Physiotherapy Clinical Education Research Articles

Development of the Clinical Placement Quality Survey – Educator (CPQS-E) Tool to Evaluate the Quality of Physiotherapy Clinical Placements

Background: Increasing demand for entry-level clinical education placements has resulted in changes to traditional models. In this evolving landscape, the ability to effectively assess clinical placement quality is critical. However, existing tools are not specific to physiotherapy and/or have focused on student’s perspectives. Purpose: To design a tool that can be utilised by clinical education providers to measure the quality of physiotherapy clinical placements. Methods: A survey was developed based on published recommendations for quality indicators in clinical education. Content and face validity were established using an expert panel of clinical educators (n=18). Test-retest reliability was tested via physiotherapy clinical educators (n=62) completing the survey twice over a two-week period. Reliability of the survey was assessed using intraclass correlation coefficients (ICC), test-retest percentage agreement, and Cronbach’s alpha. Results: The ICC of 0.87 indicated minimal measurement error. The majority (98%, n=62) of test items met criteria for close agreement. The correlation coefficient of reliability ranged from 0.73 to 0.87 across four defined constructs. Conclusion: Initial assessment of the Clinical Placement Quality Survey - Educator (CPQS-E) tool indicates that its properties provide a valid and reliable measure of entry-level physiotherapy placement quality from the perspective of the clinical educator.

The use of the Delphi technique as part of the process of developing a tool to evaluate physiotherapy clinical education programmes


 
 
 
 Objectively evaluating the quality and effectiveness of a physiotherapy clinical education programme has been unsuccessful to date, due to its complexity and the lack of a standardised tool. We undertook to develop a standardised programme evaluation tool and used the Delphi method to obtain consensus (set at 80%) to determine the face and content validity of the items and domains of the tool, the scoring system and a name for the tool. Academics, clinical physiotherapists and clinical physiotherapy educators participated in the Delphi rounds. Three Delphi rounds ensued: in Delphi round 1, a 71% response rate was obtained and 49 questions obtained 80% consensus. In Delphi round 2, a 91% response rate was obtained and 59 questions obtained 80% consensus. In Delphi round 3, a 42% response rate was obtained, several names were suggested, and the scoring system was established. The provisional tool of 85 items ultimately emerged as the Vaneshveri Naidoo Clinical Programme Evaluation Tool (VN-CPET).
 
 
 

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 Documentation During Clinical Placements: Perspectives of Physiotherapy Students and Clinical Educators

Background: Clinical documentation is a critical form of communication in healthcare settings. As defined by the Physiotherapy Practice Thresholds, clinical documentation that complies with relevant professional and legal obligations is a requirement for all physiotherapists in Australia and New Zealand. Aims: The aims of this study were to explore the experiences of clinical documentation and perceived support and training needs for physiotherapy students whilst on clinical placement, from the perspective of students and clinical educators. Method: A qualitative approach was used to investigate physiotherapy student (n=18) and clinical educator (n=17) experiences and perspectives. Interviews from eight focus groups were professionally transcribed, and reflexive thematic analysis was applied to the data to determine common themes. Results: Four overarching themes were generated; 1) Recognising the value of documentation, 2) Variance of expectations, 3) Challenges in measuring performance, and 4) Clinical placement readiness and requirements. Conclusion: The main findings from this study identify the unique challenges that students experience to meet documentation requirements on clinical placement. This study highlights the shared responsibility of university education providers and clinical placement facilities to support students to understand the importance of clinical documentation and assist in improving their documentation skills.

