Perceptions of physiotherapy clinical educators’ dual roles as mentors and assessors: Influence on teaching–learning relationships

Background: Central to clinical education is the teaching–learning (T-L) relationship that evolves between the clinical educator (CE) and the student. Within this T-L relationship, CEs may be expected to fulfil dual roles as mentors and assessors of students. Challenges for both parties may arise when CEs take on these different roles. Objectives: The goal of this study was to ascertain how CEs perceived the influence of their dual roles as mentors and assessors on their T-L relationships with physiotherapy students. Method: Individual interviews were semi-structured with nine CEs during this qualitative descriptive study at the Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University. A content analysis followed to analyse the data obtained. An iterative process, aimed to understand the phenomena under study, was conducted via an interpretive approach in context. This revealed main themes that were identified and refined. Results: Clinical educators experienced challenges when their role changed from being a mentor to that of assessor. These challenges affected the learning of students, as they influenced the T-L relationship. Clinical educators experienced ambiguities regarding their dual roles and, as a result, their expectations were often not fulfilled. Conclusion: Students’ learning processes were negatively affected by the changing roles of CEs, who acted as mentors and later as assessors of clinical competence during the students’ clinical rotations. The positioning theory was offered as a framework to resolve the challenges created by the dual roles and to manage expectations between CEs and students. The T-L encounters could be enhanced if students and CEs aligned themselves to a learning-centred paradigm where the focus was on learning and where the needs of the diverse students and the expectations of CEs were balanced. Further research should explore how a workshop with role play, demonstrating to CEs in practice how to reposition themselves, would impact the relationships between both parties. Clinical implications: It is essential to ensure a positive T-L relationship between a CE and a student as this will improve the quality of learning in the clinical environment and, therefore, directly influence student’s patient management. Implementing faculty development programmes to address this, should be further explored

Clinical practice guideline adaptation methods in resource-constrained settings : four case studies from South Africa

CITATION: McCaul, Michael et al. 2020. Clinical practice guideline adaptation methods in resource-constrained settings : four case studies from South Africa. BMJ Evidence-Based Medicine, 25(6):193-198, doi:10.1136/bmjebm-2019-111192.The original publication is available at: https://ebm.bmj.comDeveloping a clinical practice guideline (CPG) is expensive and time-consuming and therefore often unrealistic in settings with limited funding or resources. Although CPGs form the cornerstone of providing synthesised, systematic, evidence-based guidance to patients, healthcare practitioners and managers, there is no added benefit in developing new CPGs when there are accessible, good-quality, up-to-date CPGs available that can be adapted to fit local needs. Different approaches to CPG development have been proposed, including adopting, adapting or contextualising existing high-quality CPGs to make recommendations relevant to local contexts. These approaches are attractive where technical and financial resources are limited and high-quality guidance already exists. However, few examples exist to showcase such alternative approaches to CPG development. The South African Guidelines Excellence project held a workshop in 2017 to provide an opportunity for dialogue regarding different approaches to guideline development with key examples and case studies from the South African setting. Four CPGs represented the topics: mental health, health promotion, chronic musculoskeletal pain and prehospital emergency care. Each CPG used a different approach, however, using transparent, reportable methods. They included advisory groups with representation from content experts, CPG users and methodologists. They assessed CPGs and systematic reviews for adopting or adapting. Each team considered local context issues through qualitative research or stakeholder engagement. Lessons learnt include that South Africa needs fit-for-purpose guidelines and that existing appropriate, high-quality guidelines must be taken into account. Approaches for adapting guidelines are not clear globally and there are lessons to be learnt from existing descriptions of approaches from South Africa.Publisher's versio

“So, you must understand that that group changed everything”: perspectives on a telehealth group intervention for individuals with chronic pain

