Physiotherapy students and clinical educators perceive several ways in which incorporating peer-assisted learning could improve clinical placements: a qualitative study

AbstractQuestion: What are the experiences of students and clinical educators in a paired student placement model incorporating facilitated peer-assisted learning (PAL) activities, compared to a traditional paired teaching approach? Design: Qualitative study utilising focus groups. Participants: Twenty-four physiotherapy students and 12 clinical educators. Intervention: Participants in this study had experienced two models of physiotherapy clinical undergraduate education: a traditional paired model (usual clinical supervision and learning activities led by clinical educators supervising pairs of students) and a PAL model (a standardised series of learning activities undertaken by student pairs and clinical educators to facilitate peer interaction using guided strategies). Results: Peer-assisted learning appears to reduce the students’ anxiety, enhance their sense of safety in the learning environment, reduce educator burden, maximise the use of downtime, and build professional skills including collaboration and feedback. While PAL adds to the clinical learning experience, it is not considered to be a substitute for observation of the clinical educator, expert feedback and guidance, or hands-on immersive learning activities. Cohesion of the student-student relationship was seen as an enabler of successful PAL. Conclusion: Students and educators perceive that PAL can help to position students as active learners through reduced dependence on the clinical educator, heightened roles in observing practice, and making and communicating evaluative judgments about quality of practice. The role of the clinical educator is not diminished with PAL, but rather is central in designing flexible and meaningful peer-based experiences and in balancing PAL with independent learning opportunities. Registration: ACTRN12610000859088. [Sevenhuysen S, Farlie MK, Keating JL, Haines TP, Molloy E (2015) Physiotherapy students and clinical educators perceive several ways in which incorporating peer-assisted learning could improve clinical placements: a qualitative study. Journal of Physiotherapy 61: 87–92

Exploring student fitness to practise (FTP) issue identification and management with allied health clinical educators in a tertiary health service

Background: Health professional students may experience fitness to practise (FTP) issues that affect their performance during clinical placements.  Previous research with physiotherapy clinical educators found educators were aware of student FTP issues but lacked confidence in assisting students with FTP issues in the clinical setting.Aim: This research project aimed to 1) evaluate if a brief interprofessional education session changed the knowledge of supports and/or confidence of allied health clinical educators to manage student FTP issues that arise on clinical placement, 2) to elucidate personal experiences of allied health clinical educators with student FTP issues and 3) to explore allied health educator recommendations of strategies to use when supporting students on clinical placement.Method: Allied health clinical educators attended a 1.5-hour workshop about student FTP. Participants identified student FTP issue identification and management strategies during clinical placements and completed pre-post surveys. Quantitative and qualitative data were analysed with independent t-tests, content and thematic analysis respectively.Results: Forty-six clinical educators from nine professions participated. Participants initially lacked confidence and identified a need for training to support students with FTP issues.  On reflection participants identified numerous strategies that use or recommend to support students with additional learning needs, and confidence increased following the session.Discussion:  A brief facilitated workshop had an immediate impact on clinical educator confidence regarding defining FTP and knowledge of supports available.  Participants offered several experience informed insights and recommendations that build on a previous study of physiotherapy clinical educators. Conclusion:  A brief education session with an interprofessional group of allied health clinical educators elucidated a number of important strategies to consider when supporting students with FTP issues in the clinical setting

Educators’ behaviours during feedback in authentic clinical practice settings: an observational study and systematic analysis

Abstract Background Verbal feedback plays a critical role in health professions education but it is not clear which components of effective feedback have been successfully translated from the literature into supervisory practice in the workplace, and which have not. The purpose of this study was to observe and systematically analyse educators’ behaviours during authentic feedback episodes in contemporary clinical practice. Methods Educators and learners videoed themselves during formal feedback sessions in routine hospital training. Researchers compared educators’ practice to a published set of 25 educator behaviours recommended for quality feedback. Individual educator behaviours were rated 0 = not seen, 1 = done somewhat, 2 = consistently done. To characterise individual educator’s practice, their behaviour scores were summed. To describe how commonly each behaviour was observed across all the videos, mean scores were calculated. Results Researchers analysed 36 videos involving 34 educators (26 medical, 4 nursing, 4 physiotherapy professionals) and 35 learners across different health professions, specialties, levels of experience and gender. There was considerable variation in both educators’ feedback practices, indicated by total scores for individual educators ranging from 5.7 to 34.2 (maximum possible 48), and how frequently specific feedback behaviours were seen across all the videos, indicated by mean scores for each behaviour ranging from 0.1 to 1.75 (maximum possible 2). Educators commonly provided performance analysis, described how the task should be performed, and were respectful and supportive. However a number of recommended feedback behaviours were rarely seen, such as clarifying the session purpose and expectations, promoting learner involvement, creating an action plan or arranging a subsequent review. Conclusions These findings clarify contemporary feedback practice and inform the design of educational initiatives to help health professional educators and learners to better realise the potential of feedback

Intensity of challenge to the balance system is not reported in the prescription of balance exercises in randomised trials:a systematic review

