Focus group study of student physiotherapists' perceptions of reflection

An exploration of the relationship between grit, reflection-in-learning, and academic performance in entry-level doctor of physical therapy students

INTRODUCTION

Recent literature in physical therapy education suggests learners' non-cognitive skills, such as grit and reflection, may be predictors of success. Little is known about the relationship of these constructs to each other or success during the first year of entry level physical therapist education.

OBJECTIVE

The purpose of this study was to assess the relationship between Reflection-In- Learning Scale (RLS), grit, and grade point average (GPA) of entry-level physical therapy students during the first year of didactic instruction.

METHODS

One hundred and fourteen entry-level doctor of physical therapy students enrolled in a private university completed the original 12-item Grit Scale (Grit 1) and the RLS (RLS 1) during the first term and again at the end of the third trimester (Grit 2 and RLS 2).

RESULTS

The relationship between Grit 1 and RLS 1 demonstrated a fair, positive, significant correlation (r = .380, p < .001). No relationship was found between Grit 1 and GPA (r = .066, p = .485), or Grit 2 and GPA (r = .064, p = .500), or between RLS 1 and GPA (r = .017, p = .857), or RLS 2 and GPA (r = .171, p = .069). Fifty-three percent of students demonstrated a decrease in grit and 56% decreased RLS scores at the end of the first year of the program.

CONCLUSION

The fair correlation between these variables indicates they may measure different constructs. Findings suggest that doctor of physical therapy programs should be cautious when using these non-cognitive factors in making admission decisions. Future research should explore changes in grit and RLS throughout the curricula and impact on student success.

The exploration of speech-language pathology students' perceptions and attitudes towards written clinical reflection

Purpose: Written clinical reflection is frequently used in speech-language pathology training programs to develop student clinical skills. The aim of this study was to explore speech-language pathology students' perceptions towards written clinical reflection.Method: Seventy-two undergraduate speech-language pathology students completed an online survey. An observational research design was undertaken. Descriptive statistics were used to analyse quantitative data. Inductive content analysis was used for qualitative data analysis.Result: Speech-language pathology students reported that written clinical reflections are useful but also wanted to explore alternative ways to reflect. Most students used written clinical reflection to focus on self-improvement of clinical skills and a small number of students used reflection to consider stakeholders' points of view. Students wanted more guidance and feedback on written clinical reflections.Conclusion: The results indicate that written clinical reflection is a useful learning tool. To facilitate the development of reflection skills in speech-language pathology students, it is important to explicitly teach clinical reflection in university curricula and to receive guidance from professional practice educators.

Written reflective practice abilities of SLT students across the degree programme

BACKGROUND

Written reflective practice (WRP) is a teaching tool used across speech-language therapy (SLT) clinical education programmes. The process aims to support the development of reflective skills required for the workplace (e.g., problem-solving and self-evaluation).

AIMS

This cross-sectional and repeated-measures study design investigated students' demonstration of breadth of WRP across the clinical education programme.

METHODS & PROCEDURES

The participants were 77 undergraduate SLT students in their first, second or final professional year of the clinical programme. Participants wrote critical reflections following an interaction with a client/s as part of their clinical education experiences. Formative feedback was provided after each written reflection (WR). In total four WRs per participant were coded for breadth of WRP using a modification of Plack et al.'s coding schema from 2005. This was completed for each of the four time points across the academic year for each professional year.

OUTCOMES & RESULTS

There was a statistically significant association between time (i.e., professional year of the programme) and likelihood of demonstration of breadth of reflection for the lower level reflective element of 'attend' and higher level reflective element of 're-evaluate'. A positive trend between time and likelihood of demonstration of breadth of reflection was seen for the lower level element of 'reflection-for-action'. Final-professional-year students exhibited significant enhancements in the higher level elements (e.g., 'premise') compared with first- and second-professional-year students.

