols in the prehospital setting.

Interprofessional Collaborative Practice in Professional and Residency Athletic Training Programs: A Report from the Association of Athletic Training Education Research Network

Context Interprofessional collaborative practice (IPCP) is a required component of athletic training education, yet more needs to be learned about how professional and residency programs integrate IPCP into their curricula. Objective Identify current strategies used in the integration, assessment, and quality of IPCP clinical experiences in athletic training programs. Design Cross-sectional survey. Patients or Other Participants Forty-two of the 288 (14.6% response rate) invited individuals participated. All reported being faculty members affiliated with a professional or residency athletic training program. Data Collection and Analysis The IPCP implementation and assessment was e-mailed to all accredited professional and residency program directors to evaluate: (1) institutional or organizational support for and integration of IPCP; (2) faculty, learner, or preceptor preparation for IPCP engagement; and (3) tools for assessment and quality of IPCP experiences. Survey instrumentation was validated through peer and expert review. Descriptive statistics were calculated for quantitative data, and open coding was used to analyze open-ended questions. Results Respondents reported favorable support from their institution or organization (administrative, financial, and organizational structure) to integrate IPCP experiences. The most common methods for IPCP implementation included clinical simulations (n = 22, 22.9%), grand rounds (n = 13, 13.5%), morbidity and mortality conferences (n = 3, 3.1%), journal clubs (n = 6, 6.3%), direct patient care (n = 14, 14.9%), and intentional clinical education experiences (n = 28, 29.2%). Respondents reported formal IPCP training for faculty (n = 7, 16.7%) and learners (n = 23, 54.8%) but not for preceptors (n = 25, 73.5%). While programs assess their learners’ IPCP experiences (n = 25, 59.5%), the quality of those experiences is not formally captured (n = 19, 45.2%). Conclusion(s) Interprofessional collaborative practice experiences within athletic training education continue to evolve. As such, in this study, we highlight the need for formalized training in IPCP for faculty, learners, and preceptors. Additionally, program faculty should consider implementing quality assessments of IPCP experiences to assess the quality and degree to which learners experience interprofessional collaboration.

Addressing Race and Culture During Clinical Education Experiences

Abstract In 2022–2023, 27.7% of the students enrolled in Doctor of Physical Therapy programs identified as from a minoritized group, representing a 50% increase since 2015–2016 which is promising. However, students from racial/ethnic minoritized groups have additional barriers to overcome, such as isolation, exclusion, bias, and discrimination during clinical education experiences (CEE). Clinical educators may avoid conversations about race and culture due to decreased time, training, and comfort, and not wanting to “other” students from minoritized groups. However, talking about race and culture can increase trust and communication between learners and educators, decrease discrimination and stereotyping, and increase compassion and mutual understanding. The authors provide stepwise progression for educators to begin to prepare for addressing race/culture and supporting students from minoritized backgrounds during CEEs.

Knowledge, skills, and attitudes (KSAs) of adaptable academic nurse educators

AimUsing the Knowledge, Skills, and Attitudes (KSAs) framework, the aim of this study was to explore the specific knowledge, skills and attitudes of adaptable nurse educators to help inform the preparation of current and future educators for smooth transitions during periods of change. BackgroundExternal events, such as hurricanes, earthquakes, floods and wildfires can force programs to relocate and suspend classes for several days or weeks. These natural disasters have the potential to have a negative impact on the number of nursing students graduating on time as well as the quality of the clinical education experience and preparation for practice. Many lessons about educator adaptability can be learned from the COVID-19 restrictions. Identifying the KSAs of adaptable nurse educators during the rapidly changing educational landscape provided the opportunity for a foundational needs assessment to guide the preparation of educators for seamless transitions during times of change. DesignTo identify the KSA’s of adaptable nurse educators, an exploratory qualitative study using focus groups was conducted. The study used thematic analysis. MethodsThe research team developed, and pilot-tested focus group interview questions based on content areas identified in the literature. Targeted questions included queries specific to the KSAs necessary for adaptation and successful teaching using simulation. Educators from pre-licensure nursing programs in the United States participated in one of five 60-minute focus groups held virtually via a secure online meeting platform. ResultsAdaptable nurse educators have knowledge of resources, ongoing assessment, evaluation and teaching strategies and an understanding of the skillsets of their colleagues. Their skills include leadership, teamwork, redesigning learning and assessment. They demonstrate qualities such as resilience, empathy, acceptance, openness and positivity. ConclusionWith the current nursing workforce crisis, external events cannot be allowed to slow academic progression and graduation from nursing programs. In this exploratory qualitative study using focus groups, the KSAs held by adaptable nurse educators were explored. The findings of this study highlight the importance of collaboration and teamwork in academic institutes. The findings can be used as the foundation for nursing programs to prepare for future external events.

