Newly qualified physiotherapists' expectations and experiences of their first posts - A qualitative study

This thesis was submitted for the degree of Doctor of Education and awarded by Brunel University.This research was based on the premise that an exploration of the experiences of newly qualified physiotherapists could lead to a better preparation for the rapidly changing workplace by identifying the tensions and dilemmas newly qualified practitioners face. The initial review of the literature revealed limited research in physiotherapy relevant to an understanding of experiences of newly qualified physiotherapists. In consequence the literature relevant to professional socialisation, identity formation, and professionalism was also reviewed. The physiotherapy profession's reliance on the biomedical model of healthcare and positivistic research approaches was reviewed in order to highlight the lack of qualitative physiotherapy research. The research in this study is essentially illuminative and has adopted an inductive, phenomenological approach. Semi-structured interviews and reflective field notes were utilised to collect the data. Ten newly qualified physiotherapists were interviewed three times. All data collected was analysed using an inductive and interpretive approach. Three main themes were identified - doing the job; becoming a professional; and the future. The evidence suggested that they 'learnt the ropes' of the dominant culture and conformed in order to be seen to be doing a good job and thereby socialised into the professional. There was little time for CPD activities or any involvement in research. In this way the culture within physiotherapy departments was maintained. It is concluded that if physiotherapy is to adapt to the many changes in the NHS, then it must foster a working environment where newly qualified physiotherapists are encouraged to develop further their graduate skills and implement relevant research findings into their practice to provide patient care

Where is the trust? For the good of the people

In an era where the public has greater access to information than ever before, why is it that social capital in many communities is so divided and diminished? Traditionally people have experienced and generated social capital through direct contact with families and social spaces, including neighbourhoods, communities, clubs and the workplace. Nowadays, many relationships and networks operate at a global level and in cyber-space – enabled through technology and screen-mediated interactions. While there are many benefits to contemporary technologies and innovations, including new forms of sociability, these same developments have also resulted in a loss of sociability; a loss of social capital, social cohesion and trust in institutions. Western democratic societies, including Australia, appear to have become open to the exploitation of change and uncertainty in communities, amplified by propagandists and the manipulation of both mainstream and social media; to sow social discord and create fear and uncertainty, including a loss of trust in scientific research originating from universities. It is the trust in knowledge and research that has guided many governments to look beyond political cycles and plan for inclusive, tolerant societies, receptive to population diversity creating unique social assets. It is in this context that the development of new forms of social spaces, including well-designed public buildings, prospectively hold the regeneration of social capital in pursuit of more economically successful and socially cohesive communities. Regional Australia, including the regional city of Townsville, is negotiating this shift

Does ethnicity, gender or age of physiotherapy students affect performance in the final clinical placements? An exploratory study

This is the post-print version of the final paper published in Physiotherapy. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2013 Elsevier B.V.Objectives - To explore demographic differences in awarded marks of the final clinical placement in a physiotherapy undergraduate programme. Design - Retrospective analysis of clinical placement assessment marks. Setting - A London university offering clinical placements throughout South East England. Participants - 333 physiotherapy students entering physiotherapy training between 2005 to 2009. Main outcome measures Marks awarded following assessment using a clinical placement assessment form. Results - The mean mark (SD) for age were standard entry 71 (7.4) vs. mature entry 72 (7.99) (ns); for gender male 72 (8.45) vs. female 71 (7.21) (ns); and ethnicity White British 72 (7.71) vs. ethnic minority 70 (7.01) (p = 0.023). No interaction effects were observed between the independent variables and only ethnicity demonstrated a statistically significant effect (mean difference (MD) 2.4% 95%CI 0.5 to 4.3, F = 5.24, p = 0.023). This difference was maintained in most subcategories. Significant differences were observed for the interpersonal section (MD 2.21% 95%CI 0.14 to 4.28, F = 4.409, p = 0.03), the clinical reasoning section (MD 2.39% 95%CI 0.53 to 4.25, F = 6.37, p = 0.012) and the treatment section (MD 2.93 95%CI 1.10 to 4.83, F = 9.198, p = 0.003). Conclusions - Physiotherapy students from minority ethnic backgrounds were awarded a significantly lower mark than their white majority peers in final clinical placements, although the difference was small. Potential reasons are considered, with the strongest recommendation being for further enquiry into the potential relationship between ethnicity and success in undergraduate physiotherapy education

