Final-year Physiotherapy Students Research Articles

Physiotherapy students’ perceptions of engagement with people from culturally and linguistically diverse communities during clinical placement

Introduction: Student physiotherapists’ perceptions and experiences when working with people from culturally and linguistically diverse communities in Australia have not been explored. Understanding the perceptions of student physiotherapists in this context may inform educational experiences in the pursuit of culturally responsive care. Therefore, this paper explores the perceptions and experiences of student physiotherapists engaging with people from culturally and linguistically diverse communities during clinical placement. Methods: Semi-structured telephone interviews (n = 13) were conducted between March and September 2022 with final-year physiotherapy students from a single cohort at a single tertiary institution. Data were subject to reflexive thematic analysis. Results: Four themes were generated from the data: 1) culture is a challenge for all stakeholders in health, 2) adapting care and communication, 3) modelling from clinical educators and 4) university preparation. Students understood that culture significantly impacts health and that healthcare must be responsive to culture to be appropriate for a person from a culturally and linguistically diverse community. Understanding and being responsive to the unique attitudes, values and beliefs of each individual underpinned student physiotherapists’ perception of how healthcare can be culturally responsive, and this was viewed as a pivotal principle of person-centred care. Conclusion: Recommendations are made for stakeholders in physiotherapy clinical education to support opportunities for the development of cultural responsivity during physiotherapy training. University educators are encouraged to consider evaluating the volume and method in which cultural responsivity training is included in physiotherapy programs. Similarly, clinical educators are encouraged to integrate available frameworks for culturally safe practice that are appropriate to their setting of work.

Investigating the Effects of Simulation-Based Teaching on Learning Domains Designed for Physiotherapy Students

Introduction: Simulation-based teaching is a technique for imitating a situation’s behavior or process via a suitable analog situation for training or teaching purposes. Simulation-based teaching is widely used in various domains; however, there is limited literature on evaluating the role of simulated-based teaching in physiotherapy. This study investigates the effect of simulation-based teaching on learning domains for traumatic brain injury topics framed for final-year physiotherapy students.
 Materials and Methods: A total of 51 final-year physiotherapy students were randomly selected and allocated into two groups. Group A (n=25) includes didactic with PowerPoint presentation teaching session. Group B (n=26) includes simulated-based teaching sessions. There were eight simulators selected and trained for the Ranchos Los Amigos stages. The students were assessed using a self-designed pre-post multiple-choice questions (MCQ) test for knowledge and a clinical evaluation exercise for affective and psychomotor skills.
 Results: This study showed that group B significantly improved in the pre-post self-made MCQ test (t=17.34, P=0.00), and in the clinical evaluation exercise, group B performed 43.66% better than group A.
 Conclusion: The study concludes that simulation-based teaching significantly improves cognitive, affective, and psychomotor skills compared to traditional methods for traumatic brain injury topics framed for final-year physiotherapy students.

The Influence of Stress on Student Performance during Simulation-based Learning: A Pilot Randomized Trial.

Simulation-based learning is an important educational medium that is being implemented increasingly for the purpose of improved patient care and safety. However, there is evidence to suggest that simulation-based education (SBE) may increase anxiety, as illustrated through self-reporting and physiological responses. Despite such data, no studies have investigated whether anxiety and stress can be manipulated through SBE scenario design and delivery to facilitate optimal learning conditions. This pilot study examined perceived anxiety and physiological stress experienced by entry-level physiotherapy students while learning a skill using SBE and the relationship between this anxiety and their subsequent skill performance. Final-year physiotherapy students were randomly allocated to one of three SBE experiences: low, medium, or high stress. The experiences were designed to induce increasing levels of stress and anxiety. Performance of the learned skill (endotracheal airway suctioning) was measured after the SBE using a bespoke assessment form. Cortisol levels, heart rate, and perceived anxiety measurements (State-Trait Anxiety Inventory and visual analog scale) were also collected. Twenty-seven participants completed the trial. There were significant differences in perceived stress and physiological response between the groups. The low-stress group demonstrated significantly better performance of airway suctioning than the higher-stress groups (P = 0.02). Higher anxiety was correlated with poorer skill performance (r = -0.410). Students report SBE to be stressful, and scenarios themselves can influence the stress and anxiety experienced. Greater stress is associated with poor learning outcomes during SBE. Healthcare educators involved in SBE scenario design need to consider the stress levels experienced. Future research to determine optimal stress and embed measurement of stress in SBE experiences is warranted.