Public Attitudes Toward Ethics and Practices in End-of-Life Decision-Making for Neonates

Attitudes toward end-of-life decision-making in neonatology have been studied in physicians and other health care professionals and are mostly shaped by their clinical education and work experiences. In contrast, attitudes among the general public have not yet been investigated. To assess (1) attitudes in the general public toward euthanasia and withdrawal of life-prolonging treatment in neonates with severe life-limiting conditions, (2) knowledge of current German recommendations, and (3) values in the German society regarding ethical issues and proxy decisions at the beginning of life. This cross-sectional study was performed in Germany and used an exploratory design to analyze responses to an interview conducted by an independent, established commissioned polling institute in March and April 2022. Participants were 16 years or older, with German language fluency and comprehension and living in Germany. Knowledge about recommendations for euthanasia and withdrawal of life-prolonging treatment as well as personal attitudes toward (1) euthanasia and withdrawal of life-prolonging treatment and (2) surrogate end-of-life decision-making for newborn infants were assessed. The study included 2116 participants (1077 females [50.9%]; mean [SD] age 52.1 [18.7] years). Of the participants, 16.8% (311 of 1851) reported knowing the German recommendations for euthanasia and withdrawal of life-prolonging treatment for neonates. Euthanasia and withdrawal of life-prolonging treatment were supported by 64.7% (1369 of 2116) and 77.9% (1649 of 2116) of respondents, respectively. Shared decision-making between parents and physicians for neonates in end-of-life situations was supported by 65.6% of participants (1388). In situations where shared decision-making was not possible, 73.4% of respondents (1019 of 1388) put the ultimate decision to the parents. The magnitude of the associations was low between sociodemographic factors and views on ethical issues and customary practices involved in end-of-life decisions for neonates. Results of this cross-sectional study suggested that most respondents were not aware of the national German recommendations for euthanasia and withdrawal of life-prolonging treatment for sick and extremely preterm newborns. When counseling parents of periviable newborns, clinicians may need to exert more effort in explaining the legal and ethical framework; a highly individualized approach is warranted.

Nursing students’ clinical practice education experience during the COVID-19 pandemic: a qualitative study

BackgroundNursing education, including some elements of clinical practice, has largely been conducted online during the coronavirus disease 2019 (COVID-19) pandemic. Numerous studies have examined the experiences of nursing students in academia during the pandemic. However, research on nursing students’ clinical practice experiences is limited. This study aimed to analyze nursing students’ clinical practice experiences during the COVID-19 pandemic.MethodsThis study used a qualitative research design and performed thematic analysis. Participants comprised 13 nursing university students with clinical practice experience at a hospital during the COVID-19 pandemic. Interviews were conducted either online or face-to-face. Data were collected during June‒July 2021.ResultsFour themes and eight subthemes were generated through thematic analysis. Theme 1 was “Nursing students’ anxiety and strict adherence to quarantine practices,” with the subthemes of “Fear of infection” and “Protecting themselves.” Theme 2 was “Nursing students’ belief that their organization is protecting them,” with the subthemes of “Strict quarantine rules at hospitals and universities” and “The nursing students regretted the limited scope of practice but felt safe.” Theme 3 was “Learning through valuable practice,” with the subthemes of “Recognizing the importance of practice” and “Realizing the benefits of practice.” Theme 4 was “A sense of duty as a prospective nurse,” with the subthemes of “Accepting a sense of duty as a nurse” and “Establishing the expanded role of a nurse.”ConclusionsThe nursing students recognized the importance of nursing practice during the pandemic and worked harder. A better understanding of the experiences of nursing university students who completed their clinical practice during the COVID-19 pandemic can help nursing professors and managers more effectively train students during times of high stress.

