Sharing practice: problems and possibilities

Exploration of mentor and mentee perspectives of a mentored clinical practice programme to improve patient outcomes in musculoskeletal physiotherapy

Background

A recent randomised controlled trial has demonstrated the impact on practice of an educational programme for clinicians. Mentored clinical practice in musculoskeletal physiotherapy resulted in clinically significant improvements in both physiotherapist performance and patient outcomes. The objectives of this study were to explore mentor and mentee perceptions of a mentored clinical practice programme, in order to identify key factors in the process to improve patient outcomes.

Methods

Employing a case study design of a mentoring programme that led to improved patient outcomes, mentored clinical practice was explored from multiple perspectives using a grounded theory strategy of enquiry to derive a theory of mentored clinical practice grounded in the views of the participants. Semi-structured interviews with a purposive sample of mentors and mentees were employed along with qualitative observations of mentored clinical practice. Data analysis and collection were concurrent, with analysis an iterative process deriving inductive analytical categories from the data through constant comparison.

Findings

Highly informative themes of how the complex interaction between mentor, mentee, patient and environment worked successfully were identified from the data. The mentors’ knowledge, additional perspectives, critical analysis and facilitatory style were enabling factors, as were mentees’ motivation, openness to criticism and commitment to reflect on practice. Themes around potential threats to the mentees’ development were also identified. Overloading or contradictory feedback and lack of relationship with mentees were barriers that mentors could bring; fear, defensiveness, routine working, people-pleasing and lack of experience were potential mentee barriers. A model emerges from the data demonstrating how these themes interact, providing guidance to mentors and mentees to optimise the effectiveness of mentored clinical practice.

Conclusion

This study provides a sound basis for future mentored clinical practice, producing a model from key themes from a case study where impact on clinician performance and patient outcomes are established.

Evaluation of the clinical effectiveness of a work-based mentoring programme to develop clinical reasoning on patient outcome: A stepped wedge cluster randomised controlled trial

BACKGROUND

Despite persistent calls to measure the effectiveness of educational interventions on patient outcomes, few studies have been conducted. Within musculoskeletal physiotherapy, the effects of clinical mentoring on postgraduate physiotherapists have been explored, but its impact on patient outcomes is unknown. The objective of this trial was to assess the effectiveness of a work-based mentoring programme to facilitate physiotherapist clinical reasoning on patient outcomes.

METHODS

In a stepped-wedge cluster RCT in the musculoskeletal physiotherapy outpatient departments of a large NHS organisation, 16 physiotherapists were randomised by cluster to receive the intervention-150 hours of mentored clinical practice-at one of 3 time periods; control was usual training. 441 patients submitted outcome measures: Patient-Specific Functional Scale (PSFS) (primary outcome measure), EQ-5D-5L, patient activation and patient satisfaction (secondary outcome measures). A further secondary outcome measure of physiotherapist performance was collected by an independent assessor observing the physiotherapists practice.

RESULTS

80.0% of intervention patients achieved clinically significant PSFS scores compared with 63.8% of control patients. Binary logistic regression analysis modelling for time, cluster and patient characteristics showed strong statistical evidence for this difference (p = 0.023; odds ratio 4.24, 95%CI 1.22, 14.79). Physiotherapist performance scores improved from a mean of 47.8% (SD 3.60) pre-intervention to a mean of 56.0% (SD 4.24) (p<0.001). There was no statistical evidence for differences between groups on other secondary outcomes.

CONCLUSION

This is the first study that we aware of that provides patient outcomes measurement of an established educational intervention in physiotherapy, providing evidence that this type of intervention positively impacts patient outcomes and physiotherapist performance. This provides a basis for further research in education across other healthcare disciplines and outcome measures.