Perceptions of Physiotherapy students about their teaching environment at Kamuzu University of Health Sciences in Malawi.

The learning environment is defined as an environment where teaching is taking place, as perceived by both students and teachers. A conducive learning environment is critical for successful curriculum implementation, which also affects students' academic performance. There have been initiatives introduced to improve the learning environment at Kamuzu University of Health Sciences (KUHeS). The purpose of this study was to ascertain physiotherapy final year students' perceptions of their learning environment at KUHeS in Malawi. This study was conducted at KUHeS among final-year physiotherapy students. A retrospective, quantitative cross-sectional design was used. The study utilised secondary data on education environment which had already been collected using Dundee Ready Education Environment Measure (DREEM) forms. There were 26 completed DREEM forms for 2019/2020 academic year. Demographic data were captured. Mean and standard deviation were used to analyse the DREEM scores. Inferential analysis was conducted with p-value set at ≤ 0.05. The total DREEM mean score was 120/200 which represented a positive perception of students learning environment. Students' academic self-perception scored the highest (69.13%), followed by students' perception of learning (61.94%), students' social self-perception (59.46%), students' perception of atmosphere (56.25), and students' perception of teachers (55.50%). Married students had negative perceptions (p-value = 0.05) of their teachers and students with previous college experience had positive perceptions of their academic performance (p-value = 0.02). Many statements under items of perception of teachers (mean score = 24) and social self-perceptions (mean score = 16) were considered negatively. Students in their final year of physiotherapy had positive perceptions of their learning environment. However, students' perceptions of their teachers and social life were low. The learning environment had a significant impact on married students and those who had no prior experience with college life. Faculty development initiatives should aim to improve these critical areas.

Disability prevalence: comparing four types of disability measures in the community

BackgroundThere is no general consensus on how to measure disability and disability prevalence rates. The results of previous estimates could not be compared due to the varied nature of the methodologies used and the lack of standardization in the measurement of disability. The primary objective of the study was to estimate the prevalence of disability using a population-based disability survey and questions selected by the National Center for Promotion of Employment for Disabled People (NCPEDP). The secondary objective is to determine whether there was any relationship between the severity of disability and essential sociodemographic factors.The survey was carried out in the Indian state of Gujarat’s Piplag village. Eight final-year physiotherapy students gathered sociodemographic data and answers to the four disability-related questions—disability question asked in India census 2011, Washington Group (WG)-suggested question, United Nations Convention on the Rights of Persons with Disabilities (UNCRPD)-based question, and National Sample Survey Organization (NSSO)-based question.ResultsA greater percentage of the population was classified as having a functional limitation in the questions based on the UNCRPD (28.29%) (95% CI 25.1–31.3%) and the WG (29.69%) (95% CI 26.0–34.4%). Our findings demonstrated that there were significant relationships between the questions in different questionnaires (p < 0.01). Female gender strongly influences how people self-identify as having a disability (by 5.7 to 12.07 times), and the predictor variables based on the Indian census 2011 questions explained 61.7% of the variation in prevalence of disability.ConclusionsThe prevalence statistics may vary based on the questions used to gather information about disabilities. As gender and socioeconomic status can impact the prevalence of disabilities, it is important to focus on ways to improve economic growth, especially for women.

Active digital pedagogies as a substitute for clinical placement during the COVID-19 pandemic: the case of physiotherapy education

