Clinical education of physiotherapy students

EDITORIAL This Editorial introduces Journal of Physiotherapy’s article collection on clinical education of physiotherapy students. The article collection has been curated from papers published in the journal to facilitate access to important findings in this field, highlight trends in the research and summarise avenues for further investigation. The collected articles show educational models, novel approaches to finding clinical placements, early educational initiatives taken in response to the coronavirus disease 2019 (COVID-19) pandemic, the current status of entry-level physiotherapy assessment, and insights into future directions for physiotherapy education

The Assessment of Physiotherapy Practice tool provides informative assessments of clinical and professional dimensions of student performance in undergraduate placements: a longitudinal validity and reliability study

© 2020 Australian Physiotherapy Association Questions: Do one or two factors best represent clinical performance scores obtained via the Assessment of Physiotherapy Practice (APP) and what is the nature of their characterisation? To what extent are the same number of factors and their interpretation, and item scaling captured equally over time and across contexts (eg, clinical subdisciplines) for assessments of clinical performance via the APP? Design: Archival and longitudinal study of undergraduate students’ clinical performances for each of four final-year clinical placements. Participants: A total of 561 undergraduate physiotherapy students from one Australian university who were enrolled to complete their final-year clinical placements between 2014 and 2017. Outcome measures: Clinical educators’ assessments of student performance across seven key domains of clinical practice: professional behaviour, communication, assessment, analysis and planning, intervention, evidence-based practice and risk management. Results: Factor analyses supported the superiority of a two-factor representation of the APP, including dimensions characterised by professional and clinical domains, when compared with a unidimensional structure of an overarching ‘clinical performance’ factor. It was also found that the two-factor representation and item scaling was consistent across four clinical placements covering typical areas of physiotherapy practice. In other words, the same constructs are being assessed equally well across context and time. Conclusions: The APP is the nationally adopted assessment tool that is used to evaluate clinical competence to practise as a physiotherapist in Australia and New Zealand. These findings provide new evidence for an updated scoring protocol in which clinical factors are distinguished from professional competencies

An intervention to enhance the supervision of health science students who struggle during work placements

Supervisors are often reluctant to make an adverse assessment of the student's performance during work placements, which leads to a phenomenon known as "failure to fail". This Australian study evaluated resources designed to enhance the management of students who fail to meet the required standard of performance during work placements. Staff from a range of health disciplines evaluated the training program comprised of a half-day workshop and written guide using a questionnaire and semi-structured interviews. Staff reported renewed confidence in working with underperforming students,increased comfort with failing students who did not reach the required standards. The Staff Guide was seens as useful with all students undertaking work placements, not just underperforming students. The Student Guide was perceived as relevant to the student experience. The findings of this research are important to university educators engaged with work placements, work placement supervisors, and students who undertake work placements

Exploring the Reactions of Peer Learners to a New Model of Peer-Assisted Simulation-Based Learning Clinical Placement

In response to the paucity of clinical placements available in 2020 due to the COVID-19 pandemic, alternate options for prelicensure students were necessary in order for them to complete the fieldwork required for graduation. In response, Curtin University replaced a faculty-led fully-simulated placement with a peer-assisted learning model. This incorporated final-year students acting as peer teachers to penultimate-year students, thus creating new learning and teaching placements for the final-year students. To our knowledge, this had never been done on such a scale before. Considering the importance of meeting learner expectations in the tertiary setting, the perceptions of peer learners around the innovation were important but unknown. This study used a prospective qualitative observational design that utilized feedback from peer learners relating to learning using the peer-assisted model. Peer learners provided written reflections that were analysed thematically. During November and December 2020, 171 penultimate-year physiotherapy students participated in one of two three-week placements, and 170 consented to participate in data collection. Qualitative data reflected several enablers and barriers to learning during the experience. These related to the peer teacher attributes, the provision of performance feedback, the learning environment, and the facilitation of clinical reasoning. Peer learners enjoyed the peer-assisted model, found peer teachers able to facilitate learning, and provided useful insights that will shape future placements. The success of the model supports repeating it in the future. This will maintain a bilateral exchange of peer-led clinical learning and teaching with diminished faculty supervisory workload