Using the delphi approach to identify priority areas for health visiting practice in an area of deprivation

Families with children living in areas of high deprivation face multiple health and social challenges, and this high level of need has impacts on the work of health practitioners working in such areas. All families in the UK with children under five years have access to health visiting services, and health visitors have a key role in mitigating the effects of deprivation by addressing health needs through evidence based practice. This paper reports the first stage of a project in Tower Hamlets, London, an area of significant deprivation, which aims to develop an evidence-based toolkit to support health visitors in their practice with families. The first stage used a modified Delphi process to identify the priority health needs of families in the area between June and July 2012. The three-stage Delphi process involved 25 people: four health visitors, four other members of the health visiting service, and 17 representatives of other services working with families. A focus group event was followed by a second event where individuals completed a questionnaire ranking the 27 priorities identified in the first event. The consultation process concluded with participants completing a second questionnaire, by email, confirming or changing their prioritisation of the topics.

The role of hidden curriculum in teaching pharmacy students about patient safety

OBJECTIVE

To examine how hidden and informal curricula shaped pharmacy students' learning about patient safety.

METHODS

A preliminary study exploring planned patient safety content in pharmacy curricula at 3 UK schools of pharmacy was conducted. In-depth case studies were then carried out at 2 schools of pharmacy to examine patient safety education as delivered.

RESULTS

Informal learning from teaching practitioners was assigned high levels of credibility by the students, indicating the importance of role models in practice. Students felt that the hidden lessons received in the form of voluntary work experience compensated for limited practice exposure and elements of patient safety not adequately addressed in the formal curriculum, such as learning about safe systems, errors, and professionalism.

CONCLUSIONS

Patient safety is a multifaceted concept and the findings from this study highlight the importance of pharmacy students learning in a variety of settings to gain an appreciation of these different facets.

Advancing Reflective Practice: An Evaluation of an Observed Practice Workshop for Occupational Therapists and Physiotherapists

Introduction:

An action research study resulted in an observed practice programme to advance the reflective skills of occupational therapists and physiotherapists. Action research offered a way of drawing on practitioners' knowledge and experience.

Method:

The programme was introduced through a one-day workshop to occupational therapists and physiotherapists of varying levels of experience within a mental health organisation. A purpose-designed questionnaire was used to evaluate learning outcomes and to capture participants' response to the workshops.

Results and conclusion:

The evaluation confirmed that the workshop design did support participants in developing the skills and confidence to implement the observed practice programme.

Developing an Observed Practice Programme for Occupational Therapists and Physiotherapists: Reporting the First Phase of an Action Research Study

Occupational therapists working in higher education have acknowledged the benefits of peer observation to their professional development and there has been discussion of its potential benefits in clinical settings. However, there is limited literature and no practical guidance on the implementation of observed practice within clinical practice.

This action research study sought to develop a work-based observed practice programme for occupational therapists and physiotherapists in a United Kingdom mental health trust. Action research was chosen to enable the positive engagement of practitioners in order to co-create knowledge and to improve practice. Occupational therapists and physiotherapists with expertise of local practice and personal experience of staff development and clinical supervision formed a working group to develop and implement the programme.

The group considered examples of similar programmes from higher education and addressed issues relating to the purpose, status and process of the programme. It also explored its relationship to existing preceptorship programmes and clinical supervision. This paper summarises the key steps of the observed practice process and the development of supporting documentation created by the working group. The observed practice programme was implemented at workshops in the autumn of 2009 to be followed by a formal evaluation.

Contextual Factors That Have an Impact on the Transitional Experience of Newly Qualified Occupational Therapists

Many newly qualified occupational therapists (NQOTs) experience difficulties when moving into practice, with limited opportunities to co-work with colleagues. In 2005, a preceptorship programme designed to ease these transitional challenges was piloted.

The programme was evaluated using mixed methods within a realist framework in order to understand the contextual factors that have an impact on the transitional experience of NQOTs and their engagement with the programme. Semi-structured interviews were carried out with four pairs of NQOTs and supervisors at 6 and 12 months into the programme. The findings suggest that the demands placed on new practitioners are increasing, with early expectations of autonomy within an interprofessional context. Strategies that assist transition include co-working, role modelling and informal support. The preceptorship programme facilitates the provision of these.

The study highlights the importance of situated learning theories and communities of practice as frameworks to prepare therapists to analyse the complexities of the workplace and to facilitate negotiated access to the multidisciplinary communities.