Individual student characteristics and attainment in pre-registration physiotherapy : a retrospective multi-site cohort study

Introduction: Worldwide there is a desire to diversify the physiotherapy workforce. However, limited research indicates that some student characteristics linked to under-representation in pre-registration physiotherapy education have lower attainment and greater attrition. This study explored the relationship between individual characteristics and success of students in pre-registration physiotherapy education within South East England. Design: A retrospective multi-site cohort study including pre-registration physiotherapy programmes in the South East of England. Anonymised data included background information (age, gender, ethnicity, socio-economic status) and outcomes (assessment marks, type of award and classification of degree). Analysis involved Bayesian regression models and ordinal logistic regression to examine the association of student characteristics on outcomes. Results: Data from 1851 student records were collected from four institutions. There were significantly lower assessment scores for Asian (-11.1% 95% CI: -13.1 to -9.2), Black (-7.1%, 95% CI: -9.7 to -4.5) and Other/Mixed ethnicity groups (-4.7%, 95% CI: -7.1 to -2.4), most notable in clinical and observed assessments, compared to their White British colleagues. All BME groups also demonstrated worse odds for a one step lower overall award or no award (Black OR: 3.35, Asian OR: 3.97, Other OR: 2.03). Associations of learning disability, age and non-traditional entry routes with assessment scores and/or degree classification were also noted. Conclusion: These findings suggest significant attainment gaps in pre-registration physiotherapy education in this specific geographical region, particularly for non-White ethnic and disability groups. The association with assessment type challenges educators to look beyond a purely student deficit model to explore all factors that may lead to inequality. © 2017 The Authors.Health Education North West London (HENWL) grant (P063)

Are physiotherapy students adequately prepared to successfully gain employment?

This is the post-print version of the final paper published in Physiotherapy. The published article is available from the link below. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. Copyright @ 2010 Elsevier B.V.Objectives - To explore the preparedness of final-year physiotherapy students for their progression into employment, and identify what universities can do to facilitate a smooth transition. Design - A single-cohort study, utilising a qualitative design incorporating a survey followed by transcribed and coded semi-structured interviews. Setting - Interviews were held in the Placement and Careers Centre at Brunel University, London. Participants - Sixty final-year full- and part-time students participated in the survey, and 12 final-year full- and part-time students participated in the semi-structured interviews. Methods - Sixty students completed a questionnaire which explored their preparedness for employment. Questions related to the current job situation, the application process and the student's ideal first post. Responses from the questionnaire were analysed and discussed further through a digitally recorded interview. Twelve students were interviewed by an experienced interviewer from a non-physiotherapy background. Results - Students felt unprepared for employment. Forty-seven per cent wanted a rotational post, but 26% would only spend 6 months and 39% would only spend 1 year looking for a job. Seventy-one percent would change career and 99% would work abroad if they were unable to secure a post in the UK. Most importantly, students could not identify transferable skills required by potential employers; only 25% cited effective communications, and 10% cited flexible working as a transferable skill. Self-management skills (e.g. prioritisation, time management and documentation) were not perceived as essential for employment. Conclusions - The job market requires physiotherapy graduates to possess transferable skills which can be applied to any situation. Many are integral to the profession and the undergraduate curriculum; however, analysis and assimilation of these skills cannot be assumed. Universities should reflect on their curriculum delivery to produce graduates who meet employers’ expectations and make a smooth transition into the workplace

Using interpretative phenomenological analysis to inform physiotherapy practice: An introduction with reference to the lived experience of cerebellar ataxia