BackgroundIn March 2020, campuses at Norwegian academic institutions were closed due to the COVID-19 pandemic. All in-person teaching had to be replaced by digital alternatives. The closure also affected clinical placements in physiotherapy programs, which in some cases had to be replaced by online alternatives without patient contact. The aim of this study is to evaluate the benefits and challenges of using digital pedagogies to accomplish the learning outcomes of clinical placements.MethodsForty-four final-year physiotherapy students at Oslo Metropolitan University had their clinical placement substituted by an online alternative centered around two main educational activities conducted online in small groups: 1) clinical case seminars and 2) digital lectures followed by webinars where students discussed and solved tasks related to the lectures. Additionally, as a part of this alternative placement, students had to conduct a physiotherapy assessment of a family member/housemate and summarize the findings in an anonymized medical record. At the end of the placement, all students wrote a short essay reflecting on their learning process. Students’ written reflections were anonymized and subjected to a qualitative analysis.ResultsForty-three out of 44 participating students completed their essays. Although students expressed disappointment in missing out on clinical placement, they were surprised by how much learning the online alternative provided. The most valued activities were clinical case seminars where clinical cases previously experienced by the students were discussed. The seminars appeared to facilitate students’ engagement in professional discussions and to enhance their clinical reasoning skills. Seminars also seemed to strengthen students’ belief in their own and their fellow students’ capabilities. Group discussions focusing on topics related to digital lectures were also appreciated. Interestingly, the activity that most closely mimicked a clinical setting – physiotherapy assessment of family member/housemate – was rarely mentioned in the students’ essays. As expected, students most regret not meeting real patients and missing out on the new clinical experiences such encounters would provide.ConclusionsDespite lack of direct patient contact, students in physiotherapy education evaluated that an online alternative placement was highly clinically relevant. Peer-to-peer discussions of clinical cases appeared to be especially valued. The fact that students themselves had to take the main responsibility for preparing the seminars and leading the discussions was an important pedagogical aspect of the online alternative. The findings indicate that in learning of clinical skills, physiotherapy students take benefit of autonomous, student-centered interventions. Further research should investigate how digital technology-enhanced learning can be used to improve quality of ordinary clinical placement, in physiotherapy- and health education.

Impact of palliative care training on knowledge, beliefs, and attitudes of undergraduate physiotherapy students: A pilot study

Background: In palliative care settings, patient comes with multiple symptoms. Hence, an interdisciplinary team is needed for effective management with physiotherapists being an essential part of the team. The level of knowledge, exposure, and practice in palliative care settings influence the extent of team participation and quality of care provided by the physiotherapy professionals. To the best of our knowledge, palliative care is not included in the undergraduate curriculum of physiotherapy in India till now. Hence, it is necessary to add palliative care to the undergraduate curriculum of physiotherapy students. Aim: The aim of this study was to evaluate the effect of education regarding palliative care on knowledge, beliefs, and attitudes of final-year physiotherapy studentsMaterials and Methods: Final-year physiotherapy students were recruited according to the exclusion and inclusion criteria after taking ethical approval from the university’s ethical committee. They are provided with three educational sessions regarding palliative care. They were made to fill all the questionnaires (i.e., Knowledge questionnaire, FATCOD-B Scale, and Belief questionnaire) before and after the completion of the educational program. Data analysis: Data were assessed by the Shapiro–Wilk test for normality and paired t test was used for comparing before- and after-session scores. The significance level was set at P < 0.05. Results: After taking educational sessions there is an enhancement in the level of knowledge (pre-session 9.65 ± 2.10 and post-session 16.59 ± 1.81), development of more positive attitudes (pre-session score 87.50 ± 7.29 and post-session score 118.94 ± 7.56), and amplification in the belief system of the subjects towards palliative care (pre-session score 3.56 ± 0.613 and post-session score4.91 ± 0.29) at significance level P < 0.05. Conclusion: Palliative care educational program had positively influenced the subjects by bringing about statistically significant changes in the level of knowledge, positive attitudes, and beliefs. Palliative care education must be added to the curriculum of physiotherapy undergraduate courses because of the necessity in society, and the upgradation of the physiotherapy profession.

The role and preparedness of physiotherapists according to the results of students of two universities in the prevention of chronic diseases using stress urinary incontinence in women as an example

Background: The health and financial burden imposed by chronic non-communicable diseases is expected to increase in parallel with the rapid rate of global population aging. Stress urinary incontinence (SUI) is an important health problem. Medical professionals should thus provide their patients with knowledge about the appropriate prevention and treatment of chronic diseases, including SUI. Aim of the study: This study compared the level of knowledge concerning the risk factors, prevention, and treatment of SUI in women between physiotherapy graduates at two different Universities with a focus on medicine (Med) and physical education (PE). Material and Methods: This study included final-year physiotherapy students (n=401). Respondents provided answers to open-ended questions used to measure their knowledge about SUI in women. Results: The complete and correct definition of SUI was provided by 64.4% of the students at University Med, and 56.3% of the students at University PE. Students at University Med, in comparison with the students at University PE, had a significantly higher awareness of the risk factors (86.4% vs. 69.4%), prevention methods (85.6% vs. 68.7%), and conservative (92.4% vs. 77.8%) as well as surgical treatment (28.0% vs 6.7%) of SUI in women (p&lt;0.001). Conclusions: There is a need for greater emphasis on education about SUI in order to better prepare physiotherapy graduate students to provide optimal care to their female patients. The disciplinary focus of Universities that provide graduate programs in physiotherapy plays a significant role in gaining knowledge about SUI.

