"They put you on your toes": Physical Therapists' Perceived Benefits from and Barriers to Supervising Students in the Clinical Setting

An exploration of factors influencing physiotherapists' involvement in student clinical education

BACKGROUND

The demand for physiotherapy student clinical placements is increasing in many countries, including Australia, and there is continued reliance on physiotherapists to assume the student clinical educator role. Exploring factors influencing physiotherapists' decision to be involved in clinical education is essential to maintaining and building clinical education capacity for the future.

OBJECTIVE

To explore factors influencing Australian physiotherapists' decision to be involved in student clinical education.

METHODS

A qualitative study using data collected from a valid and reliable online survey tool. Respondents were physiotherapists representing public and private workplaces across varied geographical settings in Australia. Data were thematically analyzed.

RESULTS

Surveys were completed by 170 physiotherapists. Most respondents were employed in hospital (81/170, 48%) and private (53/170, 31%) settings in metropolitan locations (105/170, 62%). Six themes representing factors influencing physiotherapists' involvement in student clinical education were identified, including perceptions of: professional duty, personal benefits or gains, suitability of workplace, support requirements, role related challenges, and readiness to be a clinical educator.

CONCLUSION

Many factors influence physiotherapists' decisions to assume the clinical educator role. This study could assist clinical education stakeholders to provide practical and targeted strategies to overcome challenges, and optimize support, for physiotherapists in the clinical educator role.

Exploration of the contribution of physiotherapy students to the delivery of health services: a qualitative study

OBJECTIVE

To understand the perspectives of physiotherapists on the contribution of students to the delivery of health services during clinical placements.

METHODS

Focus groups with a semi-structured interview guide were completed separately with new graduate physiotherapists reflecting on their student experience and experienced physiotherapists from five Queensland public health-sector hospitals. Interviews were transcribed verbatim in preparation for thematic analysis. Interview manuscripts were read independently and initially coding completed. Codes were compared and further refinement of themes occurred. Themes were reviewed by two investigators.

RESULTS

There were 38 new graduate participants across nine focus groups and 35 experienced physiotherapists across six focus groups who participated in this study. Students participate in a range of activities during clinical placements some of which contribute to delivery of health services and others which support student learning. Three major themes were identified: 1) tangible student contribution; 2) non-tangible student contribution; and 3) factors that influence the student contribution.

CONCLUSIONS

Overwhelmingly, both new graduate and experienced physiotherapists felt that students do contribute to the delivery of health services however careful consideration of a variety of factors is necessary to maximize the student contribution.

What are the experiences, preparation, and support needs of early career clinical educators within an Australian tertiary health service?: a qualitative study

BACKGROUND

There is increasing demand for professional practice placement opportunities, supported by health professional educators, to enable future health workforce development. Early career health professionals performing the educator role is one strategy that can help meet this demand. However, there is a need to consider how best to prepare and support early career health professionals to become educators. This study aimed to explore the experiences and perspectives of early career occupational therapy clinical educators including their preparation and support needs.

METHODS

Semi-structured interviews were completed with ten early career occupational therapists who had supervised their first or second student on a professional practice placement. The participants worked within an Australian tertiary hospital and health service in various clinical settings. Interviews were completed within six weeks of placement completion and lasted approximately one hour. They were recorded and transcribed verbatim and reflexive inductive thematic analysis was undertaken to identify key themes.

RESULTS

Ten occupational therapists, who had been working for an average of two years and two months, consented to participate. Initially, participants expressed mixed emotions about taking on the clinical educator role. They then described their adjustment to the role responsibilities, challenges encountered, and the development of the educator-student relationship. Participants found that the experience of supervising a student enhanced their educator, clinical, and professional skills and confidence. The important support elements of tailored educator preparation, placement design, and timely access to relevant resources and experienced staff were identified.

CONCLUSIONS

This study demonstrated how early career health professionals can possess desirable educator attributes, such as enthusiasm for taking on the role and cultivating collaborative learning relationships with their students. The experience of being an educator also presents a professional development opportunity for early career health professionals. Insights gained about the specific preparation and support needs of early career clinical educators warrant consideration by organisations and staff involved in the provision of student professional practice placements. Overall, this study's findings signify the importance of engaging and investing in early career health professionals to support student clinical education and to develop our current and future healthcare workforce.

Clinical Site Visits: Perspectives of Clinical Instructors and Site Coordinators of Clinical Education

INTRODUCTION

Site visits (SVs) are a common component of clinical education. The purpose of this paper was to explore clinicians' perspectives regarding SVs, including methods of communication used and their effectiveness, purposes of SVs, and the level of interaction between the stakeholders.

REVIEW OF THE LITERATURE

Several communication methods are used to conduct SVs, with varying levels of "richness" and effectiveness. Previous studies have explored the perceptions of physical therapist (PT) students and Directors of Clinical Education regarding communication methods used during SVs, as well as reporting the purposes, effectiveness, and logistics.

SUBJECTS

Clinicians, including clinical instructors (CIs) and Site Coordinators of Clinical Education, from across the United States, representing various geographical locations and settings were invited to participate.

METHODS

An electronic survey was distributed to participants using information from 2 PT education programs and the Physical Therapist Clinical Performance Instrument database.