Programmatic Efforts to Provide Progressively Autonomous Clinical Education Experiences

Context In previous research, athletic trainers (ATs) have identified the formal coursework and clinical experiences of their professional program as contributing to preparedness for autonomous practice. However, new graduates have reported a perceived lack of skills necessary for practicing autonomously. Objective The purpose of this study was to evaluate how programs provide progressively autonomous clinical education experiences and the role of these experiences in preparing future ATs. Design Qualitative study. Setting Virtual interviews. Patients or Other Participants A sample of 17 program administrators (program directors = 12, coordinators of clinical education = 5) representing 16 master of science in athletic training programs participated in this study. Main Outcome Measure(s) Each program completed a virtual interview guided by a semistructured interview protocol. A 3-person data analysis team identified emerging domains and categories through a multiphase approach. Member checking, multiple researcher triangulation, and auditing were used to establish trustworthiness. Results Four domains emerged from participant responses: (1) curricular design, (2) preparatory experience and outcomes, (3) preceptor role, and (4) assessments. We found that intentionality in curricular design to promote progressive autonomy was beneficial in facilitating transition to practice through improved knowledge, skills, and confidence. Due to the importance of clinical education in AT preparation, preceptors played a critical role in creating opportunities for learning in the clinical environment. However, the degree to which experiences were autonomous and the effectiveness of the student in those encounters were rarely measured. Limitations outlined by participants included accreditation and program length. Conclusions The development of knowledge, skills, and confidence through intentionally selected clinical experiences and guided by preceptor feedback are critical to establishing an autonomous practitioner. However, the program’s evaluations were predominantly traditional practice assessments and informal feedback, instead of an assessment of readiness for practice.

The clinical education experience of physical therapist students during the COVID-19 pandemic: a phenomenological study

Purpose: The purpose of this study was to explore the lived experience of physical therapist (PT) students participating in clinical education (CE) experiences during the COVID-19 pandemic. Methods: This qualitative study used an interpretive phenomenological analysis to explore the lived experiences of entry-level PT students enrolled in New York (NY) and New Jersey (NJ) PT educational programs in an effort to understand the unique experience of completing full-time CE experiences during the COVID-19 pandemic. Twelve students from accredited programs in New York and New Jersey who participated in a full-time CE experience during the COVID-19 pandemic were interviewed. Results: Four themes emerged: disruption in their academic education, altered CE experiences, emotional responses to these unanticipated disruptions, and their ability to adapt to these changes. Conclusion: The COVID-19 pandemic was an exceptionally disruptive experience. However, with support, understanding, and encouragement, students adapted to the disruptions created by this unpredictable clinical environment.

Use of learner-driven, formative, ad-hoc, prospective assessment of competence in physical therapist clinical education in the United States: a prospective cohort study

The purpose of this project was to implement a process for learner-driven, formative, prospective, ad-hoc, entrustment assessment in Doctor of Physical Therapy clinical education. Our goals were to develop an innovative entrustment assessment tool, and then explore whether the tool detected (1) differences between learners at different stages of development and (2) differences within learners across the course of a clinical education experience. We also investigated whether there was a relationship between the number of assessments and change in performance. A prospective, observational, cohort of clinical instructors (CIs) was recruited to perform learner-driven, formative, ad-hoc, prospective, entrustment assessments. Two entrustable professional activities (EPAs) were used: (1) gather a history and perform an examination and (2) implement and modify the plan of care, as needed. CIs provided a rating on the entrustment scale and provided narrative support for their rating. Forty-nine learners participated across 4 clinical experiences (CEs), resulting in 453 EPA learner-driven assessments. For both EPAs, statistically significant changes were detected both between learners at different stages of development and within learners across the course of a CE. Improvement within each CE was significantly related to the number of feedback opportunities. The results of this pilot study provide preliminary support for the use of learner-driven, formative, ad-hoc assessments of competence based on EPAs with a novel entrustment scale. The number of formative assessments requested correlated with change on the EPA scale, suggesting that formative feedback may augment performance improvement.