Grit, resilience and mindset in health students.

Grit, resilience and a growth mindset are personal traits conducive to optimal learning and clinical readiness. These are important traits to consider with regards to whether a student thrives or struggles in challenging situations. Research with medical, nursing and pharmacy students demonstrates correlations of these traits with positive well-being and academic success. No research has investigated the traits of resilience, grit and mindset type together in health professional students to explore whether they are related, and none have focused on physiotherapy students. Cross-sectional study of final-year physiotherapy students (n=134) aiming to describe the levels of these personal traits and to determine whether they are related to each other or demographic factors. A proportion of physiotherapy students have low levels of resilience (25%), low academic resilience (19%) and low levels of grittiness (13%). Grit and resilience were positively related (p<0.001). A smaller fraction of students had a fixed mindset in relation to intelligence (7%) and talent (10%). Having a mental health condition or disability and the number of hours spent in paid employment were related to personal traits. This is the first study to document empirical evidence of physiotherapy students' levels of grit, resilience and mindset type with a significant proportion of students having low levels of these attributes. Results have implications for clinical educators and universities seeking to improve student well-being in order to facilitate effective learning. Institutions need to consider best-practice approaches to managing and supporting these students to foster well-being for effective learning.

Multi-level reform is required to support high-value osteoarthritis care delivery: outcomes of a multinational survey of clinicians and students