QuestionHow has balance challenge intensity been reported in trials of balance exercise interventions? Are there any instruments designed to measure the intensity of balance challenge in balance training exercises?DesignSystematic review of randomised trials of balance training exercises.ParticipantsOlder adults, ie, the majority of subjects were aged over 55 years.InterventionBalance exercise intervention, or multi-dimensional intervention that included a balance exercise intervention.Outcome measuresThe included trials were examined for descriptions and instruments used to report the intensity of the challenge to the patient's balance system provided by the balance exercise prescribed. The other included studies were examined for instruments that measure balance challenge intensity.ResultsIn most of the 148 randomised trials identified, measures of reported balance challenge ‘intensity’ were actually measures of some other aspect of the exercise, eg, aerobic intensity or a hierarchy of task difficulty without reference to the patient's ability. Three potential systems of measuring the balance challenge intensity were identified. Two were not described in any detail. One was defined in terms of the limits of the patient's postural stability, but this system appears not to have been validated. No adequate measures of balance challenge intensity were found among the other types of studies identified.ConclusionThe review highlights a serious gap in the methods used to prescribe, implement, and evaluate the effect of balance exercise programs. Comprehensive work in this area is required to develop a psychometrically sound measure of balance exercise intensity

The development of a peer assisted learning model for the clinical education of physiotherapy students

Demand for clinical placements in physiotherapy education continues to outstrip supply. Peer assisted learning, in various formats, has been trialled to increase training capacity and facilitate student learning during clinical education. There are no documented examples of measurable or repeatable peer assisted learning models to aid clinicians in implementing these strategies. The aim of this research was to develop a repeatable and quantifiable peer assisted learning model of clinical education for paired undergraduate physiotherapy students. Additionally, the project aimed to evaluate the impact of clinician engagement in the model development process on their self-rated ability to facilitate peer assisted learning. A series of four workshops was conducted to facilitate development and refinement of a peer assisted learning model by physiotherapy clinical educators. The workshops introduced relevant peer learning principles and a range of clinically relevant educational tools to educators. Consensus was targeted on the tools and approaches that would underpin the peer assisted learning model. A survey investigating participants’ self-rated ability to facilitate components of peer assisted learning was administered prior to, and on completion of, the workshop series. Educators agreed on a model to facilitate student peer interaction in clinical reasoning, observation of performance, risk identification and mitigation, and feedback and coaching. Tools to evaluate student and clinical educator outcomes were developed. On completion of the workshops, participants reported significantly more confidence in their ability to facilitate peer assisted learning. Development of a peer assisted learning model of clinical education that is acceptable to clinical educators was achieved through stakeholder involvement from concept stage. Assessment of educator knowledge and confidence, combined with critical review of stakeholder feedback at multiple stages in model development, appeared effective in conveying ownership of the model to clinical educators and identifying the support required for confidence in facilitating peer assisted learning

Access to and effectiveness of clinical supervision for allied health workers: A cross-sectional survey

Clinical supervision supports patient care and health worker wellbeing. However, access to effective clinical supervision is not equitable. We aimed to explore the access and effectiveness of clinical supervision in allied health workers. A cross-sectional survey design using the Manchester Clinical Supervision Scale (MCSS-26), including open-ended survey responses, to collect data on effectiveness. Multivariable regression was conducted to determine how MCSS-26 scores differed across discipline, work location and setting. Open-ended responses were analysed using content analysis. 1113 workers completed the survey, with 319 (28%) reporting they did not receive supervision; this group were more likely to hold management positions, work in a medical imaging discipline and practice in a regional or rural location. For those who received supervision, MCSS-26 scores significantly differed between disciplines and work settings; psychologists and those practising in private practice settings (i.e. fee-for-service) reported the highest levels of effectiveness. Suggested strategies to enhance effectiveness included the use of alternate supervision models, dedicated time for supervision, and training. Targeted subgroups for improving access include senior staff, medical imaging professionals, and those working across regional and rural settings. Where supervision was least effective, strategies to address behaviours with organisational support may be required.</p

Developing an international consensus Reporting guideline for intervention Fidelity in Non-Drug, non-surgical trials: The ReFiND protocol.

Inadequate reporting of fidelity to interventions in trials limits the transparency and interpretation of trial findings. Despite this, most trials of non-drug, non-surgical interventions lack comprehensive reporting of fidelity. If fidelity is poorly reported, it is unclear which intervention components were tested or implemented within the trial, which also hinders research reproducibility. This protocol describes the development process of a reporting guideline for fidelity of non-drug, non-surgical interventions (ReFiND) in the context of trials. The ReFiND guideline will be developed in six stages. Stage one: a guideline development group has been formed to oversee the guideline methodology. Stage two: a scoping review will be conducted to identify and summarize existing guidance documents on the fidelity of non-drug, non-surgical interventions. Stage three: a Delphi study will be conducted to reach consensus on reporting items. Stage four: a consensus meeting will be held to consolidate the reporting items and discuss the wording and structure of the guideline. Stage five: a guidance statement, an elaboration and explanation document, and a reporting checklist will be developed. Stage six: different strategies will be used to disseminate and implement the ReFiND guideline. The ReFiND guideline will provide a set of items developed through international consensus to improve the reporting of intervention fidelity in trials of non-drug, non-surgical interventions. This reporting guideline will enhance transparency and reproducibility in future non-drug, non-surgical intervention research. [Abstract copyright: Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.