CONCLUSIONS & IMPLICATIONS

This group of SLT students exhibited significant change in breadth of WRP across the degree programme. This finding has positive implications for facilitating WRP with students and using the current coding framework in clinical programmes.

WHAT THIS PAPER ADDS

What is already known on this subject WRP is one form of reflective practice (RP) used in SLT, allied health, medical and nursing clinical education programmes. Researchers have suggested that RP skills develop over time for students. Previously, studies examining WRP have focused on one off assessment of skill or over a timeframe of 6-10 weeks. Here, we examine SLT students' WRP skills across the degree programme. What this paper adds to existing knowledge SLT students exhibited significant positive change in breadth of WRP across the degree programme as their clinical experience increased. Our results provide quantitative information in support of using RP as a learning tool throughout clinical education programmes for SLT. What are the potential or actual clinical implications of this work? This study offers support for educators of SLT students; for example, how educators can assess WRP, and how educators can foster SLT student skill development with formative feedback and reflective questioning. This study also offers support for student SLT, for example, describing how WRP can be part of their individualized learning approach and provide a purposeful examination of self and clinical skill development.

Effective teaching of manual skills to physiotherapy students: a randomised clinical trial

CONTEXT

To date, despite the relevance of manual skills laboratories in physiotherapy education, evidence on the effectiveness of different teaching methods is limited.

OBJECTIVES

Peyton's four-step and the 'See one, do one' approaches were compared for their effectiveness in teaching manual skills.

METHODS

A cluster randomised controlled trial was performed among final-year, right-handed physiotherapy students, without prior experience in manual therapy or skills laboratories. The manual technique of C1-C2 passive right rotation was taught by different experienced physiotherapist using Peyton's four-step approach (intervention group) and the 'See one, do one' approach (control group). Participants, teachers and assessors were blinded to the aims of the study. Primary outcomes were quality of performance at the end of the skills laboratories, and after 1 week and 1 month. Secondary outcomes were time required to teach, time required to perform the procedure and student satisfaction.

RESULTS

A total of 39 students were included in the study (21 in the intervention group and 18 in the control group). Their main characteristics were homogeneous at baseline. The intervention group showed better quality of performance in the short, medium and long terms (F_1,111  = 35.91, p < 0.001). Both groups demonstrated decreased quality of performance over time (F_2,111  = 12.91, p < 0.001). The intervention group reported significantly greater mean ± standard deviation satisfaction (4.31 ± 1.23) than the control group (4.03 ± 1.31) (p < 0.001). Although there was no significant difference between the two methods in the time required for teaching, the time required by the intervention group to perform the procedure was significantly lower immediately after the skills laboratories and over time (p < 0.001).

CONCLUSIONS

Peyton's four-step approach is more effective than the 'See one, do one' approach in skills laboratories aimed at developing physiotherapy student competence in C1-C2 passive mobilisation.

Physiotherapy students' conceptions of skill at the beginning of their Bachelor studies

Skills have recently received widespread attention in education policy documents and discussions. This article reports the results of research on Bachelor's degree physiotherapy students' conceptions of skill at the beginning of their studies. The aim of the present study was to examine how beginning students understand skill, and the focus was on conceptions of skill in general rather than on any particular skills. The participants of the study were 35 physiotherapy students. The data were gathered within the first two weeks of their university studies. Specifically, requested essays written by the students were analyzed using the phenomenographic approach. The data-driven analysis yielded four descriptive categories which reflect the students' conceptions of skill: (1) Talents; (2) Skills requiring individual practice; (3) Skills requiring social practice; and (4) Competence requiring collaboration. The categories form a hierarchy. The differences between the categories are described along seven themes of variation. The themes were named: (1) Acquisition; (2) Emotions; (3) Motivation; (4) Reflection; (5) Evaluation; (6) Agency; and (7) Social Environment. This hierarchical system of categories sheds new light on students' understanding of the skill. The findings can be used as a basis for planning physiotherapy curricula, especially for designing skills education and training, and for supporting students along their educational path, especially in offering opportunities for students to reflect on their skill conceptions. Ultimately, physiotherapy students' awareness of different skill conceptions and developing their skills to advise and treat will benefit patients.