Purpose: Evidence-practice gaps in osteoarthritis (OA) care are commonly observed, particularly in primary care settings, resulting in many people receiving low-value care. Building workforce capacity to deliver high-value OA care requires a contemporary understanding of barriers to care delivery at multiple levels: at micro (clinical practice and training), meso (service/organisational), and macro (health system) levels. We aimed to explore factors related to OA care delivery across these levels from the perspectives of clinicians and final-year students. Methods: A cross-sectional study sampling clinicians (physiotherapists, primary care nurses, general practitioners (GPs), GP registrars; total possible denominator: n=119,735) and final-year physiotherapy and medical students (denominator: n=2,215) was undertaken across Australia, New Zealand and Canada in 2017. Respondents answered a survey consisting of customised and standard items requiring nominal and free-text responses, from which quantitative and qualitative data, respectively, were derived. At the micro-level we evaluated intrinsic factors (self-perceived confidence in OA knowledge and clinical skills, attitudes towards musculoskeletal pain (measured with Pain Attitudes Beliefs Scale (PABS)), attitudes towards high- and low-value OA care approaches, and the extent to which personal knowledge/skills were barriers to care) and extrinsic factors (use of guidelines in practice and patient-related factors). At the meso-level we explored workplace/clinical placement factors, and at the macro-level, health system factors, as potential barriers to high-value OA care delivery. Quantitative data were analysed using frequency statistics and Bonferroni-corrected general linear models. Content analysis was used to analyse and synthesise qualitative data. Results: 1,886 clinicians (1380 physiotherapists, 158 nurses, 267 GPs, 81 GP registrars) and 1,161 students (465 medical, 696 physiotherapy) responded. At the micro-level, self-rated confidence in OA knowledge and skills was significantly greater in physiotherapists compared to GPs, GP registrars and nurses; in GPs compared to nurses and GP registrars; and in GP registrars compared to nurses. Students’ confidence scores were not different. Biomedical treatment attitudes measured with the PABS were significantly greater in nurses compared to physiotherapists, GPs, and GP registrars; in GPs compared to physiotherapists; in GP registrars compared to physiotherapists and GPs; and in medical students compared to physiotherapy students (Table 1). Some clinicians and students agreed that people with OA ultimately require total joint replacement (7-19% and 19-22%, respectively); that arthroscopy is an appropriate intervention for knee OA (18-36% and 35-44%) and that MRI is informative for diagnosis and clinical management of hip/knee OA (8-61% and 21-52%). Most agreed (90-98% and 92-97%) that exercise is indicated irrespective of the stage of OA. Knowledge and skills gaps were identified as applicable barriers to care delivery by 37-88% of clinicians and 68-85% of students. Meta-synthesis of qualitative data highlighted skills gaps in: specific components of OA care; assessment, measurement and monitoring; tailoring care; managing case complexity; and translating knowledge to practice, especially among students. Extrinsically, patient-related factors and use of guidelines in practice were identified as applicable barriers to care by 49-85% and 14-59% of clinicians, respectively, and 61-71% and 23-53%, respectively, of students. At the meso (workplace)-level, 29-62% of clinicians and 22-51% of students cited barriers to care and qualitative data identified general infrastructure limitations (particularly community facilities) and inconsistent care as the most significant meso-level factors. At the macro (health system)-level, 48-70% of clinicians and 34-37% of students cited barriers to care. Qualitative data identified financing models and time pressures as relevant factors at the macro level. Overall, health system (macro) and patient-related factors (micro) were the most applicable barriers to OA care delivery for clinicians, whereas for students, personal knowledge and skills (micro) and patient-related factors (micro) were the most applicable (Figure 1). Conclusions: Clinicians and students perceived varied barriers to the delivery of high-value care for OA. Improvement strategies therefore need to be directed at all three levels, with a particular focus on closing knowledge and skills gaps at the micro-level and reforming financing models at the macro level.Table 1Summary measures of confidence and attitudes outcomes, reported as mean (SD).OutcomePhysiotherapistsPrimary care nursesGeneral practitionersGeneral practitioner registrarsMedical studentsPhysiotherapy studentsConfidence in OA knowledge [possible score range: 11-55]38.9 (7.0)asignificantly different to all clinical disciplines (p<0.05)29.6 (7.8)asignificantly different to all clinical disciplines (p<0.05)36.8 (6.2)asignificantly different to all clinical disciplines (p<0.05)33.9 (6.1)asignificantly different to all clinical disciplines (p<0.05)34.6 (6.1)35.1 (6.0)Confidence in OA skills [possible score range: 16-80]59.6 (10.2)asignificantly different to all clinical disciplines (p<0.05)45.0 (11.4)asignificantly different to all clinical disciplines (p<0.05)57.2 (8.9)asignificantly different to all clinical disciplines (p<0.05)53.6 (8.7)asignificantly different to all clinical disciplines (p<0.05)54.2 (9.1)53.2 (8.9)PABS-biomed [possible score range: 10-60]28.0 (6.8)asignificantly different to all clinical disciplines (p<0.05)34.9 (5.5)asignificantly different to all clinical disciplines (p<0.05)29.4 (6.0)asignificantly different to all clinical disciplines (p<0.05)32.2 (5.3)asignificantly different to all clinical disciplines (p<0.05)33.4 (5.5)bsignificant difference between student group31.4 (5.8)bsignificant difference between student groupa significantly different to all clinical disciplines (p<0.05)b significant difference between student group Open table in a new tab

Health professionals and students encounter multi-level barriers to implementing high-value osteoarthritis care: a multi-national study

Consistent evidence-practice gaps in osteoarthritis (OA) care are observed in primary care settings globally. Building workforce capacity to deliver high-value care requires a contemporary understanding of barriers to care delivery. We aimed to explore barriers to OA care delivery among clinicians and students. A cross-sectional, multinational study sampling clinicians (physiotherapists, primary care nurses, general practitioners (GPs), GP registrars; total possible denominator: n=119,735) and final-year physiotherapy and medical students (denominator: n=2,215) across Australia, New Zealand and Canada. Respondents answered a survey, aligned to contemporary implementation science domains, which measured barriers to OA care using categorical and free-text responses. 1886 clinicians and 1611 students responded. Items within the domains 'health system' and 'patient-related factors' represented the most applicable barriers experienced by clinicians (25-42% and 20-36%, respectively), whereas for students, 'knowledge and skills' and 'patient-related factors' (16-24% and 19-28%, respectively) were the most applicable domains. Meta-synthesis of qualitative data highlighted skills gaps in specific components of OA care (tailoring exercise, nutritional/overweight management and supporting positive behaviour change); assessment, measurement and monitoring; tailoring care; managing case complexity; and translating knowledge to practice (especially among students). Other barriers included general infrastructure limitations (particularly related to community facilities); patient-related factors (e.g., beliefs and compliance); workforce-related factors such as inconsistent care and a general knowledge gap in high-value care; and system and service-level factors relating to financing and time pressures, respectively. Clinicians and students encounter barriers to delivery of high-value OA care in clinical practice/training (micro-level); within service environments (meso-level); and within the health system (macro-level).