Identifying factors influencing orthodontic residency program selection.

The desirability of Orthodontic Residency remains high today relative to the past 30 years. This investigation seeks to re-assess factors influencing Orthodontic Residency program selection amidst contemporary challenges and changes, including increasing student debt, reduced residency stipends, and shifting practice models. This mixed-methods study consisted of interviews (qualitative) and surveys (quantitative). Fifteen final-year dental students and first-year orthodontic residents were interviewed one-on-one following a topic guide and then transcripts were analyzed using MAXQDA2022 to identify values, factors, and influences related to program selection and ranking. Qualitative findings and previous studies provided the basis for a survey distributed to residency applicants in 2020-22. Data were analyzed with bivariate and descriptive statistics with stratification by debt group. Interviews (N=15) elevated the importance of location, interview experience, program cost, and clinical education. Surveys (N=239) identified the most desirable factors for program selection: satisfied residents, strong clinical training with multiple techniques, good interview impressions, low cost, high patient numbers, a strong reputation, and good clinical facilities with new technology. Less desirable factors include programs that are hospital-based, certificate-only, research-intensive, and require considerable after-hours work. Clinical education and interview experiences are key for residency selection, consistent with prior studies, though program cost has grown in importance. Findings can help guide orthodontic programs in recruiting applicants and suggest a need to limit educational costs.

Exploring Ward Team Handoffs of Overnight Admissions: Key Lessons from Field Observations.

The diagnostic process is a dynamic, team-based activity that is an important aspect of ward rounds in teaching hospitals. However, few studies have examined how academicward teams operate in areas such as diagnosis in the handoff of overnight admissionsduring ward rounds. This study draws key lessons from team interactions in the handoff process during ward rounds. To describe how ward teams operate in the handoff of patients admitted overnight during ward rounds, and to characterize the role of the bedside patient evaluation in this context. A qualitative ethnographic approach using field observations and documentary analysis. Attendingphysicians, medical residents, and medical students on general medicine services in a single teaching hospital. Thirty-five hours of observations were undertaken over a 4-month period. We purposively approached a diverse group of attendings who cover a range of clinical teaching experience, and obtained informed consent from all ward team members and observed patients. Thirty patient handoffs were observed across 5 ward teams with 45 teammembers. We conducted thematic analysis of researcher field notes and electronic health record documents using social cognitive theories to characterize the dynamic interactions occurring in the real clinical environment. Teams spent less time during ward rounds on verifyinghistory and physical examination findings, performingbedside evaluations, and discussing differentialdiagnoses than other aspects (e.g., reviewing patientdata in conference rooms) in the team handoff process of overnight admissions. Several team-based approaches to diagnosis and bedside patient evaluationswere observed, including debriefing for learning and decision-making. This study highlights potential strengths and missed opportunities for teaching, learning, and engaging directly with patients in the ward team handoff of patients admitted overnight. These findings may inform curriculum development, faculty training, and patient safety research.

Motivators and barriers for rural community preceptors in teaching: A qualitative study.

Increasing challenges in recruiting and retaining community-based teaching physicians (e.g., community preceptors) call for a better understanding of motivators and barriers community preceptors perceive in their teaching role. Given the importance of medical school partnerships with community-based sites for student training, it is essential to understand the perspectives of community preceptors as teaching physicians in a context away from the medical school, such as rural, and the factors affecting their career choice to engage in teaching while practising medicine. We conducted semi-structured interviews with rural community preceptors and used open coding to conceptualise data and axial coding to connect codes into categories. We used the socio-cognitive career theory framework to organise categories into themes. Eleven rural community preceptors from two medical schools participated. Specialties included family medicine, internal medicine and paediatrics; clinical practice and teaching experience ranged from 3-36 and 2-29 years, respectively. Readiness for teaching ('self-efficacy') was pivotal in community preceptors' decision to teach and derived largely from vicarious learning from teaching attendings in medical school or residency; social persuasion and encouragement from clinical partners; and their accomplishments as practising physicians. However, limited faculty development, incomplete knowledge of expectations, disengagement from the medical school and lack of current mentors hindered their self-confidence. Teaching fulfilled their aspirations ('outcome expectations') to give back to the profession, but they felt undervalued and disconnected from other clinician educators. Teaching increased job satisfaction, but clinical workload, and financial impact impeded their goals for achieving excellence ('performance'). Self-efficacy was a pivotal motivator in rural community preceptors' decision to teach. Role models from early training inspired them to teach. Internal awards sustained teaching efforts. Future research should explore structural barriers influencing rural community preceptors' teaching experiences to better support their career choice to become medical educators.