RESULTS

A total of 273 responses were included in the analysis. Clinicians ranked in-person visits as their first choice of communication for future SVs (n = 157, 59.9%) and indicated that in-person communication was "very effective" (n = 143, 52.4%) when compared with videoconferencing (n = 55, 20.1%) and telephone (n = 49, 17.9%). Clinicians ranked verifying the competency level of the student and verifying site resources during the SV as "extremely important" or "important" (n = 257, 94.2% and n = 250, 91.5%, respectively). Answering CI's questions and providing support to the CI were also identified as "extremely important" or "important" (n = 262, 96% and n = 244, 89.4%, respectively). Analysis of open-ended responses revealed 5 themes: Communication is important, flexibility allows best fit for a situation, on-site visits offer a more complete picture, real-time dialog is preferred, and email can lead to misinterpretation.

DISCUSSION AND CONCLUSION

Communication is a key component of the clinical-academic relationship. Although clinicians prefer in-person communication, flexibility is necessary when planning and conducting SVs. Future research recommendations include gathering student and clinician perceptions regarding faculty involvement in SVs, as well as gathering faculty perspectives regarding their participation in SVs. In addition, the impact of the pandemic on the future of SVs warrants further exploration.

Development, Implementation and Evaluation of an Acute Care Physical Therapy 'Float' Placement during the COVID-19 Pandemic: A Case Report

Clinical education is a mandatory component of physical therapy curricula globally. COVID-19 disrupted clinical education, jeopardizing students' abilities to meet graduation requirements. The objective of this case report is to outline the development, implementation and evaluation of a multiple clinical instructor (CI), multiple unit, acute care float clinical placement for a final year, entry-level physical therapy student and offer implementation recommendations. This placement included an eight-week, multiple CI (one primary, four supporting), multiple (five) unit clinical placement which was developed between St. Joseph's Healthcare and the McMaster University Masters of Science (Physiotherapy) Program between 10 August and 2 October 2020. Student evaluations and reflections by the student and CIs were collected and analyzed using interpretive description. Analysis from the reflections revealed six themes: (1) CI and student attributes; (2) increased feasibility; (3) varied exposure; (4) central communication and resources; (5) organization; and (6) managing expectations. An acute care clinical experience is required for students in Canadian entry-to-practice physical therapy programs. Due to COVID-19, placement opportunities were limited. The float placement allowed clinicians to offer supervision despite staff re-deployment and increased organizational and work-life pressures during the pandemic. This model provides an approach to extenuating circumstances and may also increase acute care placements during non-pandemic times for physical therapy and other similarly structured healthcare professions.

The impact of rural nursing and midwifery clinical placements from the perspective of health service staff

OBJECTIVE

To explore the impact of providing nursing and midwifery student placements from the perspective of regional, rural and remote health service staff involved in hosting students.

SETTING

Hospital and health services across regional, rural and remote southern Queensland.

PARTICIPANTS

Thirty-six nursing and midwifery staff working in clinical and/or management roles who were direct clinical supervisors of students or in leadership positions with responsibility for overseeing and supporting clinical placements.

DESIGN

Semi-structured interviews exploring the experiences and perspectives of nursing and midwifery health service staff who support student placements. Data were subject to thematic analysis.

RESULTS

Five key themes were identified as follows: (a) bringing new ideas and perspectives, (b) opportunities for development, (c) supporting the future rural workforce (d) impacts on workload and productivity and (e) strategies for balancing supervision.

CONCLUSION

The results indicate that there are a range of perceived benefits and challenges of providing nursing and midwifery student placements within regional, rural and remote settings. The findings also indicate that there are opportunities to further support rural health services to optimise the positive impacts and mitigate the challenges of providing placements. To do so requires collaboration between health services and education providers to allocate students appropriately to health services and support health service staff.

Developing a student competency exam for hand therapy clinical experiences: A cross-sectional survey of hand therapists

STUDY DESIGN

Cross-sectional survey design.

INTRODUCTION

Students pursuing hand therapy clinical rotations are expected to demonstrate foundational knowledge prior to the experience.

PURPOSE OF THE STUDY

Identify content that should be included on a potential competency exam for students pursuing hand therapy rotations from the perspectives of current hand therapists.

METHODS

This questionnaire, devised from the Scope of Practice and Domains of Hand Therapy, was emailed to members of the American Society of Hand Therapists. Data was collected and analyzed with SurveyMonkey to determine descriptive statistics and frequency distributions.

RESULTS

All knowledge areas included in the survey were ranked important or very important. Knowledge areas with the highest responses of much importance were the range of motion assessments of the upper extremity, anatomy and physiology, and interpersonal skills and therapeutic communications.

DISCUSSION

Hand therapy clinical instructors expect their students to demonstrate competency in relevant topics prior to starting their clinical experiences. A hand therapy competency exam addressing the valued knowledge areas may ensure students are prepared for the rigorous expectations of a hand therapy clinical rotation.

CONCLUSION

A competency test, including knowledge areas presented in this study, given to students before starting a specialty rotation, may ensure that the student has the foundational knowledge needed to succeed in a hand therapy setting, provide an understanding of students' strengths and weaknesses, and help clinicians become more willing to accept students for hand therapy rotations.