Criterion scores, construct validity and reliability of a web-based instrument to assess physiotherapists' clinical reasoning focused on behaviour change: 'Reasoning 4 Change'.

Background and aim: ‘Reasoning 4 Change’ (R4C) is a newly developed instrument, including four domains (D1–D4), to assess clinical practitioners' and students' clinical reasoning with a focus on clients' behaviour change in a physiotherapy context. To establish its use in education and research, its psychometric properties needed to be evaluated. The aim of the study was to generate criterion scores and evaluate the reliability and construct validity of a web-based version of the R4C instrument. Methods: Fourteen physiotherapy experts and 39 final-year physiotherapy students completed the R4C instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists (PABS-PT). Twelve experts and 17 students completed the R4C instrument on a second occasion. The R4C instrument was evaluated with regard to: internal consistency (five subscales of D1); test-retest reliability (D1–D4); inter-rater reliability (D2–D4); and construct validity in terms of convergent validity (D1.4, D2, D4). Criterion scores were generated based on the experts' responses to identify the scores of qualified practitioners' clinical reasoning abilities. Results: For the expert and student samples, the analyses demonstrated satisfactory internal consistency (α range: 0.67–0.91), satisfactory test-retest reliability (ICC range: 0.46–0.94) except for D3 for the experts and D4 for the students. The inter-rater reliability demonstrated excellent agreement within the expert group (ICC range: 0.94–1.0). The correlations between the R4C instrument and PABS-PT (r range: 0.06–0.76) supported acceptable construct validity. Conclusions: The web-based R4C instrument shows satisfactory psychometric properties and could be useful in education and research. The use of the instrument may contribute to a deeper understanding of physiotherapists' and students' clinical reasoning, valuable for curriculum development and improvements of competencies in clinical reasoning related to clients' behavioural change.

Persistent Pain: Physiotherapy Student Experiences of Person-Centred Care in Musculoskeletal Outpatient Departments

Person-centred care is championed throughout healthcare and emphasised in the management of persistent pain. Research reports that physiotherapists and physiotherapy students have struggled to integrate person-centred care into their practice and clinical work with people experiencing persistent pain. The aim of the study was to explore physiotherapy students’ experiences of person-centred care with people with persistent pain in a musculoskeletal outpatients’ placement setting, and to understand what affects physiotherapy students’ ability to implement person-centred practice. An interpretive qualitative method was used with data being collected by semi-structured focus groups of a purposive sample of undergraduate final-year physiotherapy students. A thematic approach to data analysis was completed using a cyclical immersive process. Three themes emerged: understanding of person-centred care, learning, and influences on clinical practice. The students showed an understanding of person-centred care in line with current literature. Person-centred care was generally deemed ‘well taught’ at university however this did not translate into their practice in a placement setting. Several factors influenced their ability to implement person-centred care, and this impacted upon their learning and their management of people presenting with persistent pain. In conclusion, physiotherapy students struggled to integrate learning of person-centred care from university into their practice on a musculoskeletal outpatient’s placement. It is recommended that physiotherapy course teams consider their curricula so that university and placement teaching facilitate person-centred learning and improve the management of persistent pain.

Perspectives of Canadian Final-Year Physiotherapy Students on Cardiorespiratory Physiotherapy as a Career Choice.