Background The Patient Education Empowerment Programme (PEEP) is an interdisciplinary group intervention for people living with chronic pain. As a result of the COVID-19 pandemic, lockdown and restrictions on in-person group-based health care delivery in South Africa, PEEP was modified to a telehealth electronic format (ePEEP) and offered to patients on a waiting list at two interdisciplinary chronic pain clinics in Cape Town, South Africa. The purpose of this study was to explore the feasibility and acceptability of ePEEP through the perspectives of individuals with chronic pain who participated in ePEEP.  Methods A qualitative, exploratory descriptive study was conducted. One month after completion of the 6-week ePEEP programme, individuals who participated, were recruited for the study. Data were collected through semi-structured interviews. Data analysis followed an iterative process of inductive content analysis.  Results Six individuals, all women, consented and participated in the study. Three main themes emerged from the data. Theme one focussed on how ePEEP initiated a journey of personal development and discovery within the participants. In theme two, participants reflected on the importance and value of building peer and therapeutic relationships as part of ePEEP. In theme 3, participants shared that the online learning environment had features which influenced learning about pain in different ways. Conclusion ePEEP was found to be acceptable, feasible and valuable for the participants. ePEEP facilitated self-discovery, empowerment, relationship building and transformation in the participants, through experiential learning. Although barriers and facilitators to learning were present, both enhanced the learning experience. The positive reception of this telehealth initiative indicates potential for enhanced access to chronic pain management services in the South African setting

Collaborative capacity development to complement stroke rehabilitation in Africa

This scholarly book focuses on stroke in Africa. Stroke is a leading cause of disability among adults of all ages, contributing significantly to health care costs related to long term implications, particularly if rehabilitation is sub-optimal. Given the burden of stroke in Africa, there is a need for a book that focuses on functioning African stroke survivors and the implications for rehabilitation within the African context. In addition, there is a need to progress with contextualised, person-centred, evidence-based guidance for the rehabilitation of people with stroke in Africa, thereby enabling them to lead socially and economically meaningful lives. The research incorporated in the book used a range of primary and secondary methodological approaches (scoping reviews, systematic reviews, meta-analyses, descriptive studies, surveys, health economics, and clinical practice guideline methodology) to shed new insights into African-centred issues and strategies to optimise function post-stroke

Students' and clinical teachers' views on effective clinical education in Physiotherapy at Stellenbosch University

Thesis (MPhil (Curriculum Studies))--University of Stellenbosch, 2006.Clinical education in health sciences is an important and distinct part of health care education. In clinical education situations, students learn to integrate the knowledge, skills, attitudes and values of the profession. The attainment of clinical competence is one of the main outcomes of the Clinical Physiotherapy module for physiotherapy students at Stellenbosch University (SU). In its Strategy for Teaching and Learning (2001:3), SU embraces a student-centered approach to teaching. In a student-centered approach towards teaching, the focus is on the quality and quantity of student learning. In the current changing context of higher education, all spheres of education need to be assessed to determine the meaning of student-centeredness and to establish whether it is achieved. The above-mentioned approach may lead to quality management in teaching and learning

The development of a contextualised evidence-based clinical practice guideline for the primary health care of chronic musculoskeletal pain in the Western Cape