Clinical educators can supervise students without increased stress: a study of interacting factors using insights from complexity theory

Supervising students in healthcare settings is complex and can be stressful for clinical educators. However, it is unclear how to design student placements without clinical educator stress. Using complexity theory as a lens, fuzzy set Qualitative Comparative Analysis (fsQCA) was used to explore factors associated with no increased stress for clinical educators during speech pathology (SP) placements. Factor selection was informed by the Demand- Control- Support model and existing literature. No single factor was necessary for clinical educators to experience no increased stress. Varied combinations of all factors were found in 10 paths to no increased stress. These combinations often had passing student(s); however, multiple paths included other factors that could be adjusted by clinical educators prior to placement. For example, having more than one workday per week without students was a factor in four paths to no increased stress despite other potential challenges such as a higher caseload throughput. More experienced educators, who had other supporting factors (e.g. lower caseload throughput or workplace engagement such as support from colleagues and managers), also perceived no increased stress in four paths. Student placements without increased stress for clinical educators require consideration of multiple interacting factors. Principles of complexity theory provide insight into how clinical educators uniquely respond to their individual circumstances, resulting in different experiences of student placement impact even within similar workplaces. FsQCA has highlighted practical ways clinical educators supervise students without increased stress. However, any changes for an individual clinical educator need to be considered in combination with other factors given the complexity of clinical education and healthcare settings.

Physiotherapy Students' Performance in Clinical Education: An Analysis of 1 Year of Canadian Cross-Sectional Data

Purpose: This research examines 1 year of cross-sectional, Canada-wide ratings from clinical instructors using the Canadian Physiotherapy Assessment of Clinical Performance (ACP) and analyzes the performance profiles of physiotherapy students' performance ratings over the course of their entry-to-practice clinical placements. Method: Canadian physiotherapy programmes that use the ACP were invited to submit anonymized, cross-sectional data for placements completed during 2018. Descriptive analyses and summary statistics were completed. Mixed-effects modelling was used to create typical performance profiles for each evaluation criterion in the ACP. Stepwise ordered logistic regression was also completed. Results: Ten programmes contributed data on 3,290 placements. Profiles were generated for each ACP evaluative item by means of mixed-effects modelling; three profiles are presented. In all cases, the predicted typical performance by the end of 24 months of study was approximately the rating corresponding to entry level. Subtle differences among profiles were identified, including the rate at which a student may be predicted to receive a rating of "entry level." Conclusions: This analysis identified that, in 2018, the majority of Canadian physiotherapy students were successful on clinical placements and typically achieved a rating of "entry level" on ACP items at the end of 24 months.

Impact of physical therapy and occupational therapy student placements on supervisor productivity: a scoping review

INTRODUCTION

Clinical educators may perceive that student supervision is time consuming and reduces productivity. This perception is in contrast to research conducted in the 1990's that found students do not negatively impact productivity. There is a need to review the current literature on this topic as a result of health care cost-containment measures that emphasize efficiency. The purpose of this scoping review was to map and examine the impact of physical and occupational therapy student placements on productivity in the clinical environment.

METHODS

PRISMA Scoping review methodology was used to identify relevant papers. A search was completed in MEDLINE, CHINAL, ERIC and Business Source Premier. Included studies measured clinician productivity while supervising a physical or occupational therapy student. Two reviewers independently reviewed studies according to pre-determined eligibility criteria.

RESULTS AND DISCUSSION

Fourteen studies met the inclusion criteria and were included in the review. Overall, the studies suggest that the supervision of students does not have a negative impact on productivity. However, the productivity measures varied in the type and methods which limits comparisons. This variability, along with the experience of stress by clinical educators as they attempt to satisfy multiple roles may account for the discrepancy between the perception and actual measure of productivity.

CONCLUSIONS

This scoping review found some evidence that students do not negatively impact productivity. This contrasts with the perception held by the supervising physical and occupational therapists. Further research is recommended to explore this discrepancy and determine optimal productivity measures matched to the characteristics of the environment.

Supporting a teacher identity in health professions education: AMEE Guide No. 132

This guide provides an understanding of what teacher identity is and how it can be developed and supported. Developing a strong teacher identity in the context of health professions education is challenging, because teachers combine multiple roles and the environment usually is more supportive to the identity of health practitioner or researcher than to that of teacher. This causes tensions for those with a teaching role. However, a strong teacher identity is important because it enhances teachers' intention to stay in health professions education, their willingness to invest in faculty development, and their enjoyment of the teaching role. The guide offers recommendations on how to establish workplace environments that support teacher identity rather than marginalise it. Additionally, the guide offers recommendations for establishing faculty development approaches that are sensitive to teacher identity issues. Finally, the guide provides suggestions for individual teachers in relation to what they can do themselves to nurture it.

The professional development and career journey into musculoskeletal first contact physiotherapy: a telephone interview study

(a)Background: Musculoskeletal (MSK) first contact physiotherapy (FCP) is being rolled out in the National Health Service, but limited research exists on career pathways into MSK FCP, or on pre-and-post-registration educational preparation for the knowledge and skills that are required for musculoskeletal first contact physiotherapy. (b) Objectives: From the perspectives of existing MSK FCPs, the study sought to understand the pre-and-post-registration professional developmental journey into musculoskeletal first contact physiotherapy. (c) Methods: Semi-structured interviews over the telephone were conducted with a self-selected and snowball sample of 15 MSK FCPs from across Britain. Framework analysis was used to analyze the interview transcripts. (d) Results: Four overarching themes were identified: (1) Decision to choose a career path as a MSK FCP; (2) Relevancy of pre-registration physiotherapy (PT) education for MSK FCP; (3) Relevancy of post-registration continuing professional development for MSK FCP, and; (4) Improving pre-registration PT education for the foundational knowledge and skills required to work in musculoskeletal first contact physiotherapy. Each overarching theme generated several subthemes. (e)Conclusion: The research contributes to understanding the career pathway into the MSK FCP role and showed what relevant knowledge and skills were acquired for this role at pre-and-post registration levels. Findings will inform guidance for pre-registration PT curriculum development.