What Is Known About How Physiotherapy Students Make Sense of Movement as a Component of the Clinical Reasoning Process? A Scoping Review

Background: Observing and analysing movement is a core component of the diagnostic process of physiotherapists and yet, little is known about how students understand the role of movement within the clinical reasoning process. In recent years, there has been an increase in research regarding the importance of movement within the reasoning process of physiotherapists. The way in which movement is observed and analysed directly impacts diagnostic and therapeutic decisions. Purpose: This purpose of this scoping review is to determine what is known about how students understand movement and the role of movement within the clinical reasoning process. Methods: A systematic search of the databases CINAHL, ERIC, GALE, PubMed, MEDLINE and SCOPUS between the years of 2011 and 2021 was conducted by the author. Reference lists of included studies were also scanned. Studies were included if they discussed the concept of movement in relation to the clinical reasoning process, how students learn to clinically reason, or how physiotherapists incorporate movement into their reasoning processes, and qualitative data analysis was undertaken. Results: Ten articles remained after the screening processes. Data was extracted, by one reviewer, into a template that included the characteristics of each paper and four key themes were developed in order to answer the research question. These themes will be discussed further throughout this review. Conclusion: The findings of this review suggest that there is limited evidence regarding how students understand movement within the clinical reasoning process. Further research on this topic is important for the physiotherapy profession, academics and clinical educators as it might demonstrate a gap in the way that clinical reasoning is currently taught and could create a shift in the way movement is considered as a component of the clinical reasoning process.

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.

Factors affecting physiotherapy clinical education: Perceptions of students and clinical educator

Introduction. Clinical education is the cornerstone of physiotherapy education. Clinical educators play a pivotal role in shaping students’ attitude towards their future role as physiotherapist. But the implementation of physiotherapy clinical education varies significantly between institutions. Research has shown several factors influencing the clinical education. Aim. To explore the factors affecting physiotherapy clinical education. Methods. This research used mixed-methods approach and recruited participants through purposive and convenience sampling. Data was collected through a survey using questionnaire and face-to-face interviews. Thirty-four physiotherapy students completed a questionnaire after attending 12 weeks of clinical placements. Twenty-six clinical educators and 9 students participated in the interview. Descriptive statistics including frequency percentage, median and percentiles were used for quantitative data analysis. Thematic analysis method was used for qualitative data analysis. Results. Quantitative study found greater student satisfaction in clinical education. But the qualitative study identified several factors affecting clinical education in the context of this study. These factors include student interest, learning style, culture, and ability to cope with challenges. In addition, clinical educator workload, teaching strategies, curriculum knowledge, academic-clinical partnership, peer learning, placement model and expectations were the other factors that influenced physiotherapy clinical education. Conclusions. The findings of this study are useful to physiotherapy clinical educators, students, and faculty. It provides insight into various factors affecting physiotherapy clinical education. Furthermore, it recommends evidence-based strategies to neutralize those factors influencing clinical education.

A tool to evaluate physiotherapy clinical education in South Africa.

BackgroundPhysiotherapy clinical education is complex. The dynamic learning milieu is fluid and multidimensional, which contributes to the complexity of the clinical learning experience. Consequently, there are numerous factors which impact the clinical learning experience which cannot be measured objectively – a gap which led to the development of our study.ObjectivesTo develop, validate, and test the reliability of an assessment tool that evaluates the effectiveness and quality of physiotherapy clinical education programmes.MethodA mixed methods approach in three phases included physiotherapy academics, clinical educators, and clinicians throughout South Africa. Phase One was a qualitative study: focus group discussions determined items and domains of the tool. Phase Two established the content and construct validity of the tool, a scoring system and a name for the tool, using the Delphi method. In Phase Three, factor analysis reduced the number of items, and the feasibility and utility of the tool was determined cross-sectionally.ResultsThe Vaneshveri Naidoo Clinical Programme Evaluation Tool (VN-CPET) of 58 items and six domains was developed and found to be valid, reliable (α = 0.75) and useful. The six domains of VN-CPET include governance; academic processes; learning exposure; clinical orientation; clinical supervision and quality assurance and monitoring and evaluation.ConclusionThe Vaneshveri Naidoo Clinical Programme Evaluation Tool is a valid, reliable and standardised tool, that evaluates the quality and effectiveness of physiotherapy clinical education programmes.Clinical implicationsThis tool can objectively evaluate the quality and effectiveness of physiotherapy clinical education programmes in South Africa, and other health science education programmes, both locally and globally, with minor modification.