Taking the learning beyond the individual: how reflection informs change in practice

OBJECTIVE

The purpose of this research was to explore the value of reflection and its application to practice through the implementation of educational modules within a new Diabetes Care and Education Master Degree Programme in Kuwait, and to realise how this teaching intervention informs changes in practice.

METHODS

A small exploratory case study was conducted within the Dasman Diabetes Institute, Kuwait. A qualitative approach using focus group interviews was carried out with seventeen participants all of whom are studying on the Diabetes Care and Education Master Degree Programme in Kuwait. An inductive approach to thematic analysis, which focused on examining themes within data, was performed.

RESULTS

The results indicate that participants value the opportunity to study through organised, structured and assessed reflection. The learning provides useful information and support to the participant by highlighting the role which reflection plays to enhance personal and professional development, the value of educational theory, continuing professional development, collaboration and enhancing patient education and practice.

CONCLUSIONS

The significance of reflection is often seen in the literature as an important aspect of professional competence. This research has highlighted the value of reflection as a key component within a new educational programme.

Reflections on clinical learning in novice speech-language therapy students

BACKGROUND

Reflective practice is reported to enhance clinical reasoning and therefore to maximize client outcomes. The inclusion of targeted reflective practice in academic programmes in speech-language therapy has not been consistent, although providing opportunities for speech-language therapy students to reflect during their clinical practice has been reported. Indeed, there has been limited investigation of the nature of speech-language therapy students' reflections.

AIMS

(1) To describe the breadth and depth of reflection skills of novice speech-language therapy students by utilizing structured reflective learning journals. (2) To evaluate the use of a coding system to determine its reliability and relevance in identifying reflection skills.

METHODS & PROCEDURES

Participants were 52 students in their second year of a 4-year undergraduate speech-language therapy programme. Mean participant age was 20.5 years; all students were female. Participants completed guided written reflections following three interviews with a standardized patient (an actor portraying a parent of a child with delayed speech development). Reflections were coded by two raters. Nine participants' reflections were recoded by raters A and B to establish intra-rater reliability. Inter-rater reliability between these two raters was calculated and a third rater completed coding of 20% of students' reflections to further establish inter-rater reliability.

OUTCOMES & RESULTS

Results indicated that the majority of students were categorized as 'reflectors'. All students demonstrated at least one element of reflection. Their reflective writing primarily focused on a discussion of the content of and strategies used within the interviews, and reflection on and for action. Results also indicated that the coding system used within the study was reliable in determining both the breadth and depth of student reflections.

CONCLUSIONS & IMPLICATIONS

This study found that novice speech-language therapy students can reflect on their clinical learning experiences within a structured clinical environment involving standardized patients. Only a small number of novice students were found to be critical reflectors who were able to analyse the content of clinical interviews, view the interaction from the perspective of the patient, and record changes to their own perspective which occurred as a result. The coding system was established as reliable and thus relevant for use in furthering research on reflective practice within speech-language therapy and other disciplines. Further investigation of reflective skills within other clinical environments and with additional clinical experience is recommended.

The use of reflective practice in new graduate registered nurses residency program

New graduate nurses encounter emotional distress related to complex patient care situations and overwhelming workloads. Unequipped with coping mechanisms, new nurses verbalize difficulty feeling accepted in their assigned units. Self-perceptions of inadequacy and lack of independence contribute to anxiety. Consequently, hospitals are at risk for losing newly graduated nurses within the first year. The cost of losing new nurses is overwhelming to hospital institutions and further contributes to the looming nursing shortage. This article describes the use of a reflective practice exercise in a new registered nurse residency program in a magnet hospital to facilitate reflection and problem solving in the patient care unit. More research is needed to investigate the effectiveness of reflective practice in developing coping skills and retention rate in new graduate nurses.