Weighing up the benefits and challenges of hosting physiotherapy student placements in private practice; a qualitative exploration

INTRODUCTION

New graduate physiotherapists are entering private practice in increasing numbers despite limited opportunity to experience this setting during training. Exploring the perceived benefits and challenges of physiotherapy private practices in hosting students is important to help understand what motivates private practices to engage in clinical education and inform how practices can be best supported in student placement provision.

OBJECTIVE

The aim of this study was to explore the benefits and challenges of hosting physiotherapy students from the perspective of private practice providers.

METHODS

A qualitative study with an inductive thematic analytical approach was used. Semi-structured interviews of 10 physiotherapy private practice placement providers responsible for student placement provision were undertaken.

RESULTS

Five themes emerged: 1) value to client care; 2) value to staff; 3) value to future planning; 4) contribution to students and the profession; and 5) stress associated with resources.

DISCUSSION AND CONCLUSION

Private practice placement providers perceive a range of benefits to their practice, staff and clients, including rich opportunities for future recruitment when hosting physiotherapy students. These benefits are carefully weighed up against the required resources of time, physical space and opportunities for students to participate in client care. This study has identified implications for education providers in supporting physiotherapy student placements within private practice and may enhance placement capacity within this sector.

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.

Effects of Student Physical Therapists on Clinical Instructor Productivity Across Settings in an Academic Medical Center

BACKGROUND

Clinical education is an integral component of physical therapy education. Both benefits and barriers exist in clinical education, but 1 commonly stated barrier includes the perception that students have a negative impact on clinical instructor productivity.

OBJECTIVE

The purposes of this study were to evaluate the productivity of physical therapist clinical instructors in an academic medical center before, during, and after clinical education experiences, determine if there are differences in productivity during clinical education experiences across settings, and compare clinical instructor productivity with that of therapists who did not have a student during the same time frames.

DESIGN

A retrospective design examined productivity across 3 years in acute care, inpatient rehabilitation, outpatient orthopedics, and outpatient neurology. Mean daily productivity was computed, normalized to an 8-hour day, and averaged for each week of the year. Data were analyzed using a repeated-measures ANOVA. Post-hoc comparisons were made within each setting to compare therapists with a student to those without. The Bonferonni-correction was used to control for multiple comparisons.

RESULTS

Clinical instructor productivity was significantly increased in outpatient orthopedics and inpatient rehabilitation, and approached significance in outpatient neurology, but was not significant in acute care. The presence of a student made clinical instructors more productive but had no effect on the productivity of other therapists in that setting during the same time frame.

LIMITATIONS

We studied only 1 academic medical center and could not account for clinical instructor factors such as years of experience or student factors such as year in their program.

CONCLUSIONS

Our results indicate that having a student increases productivity of therapists in various settings. Future studies should examine the impact of clinical instructor experience and student characteristics and should expand to other settings.

Allied health pre-entry student clinical placement capacity: can it be sustained?

Objective Meeting the demand for clinical placements in an environment of increasing university cohort growth and changes in health service delivery models is challenging. This paper describes the outcomes of a quality review activity designed to gain key stakeholder perspectives on the enablers and barriers to sustaining effort to placement provision and reports on: (1) measures used to determine the effect of a jurisdiction-wide initiative in clinical education for five allied health professions; (2) outcomes of data related to key factors affecting placement supply and demand; and (3) qualitative perspectives from management, workforce and university stakeholders on placement sustainability. Methods This study reviewed clinical placement, staff full-time equivalent numbers, university program and student cohort data for five allied health professions from 2013 to 2016. In addition, qualitative response data from key stakeholder surveys was analysed thematically. Results In the study period, the rate of growth in placement offers did not match that of university program student numbers and full-time equivalent staff numbers. All stakeholders agreed that sustaining placement provision is enabled by collaboration, continuation of management support for dedicated clinical education staff, a focus on clinical education capacity building activities, outcome data reporting and statewide profession-specific governance, including leadership positions. Collaborations and networks across health and education sectors were reported to enhance efficiency, minimise duplication, streamline communication and support information and resource sharing within and across professions and stakeholders, ultimately sustaining placement provision. Identified barriers to sustainability centred on resourcing and the continued increasing demand for placements. Conclusion Sustaining pre-entry student placements requires stakeholder flexibility and responsiveness and is underpinned by collaboration, information and resource sharing. Dedicated clinical education positions were highly valued and seen as a key contributor to placement sustainability. What is known about the topic? The increasing demand for student placements and strategies used to enhance placement capacity are well known. To date, there have been limited studies investigating cross-sectoral trends and health service enablers and barriers to sustaining responses to placement demand. What does this paper add? This paper describes outcomes of a clinical placement capacity building initiative within public health services, developed from a unique opportunity to provide funding through an industrial agreement. It presents key allied health staff and university partner perspectives on enablers to sustaining placement supply in an environment of increasing placement demand. What are the implications for practitioners? This paper demonstrates that key enablers for the sustainability of placement provision are collaboration between university and health sectors, continuation of management support for dedicated clinical education staff, outcome data reporting and statewide profession-specific governance and leadership. It supports current practices of profession-specific and interprofessional clinical education resource and strategy development and the sharing of expertise for sustained placement provision.

Becoming a Clinical Teacher: Identity Formation in Context

PURPOSE

Most clinical teachers have not been trained to teach, and faculty development for clinical teachers is undermined by poor attendance, inadequate knowledge transfer, and unsustainability. A crucial question for faculty developers to consider is how clinicians become teachers "on the job." Such knowledge is important in the design of future workplace-based faculty development initiatives. The authors conducted a scoping review of research on the relationship between becoming a clinical teacher and the clinical environments in which those teachers work.