The development of items for a physiotherapy clinical programme evaluation tool.

Evaluating a physiotherapy clinical education programme is challenging, given its complex and multidimensional nature, resulting in a paucity of research on the topic. The objective of our study, which was part of a larger study, was to identify items that could be included in a tool to evaluate a physiotherapy clinical education programme in South Africa. A qualitative study utilising focused group discussions including academics, clinical educators and clinicians was undertaken. A broad script that delved into clinical education experience was used. An inductive thematic content analysis using MaxQda version 2018.2 was undertaken; the data were coded, and similar foci were categorised and subcategorised. This process led to the identification of themes. Both triangulation of the data (member checks, field note comparison, observer reflection and verification of the data) and assuring the data's trustworthiness (credibility, dependability and confirmability) were undertaken. Fourteen focus group discussions were held countrywide. Three themes emerged from the data. A macro theme included all governance issues, a meso theme included all structural issues and a micro theme included all aspects related to clinical experience. The complex nature of clinical physiotherapy education and its diversity can be seen in these emerging themes. All the categories and subcategories making up these themes must now be considered in the next step of developing this tool. Quality assurance and minimal training standards may be ensured.

Clinical Placement Among Malaysian Nursing Students: What Are Their Challenges?

Introduction: Nursing is a theory-practice course that requires high-quality and effective clinical education experiences. Clinical placement is one of the most important parts of nursing education; that can be challenging, stressful, and causes unpredictable changes. However, studies describing the challenges during clinical placement faced by nursing students are scarce. This study aimed to explore the challenges of Malaysian nursing students during a clinical placement at hospitals. Methods: A phenomenology qualitative study was conducted among nursing students at a public university in Malaysia. A semi-structured interview was used to collect data from October 2020 until November 2020. All interviews were recorded, transcribed, and analysed using thematic analysis. Results: Five themes emerged from this study: 1) attitude of the nurse, 2) patient’s distrust, 3) student’s issues, 4) learning environment, and 5) theory-practice gaps. Conclusion: This study revealed that nursing students face many challenges during their clinical postings. Therefore, various methods could be applied to increase the quality of practical sessions. Additionally, further research is needed to assess the coping strategies used by nursing students in dealing with the challenges during their clinical placement and the effectiveness of the interventions taken by the authority in helping the students.

The evidence-based practice teaching competence of clinical preceptors at different stages of innovation-decision process: A cross-sectional survey in traditional Chinese medicine hospitals

BackgroundTraditional Chinese Medicine Nursing Clinical Preceptors (TCMN-CPs) are crucial to cultivate undergraduates' evidence-based practice (EBP) competence during clinical practicum in traditional Chinese Medicine (TCM) hospitals. However, the TCMN-CPs' EBP teaching competence is unclear. Underpinned by Rogers' innovation-decision process, our study aimed to investigate TCMN-CPs' EBP teaching competence and the related characteristic factors at five stages of knowledge, persuasion, decision, implementation and confirmation. MethodsAn online survey was conducted by using a modified evidence-based practice teaching competence questionnaire (EBPT-COQ) encompassing attitude, knowledge/skill and practice of EBP teaching in four TCM teaching hospitals in Beijing, China. ResultsA total of 654 TCMN-CPs were included, with a response rate of 91.47 %. Most TCMN-CPs were in knowledge stage (339, 51.83 %), followed by the persuasion stage (166, 25.38 %), decision stage (123, 18.81 %), implementation stage (23, 3.52 %) and confirmation stage (3, 0.46 %). The total and dimension scores of EBPT-COQ increased as the diffusion stage developing, the confirmation stage was the highest (5.48 ± 0.80). Twenty-three items' mean scores were higher than 4 points (95.83 %), except for “Research skills” (3.58 ± 1.38). The related characteristic factors were 1) age (Z = -4.177), working experience (H = 11.087), clinical teaching experience (H = 12.602), management position (Z = 2.565), research experience (Z = -2.867) and EBP training (Z = 3.146) at Knowledge stage; 2) research experience (ZPersuasion = −2.617; ZDecision = −3.510), EBP training (ZPersuasion = 2.528; ZDecision = 3.433) at Persuasion and Decision stage (all P<0.05). And the first three stages TCMN-CPs' EBPT-COQ scores were positively correlated with TCMN-CPs' attitude toward clinical teaching (r = 0.244–0.331, P<0.001). ConclusionsMost of the TCMN-CPs' EBP teaching status are in the first three diffusion stages. Though their attitude, knowledge/skills and practice to EBP teaching competence have gradually improved with the deepening of the diffusion stage, much efforts should be made to keep progressing. TCMN-CPs' qualifications of EBP teaching could include rich clinical work and teaching experience, enjoying teaching. Nursing managers, with higher EBP teaching competence, might play a crucial role in promoting the diffusion of EBP teaching. All TCMN-CPs showed an inadequacy of research skills of EBP teaching. Therefore, it is warranted to explore the minimum research skill requirements for EBP teaching and to establish academic-practice partnerships.