The attached file is a pre-published version of the full and final paper which can be found at the link below.This article has been made available through the Brunel Open Access Publishing Fund.Qualitative research methods that focus on the lived experience of people with health conditions are relatively underutilised in physiotherapy research. This article aims to introduce interpretative phenomenological analysis (IPA), a research methodology oriented toward exploring and understanding the experience of a particular phenomenon (e.g., living with spinal cord injury or chronic pain, or being the carer of someone with a particular health condition). Researchers using IPA try to find out how people make sense of their experiences and the meanings they attach to them. The findings from IPA research are highly nuanced and offer a fine grained understanding that can be used to contextualise existing quantitative research, to inform understanding of novel or underresearched topics or, in their own right, to provoke a reappraisal of what is considered known about a specified phenomenon. We advocate IPA as a useful and accessible approach to qualitative research that can be used in the clinical setting to inform physiotherapy practice and the development of services from the perspective of individuals with particular health conditions.This article is available through the Brunel Open Access Publishing Fund

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy

Keratin 6 is not essential for mammary gland development

INTRODUCTION: Keratin 6 (K6) has previously been identified as a marker of early mammary gland development and has also been proposed to be a marker of mammary gland progenitor cells. However, the function of K6 in the mammary gland was not known, so we examined the expression pattern of the protein during both embryonic and postnatal mammary development, as well as the mammary gland phenotype of mice that were null for both K6a and K6b isoforms. METHOD: Immunostaining was performed to determine the expression pattern of K6a throughout mammary gland development, from the embryonic mammary bud to lactation. Double immunofluorescence was used to co-localize K6 with known markers of mammary gland development. Wild-type and K6ab-null mammary tissues were transplanted into the cleared fat pads of nude mice and the outgrowths were analyzed for morphology by whole-mount staining and for markers of mammary epithelium by immunostaining. Finally, progesterone receptor (PR) and bromodeoxyuridine co-localization was quantified by double immunofluorescence in wild-type and K6ab-null mammary outgrowths. RESULTS: Here we report that K6 is expressed earlier than described previously, by embryonic day 16.5. K6a is the predominant isoform expressed in the mammary gland, localized in the body cells and luminal epithelial cells but not in the cap cells or myoepithelial cells. Co-localization studies showed that most K6a-positive cells express steroid receptors but do not proliferate. When both the K6a and K6b genes are deleted, mammary gland development appears normal, with similar expression of most molecular markers examined in both the pubertal gland and the mature gland. Loss of K6a and K6b, however, leads to an increase in the number of steroid-receptor-positive cells, and increased co-localization of steroid receptor expression and proliferation was observed. CONCLUSION: Although K6a was not essential for mammary gland development, loss of both K6a and K6b resulted in an increase in PR-positive mammary epithelial cells and decreased proliferation after exposure to steroid hormones. There was also increased co-localization of PR and bromodeoxyuridine, suggesting alterations in patterning events important for normal lobuloalveolar development

A Proposed Taxonomy of Anaerobic Fungi (Class Neocallimastigomycetes) Suitable for Large-Scale Sequence-Based Community Structure Analysis

Anaerobic fungi are key players in the breakdown of fibrous plant material in the rumen, but not much is known about the composition and stability of fungal communities in ruminants. We analyzed anaerobic fungi in 53 rumen samples from farmed sheep (4 different flocks), cattle, and deer feeding on a variety of diets. Denaturing gradient gel electrophoresis fingerprinting of the internal transcribed spacer 1 (ITS1) region of the rrn operon revealed a high diversity of anaerobic fungal phylotypes across all samples. Clone libraries of the ITS1 region were constructed from DNA from 11 rumen samples that had distinctly different fungal communities. A total of 417 new sequences were generated to expand the number and diversity of ITS1 sequences available. Major phylogenetic groups of anaerobic fungi in New Zealand ruminants belonged to the genera Piromyces, Neocallimastix, Caecomyces and Orpinomyces. In addition, sequences forming four novel clades were obtained, which may represent so far undetected genera or species of anaerobic fungi. We propose a revised phylogeny and pragmatic taxonomy for anaerobic fungi, which was tested and proved suitable for analysis of datasets stemming from high-throughput next-generation sequencing methods. Comparing our revised taxonomy to the taxonomic assignment of sequences deposited in the GenBank database, we believe that >29% of ITS1 sequences derived from anaerobic fungal isolates or clones are misnamed at the genus level