METHOD

In June 2017, using the scoping review design described by Levac et al (2010), the authors searched 12 databases. They subjected the articles discovered to four phases of screening, using iteratively developed inclusion/exclusion criteria. They charted data from the final selection of articles and used thematic analysis to synthesize findings.

RESULTS

Thirty-four research reports met the inclusion criteria. Most (n = 24) took an individualist stance toward identity, focusing on how teachers individually construct their teacher identity in tension with their clinician identities. Only 10 studies conceptualized clinical teacher identity formation as a social relational phenomenon, negotiated within hierarchical social structures. Twenty-nine of the included studies made little or no use of explicit theoretical frameworks, which limited their rigor and transferability.

CONCLUSIONS

Clinicians reconciled their identities as teachers with their identities as clinicians by juggling the two, finding mutuality between them, or forging merged identities that minimized tensions between educational and clinical roles. They did so in hierarchical social settings where patient care and research were prioritized above teaching.

The effect of speech-language pathology students on clinician time use and activity

PURPOSE

This prospective study investigated the impact of supervising students on public health speech-language pathologists' (SLPs) time and patient activity levels in order to broaden evidence in the profession.

METHOD

Thirty-four SLPs supervising students collected data profiling their time use and activity during the first, middle and penultimate placement week. They also collected data for a week when not supervising students. Pre- and post-placement surveys were used to supplement quantitative data with additional information such as clinician and student experience levels.

RESULT

Overall clinical time (face-to-face and indirect) and the number of patients seen neither increased nor decreased during student placements. However, clinicians' use of time altered across placement periods. For example, SLP time delivering clinical services decreased but time observing students providing clinical services increased as the placement progressed. Some differences in time spent in non-clinical activities (e.g. student teaching and SLP administration) were found. Comparing data from placements with varying supervision models or student competence level showed few significant differences in time use, activity or productivity.

CONCLUSION

There was no significant difference in overall clinical time used, nor patient activity or productivity whether clinicians were supervising students or not. Further research is required within SLP services.

Building successful and sustainable academic health science partnerships: exploring perspectives of hospital leaders

BACKGROUND

Clinical work-based internships form a key component of health professions education. Integral to these internships, academic health science partnerships (AHSPs) exist between universities and teaching hospitals. Our qualitative descriptive study explored the perspectives of hospital leadership on AHSPs: what they are composed of, and the facilitators and barriers to establishing and sustaining these partnerships.

METHODS

Fifteen individuals in a variety of hospital leadership positions were purposively sampled to participate in face-to-face interviews, after which a thematic analysis was conducted.

RESULTS

Participants reported that healthcare and hospital infrastructure shapes and constrains the implementation of clinical education. The strength of the hospitals' relationship with the medical profession facilitated the partnership, however other health professions' partnerships were viewed less favourably. Participants emphasized the value of hospital leaders prioritizing education. Further, our findings highlighted that communication, collaboration, and involvement are considered as both facilitators and barriers to active engagement. Lastly, opportunities stemming from the partnership were identified as research, current best practice, improved patient care, and career development.

CONCLUSION

Our study found that AHSPs involve the drive of the university and hospitals to gain valued capital, or opportunities. Reciprocal communication, collaboration, and involvement are modifiable components that are integral to optimizing AHSPs.

Service dissatisfaction and non-attendance in physiotherapy student-led clinics: a qualitative study

Background and Purpose: Student-led physiotherapy clinics are a valuable means for providing education opportunities and cost-effective services to the public. Service dissatisfaction is an important construct in understanding how student-led services can maximize patient care and minimize non-attendance while maintaining effective learning environments. Design: A qualitative interview design was used with semi-structured interviews. Results: Eighteen patients from three different university student-led physiotherapy clinics were interviewed. Five themes emerged that were associated with negative perceptions of service provision: (1) inadequate communication, (2) insufficient supervision, (3) loss of autonomy, (4) time commitment, and (5) continuity of care. Conclusion: The results of this study highlight factors that service providers should consider to mitigate negative patient experiences and relevant implications of dissatisfaction including non-attendance. Ensuring transparency of patient expectations of services and enhancing patient continuity of care between physiotherapists and students are important in minimizing the potentially negative factors associated with student-led health services.

Physiotherapy clinical education in Australia: an exploration of clinical educator characteristics, confidence and training requirements

Objectives The aim of this study was to describe physiotherapists’ involvement, confidence and training needs in the provision of student clinical education (CE) in Australia. Methods A valid and reliable cross-sectional online survey instrument was used to collect data from physiotherapists employed in public and private healthcare facilities in Australia. Survey questions included participant personal and professional characteristics, participation in CE-related continuing professional development (CPD) and confidence in components of CE. Results In all, 170 (34%) physiotherapists (mean age 37 years; mean years clinical experience 13 years) completed the survey. Most participants (68%) were currently involved in CE, over half (56%) had completed CE-related CPD and many (56%) reported a need for more CPD. Participants with no previous CE experience were less confident (P≤0.05) in all components of CE. Participants with less clinical experience were less confident in managing challenging students (P=0.003), multiple students (P=<0.001) and competing workplace and education duties (P=<0.001). Conclusions Physiotherapists with varying professional characteristics were involved in CE. Although many participants had attended CE-related CPD, many reported that more training was required. Future training for clinical educators should be tailored to participants’ level of experience and focus on the components of CE in which they feel least confident. What is known about the topic? The ability of physiotherapists to confidently assume a clinical educator role may affect their willingness to be clinical educators in the future and the students’ perceptions of clinical placement quality. CPD relating to CE may help prepare physiotherapists for the clinical educator role. What does this paper add? There is a lack of information regarding physiotherapists’ involvement in CE, completion of CE-related CPD or perceived levels of confidence in various aspects of the clinical educator role, such as placement organisation, teaching, assessment and the provision of feedback. This study describes the involvement of physiotherapists in CE in Australia, including their demographic and professional characteristics, participation in CE-related CPD and confidence in various components of CE. What are the implications for practitioners? Several recommendations regarding future CE-related CPD have resulted from this study, including tailoring CPD to the needs of physiotherapists based on their level of clinical or CE experience, focusing CPD on the aspects of CE in which physiotherapists feel least confident and raising the awareness of and improving accessibility to CPD opportunities in this area.