Thesis (PhD)--Stellenbosch University, 2017.ENGLISH SUMMARY : Background: Chronic musculoskeletal pain (CMSP) is a global healthcare concern, and is a major cause of disability and morbidity in sub-Saharan Africa. The implementation of high-quality, evidence-based clinical practice guidelines can enable quality healthcare for CMSP. Clinical guidelines for CMSP developed in developed nations may not be appropriate in developing countries with resource-constrained environments, due to differences in socio-cultural, societal and policy contexts. The contextualisation of clinical guidelines may be an option to provide guidance in resource-constrained environments. Aim: The overall aim of the research project was to develop a contextualised evidence-based, multimodal clinical practice guideline for the primary health care of chronic musculoskeletal pain in adults in the Western Cape Province of South Africa (SA). Method: The research was conducted in three parts: Part 1 comprised two qualitative descriptive studies to explore contextual factors that play a role in the health care of CMSP in three community centres. Three community health centres were strategically selected to represent a rural, a semi-urban and an urban-township setting. Study one used semi-structured interviews with patients to discover patients’ perspectives of CMSP and its healthcare management. In study two, semi-structured interviews were conducted with a diverse group of healthcare practitioners’ to explore their perspectives on the contextual barriers and facilitators regarding the healthcare of CMSP. Interviews were recorded, transcribed and analysed using inductive content analysis. Part 2 entailed study three, a systematic review conducted to identify current, high-quality clinical guidelines on the primary health care of CMSP. Guidelines that met the inclusion criteria were assessed using the Appraisal of Guidelines Research and Evaluation, Version II. Evidence-based recommendations were extracted from high-quality guidelines and synthesised for the contextualisation process. Part 3 of the project entailed the validation and contextualisation of the clinical recommendations. In study four, a multi-disciplinary panel of experts validated the clinical recommendations for the South African context using a modified Delphi approach. The panel developed context points relevant to the recommendations during a consensus meeting. In study five, potential end-users reviewed the applicability and acceptability of the contextualised clinical practice guidelines through a survey. Results: Twenty patients with CMSP and 21 practitioners participated in Part one. The findings indicated that CMSP influenced patients in multiple ways. Participants largely agreed on the context factors that influence CMSP care, namely the personal characteristics of the patient and practitioner, the social and environmental circumstances within which the patient lives, the healthcare interventions received and healthcare system factors. These contextual factors formed the foundation of the relevant facilitators and barriers to CMSP care in the context investigated. Twelve clinical guidelines on the primary healthcare management of CMSP were identified through the systematic review. Six of these clinical guidelines were of high quality, and 156 recommendations were extracted from them. The recommendations were synthesised using a structured process. The end-result was a core set of 43 multimodal evidence-based, clinical recommendations. Seventeen multi-disciplinary panel members validated the recommendations for the South African context, nominated an extra recommendation and positioned the recommendations within the context of application for primary healthcare. The contextualized guideline was reviewed by a diverse group of 18 end-users who confirmed the clinical guideline to be largely applicable and acceptable for the intended context. Conclusion: The end-product of the project was a contextualised, evidence-based and multimodal clinical guideline for the primary healthcare of CMSP in the Western Cape province of South Africa. The findings indicate that modifications in practice patterns, healthcare system organization and governance will contribute to the successful implementation of the guideline. A inter-/multi-disciplinary approach, with the outcome of the patient as self-manager within a supportive environment, is underscored. Further research avenues include the development of a multilevel implementation plan and a pragmatic trial to investigate the feasibility of the contextualised clinical guideline in the South African context.AFRIKAANSE OPSOMMING : Agtergrond: Daar is wereldwyd besorgdheid oor gesondheidsorg vir kroniese muskuloskeletale pyn (KMSP). Muskuloskeletale