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.

Understanding of clinical reasoning by undergraduate students and clinical educators in health and rehabilitation sciences at a South African University: The implications for teaching practice

Background. Clinical reasoning (CR) is a skill acquired by students under supervision of clinical educators (CEs) when transitioning from classroom to clinical practice to optimise patient care. However, intra- and inter-professional differences in the definition and facilitation of CR have been reported. At the University of Cape Town, a teaching development grant was obtained and used for a staff development initiative aimed at improving the CR skills of undergraduate health and rehabilitation students. Objectives. To gain insight into the understanding of CR among CEs and a cohort of third-year students across 4 professional programmes, using an interpretive approach. Methods. The CEs responsible for third-year supervision (n=45) were invited to take part in a self-developed electronic survey and an initial workshop that explored their understanding of CR. The qualitative survey data, as well as workshop feedback and discussion, were analysed. Students’ understanding was explored during focus group discussions. Results. There were areas of commonality and differences among CEs. They agreed on a cyclical step-like process to CR and the need to cue students to develop this expertise in clinical settings. The approach of CEs in occupational therapy was client focused; physiotherapy CEs described a higher- order thinking; and audiology and speech and language pathology CEs described a structured procedure informed by evidence. Students were unable to conceptualise a complete picture to reasoning and decision-making. Conclusion. The difference between students’ understanding of CR and their poor awareness of strategies employed by CEs to facilitate reasoning could account for difficulties in transitioning from classroom to practice. This scenario suggests that divisions need to look at creating more purposeful strategies to teach students about the CR process and how the facilitation may occur within the clinical setting.

177 Going Upstream: Key Considerations When Moving a Face-to-Face Simulation Module and Assessment to Virtual Delivery

‘Preparing for on-call’ is a level 6 physiotherapy module delivered face-to-face to enable synthesis of respiratory knowledge and application to real ‘on-call scenarios’, preparing students for the transition into clinical practice. Due to lockdown, we could not deliver this module face-to-face and changed it to a ‘virtual delivery’ for teaching and assessment.The aim of the study was to deliver a face-to-face SBE module and assessment virtually.We used the principles of SBE design We achieved a ‘virtual on-call experience’ by involving SPs, confederate nurse facilitators and physiotherapy clinical educators working synchronously with students via Microsoft Teams. With teaching groups of eight, we kept to the principles of SBE by pre-briefing, running a realistic scenario with clear learning outcomes, followed by a debrief facilitated by the nurse and physiotherapy educator. Students were able to rehearse their clinical reasoning by ‘thinking out-loud’; these preparatory ‘virtual on-call scenarios’ enabled them to become familiar with ‘performing’ on Teams. This ‘process-familiarity’ led to a preparedness, professionally and psychologically for their subsequent ‘virtual on-call assessments’. Four on-call scenarios were delivered in this module, enabling the learning outcomes to be achieved via this method of delivery. The virtual on-call assessment was run in three virtual rooms on Teams, with an SP, a clinical educator as an examiner, a confederate nurse, and one student in each room. The assessment scenario ran for 30 minutes replicating the normal examination time, giving students the opportunity to rehearse the skills they had learnt in the module. Additional supportive information was given to the students by sharing a ‘patient monitor’ (screenshots from the ALS Laerdal manikin monitors). In total, 28 assessments were achieved in 1 day, with two taken separately for extenuating circumstances. Student feedback has been positive with all students passing, enabling graduation this summer.

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.