What impact do students have on clinical educators and the way they practise?

The clinical education setting plays an important part in teaching students about the real world of clinical practice. Traditionally the educational relationship between student and clinical educator has been considered one-way, with students being the ones that benefit. This review focuses on the areas of clinician practice and behaviour that students are reported to influence through clinical placements and as such, determine the overall impact students can have on supervising clinicians. Electronic searches were conducted across MEDLINE, EMBASE, PsychINFO and CINAHL in July 2016. Retrieved articles were filtered to find those which presented data relating to students in the clinical setting. Data was extracted and analysed independently by two authors through thematic analysis. Twenty-eight studies met the inclusion criteria. Results showed that practitioners enjoy the act of teaching. Clinical student presence encourages clinicians to solidify their knowledge base, stimulates learning and causes them to re-evaluate their practice. Practitioner skills were further developed as a results of students. Clinical educator workload and time spent at work increased when a student was present with time management being the predominant challenge practitioners faced. Studies demonstrated that clinicians feel they benefit by students periodically becoming the teacher. Student placements in clinical practice cause an increase in practitioner workload and lengthen their work day. These perceived limitations are outweighed by the many benefits described by supervising clinicians. Providing clinical education can enrich both the practice, and the practitioner, and the aforementioned advantages should be highlighted when offering or considering the expansion of clinical placements.

Clinical Instructors' Perspectives on the Clinical Education of Internationally Educated Physical Therapists: Diversity's Impact on the Experience

Purpose: The aim of this study was to understand the nature and extent of clinical instructors' (CIs') involvement in the clinical education of internationally educated physical therapists (IEPTs) while exploring CIs' perceptions of the similarities among and differences between IEPTs and Canadian-trained students. Method: In this qualitative descriptive study, 13 semi-structured interviews were conducted with CIs who were involved in a bridging programme for IEPTs. Data were coded using NVivo version 10, and common themes emerged through qualitative thematic analysis. Results: The majority of CIs perceived IEPTs' backgrounds to be diverse as a result of their varied previous clinical experience, physiotherapy scope of practice, and life stressors. Their diverse backgrounds contributed to the similarities and differences found in their skills, their personal motivation, and the education process, leading to successes and challenges in the clinical environment. Conclusions: Differences between IEPTs and Canadian-trained students stem from IEPTs' diverse backgrounds. Recognizing this diversity while demonstrating cultural competence will promote a successful clinical experience for both IEPT learners and CIs, which will ultimately facilitate the integration of IEPTs into the Canadian health care system.

Occupational Therapy Level II Fieldwork Impact on Clinicians: A Preliminary Time Study

The aim of this preliminary study was to quantify the amount of time clinicians spend at work with and without a student and identify predictors of time spent at work with a student. A quasi-experimental design evaluated 22 occupational therapists that supervised a student. The occupational therapists completed a time log for 3 months without a student and 3 months while supervising a student. A statistically significant difference in overall time spent at work while supervising a student compared to when not supervising a student was found. Clinicians spent an average additional 25 minutes at work per day when supervising a student. Clinician years of experience and time spent without a student were found to be predictive of the time spent at work with a student. The additional time spent at work when supervising a level II fieldwork student should be considered along with all of the documented benefits of supervising a student by potential fieldwork educators.

Factors associated with patient-satisfaction in student-led physiotherapy clinics: A qualitative study

BACKGROUND AND PURPOSE

Student-led physiotherapy clinics are a valuable means for providing clinical education opportunities for student learning and providing cost-effective services to the public. Understanding patient satisfaction within the student-led physiotherapy clinic setting is important to inform organizational, educational, and clinical processes that aim to balance both student learning experiences and quality patient care.

DESIGN

A cross-sectional qualitative design using semi-structured interviews.

RESULTS

A total of 20 patients from three different university student-led physiotherapy clinics were interviewed. Five major themes were associated with patient satisfaction, style of supervision, student-supervisor relationship, quality of physiotherapy care, student qualities and cost, and location of the service.

CONCLUSION

The results emphasize the importance placed by patients on effective communication, as well as the relationship between the supervisor and student overseeing their care. The findings highlight the influence of both the student and supervisor on patient satisfaction and provide insight into the style of student supervision from the perspective of the patient.