Clinical placements in private practice for physiotherapy students are perceived as safe and beneficial for students, private practices and universities: a national mixed-methods study

Question: What are the extent and characteristics of clinical placements in private practice for physiotherapy students? What do university clinical education managers perceive to be the benefits, risks, barriers and enablers of clinical placements in private practice for physiotherapy students? What training and support are available for private practitioners? Design: Mixed methods study combining a national survey and in-depth, semi-structured focus group interviews. Participants: Twenty clinical education managers from Australian universities who had graduating students in entry-level physiotherapy programs in 2017 (95% response rate) responded to the survey with data on 2,000 students. Twelve clinical education managers participated in the focus groups. Results: It was found that 44% of physiotherapy graduates in Australia in 2017 completed a 5-week private practice placement. Private practice placement experiences were perceived to be safe and beneficial for students, private practices and universities. The main risks identified by clinical education managers were related to the quality and consistency of the student's experience on placement and not risks to service or clients. The main perceived barriers were time costs (both practitioner and university clinical education managers) and perceived lost earning capacity. Clinical education managers emphasised that more time and resources to establish and support private practitioners would enable them to reduce risk and overcome barriers to increasing private practice placement capacity and quality. Engaging private practitioners and working collaboratively appear vital for establishing, monitoring and supporting private practice placements. Conclusion: By working collaboratively, universities and private practice physiotherapists can enhance private practice placement capacity and quality

The influence of a full-time, immersive simulation-based clinical placement on physiotherapy student confidence during the transition to clinical practice

Background: Novice students may have limited learning opportunities during their early exposure to complex clinical environments, due to the priorities of patient care. Immersive, high-fidelity simulation provides an opportunity for physiotherapy students to be exposed to relatively complex scenarios in a safe learning environment before transitioning to the clinical setting. The present study evaluated the influence of immersive simulation on student confidence and competence. Methods: Sixty penultimate year physiotherapy students completed an 18-day full-time immersive simulation placement. The placement involved students spending 6 days working in each of three core practice areas (cardiopulmonary, musculoskeletal, neurological) in which they interacted with simulated patients portrayed by professional role-play actors. The patient scenarios were developed by groups of expert practitioners and incorporated full documentary and imaging information. Students completed a questionnaire to evaluate their confidence in the clinical environment at the start and completion of each 6-day rotation. Their clinical competence was evaluated at the end of each 6-day rotation using the Assessment of Physiotherapy Practice (APP) tool. In a secondary analysis, the clinical competence of this cohort was evaluated in comparison to a matched cohort of students from the same year group that had not completed an immersive simulation placement. Results: Student confidence improved significantly in each 6-day rotation (p < 0.001); however, it reduced again at the commencement of the next rotation, and there was no cumulative improvement in confidence over the 18-day placement (p = 0.22). Students who had completed the immersive simulation placement achieved higher APP (p < 0.001) scores in an evaluation of their competence to practice during their subsequent clinical placement. Conclusion: Immersive simulation provides a beneficial learning environment to enable physiotherapy students to transition from university-based education to working in the clinical environment

Work Readiness of New Graduate Physical Therapists for Private Practice in Australia: Academic Faculty, Employer, and Graduate Perspectives