Purpose: To investigate the opinions of final-year Canadian physiotherapy students of cardiorespiratory physiotherapy (CRP) and the factors influencing their decision about whether to pursue a career in CRP. Methods: A cross-sectional online survey was completed by final-year Master of Science of Physical Therapy students from three of the largest English-speaking physiotherapy schools in Canada. Results: A total of 120 students responded to the survey (overall response rate was 44%). Fifteen students (12.5%) responded that they were extremely or quite interested in specializing in CRP. The most common factors that positively influenced students' decision to consider specializing in CRP were job accessibility, potential salary, and experiences in the area, and the most common factors that negatively influenced their decision were the clinical aspects of the area, their experiences in the area, job accessibility, and the influence of others. The most common factors that positively influenced students' opinion of CRP were their clinical supervisor, educator, or lecturer; their own clinical experience; and evidence in the literature, and the most common factors that negatively influenced their opinion were their own clinical experience and their peers. Conclusion: Strategies focusing on increasing awareness of the role of physiotherapists in the care of patients with cardiorespiratory conditions, exposing students to the positive impact that physiotherapists have in this practice area, and good mentorship experiences may promote the attractiveness of this specialty.

Standing on the Precipice: Evaluating Final-Year Physiotherapy Students' Perspectives of Their Curriculum as Preparation for Primary Health Care Practice.

Purpose: To explore final-year physiotherapy students' perceptions of primary health care practice to determine (1) aspects of their curriculum that support their learning, (2) deficiencies in their curriculum, and (3) areas that they believe should be changed to adequately equip them to make the transition from student to primary health care professional. Methods: Framework analysis methodology was used to analyze group opinion obtained using structured group feedback sessions. Sixty-eight final-year physiotherapy students from the four higher education institutions in Ireland participated. Results: The students identified several key areas that (1) supported their learning (exposure to evidence-based practice, opportunities to practise with problem-based learning, and interdisciplinary learning experiences); (2) were deficient (primary health care placements, additional active learning sessions, and further education and practice opportunities for communication and health promotion), and (3) required change (practice placements in primary health care, better curriculum organization to accommodate primary health care throughout the programme with the suggestion of a specific primary health care module). Conclusion: This study provides important insights into physiotherapy students' perceptions of primary health care. It also provides important indicators of the curriculum changes needed to increase graduates' confidence in their ability to take up employment in primary health care.

Home-based rehabilitation: Physiotherapy student and client perspectives

Background . Home-based rehabilitation (HBR) in under-resourced areas in a primary healthcare (PHC) context exposes students to the real-life situations of their clients. There is a scarcity of literature on student and client experiences of HBR in the physiotherapy context. Increased knowledge of HBR could result in an enhanced experience for both student and client. This study sought to discover the perceptions of final-year physiotherapy students and their clients relating to their experiences of HBR during a PHC placement in a resource-constrained setting. Objectives . To explore the experiences and perceptions of physiotherapy students and their clients regarding HBR as part of clinical training in resource-constrained settings. To discover the barriers to and facilitators of effective HBR. Methods . An exploratory case study was performed. A qualitative phenomenological research design in the interpretivist paradigm was used. Semistructured interviews were conducted with clients (n=7) living in an under-resourced setting, who had received HBR from physiotherapy students. Paired interviews were conducted with final-year physiotherapy students (n=6) after their HBR placement. Results . Clients appreciated the students’ services; however, data revealed communication barriers and unmet expectations. Students reported struggling to adapt to the context, resulting in interventions not being sufficiently client-centred. They voiced a need for language competency and earlier exposure to such contexts. Conclusion . Exposure to real-life situations in under-resourced settings in HBR provides valuable situated and authentic learning opportunities for physiotherapy students. The experience can be useful in preparing graduates to address the needs of the populations they serve during community service.

Using video-reflexive ethnography and simulation-based education to explore patient management and error recognition by pre-registration physiotherapists.