Enabling the feedback process in work-based learning: an evaluation of the 5 minute feedback form

Feedback is the key ingredient from which we grow. This paper contributes to the literature on student feedback in higher education, specifically within work-based learning. It provides an overview of the usability, utility and impact of a freely available feedback tool, the 5 min feedback form (5MFF). The 5MFF was constructed for use within physiotherapy and is being utilised across clinical placement sites in Ireland. The generalisability of its structure allows for transferability across healthcare professions and other work-based disciplines. A multi-site cross-sectional study utilising convenience sampling across a diverse range of placement settings was conducted. Physiotherapy students, practice educators and practice tutors were surveyed on their experience and perceptions of the 5MFF. Findings indicate strong agreement in relation to ease of use, speed of completion and the form’s ability to structure and provide timely feedback. Results support its capacity to encourage feedback prioritisation, identify strengths and weaknesses, direct learning, modify behaviours and facilitate the achievement of goals and objectives. Through facilitating collaborative dialogue the 5MFF supports the feedback conversation through raising awareness of student challenges or practice educator and tutor concerns. Utilisation of the 5MFF during physiotherapy clinical education supports effective feedback delivery and enables a positive feedback process.

Exploring student fitness to practise (FTP) issue identification and management with allied health clinical educators in a tertiary health service

Background: Health professional students may experience fitness to practise (FTP) issues that affect their performance during clinical placements. Previous research with physiotherapy clinical educators found educators were aware of student FTP issues but lacked confidence in assisting students with FTP issues in the clinical setting.Aim: This research project aimed to 1) evaluate if a brief interprofessional education session changed the knowledge of supports and/or confidence of allied health clinical educators to manage student FTP issues that arise on clinical placement, 2) to elucidate personal experiences of allied health clinical educators with student FTP issues and 3) to explore allied health educator recommendations of strategies to use when supporting students on clinical placement.Method: Allied health clinical educators attended a 1.5-hour workshop about student FTP. Participants identified student FTP issue identification and management strategies during clinical placements and completed pre-post surveys. Quantitative and qualitative data were analysed with independent t-tests, content and thematic analysis respectively.Results: Forty-six clinical educators from nine professions participated. Participants initially lacked confidence and identified a need for training to support students with FTP issues. On reflection participants identified numerous strategies that use or recommend to support students with additional learning needs, and confidence increased following the session.Discussion: A brief facilitated workshop had an immediate impact on clinical educator confidence regarding defining FTP and knowledge of supports available. Participants offered several experience informed insights and recommendations that build on a previous study of physiotherapy clinical educators. Conclusion: A brief education session with an interprofessional group of allied health clinical educators elucidated a number of important strategies to consider when supporting students with FTP issues in the clinical setting.

Designing, Implementing, and Evaluating a Practice Tutor Internship Model during an Acute Care Clinical Internship.

Purpose: The purpose of this study was to implement and evaluate a novel internship model that incorporates a practice tutor in physiotherapy clinical education during an acute care cardiorespiratory internship at a large acute tertiary care teaching hospital in Canada. Method: A prospective evaluation of this model was conducted by means of a mixed-methods approach using surveys and focus groups. The participants were students and clinical instructors (CIs) who were taking part in the internship. Results: Half of the CIs agreed that the practice tutor model gave them more time to manage their caseload and work with the student than did the traditional model, and 63% would recommend the model for future internships. In reviewing the focus group and open-ended data, we identified four themes: benefits, tensions, critical logistics, and unforeseen blind spots. There was a trend for patient attendance to increase with the practice tutor model compared with the previous year's internship session and with the 5 weeks immediately preceding the internship. Conclusions: On the basis of CIs' and students' self-reports, the piloted practice tutor model was perceived to facilitate students' clinical reasoning and collaborative learning skills. In addition, during the 5-week internship, the number of patients seen each day by the individual CIs and their students was not reduced, with a trend toward increased patient attendance. There was also a trend toward CIs having the same or more time to manage their caseload and work with the students compared with a non-practice tutor internship model. Recommendations to improve this model in future implementations are made.