Examination of depth of written reflective practice for speech-language therapy students; the impact of time and clinical competency

ABSTRACT Written reflective practice (WRP) is a teaching and learning activity utilized in clinical programmes. Identifying depth of WRP aims to provide an overall rating of students’ written reflective abilities. Engaging in reflective activities has been proposed to have a positive relationship with clinical competency. Aims: 1. To examine the impact of time on depth of WRP for SLT students across and within each year group of the SLT clinical programme. 2. To determine whether a relationship exists between depth of WRP and clinical competency of SLT students. Methods: Participants were 77 undergraduate SLT students (first, second or final professional year) in the clinical programme. Participants wrote reflections as part of their clinical education experiences. Depth of WRP was measured utilizing a modification of Plack et al.’s [2005. A method for assessing reflective journal writing. Journal of Allied Health, 34(4), 199–208] coding schema. This was completed at four time points across the academic year for each professional year. Level of clinical competency was assessed using the Competency Assessment in Speech Pathology (COMPASS®) at the end of both semesters. Results: There was a statistically significant association between time and development of depth of WRP for students in their final professional year (β = .66 (.30), z = 2.22, p < .05). There was no association between depth of WRP and level of clinical competency. Conclusion: A one-off judgement of WRP depth may be useful for supporting overall judgements of RP ability and provide observable behaviours for competency assessments. This research contributes to the evidence base examining how WRP is assessed and utilized in clinical programmes.

Mentoring the mentor: Developing clinical instructor cross-cultural psychological capital to support culturally/linguistically diverse DPT students

Rationale: Cultural and social isolation, microaggressions, and few culturally and linguistically diverse (CLD) mentors contribute to a lack of belonging on clinical education experiences (CEEs) for CLD Doctor of Physical Therapy students. The purpose was to investigate whether a multiple mentor model including a CLD learner, their clinical instructor (CI), and CLD mentor could develop CI cross-cultural psychological capital (CC PsyCap) and mentoring skills to support CLD learners on CEEs. Methods: Three CLD learners and their CIs were each matched with a CLD mentor. CIs completed online cross-cultural mentor training and met with the CLD student and mentor four times during the 10-week CEE. CIs completed the CC PsyCap survey to measure changes in CI cross-cultural self-efficacy before and after the CEE. Interview data from participants were thematically analyzed. Results: All CIs demonstrated an increase in CC PsyCap scores over the study period. CIs gained insight into the unique needs of CLD learners, often subjected to bias and discrimination, and developed strategies to proactively support learners. CLD learners faced challenges related to race in the CEE and pressure to assimilate. They valued CLD mentors who role-modeled persistence and success and CIs who celebrated diversity and created a welcoming environment. Clinical relevance: CIs play an important role in mentoring CLD learners on CEEs. This study highlighted that CI CC PsyCap can be developed through mentoring and coaching from CLD mentors, ultimately increasing support for CLD learners on CEEs.