BackgroundUpon graduation, physiotherapists are required to manage clinical caseloads involving deteriorating patients with complex conditions. In particular, emergency on-call physiotherapists are required to provide respiratory/cardio-respiratory/cardiothoracic physiotherapy, out of normal working hours, without senior physiotherapist support. To optimise patient safety, physiotherapists are required to function within complex clinical environments, drawing on their knowledge and skills (technical and non-technical), maintaining situational awareness and filtering unwanted stimuli from the environment. Prior to this study, the extent to which final-year physiotherapy students were able to manage an acutely deteriorating patient in a simulation context and recognise errors in their own practice was unknown.MethodsA focused video-reflexive ethnography study was undertaken to explore behaviours, error recognition abilities and personal experiences of 21 final-year (pre-registration) physiotherapy students from one higher education institution. Social constructivism and complexity theoretical perspectives informed the methodological design of the study. Video and thematic analysis of 12 simulation scenarios and video-reflexive interviews were undertaken.ResultsParticipants worked within the professional standards of physiotherapy practice expected of entry-level physiotherapists. Students reflected appropriate responses to their own and others’ actions in the midst of uncertainty of the situation and physiological disturbances that unfolded during the scenario. However, they demonstrated a limited independent ability to recognise errors. Latent errors, active failures, error-producing factors and a series of effective defences to mitigate errors were identified through video analysis. Perceived influential factors affecting student performance within the scenario were attributed to aspects of academic and placement learning and the completion of a voluntary acute illness management course. The perceived value of the simulation scenario was enhanced by the opportunity to review their own simulation video with realism afforded by the scenario design.ConclusionsThis study presents a unique insight into the experiences, skills, attitudes, behaviours and error recognition abilities of pre-registration physiotherapy students managing an acutely deteriorating patient in a simulation context. Findings of this research provide valuable insights to inform future research regarding physiotherapy practice, integration of educational methods to augment patient safety awareness and participant-led innovations in safe healthcare practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s41077-016-0010-5) contains supplementary material, which is available to authorized users.

Conscious seeing: A description of a reflective framework used with final-year Swedish physiotherapy students in the context of international clinical placements

This paper describes a reflective framework that aims to support physiotherapy students participating in new cultural contexts to develop their personal and professional learning, and their reflective skills. The framework was used by eight Swedish physiotherapy students who did international clinical placements in Thailand and Mexico. This was done as part of their bachelor's thesis projects. The data generated from the reflective process was analysed by the students using Interpretive Phenomenological Analysis. The outcome demonstrated that this structured approach to reflection facilitated the students’ reflective processes and led to perceived personal and professional insight, increased cultural appreciation and a greater appreciation for reflection. This framework can be a useful tool to support students’ reflection processes in new cultural contexts. It is presented for further testing and development, such as in intercultural contexts in the home country, and by physiotherapy teachers and clinical supervisors.

Physiotherapy students’ experiences of bullying on clinical internships: a qualitative study

ObjectivesTo consider the experiences of final-year physiotherapy students who have experienced workplace bullying on a clinical internship. DesignQualitative methodology using individual semi-structured interviews. SettingA university in the Midlands region of the UK. ParticipantsEight undergraduate physiotherapy students who had experienced one incident of bullying on a clinical internship. Main outcome measuresThematic analysis of semi-structured interviews. ResultsFour main themes were identified: (1) external and situational influences of bullying; (2) students’ reactions to the experience of bullying; (3) inability to reveal the experience; and (4) overcoming problems. Bullying had a range of adverse effects on the students, with many expressing self-doubt in their competence and viewing their supervisor as unapproachable and unsupportive. Five students were not initially able to recognise the experience as bullying. In addition, students did not feel able to report the experience and use the support mechanisms in place. This may have been a result of having concerns that the problem would escalate if they reported the experience and, as a consequence, have a negative effect on their grade. Students were keen to offer a range of strategies for clinical practice in order to prevent bullying for future generations of students. ConclusionsStudents’ health, security and confidence in their ability as a physiotherapist can be at great risk from bullying. Steps are needed to ensure that students are better protected from bullying, and feel more able to address bullying behaviour during clinical internships.

Learning pathways during clinical placement of physiotherapy students: a Malaysian experience of using learning contracts and reflective diaries

Purpose:Learning contracts and reflective diaries are educational tools that have been recently introduced to physiotherapy students from Malaysia during clinical education. It is unclear how students perceive the experience of using a learning contract and reflective diary. This study explores the learning pathways of the students after using a learning contract and a reflective diary for the first time in their clinical placement.Methods:A total of 26 final-year physiotherapy students completed a learning contract and a reflective diary during clinical placements. Two researchers explored the data qualitatively by the thematic content analysis method using NVivo.Results:A total of four and six main learning themes were identified from the data of the students through a learning contract and reflective diary.Conclusion:These learning themes reflected the views of the students about what they have considered to be important learning pathways during their clinical placements. They give valuable insights into the experiences and opinions of students during their clinical education process, which should be useful for enhancing teaching and learning methods in physiotherapy education.