Investigating physiotherapy stakeholders’ preferences for the development of performance-based assessment in practice education

ObjectivesDiscrete choice experiments (DCEs) are used in healthcare to measure the relative importance that stakeholders give to different features (or attributes) of medical treatments or services. They may also help to address research questions in health professional education. Several challenges exist regarding the performance-based assessment process (PBA) employed in physiotherapy practice-based education, a process which determines students’ readiness for independent practice. Evidence highlights many commonalities among these challenges, but it is unknown which factors are the most important to stakeholders. The use of DCE methodology may provide answers and help to prioritise areas for development. Thus, this study employed DCE to identify clinical educators’, practice tutors and physiotherapy students’ preferences for developing the PBA process in physiotherapy. DesignAttributes (aspects of the PBA process known to be important to stakeholders) were derived from focus group interviews conducted with three groups; physiotherapy students, clinical educators (practising clinicians) and practice tutors (dedicated educational roles in the workplace). These attributes included the PBA tool, grading mechanisms, assessors involved, and, feedback mechanisms. Preferences for each group were calculated using a logistic regression model. ResultsSeventy-two students, 124 clinical educators and 49 practice tutors (n=245) participated. Priorities identified centred primarily on the mandatory inclusion of two assessors in the PBA process and on refinement of the PBA tool. ConclusionEmployment of DCE enabled the prioritisation of stakeholder-informed challenges related to PBA in physiotherapy practice-based education. This corroborates findings from previous qualitative work and facilitates a prioritised pathway for development of this process.

Acceptance of the \u2018Assessment of Physiotherapy Practice (Chinese)\u2019 as a standardised evaluation of professional competency in Chinese physiotherapy students: an observational study

BackgroundDevelopment of an entry-level physiotherapy curriculum in China currently follows the World Confederation for Physical Therapy (WCPT) guidelines, however there is no standard, validated, assessment tool for physiotherapy practice in use in China. This article reports the process of translation of the “Assessment of Physiotherapy Practice” (APP), a validated assessment instrument adopted by all universities in Australia and New Zealand, into Chinese (APP-Chinese) and its implementation by Chinese physiotherapy clinical educators (CEs) and students during clinical placements.MethodsThe process of forward and backward translation of the APP was undertaken by a team of academics from universities in Shanghai, Hong Kong, United States and Australia. An APP-Chinese version was produced and used for assessment of the clinical performance of 4th year students at a university in Shanghai. Feedback on the implementation of the APP-Chinese was solicited from students and CEs using the same two questionnaires employed to assess implementation of the original APP.ResultsAll CEs agreed that the rules used to score the APP-Chinese were helpful in assessing student performance. Over 90% of the CEs considered the APP-Chinese was pragmatic for use in the clinical environment in China. All students agreed with the rating of their performance on the APP-Chinese marked by their educators, and that the performance indicators were useful in guiding their expected performance behaviour.ConclusionThe APP-Chinese is the first standardised assessment tool for evaluation of clinical performance of physiotherapy students in China and was shown to be well accepted by both students and CEs in the clinical education unit and university involved in this study.

Peer review (San Schmutz) - Project-based learning for physiotherapy clinical education quality and capacity

Peer review (San Schmutz) - Project-based learning for physiotherapy clinical education quality and capacity

Peer review (Shamila Gamiet) - Project-based learning for physiotherapy clinical education quality and capacity

Peer review (Shamila Gamiet) - Project-based learning for physiotherapy clinical education quality and capacity

Project-based learning for physiotherapy clinical education quality and capacity

Background: Increasing, supporting and sustaining the capacity for physiotherapy student placements is a priority for universities and the physiotherapy workforce. The interruption, and in some cases, cancellation of placements as a result of Covid-19 has provided an added impetus to consider the use of flexible and adaptive models to meet student learning needs and support new and existing placement host organisations. Project-based learning provides an opportunity to supplement clinical placements through student-led activities that are mutually beneficial for student learning and service delivery needs of the host organisation. Aim: This paper outlines the pedagogical underpinnings of project-based learning and provides tangible examples of activities that have been adopted within physiotherapy host organisations to support clinical placement quality and capacity. Discussion: Clinical placement host organisations require flexible, student-centred approaches to supporting clinical placement efforts during 2020 and beyond. Project-based learning has the potential to be adapted across settings to support student learning and host organisation services and their stakeholders. Universities should aim to encourage and support partnerships between host organisations and their students to adopt, evaluate and sustain project-based learning across physiotherapy settings.