Clinical activity profile of preregistration physiotherapy students during clinical placements

Objective The aim of the present study was to determine the clinical activity profile of preregistration physiotherapy students during clinical placements and their clinical activity contribution to health service delivery. Methods Clinical activity data for 2014 were obtained from five Queensland public sector hospitals providing preregistration physiotherapy students clinical education in three key clinical areas (cardiorespiratory, musculoskeletal and neurological) over four 5-week placement blocks. Data regarding the number of student occasions of service (OOS) and the length of the OOS (LOOS) were collected to determine the average OOS and LOOS per student in each clinical area. Results Twenty weeks of student data were collected from each hospital in each clinical area, representing 29.1% of cardiorespiratory, musculoskeletal and neurorehabilitation student placements. Students completed 19051 OOS. The average OOS per student per block for cardiorespiratory, musculoskeletal and neurorehabilitation placements was 98.3, 74.0 and 72.4 respectively. Two-way ANOVA revealed a main effect of weeks (F=402.1, P<0.001) and clinical area (F =1331.5, P<0.001) for LOOS.In addition, an interaction was found between clinical placement week and clinical area for LOOS (F=8.4, P<0.001). Conclusions Student clinical activity data are useful for understanding the student contribution to health services. Student contribution appears to increase throughout the clinical placement and consideration should be given to the clinical educator:student ratio to enhance overall student contribution. What is known about the topic? Quantitative data describing physiotherapy student clinical care activity during placements are limited. What does this paper add? This paper profiles physiotherapy student clinical care activity and the changes occurring over 5-week placements. What are the implications for practitioners? Physiotherapy students provide clinical activity for health services that changes over their 5-week placement. Student clinical activity should be considered when responding to placement demand and planning service delivery.

Factors Influencing Occupational Therapists' Decision to Supervise Fieldwork Students

The purpose of this study was to identify factors that influence the decision to supervise a Level II occupational therapy fieldwork student. A survey was sent to occupational therapists identified from licensure boards and alumni rosters, including those who have and have not supervised students (n = 548). The results identified both positive and negative influences along with predictive factors of supervising a student. While positive factors included continuing education units, education on fieldwork expectations, their own fieldwork experiences, shared supervision, and access to educational resources, negative influences consisted of: job responsibilities, caseload, productivity standards, working part-time, and fear of failing a student. The discussion focuses on how to address the needs of the clinician and facilitate fieldwork placement.

An Exploration of Canadian Physiotherapists' Decisions about Whether to Supervise Physiotherapy Students: Results from a National Survey

Purpose: To explore Canadian physiotherapists' perceptions of the factors that influence their decisions whether to supervise students in clinical placements. Methods: Using accepted survey development methodology, a survey was developed and administered to 18,110 physiotherapists to identify which factors contribute to the decision to supervise students. The survey also gave respondents opportunities to provide comments; these were analyzed via directed content analysis, using the factors identified in an exploratory factor analysis as an organizing structure. Results: A representative sample of 3,148 physiotherapists responded to the survey. Qualitative analysis of respondent comments provided a rich understanding of the factors contributing to the decision on whether to supervise students, which centred on themes related to stress, workplace productivity, the evaluation instrument, student preparation, and physiotherapists' professional roles and responsibilities. Challenges specific to loss of income and the ethics of charging for student services in private practice were also identified. Conclusions: Supervising students can be stressful, and stress is perceived by respondents to be most influential in deciding whether to supervise students. Effective supervisor training may mitigate some of the stresses related to supervising students. A collaborative approach involving all stakeholders is needed to resolve the issues of student placement capacity.

An Innovative Program to Support Internationally Educated Health Professionals and Their Instructors: Role of the Clinical Practice Facilitator

INTRODUCTION

Internationally educated health professionals immigrating to other countries may experience difficulty in clinical practice, due to linguistic and cultural factors. An important element of bridging is the opportunity for internationally educated health professionals to practice in a clinical environment. To support these health professionals and their clinical instructors, a Clinical Practice Facilitator (CPF) role was created. This study aimed to examine the CPF from internationally educated health professionals and clinical instructors' perspective.

METHODS

A quantitative survey was conducted with two cohorts (2013 and 2015) of internationally educated physical therapists and clinical instructors who were asked about the nature of interaction with CPFs, mentor, and education roles and the benefits and challenges of the role.

RESULTS

Thirty-five internationally educated physical therapists and 37 clinical instructors participated and were satisfied with the interaction with CPFs via face-to-face or e-mail communication. There was strong agreement (>80%) that the CPF educator role was to facilitate learner's reflection on clinical practice while the mentor role (>70%) was to answer questions, provide feedback, and investigate clinical concerns and conflicts. There was insufficient time for access to CPFs and resolution of learners' learning needs. There were differences (P = 0.04) in perspective on the benefit of the CPF in assisting with cultural differences.

DISCUSSION

An innovative CPF role provided support encouragement, clinical, and professional advice. There were discordant views regarding the benefits of the CPF role in addressing cultural issues, which requires further examination.

Supervision of Occupational Therapy Level II Fieldwork Students: Impact on and Predictors of Clinician Productivity

This study aimed to determine whether a difference in productivity exists between clinicians supervising and not supervising a Level II occupational therapy student and whether factors including clinician years of experience, practice setting, and clinician productivity without a student could predict clinician productivity while supervising a student. We used paired-sample t tests to examine clinician productivity with and without a student in 109 clinician-student encounters and regression analysis to determine factors predictive of clinician productivity with a student. Results indicated no difference in clinician productivity with or without a student. Clinician years of experience, practice area, and productivity without a student were significant predictors of clinician productivity while supervising a student. Study results contradict the belief that supervising Level II fieldwork students lowers clinicians' productivity. Findings suggest that practice area and productivity without a student are important factors influencing the productivity of clinicians supervising a fieldwork student.