toestande is ‘n groot oorsaak van beperkte funksie en morbiditeit in sub-Sahara Afrika. Hoe-kwaliteit, bewysgesteunde kliniese praktyk riglyne is een manier om kwaliteit-gesondheidsorg aan individue met KMSP te lewer. Kliniese riglyne vir KMSP wat in ontwikkelde lande ontwikkel is, is waarskynlik nie toepaslik vir omgewings met beperkte hulpbronne nie, vanwee verskille in die sosio-kulturele, samelewings- en politieke konteks. Die kontekstualisering van bestaande riglyne is dus ‘n opsie. Doel: Die oorhoofse doelwit van hierdie navorsingsprojek was om ‘n gekontekstualiseerde, bewysgesteunde, multimodaliteit kliniese praktyk riglyn vir die primere gesondheidsorg van KMSP in volwassenes in die Wes-Kaap, ‘n provinsie van Suid Afrika, te ontwikkel. Metode: Die navorsing het uit drie dele bestaan: Deel 1 het twee kwalitatiewe beskrywende studies behels om die konteks faktore wat 'n rol speel in die behandeling van KMSP te ondersoek, in ‘n steekproef van drie gesondheidsorgsentrums. Die drie gesondheidsentrums is strategies gekies om landelike, semi-stedelike en 'n stedelike-township te verteenwoordig. Studie een het semi-gestruktureerde onderhoude met pasiente gebruik om hul perspektiewe rakende KMSP, en die behandeling daarvan te ondersoek. In studie twee is semi-gestruktureerde onderhoude met 'n diverse groep gesondheidsorg praktisyns gevoer om hul perspektiewe rakende potensiele kontekstuele struikelblokke en fasiliteerders vir die behandeling van KMSP in primere gesondheidsorg te bepaal. Die onderhoude is opgeneem, getranskribeer en ge-analiseer deur middel van induktiewe inhoud analise. Deel 2 het studie drie van die navorsing behels. 'n Sistematiese oorsig is gedoen om huidige, hoe-kwaliteit kliniese praktyk riglyne ten opsigte van die primere gesondheidsorg van KMSP te identifiseer. Die kliniese riglyne wat voldoen het aan die insluitingskriteria is geevalueer met behulp van die Beoordeling van Kliniese Riglyne Navorsing en Evaluering, weergawe II. Bewysgebaseerde kliniese aanbevelings is vanuit die hoe-kwaliteit riglyne ontgin en verwerk vir die kontekstualiseringsproses. eel 3 van die projek het die bekragtiging en kontekstualisering van die kliniese aanbevelings behels. ‘n Multi-dissiplinere groep kundiges het die kliniese aanbevelings vir die Suid-Afrikaanse primere gesondheidsorg konteks bekragtig deur ‘n aangepaste Delphi-metode (studie vier). Die paneel het kontekspunte relevant tot die kliniese aanbevelings ontwikkel tydens ‘n konsensus vergadering. In studie vyf, het potensiele eindgebruikers die toepaslikheid en aanvaarbaarheid van die gekontekstualiseerde kliniese praktyk riglyn geevalueer deur middel van ‘n vraelys. Resultate: Twintig pasiente met KMSP en 21 praktisyns het deelgeneem aan Deel een van die projek. Die bevindinge dui daarop dat KMSP pasiente op verskeie maniere beinvloed. Deelnemers het grootliks saamgestem oor die konteks faktore wat die behandeling van KMSP beinvloed, naamlik die persoonlike eienskappe van pasiente en praktisyns, die sosiale en die omgewings omstandighede waarbinne die pasient leef, die behandeling ontvang en faktore wat betrekking het op die gesondheidsorg stelsel. Twaalf kliniese praktyk riglyne rakende die primere gesondheidsorg van KMSP is met die sistematiese oorsig geidentifiseer. Ses kliniese riglyne was van 'n hoe gehalte, en 156 aanbevelings is uit die riglyne versamel. Die aanbevelings is met behulp van 'n gestruktureerde proses gesintetiseer. Die eindresultaat was 'n kern stel van 43 multimodale, bewysgesteunde kliniese aanbevelings. 'n Multidissiplinere groep van tot 17 kundiges het die lys van aanbevelings vir die behandeling van KMSP in die Suid-Afrikaanse konteks goedgekeur, ‘n ekstra aanbeveling genomineer en het die aanbevelings binne die konteks van implementering in die Suid-Afrikaanse konteks geposisioneer. Die gekontekstualiseerde riglyn is geevalueer deur 'n diverse groep van 18 eind-verbruikers, wat bevestig het dat die riglyn grootliks toepaslik en uitvoerbaar is vir die bedoelde konteks. Gevolgtrekking: Die eind-produk van die projek was 'n gekontekstualiseerde, bewysgesteunde en multimodale kliniese riglyn vir die primere gesondheidsorg van KMSP in die Wes-Kaap provinsie van Suid-Afrika. Die bevindinge dui daarop dat veranderinge in die praktykpatrone, organisasie en bestuur van die gesondheidsorg stelsel sal bydra tot die suksesvolle implementering van die kliniese riglyn. 'n Inter-/multi-dissiplinere benadering, met die uitkoms 'n pasient as self-bestuurder binne 'n ondersteunende omgewing, word beklemtoon. Verdere navorsing behels die ontwikkeling van 'n multivlak implementeringsplan, asook 'n pragmatiese proefneming om die haalbaarheid van die gekontekstualiseerde kliniese riglyn in die Suid-Afrikaanse konteks te evalueer