Development and pilot testing of a reflective learning guide for medical education

BACKGROUND

Reflection is increasingly incorporated into all levels of medical education but little is known about best practices for teaching and learning reflection.

AIMS

To develop a literature-based reflective learning guide for medical education and conduct a pilot study to determine whether (1) guide use enhances medical students' reflective writing skills and (2) reflective scores correlate with participant demographics and satisfaction.

METHODS

Guide development consisted of literature review, needs assessment, single institution survey, and educational leader consensus. The pilot cohort study compared professionalism reflections written with and without the guide by third-year medical students on their core obstetrics and gynecology rotation. Reflections were scored using a previously validated rubric. A demographics and satisfaction survey examined effects of gender and satisfaction, as well as qualitative analysis of optional written comments. Analyses used independent t-tests and Pearson's correlations.

RESULTS

We developed a two-page, literature-based guide in clinical Subjective-Objective-Assessment-Plan (SOAP) note format. There was a statistically significant difference, p < 0.001, in the reflection scores between groups, but no effects of gender or satisfaction. Student satisfaction with the guide varied widely.

CONCLUSIONS

A single exposure to a literature-based guide to reflective learning improved written reflections by third-year medical students.

Radiation therapists’ perspectives of the role of reflection in clinical practice

A recurring theme from the literature is that the definition of reflection is nebulous and/or complex. Many authors have suggested that more research needs to be conducted to better understand an individual’s perception of reflection and reflective practice, and how these concepts affect their clinical practice as well as their personal growth and development. This paper offers the findings of a qualitative study of radiation therapists in Canada. The aim of the study was to explore radiation therapist’s understanding of the concept of reflection, and to understand how they incorporated it into their daily practice. Secondary objectives were to examine some of the perceived barriers to its use, and the possible challenges of implementing reflective writing. Two focus groups were initially conducted, and a follow-up questionnaire was developed using the themes generated from the focus groups. The questionnaire was distributed to radiation therapists at two large cancer centres in Toronto, Canada. Most participants indicated that it is an integral part of their practice and professional lives, and that they use a variety of different methods for engaging in reflection. It is not without its barriers, but many of these can be overcome by providing time, coaching and a supportive work environment. Respondents were divided as to whether they would benefit from being taught reflection; however, small group teaching would be the favoured method. Further study is suggested to determine whether there are any improvements to patient care and in particular patient outcomes.

Oral health students' perceptions of clinical reflective learning--relevance to their development as evolving professionals

CONTEXT

A clinical professional should be a reflective practitioner, however reflective learning and deliberate clinical reflections have not traditionally featured in dentistry or dental hygiene programs. To the authors' knowledge, there are no studies exploring the perceptions of oral health students to reflective learning and clinical reflective practices.

AIM

This study determined student perceptions of clinical reflective learning and its relevance to their clinical and professional development.

METHODS

Reflective learning was embedded as a topic in the curriculum of the University of Queensland Bachelor of Oral Health program, within the discipline of dental hygiene practice. Reflective practices were integrated with clinical practice, and were linked with assessment requirements. Students' perceptions of clinical reflective learning were obtained via quantitative and qualitative analyses of sequenced questionnaires. Computer-assisted thematic analyses of the students' reflective journals, reflective essays and summary notes from in-class group discussions validated students' perceptions.

RESULTS

Students (n = 17) perceived clinical reflective learning as relevant, and useful for consolidating their clinical learning and accelerating their professional development. In particular, students gained insights about their strengths and weaknesses, thought more deeply about what they were doing in the clinic, and unpacked difficult concepts.

CONCLUSION

Students views of clinical reflective learning in this program were positive. They believed that the deliberate reflective process assisted their clinical learning and professional development.