Using Appreciative Inquiry to Explore the Potential of Enhanced Practice Education Opportunities

This practice analysis demonstrates how appreciative inquiry has been used within a Local Health Board to enhance the quality of practice placements and increase the range of occupational therapy practice opportunities offered to students. A positively focused appreciative inquiry workshop, collaboratively facilitated between the Local Health Board and a university, brought about change. Both student placements and the range of placement opportunities increased, and occupational therapists and students reported greater confidence and improved experiences. The use of appreciative inquiry in discussion provided a guiding structure and a framework that enhanced and sustained positive change.

Evidence-based practice supports among Canadian occupational therapists

Background.

Supports for evidence-based practice (EBP) and research utilization are needed for moving evidence into practice.

Purpose.

The purpose of this study was to identify the presence of individual and organizational EBP supports (based on a previous scoping review) and the attitudes toward the supports in a convenience sample of Canadian occupational therapists.

Method.

A cross-sectional survey was used to collect data from members of the Canadian Association of Occupational Therapists.

Findings.

Data from 368 clinicians (21%) indicated that although factors that have been shown to support EBP, such as student supervision and participation in research and mentoring, were not common practice, attitudes toward these EBP supports were positive.

Implications.

EBP supports, although viewed favourably by clinicians, have yet to be integrated fully into clinical practice. These findings provide researchers with an opportunity to design studies to support clinicians who view EBP in a positive light in integrating evidence into their practice.

Physiotherapists and Physiotherapy Student Placements across Regions in Ontario: A Descriptive Comparison

PURPOSE

To describe the distribution and type of physiotherapy student placements in one year relative to the number of practising physiotherapists of Ontario.

METHODS

Site information about physiotherapy students' clinical placements in Ontario in 2010 was obtained from Academic Coordinators of Clinical Education. Worksite information about physiotherapists who reported providing direct patient care at a primary employment site in Ontario and at least 600 practice hours in their annual renewal was obtained from the College of Physiotherapists of Ontario. Each placement and each physiotherapist was attributed to one of Ontario's 14 local health integration networks (LHINs). For each LHIN, a ratio of student placements to practising physiotherapists was calculated, using summed counts. Counts of placement types by setting, patient mix, and practice area were also calculated for each LHIN.

RESULTS

The 5 LHINs in which the university programmes are located had high placement:physiotherapist ratios, from 0.92 to 0.38. The other 9 LHINs had lower ratios, the 3 lowest at approximately 0.15. There was a wide mix of clinical placement types across LHINs.

CONCLUSION

Physiotherapists' participation in physiotherapy students' clinical education varied widely among Ontario regions. Future research could explore whether regional differences are persistent, why they occur, and whether they should be reduced.

Barriers and facilitators to providing undergraduate physiotherapy clinical education in the primary care setting: a three-round Delphi study

BACKGROUND

With the global shift in health care from secondary to primary care, employment opportunities for newly qualified physiotherapists are likely to be in the primary care setting. However, to date, undergraduate physiotherapy clinical education has been centred around secondary care, focusing on acute services in large teaching hospitals. For contemporary physiotherapists to become effective first-contact primary care providers, they need to be exposed to the primary care environment during their undergraduate education.

OBJECTIVES

To explore the concept and identify perceived barriers and facilitators to providing physiotherapy undergraduate clinical placements in the primary healthcare setting

DESIGN

A three-round Delphi survey was used. Participants were asked to answer open-ended questions with regard to: (i) student preparation for and (ii) provision of primary care placements (Round 1). Content analysis was employed to identify key themes. These themes generated statements for Round 2. In Round 2, participants were asked to rate their level of agreement/disagreement with the generated statements. In Round 3, a final rating process was conducted. Level of consensus was established as ≥70% agreement, with an interquartile range of ≤1.

PARTICIPANTS

One hundred and ninety-eight primary care physiotherapy staff.

RESULTS

Barriers identified included shortage of resources (e.g. staff) and a lack of tradition; in other words, students are not traditionally educated in the primary care setting. Response rates were 60% (120/198), 70% (84/120) and 76% (64/84) for Rounds 1, 2 and 3, respectively. All seven key facilitators identified reached consensus. They included additional support for staff taking students and motivated students.

CONCLUSIONS

This study revealed that there is support for the provision of physiotherapy clinical education in the primary care setting. Through careful consideration with clear planning and collaboration with all stakeholders, it may be possible to convert the main barriers identified into facilitators to ensure that there will be an adequately prepared physiotherapy work force in the future.

Building Passion Develops Meaningful Mentoring Relationships among Canadian Physiotherapists

PURPOSE

To describe the meaning of mentorship among Canadian orthopaedic physiotherapists.

METHODS

As part of a phenomenological qualitative study, 14 registered physiotherapists (13 women, 1 man) each participated in a single 60-minute, semi-structured face-to-face interview. Participants reflected on their experiences in receiving and providing mentorship and described the impact of mentorship on their careers. Interviews were transcribed verbatim and analyzed using a phenomenological approach.

RESULTS

Participants described mentorship as any nurturing process in which they used their skills and experience to guide, teach, and encourage a less skilled or less experienced colleague for the purpose of promoting professional and personal development. Participants experienced mentorship as a positive, reflective phenomenon. According to participants, the true essence of mentorship in physiotherapy consists of building passion, keeping fresh, making us stronger, and promoting deeper learning.

CONCLUSIONS

Building a shared passion for learning, as well as a mentor's commitment to the mentee's success, forms the foundation of meaningful mentorship in physiotherapy. These mentoring relationships enable physiotherapists to adapt to the changing health care system, advance patient care, and develop the profession.