OBJECTIVE: The purpose of this study is to explore academic faculty, employer, and recent graduate perspectives of the work readiness of Australian new graduate physical therapists for private practice and factors that influence new graduate preparation and transition to private practice. METHODS: This study used a mixed-methods design with 3 surveys and 12 focus groups. A total of 112 participants completed a survey, and 52 participated in focus groups. Descriptive statistics were used to summarize the quantitative data, and thematic analysis was used to analyze the qualitative data. Triangulation across participant groups and data sources was undertaken. RESULTS: Australian new graduate physical therapists were perceived to be "somewhat ready" for private practice and "ready" by their third year of employment. Participants proposed that new graduates bring enthusiasm, readiness to learn, and contemporary, research-informed knowledge. New graduates were also perceived to find autonomous clinical reasoning and timely caseload management difficult; to have limited business, marketing, and administration knowledge and skills; and to present with underdeveloped confidence, communication, and interpersonal skills. Factors perceived to influence graduate transition included private practice experience, such as clinical placements and employment; employer and client expectations of graduate capabilities; workplace support; university academic preparation and continuing education; and individual graduate attributes and skills. CONCLUSION: Australian new graduate physical therapists have strengths and limitations in relation to clinical, business, and employability knowledge and skills. New graduate work readiness and transition may be enhanced by additional private practice experience, employer and client expectation management, provision of workplace support, and tailored university and continuing education. IMPACT: The number of new graduate physical therapists employed in private practice in Australia is increasing; however, until this study, their work readiness for this setting was unknown. This exploration of new graduate performance in private practice and transition can help to increase understanding and enhancement of work-readiness

Observational Study Exploring the Efficacy and Effectiveness of a New Model of Peer-Assisted Simulation-Based Learning Clinical Placement

(1) Background: Immersive simulation-based learning is relevant and effective in health care professional pre-licensure training. Peer-assisted learning has reciprocal benefit for the learner and the teacher. A fully simulated model of fieldwork placement has been utilised at [de-identified] University since 2014, historically employing full-time faculty supervisors. Due to the COVID-19 pandemic in 2020, traditional clinical placement availability diminished. (2) Methods: This mixed-methods prospective observational study aimed to translate the existing faculty-led placement for penultimate-year physiotherapy students to a peer-taught model, thereby creating new teaching placements for final-year students. Final-and penultimate-year physiotherapy students undertook the fully simulated fieldwork placement either as peer learners or peer teachers. The placement was then evaluated using four outcome measures: The ‘measure of quality of giving feedback scale’ (MQF) was used to assess peer learner satisfaction with peer-teacher supervision; plus/delta reflec-tions were provided by peer teachers and faculty supervisors; student pass/fail rates for the penul-timate-year physiotherapy students. (3) Results: For 10 weeks during November and December 2020, 195 students and 19 faculty participated in the placement. Mean MQF scores ranged from 6.4 (SD 0.86) to 6.8 (SD) out of 7; qualitative data reflected positive and negative aspects of the experience. There was a 4% fail rate for penultimate-year students for the placement. Results suggested that peer learners perceived peer-led feedback was of a high quality; there were both positives and challenges experienced using the model. (4) Conclusions: Physiotherapy students effectively adopted a peer-taught fully simulated fieldwork placement model with minimal faculty supervision, and comparable clinical competency outcomes

Inter-examiner agreement in clinical evaluation

Background: The reliability of assessment is an important issue in the evaluation of competence in medical and allied health practice, particularly when assessments are conducted by multiple examiners. The purpose of this study was to examine the agreement between multiple examiners in the assessment of a postgraduate physiotherapy student using a specifically designed performance evaluation system. Methods: Seven examiners simultaneously watched a recording of a postgraduate student’s examination and treatment of one patient. The Postgraduate Physiotherapy Performance Assessment (PPPA) form was used to guide the assessment of performance in key areas of patient examination and management. Each examiner independently recorded a grade for each of five performance categories, and these scores were used to guide the global performance grade and mark. Results: Five examiners agreed on the global performance grade and four of the performance categories. The level of pass grade awarded was more variable, with scores in the performance categories spanning two grades, and in one case, three grades. The two examiners who were not in agreement with the majority consistently awarded higher grades across most performance categories. Discussion: This preliminary study has demonstrated majority agreement in global performance between multiple examiners when physiotherapy clinical practice is assessed against specific performance standards. Not all examiners awarded global grades consistent with the majority, and there was greater variability between examiners when grading performance in specific aspects of practice. These findings highlight the importance of examiner training and review sessions to improve inter-examiner agreement in assessments of clinical performance that require multiple examiners