Roles and attributes of physiotherapy clinical educators : is there agreement between educators and students?

CITATION: Ernstzen, D. V. 2013. Roles and attributes of physiotherapy clinical educators : is there agreement between educators and students? African Journal of Health Professions Education, 5(2):91-94, doi:10.7196/AJHPE.252.The original publication is available at http://www.ajhpe.org.zaObjectives. To determine which roles and attributes of clinical educators are perceived as important in creating a clinical learning environment that is conducive to learning, and if there were differences between the perceptions of undergraduate physiotherapy students and clinical educators. Design. A cross-sectional survey in the form of a purpose-built questionnaire was conducted among physiotherapy students and clinical educators. Setting. The study was performed at the Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa. Participants. All enrolled undergraduate physiotherapy students (n=80) with clinical experience, and all clinical educators (n=37) involved in the delivery of clinical education were invited to participate. Results. The educator roles that strongly influence the clinical learning environment were found to be those of technique demonstrator, mentor, assessor, knowledge provider and facilitator of learning. Educators’ and students’ views about the role of the educator as role model, reflector, knowledge provider and technique demonstrator differed. Participants agreed that the attributes of the clinical educator that are conducive to learning are approachability, recognising student abilities, and good communication skills. Conclusion. The clinical educator is pivotal in the success of the physiotherapy clinical education programme. The study found similarities and differences about the role perceptions of educators and students. The differences might influence the learning experience, and it is recommended that expectations be clarified at the start of the clinical education programme.http://www.ajhpe.org.za/index.php/ajhpe/article/view/252Publisher's versio

Clinical practice guidelines for the management of chronic musculoskeletal pain in primary healthcare: a systematic review

Abstract Background Up-to-date, high quality, evidence-based clinical practice guidelines (CPGs) that are applicable for primary healthcare are vital to optimize services for the population with chronic musculoskeletal pain (CMSP). The study aimed to systematically identify and appraise the available evidence-based CPGs for the management of CMSP in adults presenting in primary healthcare settings. Methods A systematic review was conducted. Twelve guideline clearinghouses and six electronic databases were searched for eligible CPGs published between the years 2000 and May 2015. CPGs meeting the inclusion criteria were appraised by three reviewers using the Appraisal of Guidelines Research and Evaluation (AGREE) II. Results Of the 1082 records identified, 34 were eligible, and 12 CPGs were included based on the inclusion and exclusion criteria. The methodological rigor of CPG development was highly variable, and the median domain score was 66%. The median score for stakeholder involvement was 64%. The lowest median score was obtained for the domain applicability (48%). There was inconsistent use of frameworks to aggregate the level of evidence and the strength of the recommendation in the included CPGs. The scope and content of the included CPGs focussed on opioid prescription. Conclusion Numerous CPGs that are applicable for the primary healthcare of CMSP exists, varying in their scope and methodological quality. This study highlights specific elements to enhance the development and reporting of CPGs, which may play a role in the uptake of guidelines into clinical practice. These elements include enhanced reporting of methodological aspects, the use of frameworks to enhance decision making processes, the inclusion of patient preferences and values, and the consideration of factors influencing applicability of recommendations. Trial registration PROSPERO CRD42015022098

Patient perspectives about the healthcare of chronic musculoskeletal pain : three patient cases

CITATION: Ernstzen, D., Louw, Q. & Hillier, S. 2016. Patient perspectives about the healthcare of chronic musculoskeletal pain: Three patient cases. African Journal of Disability, 5(1): 1-7, doi: 10.4102/ajod.v5i1.216.The original publication is available at http://www.ajod.orgPublication of this article was funded by the Stellenbosch University Open Access Fund.Background: Consideration of the patient’s perspective in healthcare is important because it may inform holistic and contextually relevant management strategies. Objectives: The purpose of this study was to explore patients’ experiences and perspectives about their chronic musculoskeletal (CMSK) pain and its management in the private healthcare sector in South Africa. This work was done as a pilot study to test, adapt and finalize an interview schedule. Methods: A descriptive, qualitative study was conducted. The sampling was purposive. Three patients with CMSK pain were recruited to participate in in-depth individual interviews. The interviews were recorded and transcribed ensuring confidentiality. Inductive, thematic content analyses of the transcripts were undertaken. Initial codes were assigned and a code book developed, which was applied to the transcripts to develop categories and themes. Results: Four themes emerged from the data: (1) the participants sought understanding about the pain’s origin and the reason for pain persistence; (2) pain impacted their lives in multiple ways; (3) the participants depended on healthcare providers (HCP) for guidance and support; and (4) they had the option of acceptance of chronic pain. Conclusion: The participants’ knowledge about their health condition had important implications as it influenced their perspectives on pain and its management. The pain presented the participants with several challenges, which included developing an understanding about pain and coping with the impact of pain in their lives. HCPs were perceived to play an important role in empowering or disempowering the participants.http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0150487Publisher's versio