1 research outputs found
Using video-reflexive ethnography and simulation-based education to explore patient management and error recognition by pre-registration physiotherapists
Background: Upon graduation, physiotherapists are required to manage clinical caseloads involving deteriorating
patients with complex conditions. In particular, emergency on-call physiotherapists are required to provide respiratory/
cardio-respiratory/cardiothoracic physiotherapy, out of normal working hours, without senior physiotherapist support. To
optimise patient safety, physiotherapists are required to function within complex clinical environments, drawing on their
knowledge and skills (technical and non-technical), maintaining situational awareness and filtering unwanted stimuli
from the environment. Prior to this study, the extent to which final-year physiotherapy students were able to manage an
acutely deteriorating patient in a simulation context and recognise errors in their own practice was unknown.
Methods: A focused video-reflexive ethnography study was undertaken to explore behaviours, error recognition abilities
and personal experiences of 21 final-year (pre-registration) physiotherapy students from one higher education institution.
Social constructivism and complexity theoretical perspectives informed the methodological design of the study. Video
and thematic analysis of 12 simulation scenarios and video-reflexive interviews were undertaken.
Results: Participants worked within the professional standards of physiotherapy practice expected of entry-level
physiotherapists. Students reflected appropriate responses to their own and others’ actions in the midst of
uncertainty of the situation and physiological disturbances that unfolded during the scenario. However, they
demonstrated a limited independent ability to recognise errors. Latent errors, active failures, error-producing
factors and a series of effective defences to mitigate errors were identified through video analysis. Perceived
influential factors affecting student performance within the scenario were attributed to aspects of academic
and placement learning and the completion of a voluntary acute illness management course. The perceived
value of the simulation scenario was enhanced by the opportunity to review their own simulation video with
realism afforded by the scenario design.
Conclusions: This study presents a unique insight into the experiences, skills, attitudes, behaviours and error
recognition abilities of pre-registration physiotherapy students managing an acutely deteriorating patient in a
simulation context. Findings of this research provide valuable insights to inform future research regarding
physiotherapy practice, integration of educational methods to augment patient safety awareness and
participant-led innovations in safe healthcare practice.
Keywords: Error recognition, Deterioration, Physiotherapy, Simulation-based education, Video-reflexive
ethnograph